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Pighi M, Ribichini F. Self-Expandable Transcatheter Heart Valves in Small Annuli: Does One Valve Fit All? JACC Cardiovasc Interv 2020; 13:207-209. [PMID: 31883716 DOI: 10.1016/j.jcin.2019.09.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/24/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Michele Pighi
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy.
| | - Flavio Ribichini
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
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102
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Kolkailah AA, Hirji SA, Ejiofor JI, Del Val FR, Chowdhury R, McGurk S, Lee J, Kaneko T. Impact of Prosthesis Size and Prosthesis–Patient Mismatch on Outcomes in Younger Female Patients Undergoing Aortic Valve Replacement. Semin Thorac Cardiovasc Surg 2020; 32:219-228. [DOI: 10.1053/j.semtcvs.2019.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 01/02/2019] [Indexed: 11/11/2022]
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103
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Regazzoli D, Chiarito M, Cannata F, Pagnesi M, Miura M, Ziviello F, Picci A, Reifart J, De Marco F, Bedogni F, Adamo M, Curello S, Teles R, Taramasso M, Barbanti M, Tamburino C, Stefanini GG, Mangieri A, Giannini F, Pagnotta PA, Maisano F, Kim WK, Van Mieghem NM, Colombo A, Reimers B, Latib A. Transcatheter Self-Expandable Valve Implantation for Aortic Stenosis in Small Aortic Annuli. JACC Cardiovasc Interv 2020; 13:196-206. [DOI: 10.1016/j.jcin.2019.08.041] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/01/2019] [Accepted: 08/20/2019] [Indexed: 11/16/2022]
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104
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Bidar E, Folliguet T, Kluin J, Muneretto C, Parolari A, Barili F, Suwalski P, Bonaros N, Punjabi P, Sadaba R, De Bonis M, Al-Attar N, Obadia JF, Czerny M, Shrestha M, Zegdi R, Natour E, Lorusso R. Postimplant biological aortic prosthesis degeneration: challenges in transcatheter valve implants. Eur J Cardiothorac Surg 2019; 55:191-200. [PMID: 30541101 DOI: 10.1093/ejcts/ezy391] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 10/15/2018] [Indexed: 12/29/2022] Open
Abstract
Surgical aortic valve replacement (SAVR) is highly effective and can be achieved with relatively low risk in patients with severe aortic stenosis. Bioprostheses have been used most frequently during the past 60 years. However, the function of biological valves usually declines after 10-15 years from implant when structural valve degeneration occurs often mandating a reoperation once valve dysfunction becomes haemodynamically significant. Known for many years by surgeons and cardiologists taking care of patients with SAVR, the issue of postimplant structural valve degeneration has been recently highlighted also in patients with transcatheter aortic valve implant (TAVI). There is growing concern that TAVI valves exhibit structural valve degeneration due to inherent challenges of the deployment mode. The impact on postimplant degeneration of TAVI valves compared to SAVR has still to be understood and defined. Based on the ongoing process of expanding TAVI indications, several potential shortcomings and caveats, learned during the last 60 years of SAVR experience, should be taken into consideration to refine this technique.
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Affiliation(s)
- Elham Bidar
- Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Thierry Folliguet
- Centre Hospitalo-Universitaire Brabois ILCV, Hôpital Henri Mondor, Division of Cardio Thoracic Surgery and Transplantation, Université Paris 12 UPEC, France
| | - Jolanda Kluin
- Department of Cardio-Thoracic Surgery, Academic Medical Center, Amsterdam, Netherlands
| | - Claudio Muneretto
- Cardiac Surgery Unit, University of Brescia Medical School, Brescia, Italy
| | - Alessandro Parolari
- Cardiac Surgery and Translational Research Units, IRCCS, Policlinico S. Donato, University of Milan, Milan, Italy
| | - Fabio Barili
- Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy
| | - Piotr Suwalski
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Prakash Punjabi
- Department of Cardio-Thoracic Surgery, Imperial College Healthcare NHS Trust, Imperial College School of Medicine, London, UK
| | - Rafa Sadaba
- Department of Cardiac Surgery, Hospital de Navarra, Pamplona, Spain
| | - Michele De Bonis
- Department of Cardiac Surgery, S. Raffaele University Hospital, Milan, Italy
| | - Nawwar Al-Attar
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Glasgow, UK
| | - Jean Francois Obadia
- Department of Cardio-Thoracic Surgery, Hôpital Cardiothoracique Louis Pradel, Lyon, France
| | - Martin Czerny
- Department of Cardio-Vascular Surgery, University Hospital Freiburg, Freiburg, Germany
| | - Malakh Shrestha
- Department of Cardio-Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Rachid Zegdi
- Hôpital Européen Georges Pompidou, Paris, France
| | - Ehsan Natour
- Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
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105
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Khan FW, Said SM. Konno-Rastan Combined with Manougiaun Root Enlargement for Small Aortic Root with Coronary Anomaly in a Young Woman. Heart Views 2019; 20:172-174. [PMID: 31803375 PMCID: PMC6881867 DOI: 10.4103/heartviews.heartviews_108_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 09/15/2019] [Indexed: 12/05/2022] Open
Abstract
Aortic root enlargement (ARE) is an established procedure to deal with small aortic annulus. It becomes very important to place adequate size prosthesis to prevent patient–prosthesis mismatch (PPM). Aortic root enlargement procedures procedures are technically demanding operations, particularly in obese patients. The presence of coronary artery anomalies adds more complexity to the procedure. We present an interesting case of a 22-year-old obese female with symptomatic severe aortic valve stenosis and anomalous coronary arteries. We successfully performed aortic valve replacement using the combined Konno aortoventriculoplasty and Manouguian posterior aortic root enlargement. Combined aortic root enlargement techniques techniques should be considered in the presence of major coronary anomalies.
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Affiliation(s)
- Fazal Wahab Khan
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Sameh M Said
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
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106
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Safety, efficacy, and hemodynamic performance of a stented bovine pericardial aortic valve bioprosthesis: Two-year analysis. J Thorac Cardiovasc Surg 2019; 160:371-381.e4. [PMID: 31590957 DOI: 10.1016/j.jtcvs.2019.07.132] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 06/14/2019] [Accepted: 07/08/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The study objectives were to evaluate the safety, efficacy, and hemodynamic performance of a novel stented bovine pericardial aortic valve bioprosthesis 2 years after implantation. METHODS The PERIcardial SurGical AOrtic Valve ReplacemeNT Pivotal Trial enrolled patients with symptomatic moderate/severe aortic stenosis or regurgitation at centers in Canada, Europe, and the United States. We report the outcomes and hemodynamic performance in patients with up to 2 years of follow-up. RESULTS A total of 1273 patients were enrolled, and 1110 underwent implantation. Among patients undergoing implantation, the mean age was 70.2 ± 8.9 years; 833 (75.0%) were male. Risk of mortality (Society of Thoracic Surgeons) was 2.0% ± 1.4%. At the time of analysis, 604 patients had completed the 2-year follow-up visit. Linearized late event rates were as follows: all death, 2.68%; valve-related death, 0.42%; valve thrombosis, 0.05%; endocarditis, 0.94%; thromboembolism, 1.68%; all hemorrhage, 2.94%; major hemorrhage, 1.99%; all paravalvular leak, 0.26%; and major paravalvular leak, 0.05% per patient-year. Mean 2-year aortic gradient and effective orifice area were 13.4 ± 5.0 mm Hg and 1.5 ± 0.37 cm2, respectively. Moderate and severe prosthesis-patient mismatch were observed in 43.5% and 34.8% of patients at 2 years, respectively. Improvement in New York Heart Association class compared with baseline was observed in 73.0% with moderate mismatch and 74.1% with severe mismatch. CONCLUSIONS The Avalus (Medtronic, Minneapolis, Minn) bovine pericardial valve demonstrates good clinical and safety outcomes at 2 years. Hemodynamic performance shows mean gradients comparable to currently available bovine pericardial aortic valves. There was no clinical impact of moderate to severe mismatch at 2 years. Further follow-up is required to evaluate midterm to long-term clinical outcome.
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107
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Theologou T, Harky A, Shaw M, Harrington D, Kuduvalli M, Oo A, Field M. Mitroflow and Perimount Magna 10 years outcomes a direct propensity match analysis to assess reintervention rates and long follow‐up mortality. J Card Surg 2019; 34:1279-1287. [DOI: 10.1111/jocs.14250] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Thomas Theologou
- Department of Cardiac SurgeryLiverpool Heart and Chest HospitalLiverpool UK
| | - Amer Harky
- Department of Cardiac SurgeryLiverpool Heart and Chest HospitalLiverpool UK
| | - Matthew Shaw
- Department of Clinical Audit and Clinical QualityThe Liverpool Heart and Chest HospitalLiverpool UK
| | - Deborah Harrington
- Department of Cardiac SurgeryLiverpool Heart and Chest HospitalLiverpool UK
| | - Manoj Kuduvalli
- Department of Cardiac SurgeryLiverpool Heart and Chest HospitalLiverpool UK
| | - Aung Oo
- Department of Cardiac SurgeryLiverpool Heart and Chest HospitalLiverpool UK
| | - Mark Field
- Department of Cardiac SurgeryLiverpool Heart and Chest HospitalLiverpool UK
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108
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de Freitas Campos Guimarães L, Urena M, Wijeysundera HC, Munoz-Garcia A, Serra V, Benitez LM, Auffret V, Cheema AN, Amat-Santos IJ, Fisher Q, Himbert D, Garcia Del Blanco B, Dager A, Le Breton H, Paradis JM, Dumont E, Pibarot P, Rodés-Cabau J. Long-Term Outcomes After Transcatheter Aortic Valve-in-Valve Replacement. Circ Cardiovasc Interv 2019; 11:e007038. [PMID: 30354588 DOI: 10.1161/circinterventions.118.007038] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Data on long-term outcomes after valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) are scarce. The objective of this study was to determine the long-term clinical outcomes and structural valve degeneration (SVD) over time in patients undergoing ViV-TAVR. METHODS AND RESULTS Consecutive patients undergoing ViV-TAVR in 9 centers between 2009 and 2015 were included. Patients were followed yearly, and clinical and echocardiography data were collected prospectively. SVD was defined as subclinical (increase >10 mm Hg in mean transvalvular gradient+decrease >0.3 cm2 in valve area or new-onset mild or moderate aortic regurgitation) and clinically relevant (increase >20 mm Hg in mean transvalvular gradient+decrease >0.6 cm2 in valve area or new-onset moderate-to-severe aortic regurgitation). A total of 116 patients (mean age, 76±11 years; 64.7% male; mean Society of Thoracic Surgeons score, 8.0±5.1%) were included. Balloon- and self-expandable valves were used in 47.9% and 52.1% of patients, respectively, and 30-day mortality was 6.9%. At a median follow-up of 3 years (range, 2-7 years), 30 patients (25.9%) had died, 20 of them (17.2%) from cardiovascular causes. Average mean transvalvular gradients remained stable up to 5-year follow-up ( P=0.92), but clinically relevant SVD occurred in 3/99 patients (3.0%), and 15/99 patients (15.1%) had subclinical SVD. One patient with SVD had redo ViV-TAVR. CONCLUSIONS About one-fourth of ViV-TAVR recipients had died after a median follow-up of 3 years. Overall valve hemodynamics remained stable over time and clinically relevant SVD was infrequent, but 1 out of 10 patients exhibited some degree of SVD.
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Affiliation(s)
| | - Marina Urena
- Bichat-Claude Bernard University Hospital, Paris, France (M.U., Q.F., D.H.)
| | | | | | - Vicenç Serra
- Hospital Universitario Vall d'Hebron, Barcelona, Spain (V.S., B.G.d.B.)
| | - Luis M Benitez
- Clinica de Occidente de Cali, Valle del Cauca, Colombia (L.M.B., A.D.)
| | - Vincent Auffret
- University Hospital Pontchaillou, Rennes, France (V.A., H.L.B.)
| | - Asim N Cheema
- St Michael's Hospital (A.N.C.), University of Toronto, Ontario, Canada
| | | | - Quentin Fisher
- Bichat-Claude Bernard University Hospital, Paris, France (M.U., Q.F., D.H.)
| | - Dominique Himbert
- Bichat-Claude Bernard University Hospital, Paris, France (M.U., Q.F., D.H.)
| | | | - Antonio Dager
- Clinica de Occidente de Cali, Valle del Cauca, Colombia (L.M.B., A.D.)
| | - Hervé Le Breton
- University Hospital Pontchaillou, Rennes, France (V.A., H.L.B.)
| | - Jean-Michel Paradis
- Quebec Heart and Lung Institute, Laval University, Canada (L.d.F.C.G., J.-M.P., E.D., P.P., J.R.-C.)
| | - Eric Dumont
- Quebec Heart and Lung Institute, Laval University, Canada (L.d.F.C.G., J.-M.P., E.D., P.P., J.R.-C.)
| | - Philippe Pibarot
- Quebec Heart and Lung Institute, Laval University, Canada (L.d.F.C.G., J.-M.P., E.D., P.P., J.R.-C.)
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Canada (L.d.F.C.G., J.-M.P., E.D., P.P., J.R.-C.)
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109
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Transcatheter Aortic Valve-in-Valve Procedures Using Current-Generation Balloon-Expandable Valves: What's the Optimal Valve Positioning Strategy for a Better Outcome? JACC Cardiovasc Interv 2019; 12:1618-1620. [PMID: 31439341 DOI: 10.1016/j.jcin.2019.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 06/18/2019] [Indexed: 11/22/2022]
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110
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Ziccardi MR, Groves EM. Bioprosthetic Valve Fracture for Valve-in-Valve Transcatheter Aortic Valve Replacement: Rationale, Patient Selection, Technique, and Outcomes. Interv Cardiol Clin 2019; 8:373-382. [PMID: 31445721 DOI: 10.1016/j.iccl.2019.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Patient-prosthesis mismatch (PPM) is common after surgical valve aortic replacement. A significant percentage of patients with a small annulus have moderate to severe PPM. The outcomes for patients with larger effective orifice areas and lower gradients are better than for patients with PPM. With the advent of valve-in-valve TAVR, a degenerated surgical bioprosthesis can be treated with a percutaneous approach. However, the issue of PPM cannot be overcome by simply implanting a new valve. The technique of bioprosthetic valve fracture was therefore developed. This allows for implantation of a fully expanded transcatheter valve and results in a large effective orifice.
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Affiliation(s)
- Mary Rodriguez Ziccardi
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 South Wood Street Suite 920S, Chicago, IL 60612, USA
| | - Elliott M Groves
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, Jesse Brown VA Medical Center, 840 South Wood Street Suite 920S, Chicago, IL 60612, USA.
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111
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Hemodynamic Performance and Outcomes of Mosaic Valve for Aortic Stenosis with Decreased Left Ventricular Function: Results from J-MOVE Study. ASAIO J 2019; 66:532-538. [PMID: 31335365 DOI: 10.1097/mat.0000000000001040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We evaluated impact of a small-sized Mosaic porcine bioprosthesis on hemodynamic performance and outcomes in patients with aortic stenosis (AS) and low left ventricular ejection fraction (LVEF) in a Japan multicenter cohort. Of 1,202 patients enrolled, 105 (8.7%) who had LVEF < 50% and AS underwent aortic valve replacement (AVR). Fifty-two patients received Mosaic porcine bioprosthesis ≤ 21 mm (S-AVR), and 53 received a bioprosthesis ≥ 23 mm (L-AVR). The median follow-up period was 3.1 [1.2, 5.1] years. At 5 years, LVEF significantly improved from median 41.2 [33.8, 45.9]% to 64.2 [49.8, 72.5]% in S-AVR (p < 0.001) and from median 43.2 [37.3, 46.8]% to 61.2 [47.2, 68.0]% in L-AVR (p < 0.001). The left ventricular mass index significantly decreased from median 158.4 [122.2, 194.9] to 110.0 [83.6, 129.4] gm/m in S-AVR (p < 0.001) and from median 169.8 [132.2, 203.6] to 109.6 [101.8, 132.4] gm/m in L-AVR (p < 0.001). There were no significant differences between S-AVR and L-AVR groups regarding freedom from cardiac death (93.1 ± 3.9% vs. 96.2 ± 3.8%; p = 0.119) and valve-related death (97.6 ± 2.4% vs. 100.0 ± 0.0%; p = 0.953). Clinical outcomes and improved hemodynamic performance were similar in both groups.
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112
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Lopez S, Meyer P, Teboul J, Deharo P, Mihoubi A, Elbeze JP, Lena D, Camarasa P, Laborde JC, Drogoul L. Transcatheter valve-in-valve implantation in a degenerated very small Mitroflow prosthesis. Interact Cardiovasc Thorac Surg 2019; 27:850-855. [PMID: 29917088 DOI: 10.1093/icvts/ivy192] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 05/16/2018] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES To assess the feasibility and results of 'valve-in-valve' implantation using the 23-mm CoreValve for the treatment of degenerated 19-mm and 21-mm Mitroflow bioprostheses. METHODS We retrospectively analysed all consecutive patients who underwent transcatheter aortic valve implantation for 19-mm and 21-mm Mitroflow bioprostheses. The height of implantation with respect to the ring of the Mitroflow prosthesis was targeted at -6 mm for the first 3 cases. In the following cases, the target was higher to promote free supra-annular movement of the leaflets. RESULTS The procedure was successful in 17 of 18 patients (94%). For implantations above the limit of -6 mm, the mean gradient was 10.4 ± 2.6 mmHg compared with 28.1 ± 11.6 mmHg for implantations below the limit of -6 mm (P < 0.01). For patients with severe stenosis as main mechanism of failure of the bioprosthesis, the mean post-procedural gradient was 31.2 ± 11.8 mmHg compared with 12.7 ± 6 mmHg in the absence of severe stenosis (P < 0.01). Patient-prosthesis mismatch (indexed effective orifice area ≤ 0.85 cm2/m2) and severe mismatch (indexed effective orifice area ≤ 0.65 cm2/m2) were present in 83% (15 of 18) and 27% (5 of 18) of patients, respectively. We did not notice any complications following the procedures. Six months after the procedure, functional status was improved in all patients. CONCLUSIONS Our short series demonstrates the ability to perform transcatheter 'valve-in-valve' implantation in 19-mm and 21-mm Mitroflow prostheses with satisfactory results, but high post-procedural gradients and patient-prosthesis mismatch remain a relatively frequent problem mostly when severe stenosis is the main mechanism of failure. Implantation in a high position is critical to decrease the rate of high postimplantation gradients.
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Affiliation(s)
- Stéphane Lopez
- Department of Cardiac Surgery, Heart Institute Arnault Tzanck, CHU de Nice, Saint Laurent du Var, France
| | - Pierre Meyer
- Department of Cardiology, Cardiac Catheterization Laboratory, Heart Institute Arnault Tzanck, CHU de Nice, Saint Laurent du Var, France
| | - Jacques Teboul
- Department of Cardiac Surgery, Heart Institute Arnault Tzanck, CHU de Nice, Saint Laurent du Var, France
| | - Pierre Deharo
- Department of Cardiology, Cardiac Catheterization Laboratory, Heart Institute Arnault Tzanck, CHU de Nice, Saint Laurent du Var, France
| | - Alain Mihoubi
- Department of Cardiology, Heart Institute Arnault Tzanck, CHU de Nice, Saint Laurent du Var, France
| | - Jean Pierre Elbeze
- Department of Cardiology, Heart Institute Arnault Tzanck, CHU de Nice, Saint Laurent du Var, France
| | - Diane Lena
- Department of Anesthesiology, Heart Institute Arnault Tzanck, CHU de Nice, Saint Laurent du Var, France
| | - Philippe Camarasa
- Department of Anesthesiology, Heart Institute Arnault Tzanck, CHU de Nice, Saint Laurent du Var, France
| | - Jean Claude Laborde
- Department of Cardiology, Cardiac Catheterization Laboratory, Heart Institute Arnault Tzanck, CHU de Nice, Saint Laurent du Var, France
| | - Laurent Drogoul
- Department of Cardiology, Cardiac Catheterization Laboratory, Heart Institute Arnault Tzanck, CHU de Nice, Saint Laurent du Var, France
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Maeda K, Kuratani T, Yoshioka D, Pak K, Shimamura K, Toda K, Sawa Y. Predicting patient–prosthesis mismatch by aortic root evaluation before aortic valve replacement. J Thorac Cardiovasc Surg 2019; 158:61-69.e4. [DOI: 10.1016/j.jtcvs.2018.11.103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 11/08/2018] [Accepted: 11/25/2018] [Indexed: 11/30/2022]
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114
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Freitas-Ferraz AB, Tirado-Conte G, Dagenais F, Ruel M, Al-Atassi T, Dumont E, Mohammadi S, Bernier M, Pibarot P, Rodés-Cabau J. Aortic Stenosis and Small Aortic Annulus. Circulation 2019; 139:2685-2702. [DOI: 10.1161/circulationaha.118.038408] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Afonso B. Freitas-Ferraz
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.B.F.-F., G.T.-C., F.D., E.D., S.M., M.B., P.P., J.R.-C.)
| | - Gabriela Tirado-Conte
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.B.F.-F., G.T.-C., F.D., E.D., S.M., M.B., P.P., J.R.-C.)
| | - Francois Dagenais
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.B.F.-F., G.T.-C., F.D., E.D., S.M., M.B., P.P., J.R.-C.)
| | - Marc Ruel
- University of Ottawa Heart Institute, University of Ottawa, Ontario, Canada (M.R., T.A.-A.)
| | - Talal Al-Atassi
- University of Ottawa Heart Institute, University of Ottawa, Ontario, Canada (M.R., T.A.-A.)
| | - Eric Dumont
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.B.F.-F., G.T.-C., F.D., E.D., S.M., M.B., P.P., J.R.-C.)
| | - Siamak Mohammadi
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.B.F.-F., G.T.-C., F.D., E.D., S.M., M.B., P.P., J.R.-C.)
| | - Mathieu Bernier
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.B.F.-F., G.T.-C., F.D., E.D., S.M., M.B., P.P., J.R.-C.)
| | - Philippe Pibarot
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.B.F.-F., G.T.-C., F.D., E.D., S.M., M.B., P.P., J.R.-C.)
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (A.B.F.-F., G.T.-C., F.D., E.D., S.M., M.B., P.P., J.R.-C.)
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Sá MPBO, Cavalcanti LRP, Sarargiotto FAS, Perazzo ÁM, Rayol SDC, Diniz RGS, Sá FBCA, Menezes AM, Lima RC. Impact of Prosthesis-Patient Mismatch on 1-Year Outcomes after Transcatheter Aortic Valve Implantation: Meta-analysis of 71,106 Patients. Braz J Cardiovasc Surg 2019; 34:318-326. [PMID: 31310471 PMCID: PMC6629219 DOI: 10.21470/1678-9741-2019-0073] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 04/27/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES This study sought to evaluate the impact of prosthesis-patient mismatch (PPM) on the risk of early-term mortality after transcatheter aortic valve implantation (TAVI). METHODS Databases (Medical Literature Analysis and Retrieval System Online [MEDLINE], Excerpta Medica dataBASE [EMBASE], Cochrane Controlled Trials Register [CENTRAL/CCTR], ClinicalTrials.gov, Scientific Electronic Library Online [SciELO], Latin American and Caribbean Literature on Health Sciences [LILACS], and Google Scholar) were searched for studies published until February 2019. PPM after TAVI was defined as moderate if the indexed effective orifice area (iEOA) was between 0.85 cm2/m2 and 0.65 cm2/m2 and as severe if iEOA ≤ 0.65 cm2/m2. RESULTS The search yielded 1,092 studies for inclusion. Of these, 18 articles were analyzed, and their data extracted. The total number of patients included who underwent TAVI was 71,106. The incidence of PPM after TAVI was 36.3% (25,846 with PPM and 45,260 without PPM). One-year mortality was not increased in patients with any PPM (odds ratio [OR] 1.021, 95% confidence interval [CI] 0.979-1.065, P=0.338) neither in those with moderate PPM (OR 0.980, 95% CI 0.933-1.029, P=0.423). Severe PPM was separately associated with high risk (OR 1.109, 95% CI 1.041-1.181, P=0.001). CONCLUSION The presence of severe PPM after TAVI increased early-term mortality. Although moderate PPM seemed harmless, the findings of this study cannot not rule out the possibility of it being detrimental, since there are other registries that did not address this issue yet.
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Affiliation(s)
- Michel Pompeu Barros Oliveira Sá
- Division of Cardiovascular Surgery of Pronto-Socorro
Cardiológico Universitário de Pernambuco (PROCAPE), Recife, PE,
Brazil
- Nucleus of Postgraduate Studies and Research in Health Sciences at
Faculdade de Ciências Médicas and Instituto de Ciências
Biológicas (FCM/ICB), Recife, PE, Brazil
| | - Luiz Rafael Pereira Cavalcanti
- Division of Cardiovascular Surgery of Pronto-Socorro
Cardiológico Universitário de Pernambuco (PROCAPE), Recife, PE,
Brazil
- Universidade de Pernambuco (UPE), Recife, PE, Brazil
| | - Felipe Augusto Santos Sarargiotto
- Division of Cardiovascular Surgery of Pronto-Socorro
Cardiológico Universitário de Pernambuco (PROCAPE), Recife, PE,
Brazil
- Universidade de Pernambuco (UPE), Recife, PE, Brazil
| | - Álvaro Monteiro Perazzo
- Division of Cardiovascular Surgery of Pronto-Socorro
Cardiológico Universitário de Pernambuco (PROCAPE), Recife, PE,
Brazil
- Universidade de Pernambuco (UPE), Recife, PE, Brazil
| | - Sérgio da Costa Rayol
- Division of Cardiovascular Surgery of Pronto-Socorro
Cardiológico Universitário de Pernambuco (PROCAPE), Recife, PE,
Brazil
- Universidade de Pernambuco (UPE), Recife, PE, Brazil
| | - Roberto Gouveia Silva Diniz
- Division of Cardiovascular Surgery of Pronto-Socorro
Cardiológico Universitário de Pernambuco (PROCAPE), Recife, PE,
Brazil
- Universidade de Pernambuco (UPE), Recife, PE, Brazil
| | - Frederico Browne Correia Araújo Sá
- Division of Cardiovascular Surgery of Pronto-Socorro
Cardiológico Universitário de Pernambuco (PROCAPE), Recife, PE,
Brazil
- Universidade de Pernambuco (UPE), Recife, PE, Brazil
| | - Alexandre Motta Menezes
- Division of Cardiovascular Surgery of Pronto-Socorro
Cardiológico Universitário de Pernambuco (PROCAPE), Recife, PE,
Brazil
- Universidade de Pernambuco (UPE), Recife, PE, Brazil
| | - Ricardo Carvalho Lima
- Division of Cardiovascular Surgery of Pronto-Socorro
Cardiológico Universitário de Pernambuco (PROCAPE), Recife, PE,
Brazil
- Nucleus of Postgraduate Studies and Research in Health Sciences at
Faculdade de Ciências Médicas and Instituto de Ciências
Biológicas (FCM/ICB), Recife, PE, Brazil
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Rajiah P, Moore A, Saboo S, Goerne H, Ranganath P, MacNamara J, Joshi P, Abbara S. Multimodality Imaging of Complications of Cardiac Valve Surgeries. Radiographics 2019; 39:932-956. [PMID: 31150303 DOI: 10.1148/rg.2019180177] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Replacement with a prosthetic heart valve (PHV) remains the definitive surgical procedure for management of severe cardiac valve disease. PHV dysfunction is uncommon but can be a life-threatening condition. The broad hemodynamic and pathophysiologic manifestations of PHV dysfunction are stenosis, regurgitation, and a stuck leaflet. Specific structural abnormalities that cause PHV dysfunction include prosthetic valve-patient mismatch, structural failure, valve calcification, dehiscence, paravalvular leak, infective endocarditis, abscess, pseudoaneurysm, abnormal connections, thrombus, hypoattenuating leaflet thickening, and pannus. Multiple imaging modalities are available for evaluating a PHV and its dysfunction. Transthoracic echocardiography is often the first-line imaging modality, with additional modalities such as transesophageal echocardiography, CT, MRI, cine fluoroscopy, and nuclear medicine used for further characterization and establishing a specific cause. The authors review PHVs and the role of imaging modalities in evaluation of PHV dysfunction and illustrate the imaging appearances of different complications. Online supplemental material is available for this article. ©RSNA, 2019.
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Affiliation(s)
- Prabhakar Rajiah
- From the Department of Radiology, Division of Cardiothoracic Imaging (P. Rajiah, A.M., S.S., H.G., P. Ranganath., S.A.), and Department of Cardiology (J.M., P.J.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6.122G, Mail Code 9316, Dallas, TX 75390-8896; Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.); IMSS Centro Medico Nacional de Occidente, Guadalajara, Mexico (H.G.); and CID Imaging and Diagnostic Center, Guadalajara, Mexico (H.G.)
| | - Alastair Moore
- From the Department of Radiology, Division of Cardiothoracic Imaging (P. Rajiah, A.M., S.S., H.G., P. Ranganath., S.A.), and Department of Cardiology (J.M., P.J.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6.122G, Mail Code 9316, Dallas, TX 75390-8896; Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.); IMSS Centro Medico Nacional de Occidente, Guadalajara, Mexico (H.G.); and CID Imaging and Diagnostic Center, Guadalajara, Mexico (H.G.)
| | - Sachin Saboo
- From the Department of Radiology, Division of Cardiothoracic Imaging (P. Rajiah, A.M., S.S., H.G., P. Ranganath., S.A.), and Department of Cardiology (J.M., P.J.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6.122G, Mail Code 9316, Dallas, TX 75390-8896; Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.); IMSS Centro Medico Nacional de Occidente, Guadalajara, Mexico (H.G.); and CID Imaging and Diagnostic Center, Guadalajara, Mexico (H.G.)
| | - Harold Goerne
- From the Department of Radiology, Division of Cardiothoracic Imaging (P. Rajiah, A.M., S.S., H.G., P. Ranganath., S.A.), and Department of Cardiology (J.M., P.J.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6.122G, Mail Code 9316, Dallas, TX 75390-8896; Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.); IMSS Centro Medico Nacional de Occidente, Guadalajara, Mexico (H.G.); and CID Imaging and Diagnostic Center, Guadalajara, Mexico (H.G.)
| | - Praveen Ranganath
- From the Department of Radiology, Division of Cardiothoracic Imaging (P. Rajiah, A.M., S.S., H.G., P. Ranganath., S.A.), and Department of Cardiology (J.M., P.J.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6.122G, Mail Code 9316, Dallas, TX 75390-8896; Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.); IMSS Centro Medico Nacional de Occidente, Guadalajara, Mexico (H.G.); and CID Imaging and Diagnostic Center, Guadalajara, Mexico (H.G.)
| | - James MacNamara
- From the Department of Radiology, Division of Cardiothoracic Imaging (P. Rajiah, A.M., S.S., H.G., P. Ranganath., S.A.), and Department of Cardiology (J.M., P.J.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6.122G, Mail Code 9316, Dallas, TX 75390-8896; Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.); IMSS Centro Medico Nacional de Occidente, Guadalajara, Mexico (H.G.); and CID Imaging and Diagnostic Center, Guadalajara, Mexico (H.G.)
| | - Parag Joshi
- From the Department of Radiology, Division of Cardiothoracic Imaging (P. Rajiah, A.M., S.S., H.G., P. Ranganath., S.A.), and Department of Cardiology (J.M., P.J.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6.122G, Mail Code 9316, Dallas, TX 75390-8896; Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.); IMSS Centro Medico Nacional de Occidente, Guadalajara, Mexico (H.G.); and CID Imaging and Diagnostic Center, Guadalajara, Mexico (H.G.)
| | - Suhny Abbara
- From the Department of Radiology, Division of Cardiothoracic Imaging (P. Rajiah, A.M., S.S., H.G., P. Ranganath., S.A.), and Department of Cardiology (J.M., P.J.), UT Southwestern Medical Center, 5323 Harry Hines Blvd, E6.122G, Mail Code 9316, Dallas, TX 75390-8896; Department of Radiology, UT Health Science Center, San Antonio, Tex (S.S.); IMSS Centro Medico Nacional de Occidente, Guadalajara, Mexico (H.G.); and CID Imaging and Diagnostic Center, Guadalajara, Mexico (H.G.)
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Kleine Aortenwurzel. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2019. [DOI: 10.1007/s00398-018-0277-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bilkhu R, Jahangiri M, Otto CM. Patient-prosthesis mismatch following aortic valve replacement. Heart 2019; 105:s28-s33. [DOI: 10.1136/heartjnl-2018-313515] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 10/01/2018] [Accepted: 10/14/2018] [Indexed: 01/12/2023] Open
Abstract
Patient-prosthesis mismatch (PPM) occurs when an implanted prosthetic valve is too small for the patient; severe PPM is defined as an indexed effective orifice area (iEOA) <0.65 cm2/m2 following aortic valve replacement (AVR). This review examines articles from the past 10 years addressing the prevalence, outcomes and options for prevention and treatment of PPM after AVR. Prevalence of PPM ranges from 8% to almost 80% in individual studies. PPM is thought to have an impact on mortality, mainly in patients with severe PPM, although severe PPM accounts for only 10–15% of cases. Outcomes of patients with moderate PPM are not significantly different to those without PPM. PPM is associated with higher rates of perioperative stroke and renal failure and lack of left ventricular mass regression. Predictors include female sex, older age, hypertension, diabetes, renal failure and higher surgical risk score. PPM may be a marker of comorbidity rather than a risk factor for adverse outcomes. PPM should be suspected in patients with persistent cardiac symptoms after AVR when there is high prosthetic valve velocity or gradient and a small calculated effective orifice area. After exclusion of other causes of increased transvalvular gradient, re-intervention may be considered if symptoms persist and are unresponsive to medical therapy. However, this decision needs to consider the available options to relieve PPM and whether expected benefits justify the risk of intervention. The only effective intervention is redo surgery with implantation of a larger valve and/or annular enlargement. Therefore, focus needs to be on prevention.
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Moscarelli M, Fattouch K, Speziale G, Nasso G, Santarpino G, Gaudino M, Athanasiou T. A meta-analysis of the performance of small tissue versus mechanical aortic valve prostheses. Eur J Cardiothorac Surg 2019; 56:510-517. [DOI: 10.1093/ejcts/ezz056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/18/2019] [Accepted: 01/19/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
OBJECTIVES
Small aortic prosthetic valves have been associated with suboptimal performance due to patient–prosthesis mismatch (PPM). This meta-analysis compared the outcomes of patients with a small root who received tissue versus mechanical aortic valves.
METHODS
A systematic literature review identified 7 candidate studies; of these, 5 met the meta-analysis criteria. We analysed outcomes for a total of 680 patients (227 tissue valves and 453 mechanical valves) using random effects modelling. Each study was assessed for heterogeneity and quality. The primary end point was mortality at follow-up. Secondary end points included intraoperative and postoperative outcomes, the rate of PPM and left ventricle mass regression and major cardiac and prosthesis-related adverse events at follow-up.
RESULTS
There was no between-group difference in mortality at follow-up [incidence rate ratio 1, 95% confidence interval (CI) 0.50–2.01; P = 0.99]. The tissue group had a higher rate of PPM (odds ratio 17.19, 95% CI 8.6–25.78; P = 0.002) and significantly less reduction in ventricular mass (weighted mean difference 40.79, 95% CI 4.62–76.96; P = 0.02). There were no significant differences in the incidence of structural valve disease at follow-up compared to that in the mechanical valve group. There was also no between-group difference in aggregated adverse events at follow-up (P = 0.68).
CONCLUSIONS
Tissue and mechanical valves were associated with similar mortality rates; however, patients receiving tissue valves had a higher rate of PPM and significantly less left ventricle mass regression. These findings indicate that patients receiving small tissue valves may require closer clinical surveillance than those receiving mechanical valves.
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Affiliation(s)
- Marco Moscarelli
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Cardiac Surgery, GVM Care and Research, Anthea Hospital, Bari, Italy
| | - Khalil Fattouch
- Department of Cardiac Surgery, GVM Care and Research, Anthea Hospital, Bari, Italy
| | - Giuseppe Speziale
- Department of Cardiac Surgery, GVM Care and Research, Anthea Hospital, Bari, Italy
| | - Giuseppe Nasso
- Department of Cardiac Surgery, GVM Care and Research, Anthea Hospital, Bari, Italy
| | - Giuseppe Santarpino
- Department of Cardiac Surgery, GVM Care and Research, Anthea Hospital, Bari, Italy
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College, Paddington, London, UK
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Kamioka N, Arita T, Hanyu M, Hayashi M, Watanabe S, Miura S, Isotani A, Arai Y, Kakumoto S, Ando K, Shirai S. Valve Hemodynamics and Clinical Outcomes After Transcatheter Aortic Valve Replacement for a Small Aortic Annulus. Int Heart J 2019; 60:86-92. [DOI: 10.1536/ihj.17-656] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | | | - Michiya Hanyu
- Department of Cardiovascular Surgery, Kokura Memorial Hospital
| | | | - Shun Watanabe
- Department of Cardiovascular Surgery, Kokura Memorial Hospital
| | - Shiro Miura
- Department of Cardiology, Kokura Memorial Hospital
| | | | - Yoshio Arai
- Department of Cardiovascular Surgery, Kokura Memorial Hospital
| | | | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital
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Sá MPBDO, de Carvalho MMB, Sobral Filho DC, Cavalcanti LRP, Rayol SDC, Diniz RGS, Menezes AM, Clavel MA, Pibarot P, Lima RC. Surgical aortic valve replacement and patient–prosthesis mismatch: a meta-analysis of 108 182 patients. Eur J Cardiothorac Surg 2019; 56:44-54. [DOI: 10.1093/ejcts/ezy466] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 12/10/2018] [Accepted: 12/13/2018] [Indexed: 11/14/2022] Open
Abstract
Abstract
OBJECTIVES
This study sought to evaluate the impact of patient–prosthesis mismatch (PPM) on the risk of perioperative, early-, mid- and long-term mortality rates after surgical aortic valve replacement.
METHODS
Databases were searched for studies published until March 2018. The main outcomes of interest were perioperative mortality, 1-year mortality, 5-year mortality and 10-year mortality.
RESULTS
The search yielded 3761 studies for inclusion. Of these, 70 articles were analysed, and their data were extracted. The total number of patients included was 108 182 who underwent surgical aortic valve replacement. The incidence of PPM after surgical aortic valve replacement was 53.7% (58 116 with PPM and 50 066 without PPM). Perioperative mortality [odds ratio (OR) 1.491, 95% confidence interval (CI) 1.302–1.707; P < 0.001], 1-year mortality (OR 1.465, 95% CI 1.277–1.681; P < 0.001), 5-year mortality (OR 1.358, 95% CI 1.218–1.515; P < 0.001) and 10-year mortality (OR 1.534, 95% CI 1.290–1.825; P < 0.001) were increased in patients with PPM. Both severe PPM and moderate PPM were associated with increased risk of perioperative mortality, 1-year mortality, 5-year mortality and 10-year mortality when analysed together and separately, although we observed a higher risk in the group with severe PPM.
CONCLUSIONS
Moderate/severe PPM increases perioperative, early-, mid- and long-term mortality rates proportionally to its severity. The findings of this study support the implementation of surgical strategies to prevent PPM in order to decrease mortality rates.
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Affiliation(s)
- Michel Pompeu Barros de Oliveira Sá
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco—PROCAPE, Recife, Brazil
- University of Pernambuco—UPE, Recife, Brazil
- Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Institute—FCM/ICB, Recife, Brazil
| | - Martinha Millianny Barros de Carvalho
- University of Pernambuco—UPE, Recife, Brazil
- Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Institute—FCM/ICB, Recife, Brazil
| | - Dário Celestino Sobral Filho
- University of Pernambuco—UPE, Recife, Brazil
- Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Institute—FCM/ICB, Recife, Brazil
| | - Luiz Rafael Pereira Cavalcanti
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco—PROCAPE, Recife, Brazil
- University of Pernambuco—UPE, Recife, Brazil
| | - Sérgio da Costa Rayol
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco—PROCAPE, Recife, Brazil
- University of Pernambuco—UPE, Recife, Brazil
| | - Roberto Gouvea Silva Diniz
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco—PROCAPE, Recife, Brazil
- University of Pernambuco—UPE, Recife, Brazil
| | - Alexandre Motta Menezes
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco—PROCAPE, Recife, Brazil
- University of Pernambuco—UPE, Recife, Brazil
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Canada
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Canada
| | - Ricardo Carvalho Lima
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco—PROCAPE, Recife, Brazil
- University of Pernambuco—UPE, Recife, Brazil
- Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Institute—FCM/ICB, Recife, Brazil
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Iqbal A, Panicker VT, Karunakaran J. Patient prosthesis mismatch and its impact on left ventricular regression following aortic valve replacement in aortic stenosis patients. Indian J Thorac Cardiovasc Surg 2019; 35:6-14. [PMID: 33060963 DOI: 10.1007/s12055-018-0706-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 06/14/2018] [Accepted: 07/13/2018] [Indexed: 01/20/2023] Open
Abstract
Introduction Patient prosthesis mismatch is known to alter post-operative remodeling of left ventricle adversely in aortic stenosis patients. An indexed orifice area of 0.85 is considered as conventional cutoff for patient prosthesis mismatch based on hemodynamic principles. Many patients have smaller annulus and annulus enlargement techniques may be required to avoid this benchmark which complicates the surgery. Aims and objectives To determine incidence of patient prosthesis mismatch (PPM) in our population, to assess left ventricle (LV) regression and impact of indexed effective orifice area on LV regression, and to determine a minimum acceptable cut off indexed orifice area that will result in LV regression. Materials and methods A single-center retrospective observational study of all patients who underwent aortic valve replacement surgery for severe aortic stenosis between July 2015 and December 2015 was conducted. Patients who underwent concomitant revascularization or other valve surgery were excluded. Data regarding conventional risk factors for PPM, valve type, and indexed orifice area as well as pre-operative and late post-operative LV mass were collected. Observations Thirty-seven of the 91 patients satisfied inclusion criteria. All patients had significant regression in LV mass. The incidence of PPM was 68%. Regression of indexed left ventricular mass showed a positive correlation of with indexed effective orifice area of the prosthetic valve. The correlation coefficient is + 0.48 (95% CI 0.18-0.698). Left ventricular mass regression was significantly higher in patients with indexed effective orifice area more than 0.75 (68.89 ± 29 vs 122.55 ± 58.84, p = 0.028). Relative left ventricular regression also was significantly higher in patients with an indexed effective orifice area more than 0.75 (39.53 ± 13.13 vs 49.73 ± 15.56, p = 0.022). There is a positive correlation between left ventricular regression and the reduction in mean gradient achieved by valve replacement. The correlation coefficient was + 0.35 (95% CI 0.03-0.61). Conclusions The incidence of PPM was found to be comparable to literature. There is a positive correlation between left ventricular regression and indexed effective orifice area of the prosthetic valve. Left ventricular regression was significantly higher in patients with an indexed effective area more than 0.75. This can be considered as criteria for significant PPM in study population.
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Affiliation(s)
- Abid Iqbal
- Department of Cardio Vascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala 695011 India
| | - Varghese Thomas Panicker
- Department of Cardio Vascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala 695011 India
| | - Jayakumar Karunakaran
- Department of Cardio Vascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala 695011 India
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Del Bene MR, Barletta G, Venditti F, Di Mario C, Blanzola C, Stefàno P. Left ventricular mass regression after aortic valve replacement: Sex differences or effect of different methods of indexation? Echocardiography 2018; 36:219-228. [DOI: 10.1111/echo.14221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/07/2018] [Accepted: 11/08/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
| | | | | | - Carlo Di Mario
- Structural Interventional CardiologyCareggi University Hospital Florence Italy
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Incidence and impact of prosthesis–patient mismatch following transcatheter aortic valve implantation. Clin Res Cardiol 2018; 108:660-668. [DOI: 10.1007/s00392-018-1394-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 11/15/2018] [Indexed: 12/28/2022]
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Stented versus Stentless Aortic Valve Replacement in Patients with Small Aortic Root. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018; 13:404-416. [DOI: 10.1097/imi.0000000000000569] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective The aim of the study was to compare hemodynamic and perioperative outcomes of stented against stentless aortic valve replacement in patients with small aortic root (21 mm or less). Methods A comprehensive search was undertaken among the four major databases (PubMed, Embase, Scopus, and Ovid) to identify all randomized and nonrandomized controlled trials comparing stentless to stented bioprosthetic valves in small aortic root patients. Odds ratios, weighted mean differences, or standardized mean differences and their 95% confidence intervals were analyzed. Results A total of seven studies with a total of 965 patients fulfilled the inclusion criteria. There was no significant difference in preoperative baselines including mean age between both groups ( P = 0.08), peak aortic valve gradient ( P = 0.06), and effective orifice area ( P = 0.28), whereas higher mean aortic valve gradient in the stented group ( P = 0.007). No difference in cardiopulmonary bypass time ( P = 0.74), aortic cross-clamp times ( P = 0.88), intensive care unit stay ( P = 0.13), and stroke rate ( P = 0.56) were noted. However, stented group of patients showed higher rate of patient prosthesis mismatch ( P = 0.0001) and longer total hospital stay ( P = 0.002). Postoperatively, stentless group showed lower peak and mean aortic valve gradient ( P = 0.003 and P = 0.008, respectively) with a better effective orifice area ( P < 0.00001) at 6 months of follow-up. Mortality rates while in-hospital and at 1 year were similar in both groups ( P = 0.94 and P = 0.86, respectively). Conclusions Stentless aortic valves offer superior short-term hemodynamic outcomes in patients with small aortic root when compared with stented aortic valves. Although both groups have similar perioperative complications rates, stentless valves bring about a shorter hospital stay. A further large multicenter randomized controlled trial should address the longer-term benefit of stentless aortic valve over stented valve.
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De Vecchi A, Marlevi D, Nordsletten DA, Ntalas I, Leipsic J, Bapat V, Rajani R, Niederer SA. Left ventricular outflow obstruction predicts increase in systolic pressure gradients and blood residence time after transcatheter mitral valve replacement. Sci Rep 2018; 8:15540. [PMID: 30341365 PMCID: PMC6195528 DOI: 10.1038/s41598-018-33836-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 10/01/2018] [Indexed: 11/14/2022] Open
Abstract
Left ventricular outflow tract (LVOT) obstruction is a relatively common consequence of transcatheter mitral valve replacement (TMVR). Although LVOT obstruction is associated with heart failure and adverse remodelling, its effects upon left ventricular hemodynamics remain poorly characterised. This study uses validated computational models to identify the LVOT obstruction degree that causes significant changes in ventricular hemodynamics after TMVR. Seven TMVR patients underwent personalised flow simulations based on pre-procedural imaging data. Different virtual valve configurations were simulated in each case, for a total of 32 simulations, and the resulting obstruction degree was correlated with pressure gradients and flow residence times. These simulations identified a threshold LVOT obstruction degree of 35%, beyond which significant deterioration of systolic function was observed. The mean increase from baseline (pre-TMVR) in the peak systolic pressure gradient rose from 5.7% to 30.1% above this threshold value. The average blood volume staying inside the ventricle for more than two cycles also increased from 4.4% to 57.5% for obstruction degrees above 35%, while the flow entering and leaving the ventricle within one cycle decreased by 13.9%. These results demonstrate the unique ability of modelling to predict the hemodynamic consequences of TMVR and to assist in the clinical decision-making process.
