151
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Long-Term Results (up to 20 Years) of 19 mm or Smaller Prostheses in the Aortic Position. Does Size Matter? A Propensity-Matched Survival Analysis. J Clin Med 2021; 10:jcm10102055. [PMID: 34064845 PMCID: PMC8151595 DOI: 10.3390/jcm10102055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/19/2021] [Accepted: 05/07/2021] [Indexed: 11/28/2022] Open
Abstract
Background: The long-term performance of prostheses in the small aortic root is still unclear. Methods: Patients who received a 21 mm or smaller aortic valve between 2000–2018 were retrospectively analyzed. Propensity matching was used in order to account for baseline differences in 19 mm vs. 21 mm valve subgroups. Results: Survival at 10 years was 55.87 ± 5.54% for 19 mm valves vs. 57.17 ± 2.82% for 21 mm ones in the original cohort (p = 0.37), and 58.69 ± 5.61% in 19 mm valve recipients vs. 53.60 ± 5.66% for 21 mm valve subgroups in the matched cohort (p = 0.55). Smaller valves exhibited significantly more patient–prothesis mismatch (PPM) than larger ones (87.30% vs. 57.94%, p < 0.01). All-cause mortality was affected by PPM at 10 years (52.66 ± 3.28% vs. 64.38 ± 3.87%, p = 0.04) in the unmatched population. This difference disappeared, however, after matching: survival at 10 years was 51.82 ± 5.26% in patients with PPM and 63.12 ± 6.43% in patients without PPM. (p = 0.14) Conclusions: There is no survival penalty in using 19 mm prostheses in the small aortic root in the current era. Although PPM is more prevalent in smaller sized valve recipients, this does not translate into reduced survival at 10 years of follow-up.
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152
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Trumello C, Giambuzzi I, Bonalumi G, Bargagna M, Naliato M, Ruggeri S, Fileccia D, Castiglioni A, Alfieri O, Alamanni F, De Bonis M. Rheumatic mitral regurgitation: is repair justified by the long-term results? Interact Cardiovasc Thorac Surg 2021; 33:333-338. [PMID: 33948663 DOI: 10.1093/icvts/ivab091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/07/2021] [Accepted: 02/05/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The best treatment for rheumatic mitral regurgitation is still under debate. Our goal was to assess the long-term results of mitral repair for rheumatic mitral regurgitation performed in 2 referral centres for mitral repair. METHODS Patients who underwent mitral valve repair between 1999 and 2009 were selected. Preoperative and postoperative data were prospectively entered into a dedicated database and retrospectively reviewed. Kaplan-Meier estimates were used to analyse long-term survival. Competing risk analysis was performed by calculating the cumulative incidence function for time to recurrence of mitral regurgitation ≥3+, mitral regurgitation ≥2+, mitral reoperation and the combined end point of repair failure (mitral regurgitation ≥ 3+ and/or mean gradient ≥ 10 mmHg and/or mitral valve REDO) with death as a competing risk. RESULTS A total of 72 patients were included. Mitral calcifications were present in 25 patients (34.7%). Most of the patients (65/72, 90.3%) underwent annuloplasty, and mixes of reparative techniques were used in 21 patients (29.2%). In-hospital mortality was 2.8%. Mean follow-up was 11.6 ± 5.16 (max 19.1 years), 98.6% completed. Survival at 14 years was 70 ± 6.27%. At 14 years, the cumulative incidence function of repair failure was 36.7 ± 6.52%. The presence of severe mitral annulus calcification was an independent predictor of repair failure. CONCLUSIONS Mitral repair for rheumatic mitral regurgitation is characterized by a high rate of failure in the long term (14 years), particularly in patients with severe annular calcifications. These results call for a very selective approach when considering a repair strategy in this setting, especially in case of unfavourable anatomical conditions.
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Affiliation(s)
- Cinzia Trumello
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Ilaria Giambuzzi
- Department of Cardiac Surgery, IRCCS Monzino Cardiology Center, Milan, Italy.,DISCCO University of Milan, Milan, Italy
| | - Giorgia Bonalumi
- Department of Cardiac Surgery, IRCCS Monzino Cardiology Center, Milan, Italy
| | - Marta Bargagna
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Moreno Naliato
- Department of Cardiac Surgery, IRCCS Monzino Cardiology Center, Milan, Italy
| | - Stefania Ruggeri
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Daniele Fileccia
- Department of Cardiac Surgery, IRCCS Monzino Cardiology Center, Milan, Italy.,DISCCO University of Milan, Milan, Italy
| | - Alessandro Castiglioni
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Ottavio Alfieri
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Alamanni
- Department of Cardiac Surgery, IRCCS Monzino Cardiology Center, Milan, Italy.,DISCCO University of Milan, Milan, Italy
| | - Michele De Bonis
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
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153
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The First 100 Cases of Two Innovations Combined: Video-Assisted Minimally Invasive Aortic Valve Replacement Through Right Anterior Mini-Thoracotomy Using a Novel Aortic Prosthesis. Adv Ther 2021; 38:2435-2446. [PMID: 33788152 PMCID: PMC8010499 DOI: 10.1007/s12325-021-01705-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/10/2021] [Indexed: 11/25/2022]
Abstract
Introduction Aortic valve replacement (AVR) via right anterior mini-thoracotomy (RAMT) is less traumatic than via other surgical routes; using a novel aortic valve may confer long-term resistance against valve deterioration, and thus be useful in younger, more active patients. Here we aim to validate using the INSPIRIS RESILIA valve with minimally invasive RAMT. Methods Between April 2017 and June 2019, 100 patients underwent video-assisted minimally invasive AVR by RAMT, using the INSPIRIS RESILIA aortic valve. Cannulation for cardiopulmonary bypass (CPB) was through femoral vessels. Clinical data were prospectively entered into our institutional database. Results Cardiopulmonary bypass (CPB) and cross-clamping times were 79 ± 38 and 41 ± 17 min. Surgical access was successful in 100% of cases. There were no cases of intraoperative mortality, 30-day mortality, cerebrovascular events, rethoracotomy for bleeding, valve-related reoperation, right internal mammary artery injury, or conversion to sternotomy. Intensive care and hospital stays were 2 ± 1 and 6 ± 3 days, respectively. One patient had a pacemaker fitted. Postoperative dialysis was necessary in one patient. Trace to mild aortic valve regurgitation occurred in two patients. No structural valve deterioration (SVD) and paravalvular leak were seen. At 1-year follow-up mean effective orifice area (EOA) was 1.8 ± 0.1 cm2, peak gradient was 22.1 ± 3.1 mmHg, and mean gradient was 11.5 ± 2.3 mmHg. Conclusion Our preliminary experience suggests that RAMT for AVR using the INSPIRIS RESILIA aortic valve is safe, effective, and reproducible. Larger studies are needed to evaluate the long-term efficacy and durability of this new valve.
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154
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Moscarelli M, Nasso G, Vite G, Speziale G. Surgical treatment of prosthetic mechanical valve thrombosis with the aid of high-flow CO2. Eur J Cardiothorac Surg 2021; 59:908-910. [PMID: 33020841 DOI: 10.1093/ejcts/ezaa349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/07/2020] [Accepted: 08/18/2020] [Indexed: 11/12/2022] Open
Abstract
The surgical treatment of prosthetic mechanical valve thrombosis involves redo valve replacement and removal of the thrombi layers. The hinges and near-hinge areas of the bi-leaflet mechanical valve are a 'stagnation area' where blood flow is typically unsteady and can give rise to thrombi; however, these zones are not easily accessed with surgical instruments. Here, we present a case in which high-flow CO2 was used to facilitate the removal of microthrombi in the stagnation area around a prosthetic mechanical valve.
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Affiliation(s)
- Marco Moscarelli
- Department of Cardiovascular Surgery, GVM Care & Research, Bari, Italy
| | - Giuseppe Nasso
- Department of Cardiovascular Surgery, GVM Care & Research, Bari, Italy
| | - Giuseppe Vite
- Department of Cardiovascular Surgery, GVM Care & Research, Bari, Italy
| | - Giuseppe Speziale
- Department of Cardiovascular Surgery, GVM Care & Research, Bari, Italy
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155
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Anselmi A, Aymami M, Tomasi J, Chabanne C, Beneux X, Corbineau H, Verhoye JP. DURABILITY OF MITRAL VALVE REPLACEMENT WITH A 3 RD GENERATION BIOPROSTHESIS. Ann Thorac Surg 2021; 113:837-844. [PMID: 33901453 DOI: 10.1016/j.athoracsur.2021.03.097] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 02/05/2021] [Accepted: 03/09/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND To evaluate the durability of a third-generation porcine bioprosthesis (Epic® valve) in the mitral position, according to patients' age at surgery. METHODS A total of 482 mitral valve replacements (MVR) using the Epic® valve at a single center were included (2009-2018). Perioperative and early postoperative data were prospectively collected. A systematic follow-up was performed (99% complete, 1,609.5 patient/years, average: 3.8 ± 2.5 years). Standardized definitions of valve-related events were adopted. Age at MVR was 68.1 ± 10.4 years. RESULTS Operative mortality was 9.3%. The were 5 early valve-related reoperations, mainly due to recurrent infectious endocarditis. Global survival at 8.8 years was 69.5% ± 5. There were 9 SVD events during the follow-up (3 receiving reoperations, 4 TMVR valve-in-valve, and 2 medical treatment only). The freedom from SVD at 5 and 10 years was 97.4% ± 1.2 and 89.6% ± 4.4 (actuarial), and 97.8% ± 1 and 91.9% ± 3.3, respectively (competing risks). After stratification into subgroups by age at surgery (≤59: 50.8%, 60-69: 32.8%, ≥70: 16.4%) there was no significant intergroup difference in freedom from SVD (log-rank p=0.24). The overall freedom from any reintervention for SVD at 10 years was 90.5% ± 4.4 (actuarial) and 92.7% ± 3.3 (competing risks), with no intergroup difference (log-rank p=0.14). The freedom from any valve-related complication at 8.4 years was 83.2% ± 4.5 (actuarial). CONCLUSIONS The Epic® bioprosthesis shows good durability at 5 to 10 years in the mitral position.
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Affiliation(s)
- Amedeo Anselmi
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France.
| | - Marie Aymami
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Jacques Tomasi
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Celine Chabanne
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Xavier Beneux
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Hervé Corbineau
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Jean-Philippe Verhoye
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital, Rennes, France
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156
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Vinciguerra M, Grigioni F, Romiti S, Benfari G, Rose D, Spadaccio C, Cimino S, De Bellis A, Greco E. Ischemic Mitral Regurgitation: A Multifaceted Syndrome with Evolving Therapies. Biomedicines 2021; 9:biomedicines9050447. [PMID: 33919263 PMCID: PMC8143318 DOI: 10.3390/biomedicines9050447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/14/2021] [Accepted: 04/19/2021] [Indexed: 12/24/2022] Open
Abstract
Dysfunction of the left ventricle (LV) with impaired contractility following chronic ischemia or acute myocardial infarction (AMI) is the main cause of ischemic mitral regurgitation (IMR), leading to moderate and moderate-to-severe mitral regurgitation (MR). The site of AMI exerts a specific influence determining different patterns of adverse LV remodeling. In general, inferior-posterior AMI is more frequently associated with regional structural changes than the anterolateral one, which is associated with global adverse LV remodeling, ultimately leading to different phenotypes of IMR. In this narrative review, starting from the aforementioned categorization, we proceed to describe current knowledge regarding surgical approaches in the management of IMR.
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Affiliation(s)
- Mattia Vinciguerra
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy; (S.R.); (S.C.); (E.G.)
- Correspondence:
| | - Francesco Grigioni
- Unit of Cardiovascular Sciences, Department of Medicine Campus Bio-Medico, University of Rome, 00128 Rome, Italy;
| | - Silvia Romiti
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy; (S.R.); (S.C.); (E.G.)
| | - Giovanni Benfari
- Division of Cardiology, Department of Medicine, University of Verona, 37219 Verona, Italy;
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - David Rose
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool FY3 8NP, UK; (D.R.); (C.S.)
| | - Cristiano Spadaccio
- Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool FY3 8NP, UK; (D.R.); (C.S.)
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, UK
| | - Sara Cimino
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy; (S.R.); (S.C.); (E.G.)
| | - Antonio De Bellis
- Department of Cardiology and Cardiac Surgery, Casa di Cura “S. Michele”, 81024 Maddaloni, Caserta, Italy;
| | - Ernesto Greco
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy; (S.R.); (S.C.); (E.G.)
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157
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Pfannmueller B, Budde LM, Etz CD, Noack T, Cuartas MM, Misfeld M, Borger MA. Postoperative outcome after reoperative isolated tricuspid valve surgery-is there a predictor for survival? Eur J Cardiothorac Surg 2021; 60:867-871. [PMID: 33769458 DOI: 10.1093/ejcts/ezab134] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/11/2021] [Accepted: 02/13/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Reoperative tricuspid valve (TV) surgery is considered high risk even in the absence of additional concomitant cardiac procedures. The purpose of this study was to evaluate preoperative clinical parameters as predictors for survival after isolated reoperative TV surgery. METHODS From January 2005 to January 2019, 85 patients (mean age: 66.7 ± 10.3 years, 34 male) with severe isolated TV regurgitation and prior cardiac surgery were referred to our centre for elective or urgent TV repair/replacement; patients with endocarditis were excluded. We retrospectively analysed preoperative hepatorenal function [reflected by widely used clinical and laboratory parameters and the Model of End-stage-Liver Disease excluding International Normalized Ratio (MELD-XI) score] as a predictor for postoperative survival. RESULTS At hospital admission, the patients' average preoperative New York Heart Association class was 2.9 ± 0.6, left ventricular ejection fraction 52.5 ± 10.6%, mean pulmonary artery pressure 24.7 ± 8.0 mmHg, creatinine 115.4 ± 66.6 μmol/l, bilirubin 20.0 ± 19.6 μmol/l and the mean MELD-XI score was 13.3 ± 4.0 μmol/l. The mean follow-up was 5.4 ± 4.2 years. Thirty-day mortality was 5%, 5-year survival was 60.6 ± 5.4% and 10-year survival was 42.9 ± 6.5%. The multivariable Cox regression analysis evaluated the MELD-XI score [hazard ratio (HR 1.144, confidence interval 95% 1.0-1.3, P = 0.005] and diabetes mellitus (HR 2.27, confidence interval 95% 1.0-5.0, P = 0.04) as significant predictors for excess mortality while age and mean pulmonary artery pressure did not reliably predict clinical outcome. CONCLUSIONS Hepatorenal dysfunction was one main factor accounting for limited postoperative survival in our patient cohort. The MELD-XI score is easy to calculate and seems to reliably predict the perioperative risk in patients with prior cardiac surgery and indication for TV surgery.
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Affiliation(s)
| | - Luca-Marie Budde
- University Clinic for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Christian D Etz
- University Clinic for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Thilo Noack
- University Clinic for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Mateo Marin Cuartas
- University Clinic for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Martin Misfeld
- University Clinic for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.,Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,The Discipline of Medicine, The Central Clinical School, The Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Michael A Borger
- University Clinic for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
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158
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Biofabrication in Congenital Cardiac Surgery: A Plea from the Operating Theatre, Promise from Science. MICROMACHINES 2021; 12:mi12030332. [PMID: 33800971 PMCID: PMC8004062 DOI: 10.3390/mi12030332] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/08/2021] [Accepted: 03/18/2021] [Indexed: 12/11/2022]
Abstract
Despite significant advances in numerous fields of biofabrication, clinical application of biomaterials combined with bioactive molecules and/or cells largely remains a promise in an individualized patient settings. Three-dimensional (3D) printing and bioprinting evolved as promising techniques used for tissue-engineering, so that several kinds of tissue can now be printed in layers or as defined structures for replacement and/or reconstruction in regenerative medicine and surgery. Besides technological, practical, ethical and legal challenges to solve, there is also a gap between the research labs and the patients' bedside. Congenital and pediatric cardiac surgery mostly deal with reconstructive patient-scenarios when defects are closed, various segments of the heart are connected, valves are implanted. Currently available biomaterials lack the potential of growth and conduits, valves derange over time surrendering patients to reoperations. Availability of viable, growing biomaterials could cancel reoperations that could entail significant public health benefit and improved quality-of-life. Congenital cardiac surgery is uniquely suited for closing the gap in translational research, rapid application of new techniques, and collaboration between interdisciplinary teams. This article provides a succinct review of the state-of-the art clinical practice and biofabrication strategies used in congenital and pediatric cardiac surgery, and highlights the need and avenues for translational research and collaboration.
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159
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Transcatheter Aortic Valve Replacement in Rheumatic Aortic Stenosis: A Comprehensive Review. Curr Probl Cardiol 2021; 46:100843. [PMID: 33994024 DOI: 10.1016/j.cpcardiol.2021.100843] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 03/08/2021] [Indexed: 12/31/2022]
Abstract
Rheumatic heart disease (RHD) mainly affects people in developing, low-income countries. However, due to globalization and migration, developed countries are now seeing more cases of RHD. In RHD patients who develop severe symptomatic aortic stenosis, surgical aortic valve replacement remains the treatment of choice. In the past decade, there has been an extension of transcatheter aortic valve replacement (TAVR) to intermediate-risk and lower-risk patients with aortic stenosis. This review suggests the possible utility of TAVR for the treatment of rheumatic aortic stenosis. Rheumatic aortic stenosis has been excluded from major TAVR studies due to the predominantly noncalcific pathology of the rheumatic aortic valve. However, there have been case reports and case series showing successful implantation of the valve even in patients with and without significant leaflet calcification. In this review article, we summarize the latest evidence of severe rheumatic aortic stenosis treated with TAVR and discuss the procedure's impact on patient care, safety, and efficacy.
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160
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Saade W, Marullo AG, Peruzzi M. Lambl's excrescences in transcatheter aortic valve implantation: a word of caution on the way to tailored and individualized approach. Minerva Cardiol Angiol 2021; 70:5-7. [PMID: 33703861 DOI: 10.23736/s2724-5683.21.05563-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Wael Saade
- Department of Internal, Anesthesiology and Cardiovascular Clinical Sciences, Sapienza University of Rome, Rome, Italy
| | - Antonino G Marullo
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Mariangela Peruzzi
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy - .,Mediterranea Cardiocentro, Napoli, Italy
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161
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Chiariello GA, Beraud AS, Vahdat O, Van Rothem J, Garcia O, Soula P, Berthoumieu P, Abouliatim I. Late results after mitral valve replacement with Mosaic bioprosthesis in patients aged 65 years or younger. Interact Cardiovasc Thorac Surg 2021; 33:181-187. [PMID: 33693682 DOI: 10.1093/icvts/ivab066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 01/07/2021] [Accepted: 02/05/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Although in younger patients indications for biological prosthesis implantation in mitral valve replacement remain controversial, recently bioprostheses use increased considerably. We present late results obtained with the Medtronic Mosaic bioprosthesis in patients aged 65 years or younger. METHODS Between 2007 and 2017, 67 mitral Mosaic bioprostheses were implanted in patients aged 65 years or younger (58.5 ± 6.4 years). Follow-up extended up to 13 years. Survival, freedom from structural valve degeneration, endocarditis, thromboembolic events and reoperation were considered as main clinical end points evaluated at 1, 5 and 10 years. RESULTS The mean follow-up was 4.7 ± 2.8 years. Overall mortality rate was 12%. At 1, 5 and 10 years, survival was 94 ± 3%, 89 ± 4% and 77 ± 9%, respectively. Freedom from structural valve degeneration was 100%, 94 ± 4% and 71 ± 21%. Freedom from endocarditis was 95 ± 3%, 90 ± 6% and 84 ± 8%. Freedom from thromboembolic events was 94 ± 3%, 90 ± 5% and 90 ± 5%. Freedom from reoperation was 94 ± 3%, 87 ± 5% and 65 ± 19%. CONCLUSIONS Mosaic bioprosthesis appears a valid mitral valve substitute even when employed in ≤65-year-old patients.
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Affiliation(s)
- Giovanni A Chiariello
- Cardiovascular and Thoracic Surgery Department, Clinique Pasteur, Toulouse, France.,Catholic University of the Sacred Heart, Rome, Italy
| | | | - Olivier Vahdat
- Cardiovascular and Thoracic Surgery Department, Clinique Pasteur, Toulouse, France
| | | | - Olivier Garcia
- Cardiovascular and Thoracic Surgery Department, Clinique Pasteur, Toulouse, France
| | - Philippe Soula
- Cardiovascular and Thoracic Surgery Department, Clinique Pasteur, Toulouse, France
| | - Pierre Berthoumieu
- Cardiovascular and Thoracic Surgery Department, Clinique Pasteur, Toulouse, France
| | - Issam Abouliatim
- Cardiovascular and Thoracic Surgery Department, Clinique Pasteur, Toulouse, France
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162
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Ye Y, Yu C, Qian X. Aortic valve bypass for high-risk patients with symptomatic aortic stenosis: A case report. J Card Surg 2021; 36:2153-2155. [PMID: 33682948 PMCID: PMC8251971 DOI: 10.1111/jocs.15473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 02/19/2021] [Accepted: 02/21/2021] [Indexed: 12/25/2022]
Abstract
There are a significant number of symptomatic aortic stenosis (AS) patients not referred to the traditional methods for some complex conditions. We described a case of a 61‐year‐old female with severe symptomatic AS, calcific small aortic annulus (16.6 mm), narrow porcelain ascending aorta (aortic root: 14.6 mm, internal diameter: 14.0 mm), chronic renal insufficiency, and a history of the previous sternotomy for mechanical mitral valve replacement and coronary artery bypass grafting who underwent aortic valve bypass (AVB) with favorable results. AVB has been proposed as a complementary to surgery operation of aortic valve replacement and transcatheter aortic valve implantation in high‐risk AS patients.
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Affiliation(s)
- Yanqiong Ye
- Department of Cardiac Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Changjiang Yu
- Department of Cardiac Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ximing Qian
- Department of Cardiac Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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163
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Buono A, Medda M, Cesna S, Davidavicius G, Casilli F, Bande M, Pellicano M, Tespili M, Ielasi A. Snaring the Transcatheter Heart Valve Delivery System During Aortic Valve Replacement: When and Why. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 28S:81-84. [PMID: 33674218 DOI: 10.1016/j.carrev.2021.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/16/2021] [Accepted: 02/12/2021] [Indexed: 10/22/2022]
Abstract
None of the commercially available self-expanding (SE)-trans-catheter heart valve (THVs) used for trans-catheter aortic valve replacement (TAVR) has a deflectable delivery system. This aspect can represent a shortcoming, especially in some anatomical scenario where THV advancement is challenging. The use of a snare catheter (SC), applying an external traction force, can increase THV trackability. We describe three different TAVR cases, in which a SE-THV was the only available option and where the THV delivery system advancement in the aortic arch was not feasible, if not with the combined use of a SC.
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Affiliation(s)
- Andrea Buono
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
| | - Massimo Medda
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
| | - Sigitas Cesna
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Centre of Cardiology and Angiology, Department of Cardiovascular Diseases, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Giedrius Davidavicius
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Centre of Cardiology and Angiology, Department of Cardiovascular Diseases, Vilnius University Hospital Santaros Clinics, Vilnius, Lithuania
| | - Francesco Casilli
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
| | - Marta Bande
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
| | - Mariano Pellicano
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
| | - Maurizio Tespili
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
| | - Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy.
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Comparison of Anticoagulation Quality between Acenocoumarol and Warfarin in Patients with Mechanical Prosthetic Heart Valves: Insights from the Nationwide PLECTRUM Study. Molecules 2021; 26:molecules26051425. [PMID: 33800767 PMCID: PMC7961992 DOI: 10.3390/molecules26051425] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 01/16/2023] Open
Abstract
Vitamin K antagonists are indicated for the thromboprophylaxis in patients with mechanical prosthetic heart valves (MPHV). However, it is unclear whether some differences between acenocoumarol and warfarin in terms of anticoagulation quality do exist. We included 2111 MPHV patients included in the nationwide PLECTRUM registry. We evaluated anticoagulation quality by the time in therapeutic range (TiTR). Factors associated with acenocoumarol use and with low TiTR were investigated by multivariable logistic regression analysis. Mean age was 56.8 ± 12.3 years; 44.6% of patients were women and 395 patients were on acenocoumarol. A multivariable logistic regression analysis showed that patients on acenocoumarol had more comorbidities (i.e., ≥3, odds ratio (OR) 1.443, 95% confidence interval (CI) 1.081–1.927, p = 0.013). The mean TiTR was lower in the acenocoumarol than in the warfarin group (56.1 ± 19.2% vs. 61.6 ± 19.4%, p < 0.001). A higher prevalence of TiTR (<60%, <65%, or <70%) was found in acenocoumarol users than in warfarin ones (p < 0.001 for all comparisons). Acenocoumarol use was associated with low TiTR regardless of the cutoff used at multivariable analysis. A lower TiTR on acenocoumarol was found in all subgroups of patients analyzed according to sex, hypertension, diabetes, age, valve site, atrial fibrillation, and INR range. In conclusion, anticoagulation quality was consistently lower in MPHV patients on acenocoumarol compared to those on warfarin.
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165
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Hu X, Jiang W, Li H, Zhou T, Dong N, Wang Y. Prosthesis selection for aortic valve replacement with concomitant coronary artery bypass graft. Ann Thorac Surg 2021; 113:100-108. [PMID: 33667456 DOI: 10.1016/j.athoracsur.2021.02.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 02/17/2021] [Accepted: 02/22/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The optimal prosthesis for aortic valve replacement (AVR) with concomitant coronary artery bypass graft (CABG) is controversial. We aim to investigate postoperative outcomes in these patients with a bioprosthetic or mechanical prosthesis. METHODS A retrospective cohort analysis of 2485 patients aged 50-69 years who underwent AVR+CABG in Hubei province hospitals from 2002-2018. The Median follow-up duration was 6.5 years (0-15.8 years). Propensity score matching for 18 baseline characteristics yielded 346 patient pairs between bioprosthetic and mechanical prosthetic groups. Endpoints were mortality, stroke, major bleeding event, and reoperation. RESULTS No differences in survival, stroke, or overall reoperation rates were observed between the bioprosthetic and mechanical valve group. The 15-year cumulative incidence of reoperation due to prosthesis failure/dysfunction was higher in the bioprosthetic group (HR, 2.72 [95% CI, 1.26-5.88], P =0.011), whereas the 15-year cumulative incidence of reoperation due to CAD progression/bypass failure was similar between two groups (HR, 0.76 [95% CI, 0.37-1.57], P =0.459). Mechanical valves were associated with a higher 15-year cumulative incidence of the major bleeding events compared with bioprosthesis (HR, 1.92 [95% CI, 1.16-3.19], P =0.012). CONCLUSIONS Long-term survival, overall reoperation, or stroke incidence was comparable among the two groups, while patients with a mechanical valve showed a greater likelihood of major bleeding events. Regarding the limited durability of bioprostheses, a larger sample size followed for 15 or more years will be necessary to determine the optimal aortic valve prosthesis for patients aged 50 to 69 years undergoing concurrent AVR and CABG.
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Affiliation(s)
- Xingjian Hu
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Quality control center of Cardiovascular Surgery, Health Committee of Hubei province, Wuhan, China
| | - Weiwei Jiang
- Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huadong Li
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Department of Biomedical Engineering, The University of Alabama, USA
| | - Tingwen Zhou
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Quality control center of Cardiovascular Surgery, Health Committee of Hubei province, Wuhan, China
| | - Yin Wang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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166
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Hu X, Jiang W, Li H, Yan G, Wang Y. Timing of Valve Repair for Asymptomatic Mitral Regurgitation and Preserved Left Ventricular Function. Ann Thorac Surg 2021; 111:862-870. [DOI: 10.1016/j.athoracsur.2020.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/12/2020] [Accepted: 06/01/2020] [Indexed: 11/30/2022]
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167
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Williams MC, Massera D, Moss AJ, Bing R, Bularga A, Adamson PD, Hunter A, Alam S, Shah ASV, Pawade T, Roditi G, van Beek EJR, Nicol ED, Newby DE, Dweck MR. Prevalence and clinical implications of valvular calcification on coronary computed tomography angiography. Eur Heart J Cardiovasc Imaging 2021; 22:262-270. [PMID: 33306104 PMCID: PMC7899264 DOI: 10.1093/ehjci/jeaa263] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/07/2020] [Indexed: 12/11/2022] Open
Abstract
AIMS Valvular heart disease can be identified by calcification on coronary computed tomography angiography (CCTA) and has been associated with adverse clinical outcomes. We assessed aortic and mitral valve calcification in patients presenting with stable chest pain and their association with cardiovascular risk factors, coronary artery disease, and cardiovascular outcomes. METHODS AND RESULTS In 1769 patients (58 ± 9 years, 56% male) undergoing CCTA for stable chest pain, aortic and mitral valve calcification were quantified using Agatston score. Aortic valve calcification was present in 241 (14%) and mitral calcification in 64 (4%). Independent predictors of aortic valve calcification were age, male sex, hypertension, diabetes mellitus, and cerebrovascular disease, whereas the only predictor of mitral valve calcification was age. Patients with aortic and mitral valve calcification had higher coronary artery calcium scores and more obstructive coronary artery disease. The composite endpoint of cardiovascular mortality, non-fatal myocardial infarction, or non-fatal stroke was higher in those with aortic [hazard ratio (HR) 2.87; 95% confidence interval (CI) 1.60-5.17; P < 0.001] or mitral (HR 3.50; 95% CI 1.47-8.07; P = 0.004) valve calcification, but this was not independent of coronary artery calcification or obstructive coronary artery disease. CONCLUSION Aortic and mitral valve calcification occurs in one in six patients with stable chest pain undergoing CCTA and is associated with concomitant coronary atherosclerosis. Whilst valvular calcification is associated with a higher risk of cardiovascular events, this was not independent of the burden of coronary artery disease.
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Affiliation(s)
- Michelle C Williams
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh EH164TJ, UK
| | - Daniele Massera
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Alastair J Moss
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
| | - Rong Bing
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
| | - Anda Bularga
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
| | - Philip D Adamson
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
- Christchurch Heart Institute, University of Otago, Christchurch 8140, New Zealand
| | - Amanda Hunter
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
| | - Shirjel Alam
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
| | - Anoop S V Shah
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
| | - Tania Pawade
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
| | - Giles Roditi
- Glasgow Clinical Research Imaging Facility, Queen Elizabeth University Hospital, Glasgow G514LB, UK
| | - Edwin J R van Beek
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh EH164TJ, UK
| | | | - David E Newby
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh EH164TJ, UK
| | - Marc R Dweck
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Chancellor’s Building, 49 Little France Crescent, Edinburgh EH164SB, UK
- Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh EH164TJ, UK
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168
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Wayne SL, Martin C, Smith JA, Almeida AA. Mitral valve repair rates in degenerative mitral valve disease correlate with surgeon and hospital procedural volume. J Card Surg 2021; 36:1419-1426. [PMID: 33616240 DOI: 10.1111/jocs.15310] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/14/2020] [Accepted: 11/19/2020] [Indexed: 11/26/2022]
Abstract
STUDY AIM To determine the relationship between surgeon and hospital procedural volume, and mitral valve repair rates and 30-day mortality for degenerative mitral regurgitation (MR), in Australian cardiac surgical centers. METHODS A total of 4420 patients who underwent elective surgery for degenerative MR between January 2008 and December 2017 in the Australian and New Zealand Society of Cardiac and Thoracic Surgeons Database were retrospectively included. Univariate and multivariate regression analyses examined surgeon and hospital procedural volumes for associations with repair rate and mortality. RESULTS Repair rates varied widely by caseload; from 62.57% to 79.53% for lowest to highest volume surgeons; and from 54.56% to 77.54% for lowest to highest volume hospitals. Compared to surgeons performing ≤5 procedures/annum, surgeons performing 10.1-20/annum were more likely to repair the valve (odds ratio [OR] 2.40, 95% confidence interval [CI] 1.09-5.28, p = .03), particularly if performing more than 20/annum (OR 2.88, 95% CI 1.09-7.60, p = .03). Compared to hospitals performing ≤10/annum, those performing any number of procedures more than 10 demonstrated an increased likelihood of repair (caseload 10.1-20/year OR 1.96, 95% CI 1.25-3.07, p = .003) though odds did not increase above this threshold. Low incidence of 30-day mortality (63 of 4414, 1.43%) limited analysis of contributing variables; procedural volume did not confer a survival benefit. CONCLUSIONS Surgeon and hospital caseload were significantly associated with repair rates of degenerative MR. A threshold minimum of 10 procedures annually for surgeons and hospitals should be utilized to maximize repair rates, and ideally of 20 for surgeons. Mortality was low and may not be significantly impacted by procedural volume.
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Affiliation(s)
- Stephanie Lauren Wayne
- Department of Cardiothoracic Surgery, Monash Health, and Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Catherine Martin
- Biostatistics Consulting Platform, Monash University, Melbourne, Victoria, Australia
| | - Julian Anderson Smith
- Department of Cardiothoracic Surgery, Monash Health, and Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Aubrey Anthony Almeida
- Department of Cardiothoracic Surgery, Monash Health, and Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
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169
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Saccocci M, Colli A. "Learning curve and procedural volume in mitral valve disease". J Card Surg 2021; 36:1427-1430. [PMID: 33616264 DOI: 10.1111/jocs.15324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 12/31/2020] [Indexed: 12/01/2022]
Abstract
The impact of procedural volume on outcome results is a widespread topic in surgery, The importance of referral centers and high-volume hospitals have reached the forefront, particularly in mitral valve surgery, impacting the recommendations of the latest European and American guidelines. In this issue, Wayne et al. presented an interesting analysis of the relationship between surgeon and hospital procedural volume, mitral valve repair rates, and 30-day mortality for degenerative mitral regurgitation (MR) in Australia. Based on the database of the Australian and New Zealand Society of Cardiac and Thoracic Surgeons, they have shown how the surgeon and hospital caseload are significantly associated with repair rates of degenerative MR. This study reaches the same results presented by Chikwe et al. and others and corroborates what guidelines reported about the need for referral centers for mitral valve disease. These results are the reasons why many surgeons, as Adams et al., published papers to highlight the importance of a minimum mitral valve surgery volume threshold to achieve optimum results and discourage at the same time low-volume centers. The concept of minimum thresholds in mitral surgery suggested by Wayne et al. and previously by Vassileva et al. is fundamental to guarantee periprocedural safety, accuracy, and a high rate of reparation. Moreover, not only hospital volume but also surgeon yearly number of mitral valve interventions are crucial in valve repair rate and the threshold of 20 mitral procedures per year, proposed by Wayne et al., seems absolutely consistent with the literature.
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Affiliation(s)
- Matteo Saccocci
- Cardiovascular Department, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Andrea Colli
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
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170
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Lechiancole A, Vendramin I, Sponga S, Piani D, Benedetti G, Meneguzzi M, Ferrara V, Tullio A, Bortolotti U, Livi U. Bentall procedure with the CarboSeal™ and CarboSeal Valsalva™ composite conduits: long-term outcomes. Interact Cardiovasc Thorac Surg 2021; 33:93-100. [PMID: 33598695 DOI: 10.1093/icvts/ivab045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/10/2020] [Accepted: 01/21/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Data on the long-term results with the standard CarboSeal™ mechanical conduit used for the modified Bentall procedure are lacking as well as information on performance of the Valsalva CarboSeal™ conduit. METHODS We have analysed 208 recipients of a standard (n = 110) or a Valsalva (n = 98) CarboSeal™ conduit. The median age was 60 years and 90% were males; 35 (17%) had type A aortic dissection and 65 (30%) a bicuspid aortic valve. Data were retrospectively analysed and results were compared between the 2 conduit models. RESULTS Early mortality was 1.9%; the mean follow-up was 175 ± 95 for standard and 94 ± 51 months for Valsalva conduits (P < 0.01). Actuarial survival was 86 ± 4%, 75 ± 6%, 59 ± 7% and 51 ± 9% at 5, 10, 15 and 20 years, respectively. There were 13 thromboembolic episodes with 3 deaths with an actuarial freedom of 98 ± 1%, 94 ± 2%, 90 ± 3% and 89 ± 4% at 5, 10, 15 and 20 years, respectively. Reoperation on the aortic root was performed in 9 patients for endocarditis (n = 8) and pseudoaneurysm at the right coronary button (n = 1) with an actuarial freedom of 97 ± 1%, 95 ± 2%, 92 ± 3% and 87 ± 4% at 5, 10, 15 and 20 years, respectively. There were no differences between the 2 conduit models in survival and major postoperative complications. CONCLUSIONS The CarboSeal™ conduit has shown gratifying overall performance up to 20 years and appears a valid option for a modified Bentall operation, when a mechanical prosthesis is indicated. Both CarboSeal™ conduit models provided not statistically different overall long-term results.
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Affiliation(s)
| | - Igor Vendramin
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Sandro Sponga
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Daniela Piani
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | | | - Matteo Meneguzzi
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | | | - Annarita Tullio
- Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy
| | - Uberto Bortolotti
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Ugolino Livi
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
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171
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Gürbak İ, Güner A, Güler A, Şahin AA, Çelik Ö, Uzun F, Onan B, Ertürk M. Prognostic influence of objective nutritional indexes on mortality after surgical aortic valve replacement in elderly patients with severe aortic stenosis (from the nutrition-SAVR trial). J Card Surg 2021; 36:1872-1881. [PMID: 33586213 DOI: 10.1111/jocs.15434] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/21/2021] [Accepted: 02/01/2021] [Indexed: 02/06/2023]
Abstract
AIM Several scoring systems, such as controlling nutritional status (CONUT) score, geriatric nutritional risk index (GNRI), and prognostic nutritional index (PNI), have been previously described to show nutritional status. In the present study, we aimed to investigate the value of these scoring systems in predicting in-hospital and long-term mortality in patients undergoing surgical aortic valve replacement (SAVR). METHODS PNI, GNRI, and CONUT were determined using the receiver operator characteristics curve analysis in 150 consecutive elderly patients (age: 70 (66-74) years, male: 78) who underwent SAVR due to degenerative severe aortic stenosis (AS). Patients were divided into two groups according to cutoff values from these indexes. RESULTS During the 50 ± 31 months follow-up period, a total of 36 (24%) patients died. 30-day mortality, 1-year mortality, and total mortality were significantly higher in lower PNI, lower GNRI, and higher CONUT groups. PNI cutoff value was 49.2, GNRI cutoff value was 102.5, and CONUT cutoff value was 1.5. PNI ≤ 49.2, GNRI ≤ 102.5, and CONUT > 1.5 values were found to be independent predictors of total mortality even after risk adjustment. In addition, in the mortality group, PNI (53.7 ± 5.9 vs. 47.4 ± 6.3; p < .001) and GNRI (108 ± 10 vs. 99 ± 6.3); p < .001) were significantly lower, while CONUT score (1 [0-2] vs. 2 [0.2-3]; p < .001) was significantly higher. CONCLUSION Objective nutritional indexes including CONUT score, PNI, and GNRI are important prognostic factors and those indexes should be part of frailty assessment in patients with severe AS.
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Affiliation(s)
- İsmail Gürbak
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ahmet Güner
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Arda Güler
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ahmet A Şahin
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ömer Çelik
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Fatih Uzun
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Burak Onan
- Department of Cardiovascular Surgery, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mehmet Ertürk
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Thilén M, James S, Ståhle E, Lindhagen L, Christersson C. Preoperative heart failure worsens outcome after aortic valve replacement irrespective of left ventricular ejection fraction. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 8:127-134. [PMID: 33543245 DOI: 10.1093/ehjqcco/qcab008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/14/2021] [Accepted: 01/29/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Left ventricular ejection fraction (LVEF) affects outcome of valve replacement (AVR) in aortic stenosis (AS). The study aim was to investigate the prognostic importance of concomitant cardiovascular disease in relation to preoperative LVEF. METHODS AND RESULTS All adult patients undergoing AVR due to AS 2008-2014 in a national register for heart diseases were included. All-cause mortality and hospitalization for heart failure during follow-up after AVR, stratified by preserved or reduced LVEF (=50%), was derived from national patient registers and analyzed by Cox regression.During the study period 10,406 patients, median age 73 years, a median follow-up of 35 months were identified. Preserved LVEF was present in 7,512 (72.2%). Among them 647 (8.6%) had a history of heart failure (HF) and 1,099 (14.6%) atrial fibrillation (AF) before intervention. Preoperative HF was associated with higher mortality irrespective of preserved or reduced LVEF: Hazard Ratio (HR) 1.64 (95% C.I. 1.35 -1.99) and 1.58 (95% C.I. 1.30 -1.92). Prior AF was associated with a higher risk of mortality in patients with preserved but not in those with reduced LVEF: HR 1.62 (95% C.I. 1.36 -1.92) and 1.05 (95% C.I. 0.86 -1.28). Irrespective of LVEF preoperative HF and AF were associated with an increased risk of postoperative heart failure hospitalization. CONCLUSION In patients planned for AVR, a history of HF or AF, irrespective of LVEF, worsens the postoperative prognosis. HF and AF can be seen as markers of myocardial fibrosis not necessarily discovered by LVEF and the merely use of it, besides symptoms, for timing of AVR seems suboptimal.
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Affiliation(s)
- Maria Thilén
- Department of Medical Sciences, Cardiology, Uppsala University
| | - Stefan James
- Department of Medical Sciences, Cardiology, Uppsala University.,Uppsala Clinical Research Center, Uppsala University
| | - Elisabeth Ståhle
- Department of Surgical Sciences, Thoracic Surgery, Uppsala University, Uppsala, Sweden
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Sugiura A, Weber M, Tabata N, Goto T, Öztürk C, Lin M, Zimmer S, Nickenig G, Sinning JM. QRS duration is a risk indicator of adverse outcomes after MitraClip. Catheter Cardiovasc Interv 2021; 98:E594-E601. [PMID: 33527610 DOI: 10.1002/ccd.29505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 11/11/2020] [Accepted: 12/10/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND While QRS duration is a known marker of left ventricular (LV) function, little is known about its utility for predicting clinical prognosis after transcatheter mitral valve repair (TMVR). We investigated the association between QRS duration and one-year adverse events after TMVR with the MitraClip system. METHODS From January 2011 through April 2019, we identified consecutive patients who underwent TMVR. Patients who had prior cardiac resynchronization therapy or a ventricular pacing rhythm were excluded. The patients were divided into two groups according to their QRS duration (<120 or ≥ 120 ms). Cox proportional hazard model was applied to determine the association between QRS duration and the composite outcome (all-cause mortality and re-hospitalization due to heart failure) within 1 year. RESULTS A total of 348 patients were analyzed. Prolonged QRS duration (≥120 ms) was associated with an increased risk of the composite outcome (adjusted-HR 2.35, 95%CI 1.30-4.24, p = .005). There was a linear relationship between prolonged QRS duration and the increased risk of the composite outcomes. The observed association was consistent both in patients with left ventricular ejection fraction ≤35% and those with >35%. Furthermore, a QRS duration ≥120 ms was associated with lower improvement of LVEF at follow-up (adjusted-β coefficient - 5.31%, 95%CI -8.17 to -2.46, p < .001). CONCLUSIONS Prolonged QRS duration was associated with an increased risk of mortality and re-hospitalization and less improvement of LVEF following TMVR. QRS duration could be a useful marker to predict adverse outcomes and LV function after TMVR.
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Affiliation(s)
- Atsushi Sugiura
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Marcel Weber
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Noriaki Tabata
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Tadahiro Goto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, TXP Medical Co. Ltd., Tokyo, Japan
| | - Can Öztürk
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Maoshin Lin
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Jan-Malte Sinning
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany.,Department of Cardiology, St. Vinzenz-Hospital Cologne, Cologne, Germany
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174
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YOUSSEFI P, ZACEK P, BERREBI A, CZYTROM D, MANKOUBI L, NOGHIN M, MONIN JL, DEBAUCHEZ M, LANSAC E. Root repair with aortic ring annuloplasty using the standard approach. THE JOURNAL OF CARDIOVASCULAR SURGERY 2021; 62:12-18. [DOI: 10.23736/s0021-9509.20.11690-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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175
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Žvirblytė R, Montvilaitė A, Tamulėnaitė E, Saniukaitė A, Ereminienė E, Vaškelytė JJ. Echocardiographic predictors of exercise induced pulmonary hypertension in patients with asymptomatic moderate to severe mitral regurgitation and preserved left ventricular ejection fraction. Perfusion 2021; 37:188-197. [PMID: 33509060 DOI: 10.1177/0267659120987545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The significant role of mitral regurgitation (MR) in development of pulmonary hypertension (PH) has been proved in previous studies. Experts suggest systolic pulmonary arterial pressure (SPAP) ⩾60 mmHg during exercise as a significant threshold of negative prognostic value in patients with MR. PURPOSE The aim of this study was to evaluate the changes of SPAP and to ascertain the determinants of exercise induced pulmonary hypertension (EIPH) in patients with asymptomatic primary MR. METHODS We performed a prospective study that included 50 patients with asymptomatic primary moderate to severe MR with preserved left ventricular ejection fraction (LV EF ⩾60%) at rest. They were divided into two groups according to the presence (PH group; n = 13) or absence (non-PH group; n = 37) of EIPH. Rest and stress (bicycle ergometry) echocardiography and speckle-tracking offline analysis were performed. RESULTS An increment of SPAP from rest to peak stress was higher in PH group (p < 0.001). Multivariate regression analysis showed that MR effective regurgitation orifice area (EROA; p = 0.008) and regurgitant volume (RVol; p = 0.006) contributed significantly to SPAP at rest. Higher increment of MR EROA during stress and worse parameters of LV diastolic function at rest (E, A, E/e') correlated significantly with higher SPAP during peak stress and they had a major role in predicting EIPH according to univariate logistic regression analysis. In ROC analysis SPAP >33.1 mmHg at rest could predict EIPH with 84.6% sensitivity and 87.1% specificity (95%CI 0.849-1.000; p < 0.001). CONCLUSIONS Parameters of MR severity (EROA and RVol) were significant determinants of SPAP at rest, while the increment of MR EROA during stress and parameters of resting LV diastolic function were the best predictors of significant EIPH.
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Affiliation(s)
- Rūta Žvirblytė
- Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Aistė Montvilaitė
- Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Eglė Tamulėnaitė
- Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Agnė Saniukaitė
- Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Eglė Ereminienė
- Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Jolanta Justina Vaškelytė
- