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Díaz R, Hernández-Vaquero D, Silva J, Pascual I, de la Hera JM, León V, Martín M, Barriales V, Colunga S, Del Valle R, Morís C. Real Structural Valve Deterioration of the Mitroflow Aortic Prosthesis: Competing Risk Analysis. ACTA ACUST UNITED AC 2017; 70:1074-1081. [PMID: 28465144 DOI: 10.1016/j.rec.2017.02.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 02/16/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND OBJECTIVES The Mitroflow aortic prosthesis is a bovine pericardial bioprosthesis specially designed to increase the valve area in relation to its size. There is controversy regarding the pattern of structural valve deterioration (SVD). Our aim was to determine the cumulative incidence of SVD, risk factors influencing its occurrence, and its impact on mortality. METHODS A total of 1028 patients were clinically and echocardiographically followed up. Because the study population was elderly and had heart disease, we used a competing risk analysis. RESULTS The percentage of patients with SVD at 5 years was 4.22% (95%CI, 2.96-5.81) and was 15.77% at 8 years (95%CI, 12.46-19.43). The incidence was higher for small valves (19mm and 21mm) reaching 6.43% at 5 years (95%CI, 4.48-8.84) and 20.06% at 8 years (95%CI, 15.53-25.01). Severe patient-prosthesis mismatch (PPM) influenced the incidence of SVD (sHR, 3.53; 95%CI, 2.20-5.66; P < .001) but moderate PPM had no impact. The most powerful predictor of mortality was the presence of SVD (HR, 4.59; 95%CI, 2.91-7.22; P < .001). CONCLUSIONS This study used a definition based on the increase in the transprosthetic gradient and found a higher incidence of SVD of the Mitroflow prosthesis than that reported by other series, especially for sizes 19mm and 21mm and in patients with severe PPM. The incidence of SVD increased exponentially from the fifth year after implantation and its occurrence led to a 4.5-fold increase in the risk of death.
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Affiliation(s)
- Rocío Díaz
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.
| | | | - Jacobo Silva
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Departamento de Medicina, Universidad de Oviedo, Oviedo, Asturias, Spain
| | - Isaac Pascual
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Jesús M de la Hera
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Víctor León
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - María Martín
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Vicente Barriales
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Santiago Colunga
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Raquel Del Valle
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - César Morís
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Departamento de Medicina, Universidad de Oviedo, Oviedo, Asturias, Spain
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Risteski P, Monsefi N, Miskovic A, Josic T, Bala S, Salem R, Zierer A, Moritz A. Triple valve surgery through a less invasive approach: early and mid-term results. Interact Cardiovasc Thorac Surg 2017; 24:677-682. [PMID: 28453792 DOI: 10.1093/icvts/ivw430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 10/19/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES A partial upper sternotomy has become established as a less invasive approach mainly for single and double valve surgery. This report evaluates the clinical outcomes of triple valve surgery performed through a partial upper sternotomy. METHODS We reviewed the medical records of 37 consecutive patients (28 men, 76%) who underwent triple valve surgery through a partial upper sternotomy between 2005 and 2015. The patients' mean age was 67 ± 17 years; 27 (73%) were in New York Heart Association Class III or IV. Aortic and mitral valve insufficiency was more common than stenosis. Ninety-three percent of surviving patients were followed for a mean period of 58 ± 24 months. RESULTS Aortic valve procedures consisted of 24 (65%) replacements and 13 (35%) repairs. The mitral valve was repaired in 28 (76%) patients, whereas tricuspid valve repair was feasible in all patients. No conversion to full sternotomy was necessary. Myocardial infarction was not observed. Chest tube drainage was 330 ± 190 ml, and 4 patients required reopening for bleeding (1, 3%) or tamponade (3, 8%). One stroke was observed due to heparin-induced thrombocytopaenia after initial unremarkable neurological recovery. Early mortality included 5 (13.5%) patients. Actuarial survival at 5 years was 52 ± 10%. CONCLUSIONS A partial upper sternotomy provides adequate exposure to all heart valves. We did not experience technical limitations with this approach. Wound dehiscence, postoperative bleeding, intensive care unit and hospital stay and early deaths were low compared to data from other published series of triple valve surgery through a full median sternotomy. Early and mid-term outcomes were not adversely affected by this less invasive approach.
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Affiliation(s)
- Petar Risteski
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University Hospital, Frankfurt am Main, Germany
| | - Nadejda Monsefi
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University Hospital, Frankfurt am Main, Germany
| | - Aleksandra Miskovic
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University Hospital, Frankfurt am Main, Germany
| | - Tanja Josic
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University Hospital, Frankfurt am Main, Germany
| | - Sherife Bala
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University Hospital, Frankfurt am Main, Germany
| | - Razan Salem
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University Hospital, Frankfurt am Main, Germany
| | - Andreas Zierer
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University Hospital, Frankfurt am Main, Germany
| | - Anton Moritz
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University Hospital, Frankfurt am Main, Germany
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Remodeling root repair with an external aortic ring annuloplasty. J Thorac Cardiovasc Surg 2017; 153:1033-1042. [DOI: 10.1016/j.jtcvs.2016.12.031] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 11/25/2016] [Accepted: 12/09/2016] [Indexed: 12/20/2022]
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104
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Head SJ, Çelik M, Kappetein AP. Mechanical versus bioprosthetic aortic valve replacement. Eur Heart J 2017; 38:2183-2191. [DOI: 10.1093/eurheartj/ehx141] [Citation(s) in RCA: 159] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 03/03/2017] [Indexed: 02/06/2023] Open
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105
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Goldman S, Cheung A, Bavaria JE, Petracek MR, Groh MA, Schaff HV. Midterm, multicenter clinical and hemodynamic results for the Trifecta aortic pericardial valve. J Thorac Cardiovasc Surg 2017; 153:561-569.e2. [DOI: 10.1016/j.jtcvs.2016.09.089] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 09/09/2016] [Accepted: 09/28/2016] [Indexed: 11/16/2022]
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106
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Lange R, Voss B, Kehl V, Mazzitelli D, Tassani-Prell P, Günther T. Right Minithoracotomy Versus Full Sternotomy for Mitral Valve Repair: A Propensity Matched Comparison. Ann Thorac Surg 2017; 103:573-579. [DOI: 10.1016/j.athoracsur.2016.06.055] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 05/23/2016] [Accepted: 06/06/2016] [Indexed: 10/21/2022]
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107
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Grubitzsch H, Zobel S, Christ T, Holinski S, Stangl K, Treskatsch S, Falk V, Laule M. Redo procedures for degenerated stentless aortic xenografts and the role of valve-in-valve transcatheter techniques†. Eur J Cardiothorac Surg 2017; 51:653-659. [DOI: 10.1093/ejcts/ezw397] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 11/10/2016] [Indexed: 11/13/2022] Open
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108
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Marchetto G, Anselmino M, Rovera C, Mancuso S, Ricci D, Antolini M, Morello M, Gaita F, Rinaldi M. Results of Cryoablation for Atrial Fibrillation Concomitant With Video-Assisted Minimally Invasive Mitral Valve Surgery. Semin Thorac Cardiovasc Surg 2017; 28:271-280. [PMID: 28043429 DOI: 10.1053/j.semtcvs.2016.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2016] [Indexed: 11/11/2022]
Abstract
Interest in minimally invasive video-assisted mitral valve surgery (MIMVS) is rapidly growing. Data on concomitant atrial fibrillation (AF) ablation to MIMVS are still lacking. The present study investigates the long-term results of AF cryoablation concomitant to MIMVS. From October 2006-September 2014, 68 patients with mitral valve disease (age 65.9 ± 11.1 years, 34 men out of 68 patients, Euroscore log 5.4 ± 4.5) and drug-resistant AF underwent MIMVS via right minithoracotomy and concomitant left-sided AF endocardial cryoablation (Cryoflex Medtronic, Minneapolis, MN). Patients were independently followed up by cardiological outpatient visits and underwent electrophysiological study when indicated. In total, 44 out of 68 patients (64.7%) underwent mitral valve repair and 8 patients (11.8%) also received concomitant tricuspid valve surgery. One procedure was electively converted to full sternotomy (1.5%). Total clamp time was 97.6 ± 22.8 minutes. In March 2015, 60 patients were alive and completed the follow-up after a mean of 3.4 ± 2.0 years following the procedure. In all, 48 patients (80%) presented sinus rhythm throughout the whole follow-up. Freedom from AF was respectively 95%, 87%, and 72% at 1, 3, and 5 years, respectively. We recorded 2 pacemaker implants (3.3%). A total of 3 patients suffered symptomatic recurrences (2 atypical atrial flutter and 1 atrial fibrillation) and underwent transcatheter ablation-all the 3 patients remained in stable sinus rhythm for the remaining follow-up. In conclusions, given the favorable long-term sinus rhythm maintenance rates of concomitant cryoablation, MIMVS can also be offered to patients with symptomatic AF. AF transcatheter ablation may easily avoid further symptomatic recurrences.
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Affiliation(s)
- Giovanni Marchetto
- Department of Surgical Sciences, Città della Salute e della Scienza di Torino Hospital, University of Turin, Turin, Italy; Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, University of Turin, Turin, Italy.
