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Nicoara A, Song P, Bollen BA, Paone G, Abernathy JJ, Taylor MA, Habib RH, Del Rio JM, Lauer RE, Nussmeier NA, Glance LG, Petty JV, Mackensen GB, Vener DF, Kertai MD. The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2021 Update on Echocardiography. Ann Thorac Surg 2021; 113:13-24. [PMID: 34536378 DOI: 10.1016/j.athoracsur.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/05/2021] [Accepted: 09/07/2021] [Indexed: 11/01/2022]
Abstract
The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database (ACSD) is the world's premier clinical outcomes registry for adult cardiac surgery and a driving force for quality improvement in cardiac surgery. Echocardiographic data provide a wealth of hemodynamic, structural, and functional data and have been part of STS ACSD data collection since its inception. An increasing body of evidence suggests that the use of echocardiography in patients undergoing cardiac surgery has a positive impact on postoperative outcomes. In this report, we describe and summarize the type and rate of reporting of echocardiography-related variables in the STS ACSD, including the Adult Cardiac Anesthesiology Module, from July 2017 to December 2019 for the most frequently performed cardiac surgical procedures. With this review, we aim to increase awareness of the importance of collecting accurate and consistent echocardiography data in the STS ACSD and to highlight opportunities for growth and improvement.
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Affiliation(s)
- Alina Nicoara
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | - Pinping Song
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington
| | - Bruce A Bollen
- International Heart Institute of Montana, Missoula Anesthesiology, PC, Missoula, Montana
| | - Gaetano Paone
- Department of Surgery, Emory University, Atlanta, Georgia
| | - James Jake Abernathy
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Mark A Taylor
- Anesthesiology Institute/Cleveland Clinic Foundation, Cleveland, Ohio
| | - Robert H Habib
- STS Research Center, The Society of Thoracic Surgeons, Chicago, Illinois
| | | | - Ryan E Lauer
- Department of Anesthesiology, Loma Linda University, Loma Linda, California
| | - Nancy A Nussmeier
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Laurent G Glance
- Department of Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, New York
| | - Joseph V Petty
- CHI Health Clinic Physician Enterprise Anesthesia, CHI Health Nebraska Heart, Lincoln, Nebraska
| | - G Burkhard Mackensen
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington
| | - David F Vener
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children Hospital, Baylor College of Medicine, Houston, Texas
| | - Miklos D Kertai
- Department of Anesthesiology Vanderbilt University, Nashville, Tennessee.
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Okamura H, Kusadokoro S, Mieno M, Kimura N, Yamaguchi A. Long-term outcomes after aortic valve replacement using a 19-mm bioprosthesis. Eur J Cardiothorac Surg 2021; 61:625-634. [PMID: 34431991 DOI: 10.1093/ejcts/ezab379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/01/2021] [Accepted: 07/22/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Transcatheter aortic valve replacement is known to be associated with improved haemodynamics in patients with aortic stenosis and a small aortic annulus. However, limited benchmark data are available regarding the long-term outcomes in patients treated with surgical aortic valve replacement (SAVR). We investigated the long-term outcomes of SAVR using a 19-mm bioprosthesis. METHODS This study included consecutive patients who underwent SAVR using a 19-mm bioprosthesis at our hospital between 2008 and 2012. RESULTS In a total of 132 patients, moderate and severe prosthesis-patient mismatch occurred in 36 (27.3%) and 7 patients (5.3%), respectively. The median follow-up period was 7.7 years. The overall 5- and 10-year survival rates were 79.4% and 52.9%, respectively. The 5- and 10-year freedom from major adverse valve-related events rates were 89.6% and 74.2%, respectively. Neither moderate nor severe prosthesis-patient mismatch was associated with late mortality, major adverse valve-related events or heart failure. Follow-up echocardiographic data were obtained at a median interval of 4.8 years in 80% of patients who survived ≥6 months postoperatively. Follow-up echocardiographic data showed a significantly increased left ventricular ejection fraction, decreased mean transvalvular/transprosthetic pressure gradients and a decreased mean left ventricular mass. At follow-up, we observed moderate or severe haemodynamic structural valve deterioration in 17 patients; however, structural valve deterioration did not affect late survival or freedom from major adverse valve-related events rates, or heart failure. CONCLUSIONS SAVR using the 19-mm bioprosthesis was associated with satisfactory long-term clinical and haemodynamic outcomes.
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Affiliation(s)
- Homare Okamura
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Sho Kusadokoro
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Makiko Mieno
- Department of Medical Informatics, Center for Information, Jichi Medical University, Tochigi, Japan
| | - Naoyuki Kimura
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Atsushi Yamaguchi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Vo AT, Nakajima T, Nguyen TTT, Nguyen NTH, Le NB, Cao TH, Nguyen DH. Aortic prosthetic size predictor in aortic valve replacement. J Cardiothorac Surg 2021; 16:221. [PMID: 34348752 PMCID: PMC8336273 DOI: 10.1186/s13019-021-01601-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/28/2021] [Indexed: 11/16/2022] Open
Abstract
Background Patient-prosthesis mismatch (PPM) is a major concern in aortic valve replacement (AVR) and leads to perioperative morbidity and rehospitalization. Predicting aortic annulus diameter pre-procedurally is crucial to managing patients with high-risk of PPM. Objectives To compare preoperative measurements of aortic annulus from echocardiography and CT scan with surgical sizing and develop an imaging-based algorithm to predict PPM.
Methods From January 2017 to December 2020, patients underwent AVR at a teaching hospital were examined. The relationship between imaging measurements with operative values was assesed using scatter plots and Pearson’s correlation coefficient. Univariable linear regression was then used to build the predictive model. Results A total of 144 patients underwent AVR during the study period. Suture types and surgical approaches were not significantly associated with prosthesis size. CT scan-based measurements showed strong correlation with prosthesis size: mean diameter (R = 0.79), perimeter-derived diameter (R = 0.76), and area-derived diameter (R = 0.75). Mechanical valve and tissue valve shared similar correlation coefficients. Prosthesis size predictive models based on CT scan were 12.89 + 0.335 × d for mean diameter, 13.275 + 0.315 × d for perimeter-derived diameter and 13.626 + 0.309 × d for area-derived diameter. Conclusions Preoperative CT scan measurements are a reliable predictor of aortic prosthesis size. Transthoracic echocardiography is a possible alternative, though it is highly performer-dependent and unable to represent the aortic annulus fully. Together, these two imaging modalities can be used to quantitatively anticipate PPM preoperatively.
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Affiliation(s)
- Anh Tuan Vo
- Department of Cardiovascular Surgery, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, 215 Hong Bang Street, District 5, Ho Chi Minh City, Vietnam
| | - Tomomi Nakajima
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Trang Thi Thu Nguyen
- Department of Cardiovascular Surgery, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, 215 Hong Bang Street, District 5, Ho Chi Minh City, Vietnam
| | - Nguyen Thoi Hai Nguyen
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nga Bich Le
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tri Huu Cao
- Department of Surgery, Nguyen Tri Phuong Hospital, Ho Chi Minh City, Vietnam
| | - Dinh Hoang Nguyen
- Department of Cardiovascular Surgery, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, 215 Hong Bang Street, District 5, Ho Chi Minh City, Vietnam. .,Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
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Swinkels BM, Ten Berg JM, Kelder JC, Vermeulen FE, van Boven WJ, de Mol BA. Prosthesis-patient mismatch affects late survival after valve surgery for severe aortic stenosis. THE JOURNAL OF CARDIOVASCULAR SURGERY 2021; 63:91-98. [PMID: 34308612 DOI: 10.23736/s0021-9509.21.11786-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The effect of prosthesis-patient mismatch (PPM) on late survival after aortic valve replacement (AVR) in patient with symptomatic severe aortic stenosis (AS) remains unclear. Also, late follow-up in previous studies is confined to only one decade. We aimed to determine the effect of PPM on late survival after isolated AVR for symptomatic severe AS during 25 years of follow-up. METHODS In this retrospective cohort study, Kaplan-Meier survival analysis was performed to determine late survival in 404 consecutive patients with moderate PPM (N.=86), severe (N.=11), or no/mild PPM (N.=307) after isolated AVR for symptomatic severe AS during a mean follow-up of 25.0±2.9 years. Moderate, severe, and no/mild PPM were defined as indexed effective orifice area of >0.65≤0.85, ≤0.65, and >0.85 cm2/m2, respectively. Multivariable analysis was performed to identify possible independent predictors of decreased late survival, including moderate or severe PPM. RESULTS Late survival of patients with severe PPM was worse in comparison with those with no/mild PPM: 7.4±2.6 (95% confidence interval 2.2-12.5) vs. 13.6±0.5 (95% confidence interval 12.6-14.6) years, respectively; P=0.020. Late survival of patients with moderate PPM was similar to those with no/mild PPM. Severe PPM was an independent predictor of decreased late survival: hazards ratio 4.002 (95% confidence interval 1.869-8.569); P<0.001. Moderate PPM was not an independent predictor of decreased late survival. CONCLUSIONS Severe PPM was independently associated with decreased late survival after isolated AVR for symptomatic severe AS during a mean follow-up of 25.0±2.9 years. Therefore, severe PPM should be prevented as much as possible.
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Affiliation(s)
- Ben M Swinkels
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands -
| | - Jurriën M Ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Johannes C Kelder
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Freddy E Vermeulen
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Wim J van Boven
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, location Academic Medical Center, Amsterdam, The Netherlands
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Pierard LA. Measure or predict prosthesis-patient mismatch? Eur Heart J Cardiovasc Imaging 2021; 22:21-23. [PMID: 33152078 DOI: 10.1093/ehjci/jeaa267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/12/2020] [Indexed: 11/13/2022] Open
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Ternacle J, Pibarot P, Herrmann HC, Kodali S, Leipsic J, Blanke P, Jaber W, Mack MJ, Clavel MA, Salaun E, Guzzetti E, Annabi MS, Bernier M, Beaudoin J, Khalique OK, Weissman NJ, Douglas P, Bax J, Dahou A, Xu K, Alu M, Rogers E, Leon M, Thourani VH, Abbas AE, Hahn RT. Prosthesis-Patient Mismatch After Aortic Valve Replacement in the PARTNER 2 Trial and Registry. JACC Cardiovasc Interv 2021; 14:1466-1477. [PMID: 34238557 DOI: 10.1016/j.jcin.2021.03.069] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study aimed to compare incidence and impact of measured prosthesis-patient mismatch (PPMM) versus predicted PPM (PPMP) after surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). BACKGROUND TAVR studies have used measured effective orifice area indexed (EOAi) to body surface area (BSA) to define PPM, but most SAVR series have used predicted EOAi. This difference may contribute to discrepancies in incidence and outcomes of PPM between series. METHODS The study analyzed SAVR patients from the PARTNER (Placement of Aortic Transcatheter Valves) 2A trial and TAVR patients from the PARTNER 2 SAPIEN 3 Intermediate Risk registry. PPM was classified as moderate if EOAi ≤0.85 cm2/m2 (≤0.70 if obese: body mass index ≥30 kg/m2) and severe if EOAi ≤0.65 cm2/m2 (≤0.55 if obese). PPMM was determined by the core lab-measured EOAi on 30-day echocardiogram. PPMP was determined by 2 methods: 1) using normal EOA reference values previously reported for each valve model and size (PPMP1; n = 929 SAVR, 1,069 TAVR) indexed to BSA; and 2) using normal reference EOA predicted from aortic annulus size measured by computed tomography (PPMP2; n = 864 TAVR only) indexed to BSA. Primary endpoint was the composite of 5-year all-cause death and rehospitalization. RESULTS The incidence of moderate and severe PPMP was much lower than PPMM in both SAVR (PPMP1: 28.4% and 1.2% vs. PPMM: 31.0% and 23.6%) and TAVR (PPMP1: 21.0% and 0.1% and PPMP2: 17.0% and 0% vs. PPMM: 27.9% and 5.7%). The incidence of severe PPMM and severe PPMP1 was lower in TAVR versus SAVR (P < 0.001). The presence of PPM by any method was associated with higher transprosthetic gradient. Severe PPMP1 was independently associated with events in SAVR after adjustment for sex and Society of Thoracic Surgeons score (hazard ratio: 3.18;95% CI: 1.69-5.96; P < 0.001), whereas no association was observed between PPM by any method and outcomes in TAVR. CONCLUSIONS EOAi measured by echocardiography results in a higher incidence of PPM following SAVR or TAVR than PPM based on predicted EOAi. Severe PPMP is rare (<1.5%), but is associated with increased all-cause death and rehospitalization after SAVR, whereas it is absent following TAVR.