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Affiliation(s)
- Adelaide De Vecchi
- Department of Biomedical Engineering, School of Imaging Sciences & Biomedical Engineering, King's College London, King's Health Partners, St Thomas Hospital, London, SE1 7EH, UK.
| | - David Marlevi
- School of Technology and Health, KTH Royal Institute of Technology, Hälsovägen 11C, 141 52, Huddinge, Sweden
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, 17177, Stockholm, Sweden
| | - David A Nordsletten
- Department of Biomedical Engineering, School of Imaging Sciences & Biomedical Engineering, King's College London, King's Health Partners, St Thomas Hospital, London, SE1 7EH, UK
| | - Ioannis Ntalas
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jonathon Leipsic
- Department of Radiology and Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Vinayak Bapat
- Department of Surgery, Columbia University Medical Center, New York, NY, 10032, USA
| | - Ronak Rajani
- Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Steven A Niederer
- Department of Biomedical Engineering, School of Imaging Sciences & Biomedical Engineering, King's College London, King's Health Partners, St Thomas Hospital, London, SE1 7EH, UK
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127
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Sénage T, Gillaizeau F, Le Tourneau T, Marie B, Roussel JC, Foucher Y. Structural valve deterioration of bioprosthetic aortic valves: An underestimated complication. J Thorac Cardiovasc Surg 2018; 157:1383-1390.e5. [PMID: 30415900 DOI: 10.1016/j.jtcvs.2018.08.086] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 07/30/2018] [Accepted: 08/03/2018] [Indexed: 02/09/2023]
Abstract
OBJECTIVES Structural valve deterioration (SVD) remains a major bioprosthesis-related complication, as recently described for the Mitroflow valve (models LX and 12A) (LivaNova, London, United Kingdom). The real incidence of the SVD risk remains unclear, often due to methodologic pitfalls by systematically using the Kaplan-Meier estimator and/or the Cox model. In this report, we propose for the first time a precise statistical modeling of this issue. METHODS Five hundred sixty-one patients who underwent aortic valve replacement with the aortic Mitroflow valve between 2002 and 2007 were included. We used an illness-death model for interval-censored data. Median follow-up was 6.6 years; 103 cases of SVD were diagnosed. RESULTS The 4-year and 7-year SVD cumulative incidences after the first anniversary of surgery were 15.2% (95% confidence interval, 11.9-19.1) and 31.0% (95% confidence interval, 25.8-37.2), respectively. Female gender, dyslipidemia, chronic obstructive pulmonary disease, and severe patient-prosthesis mismatch were significant risk factors of SVD. The occurrence of SVD was associated with a 2-fold increase in the risk of death. CONCLUSIONS Appropriate statistical models should be used to avoid underestimating the SVD complication associated with worse long-term survival.
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Affiliation(s)
- Thomas Sénage
- INSERM UMR 1246 - SPHERE for Nantes University, Tours University, Tours, France; Cardiothoracic Surgical Unit, Thorax Institute, St Herblain, France.
| | - Florence Gillaizeau
- INSERM UMR 1246 - SPHERE for Nantes University, Tours University, Tours, France; Center for Research in Transplantation and Immunology, Institute of Transplantation Urology and Nephrology, St Herblain, France; Department of Statistical Science for University College London, London, United Kingdom
| | - Thierry Le Tourneau
- Department of Physiology, Thorax Institute, St Herblain, France; National Center for Scientific Research (CNRS) UMR 6291, for University of Nantes, St Herblain, France
| | - Basile Marie
- Cardiothoracic Surgical Unit, Thorax Institute, St Herblain, France
| | | | - Yohann Foucher
- INSERM UMR 1246 - SPHERE for Nantes University, Tours University, Tours, France; Center for Research in Transplantation and Immunology, Institute of Transplantation Urology and Nephrology, St Herblain, France
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128
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Mannam G, Mishra Y, Modi R, Gokhale AGK, Sethuratnam R, Pandey K, Malhotra R, Anand S, Borah A, Mukhopadhyay S, Shah D, Mahant TS. Early hemodynamic performance of the Trifecta™ surgical bioprosthesis aortic valve in Indian patient population: 12 month outcomes of the EVEREST post-market study. J Cardiothorac Surg 2018; 13:96. [PMID: 30253784 PMCID: PMC6157043 DOI: 10.1186/s13019-018-0783-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 08/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Indian patients undergoing surgical aortic valve replacement (SAVR) differ from western populations with respect to aortic annulus size and valve disease morphology. The purpose of this post-market, non-randomized observational study was to evaluate the early hemodynamic performance of the Trifecta™ bioprosthesis (Abbott, previously St. Jude Medical, Minneapolis, US) in an Indian patient population. METHODS From January 2014 to September 2015, 100 patients (mean age 64.4 ± 7.1 years, 62% male) undergoing SAVR for valve disease (68% stenosis, 7% insufficiency, 25% mixed pathology) were enrolled across 10 centers in India. Patients implanted with a 19-27 mm Trifecta™ valve were eligible to participate and were prospectively followed for 12-months post-implantation. Echocardiographic hemodynamic performance was evaluated at pre-implant, pre-discharge and at 12-months by an independent core laboratory. Adverse events were adjudicated by the study sponsor. Functional status at 12-months was assessed according to NYHA classification. Continuous data was summarized using descriptive statistics (mean &standard deviation,) and categorical data was summarized using frequencies and percentages. RESULT Ninety patients (mean age 64.5, 62.2% male) completed the 12-month follow up. Significant improvements in hemodynamic valve performance were reported in 81 patients with available echocardiographic data at 12 months. Compared to baseline at 12-month follow up visit, mean effective orifice area increased from 0.75cm2 to 1.61cm2 (p < 0.0001), mean pressure gradient reduced to 10.42 mmHg from 51.47 mmHg (p < 0.0001), cardiac output increased from 4.46 l/min to 4.85 l/min (P 0.9254). Compared to baseline, functional status improved by ≥1 NYHA class in 75% of patients at 12 months (95% Clopper-Pearson (Exact) confidence limit [64.6%, 83.6%]). No instances of early mortality (< 30 days from index procedure) or structural valve dysfunction were reported. CONCLUSION In an Indian patient population, implantation of the Trifecta™ bioprosthesis is shown to be safe and associated with favorable early hemodynamic performance and improved functional status at 12 months. TRIAL REGISTRATION The clinical study has been registered under Clinical Trial Registry-India ( http://www.ctri.nic.in ) and registration number is CTRI/2014/02/004434 registered on 25 February 2014 retrospectively registered.
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Affiliation(s)
- Gopichand Mannam
- Department of cardiac surgery, Star Hospital Banjara Hills, 8-2-596/5, Road No.10, Banjara Hills, Hyderabad, Telangana, 500034, India.
| | - Yugal Mishra
- Department of cardiac surgery, Escorts Heart Institute and Research Centre, New Delhi, India
| | - Rajan Modi
- Department of cardiac surgery, SAL Hospital, Ahmedabad, India
| | | | - Rajan Sethuratnam
- Department of cardiac surgery, The Madras Medical Mission, Chennai, India
| | - Kaushal Pandey
- Department of cardiac surgery, P. D. Hinduja National Hospital & Medical Research Center, Mumbai, India
| | - Rajneesh Malhotra
- Department of cardiac surgery, Max Super Speciality Hospital, New Delhi, India
| | | | | | | | - Dhiren Shah
- Department of cardiac surgery, Care Institute of Medical Sciences, Ahmedabad, India
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129
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Carter-Storch R, Dahl JS, Christensen NL, Søndergaard EV, Irmukhamedov A, Pecini R, Hassager C, Marcussen N, Møller JE. Exercise Hemodynamics After Aortic Valve Replacement for Severe Aortic Stenosis. J Am Soc Echocardiogr 2018; 31:1091-1100. [PMID: 30143436 DOI: 10.1016/j.echo.2018.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Severe aortic stenosis (AS) is often accompanied by diastolic dysfunction. After aortic valve replacement (AVR), the left ventricle often undergoes considerable reverse remodeling. Despite this, diastolic dysfunction may persist after AVR. The aims of this study were to determine the incidence of elevated left ventricular (LV) filling pressure at rest and during exercise among patients with severe AS after AVR and to describe factors related to elevated LV filling pressure, especially its association with LV and left atrial remodeling and myocardial fibrosis. METHODS Thirty-seven patients undergoing AVR were included. Echocardiography, cardiac computed tomography, and magnetic resonance imaging were performed before AVR. An LV biopsy sample was obtained during AVR and analyzed for collagen fraction. One year after AVR, right heart catheterization with exercise was performed. A mean pulmonary capillary wedge pressure (PCWP) ≥ 28 mm Hg during exercise was considered elevated. RESULTS Twelve patients (32%) had elevated exercise PCWP 1 year after AVR. Exercise PCWP was highest among patients undergoing concomitant coronary artery bypass graft surgery (30 ± 7 vs 25 ± 6 mm Hg, P = .04) and among patients with preoperative stroke volume index < 35 mL/m2 (28 ± 8 vs 23 ± 4 mm Hg, P < .05). Baseline LV ejection fraction was lower among patients with elevated PCWP (56 ± 8% vs 64 ± 8%, P = .01), and coronary calcium score was significantly higher (median 870 AU [interquartile range, 454-2,491 AU] vs 179 AU [interquartile range, 63-513 AU], P = .02). Conversely, exercise PCWP was not related to the presence of high LV wall mass or to the severity of AS. Among patients undergoing isolated AVR, there was a correlation between LV interstitial volume fraction and PCWP (r = 0.57, P = .01) and mean pulmonary artery pressure (r = 0.51, P = .03) during exercise. CONCLUSIONS Elevated filling pressure during exercise was seen in one third of patients after AVR in this population and was seen primarily among patients with coexisting ischemic heart disease or diffuse myocardial fibrosis but was unrelated to preoperative severity of AS and LV remodeling.
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Affiliation(s)
- Rasmus Carter-Storch
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Odense Patient Data Explorative Network, Odense, Denmark.
| | - Jordi S Dahl
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Eva V Søndergaard
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Redi Pecini
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Christian Hassager
- Heart Center Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Niels Marcussen
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Jacob E Møller
- Department of Cardiology, Odense University Hospital, Odense, Denmark; Odense Patient Data Explorative Network, Odense, Denmark
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130
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de Agustin JA, Islas F, Jimenez-Quevedo P, Nombela-Franco L, Rueda Liñares A, Mahia P, Marcos-Alberca P, Pozo E, Gomez de Diego JJ, Luaces M, Nuñez-Gil IJ, Garcia-Fernandez MÁ, Fernandez-Ortiz A, Macaya C, Perez de Isla L. Discongruence Index - Simple Indicator to Predict Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement. Circ J 2018; 82:2880-2886. [PMID: 30135324 DOI: 10.1253/circj.cj-18-0298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) remains an important issue. The aim of this study was to assess the value of a new discongruence index, to predict PPM after TAVR.Methods and Results: A total of 185 patients with severe aortic stenosis who underwent TAVR with the Edwards Sapien prosthesis or CoreValve Revalving system were included (Edwards valve, n=119; Core Valve Revalving system, n=66). Discongruence index was calculated pre-procedurally as the ratio of selected transcatheter valve size (mm) to body surface area (cm2). PPM was defined as effective orifice area (EOA) ≤0.85 cm2/m2 on transthoracic echocardiography before hospital discharge. Mean age was 82±5 years and 72 patients (38.9%) were men. The overall incidence of post-TAVR PPM was 35.1% (n=65). Discongruence index correlated with post-TAVR indexed EOA (y=0.18+0.057x; P<0.001). On multivariate logistic regression analysis, discongruence index was the only independent predictor of post-TAVR PPM (OR, 0.15; 95% CI: 0.03-0.66; P=0.012), and the area under the receiver operating characteristic curve was 0.62 (95% CI: 0.54-0.70, P=0.003), with an optimal cut-off point of 15.02 (sensitivity, 86.2%; specificity, 72.5%; positive predictive value, 74.3%; negative predictive value, 83.4%). CONCLUSIONS The new discongruence index may be useful tool to predict PPM after TAVR.
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Affiliation(s)
| | - Fabian Islas
- Cardiovascular Institute, San Carlos University Clinical Hospital
| | | | | | | | - Patricia Mahia
- Cardiovascular Institute, San Carlos University Clinical Hospital
| | | | - Eduardo Pozo
- Cardiovascular Institute, San Carlos University Clinical Hospital
| | | | - Maria Luaces
- Cardiovascular Institute, San Carlos University Clinical Hospital
| | | | | | | | - Carlos Macaya
- Cardiovascular Institute, San Carlos University Clinical Hospital
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131
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Issa IF, Poulsen SH, Waziri F, Torp Pedersen C, Nielsen PH, Riber L, Dahl JS, Søgaard P, Nørgaard MA, Møller JE. Structural valve deterioration in the Mitroflow biological heart valve prosthesis. Eur J Cardiothorac Surg 2018; 53:136-142. [PMID: 29029140 DOI: 10.1093/ejcts/ezx321] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 07/30/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Concern has been raised regarding the long-term durability of the Mitroflow biological heart valve prosthesis. Our aim was to assess the incidence of structural valve degeneration (SVD) for the Mitroflow bioprosthesis in a nationwide study in Denmark including all patients alive in Denmark who had received a Mitroflow aortic bioprosthesis since 2000. METHODS Patients alive in Denmark with a Mitroflow bioprosthesis implanted since January 2000 were invited to participate in a nationwide cross-sectional study with a predefined definition of SVD. Of 1552 patients, 861 patients had died and 47 patients had been reoperated with 40 reoperations due to SVD. The remaining 644 patients were invited for evaluation; 574 patients accepted and were evaluated for SVD. The incidence of SVD was calculated using competing risk regression analysis with death as the competing event. RESULTS A total of 173 patients were diagnosed with SVD by echocardiography. Of these, 64 (11%) patients had severe SVD and 109 (19%) patients moderate SVD. Severe SVD was associated with the age of the prosthesis and small prosthesis size [Size 21: hazard ratio (95% confidence interval, CI) 2.72 (0.97-8.56), P = 0.06; Size 19: 6.26 (1.63-24.06), P = 0.008]. The cumulative incidences of reoperation or severe SVD at Year 9 were 12.5% for Size 19, 7.6% for Size 21 and 3.1 (1.2-6.4)% for Size 23. Median survival in patients with prosthesis Sizes 23-29 was 6.4 (95% CI 5.7-7.0) years, with Size 21 it was 6.5 (95% CI 5.9-7.1) years and with Size 19 it was 6.9 (95% CI 5.7-8.2) years (P = 0.78). CONCLUSIONS The incidence of undetected severe SVD was as high as the incidence of operated SVD. The overall risk for SVD is high for the Mitroflow bioprosthesis, especially if the prosthesis is small and older than 5 years.
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Affiliation(s)
- Issa Farah Issa
- Department of Cardiology and OPEN-Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | | | - Farhad Waziri
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | | | - Per Hostrup Nielsen
- Department of Cardiothoracic Surgery, Aarhus University Hospital, Skejby, Denmark
| | - Lars Riber
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - Jordi S Dahl
- Department of Cardiology and OPEN-Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Martin Agge Nørgaard
- Department of Cardiology and Cardiothoracic and Vascular Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology and OPEN-Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
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132
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Ibrahim M, Spelde AE, Carter TI, Patel PA, Desai N. The Ross Operation in the Adult: What, Why, and When? J Cardiothorac Vasc Anesth 2018. [DOI: 10.1053/j.jvca.2017.12.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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133
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Ammannaya GKK, Mishra P, Khandekar JV, Mohapatra CKR, Seth HS, Raut C, Shah V, Saini JS. Effect of prosthesis patient mismatch in mitral position on pulmonary hypertension. Eur J Cardiothorac Surg 2018; 52:1168-1174. [PMID: 28591821 DOI: 10.1093/ejcts/ezx167] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 04/27/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Pulmonary arterial hypertension (PAH) is associated with poor outcome after mitral valve replacement (MVR). We proposed to evaluate the effect of valve prosthesis patient mismatch (PPM) on pulmonary arterial (PA) pressure following MVR. METHODS Five hundred patients who have undergone MVR were studied retrospectively. Postoperative PA systolic pressure (PASP) measured 6 months postoperatively by Doppler echocardiography was compared with preoperative values. PASP ≥ 40 mmHg was defined as PAH. Mitral valve effective orifice area was calculated by the continuity equation and indexed for body surface area. PPM was defined as indexed effective orifice area ≤ 1.2 cm2/m2. A multivariate model was constructed to ascertain the independent determinants of systolic PA pressure. Also, a propensity score model was constructed to overcome the baseline differences between the PPM and no PPM groups. RESULTS The incidence of PPM in this study was 37.2%. The average postoperative PASPs were 30.49 and 42.35 mmHg in the no PPM and PPM groups, respectively; (P < 0.001). Regression of PAH in the PPM and no PPM groups was 76.26% and 20.64%, respectively; (P < 0.001). The indexed effective orifice area correlated well with postoperative PASP (r = 0.71). The overall survival and freedom from cardiac death at 10 years were 79.8% and 85.3%; and at 20 years were 66.5% and 74.3%, respectively. Both, overall survival and the freedom from cardiac death were higher in the no PPM group than in the PPM group; (P < 0.001). Propensity score matching analysis yielded 112 pairs of the PPM and no PPM cohorts, which revealed higher overall survival and freedom from cardiac death in the no PPM group; (P = 0.028 and 0.012, respectively). CONCLUSIONS Mitral PPM is an independent predictor of persistent PAH after MVR along with associated morbidity and reduced survival.
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Affiliation(s)
- Ganesh Kumar K Ammannaya
- Department of Cardiovascular & Thoracic Surgery, Lokmanya Tilak Municipal Medical College & General Hospital, Mumbai, India
| | - Prashant Mishra
- Department of Cardiovascular & Thoracic Surgery, Lokmanya Tilak Municipal Medical College & General Hospital, Mumbai, India
| | - Jayant V Khandekar
- Department of Cardiovascular & Thoracic Surgery, Lokmanya Tilak Municipal Medical College & General Hospital, Mumbai, India
| | - Chandan Kumar Ray Mohapatra
- Department of Cardiovascular & Thoracic Surgery, Lokmanya Tilak Municipal Medical College & General Hospital, Mumbai, India
| | - Harsh S Seth
- Department of Cardiovascular & Thoracic Surgery, Lokmanya Tilak Municipal Medical College & General Hospital, Mumbai, India
| | - Chaitanya Raut
- Department of Cardiovascular & Thoracic Surgery, Lokmanya Tilak Municipal Medical College & General Hospital, Mumbai, India
| | - Vaibhav Shah
- Department of Cardiovascular & Thoracic Surgery, Lokmanya Tilak Municipal Medical College & General Hospital, Mumbai, India
| | - Jaskaran S Saini
- Department of Cardiovascular & Thoracic Surgery, Lokmanya Tilak Municipal Medical College & General Hospital, Mumbai, India
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134
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Shivaraju A, Michel J, Frangieh AH, Ott I, Thilo C, Schunkert H, Kastrati A, Leon MB, Dvir D, Kodali S, Bapat V, Guerrero M, Kasel AM. Transcatheter Aortic and Mitral Valve-in-Valve Implantation Using the Edwards Sapien 3 Heart Valve. J Am Heart Assoc 2018; 7:JAHA.117.007767. [PMID: 29982230 PMCID: PMC6064864 DOI: 10.1161/jaha.117.007767] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Anupama Shivaraju
- Department for Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,Department of Cardiology, Advocate Christ Medical Center, Oak Lawn, IL
| | - Jonathan Michel
- Department for Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Antonio H Frangieh
- Department for Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Ilka Ott
- Department for Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Christian Thilo
- Department of Cardiology, Klinikum Augsburg Herzzentrum Augsburg-Schwaben, Augsburg, Germany
| | - Heribert Schunkert
- Department for Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,Deutsches Zentrum für Herz- und Kreislauferkrankungen (DZHK), partner site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- Department for Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,Deutsches Zentrum für Herz- und Kreislauferkrankungen (DZHK), partner site Munich Heart Alliance, Munich, Germany
| | - Martin B Leon
- Division of Cardiology, Columbia University Medical Center, New York, NY
| | - Danny Dvir
- University of Washington Medical Center, Seattle, WA
| | - Susheel Kodali
- Division of Cardiology, Columbia University Medical Center, New York, NY
| | - Vinayak Bapat
- Division of Cardiology, Columbia University Medical Center, New York, NY
| | - Mayra Guerrero
- Evanston Hospital/NorthShore University Health System, University of Chicago Pritzker School of Medicine, Evanston, IL
| | - Albert M Kasel
- Department for Cardiovascular Diseases, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
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135
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Nardi P, Russo M, Saitto G, Ruvolo G. The Prognostic Significance of Patient-Prosthesis Mismatch after Aortic Valve Replacement. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 51:161-166. [PMID: 29854659 PMCID: PMC5973211 DOI: 10.5090/kjtcs.2018.51.3.161] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 02/02/2018] [Accepted: 02/07/2018] [Indexed: 11/16/2022]
Abstract
Patient-prosthesis mismatch (PPM) is a controversial issue in current clinical practice. PPM has been reported to have a negative impact on patients’ prognosis after aortic valve replacement in several studies, showing increased all-cause and cardiac mortality. Moreover, a close relationship has recently been described between PPM and structural valve deterioration in biological prostheses. In patients at risk for PPM, several issues should be considered, and in the current era of cardiac surgery, preoperative planning should consider the different types of valves available and the various surgical techniques that can be used to prevent PPM. The present paper analyses the state of the art of the PPM issue.
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Affiliation(s)
- Paolo Nardi
- Cardiac Surgery Division, Tor Vergata University Policlinic of Rome
| | - Marco Russo
- Cardiac Surgery Division, Tor Vergata University Policlinic of Rome
| | - Guglielmo Saitto
- Cardiac Surgery Division, Tor Vergata University Policlinic of Rome
| | - Giovanni Ruvolo
- Cardiac Surgery Division, Tor Vergata University Policlinic of Rome
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136
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Surgical Enlargement of the Aortic Root Does Not Increase the Operative Risk of Aortic Valve Replacement. Circulation 2018; 137:1585-1594. [DOI: 10.1161/circulationaha.117.030525] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 11/03/2017] [Indexed: 11/16/2022]
Abstract
Background:
Surgical aortic root enlargement (ARE) during aortic valve replacement (AVR) allows for larger prosthesis implantation and may be an important adjunct to surgical AVR in the transcatheter valve-in-valve era. The incremental operative risk of adding ARE to AVR has not been established. We aimed to evaluate the early outcomes of patients undergoing AVR with or without ARE.
Methods:
From January 1990 to August 2014, 7039 patients underwent AVR (AVR+ARE, n=1854; AVR, n=5185) at a single institution. Patients with aortic dissection and active endocarditis were excluded. Mean age was 65±14 years and 63% were male. Logistic regression and propensity score matching were used to adjust for unbalanced variables in group comparisons.
Results:
Patients undergoing AVR+ARE were more likely to be female (46% versus 34%,
P
<0.001) and had higher rates of previous cardiac surgery (18% versus 12%,
P
<0.001), chronic obstructive pulmonary disease (5% versus 3%,
P
=0.004), urgent/emergent status (6% versus 4%,
P
=0.01), and worse New York Heart Association status (
P
<0.001). Most patients received bioprosthetic valves (AVR+ARE: 73.4% versus AVR: 73.3%,
P
=0.98) and also underwent concomitant cardiac procedures (AVR+ARE: 68% versus AVR: 67%,
P
=0.31). Mean prosthesis size implanted was slightly smaller in patients requiring AVR+ARE versus AVR (23.4±2.1 versus 24.1±2.3,
P
<0.001). In-hospital mortality was higher after AVR+ARE (4.3% versus 3.0%,
P
=0.008), although when the cohort was restricted to patients undergoing isolated aortic valve replacement with or without root enlargement, mortality was not statistically different (AVR+ARE: 1.7% versus AVR: 1.1%,
P
=0.29). After adjustment for baseline characteristics, AVR+ARE was not associated with an increased risk of in-hospital mortality when compared with AVR (odds ratio, 1.03; 95% confidence interval, 0.75–1.41;
P
=0.85). Furthermore, AVR+ARE was not associated with an increased risk of postoperative adverse events. Results were similar if propensity matching was used instead of multivariable adjustments for baseline characteristics.
Conclusions:
In the largest analysis to date, ARE was not associated with increased risk of mortality or adverse events. Surgical ARE is a safe adjunct to AVR in the modern era.
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137
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Mahmood F, Matyal R, Mahmood F, Sheu RD, Feng R, Khabbaz KR. Intraoperative Echocardiographic Assessment of Prosthetic Valves: A Practical Approach. J Cardiothorac Vasc Anesth 2018; 32:823-837. [DOI: 10.1053/j.jvca.2017.10.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Indexed: 12/30/2022]
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138
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Miyasaka M, Tada N, Taguri M, Kato S, Enta Y, Otomo T, Hata M, Watanabe Y, Naganuma T, Araki M, Yamanaka F, Shirai S, Ueno H, Mizutani K, Tabata M, Higashimori A, Takagi K, Yamamoto M, Hayashida K. Incidence, Predictors, and Clinical Impact of Prosthesis–Patient Mismatch Following Transcatheter Aortic Valve Replacement in Asian Patients. JACC Cardiovasc Interv 2018; 11:771-780. [DOI: 10.1016/j.jcin.2018.01.273] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 01/25/2018] [Accepted: 01/30/2018] [Indexed: 11/16/2022]
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139
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Impact of Annular Size on Outcomes After Surgical or Transcatheter Aortic Valve Replacement. Ann Thorac Surg 2018; 105:1129-1136. [DOI: 10.1016/j.athoracsur.2017.08.059] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 08/11/2017] [Accepted: 08/15/2017] [Indexed: 11/20/2022]
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140
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Belluschi I, Moriggia S, Giacomini A, Del Forno B, Di Sanzo S, Blasio A, Scafuri A, Alfieri O. Can Perceval sutureless valve reduce the rate of patient-prosthesis mismatch?†. Eur J Cardiothorac Surg 2018; 51:1093-1099. [PMID: 28329177 DOI: 10.1093/ejcts/ezx009] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 12/17/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The aim of this study is to compare the theoretical incidence of patient-prosthesis mismatch (PPM) in patients undergoing a sutureless or a sutured aortic valve replacement using an exact statistical matching. METHODS Between May 2012 and March 2016, 65 patients with severe symptomatic aortic stenosis underwent a sutureless aortic valve replacement with the Perceval bioprosthesis in 2 centres. Moreover, 177 aortic valve replacements with conventional sutured bioprosthesis were performed between August 2003 and September 2015. Perceval and sutured patients were 1:1 exactly matched for sex and body surface area (BSA), resulting in 62 couples (sutureless: BSA 1.77 ± 0.16 m 2 , female 62.9% vs sutured: BSA 1.77 ± 0.15 m 2 , female 62.9%). RESULTS After matching, the indexed effective orifice area was 1.50 ± 0.18 cm 2 /m 2 and 0.81 ± 0.19 cm 2 /m 2 in the sutureless and the sutured group, respectively ( P < 0.001). No PPM occurred in patients who received a Perceval bioprosthesis ( n = 62). In the sutured group ( n = 62), 38 patients (61.3%) developed a PPM, which was moderate in 41.9% ( n = 26) and severe in 19.4% ( n = 12) ( P < 0.001). CONCLUSIONS The indexed effective orifice area of the sutureless group was significantly larger than in the sutured one. The incidence of PPM with the conventional sutured biprosthesis was 61.3%, while it decreases to 0% in the sutureless group. No PPM was reported in the sutureless valve group. Therefore, the Perceval sutureless valve provides larger effective orifice areas compared to the sutured conventional bioprosthesis and could be considered as a good option to reduce the risk of a PPM.
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Affiliation(s)
- Igor Belluschi
- Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
| | - Stefano Moriggia
- Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
| | - Andrea Giacomini
- Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
| | - Benedetto Del Forno
- Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
| | - Stefania Di Sanzo
- Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
| | - Andrea Blasio
- Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
| | - Antonio Scafuri
- Department of Cardiac Surgery, Tor Vergata University of Rome, Rome, Italy
| | - Ottavio Alfieri
- Department of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy
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141
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Lahori A, Frogel J, Augoustides JG, Patel PA, Vernick WJ, Gutsche JT, Feinman JW, Patel S, Munroe R, MacKay EJ, Weiss SJ, Dwarakanath S, Sheu RD. Aortic Valve Prosthesis-Patient Mismatch in a Patient Undergoing Redo Mitral Valve Replacement for Infective Endocarditis. J Cardiothorac Vasc Anesth 2018; 32:2802-2809. [PMID: 29555388 DOI: 10.1053/j.jvca.2018.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Anna Lahori
- Cardiovascular and Thoracic Section, Department of Anesthesiology, Sheba Medical Center, Tel HaShomer, Israel
| | - Jonathan Frogel
- Cardiovascular and Thoracic Section, Department of Anesthesiology, Sheba Medical Center, Tel HaShomer, Israel
| | - John G Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Prakash A Patel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - William J Vernick
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jacob T Gutsche
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jared W Feinman
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Saumil Patel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ray Munroe
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Emily J MacKay
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Stuart J Weiss
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sanjay Dwarakanath
- Department of Anesthesiology, School of Medicine, University of Kentucky, Lexington, KY
| | - Richard D Sheu
- Department of Anesthesiology & Pain Medicine, University of Washington Medical Center, Seattle, WA
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142
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Raimundo R, Moreira S, Saraiva F, Cerqueira RJ, Teixeira P, Salgueiro E, Lourenço A, Amorim MJ, Almeida J, Pinho P, Leite-Moreira AF. Early and mid-term haemodynamic performance and clinical outcomes of St. Jude Medical Trifecta™ valve. J Thorac Dis 2018; 10:889-898. [PMID: 29607162 DOI: 10.21037/jtd.2018.01.15] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background New models of aortic bioprostheses have proven excellent early haemodynamic profile, but their mid and long-term performance warrants further systematic assessment. The aim of this study is to report clinical and haemodynamic performance of St. Jude Medical Trifecta bioprosthesis during 5 years of implantation. Methods We performed a single centre, retrospective, observational and descriptive study including all 556 individuals who underwent aortic valve replacement (AVR) with the Trifecta bioprosthesis (between July of 2011 and June of 2016). Survival and re-intervention were censored in February 2017. Postoperative ambulatory echocardiographic data was available for 490 patients. A complete clinical follow-up was available in 463 individuals (mean follow-up time, 27±17 months). Results In our sample the mean age was 73±9 years, 57.6% were male and median European System for Cardiac Operative Risk Evaluation (EuroSCORE) II was 2.9 (interquartile range, 1.6-5.8). There were 301 (54.1%) combined procedures, mostly coronary artery bypass grafting in 170 (30.6%). Overall 30-days mortality was 5.4% (n=30) and cumulative survival at 5-years was 72.3%. There were 23 (4.3%) permanent pacemaker implantations. During follow-up, 5 (0.9%) patients presented non-structural valve dysfunction (NSVD) and 4 (0.8%) underwent reoperation due to prosthesis endocarditis. At the first ambulatory evaluation transvalvular mean gradient and effective orifice area (EOA) were 10.9±4.1 mmHg and 2.0±0.5 cm2, respectively. Severe patient-prosthesis mismatch (PPM) was observed in 5 (1.1%) individuals and moderate in 52 (11.3%). Conclusions In a "real-world" clinical setting, our findings support the good overall mid-term haemodynamic and safety profile of the Trifecta bioprosthesis.
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Affiliation(s)
- Renata Raimundo
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Soraia Moreira
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Francisca Saraiva
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Rui J Cerqueira
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Serviço de Cirurgia Cardiotorácica, Centro Hospitalar de São João, Porto, Portugal
| | - Pedro Teixeira
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Elson Salgueiro
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Serviço de Cirurgia Cardiotorácica, Centro Hospitalar de São João, Porto, Portugal
| | - André Lourenço
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Serviço de Anestesiologia, Centro Hospitalar de São João, Porto, Portugal
| | - Mário J Amorim
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Serviço de Cirurgia Cardiotorácica, Centro Hospitalar de São João, Porto, Portugal
| | - Jorge Almeida
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Serviço de Cirurgia Cardiotorácica, Centro Hospitalar de São João, Porto, Portugal
| | - Paulo Pinho
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Serviço de Cirurgia Cardiotorácica, Centro Hospitalar de São João, Porto, Portugal
| | - Adelino F Leite-Moreira
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Serviço de Cirurgia Cardiotorácica, Centro Hospitalar de São João, Porto, Portugal
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143
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An Unexpected Risk Factor for Early Structural Deterioration of Biological Aortic Valve Prostheses. Ann Thorac Surg 2018; 105:521-527. [DOI: 10.1016/j.athoracsur.2017.07.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 07/06/2017] [Accepted: 07/07/2017] [Indexed: 11/22/2022]
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144
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Bleiziffer S, Erlebach M, Simonato M, Pibarot P, Webb J, Capek L, Windecker S, George I, Sinning JM, Horlick E, Napodano M, Holzhey DM, Petursson P, Cerillo A, Bonaros N, Ferrari E, Cohen MG, Baquero G, Jones TL, Kalra A, Reardon MJ, Chhatriwalla A, Gama Ribeiro V, Alnasser S, Van Mieghem NM, Rustenbach CJ, Schofer J, Garcia S, Zeus T, Champagnac D, Bekeredjian R, Kornowski R, Lange R, Dvir D. Incidence, predictors and clinical outcomes of residual stenosis after aortic valve-in-valve. Heart 2018; 104:828-834. [DOI: 10.1136/heartjnl-2017-312422] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 12/18/2017] [Accepted: 12/20/2017] [Indexed: 11/04/2022] Open
Abstract
ObjectiveWe aimed to analyse the incidence of prosthesis–patient mismatch (PPM) and elevated gradients after aortic valve in valve (ViV), and to evaluate predictors and associations with clinical outcomes of this adverse event.MethodsA total of 910 aortic ViV patients were investigated. Elevated residual gradients were defined as ≥20 mm Hg. PPM was identified based on the indexed effective orifice area (EOA), measured by echocardiography, and patient body mass index (BMI). Moderate and severe PPM (cases) were defined by European Association of Cardiovascular Imaging (EACVI) criteria and compared with patients without PPM (controls).ResultsModerate or greater PPM was found in 61% of the patients, and severe in 24.6%. Elevated residual gradients were found in 27.9%. Independent risk factors for the occurrence of lower indexed EOA and therefore severe PPM were higher gradients of the failed bioprosthesis at baseline (unstandardised beta −0.023; 95% CI −0.032 to –0.014; P<0.001), a stented (vs a stentless) surgical bioprosthesis (unstandardised beta −0.11; 95% CI −0.161 to –0.071; P<0.001), higher BMI (unstandardised beta −0.01; 95% CI −0.013 to –0.007; P<0.001) and implantation of a SAPIEN/SAPIEN XT/SAPIEN 3 transcatheter device (unstandardised beta −0.064; 95% CI −0.095 to –0.032; P<0.001). Neither severe PPM nor elevated gradients had an association with VARC II-defined outcomes or 1-year survival (90.9% severe vs 91.5% moderate vs 89.3% none, P=0.44).ConclusionsSevere PPM and elevated gradients after aortic ViV are very common but were not associated with short-term survival and clinical outcomes. The long-term effect of poor post-ViV haemodynamics on clinical outcomes requires further evaluation.
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145
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Cerqueira RJ, Raimundo R, Moreira S, Saraiva FA, Andrade M, Salgueiro E, Almeida J, Amorim MJ, Pinho P, Lourenço AP, Leite-Moreira A. Freedom Solo® versus Trifecta® bioprostheses: clinical and haemodynamic evaluation after propensity score matching†. Eur J Cardiothorac Surg 2018; 53:1264-1271. [DOI: 10.1093/ejcts/ezx472] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 11/23/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rui J Cerqueira
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Cardiothoracic Surgery, São João Hospital Centre, Porto, Portugal
| | - Renata Raimundo
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Soraia Moreira
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Francisca A Saraiva
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Marta Andrade
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Cardiothoracic Surgery, São João Hospital Centre, Porto, Portugal
| | - Elson Salgueiro
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Cardiothoracic Surgery, São João Hospital Centre, Porto, Portugal
| | - Jorge Almeida
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Cardiothoracic Surgery, São João Hospital Centre, Porto, Portugal
| | - Mário Jorge Amorim
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Cardiothoracic Surgery, São João Hospital Centre, Porto, Portugal
| | - Paulo Pinho
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Cardiothoracic Surgery, São João Hospital Centre, Porto, Portugal
| | - André P Lourenço
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Cardiothoracic Surgery, São João Hospital Centre, Porto, Portugal
- Department of Anaesthesiology, São João Hospital Centre, Porto, Portugal
| | - Adelino Leite-Moreira
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Cardiothoracic Surgery, São João Hospital Centre, Porto, Portugal
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146
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Barletta G, Venditti F, Stefano P, Del Bene R, Di Mario C. Left ventricular outflow tract shape after aortic valve replacement with St. Jude Trifecta prosthesis. Echocardiography 2017; 35:329-336. [DOI: 10.1111/echo.13778] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Giuseppe Barletta
- Cardiology Diagnostics, Cardiac, Thoracic & Vascular Department; University Hospital Careggi; Florence Italy
| | - Francesco Venditti
- Cardiology Diagnostics, Cardiac, Thoracic & Vascular Department; University Hospital Careggi; Florence Italy
| | - Pierluigi Stefano
- Cardiac Surgery, Cardiac, Thoracic & Vascular Department; University Hospital Careggi; Florence Italy
| | - Riccarda Del Bene
- Cardiology Diagnostics, Cardiac, Thoracic & Vascular Department; University Hospital Careggi; Florence Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology Division; Cardiac, Thoracic & Vascular Department; University Hospital Careggi; Florence Italy
- National Institute for Health Research (NIHR) Biomedical Research Unit; Royal Brompton & Harefield NHS Foundation Trust; London UK
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147
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Christ T, Holinski S, Zhigalov K, Zielinski CB, Grubitzsch H. Hemodynamics of Pericardial Aortic Valves: Contemporary Stented versus Stentless Valves in a Matched Comparison. Ann Thorac Cardiovasc Surg 2017; 23:298-303. [PMID: 28890465 DOI: 10.5761/atcs.oa.17-00061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Hemodynamic performance of aortic valve bioprostheses is essential for reliable function and durability. So far, the supra-annularly implanted stentless Sorin Freedom Solo (SFS) demonstrated unsurpassed hemodynamic properties. As contemporary stented and externally mounted pericardial bioprostheses, like the Labcor Dokimos Plus (LDP), also improve hemodynamic performance, these types of valves were compared in this study. METHODS A total of 218 patients, who underwent aortic valve replacement with the LDP or the SFS, were matched retrospectively 1:1 on variables affecting hemodynamic measurements: implanted valve size, age, sex, and body surface area (BSA). With matching tolerance for valve size and gender of 0%, for age and BSA of 5%, 57 patient-pairs were yielded. Operative data, clinical, and hemodynamic outcome were analyzed. RESULTS Except for slightly higher left ventricular function and lower procedural times in the SFS group, preoperative, operative, and postoperative characteristics of patient-pairs did not differ significantly. Mean pressure gradients, effective orifice areas (EOAs), and indexed EOAs were comparable. Corresponding to valve sizes of 21, 23, 25, and 27 mm, the indexed EOAs of the LDP and SFS prostheses were 1.08 ± 0.33, 0.92 ± 0.19, 0.93 ± 0.24, 0.99 ± 0.13 cm2/m2 and 0.81 ± 0.13, 0.92 ± 0.28, 0.95 ± 0.20, 1.04 ± 0.27 cm2/m2, respectively. CONCLUSION Contemporary stented and stentless pericardial bioprostheses showed excellent hemodynamic properties without significant differences in EOAs and indexed EOAs.
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Affiliation(s)
| | | | - Konstantin Zhigalov
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Cardiovascular Surgery, Berlin, Germany
| | - Christina Barbara Zielinski
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Cardiovascular Surgery, Berlin, Germany
| | - Herko Grubitzsch
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Cardiovascular Surgery, Berlin, Germany
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148
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Postoperative Reverse Remodeling and Symptomatic Improvement in Normal-Flow Low-Gradient Aortic Stenosis After Aortic Valve Replacement. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.117.006580. [DOI: 10.1161/circimaging.117.006580] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 11/01/2017] [Indexed: 02/07/2023]
Abstract
Background—
Severe aortic stenosis (AS) most often presents with reduced aortic valve area (<1 cm
2
), normal stroke volume index (≥35 mL/m
2
), and either high mean gradient (≥40 mm Hg; normal-flow high-gradient AS) or low mean gradient (normal-flow low-gradient [NFLG] AS). The benefit of aortic valve replacement (AVR) among NFLG patients is controversial. We compared the impact of NFLG condition on preoperative left ventricular (LV) remodeling and myocardial fibrosis and postoperative remodeling and symptomatic benefit.
Methods and Results—
Eighty-seven consecutive patients with reduced aortic valve area and normal stroke volume index undergoing AVR underwent echocardiography, magnetic resonance imaging, a 6-minute walk test, and measurement of natriuretic peptides before and 1 year after AVR. Myocardial fibrosis was assessed from magnetic resonance imaging. Patients were stratified as NFLG or normal-flow high-gradient. In total, 33 patients (38%) had NFLG. Before AVR, they were characterized by similar symptom burden but less severe AS measured by aortic valve area index (0.50±0.09 versus 0.40±0.08 cm
2
/m
2
;
P
<0.0001), lower LV mass index (74±18 versus 90±26 g/m
2
;
P
=0.01), but the same degree of myocardial fibrosis. After AVR, NFLG had a smaller reduction in LV mass index (−3±10 versus −±18 g/m
2
;
P
<0.0001) and a smaller reduction in natriuretic peptides. Both groups experienced similar symptomatic improvement. Normal-flow high-gradient condition independently predicted change in LV mass index.
Conclusions—
Patients with NFLG had less severe AS and LV remodeling than patients with normal-flow high-gradient. Furthermore, NFLG patients experienced less reverse remodeling but the same symptomatic benefit.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT02316587.
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149
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Nakashima M, Watanabe Y, Hioki H, Nara Y, Nagura F, Hosogoe N, Kawashima H, Kataoka A, Otsuki S, Konno K, Kyono H, Yokoyama N, Kozuma K. Efficacy and safety of transcatheter aortic valve implantation with Edwards SAPIEN 3 and XT in smaller Asian anatomy. Cardiovasc Interv Ther 2017; 33:384-390. [PMID: 29185181 DOI: 10.1007/s12928-017-0502-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 11/20/2017] [Indexed: 12/19/2022]
Abstract
We aimed to compare the efficacy and safety of transcatheter aortic valve implantation (TAVI) using Edwards SAPIEN 3 (S3) valve and SAPIEN XT) in smaller anatomy. The new generation S3 TAVI device has been used worldwide; however, its efficacy and safety in smaller Asian anatomy remain unknown. Between February 2014 and March 2017, 166 consecutive patients (S3, 54; XT, 112) were treated with balloon-expandable TAVI in a single center and their outcomes were analyzed. Median patient age was 85 (range: 81-88) years and mean body surface area was 1.41 ± 0.15 m2. A 23-mm size valve was used in S3 and XT groups (70 vs. 62%, p = 0.224). The transfemoral approach was more frequently used in the S3 than in the XT group (96 vs. 72%, p < 0.001). Although, the minimal luminal diameter of the femoral artery was smaller in the S3 group (5.9 vs. 6.4 mm, p = 0.001), the rates of major (2 vs. 11%, p = 0.226) and minor (11 vs. 5%, p = 0.107) vascular complications did not increase. The frequency of paravalvular leaks (PVL) ≥ 2 was significantly reduced in the S3 group (11 vs. 61%, p < 0.001); however, pre- (24 vs. 91%, p < 0.001) and post- (4 vs. 19%, p < 0.001) dilatations were less frequently performed. Pacemaker implantation incidence did not increase (4 vs. 5%, p = 1.0) and peak velocity of the transcatheter heart valve was significantly higher in the S3 group (2.3 vs. 2.2 m/s, p = 0.046). Device success was high (89 vs. 93%, p = 0.387) while the 30-day all-cause mortality was low (2 vs. 1%, p = 0.583) in both groups. TAVI with the S3 device was safe and effective, with low incidence of vascular complications and reduced PVL, in smaller body-sized Asians.
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Affiliation(s)
- Makoto Nakashima
- Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan.
| | - Yusuke Watanabe
- Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan
| | - Hirofumi Hioki
- Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan
| | - Yugo Nara
- Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan
| | - Fukuko Nagura
- Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan
| | - Naoyoshi Hosogoe
- Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan
| | - Hideyuki Kawashima
- Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan
| | - Akihisa Kataoka
- Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan
| | - Shuji Otsuki
- Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan
| | - Kumiko Konno
- Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan
| | - Hiroyuki Kyono
- Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan
| | - Naoyuki Yokoyama
- Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan
| | - Ken Kozuma
- Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan
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150
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Liao YB, Li YJ, Jun-Li L, Zhao ZG, Wei X, Tsauo JY, Xiong TY, Xu YN, Feng Y, Chen M. Incidence, Predictors and Outcome of Prosthesis-Patient Mismatch after Transcatheter Aortic Valve Replacement: a Systematic Review and Meta-analysis. Sci Rep 2017; 7:15014. [PMID: 29118326 PMCID: PMC5678180 DOI: 10.1038/s41598-017-15396-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 10/26/2017] [Indexed: 02/05/2023] Open
Abstract
The aim of this study was to investigate the incidence, predictors and outcome of prosthesis-patient mismatch (PPM) following transcatheter aortic valve replacement (TAVR). A total of 30 articles incorporating 4,691 patients were identified. The pooled incidences of overall, moderate and severe PPM following TAVR were 33.0%, 25.0% and 11.0% respectively. Medtronic CoreValve (MCV) had lower incidence of overall (32% vs: 40%, P < 0.0001) and moderate (23% vs 32%, P < 0.0001) than Edwards Sapien (ESV). PPM was associated with a younger age, smaller annulus diameter and lower left ventricular ejection fraction in comparison with those patients without PPM. Post-dilation (OR, 0.51, 95% CI, 0.38 to 0.68, p < 0.001) during TAVR would decrease the incidence of PPM. Although PPM was common after TAVR, no significant differences were observed both in short- and mid-term all-cause mortality (30 day: OR: 1.1, 95% CI, 0.70 to 1.73 and 2 year: OR: 1.01, 95% CI, 0.74 to 1.38) between patients with PPM and those without PPM. In conclusion, despite being common after TAVR, the incidence of PPM was lower than that of surgical aortic valve replacement (SAVR) and decreased with the experience accumulating, and PPM was not seen to impact on short- and mid-term survival, regardless of its magnitude.
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Affiliation(s)
- Yan-Biao Liao
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Yi-Jian Li
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Li Jun-Li
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Zhen-Gang Zhao
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Xin Wei
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Jiay-Yu Tsauo
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Tian-Yuan Xiong
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Yuan-Ning Xu
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Yuan Feng
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China.
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China.
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