| | - Matteo Anselmino
- Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, University of Turin, Turin, Italy
| | - Chiara Rovera
- Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, University of Turin, Turin, Italy
| | - Samuel Mancuso
- Department of Surgical Sciences, Città della Salute e della Scienza di Torino Hospital, University of Turin, Turin, Italy; Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, University of Turin, Turin, Italy
| | - Davide Ricci
- Department of Surgical Sciences, Città della Salute e della Scienza di Torino Hospital, University of Turin, Turin, Italy; Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, University of Turin, Turin, Italy
| | - Marina Antolini
- Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, University of Turin, Turin, Italy
| | - Mara Morello
- Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, University of Turin, Turin, Italy
| | - Fiorenzo Gaita
- Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, University of Turin, Turin, Italy
| | - Mauro Rinaldi
- Department of Surgical Sciences, Città della Salute e della Scienza di Torino Hospital, University of Turin, Turin, Italy; Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, University of Turin, Turin, Italy
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De Paulis R, D'Aleo S, Bellisario A, Salica A, Weltert LP, Scaffa R, Wolf LG, Maselli D, Di Mauro M. The fate of small-size pericardial heart valve prostheses in an older patient population. J Thorac Cardiovasc Surg 2017; 153:31-39.e2. [DOI: 10.1016/j.jtcvs.2016.08.063] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 08/26/2016] [Accepted: 08/30/2016] [Indexed: 11/30/2022]
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110
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Chang HW, Jeong DS, Cho YH, Sung K, Kim WS, Lee YT, Park PW. Tricuspid Valve Replacement vs. Repair in Severe Tricuspid Regurgitation. Circ J 2016; 81:330-338. [PMID: 28025464 DOI: 10.1253/circj.cj-16-0961] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The aim of this study was to compare early and late outcomes of tricuspid valve replacement (TVR) and tricuspid valve repair (TVr) for severe tricuspid regurgitation (TR).Methods and Results:From 1994 to 2012, 360 patients (mean age, 58±13 years) with severe TR underwent TVR (n=97, 27%) or TVr (n=263, 73%). Among them, 282 patients (78%) had initial rheumatic etiology, and 307 patients (85%) had preoperative atrial fibrillation. The TVR group had higher total bilirubin, higher baseline central venous pressure, and higher incidence of previous cardiac operation. There was no difference in early mortality (TVR:TVr, 3.1%:3.4%, P=0.877). Ten-year overall survival (TVR:TVr, 72%:70%, P=0.532) and 10-year freedom from cardiac death (TVR:TVr, 76%:77%, P=0.715) were not significantly different between groups. After applying stabilized inverse probability of treatment weighting methods, there were still no significant differences in early mortality (P=0.293), overall survival (P=0.649) or freedom from cardiac death (P=0.870). Higher NYHA functional class, total bilirubin (>2 mg/dL), initial central venous pressure, and cardiopulmonary bypass time were independent predictors of early mortality. Older age, LV dysfunction (EF <40%), and hemoglobin <10 g/dL were independent predictors of late cardiac mortality. CONCLUSIONS Compared with TVr, TVR had acceptable early and late outcomes in patients with severe TR. TVR can be considered as a valid option with acceptable clinical outcomes in patients who are not suitable candidates for TVr.
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Affiliation(s)
- Hyoung Woo Chang
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
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111
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Ennker J, Meilwes M, Pons-Kuehnemann J, Niemann B, Grieshaber P, Ennker IC, Boening A. Freestyle stentless bioprosthesis for aortic valve therapy: 17-year clinical results. Asian Cardiovasc Thorac Ann 2016; 24:868-874. [PMID: 27926465 DOI: 10.1177/0218492316675244] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Aortic valve replacement with stentless bioprostheses has been shown to produce lower aortic gradients than stented bioprostheses, thus facilitating left ventricular mass regression and preventing heart failure. We sought to determine the long-term results of stentless biological aortic valve replacement over a 17-year follow-up. METHODS Between 1996 and 2012, 2551 patients underwent isolated aortic valve replacement with a stentless prosthesis (Medtronic Freestyle) at a single center. The mean patient age was 72 ± 10 years, 55% were male, 24.1% were in New York Heart Association class I and II, 9.6% had undergone previous surgery, 18.1% had coronary artery disease, and 23.1% had diabetes. For the long-term follow-up, patients were contacted in writing and by telephone; follow-up was 96.3% complete, resulting in 11,546 patient-years. RESULTS At 30 days, mortality (5.4%), renal failure (3.9%), myocardial infarction (0.7%), and stroke (1.4%) rates were acceptable. During long-term follow-up of 1-17 years, the bleeding rate (2.9%) was higher than the thromboembolic event rate (0.7%) despite 18.1% of patients being on oral anticoagulants. New pacemaker implantation (4.5%; 0.87 events/100 patient-years), neurological disorders (5%; 0.52 events/100 patient-years), valve insufficiency (0.7%; 0.16 events/100 patient-years), paravalvular leakage (0.4%; 0.09 events/100 patient-years) and reoperation due to valvular complications (0.7%; 0.38 events/100 patient-years) were rare. Long-term survival was 41.8% ± 1.6 after 10 years, 21.3% ± 2.3 after 15 years, and 12.1% ± 3.9 after 17 years. CONCLUSION Long-term results after aortic valve replacement with stentless biological prostheses compare favorably with those obtained with stented bioprostheses.
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Affiliation(s)
- Juergen Ennker
- Heart Center, Helios Hospital Siegburg Germany.,Faculty of Medicine, Witten-Herdecke University, Witten, Germany
| | - Markus Meilwes
- Institute of Medical Statistics, Justus-Liebig University Giessen, Giessen, Germany.,Department of Cardiovascular Surgery, Justus-Liebig University Giessen, Giessen, Germany
| | | | - Bernd Niemann
- Department of Cardiovascular Surgery, Justus-Liebig University Giessen, Giessen, Germany
| | - Philippe Grieshaber
- Department of Cardiovascular Surgery, Justus-Liebig University Giessen, Giessen, Germany
| | - Ina C Ennker
- Hannover Medical School, Department of Plastic and Reconstructive Surgery, Hannover, Germany
| | - Andreas Boening
- Department of Cardiovascular Surgery, Justus-Liebig University Giessen, Giessen, Germany
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112
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Huygens SA, Rutten-van Mölken MPMH, Bekkers JA, Bogers AJJC, Bouten CVC, Chamuleau SAJ, de Jaegere PPT, Kappetein AP, Kluin J, van Mieghem NMDA, Versteegh MIM, Witsenburg M, Takkenberg JJM. Conceptual model for early health technology assessment of current and novel heart valve interventions. Open Heart 2016; 3:e000500. [PMID: 27843569 PMCID: PMC5073474 DOI: 10.1136/openhrt-2016-000500] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 08/02/2016] [Indexed: 01/02/2023] Open
Abstract
Objective The future promises many technological advances in the field of heart valve interventions, like tissue-engineered heart valves (TEHV). Prior to introduction in clinical practice, it is essential to perform early health technology assessment. We aim to develop a conceptual model (CM) that can be used to investigate the performance and costs requirements for TEHV to become cost-effective. Methods After scoping the decision problem, a workgroup developed the draft CM based on clinical guidelines. This model was compared with existing models for cost-effectiveness of heart valve interventions, identified by systematic literature search. Next, it was discussed with a Delphi panel of cardiothoracic surgeons, cardiologists and a biomedical scientist (n=10). Results The CM starts with the valve implantation. If patients survive the intervention, they can remain alive without complications, die from non-valve-related causes or experience a valve-related event. The events are separated in early and late events. After surviving an event, patients can experience another event or die due to non-valve-related causes. Predictors will include age, gender, NYHA class, left ventricular function and diabetes. Costs and quality adjusted life years are to be attached to health conditions to estimate long-term costs and health outcomes. Conclusions We developed a CM that will serve as foundation of a decision-analytic model that can estimate the potential cost-effectiveness of TEHV in early development stages. This supports developers in deciding about further development of TEHV and identifies promising interventions that may result in faster take-up in clinical practice by clinicians and reimbursement by payers.
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Affiliation(s)
- Simone A Huygens
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands; Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands; Department of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | - Maureen P M H Rutten-van Mölken
- Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands; Department of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | - Jos A Bekkers
- Department of Cardio-Thoracic Surgery , Erasmus University Medical Centre , Rotterdam , The Netherlands
| | - Ad J J C Bogers
- Department of Cardio-Thoracic Surgery , Erasmus University Medical Centre , Rotterdam , The Netherlands
| | - Carlijn V C Bouten
- Department of Biomedical Engineering , Eindhoven University of Technology , Eindhoven , The Netherlands
| | - Steven A J Chamuleau
- Department of Cardiology , University Medical Centre , Utrecht , The Netherlands
| | - Peter P T de Jaegere
- Department of Cardiology , Erasmus University Medical Centre , Rotterdam , The Netherlands
| | - Arie Pieter Kappetein
- Department of Cardio-Thoracic Surgery , Erasmus University Medical Centre , Rotterdam , The Netherlands
| | - Jolanda Kluin
- Department of Cardio-Thoracic Surgery , Academic Medical Centre , Amsterdam , The Netherlands
| | | | - Michel I M Versteegh
- Department of Cardio-Thoracic Surgery , Leiden University Medical Centre , Leiden , The Netherlands
| | - Maarten Witsenburg
- Department of Cardiology , Erasmus University Medical Centre , Rotterdam , The Netherlands
| | - Johanna J M Takkenberg
- Department of Cardio-Thoracic Surgery , Erasmus University Medical Centre , Rotterdam , The Netherlands
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113
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Lansac E, Di Centa I, Sleilaty G, Lejeune S, Khelil N, Berrebi A, Diakov C, Mankoubi L, Malergue MC, Noghin M, Zannis K, Salvi S, Dervanian P, Debauchez M. Long-term results of external aortic ring annuloplasty for aortic valve repair. Eur J Cardiothorac Surg 2016; 50:350-60. [DOI: 10.1093/ejcts/ezw070] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 01/25/2016] [Indexed: 01/18/2023] Open
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114
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Bileaflet mechanical valve replacement: an assessment of outcomes with 30 years of follow-up. Interact Cardiovasc Thorac Surg 2016; 23:599-607. [DOI: 10.1093/icvts/ivw196] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 04/19/2016] [Indexed: 11/14/2022] Open
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115
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Huygens SA, Mokhles MM, Hanif M, Bekkers JA, Bogers AJJC, Rutten-van Mölken MPMH, Takkenberg JJM. Contemporary outcomes after surgical aortic valve replacement with bioprostheses and allografts: a systematic review and meta-analysis. Eur J Cardiothorac Surg 2016; 50:605-616. [PMID: 27026750 PMCID: PMC5052462 DOI: 10.1093/ejcts/ezw101] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/17/2016] [Accepted: 02/26/2016] [Indexed: 11/14/2022] Open
Abstract
Many observational studies have reported outcomes after surgical aortic valve replacement (AVR), but there are no recent systematic reviews and meta-analyses including all available bioprostheses and allografts. The objective of this study is to provide a comprehensive and up-to-date overview of the outcomes after AVR with bioprostheses and allografts reported in the last 15 years. We conducted a systematic literature review (PROSPERO register: CRD42015017041) of studies published between 2000–15. Inclusion criteria were observational studies or randomized controlled trials reporting on outcomes of AVR with bioprostheses (stented or stentless) or allografts, with or without coronary artery bypass grafting (CABG) or valve repair procedure, with study population size n ≥ 30 and mean follow-up length ≥5 years. Fifty-four bioprosthesis studies and 14 allograft studies were included, encompassing 55 712 and 3872 patients and 349 840 and 32 419 patient-years, respectively. We pooled early mortality risk and linearized occurrence rates of valve-related events, reintervention and late mortality in a random-effects model. Sensitivity, meta-regression and subgroup analyses were performed to investigate the influence of outliers on the pooled estimates and to explore sources of heterogeneity. Funnel plots were used to investigate publication bias. Pooled early mortality risks for bioprostheses and allografts were 4.99% (95% confidence interval [CI], 4.44–5.62) and 5.03% (95% CI, 3.61–7.01), respectively. The late mortality rate was 5.70%/patient-year (95% CI, 4.99–5.62) for bioprostheses and 1.68%/patient-year (95% CI, 1.23–2.28) for allografts. Pooled reintervention rates for bioprostheses and allografts were 0.75%/patient-year (95% CI, 0.61–0.91) and 1.87%/patient-year (95% CI, 1.52–2.31), respectively. There was substantial heterogeneity in most outcomes. Meta-regression analyses identified covariates that could explain the heterogeneity: implantation period, valve type, patient age, gender, pre-intervention New York Heart Association class III/IV, concomitant CABG, study design and follow-up length. There is possible publication bias in all outcomes. This comprehensive systematic review and meta-analysis provides an overview of the outcomes after AVR with bioprostheses and allografts reported during the last 15 years. The results of this study can support patients and doctors in the prosthetic valve choice and can be used in microsimulation models to predict patient outcomes and estimate the cost-effectiveness of AVR with bioprostheses or allografts compared with current and future heart valve prostheses.
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Affiliation(s)
- Simone A Huygens
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands .,Institute for Medical Technology Assessment, Erasmus University, Rotterdam, Netherlands.,Department of Health Policy and Management, Erasmus University, Rotterdam, Netherlands
| | - Mostafa M Mokhles
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Milad Hanif
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Jos A Bekkers
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Maureen P M H Rutten-van Mölken
- Institute for Medical Technology Assessment, Erasmus University, Rotterdam, Netherlands.,Department of Health Policy and Management, Erasmus University, Rotterdam, Netherlands
| | - Johanna J M Takkenberg
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
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Andreas M, Wallner S, Habertheuer A, Rath C, Schauperl M, Binder T, Beitzke D, Rosenhek R, Loewe C, Wiedemann D, Kocher A, Laufer G. Conventional versus rapid-deployment aortic valve replacement: a single-centre comparison between the Edwards Magna valve and its rapid-deployment successor. Interact Cardiovasc Thorac Surg 2016; 22:799-805. [PMID: 26976130 DOI: 10.1093/icvts/ivw052] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 02/01/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Sutureless and rapid-deployment valves were recently introduced into clinical practice. The Edwards INTUITY valve system is a combination of the Edwards Magna pericardial valve and a subvalvular stent-frame to enable rapid deployment. We performed a parallel cohort study for comparison of the two valve types. METHODS All patients receiving either an Edwards Magna Ease valve or an Edwards INTUITY valve system due to aortic stenosis from May 2010 until July 2014 were included. Patients undergoing bypass surgery, an additional valve procedure, atrial ablation surgery or replacement of the ascending aorta were excluded. Preoperative characteristics, operative specifications, survival, valve-related adverse events and transvalvulvar gradients were compared. RESULTS One hundred sixteen patients underwent rapid-deployment aortic valve replacement [mean age 75 years (SD: 8); 62% female] and 132 patients underwent conventional aortic valve replacement [70 years (SD: 9); 31% female; P < 0.001]. Conventional valve patients were taller and heavier. The mean EuroSCORE II was 3.1% (SD: 2.7) and 4.4% (SD: 6.0) for rapid-deployment and conventional valve patients, respectively (P = 0.085). The mean implanted valve size was higher in the conventional group [23.2 mm (SD: 2.0) vs 22.5 mm (SD: 2.2); P = 0.007], but postoperative transvalvular mean gradients were comparable [15 mmHg (SD: 6) vs 14 mmHg (SD: 5); P = 0.457]. A subgroup analysis of the most common valve sizes (21 and 23 mm; implanted in 63% of patients) revealed significantly reduced mean postoperative transvalvular gradients in the rapid-deployment group [14 mmHg (SD: 4) vs 16 mmHg (SD: 5); P = 0.025]. A significantly higher percentage received minimally invasive procedures in the rapid-deployment group (59 vs 39%; P < 0.001). The 1- and 3-year survival rate was 96 and 90% in the rapid-deployment group and 95 and 89% in the conventional group (P = 0.521), respectively. Valve-related pacemaker implantations were more common in the rapid-deployment group (9 vs 2%; P = 0.014) and postoperative stroke was more common in the conventional group (1.6 vs 0% per patient year; P = 0.044). CONCLUSIONS We conclude that this rapid-deployment valve probably facilitates minimally invasive surgery. Furthermore, a subgroup analysis showed reduced transvalvular gradients in smaller valve sizes compared with the conventionally implanted valve of the same type. The favourable haemodynamic profile and the potentially different spectrum of valve-related adverse events should be addressed in further clinical trials.
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Affiliation(s)
- Martin Andreas
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Stephanie Wallner
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Andreas Habertheuer
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Claus Rath
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Martin Schauperl
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Thomas Binder
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Dietrich Beitzke
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Raphael Rosenhek
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Christian Loewe
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Dominik Wiedemann
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Alfred Kocher
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Guenther Laufer
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
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Uchimuro T, Fukui T, Shimizu A, Takanashi S. Mitral Valve Surgery in Patients With Severe Mitral Annular Calcification. Ann Thorac Surg 2016; 101:889-95. [DOI: 10.1016/j.athoracsur.2015.08.071] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 07/25/2015] [Accepted: 08/28/2015] [Indexed: 10/22/2022]
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Beckmann E, Martens A, Alhadi F, Hoeffler K, Umminger J, Kaufeld T, Sarikouch S, Koigeldiev N, Cebotari S, Schmitto JD, Haverich A, Shrestha M. Aortic valve replacement with sutureless prosthesis: better than root enlargement to avoid patient-prosthesis mismatch? Interact Cardiovasc Thorac Surg 2016; 22:744-9. [PMID: 26920726 DOI: 10.1093/icvts/ivw041] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 01/11/2016] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Aortic valve replacement in patients with a small aortic annulus may result in patient-prosthesis mismatch (PPM). Aortic root enlargement (ARE) can reduce PPM, but leads to extended cardiac ischaemia times. Sutureless valves have the potential to prevent PPM while reducing cardiac ischaemia times. METHODS Between January 2007 and December 2011, a total of 128 patients with a small aortic annulus underwent surgery for aortic valve stenosis at our centre. Thirty-six (17% male, n = 6) patients received conventional valve replacement with ARE and 92 (16% male, n = 18) subjects received sutureless valve implantation (Sorin Perceval). We conducted a comparative, retrospective study with follow-up. RESULTS The sutureless group showed a significantly higher age (79 years) than the ARE patients (62 years, P < 0.001) and received significantly more concomitant cardiac procedures (33%, n = 30 vs 6%, n = 2, P = 0.001). The mean operation, cardiopulmonary bypass and cross-clamp times were significantly lower in sutureless patients (147 ± 42, 67 ± 26 and 35 ± 13 min, respectively) than in ARE patients (181 ± 41, 105 ± 29 and 70 ± 19 min, respectively, P < 0.001). The mean postoperative effective orifice area (EOA) indexed to the body surface area was 0.91 ± 0.2 cm(2)/m(2) in ARE patients and 0.83 ± 0.14 cm(2)/m(2) in sutureless patients (P = 0.040). The rate of patients with severe PPM was 6% (n = 2) in ARE patients and 11% (n = 8%) in sutureless patients (not significant, n.s.). The 30-day mortality rates were 2% (n = 2) in sutureless patients and 6% (n = 2) in ARE patients (n.s.). The 1- and 5-year survival rates of the sutureless group were 92 and 54% years, respectively, whereas the 1- and 5-year survival rates of the ARE group were 76% (n.s.). CONCLUSIONS Although the sutureless valve patients received significantly more concomitant procedures, all operation-associated times were significantly shorter. Despite sutureless valve patients being older, the 30-day mortality and survival rates were comparable in the two groups. Since the indexed EOA was only slightly lower and the incidence of severe PPM was not significantly higher in the sutureless valve patients, we conclude that sutureless valve implantation is an alternative to conventional ARE to treat a small aortic annulus and avoid PPM, especially in geriatric patients who benefit from the quick implantation process.
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Affiliation(s)
- Erik Beckmann
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Andreas Martens
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Firas Alhadi
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Klaus Hoeffler
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Julia Umminger
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Tim Kaufeld
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Samir Sarikouch
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Nurbol Koigeldiev
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Serghei Cebotari
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jan Dieter Schmitto
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Malakh Shrestha
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Hwang HY, Kim KH, Kim KB, Ahn H. Reoperations after tricuspid valve repair: re-repair versus replacement. J Thorac Dis 2016; 8:133-9. [PMID: 26904221 DOI: 10.3978/j.issn.2072-1439.2016.01.43] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Data demonstrating results of reoperation after initial tricuspid valve repair are scarce. We evaluated outcomes of tricuspid reoperations after tricuspid valve repair and compared the results of tricuspid re-repair with those of tricuspid valve replacement (TVR). METHODS From 1994 to 2012, 53 patients (56±15 years, male:female =14:39) underwent tricuspid reoperations due to recurrent tricuspid regurgitation (TR) after initial repair. Twenty-two patients underwent tricuspid re-repair (TAP group) and 31 patients underwent TVR (TVR group). RESULTS Early mortality occurred in 6 patients (11%). Early mortality and incidence of postoperative complications were similar between the 2 groups. There were 14 cases of late mortality including 9 cardiac deaths. Five- and 10-year free from cardiac death rates were 82% and 67%, respectively, without any intergroup difference. Recurrent TR (> moderate) developed in 6 TAP group patients and structural valve deterioration occurred in 1 TVR group patient (P=0.002). Isolated tricuspid valve surgery (P=0.044) and presence of atrial fibrillation during the follow-up (P=0.051) were associated with recurrent TR after re-repair. However, the overall tricuspid valve-related event rates were similar between the 2 groups with 5- and 10-year rates of 61% and 41%, respectively. CONCLUSIONS Tricuspid valve reoperation after initial repair resulted in high rates of operative mortality and complications. Long-term event-free rate was similar regardless of the type of surgery. However, great care might be needed when performing re-repair in patients with atrial fibrillation and those who had isolated tricuspid valve disease due to high recurrence of TR after re-repair.
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Affiliation(s)
- Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung-Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ki-Bong Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyuk Ahn
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
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Hegazy YY, Rayan A, Sodian R, Hassanein W, Ennker J. Medtronic Freestyle aortic bioprosthesis: a potential option for haemodialysis patients. Interact Cardiovasc Thorac Surg 2016; 22:459-63; discussion 463-4. [DOI: 10.1093/icvts/ivv388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 12/11/2015] [Indexed: 11/13/2022] Open
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Coutinho GF, Correia PM, Branco C, Antunes MJ. Long-term results of mitral valve surgery for degenerative anterior leaflet or bileaflet prolapse: analysis of negative factors for repair, early and late failures, and survival. Eur J Cardiothorac Surg 2016; 50:66-74. [PMID: 26792923 DOI: 10.1093/ejcts/ezv470] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 12/04/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To evaluate the feasibility of mitral valve repair in patients with anterior leaflet (ALP) or bileaflet prolapse (BLP) and identify factors predisposing patients to replacement. To compare long-term survival of patients submitted to repair (Group Repair) against those submitted to replacement (Group Replacement), and investigate causes of early and late failures of repair. METHODS From January 1992 through December 2012, 768 patients with ALP or BLP were submitted to mitral valve surgery, of whom 501 had degenerative involvement [Myxomatous (Myx)-336 (67.1%) or fibroelastic deficiency (Fed)-165 (32.9%)] and constituted the study population. Isolated ALP was present in 274 patients (54.7%) and BLP in 227 (45.3%). Associated procedures were admitted. RESULTS Patients with Fed were significantly older (64.4 ± 12.1 vs 54.8 ± 15.5 years, P < 0.001), more symptomatic (63 vs 44.3%; P < 0.001) and with higher incidence of atrial fibrillation (43.6 vs 26.2%; P < 0.001). Repair was achieved in 94.8% of patients with an overall 30-day mortality rate of 1.2% (0.3% in the last decade) and no differences regarding aetiology. Age, moderate to severe left ventricular (LV) dysfunction, previous cardiac surgery, multiple segment prolapse, mitral calcification, leaflet retraction and the performing surgeon were independently associated with replacement. Group Repair patients had a greater adjusted 20-year survival by comparison with Group Replacement (43.4 ± 5.5 vs 13.6 ± 11.3%; P < 0.001) and similar to that of the age- and sex-adjusted general population (P = 0.10). Valve replacement, New York Heart Association (NYHA) class III-IV, pulmonary hypertension and LV dysfunction emerged as independent predictors of late mortality. Patients in NYHA class I-II experienced a higher repair rate (98.4%) and better survival than those in Class III-IV. Two repair patients were reoperated during the first year after surgery (early failure) and both were 'rerepaired'. Late failure was observed in 21 patients, mostly for progression of the disease. The 20-year rate of freedom from reoperation was 88 ± 2.7%, significantly worse in ALP patients (P = 0.040), and not different between Fed and Myx. CONCLUSIONS Patients with ALP or BLP can be submitted to surgery with low mortality and great probability of repair in expert hands. Patients should be operated on at an early phase (asymptomatic or mildly symptomatic), because there is a higher probability of repair and greater benefit on long-term survival.
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Affiliation(s)
- Gonçalo F Coutinho
- Centre of Cardiothoracic Surgery, University Hospital and Faculty of Medicine, Coimbra, Portugal
| | - Pedro M Correia
- Centre of Cardiothoracic Surgery, University Hospital and Faculty of Medicine, Coimbra, Portugal
| | - Carlos Branco
- Centre of Cardiothoracic Surgery, University Hospital and Faculty of Medicine, Coimbra, Portugal
| | - Manuel J Antunes
- Centre of Cardiothoracic Surgery, University Hospital and Faculty of Medicine, Coimbra, Portugal
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Kim TS, Lee JH, Na CY. Blood Conservation Strategy during Cardiac Valve Surgery in Jehovah's Witnesses: a Comparative Study with Non-Jehovah's Witnesses. Korean J Crit Care Med 2016. [DOI: 10.4266/kjccm.2016.31.2.101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Tae Sik Kim
- Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Seoul, Korea
| | - Jong Hyun Lee
- Department of Anesthesiology and Pain Medicine, Sejong General Hospital, Bucheon, Korea
| | - Chan-Young Na
- Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Medical Center, Daegu, Korea
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Ius F, Koigeldiyev N, Roumieh M, Ismail I, Tudorache I, Shrestha M, Fleissner F, Haverich A, Cebotari S. Impact of sinuses of Valsalva on prosthesis durability in patients undergoing ascending aorta and aortic valve replacement with Carpentier-Edwards bioprosthesis: a propensity score-based study. Eur J Cardiothorac Surg 2015; 49:1676-84. [PMID: 26656448 DOI: 10.1093/ejcts/ezv425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 10/13/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The effect of sinuses of Valsalva on aortic bioprosthesis durability has not been investigated so far. The aim of this study was to compare durability of the Carpentier-Edwards aortic bioprosthesis in patients undergoing aortic valve and ascending aorta replacement as a composite bioconduit (Group A, case group) versus patients undergoing separate replacement of the aortic valve and ascending aorta, with preservation of the aortic root (Group B, control group), between January 2000 and January 2014. METHODS Records of Group A (n = 133) and Group B (n = 162) patients were retrospectively reviewed. End-points were evaluated among groups in three ways: before and after propensity score 1:1 matching (Group A, n = 94; Group B, n = 94 patients) and after patient stratification through quintiles of propensity scores. RESULTS There was no difference among groups regarding mean and maximal trans-prosthetic pressure gradients at discharge (P = 0.07 and 0.45, respectively). Maximal trans-prosthetic gradients were lower in Group A patients at last control (P = 0.03). Structural valve deterioration (SVD) was due to prosthesis regurgitation (Group A, n = 5; Group B, n = 1), stenosis (Group A, n = 2; Group B, n = 5) or combined (Group A, n = 4; Group B, n = 2). After a mean follow-up of 68 ± 42 months, there was no difference among groups, at 5 and 12 years, regarding mortality, freedom from SVD, from redo aortic valve replacement for SVD and cardiac redo of any type, before and after matching and after stratification according to quintiles of propensity scores. CONCLUSIONS Within the 12-year follow-up, the absence of the sinuses of Valsalva seems to have no influence on durability of Carpentier Edwards aortic bioprosthesis. Longer follow-up may be warranted.
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Affiliation(s)
- Fabio Ius
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Nurbol Koigeldiyev
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Mazen Roumieh
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Issam Ismail
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Igor Tudorache
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Malakh Shrestha
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Felix Fleissner
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Serghei Cebotari
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Characteristics and Outcomes of Patients With Severe Bioprosthetic Aortic Valve Stenosis Undergoing Redo Surgical Aortic Valve Replacement. Circulation 2015; 132:1953-60. [DOI: 10.1161/circulationaha.115.015939] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 09/02/2015] [Indexed: 11/16/2022]
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125
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[Surgery in the Cardiovascular Surgical Intensive Care Unit]. Cir Esp 2015; 94:227-31. [PMID: 26319571 DOI: 10.1016/j.ciresp.2015.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 06/15/2015] [Accepted: 07/07/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND To analyze the indications, actions and results of the operations performed in the Cardiovascular Surgery Intensive Care Unit. METHODS Retrospective analysis of consecutive non-selected adult patients operated in the ICU. All operations were included. Descriptive statistics were used. RESULTS Between 2008 and 2013, 3379 consecutive adult patients were operated upon. A total of 124 operations were performed in the ICU in 109 patients, 70 male (64.2%) and 39 female (35.8%) with a mean age of 61.6 years (12-80). This represented 3.2% of all operations. During the study period, 185 patients (5.5%) were reoperated for postoperative bleeding/tamponade in the operating room. The index interventions were for valvular heart disease (34.9%), aortic disease (22.9%), ischemic heart disease (15.6%), combined valvular/ischemic (12%), valvular/aorta (11%) and miscellaneous (3.6%). The indications for reoperation were persistent bleeding 54 (43.5%), pericardial tamponade 41 (33%), low cardiac output 13 (10.5%), cardiac arrest/arrhythmia 8 (6.5%), respiratory insufficiency 6 (4.8%) and acute ischemic limb 2 (1.7%). Operations performed were: mediastinal exploration 73 (58.9%), implant/removal of ECMO 17 (13.7%), sternal closure 16 (12.9%), open resuscitation 9 (7.3%), subxyphoid drainage 7 (5.6%) and femoral embolectomy 2 (1.6%). Overall mortality was 33%. There was one case of mediastinitis (0,9%), with no difference from patients operated in the regular operating room. CONCLUSIONS Operations in the ICU represent a safe, life-saving alternative in specific subgroups of patients. The risk of wound infection is not increased, unstable patients are not transferred and there is time savings.
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Mazzitelli D, Fischlein T, Rankin JS, Choi YH, Stamm C, Pfeiffer S, Pirk J, Detter C, Kroll J, Beyersdorf F, Griffin CD, Shrestha M, Nöbauer C, Crooke PS, Schreiber C, Lange R. Geometric ring annuloplasty as an adjunct to aortic valve repair: clinical investigation of the HAART 300 device. Eur J Cardiothorac Surg 2015; 49:987-93. [DOI: 10.1093/ejcts/ezv234] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 06/03/2015] [Indexed: 01/09/2023] Open
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Affiliation(s)
- Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.
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128
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Davarpasand T, Hosseinsabet A, Jalali A. Concomitant coronary artery bypass graft and aortic and mitral valve replacement for rheumatic heart disease: short- and mid-term outcomes. Interact Cardiovasc Thorac Surg 2015; 21:322-8. [DOI: 10.1093/icvts/ivv132] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 04/29/2015] [Indexed: 11/13/2022] Open
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Hickey GL, Dunning J, Seifert B, Sodeck G, Carr MJ, Burger HU, Beyersdorf F. Statistical and data reporting guidelines for the European Journal of Cardio-Thoracic Surgery and the Interactive CardioVascular and Thoracic Surgery. Eur J Cardiothorac Surg 2015; 48:180-93. [PMID: 25971435 DOI: 10.1093/ejcts/ezv168] [Citation(s) in RCA: 157] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 04/02/2015] [Indexed: 01/09/2023] Open
Abstract
As part of the peer review process for the European Journal of Cardio-Thoracic Surgery (EJCTS) and the Interactive CardioVascular and Thoracic Surgery (ICVTS), a statistician reviews any manuscript that includes a statistical analysis. To facilitate authors considering submitting a manuscript and to make it clearer about the expectations of the statistical reviewers, we present up-to-date guidelines for authors on statistical and data reporting specifically in these journals. The number of statistical methods used in the cardiothoracic literature is vast, as are the ways in which data are presented. Therefore, we narrow the scope of these guidelines to cover the most common applications submitted to the EJCTS and ICVTS, focusing in particular on those that the statistical reviewers most frequently comment on.
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Affiliation(s)
- Graeme L Hickey
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, The Farr Institute@HeRC, Liverpool, UK National Institute for Cardiovascular Outcomes Research (NICOR), University College London, London, UK Academic Surgery Unit, University of Manchester, Manchester Academic Health Science Centre, University Hospital of South Manchester, Manchester, UK
| | - Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Burkhardt Seifert
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zurich, Switzerland
| | - Gottfried Sodeck
- Department of Emergency Medicine, Medical University Vienna, Vienna, Austria
| | - Matthew J Carr
- University of Manchester, Institute of Brain, Behaviour and Mental Health, Manchester, UK
| | | | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, Freiburg University Heart Center, Freiburg, Germany
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Colli A, Marchetto G, Salizzoni S, Rinaldi M, Di Marco L, Pacini D, Di Bartolomeo R, Nicolini F, Gherli T, Agrifoglio M, Borghetti V, Khoury G, De Paolis M, Zoffoli G, Mangino D, Amorim MJ, Manzan E, Zucchetta F, Balduzzi S, Gerosa G. The TRIBECA study: (TRI)fecta (B)ioprosthesis (E)valuation versus (C)arpentier Magna-Ease in (A)ortic position. Eur J Cardiothorac Surg 2015; 49:478-85. [PMID: 25769464 DOI: 10.1093/ejcts/ezv070] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 01/23/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine whether the Trifecta bioprosthetic aortic valve produces postoperative haemodynamic results comparable with or better than those of the Magna Ease aortic valve bioprosthesis. METHODS We retrospectively reviewed the medical records of patients who had undergone aortic valve replacement with Trifecta or Magna Ease prostheses at eight European institutions between January 2011 and May 2013, and analysed early postoperative haemodynamic performance by means of echocardiography. RESULTS A total of 791 patients underwent aortic valve replacement (469 Magna Ease, 322 Trifecta). Haemodynamic variables were evaluated on discharge and during the follow-up (minimum 6 months, maximum 12 months). The mean gradient and the indexed effective orifice area (IEOA) were as follows: 10 mmHg [interquartile range (IQR): 8-13] and 1.10 cm(2)/m(2) (IQR: 0.95-1.27) for Trifecta; 16 mmHg (IQR: 11-22) and 0.96 cm(2)/m(2) (IQR: 0.77-1.13) for Magna Ease (P < 0.001). These significant differences were maintained across all valve sizes. Similar statistically significant differences were found when patients were matched and/or stratified for preoperative characteristics: body-surface area, ejection fraction, mean gradients and valve size. Severe prosthesis-patient mismatch (IEOA: <0.65 cm(2)/m(2)) was detected in 2 patients (0.6%) with Trifecta and 40 patients (8.5%) with Magna Ease (P < 0.001). CONCLUSIONS The haemodynamic performance of the Trifecta bioprosthesis was superior to that of the Magna Ease valve across all conventional prosthesis sizes, with almost no incidence of severe patient-prosthesis mismatch. The long-term follow-up is needed to determine whether these significant haemodynamic differences will persist, and influence clinical outcomes.
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Affiliation(s)
- Andrea Colli
- Department of Cardiology, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Giovanni Marchetto
- Division of Cardiac Surgery, San Giovanni Battista Hospital 'Molinette', University of Turin, Turin, Italy
| | - Stefano Salizzoni
- Division of Cardiac Surgery, San Giovanni Battista Hospital 'Molinette', University of Turin, Turin, Italy
| | - Mauro Rinaldi
- Division of Cardiac Surgery, San Giovanni Battista Hospital 'Molinette', University of Turin, Turin, Italy
| | - Luca Di Marco
- Cardiac Surgery Department, S.Orsola-Malpighi Hospital, University of Bologna, Parma, Italy
| | - Davide Pacini
- Cardiac Surgery Department, S.Orsola-Malpighi Hospital, University of Bologna, Parma, Italy
| | - Roberto Di Bartolomeo
- Cardiac Surgery Department, S.Orsola-Malpighi Hospital, University of Bologna, Parma, Italy
| | - Francesco Nicolini
- Department of Clinical and Experimental Medicine, Cardiac Surgery Unit, University of Parma, Parma, Italy
| | - Tiziano Gherli
- Department of Clinical and Experimental Medicine, Cardiac Surgery Unit, University of Parma, Parma, Italy
| | - Marco Agrifoglio
- Department of Clinical Sciences and Community Health, Cardiac Surgery, University of Milan, Centro Cardiologico Monzino Hospital, Milan, Italy
| | - Valentino Borghetti
- Cardio-Thoracic and Vascular Department, University Hospital of Terni, Terni, Italy
| | - Georgette Khoury
- Cardio-Thoracic and Vascular Department, University Hospital of Terni, Terni, Italy
| | - Marcella De Paolis
- Cardio-Thoracic and Vascular Department, University Hospital of Terni, Terni, Italy
| | - Giampaolo Zoffoli
- Department of Cardiac Surgery, Ospedale dell'Angelo, Venezia-Mestre, Italy
| | - Domenico Mangino
- Department of Cardiac Surgery, Ospedale dell'Angelo, Venezia-Mestre, Italy
| | | | - Erica Manzan
- Department of Cardiology, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Fabio Zucchetta
- Department of Cardiology, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Sara Balduzzi
- Department of Clinical and Diagnostic Medicine and Public Health, University of Modena and Reggio Emilia, Padua, Italy
| | - Gino Gerosa
- Department of Cardiology, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
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Shrestha M, Fischlein T, Meuris B, Flameng W, Carrel T, Madonna F, Misfeld M, Folliguet T, Haverich A, Laborde F. European multicentre experience with the sutureless Perceval valve: clinical and haemodynamic outcomes up to 5 years in over 700 patients. Eur J Cardiothorac Surg 2015; 49:234-41. [DOI: 10.1093/ejcts/ezv040] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 01/15/2015] [Indexed: 11/13/2022] Open
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Lehmann S, Merk DR, Etz CD, Seeburger J, Schroeter T, Oberbach A, Uhlemann M, Hoellriegel R, Haensig M, Leontyev S, Garbade J, Misfeld M, Mohr FW. Minimally invasive aortic valve replacement: the Leipzig experience. Ann Cardiothorac Surg 2015; 4:49-56. [PMID: 25694976 DOI: 10.3978/j.issn.2225-319x.2014.11.03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 09/18/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND Minimally invasive techniques are progressively challenging traditional approaches in cardiothoracic surgery. Minimally invasive aortic valve replacement (AVR) has become a routine procedure at our institution. METHODS We retrospectively analyzed all patients undergoing minimally invasive isolated AVR between January 2003 and March 2014, at our institution. Mean follow-up was 4.7±4.3 years (range: 0-18 years) and was 99.8% complete. RESULTS There were 1,714 patients who received an isolated minimally invasive AVR. The mean (± SD) patient age was 65±12.8 years, ejection fraction 60%±12% and log EuroSCORE 5.3%±5.1%. Mean cross-clamp time was 58±18 minutes and mean cardiopulmonary bypass (CPB) time was 82.9±26.7 minutes. Thirty-day survival was 97.8%±0.4%, and 69.4%±1.7% at 10-years. The multivariate analysis revealed age at surgery [P=0.016; odds ratio (OR), 1.1], length of surgery time (P=0.002; OR, 1.01), female gender (P=0.023; OR, 3.54), preoperative myocardial infarction (MI) (P=0.006; OR, 7.87), preoperative stroke (P=0.001; OR, 13.76) and preoperative liver failure (P=0.015; OR, 10.28) as independent risk factors for mortality. Cox-regression analysis revealed the following predictors for long term mortality: age over 75 years (P<0.001; OR, 3.5), preoperative dialysis (P<0.01; OR, 2.14), ejection fraction less than 30% (P=0.003; OR, 3.28) and urgent or emergency operation (P<0.001; OR, 2.3). CONCLUSIONS Minimally invasive AVR can be performed safely and effectively with very few perioperative complications. The early and long-term outcomes in these patients are acceptable.
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Affiliation(s)
- Sven Lehmann
- 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Denis R Merk
- 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Christian D Etz
- 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Joerg Seeburger
- 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Thomas Schroeter
- 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Andreas Oberbach
- 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Madlen Uhlemann
- 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Robert Hoellriegel
- 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Martin Haensig
- 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Sergey Leontyev
- 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Jens Garbade
- 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Martin Misfeld
- 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Friedrich W Mohr
- 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
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Andreas M, Doll N, Livesey S, Castella M, Kocher A, Casselman F, Voth V, Bannister C, Encalada Palacios JF, Pereda D, Laufer G, Czesla M. Safety and feasibility of a novel adjustable mitral annuloplasty ring: a multicentre European experience. Eur J Cardiothorac Surg 2015; 49:249-54. [PMID: 25694471 PMCID: PMC4678969 DOI: 10.1093/ejcts/ezv015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 12/19/2014] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Recurrent mitral regurgitation is a significant problem after mitral valve repair in patients with functional valve disease. We report the safety and feasibility of a novel adjustable mitral annuloplasty device that permits downsizing of the anterior–posterior diameter late after initial surgery. METHODS In this multicentre, non-randomized, observational register, patients with moderate or severe mitral regurgitation undergoing surgical mitral valve repair with the MiCardia EnCorSQ™ Mitral Valve Repair system were evaluated. Patient characteristics, operative specifications and results as well as postoperative follow-up were collected for all five centres. RESULTS Ninety-four patients with a median age of 71 (64–75) years (EuroSCORE II 6.7 ± 6.3; 66% male, 48% ischaemic MR, 37% dilated cardiomyopathy and 15% degenerative disease) were included. Operative mortality was 1% and the 1-year survival was 93%. Ring adjustment was attempted in 12 patients at a mean interval of 9 ± 6 months after surgery. In three of these attempts, a technical failure occurred. In 1 patient, mitral regurgitation was reduced two grades, in 2 patients mitral regurgitation was reduced one grade and in 6 patients, mitral regurgitation did not change significantly. The mean grade of mitral regurgitation changed from 2.9 ± 0.9 to 2.1 ± 0.7 (P = 0.02). Five patients were reoperated after 11 ± 9 months (Ring dehiscence: 2; failed adjustment: 3). CONCLUSION We conclude that this device may provide an additional treatment option in patients with functional mitral regurgitation, who are at risk for reoperation due to recurrent mitral regurgitation. Clinical results in this complex disease were ambiguous and patient selection seems to be a crucial step for this device. Further trials are required to estimate the clinical value of this therapeutic concept.
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Affiliation(s)
- Martin Andreas
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Nicolas Doll
- Sana Herzchirurgie Stuttgart GmbH, Stuttgart, Germany
| | - Steve Livesey
- Department of Cardiothoracic Surgery, Southampton General Hospital, Southampton, UK
| | - Manuel Castella
- Department of Cardiovascular Surgery, Institut Clínic del Tòrax, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Alfred Kocher
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Filip Casselman
- Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
| | - Vladimir Voth
- Sana Herzchirurgie Stuttgart GmbH, Stuttgart, Germany
| | - Christina Bannister
- Department of Cardiothoracic Surgery, Southampton General Hospital, Southampton, UK
| | - Juan F Encalada Palacios
- Department of Cardiovascular Surgery, Institut Clínic del Tòrax, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Daniel Pereda
- Department of Cardiovascular Surgery, Institut Clínic del Tòrax, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Guenther Laufer
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Markus Czesla
- Sana Herzchirurgie Stuttgart GmbH, Stuttgart, Germany
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Sievers HH, Stierle U, Charitos EI, Takkenberg JJM, Hörer J, Lange R, Franke U, Albert M, Gorski A, Leyh RG, Riso A, Sachweh J, Moritz A, Hetzer R, Hemmer W. A multicentre evaluation of the autograft procedure for young patients undergoing aortic valve replacement: update on the German Ross Registry†. Eur J Cardiothorac Surg 2015; 49:212-8. [PMID: 25666469 DOI: 10.1093/ejcts/ezv001] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 12/29/2014] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Conventional aortic valve replacement (AVR) in young, active patients represents a suboptimal solution in terms of long-term survival, durability and quality of life. The aim of the present work is to present an update on the multicentre experience with the pulmonary autograft procedure in young, adult patients. METHODS Between 1990-2013, 1779 adult patients (1339 males; 44.7 ± 11.6 years) underwent the pulmonary autograft procedure in 8 centres. All patients underwent prospective clinical and echocardiographic examinations annually. The mean follow-up was 8.3 ± 5.1 years (range 0-24.3 years) with a total cumulative follow-up of 14 288 years and 662 patients having a follow-up of at least 10 years. RESULTS The early (30-day) mortality rate was 1.1% (n = 19). Late (>30 day) survival of the adult population was comparable with the age- and gender-matched general population (observed deaths: 101, expected deaths: 91; P = 0.29). Freedom from autograft reoperation at 5, 10 and 15 years was 96.8, 94.7 and 86.7%, respectively, whereas freedom from homograft reoperation was 97.6, 95.5 and 92.3%, respectively. The overall freedom from reoperation was 94.9, 91.1 and 82.7%, respectively. Longitudinal modelling of functional valve performance revealed a low (<5%) probability of a patient being in higher autograft regurgitation grades throughout the first decade. Similarly, excellent homograft function was observed throughout the first 15 years. CONCLUSION The autograft principle results in postoperative long-term survival comparable with that of the age- and gender-matched general population and reoperation rates within the 1%/patient-year boundaries and should be considered in young, active patients who want to avoid the shortcomings of conventional prostheses.
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Affiliation(s)
- Hans-Hinrich Sievers
- Department of Cardiac and Thoracic Vascular Surgery, University of Lübeck, Lübeck, Germany
| | - Ulrich Stierle
- Department of Cardiac and Thoracic Vascular Surgery, University of Lübeck, Lübeck, Germany
| | - Efstratios I Charitos
- Department of Cardiac and Thoracic Vascular Surgery, University of Lübeck, Lübeck, Germany
| | - Johanna J M Takkenberg
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Jürgen Hörer
- Department of Cardiovascular Surgery, German Heart Centre Munich, Munich, Germany
| | - Rüdiger Lange
- Department of Cardiovascular Surgery, German Heart Centre Munich, Munich, Germany
| | - Ulrich Franke
- Department of Cardiac and Vascular Surgery, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Marc Albert
- Department of Cardiac and Vascular Surgery, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Armin Gorski
- Department of Cardiothoracic and Thoracic Vascular Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Rainer G Leyh
- Department of Cardiothoracic and Thoracic Vascular Surgery, University Hospital Würzburg, Würzburg, Germany
| | - Arlindo Riso
- Paediatric Cardiology/Paediatric Cardiac Surgery, University Heart Center, Hamburg, Germany
| | - Jörg Sachweh
- Paediatric Cardiology/Paediatric Cardiac Surgery, University Heart Center, Hamburg, Germany
| | - Anton Moritz
- Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Roland Hetzer
- Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Berlin, Germany
| | - Wolfgang Hemmer
- Department of Cardiac Surgery, Sana Cardiac Surgery Stuttgart, Stuttgart, Germany
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Coutinho GF, Bihun V, Correia PE, Antunes PE, Antunes MJ. Preservation of the subvalvular apparatus during mitral valve replacement of rheumatic valves does not affect long-term survival. Eur J Cardiothorac Surg 2015; 48:861-7; discussion 867. [DOI: 10.1093/ejcts/ezu537] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 12/10/2014] [Indexed: 11/13/2022] Open
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136
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Coutinho GF, Garcia AL, Correia PM, Branco C, Antunes MJ. Negative impact of atrial fibrillation and pulmonary hypertension after mitral valve surgery in asymptomatic patients with severe mitral regurgitation: a 20-year follow-up. Eur J Cardiothorac Surg 2015; 48:548-55; discussion 555-6. [DOI: 10.1093/ejcts/ezu511] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 11/19/2014] [Indexed: 11/14/2022] Open
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Andreas M, Wallner S, Ruetzler K, Wiedemann D, Ehrlich M, Heinze G, Binder T, Moritz A, Hiesmayr MJ, Kocher A, Laufer G. Comparable long-term results for porcine and pericardial prostheses after isolated aortic valve replacement. Eur J Cardiothorac Surg 2014; 48:557-61. [PMID: 25527170 PMCID: PMC4573977 DOI: 10.1093/ejcts/ezu466] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 11/03/2014] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Outcome of aortic valve replacement may be influenced by the choice of bioprosthesis. Pericardial heart valves are described to have a favourable haemodynamic profile compared with porcine valves, although the clinical notability of this finding is still controversially debated. Herein, we compared the long-term results of two commonly implanted bioprosthesis at a single centre. METHODS All consecutive patients undergoing isolated aortic valve replacement with either a Carpentier-Edwards Magna pericardial prosthesis or a Medtronic Mosaic porcine prosthesis between 2002 and 2008 were analysed regarding preoperative characteristics, short- and long-term survival, valve-related complications and echocardiographic findings. RESULTS The Medtronic Mosaic was implanted in 163 patients and the Carpentier-Edwards Magna in 295 patients. The sizes of implanted valves were 22.4 ± 1.5 mm for the Mosaic and 21.8 ± 1.8 mm for the Magna (P = 0.001). The long-term survival rate was 76 and 56% after 5 and 10 years for the Medtronic Mosaic, which was comparable with the Carpentier-Edwards Magna (77 and 57%; P = 0.92). Overall long-term survival was comparable with an age- and sex-matched Austrian general population for both groups. Valve-related adverse events were similar between groups. The postoperative mean transvalvular gradient was significantly increased in the Mosaic group (24 ± 9 mmHg vs 17 ± 7 mmHg; P < 0.001). CONCLUSIONS Both types of aortic bioprostheses offer excellent results after isolated aortic valve replacement. Despite relevant differences in gradients, long-term survival was comparable with the expected normal survival for both bioprostheses. Patients with a porcine heart valve had a higher postoperative transvalvular gradient.
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Affiliation(s)
- Martin Andreas
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Stephanie Wallner
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Kurt Ruetzler
- Department of Anesthesiology and Intensive Care, Medical University of Vienna, Vienna, Austria Department of Anesthesiology, University Hospital Zuerich, Zuerich, Switzerland
| | - Dominik Wiedemann
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Marek Ehrlich
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Georg Heinze
- Center for Medical Statistics, Informatics and Intelligent Systems, Section for Medical Information Management and Imaging, Medical University of Vienna, Vienna, Austria
| | - Thomas Binder
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Anton Moritz
- Department of Thoracic, Cardiac and Thoracovascular Surgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
| | - Michael J Hiesmayr
- Department of Anesthesiology and Intensive Care, Medical University of Vienna, Vienna, Austria
| | - Alfred Kocher
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Guenther Laufer
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
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Coutinho GF, Branco CF, Jorge E, Correia PM, Antunes MJ. Mitral valve surgery after percutaneous mitral commissurotomy: is repair still feasible? Eur J Cardiothorac Surg 2014; 47:e1-6. [DOI: 10.1093/ejcts/ezu365] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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139
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Davarpasand T, Hosseinsabet A. Triple valve replacement for rheumatic heart disease: short- and mid-term survival in modern era. Interact Cardiovasc Thorac Surg 2014; 20:359-64. [PMID: 25476461 DOI: 10.1093/icvts/ivu400] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Triple valve replacement (TVR) is still deemed a complex and challenging choice for rheumatic heart disease (RHD) and carries significant mortality and morbidity. We report the short- and mid-term results after TVR in the last decade. METHODS In a historical cohort, ninety consecutive patients, at a mean age of 47 ± 12 years underwent TVR between 2003 and 2013 for RHD. Most of the patients were in the New York Heart Association (NYHA) functional class II or III. Univariate and multivariate analyses were performed to identify the predictors of overall and event-free survival. RESULTS The 30-day hospital mortality rate was 6% (n = 5). One-year and 4-year overall survival (cardiac survival) rates were 91.7 and 89.5%, respectively. One-year and 4-year rates of freedom from cardiac events (e.g. cardiac death, cardiac rehospitalization, cardiac reoperation, cerebrovascular events, anticoagulation-related major haemorrhage and significant valvular malfunction) were 83.5 and 69.5%, respectively. Age, diabetes and pump time were the independent predictors of overall survival, and diabetes and hypertension were the independent predictors of event-free survival. One-year and 4-year freedom rates from anticoagulation-related major haemorrhage were 96.6 and 90.7%, respectively. The 1-year and 4-year rates of freedom from a composite of valvular thrombosis, major bleeding events and thromboemboli were 94.1 and 88.5%, respectively. One-year and 4-year freedom rates from cardiac rehospitalization were 94.0 and 88.0%, respectively. One-year and 4-year rates of freedom from cardiac reoperation were 98.8 and 93.9%, respectively. One-year and 4-year rates of freedom from significant prosthetic valve malfunction (e.g. structural valve deterioration, valve thrombosis and paravalvular leakage) were 96.6 and 90.7%, respectively. The 1-year and 4-year rates of freedom from major adverse valve-related events were 86.3 and 78.5%, respectively. CONCLUSIONS TVR for RHD appears to confer satisfactory short- and mid-term results with excellent symptomatic improvement. The overall mortality following TVR may be improved by early surgical treatment before the NYHA functional class IV.
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Affiliation(s)
- Tahereh Davarpasand
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Hosseinsabet
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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Sénage T, Le Tourneau T, Foucher Y, Pattier S, Cueff C, Michel M, Serfaty JM, Mugniot A, Périgaud C, Carton HF, Al Habash O, Baron O, Roussel JC. Early Structural Valve Deterioration of Mitroflow Aortic Bioprosthesis. Circulation 2014; 130:2012-20. [DOI: 10.1161/circulationaha.114.010400] [Citation(s) in RCA: 159] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Thomas Sénage
- From the Department of Thoracic and Cardiovascular Surgery (T.S., S.P., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Institut du Thorax (T.S., T.L.T., S.P., C.C., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Department of Cardiology (T.L.T., C.C.), and Department of Radiology (J.S.), University Hospital, Nantes, France; Member of Translink European Network (dedicated to structural valve deterioration) (T.S., T.L.T., C.C., J.C.R.); INSERM UMR1087, Nantes, France (T.L.T.); and EA 4275 SPHERE
| | - Thierry Le Tourneau
- From the Department of Thoracic and Cardiovascular Surgery (T.S., S.P., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Institut du Thorax (T.S., T.L.T., S.P., C.C., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Department of Cardiology (T.L.T., C.C.), and Department of Radiology (J.S.), University Hospital, Nantes, France; Member of Translink European Network (dedicated to structural valve deterioration) (T.S., T.L.T., C.C., J.C.R.); INSERM UMR1087, Nantes, France (T.L.T.); and EA 4275 SPHERE
| | - Yohann Foucher
- From the Department of Thoracic and Cardiovascular Surgery (T.S., S.P., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Institut du Thorax (T.S., T.L.T., S.P., C.C., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Department of Cardiology (T.L.T., C.C.), and Department of Radiology (J.S.), University Hospital, Nantes, France; Member of Translink European Network (dedicated to structural valve deterioration) (T.S., T.L.T., C.C., J.C.R.); INSERM UMR1087, Nantes, France (T.L.T.); and EA 4275 SPHERE
| | - Sabine Pattier
- From the Department of Thoracic and Cardiovascular Surgery (T.S., S.P., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Institut du Thorax (T.S., T.L.T., S.P., C.C., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Department of Cardiology (T.L.T., C.C.), and Department of Radiology (J.S.), University Hospital, Nantes, France; Member of Translink European Network (dedicated to structural valve deterioration) (T.S., T.L.T., C.C., J.C.R.); INSERM UMR1087, Nantes, France (T.L.T.); and EA 4275 SPHERE
| | - Caroline Cueff
- From the Department of Thoracic and Cardiovascular Surgery (T.S., S.P., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Institut du Thorax (T.S., T.L.T., S.P., C.C., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Department of Cardiology (T.L.T., C.C.), and Department of Radiology (J.S.), University Hospital, Nantes, France; Member of Translink European Network (dedicated to structural valve deterioration) (T.S., T.L.T., C.C., J.C.R.); INSERM UMR1087, Nantes, France (T.L.T.); and EA 4275 SPHERE
| | - Magali Michel
- From the Department of Thoracic and Cardiovascular Surgery (T.S., S.P., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Institut du Thorax (T.S., T.L.T., S.P., C.C., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Department of Cardiology (T.L.T., C.C.), and Department of Radiology (J.S.), University Hospital, Nantes, France; Member of Translink European Network (dedicated to structural valve deterioration) (T.S., T.L.T., C.C., J.C.R.); INSERM UMR1087, Nantes, France (T.L.T.); and EA 4275 SPHERE
| | - Jean-Michel Serfaty
- From the Department of Thoracic and Cardiovascular Surgery (T.S., S.P., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Institut du Thorax (T.S., T.L.T., S.P., C.C., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Department of Cardiology (T.L.T., C.C.), and Department of Radiology (J.S.), University Hospital, Nantes, France; Member of Translink European Network (dedicated to structural valve deterioration) (T.S., T.L.T., C.C., J.C.R.); INSERM UMR1087, Nantes, France (T.L.T.); and EA 4275 SPHERE
| | - Antoine Mugniot
- From the Department of Thoracic and Cardiovascular Surgery (T.S., S.P., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Institut du Thorax (T.S., T.L.T., S.P., C.C., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Department of Cardiology (T.L.T., C.C.), and Department of Radiology (J.S.), University Hospital, Nantes, France; Member of Translink European Network (dedicated to structural valve deterioration) (T.S., T.L.T., C.C., J.C.R.); INSERM UMR1087, Nantes, France (T.L.T.); and EA 4275 SPHERE
| | - Christian Périgaud
- From the Department of Thoracic and Cardiovascular Surgery (T.S., S.P., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Institut du Thorax (T.S., T.L.T., S.P., C.C., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Department of Cardiology (T.L.T., C.C.), and Department of Radiology (J.S.), University Hospital, Nantes, France; Member of Translink European Network (dedicated to structural valve deterioration) (T.S., T.L.T., C.C., J.C.R.); INSERM UMR1087, Nantes, France (T.L.T.); and EA 4275 SPHERE
| | - Hubert François Carton
- From the Department of Thoracic and Cardiovascular Surgery (T.S., S.P., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Institut du Thorax (T.S., T.L.T., S.P., C.C., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Department of Cardiology (T.L.T., C.C.), and Department of Radiology (J.S.), University Hospital, Nantes, France; Member of Translink European Network (dedicated to structural valve deterioration) (T.S., T.L.T., C.C., J.C.R.); INSERM UMR1087, Nantes, France (T.L.T.); and EA 4275 SPHERE
| | - Ousama Al Habash
- From the Department of Thoracic and Cardiovascular Surgery (T.S., S.P., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Institut du Thorax (T.S., T.L.T., S.P., C.C., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Department of Cardiology (T.L.T., C.C.), and Department of Radiology (J.S.), University Hospital, Nantes, France; Member of Translink European Network (dedicated to structural valve deterioration) (T.S., T.L.T., C.C., J.C.R.); INSERM UMR1087, Nantes, France (T.L.T.); and EA 4275 SPHERE
| | - Olivier Baron
- From the Department of Thoracic and Cardiovascular Surgery (T.S., S.P., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Institut du Thorax (T.S., T.L.T., S.P., C.C., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Department of Cardiology (T.L.T., C.C.), and Department of Radiology (J.S.), University Hospital, Nantes, France; Member of Translink European Network (dedicated to structural valve deterioration) (T.S., T.L.T., C.C., J.C.R.); INSERM UMR1087, Nantes, France (T.L.T.); and EA 4275 SPHERE
| | - Jean Christian Roussel
- From the Department of Thoracic and Cardiovascular Surgery (T.S., S.P., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Institut du Thorax (T.S., T.L.T., S.P., C.C., M.M., A.M., C.P., H.F.C., O.A.H., O.B., J.C.R.), Department of Cardiology (T.L.T., C.C.), and Department of Radiology (J.S.), University Hospital, Nantes, France; Member of Translink European Network (dedicated to structural valve deterioration) (T.S., T.L.T., C.C., J.C.R.); INSERM UMR1087, Nantes, France (T.L.T.); and EA 4275 SPHERE
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141
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Ratschiller T, Guenther T, Knappich C, Guenzinger R, Kehl V, Voss B, Lange R. Do transvalvular pacemaker leads influence functional outcome after tricuspid ring annuloplasty? Eur J Cardiothorac Surg 2014; 48:363-9. [DOI: 10.1093/ejcts/ezu449] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 10/28/2014] [Indexed: 11/14/2022] Open
Affiliation(s)
- Thomas Ratschiller
- Department of Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
| | - Thomas Guenther
- Department of Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
| | - Christoph Knappich
- Department of Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
| | - Ralf Guenzinger
- Department of Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
| | - Victoria Kehl
- Institute of Medical Statistics and Epidemiology, Technische Universität München, Munich, Germany
| | - Bernhard Voss
- Department of Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
| | - Ruediger Lange
- Department of Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
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142
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Azeredo LG, Veronese ET, Santiago JAD, Brandão CMDA, Pomerantzeff PMA, Jatene FB. Late outcome analysis of the Braile Biomédica® pericardial valve in the aortic position. Braz J Cardiovasc Surg 2014; 29:316-21. [PMID: 25372903 PMCID: PMC4412319 DOI: 10.5935/1678-9741.20140081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 06/22/2014] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Aortic valve replacement with Braile bovine pericardial prosthesis has been routinely done at the Heart Institute of the Universidade de São Paulo Medical School since 2006. The objective of this study is to analyze the results of Braile Biomédica® aortic bioprosthesis in patients with aortic valve disease. METHODS We retrospectively evaluated 196 patients with aortic valve disease submitted to aortic valve replacement with Braile Biomédica® bovine pericardial prosthesis, between 2006 and 2010. Mean age was 59.41±16.34 years and 67.3% were male. Before surgery, 73.4% of patients were in NYHA functional class III or IV. RESULTS Hospital mortality was 8.16% (16 patients). Linearized rates of mortality, endocarditis, reintervention, and structural dysfunction were 1.065%, 0.91%, 0.68% and 0.075% patients/year, respectively. Actuarial survival was 90.59±2.56% in 88 months. Freedom from reintervention, endocarditis and structural dysfunction was respectively 91.38±2.79%, 89.84±2.92% and 98.57±0.72% in 88 months. CONCLUSION The Braile Biomédica® pericardial aortic valve prosthesis demonstrated actuarial survival and durability similar to that described in the literature, but further follow up is required to assess the incidence of prosthetic valve endocarditis and structural dysfunction in the future.
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Affiliation(s)
| | | | | | | | | | - Fabio Biscegli Jatene
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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143
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Roumieh M, Ius F, Tudorache I, Ismail I, Fleissner F, Haverich A, Cebotari S. Comparison between biological and mechanical aortic valve prostheses in middle-aged patients matched through propensity score analysis: long-term results. Eur J Cardiothorac Surg 2014; 48:129-36. [PMID: 25312522 DOI: 10.1093/ejcts/ezu392] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 09/04/2014] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Choice of prosthesis type in middle-aged patients undergoing aortic valve replacement (AVR) is still debated. The aim of this study is to compare long-term follow-up results in middle-aged patients who underwent isolated AVR with a biological or mechanical prosthesis. METHODS A retrospective analysis of a single-centre database was performed to identify patients aged between 55 and 65 years old who underwent isolated AVR with a biological or mechanical prosthesis from January 1996 to January 2008. Sixty patients with a biological aortic valve prosthesis (Group A) were identified and matched through propensity score analysis to other 60 patients with a mechanical aortic valve prosthesis (Group B). RESULTS There was no difference among groups regarding postoperative complications. Follow-up amounted to 117 ± 51 months. In Group A and B patients, 10- and 15-year survival was 77 ± 6 vs 75 ± 6 and 54 ± 13 vs 53 ± 8%, respectively (P = 0.95); 10- and 15-year freedom from structural valve deterioration, 81 ± 7 vs 100 and 64 ± 12 vs 93 ± 5%, respectively (P = 0.003); 10- and 15-year freedom from redo AVR, 87 ± 6 vs 91 ± 5 and 73 ± 11 vs 91 ± 5%, respectively (P = 0.04); 10- and 15-year freedom from endocarditis, 94 ± 3 vs 98 ± 2 and 83 ± 8 vs 98 ± 2%, respectively (P = 0.05); 10- and 15-year freedom from bleeding events, 98 ± 2 vs 96 ± 5 and 88 ± 6 vs 77 ± 10%, respectively (P = 0.98); and 10- and 15-year freedom from cerebrovascular events, 94 ± 3 vs 97 ± 3 and 83 ± 8 vs 97 ± 3%, respectively (P = 0.03). CONCLUSIONS While survival was not different among groups, patients with a biological prosthesis showed a higher valve-related morbidity at follow-up. Therefore, middle-aged patients should preferably receive a mechanical prosthesis.
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Affiliation(s)
- Mazen Roumieh
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Fabio Ius
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Igor Tudorache
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Issam Ismail
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Felix Fleissner
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Serghei Cebotari
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
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144
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Mestres Fetcs CA. Mortalidad del bypass aortocoronario por comunidades autónomas: sorpresa aclarada –Los datos administrativos y la calidad. CIRUGIA CARDIOVASCULAR 2014. [DOI: 10.1016/j.circv.2014.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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145
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Mordi I, Al-Attar N, Tzemos N. Preoperative Assessment of Left Ventricular Diastolic Function and Right Ventricular Systolic Function Have Independent and Incremental Prognostic Value in Prediction of Early Postoperative Mortality in Redo Valve Surgery. Echocardiography 2014; 32:749-57. [PMID: 25109924 DOI: 10.1111/echo.12725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Ify Mordi
- Institute of Cardiovascular and Medical Sciences; British Heart Foundation Glasgow Cardiovascular Research Centre; University of Glasgow; Glasgow United Kingdom
| | - Nawwar Al-Attar
- West of Scotland Regional Heart and Lung Centre; Golden Jubilee National Hospital; Clydebank United Kingdom
| | - Nikolaos Tzemos
- Institute of Cardiovascular and Medical Sciences; British Heart Foundation Glasgow Cardiovascular Research Centre; University of Glasgow; Glasgow United Kingdom
- West of Scotland Regional Heart and Lung Centre; Golden Jubilee National Hospital; Clydebank United Kingdom
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146
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Hwang HY, Kim KH, Kim KB, Ahn H. Treatment for severe functional tricuspid regurgitation: annuloplasty versus valve replacement. Eur J Cardiothorac Surg 2014; 46:e21-7. [PMID: 24917649 DOI: 10.1093/ejcts/ezu224] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Previous studies have compared the outcomes of mitral annuloplasty with those of mitral valve replacement in patients with functional mitral regurgitation. However, data comparing the results of tricuspid annuloplasty (TAP) with those of tricuspid valve replacement (TVR) in patients with functional tricuspid regurgitation (FTR) have been scarce. We evaluated whether TAP was an optimal option for severe FTR. METHODS From 1996 to 2012, 175 patients (57 ± 11 years old) underwent surgical correction for severe FTR. A total of 108 patients underwent TAP (the TAP group), and 67 underwent TVR (the TVR group). Inverse probability of treatment weighting (IPTW) analysis and propensity score matching with 37 patients in each group were performed to adjust for the baseline differences between the two groups. RESULTS Early mortality occurred in 13 patients without any inter-group differences. There were 35 late mortalities, including 24 cardiac deaths. The 5- and 10-year freedom rates from cardiac death were 93.0 and 88.5%, respectively, in the TAP group, and 84.7 and 69.8%, respectively, in the TVR group. The IPTW-adjusted multivariable analysis revealed that the freedom rates from cardiac death were higher in the TAP group than in the TVR group (P = 0.01). In the propensity score-matched patients, the freedom rates from cardiac death and tricuspid valve-related event were higher in the TAP group than in the TVR group, although the difference was not statistically significant. CONCLUSIONS TAP should be considered as a treatment of choice for patients with severe FTR because TVR has been associated with long-term cardiac death and valve-related events.
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Affiliation(s)
- Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung-Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ki-Bong Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyuk Ahn
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
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Berdajs DA, Muradbegovic M, Haselbach D, Kofmehl R, Steurer J, Ferrari E, Held U, von Segesser LK. Ross procedure: is the root replacement technique superior to the sub-coronary implantation technique? Long-term results. Eur J Cardiothorac Surg 2014; 46:944-51. [DOI: 10.1093/ejcts/ezu176] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Saczkowski R, Malas T, Mesana T, de Kerchove L, El Khoury G, Boodhwani M. Aortic valve preservation and repair in acute Type A aortic dissection. Eur J Cardiothorac Surg 2014; 45:e220-6. [PMID: 24648432 DOI: 10.1093/ejcts/ezu099] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Repair and preservation of the aortic valve in Type A aortic dissection (AAD) remains controversial. We performed a meta-analysis of outcomes for aortic valve (AV) repair and preservation in AAD focusing on long-term valve-related events. METHODS Structured searches were performed in Embase (1980-2013) and PubMed (1966-2013) for studies reporting AV repair or preservation in AAD. Early mortality and linearized rates for late mortality and valve-related events were derived. Outcome data were pooled with an inverse-variance-weighted random-effects model. RESULTS Of 5325 screened articles, 19 observational studies met the eligibility criteria consisting of 2402 patients with a median follow-up of 4.1 [range: 3.1-12.6 years, total 13 733 patient-years (pt-yr)]. The cohort was principally male (median = 68.1%, range: 39-89) with a median age of 59 (range: 55-68) years and Marfan's syndrome was present in 2.5%. AV resuspension was performed in 95% of the patients and the remainder underwent valve-sparing root replacement (reimplantation = 2.5% and remodelling = 2.5%). Pooled early mortality rate was 18.7% [95% confidence interval (95% CI): 12.2-26.2%], and linearized late mortality rate was 4.7%/pt-yr (95% CI: 3.4-6.3). Linearized rate for AV reintervention was 2.1%/pt-yr (95% CI: 1.0-3.6), recurrent aortic insufficiency (>2+) was 0.9%/pt-yr (95% CI: 0.3-2.2) and endocarditis was 0.2%/pt-yr (95% CI: 0.1-0.5). The composite rate of thromboembolism and bleeding was 1.4%/pt-yr (95% CI: 0.7-2.2). CONCLUSIONS Patients surviving an AAD have a limited long-term survival. Preservation and repair of the aortic valve is associated with a moderate risk of reoperation, but a low risk of thromboembolism, bleeding and endocarditis.
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Affiliation(s)
- Richard Saczkowski
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Tarek Malas
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Thierry Mesana
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Laurent de Kerchove
- Department of Thoracic and Cardiovascular Surgery, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Gebrine El Khoury
- Department of Thoracic and Cardiovascular Surgery, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Munir Boodhwani
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON, Canada
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García Fuster R, Martín E, Paredes F, Mena A, Cánovas S, Gil O, Hornero F, Martínez J. Artificial chordae in the setting of complex mitral valve repair: early outcomes using the folding leaflet technique. Interact Cardiovasc Thorac Surg 2014; 18:586-95. [DOI: 10.1093/icvts/ivu013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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150
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Charitos EI, Stierle U, Petersen M, Mohamed SA, Hanke T, Schmidtke C, Klotz S, Sievers HH. The fate of the bicuspid valve aortopathy after aortic valve replacement. Eur J Cardiothorac Surg 2014; 45:e128-35. [PMID: 24482387 DOI: 10.1093/ejcts/ezt666] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES The fate of the aortic dimensions in patients with a bicuspid aortic valve (BAV) after aortic valve replacement (AVR) is unclear. We investigated the evolution of aortic root and ascending aorta dimensions in patients with a BAV after AVR. To neutralize the effect of pathological transvalvular haemodynamics on aortic dimensions, we evaluated our hypotheses in patients with normal transvalvular haemodynamics after a subcoronary autograft procedure, which preserves intact the native aortic wall. METHODS We excluded patients operated on for endocarditis; who developed autograft insufficiency > trivial and who required autograft reoperation during the follow-up. We included 448 patients (361 with BAV; 340 males; 44.6 ± 11.4 years; mean follow-up: 7.5 ± 3.9 years). Valve phenotype was determined during surgery. Annual echocardiographic examinations (n = 3336) were performed (follow-up completeness: 98%). To allow for somatometric, gender and age influences, z-values of measurements were calculated from the general population (GP) and analysed using longitudinal methods. RESULTS The increase in ascending aorta did not differ from that expected in the GP (0.04 z-values/year; P = 0.06). No difference could be observed in diameter increase rates between BAV and tricuspid aortic valve patients (TAV) (0.04 vs 0.06 z-values/year; P = 0.3), as well as between BAV phenotypes. The sinus increase did not differ from that expected in the GP (0.03 z-values/year; P = 0.1), and no significant differences could be observed between BAV phenotypes. In patients undergoing aortoplasty (n = 70), no significant difference in the rates of ascending aorta and sinus increase could be observed, compared with the GP. CONCLUSION For the time period of this study and in patients with normal aortic root haemodynamics after AVR, ascending aorta dimensions over time are similar to that of the matched GP. Patients with a BAV did not exhibit higher rates of ascending aorta dilatation after AVR than patients with TAV. At least for the first postoperative decade, transvalvular haemodynamics appear to exhibit a greater influence than the genetic component of BAV on the development of the BAV aortopathy.
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Affiliation(s)
- Efstratios I Charitos
- Department of Cardiac and Thoracic Vascular Surgery, University of Lübeck, Lübeck, Germany
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