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Affiliation(s)
- Julien Ternacle
- Québec Heart and Lung Institute, Université Laval, Quebec City, Quebec, Canada
| | - Philippe Pibarot
- Québec Heart and Lung Institute, Université Laval, Quebec City, Quebec, Canada.
| | - Howard C Herrmann
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Susheel Kodali
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Jonathon Leipsic
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Philipp Blanke
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Marie-Annick Clavel
- Québec Heart and Lung Institute, Université Laval, Quebec City, Quebec, Canada
| | - Erwan Salaun
- Québec Heart and Lung Institute, Université Laval, Quebec City, Quebec, Canada
| | - Ezequiel Guzzetti
- Québec Heart and Lung Institute, Université Laval, Quebec City, Quebec, Canada
| | | | - Mathieu Bernier
- Québec Heart and Lung Institute, Université Laval, Quebec City, Quebec, Canada
| | - Jonathan Beaudoin
- Québec Heart and Lung Institute, Université Laval, Quebec City, Quebec, Canada
| | - Omar K Khalique
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Neil J Weissman
- MedStar Heath Research Institute, Georgetown University, Washington, DC, USA
| | - Pamela Douglas
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Jeroen Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Ke Xu
- Edwards Lifesciences, Irvine, California, USA
| | - Maria Alu
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Erin Rogers
- Edwards Lifesciences, Irvine, California, USA
| | - Martin Leon
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Amr E Abbas
- Oakland University William Beaumont School of Medicine, Auburn Hills, Michigan, USA; Beaumont Hospital Royal Oak, Royal Oak, Michigan, USA
| | - Rebecca T Hahn
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
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Vriesendorp MD, De Lind Van Wijngaarden RAF, Head SJ, Kappetein AP, Hickey GL, Rao V, Weissman NJ, Reardon MJ, Moront MG, Sabik JF, Klautz RJM. The fallacy of indexed effective orifice area charts to predict prosthesis-patient mismatch after prosthesis implantation. Eur Heart J Cardiovasc Imaging 2021; 21:1116-1122. [PMID: 32243493 PMCID: PMC7971169 DOI: 10.1093/ehjci/jeaa044] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/20/2020] [Accepted: 02/27/2020] [Indexed: 12/02/2022] Open
Abstract
Aims Indexed effective orifice area (EOAi) charts are used to determine the likelihood of prosthesis–patient mismatch (PPM) after aortic valve replacement (AVR). The aim of this study is to validate whether these EOAi charts, based on echocardiographic normal reference values, can accurately predict PPM. Methods and results In the PERIcardial SurGical AOrtic Valve ReplacemeNt (PERIGON) Pivotal Trial, 986 patients with aortic valve stenosis/regurgitation underwent AVR with an Avalus valve. Patients were randomly split (50:50) into training and test sets. The mean measured EOAs for each valve size from the training set were used to create an Avalus EOAi chart. This chart was subsequently used to predict PPM in the test set and measures of diagnostic accuracy (sensitivity, specificity, and negative and positive predictive value) were assessed. PPM was defined by an EOAi ≤0.85 cm2/m2, and severe PPM was defined as EOAi ≤0.65 cm2/m2. The reference values obtained from the training set ranged from 1.27 cm2 for size 19 mm up to 1.81 cm2 for size 27 mm. The test set had an incidence of 66% of PPM and 24% of severe PPM. The EOAi chart inaccurately predicted PPM in 30% of patients and severe PPM in 22% of patients. For the prediction of PPM, the sensitivity was 87% and the specificity 37%. For the prediction of severe PPM, the sensitivity was 13% and the specificity 98%. Conclusion The use of echocardiographic normal reference values for EOAi charts to predict PPM is unreliable due to the large proportion of misclassifications.
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Affiliation(s)
- Michiel D Vriesendorp
- Cardiothoracic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
| | | | - Stuart J Head
- Global Clinical Operations, Coronary and Structural Heart, Medtronic, Endepolsdomein 5, 6229 GW, Maastricht, Netherlands
| | - Arie-Pieter Kappetein
- Global Clinical Operations, Coronary and Structural Heart, Medtronic, Endepolsdomein 5, 6229 GW, Maastricht, Netherlands
| | - Graeme L Hickey
- Global Clinical Operations, Coronary and Structural Heart, Medtronic, Endepolsdomein 5, 6229 GW, Maastricht, Netherlands
| | - Vivek Rao
- Cardiovascular Surgery, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario, Canada
| | - Neil J Weissman
- Cardiovascular Core Laboratories, MedStar Health Research Institute, 6525 Belcrest Road, Suite 700, Hyattsville, MD 20782, USA
| | - Michael J Reardon
- Cardiovascular Surgery, Houston Methodist Debakey Heart and Vascular Center, 6550 Fannin Street, Houston, TX 77030, USA
| | - Michael G Moront
- Cardiothoracic Surgery, ProMedica Toledo Hospital, 2109 Hughes Drive, Suite 720, Toledo, OH 43606, USA
| | - Joseph F Sabik
- Cardiac Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside 7, Cleveland, OH 44106-7060, USA
| | - Robert J M Klautz
- Cardiothoracic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
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Leone PP, Fazzari F, Cannata F, Sanz-Sanchez J, Mangieri A, Monti L, Cozzi O, Stefanini GG, Bragato R, Colombo A, Reimers B, Regazzoli D. Clinical and Technical Challenges of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Implantation. Front Cardiovasc Med 2021; 8:670457. [PMID: 34150868 PMCID: PMC8211887 DOI: 10.3389/fcvm.2021.670457] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 04/22/2021] [Indexed: 12/30/2022] Open
Abstract
Prosthesis-patient mismatch (PPM) is present when the effective area of a prosthetic valve inserted into a patient is inferior to that of a normal human valve; the hemodynamic consequence of a valve too small compared with the size of the patient's body is the generation of higher than expected transprosthetic gradients. Despite evidence of increased risk of short- and long-term mortality and of structural valve degeneration in patients with PPM after surgical aortic valve replacement, its clinical impact in patients subject to transcatheter aortic valve implantation (TAVI) is yet unclear. We aim to review and update on the definition and incidence of PPM after TAVI, and its prognostic implications in the overall population and in higher-risk subgroups, such as small aortic annuli or valve-in-valve procedures. Last, we will focus on the armamentarium available in order to reduce risk of PPM when planning a TAVI procedure.
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Affiliation(s)
- Pier Pasquale Leone
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Humanitas Research Hospital IRCCS, Rozzano, Italy
| | | | - Francesco Cannata
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Humanitas Research Hospital IRCCS, Rozzano, Italy
| | - Jorge Sanz-Sanchez
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Humanitas Research Hospital IRCCS, Rozzano, Italy
| | | | | | - Ottavia Cozzi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Humanitas Research Hospital IRCCS, Rozzano, Italy
| | - Giulio Giuseppe Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Humanitas Research Hospital IRCCS, Rozzano, Italy
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Witten JC, Durbak E, Houghtaling PL, Unai S, Roselli EE, Bakaeen FG, Johnston DR, Svensson LG, Jaber W, Blackstone EH, Pettersson GB. Performance and Durability of Cryopreserved Allograft Aortic Valve Replacements. Ann Thorac Surg 2021; 111:1893-1900. [DOI: 10.1016/j.athoracsur.2020.07.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 07/02/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
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Ngiam JN, Chew NW, Pramotedham T, Tan BYQ, Sia CH, Loh PH, Ruan W, Tay E, Kong WK, Yeo TC, Poh KK. Implications of Coexisting Aortic Regurgitation in Patients With Aortic Stenosis. JACC: ASIA 2021; 1:105-111. [PMID: 36338366 PMCID: PMC9627873 DOI: 10.1016/j.jacasi.2021.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 12/03/2022]
Abstract
Background Aortic regurgitation (AR) is a common comorbidity in patients with aortic stenosis (AS), but coexisting AR has often been excluded from major clinical studies on AS. The impact of coexisting AR on the natural history of AS has not been well-described. Objectives The authors compared clinical outcomes in medically managed patients with moderate-to-severe AS with or without coexisting AR. Methods Consecutive patients (N = 1,188) with index echocardiographic diagnosis of moderate-to-severe AS (aortic valve area <1.5 cm2) were studied. All patients were medically managed and were divided into those with coexisting AR (at least moderate severity) and those without. Adverse composite clinical outcomes were defined as mortality or admissions for congestive cardiac failure on subsequent follow-up. The authors compared differences in clinical profile and outcomes between the groups. Results There were 88 patients (7.4%) with coexisting AR and AS. These patients did not differ significantly in age, but had lower body mass index (22.9 ± 3.8 vs 25.3 ± 5.1 kg/m2), lower diastolic blood pressure (68.7 ± 10.7 vs 72.2 ± 12.3 mm Hg), larger end-diastolic volume index (68.8 ± 18.8 vs 60.4 ± 17.8 mL/m2) and larger left ventricular mass index (118.6 ± 36.4 vs 108.9 ± 33.1 g/m2). The prevalence of cardiovascular risk factors did not differ significantly. Coexisting AR was associated with increased incidence of adverse outcomes (log-rank 4.20; P = 0.040). On multivariable Cox regression, coexisting AR remained independently associated with adverse outcomes (HR: 1.36; 95% CI: 1.02-1.82) after adjusting for age, AS severity, left ventricular ejection fraction, and year of study. Conclusions In patients with AS, coexisting AR was associated with changes in echocardiographic profile and adverse outcomes.
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Affiliation(s)
| | - Nicholas W.S. Chew
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore
| | | | | | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Poay Huan Loh
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wen Ruan
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Edgar Tay
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - William K.F. Kong
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tiong-Cheng Yeo
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kian-Keong Poh
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Address for correspondence: A/Prof Poh Kian-Keong, Department of Cardiology, National University Heart Centre, National University Health System, Singapore, 1E Kent Ridge Rd, NUHS Tower Block, Level 9, Singapore 119228.
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Leone PP, Regazzoli D, Pagnesi M, Sanz-Sanchez J, Chiarito M, Cannata F, Van Mieghem NM, Barbanti M, Tamburino C, Teles R, Adamo M, Miura M, Maisano F, Kim WK, Bedogni F, Stefanini G, Mangieri A, Giannini F, Colombo A, Reimers B, Latib A. Predictors and Clinical Impact of Prosthesis-Patient Mismatch After Self-Expandable TAVR in Small Annuli. JACC Cardiovasc Interv 2021; 14:1218-1228. [PMID: 34112458 DOI: 10.1016/j.jcin.2021.03.060] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/01/2021] [Accepted: 03/23/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this study was to define predictors of prosthesis-patient mismatch (PPM) and its impact on mortality after transcatheter aortic valve replacement (TAVR) with self-expandable valves (SEVs) in patients with small annuli. BACKGROUND TAVR seems to reduce the risk for PPM compared with surgical aortic valve replacement, especially in patients with small aortic annuli. Nevertheless, predictors and impact of PPM in this population have not been clarified yet. METHODS Predictors of PPM and all-cause mortality were investigated using multivariable logistic regression analysis from the cohort of the TAVI-SMALL (International Multicenter Registry to Evaluate the Performance of Self-Expandable Valves in Small Aortic Annuli) registry, which included patients with severe aortic stenosis and small annuli (annular perimeter <72 mm or area <400 mm2 on computed tomography) treated with transcatheter SEVs: 445 patients with (n = 129) and without (n = 316) PPM were enrolled. RESULTS Intra-annular valves conferred increased risk for PPM (odds ratio [OR]: 2.36; 95% confidence interval [CI]: 1.16 to 4.81), while post-dilation (OR: 0.46; 95% CI: 0.25-0.84) and valve oversizing (OR: 0.53; 95% CI: 0.28-1.00) seemed to protect against PPM occurrence. At a median follow-up of 354 days, patients with severe PPM, but not those with moderate PPM, had a higher all-cause mortality rate compared with those without PPM (log-rank p = 0.008). Multivariable Cox regression confirmed severe PPM as an independent predictor of all-cause mortality (hazard ratio: 4.27; 95% CI: 1.34 to 13.6). CONCLUSIONS Among patients with aortic stenosis and small aortic annuli undergoing transcatheter SEV implantation, use of intra-annular valves yielded higher risk for PPM; conversely, post-dilation and valve oversizing protected against PPM occurrence. Severe PPM was independently associated with all-cause mortality.
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Affiliation(s)
- Pier Pasquale Leone
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | | | - Matteo Pagnesi
- Cardio-Thoracic-Vascular Department, San Raffaele Scientific Institute, Milan, Italy
| | | | - Mauro Chiarito
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Francesco Cannata
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Marco Barbanti
- U.O.C. Cardiologia, Centro Alte Specialità e Trapianti, P.O.G. Rodolico, A.O.U. Policlinico-V. Emanuele, Università di Catania, Catania, Italy
| | - Corrado Tamburino
- U.O.C. Cardiologia, Centro Alte Specialità e Trapianti, P.O.G. Rodolico, A.O.U. Policlinico-V. Emanuele, Università di Catania, Catania, Italy
| | - Rui Teles
- Centro Hospitalar de Lisboa Ocidental, Hospital de Santa Cruz, Lisbon, Portugal
| | - Marianna Adamo
- Civil Hospital and University of Brescia, Brescia, Italy
| | - Mizuki Miura
- Cardiac Surgery, University of Zürich, Zürich, Switzerland
| | | | - Won-Keun Kim
- Department of Cardiology and Cardiac Surgery, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy; Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | | | | | - Antonio Colombo
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy; GVM Care and Research, Maria Cecilia Hospital, Ravenna, Italy
| | - Bernhard Reimers
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
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Long-Term Results (up to 20 Years) of 19 mm or Smaller Prostheses in the Aortic Position. Does Size Matter? A Propensity-Matched Survival Analysis. J Clin Med 2021; 10:jcm10102055. [PMID: 34064845 PMCID: PMC8151595 DOI: 10.3390/jcm10102055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/19/2021] [Accepted: 05/07/2021] [Indexed: 11/28/2022] Open
Abstract
Background: The long-term performance of prostheses in the small aortic root is still unclear. Methods: Patients who received a 21 mm or smaller aortic valve between 2000–2018 were retrospectively analyzed. Propensity matching was used in order to account for baseline differences in 19 mm vs. 21 mm valve subgroups. Results: Survival at 10 years was 55.87 ± 5.54% for 19 mm valves vs. 57.17 ± 2.82% for 21 mm ones in the original cohort (p = 0.37), and 58.69 ± 5.61% in 19 mm valve recipients vs. 53.60 ± 5.66% for 21 mm valve subgroups in the matched cohort (p = 0.55). Smaller valves exhibited significantly more patient–prothesis mismatch (PPM) than larger ones (87.30% vs. 57.94%, p < 0.01). All-cause mortality was affected by PPM at 10 years (52.66 ± 3.28% vs. 64.38 ± 3.87%, p = 0.04) in the unmatched population. This difference disappeared, however, after matching: survival at 10 years was 51.82 ± 5.26% in patients with PPM and 63.12 ± 6.43% in patients without PPM. (p = 0.14) Conclusions: There is no survival penalty in using 19 mm prostheses in the small aortic root in the current era. Although PPM is more prevalent in smaller sized valve recipients, this does not translate into reduced survival at 10 years of follow-up.
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63
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Marsico R, Zakkar M, Bruno VD, Mansour S, Bryan AJ, Angelini GD. The impact of patient-prosthesis mismatch on early and long-term survival after aortic replacement with the Edwards Perimount valve: A propensity score-matched analysis. J Card Surg 2021; 36:2269-2276. [PMID: 33821500 DOI: 10.1111/jocs.15534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND To investigate the impact of severe patient-prosthesis mismatch (PPM) related to the Edwards Lifesciences Perimount (EP) bioprosthesis in the aortic position on early in-hospital outcomes and long-term survival. METHODS A total of 5964 consecutive patients underwent aortic valve replacement at the Bristol Heart Institute between 1998 and 2014, 2667 representing the cohort of this study received EP. PPM was defined severe as EOAi < 0.65 cm2 /m2 . To minimize bias, propensity score matching was conducted and two groups A and B (without and with severe PPM) of 320 patients with similar preoperative characteristics were matched. We assessed early in-hospital outcomes including CVA, re-exploration for bleeding, low cardiac output, wound infection, acute renal injury, length of hospital stay, and long-term survival for both groups in unmatched and matched populations. RESULTS In the unmatched analysis, 18.3% of patients had severe PPM. Severe PPM was not associated with increased in-hospital mortality (4.5% vs. 2.9%, respectively, p = .09) or any other early adverse outcomes except increased length of hospital stay (10.57 ± 8.2 vs. 11.7 ± 9.4, respectively, p = .01). Long-term survival differed significantly between groups at 2 and 8 years (91.8% vs. 91.4% and 60.5% vs. 55.7%, respectively, p = .02). Matched analysis showed no differences between the groups in early health outcomes and overall survival at 2 and 8 years was also similar (89.7% vs. 91% and 57.3% vs. 58%, group A vs. B, respectively p = .9). CONCLUSION Presence of PPM does not seem to affect early in-hospital outcomes or late survival when using EP in patients undergoing aortic valve replacement.
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Affiliation(s)
- Roberto Marsico
- Faculty of Health Sciences, Bristol Heart Institute, Bristol Royal Infirmary, University of Bristol, Bristol, UK
| | - Mustafa Zakkar
- Department of Cardiovascular Sciences, Clinical Sciences Wing, University of Leicester, Glenfield Hospital, Leicester, UK
| | - Vito D Bruno
- Faculty of Health Sciences, Bristol Heart Institute, Bristol Royal Infirmary, University of Bristol, Bristol, UK
| | - Sherif Mansour
- Department of Cardiovascular Sciences, Clinical Sciences Wing, University of Leicester, Glenfield Hospital, Leicester, UK
| | - Alan J Bryan
- Faculty of Health Sciences, Bristol Heart Institute, Bristol Royal Infirmary, University of Bristol, Bristol, UK
| | - Gianni D Angelini
- Faculty of Health Sciences, Bristol Heart Institute, Bristol Royal Infirmary, University of Bristol, Bristol, UK
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64
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Ösken A, Ünal Dayı Ş, Özcan KS, Keskin M, Kemaloğlu Öz T, Poyraz E, Gürkan U, Akgöz H, Çam N. Speckle tracking echocardiography in severe patient-prosthesis mismatch. Herz 2021; 46:375-380. [PMID: 33687479 DOI: 10.1007/s00059-021-05031-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/06/2020] [Accepted: 02/06/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although aortic valve replacement (AVR) when successfully performed boasts low mortality rates in selected patients, prosthesis-patient mismatch (PPM) can be found in the majority of these individuals. Limited research is available supporting the benefit of two-dimensional speckle tracking echocardiography (2D-STE) in patients with severe PPM. This study sought to assess myocardial strain using 2D-STE to determine the relationship between subclinical left ventricular (LV) dysfunction and aortic PPM in patients undergoing AVR with preserved LV ejection fraction. MATERIAL AND METHODS We retrospectively examined all consecutive patients with isolated AVR who presented to our center from 2005 to 2018. The data of 1086 patients were analyzed. Severe PPM was defined as an indexed effective orifice area of 0.65 cm2/m2 or less. As a result of the detailed assessment, 54 patients meeting the eligibility criteria were included in the study. Baseline data were collected and compared between the two groups of patients with severe PPM (n = 27) and those with normofunctional aortic prosthesis valve as a control group (n = 27). All patients underwent baseline echocardiography. Global longitudinal strain (GLS) and global circumferential strain (GCS) were evaluated by 2D-STE. RESULTS When compared with controls, patients with severe PPM had significantly decreased GLS (18.6 ± 2.9 vs. 21.4 ± 2.1; p < 0.01) and GCS (17.2 ± 3.6 vs. 21.7 ± 2.1; p < 0.01) values. CONCLUSION In addition to standard clinical and echocardiographic parameters, GLS and GCS suggest subclinical dysfunction and have incremental value in patients with severe PPM.
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Affiliation(s)
- Altuğ Ösken
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey. .,Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Tibbiye cad. 13, Haydarpasa/Istanbul/Turkey, 34668, İstanbul, Turkey.
| | - Şennur Ünal Dayı
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Kazım Serhan Özcan
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Muhammed Keskin
- Department of Cardiology, Sultan II. Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Tuğba Kemaloğlu Öz
- Department of Cardiology, Istinye University Faculty of Medicine, Istanbul, Turkey
| | - Esra Poyraz
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ufuk Gürkan
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Haldun Akgöz
- Department of Cardiology, Acibadem University Faculty of Medicine, Istanbul, Turkey
| | - Neşe Çam
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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65
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A Retrospective Comparison of Hemodynamic and Clinical Outcomes between Two Differently Designed Aortic Bioprostheses for Small Aortic Annuli. J Clin Med 2021; 10:jcm10051063. [PMID: 33806531 PMCID: PMC7961368 DOI: 10.3390/jcm10051063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/20/2021] [Accepted: 02/27/2021] [Indexed: 11/17/2022] Open
Abstract
The Trifecta valve has externally mounted leaflets; it differs from classic internally mounted valves (e.g., Carpentier-Edwards [C-E]). We evaluated post-implantation hemodynamics and clinical outcomes of these bioprostheses in small aortic annuli. From January 2015 to April 2019, 490 patients who underwent aortic valve replacement (AVR) were reviewed retrospectively. Altogether, 183 patients received 19 or 21 mm diameter C-E (n = 121) or Trifecta (n = 62) prostheses. To minimize confounding variables, we performed propensity-score matching analysis. The mean transvalvular pressure gradient (TVPG) was significantly lower in the Trifecta than in the C-E group at discharge (12.9 ± 4.8 vs. 15.0 ± 5.3 mmHg, p = 0.044). TVPG change over time was not significantly different between groups (p = 0.357). Left ventricular mass index decreased postoperatively (reduction: C-E, 28.1%; Trifecta, 30.1%, p = 0.879). No late mortality, severe patient–prosthesis mismatch, moderate-to-severe paravalvular leakage, structural valve degeneration, or valve thromboses were observed. Freedom from valve-related events at 3 years were similar for C-E (97.9% ± 2.1%) and Trifecta (97.7% ± 2.2%) patients (log-rank p = 0.993). Bioprosthesis design for small annuli significantly affected TVPG immediately after AVR. However, hemodynamics over time and clinical outcomes did not differ between the two designs.
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66
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Dietrich M, Mankad R. Elevated Prosthetic Valve Gradients: What to Consider When Determining an Etiology. J Cardiothorac Vasc Anesth 2021; 35:2223-2227. [PMID: 33744112 DOI: 10.1053/j.jvca.2021.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 11/11/2022]
Abstract
DOPPLER echocardiography is a useful noninvasive tool for the assessment of cardiac hemodynamics. However, it is subject to limitations that can have important clinical implications, especially in the setting of valve prosthesis. Elevation in mean transvalvular gradient is a finding that has a variety of etiologies. One such etiology is the pressure-recovery (PR) phenomenon, a consequence of stream convergence and energy conversion across a narrowing, which is an artifact of Doppler echocardiographic calculations of valvular flow. The elevated gradient measured with Doppler echocardiography as a result of PR is not present on cardiac catheterization and does not represent true problematic valve hemodynamics. PR should be suspected with an elevated gradient on Doppler echocardiography with normal leaflet motion, especially in the setting of a small proximal aorta. Understanding and awareness of PR are important because PR can lead to overestimation of disease severity in the clinical setting.
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67
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Vriesendorp MD, de Lind van Wijngaarden RAF, Klautz RJM. A bigger picture for valve charts. J Thorac Cardiovasc Surg 2021; 161:e371-e372. [PMID: 33451830 DOI: 10.1016/j.jtcvs.2020.11.097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 10/30/2020] [Accepted: 11/03/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Michiel D Vriesendorp
- Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, The Netherlands
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68
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Mehta S, Sharma D, Pathania R. Early myocardial remodeling after aortic valve replacement. INTERNATIONAL JOURNAL OF THE CARDIOVASCULAR ACADEMY 2021. [DOI: 10.4103/ijca.ijca_28_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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69
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Early Hemodynamics after Aortic Valve Replacement. ACTA ACUST UNITED AC 2020; 56:medicina56120674. [PMID: 33297308 PMCID: PMC7762237 DOI: 10.3390/medicina56120674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/02/2020] [Accepted: 12/04/2020] [Indexed: 11/16/2022]
Abstract
Background and objectives: The aims of this study were to investigate changes in the hemodynamics associated with different types of aortic prostheses and to evaluate patient-prosthesis mismatch (PPM) at rest and after exercise. Materials and Methods: We retrospectively analyzed 150 patients who presented with indications for aortic valve replacement (AVR) with/without concomitant surgery from March 2019 to January 2020. The study population included 90 (60%) men and 60 (40%) women (mean age, 67.33 ± 10.22 years; range, 37-88 years). Echocardiography data such as peak and mean transprosthetic pressure gradients (Gmax, Gmean), velocity (V), effective orifice area (EOA), and indexed EOA (iEOA) were derived at rest and after exercise at baseline and before discharge. The study patients performed the six-minute walk test (6MWT) on the 5th-7th postoperative day. Results: Stented tissue valves showed excellent performance at rest and after exercise in comparison with mechanical valves, which showed favorable hemodynamics at rest only. At the time of discharge, moderate PPM was observed in 7/74 patients (9.5%) at rest and 5/98 (3.3%) patients after exercise. None of the patients showed severe PPM. EOA and iEOA were not significantly different between the groups. However, the stented group showed more pronounced changes in EOA and iEOA after exercise, whereas the changes in the mechanical valve group did not reach significance. Conclusions: In the early postoperative period, mechanical valves and stented valves showed favorable resting hemodynamics. The PPM rate measured after exercise was lower than that at rest.
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70
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Tam DY, Chikwe J. Commentary: The problem of valve prosthesis-patient mismatch revisited. J Thorac Cardiovasc Surg 2020; 164:831-832. [PMID: 33422310 DOI: 10.1016/j.jtcvs.2020.11.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 11/25/2020] [Accepted: 11/30/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Derrick Y Tam
- Division of Cardiac Surgery, Schulich Heart Centre, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
| | - Joanna Chikwe
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif
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71
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Patel KV, Omar W, Gonzalez PE, Jessen ME, Huffman L, Kumbhani DJ, Bavry AA. Expansion of TAVR into Low-Risk Patients and Who to Consider for SAVR. Cardiol Ther 2020; 9:377-394. [PMID: 32875469 PMCID: PMC7584721 DOI: 10.1007/s40119-020-00198-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Indexed: 12/15/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of severe aortic stenosis (AS) over the last decade. The results of the Placement of Aortic Transcatheter Valves (PARTNER) 3 and Evolut Low Risk trials demonstrated the safety and efficacy of TAVR in low-surgical-risk patients and led to the approval of TAVR for use across the risk spectrum. Heart teams around the world will now be faced with evaluating a deluge of younger, healthier patients with severe AS. Prior to the PARTNER 3 and Evolut Low Risk studies, this heterogenous patient population would have undergone surgical aortic valve replacement (SAVR). It is unlikely that TAVR will completely supplant SAVR for the treatment of severe AS in patients with a low surgical risk, as SAVR has excellent short- and long-term outcomes and years of durability data. In this review, we outline the critical role that SAVR will continue to play in the treatment of severe AS in the post-PARTNER 3/Evolut Low Risk era.
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Affiliation(s)
- Kunal V Patel
- Division of Cardiology, University of Texas Southwestern Medical Center, Texas, USA
| | - Wally Omar
- Division of Cardiology, University of Texas Southwestern Medical Center, Texas, USA
| | - Pedro Engel Gonzalez
- Division of Cardiology, University of Texas Southwestern Medical Center, Texas, USA
| | - Michael E Jessen
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Texas, USA
| | - Lynn Huffman
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Texas, USA
| | - Dharam J Kumbhani
- Division of Cardiology, University of Texas Southwestern Medical Center, Texas, USA
| | - Anthony A Bavry
- Division of Cardiology, University of Texas Southwestern Medical Center, Texas, USA.
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72
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Okamura H, Hori D, Kusadokoro S, Mieno M, Kimura N, Yuri K, Yamaguchi A. Long-Term Outcomes and Echocardiographic Data After Aortic Valve Replacement With a 17-mm Mechanical Valve. Circ J 2020; 84:2312-2319. [PMID: 33100280 DOI: 10.1253/circj.cj-20-0201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND We investigated the long-term clinical and hemodynamic outcomes after aortic valve replacement (AVR) with a 17-mm mechanical valve.Methods and Results:Between January 2005 and December 2011, 80 patients with aortic stenosis underwent AVR with the 17-mm St. Jude Medical Regent prosthetic valve. Echocardiography was performed preoperatively, at discharge, and at follow-up, which was performed at least 2 years postoperatively (median interval, 7.3 years). Prosthesis-patient mismatch (PPM) was defined as an indexed effective orifice area <0.85 cm2/m2at discharge and occurred in 25 patients (31%). The median follow-up period was 8.7 years (100% complete). Overall in-hospital mortality was 2.5% (2 patients) with 27 late deaths (34%). The 5- and 10-year survival rates were 78.7% and 63.0%, respectively. Peripheral arterial disease and concomitant mitral valve repair were independent predictors of late mortality. The 5- and 10-year freedom from major adverse valve-related events (MAVRE) rates were 91.6% and 83.5%, respectively. PPM at discharge did not affect long-term survival, freedom from MAVRE, or freedom from heart failure. Echocardiographic data at follow-up revealed a significant reduction in the mean left ventricular mass index (LVMI). LVMI reduction observed at follow-up was similar between patients with and without PPM. CONCLUSIONS AVR with the 17-mm mechanical prosthesis had acceptable long-term clinical and hemodynamic outcomes. Significant reduction in LVMI was observed regardless of PPM.
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Affiliation(s)
- Homare Okamura
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University
| | - Daijiro Hori
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University
| | - Sho Kusadokoro
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University
| | - Makiko Mieno
- Department of Medical Informatics, Center for Information, Jichi Medical University
| | - Naoyuki Kimura
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University
| | - Koichi Yuri
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University
| | - Atsushi Yamaguchi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University
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Nitta K, Fukuda Y, Susawa H, Ikenaga H, Utsunomiya H, Ishibashi K, Kurisu S, Takahashi S, Nakano Y, Awai K, Sueda T, Kihara Y. Impact of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement on Changes in Cardiac Sympathetic Nervous Function. Int Heart J 2020; 61:1188-1195. [PMID: 33191358 DOI: 10.1536/ihj.20-381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The impact of prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) on changes in cardiac sympathetic nervous (CSN) function remains unclear. Using 123I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy, we investigated the impact of PPM after TAVR on CSN activity.We enrolled 44 of 117 patients with severe aortic stenosis who underwent TAVR for analysis in the present study. We conducted 123I-MIBG scintigraphy at baseline and at about 9 months after TAVR. Differences between baseline and post-TAVR 123I-MIBG parameters were compared between cases with and without PPM.There were 17 and 27 patients with and without PPM, respectively. Those without PPM exhibited significantly decreased left ventricular mass index (122 ± 36 g/m2 versus 108 ± 30 g/m2, P < 0.001) following TAVR, whereas those with PPM did not (117 ± 21 g/m2 versus 110 ± 17 g/m2, P = 0.09). Significant improvements in delayed heart-to-mediastinum (H/M) ratio (2.8 ± 0.4 versus 3.0 ± 0.4, P = 0.004) and washout rate (WR) (33% ± 10% versus 24% ± 12%, P < 0.001) were observed after TAVR in patients without PPM but not in those with PPM. Multivariable linear regression analysis revealed PPM to be a negative predictor of improvements in delayed H/M ratio and WR.Delayed H/M ratio and WR improve significantly after TAVR in the absence of PPM, whereas these improvements are not observed in patients with PPM. Hence, the presence of PPM is a negative predictor of improvements in delayed H/M ratio and WR in patients undergoing TAVR.
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Affiliation(s)
- Kazuhiro Nitta
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Yukihiro Fukuda
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Hitoshi Susawa
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Hiroki Ikenaga
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Hiroto Utsunomiya
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Ken Ishibashi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Satoshi Kurisu
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Shinya Takahashi
- Department of Cardiovascular Surgery, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Kazuo Awai
- Department of Diagnostic Radiology, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Taijiro Sueda
- Department of Cardiovascular Surgery, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
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74
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Vriesendorp MD, Deeb GM, Reardon MJ, Kiaii B, Bapat V, Labrousse L, Rao V, Sabik JF, Gearhart E, Klautz RJM. Why the categorization of indexed effective orifice area is not justified for the classification of prosthesis-patient mismatch. J Thorac Cardiovasc Surg 2020; 164:822-829.e6. [PMID: 33339597 DOI: 10.1016/j.jtcvs.2020.10.123] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 10/08/2020] [Accepted: 10/20/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Although the impact of prosthesis-patient mismatch (PPM) on survival has been widely studied, there has been little debate about whether the current definition of PPM truly reflects hemodynamic obstruction. This study aimed to validate the categorization of indexed effective orifice area (EOAi) for the classification of PPM. METHODS In total, 2171 patients who underwent aortic valve replacement with a surgical stented bioprosthesis in 5 trials (CoreValve US High-Risk, SURTAVI [Surgical Replacement and Transcatheter Aortic Valve Implantation Trial], Evolut Low Risk, PERIGON [PERIcardial SurGical AOrtic Valve ReplacemeNt] Pivotal Trial for the Avalus valve, and PERIGON Japan) were used for this analysis. The echocardiographic images at the 1-year follow-up visit were evaluated to explore the association between EOAi and mean aortic gradient and its interaction with other patient characteristics, including obesity. In addition, different criteria of PPM were compared with reflect elevated mean aortic gradients (≥20 mm Hg). RESULTS A relatively smaller exponential decay in mean aortic gradient was found for increasing EOAi, as the slope on the log scale was -0.83 versus -2.5 in the publication from which the current cut-offs for PPM originate. The accuracy of the American Society of Echocardiography, Valve Academic Research Consortium-2, and European Association of Cardiovascular Imaging definitions of PPM to reflect elevated mean aortic gradients was 49%, 57%, and 57%, respectively. The relation between EOAi and mean aortic gradient was not significantly different between obese and non-obese patients (P = .20). CONCLUSIONS The use of EOAi thresholds to classify patients with PPM is undermined by a less-pronounced exponential relationship between EOAi and mean aortic gradient than previously demonstrated. Moreover, recent adjustment for obesity in the definition of PPM is not supported by these data.
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Affiliation(s)
- Michiel D Vriesendorp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
| | - G Michael Deeb
- Department of Cardiac Surgery, University of Michigan Health System-University Hospital, Ann Arbor, Mich
| | - Michael J Reardon
- Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Tex
| | - Bob Kiaii
- Department of Cardiovascular and Thoracic Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Vinayak Bapat
- Department of Surgery, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, NY
| | - Louis Labrousse
- Medico-Surgical Department of Valvulopathies, CHU Hospital of Bordeaux, Bordeaux, France
| | - Vivek Rao
- Department of Cardiovascular Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | - Joseph F Sabik
- Department of Surgery, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
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75
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Catalano MA, Rutkin B, Koss E, Maurer G, Berg J, Hartman A, Yu PJ. Accuracy of predicted effective orifice area in determining incidence of patient-prosthesis mismatch after transcatheter aortic valve replacement. J Card Surg 2020; 36:191-196. [PMID: 33169868 DOI: 10.1111/jocs.15148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 09/27/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Patient-prosthesis mismatch (PPM) is associated with poor outcomes after aortic valve replacement. The aim of this study was to assess the accuracy of indexed effective orifice area (EOAi) charts in predicting PPM after transcatheter aortic valve replacement (TAVR). METHODS A retrospective review of 346 TAVR patients from January 2017 to November 2018 was performed. EOAi was predicted for patients based on published predictive tables using valve type, annulus diameter, and body surface area. Actual EOAi was calculated based on intraoperative transesophageal echocardiogram (TEE) measurements. PPM was defined by EOAi ≤ 0.85 cm2 /m2 . The accuracy of predicted PPM was assessed. Differences in clinical outcomes, including mean gradient, length of stay, mortality, complications, and change in Kansas City cardiomyopathy questionnaire score as an indicator of quality of life, were evaluated based on actual PPM. RESULTS Of the 346 patients analyzed, 44 (12.7%) of patients had PPM on intraoperative TEE. Of the 182 patients who received Sapien 3 valves, 42 (23.1%) were predicted to have PPM while 25 (13.7%) had actual PPM. Of the 164 patients who received Evolut valves, 3 (1.8%) were predicted to have PPM while 19 (11.6%) had actual PPM. EOAi charts had poor sensitivity (40.0% for Sapien 3; 5.25% for Evolut) and positive predictive value (23.8% for Sapien 3; 33.3% for Evolut) for both valve types. CONCLUSION Preoperative prediction of PPM in TAVR patients using tables of expected EOA demonstrates significant variation from actual PPM. The utility of EOAi charts to predict PPM in patients undergoing TAVR may be limited.
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Affiliation(s)
- Michael A Catalano
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, New York, USA
| | - Bruce Rutkin
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, New York, USA
| | - Elana Koss
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, New York, USA
| | - Greg Maurer
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, New York, USA
| | - Jacinda Berg
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, New York, USA
| | - Alan Hartman
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, New York, USA
| | - Pey-Jen Yu
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, New York, USA
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76
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Commentary: Prosthesis-patient mismatch. A blast from the past? J Thorac Cardiovasc Surg 2020; 164:830-831. [PMID: 33277038 DOI: 10.1016/j.jtcvs.2020.10.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 10/27/2020] [Accepted: 10/27/2020] [Indexed: 11/22/2022]
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77
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Affonso da Costa FD. Commentary: Prosthesis-patient mismatch, the controversy goes on. J Thorac Cardiovasc Surg 2020; 164:833-834. [PMID: 33309085 DOI: 10.1016/j.jtcvs.2020.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 10/23/2022]
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78
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Pingpoh C, Schroefel H, Franz T, Czerny M, Kreibich M, Moser M, Bode C, Beyersdorf F, Neumann FJ, Hochholzer W, Siepe M. Transcatheter valve-in-valve implantation in degenerated aortic bioprostheses: are patients with small surgical bioprostheses at higher risk for unfavourable mid-term outcomes? Ann Cardiothorac Surg 2020; 9:478-486. [PMID: 33312905 DOI: 10.21037/acs-2020-av-fs-0124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To examine outcomes of valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) according to the inner diameter (ID) of the degenerated aortic valve bioprosthesis. Methods We analyzed survival, stroke, permanent pacemaker (PPM) implantation, paravalvular (PV) leakage, acute kidney injury and vascular complications in fifty-nine patients during a ten-year period. Patients were stratified according to the ID of the indwelling degenerated biological aortic valve (true ID ≤ and >20 mm). Differences in post-procedural transvalvular gradients and hospital re-admissions were analyzed. Results The median age of the small diameter group and large diameter group was eighty-one and eighty years, respectively. Median logistic EuroSCORE I was 23.9% and 26.2% and median Society of Thoracic Surgeons (STS) score was 5.7% and 7.8% for the small and large groups, respectively. Survival, stroke, PPM implantation, PV leakage, acute kidney injury and vascular complications did not reach any statistically significant difference between both groups. Postprocedural transvalvular gradients differed significantly according to the true ID of the degenerated bioprosthetic valve and consequently of the respective TAVI valve. There was a significant difference with regard to hospital readmissions according to the true ID. Conclusions TAVI ViV implantation for aortic bioprostheses with small true IDs of ≤20 mm is associated with comparable mid-term mortality and periprocedural stroke rate compared to implantation into larger bioprostheses. However, the periprocedural and mid-term transvalvular gradients, as well as hospital re-admission rates are significantly higher in the small diameter group.
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Affiliation(s)
- Clarence Pingpoh
- Department of Cardiovascular Surgery, University Heart Center Freiburg · Bad Krozingen, Bad Krozingen, Germany.,Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Holger Schroefel
- Department of Cardiovascular Surgery, University Heart Center Freiburg · Bad Krozingen, Bad Krozingen, Germany.,Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Tanja Franz
- Department of Cardiovascular Surgery, University Heart Center Freiburg · Bad Krozingen, Bad Krozingen, Germany.,Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Heart Center Freiburg · Bad Krozingen, Bad Krozingen, Germany.,Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Maximilian Kreibich
- Department of Cardiovascular Surgery, University Heart Center Freiburg · Bad Krozingen, Bad Krozingen, Germany.,Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Martin Moser
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Christoph Bode
- Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, University Heart Center Freiburg · Bad Krozingen, Bad Krozingen, Germany.,Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Franz-Josef Neumann
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Willibald Hochholzer
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Matthias Siepe
- Department of Cardiovascular Surgery, University Heart Center Freiburg · Bad Krozingen, Bad Krozingen, Germany.,Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
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79
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Fiore A, Gueldich M, Folliguet T. Sutureless valves fit/perform well in a small aortic annulus. Ann Cardiothorac Surg 2020; 9:414-416. [PMID: 33102181 DOI: 10.21037/acs.2020.04.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Antonio Fiore
- Department of Cardiac Surgery, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Majdi Gueldich
- Department of Cardiac Surgery, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Thierry Folliguet
- Department of Cardiac Surgery, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
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80
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Ma W, Shi W, Wu W, Ma X, Kong Y, Zhu D, Zhang W. Patient-prosthesis mismatch in mitral annuloplasty for degenerative mitral regurgitation: an ignored issue. Eur J Cardiothorac Surg 2020; 56:976-982. [PMID: 30903154 DOI: 10.1093/ejcts/ezz086] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 02/10/2019] [Accepted: 02/20/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Elevated postoperative transmitral gradient (TMG), partially induced by a small annuloplasty ring, is associated with late atrial fibrillation (AF) after mitral valve repair. Here, we aimed to provide the optimal cut-off of prosthetic ring size to reduce patient-prosthesis mismatch (PPM) after mitral annuloplasty. METHODS From 2006 to 2017, 262 patients who underwent mitral valve repair for degenerative pathologies were retrospectively studied. The relationships of body surface area (BSA)-indexed prosthetic orifice area (POAi)-postoperative TMG and POAi-late AF were tested using regression curves and receiver operating characteristic curves, respectively. The optimal cut-off of POAi predictive of late AF was used to define PPM. Baseline and follow-up data of patients with and without PPM were compared in propensity score-matched cohorts. RESULTS In-hospital mortality was 0. Late AF was observed in 9.2% (24/262) patients during a median follow-up of 3.8 years. An exponential model was best fitted based on the POAi-postoperative TMG relationship (P < 0.001). Using late AF as the dependent variable, the optimal cut-off for PPM was POAi ≤2.28 cm2/m2 (c-statistic 0.71; sensitivity 0.61; specificity 0.80; P < 0.001). PPM was identified in 113 (43.1%) patients. After propensity score matching, the estimated 5-year rate of late AF was significantly higher in PPM patients than in non-PPM patients (24% vs 5%; P < 0.001). CONCLUSIONS Postoperative TMG increases significantly with a small POAi for full ring annuloplasty. A patient's BSA should be considered in addition to valvular dimensions during the selection of a proper ring size to reduce PPM-related AF.
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Affiliation(s)
- Wenrui Ma
- Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Shi
- Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Weihua Wu
- Department of Echocardiography, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xinyu Ma
- Department of Bioinformatics, School of Life Sciences, Fudan University, Shanghai, China
| | - Ye Kong
- Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Dan Zhu
- Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Zhang
- Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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81
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Essential information on surgical heart valve characteristics for optimal valve prosthesis selection: Expert consensus document from the European Association for Cardio-Thoracic Surgery (EACTS)-The Society of Thoracic Surgeons (STS)-American Association for Thoracic Surgery (AATS) Valve Labelling Task Force. J Thorac Cardiovasc Surg 2020; 161:545-558. [PMID: 33070936 DOI: 10.1016/j.jtcvs.2020.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Comprehensive information on the characteristics of surgical heart valves (SHVs) is essential for optimal valve selection. Such information is also important in assessing SHV function after valve replacement. Despite the existing regulatory framework for SHV sizing and labelling, this information is challenging to obtain in a uniform manner for various SHVs. To ensure that clinicians are adequately informed, the European Association for Cardio-Thoracic Surgery (EACTS), The Society of Thoracic Surgeons (STS) and American Association for Thoracic Surgery (AATS) set up a Task Force comprised of cardiac surgeons, cardiologists, engineers, regulatory bodies, representatives of the International Organization for Standardization and major valve manufacturers. Previously, the EACTS-STS-AATS Valve Labelling Task Force identified the most important problems around SHV sizing and labelling. This Expert Consensus Document formulates recommendations for providing SHV physical dimensions, intended implant position and hemodynamic performance in a transparent, uniform manner. Furthermore, the Task Force advocates for the introduction and use of a standardized chart to assess the probability of prosthesis-patient mismatch and calls valve manufacturers to provide essential information required for SHV choice on standardized Valve Charts, uniformly for all SHV models.
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82
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Durko AP, Pibarot P, Atluri P, Bapat V, Cameron DE, Casselman FPA, Chen EP, Dahle G, Elefteriades JA, Lancellotti P, Prager RL, Rosenhek R, Speir A, Stijnen M, Tasca G, Yoganathan A, Walther T, De Paulis R. Essential Information on Surgical Heart Valve Characteristics for Optimal Valve Prosthesis Selection: Expert Consensus Document From the European Association for Cardio-Thoracic Surgery (EACTS)-The Society of Thoracic Surgeons (STS)-American Association for Thoracic Surgery (AATS) Valve Labelling Task Force. Ann Thorac Surg 2020; 111:314-326. [PMID: 33036738 DOI: 10.1016/j.athoracsur.2020.05.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/27/2020] [Indexed: 10/23/2022]
Abstract
Comprehensive information on the characteristics of surgical heart valves (SHVs) is essential for optimal valve selection. Such information is also important in assessing SHV function after valve replacement. Despite the existing regulatory framework for SHV sizing and labelling, this information is challenging to obtain in a uniform manner for various SHVs. To ensure that clinicians are adequately informed, the European Association for Cardio-Thoracic Surgery (EACTS), The Society of Thoracic Surgeons (STS) and American Association for Thoracic Surgery (AATS) set up a Task Force comprised of cardiac surgeons, cardiologists, engineers, regulatory bodies, representatives of the International Organization for Standardization and major valve manufacturers. Previously, the EACTS-STS-AATS Valve Labelling Task Force identified the most important problems around SHV sizing and labelling. This Expert Consensus Document formulates recommendations for providing SHV physical dimensions, intended implant position and hemodynamic performance in a transparent, uniform manner. Furthermore, the Task Force advocates for the introduction and use of a standardized chart to assess the probability of prosthesis-patient mismatch and calls valve manufacturers to provide essential information required for SHV choice on standardized Valve Charts, uniformly for all SHV models.
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Affiliation(s)
- Andras P Durko
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Philippe Pibarot
- Québec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada
| | - Pavan Atluri
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Vinayak Bapat
- Department of Cardiovascular Surgery, New York-Presbyterian/Columbia University Medical Center, New York, New York
| | - Duke E Cameron
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Filip P A Casselman
- Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
| | - Edward P Chen
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Gry Dahle
- Department of Cardiothoracic and Thoracic Surgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - John A Elefteriades
- Department of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Patrizio Lancellotti
- GIGA Cardiovascular Sciences, Department of Cardiology, University of Liège Hospital, Liège, Belgium
| | - Richard L Prager
- Department of Cardiac Surgery, University of Michigan Hospital, Ann Arbor, Michigan
| | - Raphael Rosenhek
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Alan Speir
- Department of Cardiac Surgery, Inova Heart and Vascular Institute, Falls Church, Virginia
| | | | - Giordano Tasca
- Cardiac Surgery Unit, Heart Health Center, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Ajit Yoganathan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory School of Medicine, Atlanta, Georgia
| | - Thomas Walther
- Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt and Johann Wolfgang Goethe University, Frankfurt, Germany
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83
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Durko AP, Pibarot P, Atluri P, Bapat V, Cameron DE, Casselman FP, Chen EP, Dahle G, Elefteriades JA, Lancellotti P, Prager RL, Rosenhek R, Speir A, Stijnen M, Tasca G, Yoganathan A, Walther T, De Paulis R. Essential information on surgical heart valve characteristics for optimal valve prosthesis selection: expert consensus document from the European Association for Cardio-Thoracic Surgery (EACTS)–The Society of Thoracic Surgeons (STS)–American Association for Thoracic Surgery (AATS) Valve Labelling Task Force. Eur J Cardiothorac Surg 2020; 59:54-64. [DOI: 10.1093/ejcts/ezaa263] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/26/2020] [Accepted: 04/08/2020] [Indexed: 01/17/2023] Open
Abstract
Abstract
Comprehensive information on the characteristics of surgical heart valves (SHVs) is essential for optimal valve selection. Such information is also important in assessing SHV function after valve replacement. Despite the existing regulatory framework for SHV sizing and labelling, this information is challenging to obtain in a uniform manner for various SHVs. To ensure that clinicians are adequately informed, the European Association for Cardio-Thoracic Surgery (EACTS), The Society of Thoracic Surgeons (STS) and American Association for Thoracic Surgery (AATS) set up a Task Force comprised of cardiac surgeons, cardiologists, engineers, regulatory bodies, representatives of the International Organization for Standardization and major valve manufacturers. Previously, the EACTS–STS–AATS Valve Labelling Task Force identified the most important problems around SHV sizing and labelling. This Expert Consensus Document formulates recommendations for providing SHV physical dimensions, intended implant position and haemodynamic performance in a transparent, uniform manner. Furthermore, the Task Force advocates for the introduction and use of a standardized chart to assess the probability of prosthesis–patient mismatch and calls valve manufacturers to provide essential information required for SHV choice on standardized Valve Charts, uniformly for all SHV models.
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Affiliation(s)
- Andras P Durko
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Philippe Pibarot
- Québec Heart and Lung Institute, Laval University, Quebec, QC, Canada
| | - Pavan Atluri
- Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Vinayak Bapat
- Department of Cardiovascular Surgery, New York-Presbyterian/Columbia University Medical Center, New York, NY, USA
| | - Duke E Cameron
- Division of Cardiac Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Filip P.A Casselman
- Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
| | - Edward P Chen
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Gry Dahle
- Department of Cardiothoracic and Thoracic surgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - John A Elefteriades
- Department of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Patrizio Lancellotti
- GIGA Cardiovascular Sciences, Department of Cardiology, University of Liège Hospital, Liège, Belgium
| | - Richard L Prager
- Department of Cardiac Surgery, University of Michigan Hospital, Ann Arbor, MI, USA
| | - Raphael Rosenhek
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Alan Speir
- Department of Cardiac Surgery, Inova Heart and Vascular Institute, Falls Church, VA, USA
| | | | - Giordano Tasca
- Cardiac Surgery Unit, Heart Health Center, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Ajit Yoganathan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory School of Medicine, Atlanta, GA, USA
| | - Thomas Walther
- Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt and Johann Wolfgang Goethe University, Frankfurt, Germany
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Lee H, Hwang HY, Sohn SH, Choi JW, Park JB, Kim KH, Kim KB. Hemodynamic Performance of Pericardial Bioprostheses in the Aortic Position. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 53:285-290. [PMID: 33020346 PMCID: PMC7553830 DOI: 10.5090/kjtcs.19.099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/26/2020] [Accepted: 05/16/2020] [Indexed: 11/17/2022]
Abstract
Background This study was conducted to evaluate the hemodynamic performance and the incidence of prosthesis-patient mismatch (PPM) after aortic valve replacement (AVR) using bovine pericardial valves (Carpentier-Edwards Perimount Magana and Magna Ease). Methods In total, 216 patients (mean age, 70.0±10.5 years) who underwent AVR using stented bovine pericardial valves and had follow-up echocardiography between 3 months and 2 years (mean, 12.0±6.6 months) after surgery were enrolled. The implanted valve sizes were 19, 21, 23, and 25 mm in 32, 56, 99, and 29 patients, respectively. Results On follow-up echocardiography, the mean transvalvular pressure gradients for the 19-mm, 21-mm, 23-mm, and 25-mm valves were 13.3±4.4, 12.6±4.2, 10.5±3.9, and 10.2± 3.7 mm Hg, respectively. The effective orifice area (EOA) was 1.25±0.26, 1.54±0.31, 1.81±0.41, and 1.87±0.33 cm2, respectively. These values were smaller than those suggested by the manufacturer for the corresponding sizes. No patients had PPM, when based on the reference EOA. However, moderate (EOA index ≤0.85 cm2/m2) and severe (EOA index ≤0.65 cm2/m2) PPM was present in 56 patients (11.8%) and 9 patients (1.9%), respectively, when using the measured values. Conclusion Carpentier-Edwards Perimount Magna and Magna Ease bovine pericardial valves showed satisfactory hemodynamic performance with low rates of PPM, although the reference EOA could overestimate the true EOA for individual patients.
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Affiliation(s)
- Haeju Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Suk Ho Sohn
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Jae Woong Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Jun-Bean Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kyung Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Ki-Bong Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
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85
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Tam DY, Dharma C, Rocha RV, Ouzounian M, Wijeysundera HC, Austin PC, Fremes SE. Early and late outcomes following aortic root enlargement: A multicenter propensity score–matched cohort analysis. J Thorac Cardiovasc Surg 2020; 160:908-919.e15. [DOI: 10.1016/j.jtcvs.2019.09.062] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 08/15/2019] [Accepted: 09/01/2019] [Indexed: 10/25/2022]
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Carmona García P, García Fuster R, Mateo E, Badía Gamarra S, López Cantero M, Gutiérrez Carretero E, Maestre ML, Legname V, Fita G, Vives M, Koller Bernhard T, Sánchez Pérez E, Miralles Bagán J, Italiano S, Darias-Delbey B, Barrio JM, Hortal J, Sáez de Ibarra JI, Hernández A. Intraoperative transesophageal echocardiography in cardiovascular surgery. Consensus document from the Spanish Society of Anesthesia and Critical Care (SEDAR) and the Spanish Society of Endovascular and Cardiovascular Surgery (SECCE). ACTA ACUST UNITED AC 2020; 67:446-480. [PMID: 32948329 DOI: 10.1016/j.redar.2020.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/17/2020] [Indexed: 12/15/2022]
Abstract
Transesophageal echocardiography is a semi-invasive technique that allows an evaluation of cardiac morphology and function in real time and it is a quality standard in cardiovascular surgery. It has become a fundamental tool for both monitoring and diagnosis in the intraoperative period that allows decide the correct surgical planning and pharmacological management. The goal of this document is to answer the questions of when and how the perioperative TEE should be performed in cardiovascular surgery, what are their applications in the intraoperative, who should perform it and how the information should be transmitted. The authors made a systematic review of international guidelines, review articles and clinical trials to answer by consensus to these questions.
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Affiliation(s)
- P Carmona García
- Servicio de Anestesiología y Reanimación, Hospital Universitario la Fe, Valencia, España. Miembro del grupo de trabajo en Ecografía de la Sección de Cuidados Críticos de la SEDAR. Coordinadora del grupo de trabajo en Ecocardiografía, transesofágica intraoperatoria de la SEDAR
| | - R García Fuster
- Servicio de Cirugía Cardiaca, Consorcio Hospital General Universitario de Valencia, España. Coordinador del grupo de trabajo en Ecocardiografía, transesofágica intraoperatoria de la SECCE.
| | - E Mateo
- Servicio de Anestesiología y Reanimación, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - S Badía Gamarra
- Servicio de Cirugía Cardiaca, Hospital Universitario Trías y Pujol, Badalona, España
| | - M López Cantero
- Servicio de Anestesiología y Reanimación, Hospital Universitario la Fe, Valencia, España
| | - E Gutiérrez Carretero
- Servicio de Cirugía Cardiaca, Hospital, Universitario Virgen del Rocío, Sevilla, España
| | - M L Maestre
- Sección Cardiotorácica, Servicio de Anestesiología y Reanimación, Hospital Sant Pau, Barcelona, España
| | - V Legname
- Servicio de Cirugía Cardiaca, Centro Médico Teknon, Barcelona, España
| | - G Fita
- Sección Cardiotorácica, Servicio de Anestesiología y Reanimación. Hospital Clínic, Barcelona, España
| | - M Vives
- EDAIC. PhD. Sección Cardiotorácica, Servicio de Anestesiología y Reanimación, Hospital Universitario Dr Josep Trueta de Girona, España. Representante de España en la EACTA. Co-director del grupo de trabajo en Ecografía de la Sección de Cuidados Críticos de la SEDAR. Representante del subcomité de Educación de EACTA. Co-director grupo EchoSim
| | - T Koller Bernhard
- Sección Cardiotorácica, Servicio de Anestesiología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - E Sánchez Pérez
- EDAIC. Sección de Cirugía Cardiaca, Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España. Miembro del grupo de trabajo en Ecografía de la Sección de Cuidados Críticos de la SEDAR
| | - J Miralles Bagán
- Sección Cardiotorácica, Servicio Anestesiología y Reanimación, Hospital Sant Pau, Barcelona, España
| | - S Italiano
- Sección Cardiotorácica, Servicio de Anestesiología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - B Darias-Delbey
- Servicio Anestesiología y Reanimación, Proceso del Paciente, Cardioquirúrgico, Complejo Hospitalario Universitario de Canarias, Santa Cruz de Tenerife, España
| | - J M Barrio
- Sección Anestesia y Reanimación Cardiovascular, Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J Hortal
- Servicio de Anestesiología y Reanimación, Hospital General. Universitario Gregorio Marañón, Madrid, España
| | - J I Sáez de Ibarra
- Servicio de Cirugía Cardiaca, Hospital Universitario Son Espases, Palma de Mallorca, España
| | - A Hernández
- Departamento de Anestesia y Cuidados Intensivos, Grupo Policlínica, Ibiza, España. Miembro del grupo de trabajo en Ecografía de la Sección de Cuidados Críticos, de la SEDAR Representante del subcomité de Educación de EACTA, EDAIC, Codirector grupo EchoSim
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87
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Carmona García P, García Fuster R, Mateo E, Badía Gamarra S, López Cantero M, Gutiérrez Carretero E, Maestre ML, Legname V, Fita G, Vives M, Koller Bernhard T, Sánchez Pérez E, Miralles Bagán J, Italiano S, Darias-Delbey B, Barrio JM, Hortal J, Sáez de Ibarra JI, Hernández A. Ecocardiografía transesofágica intraoperatoria en cirugía cardiovascular. Documento de consenso de la Sociedad Española de Anestesiología y Reanimación (SEDAR) y Sociedad Española de Cirugía Cardiovascular y Endovascular (SECCE). CIRUGIA CARDIOVASCULAR 2020. [DOI: 10.1016/j.circv.2020.03.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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88
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Panoulas VF, Chandrasekhar J, Busi G, Ruparelia N, Zhang Z, Mehilli J, Sartori S, Lefèvre T, Presbitero P, Capranzano P, Tchetche D, Iadanza A, Sardella G, Van Mieghem NM, Meliga E, Dumonteil N, Fraccaro C, Trabattoni D, Sharma S, Ferrer‐Gracia M, Naber CK, Kievit PC, Snyder C, Sutaria N, Sen S, Malik IS, Morice M, Nihoyannopoulos P, Petronio AS, Mehran R, Chieffo A, Mikhail GW. Prevalence, predictors, and outcomes of patient prosthesis mismatch in women undergoing
TAVI
for severe aortic stenosis: Insights from the
WIN‐TAVI
registry. Catheter Cardiovasc Interv 2020; 97:516-526. [DOI: 10.1002/ccd.29227] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 08/05/2020] [Accepted: 08/08/2020] [Indexed: 12/28/2022]
Affiliation(s)
- Vasileios F. Panoulas
- Department of cardiology Hammersmith Hospital, Imperial College Healthcare NHS Trust London UK
- Faculty of Medicine, Cardiovascular Sciences National Heart and Lung Institute, Imperial College London London UK
| | - Jaya Chandrasekhar
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai One Gustave L. Levy Place New York New York Box 1030 USA
| | - Gherardo Busi
- Interventional cardiology unit San Raffaele Scientific Institute Milan Italy
| | - Neil Ruparelia
- Department of cardiology Hammersmith Hospital, Imperial College Healthcare NHS Trust London UK
| | - Zhongjie Zhang
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai One Gustave L. Levy Place New York New York Box 1030 USA
| | - Julinda Mehilli
- Department of cardiology Ludwig‐Maximilians‐University of Munich Munich Germany
| | - Samantha Sartori
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai One Gustave L. Levy Place New York New York Box 1030 USA
| | - Thierre Lefèvre
- Institut Cardiovasculaire Paris Sud Hôpital privé Jacques cartier, Ramsay Générale de santé Massy France
| | - Patrizia Presbitero
- Department of Cardiology IRCCS Humanitas Clinical and Research Centre Milan Italy
| | | | | | - Alessandro Iadanza
- Emodinamica Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte Siena Italy
| | - Gennaro Sardella
- Interventional cardiology unit Policlinico “Umberto I Rome Italy
| | - Nicolas M. Van Mieghem
- Department of interventional cardiology Erasmus Medical Center, Thoraxcenter Rotterdam The Netherlands
| | - Emanuele Meliga
- Interventional cardiology unit Mauriziano Hospital Turin Italy
| | | | - Chiara Fraccaro
- Interventional cardiology unit University of Padova Padova Italy
| | - Daniela Trabattoni
- Invasive Cardiology Unit 3 Centro Cardiologico Monzino, IRCCS Milan Italy
| | - Samin Sharma
- Department of cardiology Mount Sinai Hospital New York New York USA
| | - Maria‐Cruz Ferrer‐Gracia
- Department of Cardiology, Interventional Cardiology Unit Hospital Universitario Miguel Servet Zaragoza Spain
| | - Christoph K. Naber
- Department of cardiology Contilia Heart and Vascular Centre, Elisabeth Krankenhaus Essen Germany
| | - Peter C. Kievit
- Department of cardiology Radboud University Nijmegen Medical Center Nijmegan, The Netherlands
| | - Clayton Snyder
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai One Gustave L. Levy Place New York New York Box 1030 USA
| | - Nilesh Sutaria
- Department of cardiology Hammersmith Hospital, Imperial College Healthcare NHS Trust London UK
| | - Sayan Sen
- Department of cardiology Hammersmith Hospital, Imperial College Healthcare NHS Trust London UK
- Faculty of Medicine, Cardiovascular Sciences National Heart and Lung Institute, Imperial College London London UK
| | - Iqbal S. Malik
- Department of cardiology Hammersmith Hospital, Imperial College Healthcare NHS Trust London UK
- Faculty of Medicine, Cardiovascular Sciences National Heart and Lung Institute, Imperial College London London UK
| | - Marie‐Claude Morice
- Department of cardiology Ludwig‐Maximilians‐University of Munich Munich Germany
| | - Petros Nihoyannopoulos
- Department of cardiology Hammersmith Hospital, Imperial College Healthcare NHS Trust London UK
- Faculty of Medicine, Cardiovascular Sciences National Heart and Lung Institute, Imperial College London London UK
| | - Anna Sonia Petronio
- Interventional cardiology unit AOUP Cisanello, University Hospital Pisa Italy
| | - Roxana Mehran
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai One Gustave L. Levy Place New York New York Box 1030 USA
| | - Alaide Chieffo
- Interventional cardiology unit San Raffaele Scientific Institute Milan Italy
| | - Ghada W. Mikhail
- Department of cardiology Hammersmith Hospital, Imperial College Healthcare NHS Trust London UK
- Faculty of Medicine, Cardiovascular Sciences National Heart and Lung Institute, Imperial College London London UK
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89
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Une D, Karkhanis R, David TE, Machida D, Masuda M, Goldman BS. Long-term clinical outcomes of the Toronto stentless porcine valve: 15-year results from dual centers. J Card Surg 2020; 35:2279-2285. [PMID: 32720369 DOI: 10.1111/jocs.14837] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY The purpose of this study is to examine the long-term durability of the Toronto stentless porcine valve (SPV) in the aortic position (St Jude Medical, Minneapolis, MN). METHODS We assessed the long-term clinical outcomes of 515 patients with aortic valve replacement (AVR) with the Toronto SPV from 1987 to 2001 at two centers, excluding early (<30 days) death. Median follow-up was 11.5 years (maximum 19.0 years). RESULTS Average age was 64.2 ± 10.8 years, and females were 34% (173/515). The incidence of prosthesis-patient mismatch was low, 10.9%. Overall survival was 90.7 ± 1.3%, 75.4 ± 2.0%, and 56.8 ± 3.2% at 5, 10, and 15 years, respectively after surgery. Over the follow-up duration, 116 patients (23%) underwent repeated AVR: 90 for structural valve deterioration (SVD), 12 for endocarditis, 10 nonstructural valve dysfunction (10 aortic regurgitation due to aorta dilatation), and four for other reasons. The cumulative incidence of repeated AVR with death as a competing risk was 1.4% (95% confidence interval [CI], 0.6-2.7), 11.1% (95% CI, 8.4-14.2), and 34.4% (95% CI, 28.8-40.2) at 5, 10, and 15 years, respectively. Reoperative mortality was 5.2% (6/116). In SVD, the regurgitation type was dominant (82%). CONCLUSIONS The Toronto SPV is associated with excellent survival and durability during the first decade of follow-up. However, regurgitation type of SVD increases from 10 years after operation with acceptable reoperative mortality. These findings may assist with prosthesis selection and reintervention strategy for failing stentless bioprosthesis.
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Affiliation(s)
- Dai Une
- Division of Cardiac Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.,Department of Surgery, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Reena Karkhanis
- Division of Cardiac Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Tirone E David
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital and University of Toronto, Toronto, Canada
| | - Daisuke Machida
- Department of Surgery, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Munetaka Masuda
- Department of Surgery, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Bernard S Goldman
- Division of Cardiac Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
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90
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Chauvette V, Sénéchal M, Barrette V, Dagenais F, Mohammadi S, Kalavrouziotis D, Voisine P. Annulus root enlargement during redo aortic valve replacement: Perioperative results and hemodynamic impact. J Card Surg 2020; 35:2158-2164. [PMID: 32720421 DOI: 10.1111/jocs.14726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Redo aortic valve replacement (AVR) might present an increased risk for predicted patient-prosthesis mismatch (PPM). Aortic root enlargement (ARE) procedures can decrease PPM and improve hemodynamic parameters. It is crucial to evaluate the safety of ARE in the context of redo AVR to allow better patient selection. METHODS This is a matched case-control study of 125 patients who underwent a redo AVR between 1991 and 2016, 21 patients had a concomitant ARE procedure. Patients were matched for age, gender, presence of coronary artery disease, renal clearance, left ventricular ejection fraction, and body mass index. The primary outcome was the occurrence of major adverse cardiovascular events (MACE). Secondary outcomes were postoperative impact of the ARE procedures on echocardiographic measurements and survival. RESULTS Preoperatively, indexed aortic valve area (0.49 vs 0.66 cm2 /m2 ; P = .02) and left ventricle outflow tract diameters (20.1 vs 22.2 mm; P < .01) were significantly smaller in the ARE group. ARE procedures increased the aortic valve area by an average of 0.4 cm2 (pre = 0.9, post = 1.3; P < .01), with a reduction of maximum and mean transvalvular gradients of 26.6 mm Hg (pre = 56.8, post = 30.2; P < .01) and 17.1 mm Hg (pre = 31.9, post = 14.8; P < .01), respectively. Postoperatively, the occurrence of MACE was similar (ARE = 19%, no ARE = 14%; P = .68). Survival rates were similar (P = .29). CONCLUSIONS For patients undergoing redo AVR, ARE is not associated with higher perioperative mortality and morbidity when compared with patients undergoing AVR without ARE. The fear of perioperative complications potentially associated with ARE should not be a prohibiting factor in symptomatic redo patients with small aortic annulus and predicted PPM.
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Affiliation(s)
- Vincent Chauvette
- Department of Cardiac Surgery, University of Montreal, Montreal, Quebec, Canada
| | - Mario Sénéchal
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
| | - Vincent Barrette
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
| | - François Dagenais
- Department of Cardiac Surgery, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
| | - Siamak Mohammadi
- Department of Cardiac Surgery, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
| | - Dimitri Kalavrouziotis
- Department of Cardiac Surgery, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
| | - Pierre Voisine
- Department of Cardiac Surgery, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
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91
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Le Bars F, Tomasi J, Belhaj Soulami R, Colas F, Anselmi A, Verhoye JP. Long-term follow-up of the Shelhigh™ superstentless bioprosthesis aortic valve and valved conduit in a monocentric experience. THE JOURNAL OF CARDIOVASCULAR SURGERY 2020; 61:776-783. [PMID: 32558524 DOI: 10.23736/s0021-9509.20.11219-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The Shelhigh™ SuperStentless (Shelhigh, INC., Union, NJ, USA) is a stentless aortic valve bioprosthesis and aortic root valved conduit. In 2007, this device was recalled by FDA due to malfunction, and subsequently reintegrated by BioIntegral Surgical™ Few data are available over late durability of this device. We performed a long-term follow-up of Shelhigh™ devices implanted at our center. METHODS Between 2002 and 2007, 44 patients underwent aortic valve replacement with a Shelhigh™ device (40 aortic valve bioprosthesis and 4 valved conduit). We performed a clinical and echocardiographic follow-up (9.2 years±4.3). Standardized definitions of valve-related events were adopted. RESULTS At discharge, maximum and mean aortic gradients averaged 36.1±11.3 and 21.0±6.8 mmHg, respectively. The 30-days mortality was 2.3%. Over the follow-up period, 29 patients died (65.9%); 2 deaths were valve related. Overall survival at 1, 5 and 10 years was 97.7%, 85.8% and 54% respectively. At last echocardiography, average transvalvular gradients had remained globally stable in the population (33.6±12 and 20.4±10.5 mmHg). Eight (19%) structural valve deterioration (SVD) events were reported. Two (5%) non-structural valve dysfunction (NSVD) events occurred (periprosthetic leak). Two (5%) infectious endocarditis events and two (5%) valve thromboses were also deplored. Three (7%) patients required re-operation (2 due to SVD and 1 due to endocarditis). CONCLUSIONS The immediate hemodynamic performance of the Shelhigh™ aortic bioprostheses was unexpectedly suboptimal. Despite this, hemodynamic performance remained stable over time. Patients survival at follow-up was satisfactory, however, continued surveillance is necessary.
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Affiliation(s)
- Florent Le Bars
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital Center, Rennes, France
| | - Jacques Tomasi
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital Center, Rennes, France
| | - Reda Belhaj Soulami
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital Center, Rennes, France
| | - Fabrice Colas
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital Center, Rennes, France
| | - Amedeo Anselmi
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital Center, Rennes, France -
| | - Jean-Philippe Verhoye
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital Center, Rennes, France
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92
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Abbas AE, Mando R, Hanzel G, Goldstein J, Shannon F, Pibarot P. Hemodynamic principles of prosthetic aortic valve evaluation in the transcatheter aortic valve replacement era. Echocardiography 2020; 37:738-757. [DOI: 10.1111/echo.14663] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/28/2020] [Accepted: 03/29/2020] [Indexed: 12/01/2022] Open
Affiliation(s)
- Amr E. Abbas
- Beaumont Health Royal Oak Michigan
- Oakland University William Beaumont School of Medicine Auburn Hills Michigan
| | | | - George Hanzel
- Beaumont Health Royal Oak Michigan
- Oakland University William Beaumont School of Medicine Auburn Hills Michigan
| | - James Goldstein
- Beaumont Health Royal Oak Michigan
- Oakland University William Beaumont School of Medicine Auburn Hills Michigan
| | - Francis Shannon
- Beaumont Health Royal Oak Michigan
- Oakland University William Beaumont School of Medicine Auburn Hills Michigan
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93
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Chau KH, Douglas PS, Pibarot P, Hahn RT, Khalique OK, Jaber WA, Cremer P, Weissman NJ, Asch FM, Zhang Y, Gertz ZM, Elmariah S, Clavel MA, Thourani VH, Daubert M, Alu MC, Leon MB, Lindman BR. Regression of Left Ventricular Mass After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2020; 75:2446-2458. [DOI: 10.1016/j.jacc.2020.03.042] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 03/15/2020] [Indexed: 12/20/2022]
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94
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Deeb GM, Popma JJ, Chetcuti SJ, Yakubov SJ, Mumtaz M, Gleason TG, Williams MR, Gada H, Oh JK, Li S, Boulware MJ, Kappetein AP, Reardon MJ. Computed Tomography Annular Dimensions: A Novel Method to Compare Prosthetic Valve Hemodynamics. Ann Thorac Surg 2020; 110:1502-1510. [PMID: 32289296 DOI: 10.1016/j.athoracsur.2020.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/19/2020] [Accepted: 03/02/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The Cardiac Surgical Societies Valve Labeling Task Force consensus document acknowledged inconsistent sizing and labeling of prosthetic heart valves. This study compared the labeled size, internal diameter, and hemodynamics of different surgical and transcatheter valve types implanted into the same size annulus, measured by preprocedural computed tomography (CT). METHODS Patients were retrospectively sorted into 3 CT annular diameter size groups: small (less than 23 mm), medium (23 to less than 26 mm), and large (26 mm or greater). Surgical valves were sorted into 4 categories based on tissue and design: (stentless porcine, standard stented bovine, wraparound stented bovine, and stented porcine). Comparisons were made within the surgical types and with a transcatheter valve. Echocardiograms were independently assessed and CTs were centrally measured. RESULTS We analyzed 726 surgical and 923 transcatheter valve paired data sets. Among the various valve types implanted into the same size CT annulus, there were significant differences regarding size, internal diameter, and hemodynamics within all 3 size groups. Root enlargement procedures occurred in 1.2% with no differences across valve types or size groups. Transcatheter valve hemodynamics were similar to stentless valves and were significantly better than all stented valves. There was no difference in hemodynamics between the 2 bovine stented valve types, and stented porcine valves were inferior to all valve types. CONCLUSIONS This study documents that prosthetic heart valve sizing and labeling inconsistencies exist. Use of preoperative CT annular dimensions is the most accurate method to compare size, internal diameter, and hemodynamics of bioprosthetic aortic valves because it compares values among various valve types implanted into the same size annulus.
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Affiliation(s)
- G Michael Deeb
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
| | - Jeffrey J Popma
- Department of Interventional Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Stanley J Chetcuti
- Department of Interventional Cardiology, University of Michigan, Ann Arbor, Michigan; Department of Interventional Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Steven J Yakubov
- Department of Interventional Cardiology, Riverside Methodist-Ohio Health, Columbus, Ohio
| | - Mubashir Mumtaz
- Department of Cardiac Surgery, University of Pittsburgh Medical Center-Pinnacle, Wormsleysburg, Pennsylvania; Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Thomas G Gleason
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Mathew R Williams
- Department of Cardiac Surgery, New York University-Langone Medical Center, New York, New York
| | - Hemal Gada
- Department of Interventional Cardiology, University of Pittsburgh Medical Center-Pinnacle, Wormsleysburg, Pennsylvania
| | - Jae K Oh
- Echocardiography Department, Mayo Clinic, Rochester, Minnesota
| | - Shuzhen Li
- Department of Statistical Services, Medtronic, Minneapolis, Minnesota
| | | | - Arie Pieter Kappetein
- Department of Cardiac Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Michael J Reardon
- Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Institute, Houston, Texas
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Sciatti E, Orabona R, Prefumo F, Vizzardi E, Valcamonico A, Repossini A, Sartori E, Metra M, Chiari E. A case of combined aortic bioprosthetic valve degeneration and patient-prosthesis mismatch during pregnancy: decision-making and implications after pregnancy. J Cardiovasc Med (Hagerstown) 2020; 21:820-824. [PMID: 32229765 DOI: 10.2459/jcm.0000000000000941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | | | | | | | - Alberto Repossini
- Cardiac Surgery Unit, ASST Spedali Civili and University of Brescia, Brescia, Italy
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96
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Tsubota H, Sakaguchi G, Marui A. Incidence and influence of prosthesis-patient mismatch after reoperative aortic valve replacement: a retrospective single-center study. J Cardiothorac Surg 2020; 15:53. [PMID: 32228628 PMCID: PMC7104489 DOI: 10.1186/s13019-020-01094-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/23/2020] [Indexed: 11/10/2022] Open
Abstract
Background Reoperative aortic valve replacement (AVR) is associated with increased mortality compared with initial surgery, and a smaller valve might be implanted during repeat AVR (re-AVR; AVR after prior AVR). We describe the clinical outcomes and incidence of prosthesis-patient mismatches (PPM) after reoperative AVR. Methods Among 113 patients who underwent reoperative AVR between 2007 and 2018, 44 underwent re-AVR and 69 underwent a first replacement of a diseased natural valve after any cardiac surgery except AVR (primary AVR). We then compared early and late outcomes, the impact of re-AVR on the effective orifice areas (EOA), and the incidence and influence of PPM on reoperative AVR. Results Hospital mortality was 2.7%, and the overall 1-, 3-, and 5-year survival rates were 95, 91 and 86%, respectively. The reference EOA of the newly implanted valve was smaller than that of the previous valve (1.4 ± 0.3 vs. 1.6 ± 0.3 cm2, p < 0.01). The mean pressure gradient was greater (15.2 ± 6.4 vs. 12.7 ± 6.2 mmHg, p = 0.04) and indexed EOA was smaller (0.92 ± 0.26 vs. 1.06 ± 0.36 cm2/m2, p = 0.04) during re-AVR than primary AVR, whereas the incidence of PPM was similar (38.7% vs. 34.8%, p = 0.87) between the groups. Conclusions The clinical outcomes of reoperative AVR were acceptable. Although the reference EOA of new implanted valves was smaller than that of previous valves, re-AVR did not increase the incidence of PPM. These findings might serve as a guide for future decisions regarding the surgical approach to treating degenerated prosthetic valves.
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Affiliation(s)
- Hideki Tsubota
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Asano 3-2-1, Kokura Kita-ku, Kitakyushu, Fukuoka, 802-8555, Japan.
| | - Genichi Sakaguchi
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Asano 3-2-1, Kokura Kita-ku, Kitakyushu, Fukuoka, 802-8555, Japan
| | - Akira Marui
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Asano 3-2-1, Kokura Kita-ku, Kitakyushu, Fukuoka, 802-8555, Japan
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97
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Tam DY, Rocha RV, Wijeysundera HC, Austin PC, Dvir D, Fremes SE. Surgical valve selection in the era of transcatheter aortic valve replacement in the Society of Thoracic Surgeons Database. J Thorac Cardiovasc Surg 2020; 159:416-427.e8. [DOI: 10.1016/j.jtcvs.2019.05.081] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/29/2019] [Accepted: 05/13/2019] [Indexed: 11/30/2022]
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98
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Pighi M, Ribichini F. Self-Expandable Transcatheter Heart Valves in Small Annuli: Does One Valve Fit All? JACC Cardiovasc Interv 2020; 13:207-209. [PMID: 31883716 DOI: 10.1016/j.jcin.2019.09.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/24/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Michele Pighi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy.
| | - Flavio Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
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99
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Kolkailah AA, Hirji SA, Ejiofor JI, Del Val FR, Chowdhury R, McGurk S, Lee J, Kaneko T. Impact of Prosthesis Size and Prosthesis–Patient Mismatch on Outcomes in Younger Female Patients Undergoing Aortic Valve Replacement. Semin Thorac Cardiovasc Surg 2020; 32:219-228. [DOI: 10.1053/j.semtcvs.2019.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 01/02/2019] [Indexed: 11/11/2022]
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100
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Regazzoli D, Chiarito M, Cannata F, Pagnesi M, Miura M, Ziviello F, Picci A, Reifart J, De Marco F, Bedogni F, Adamo M, Curello S, Teles R, Taramasso M, Barbanti M, Tamburino C, Stefanini GG, Mangieri A, Giannini F, Pagnotta PA, Maisano F, Kim WK, Van Mieghem NM, Colombo A, Reimers B, Latib A. Transcatheter Self-Expandable Valve Implantation for Aortic Stenosis in Small Aortic Annuli. JACC Cardiovasc Interv 2020; 13:196-206. [DOI: 10.1016/j.jcin.2019.08.041] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/01/2019] [Accepted: 08/20/2019] [Indexed: 11/16/2022]
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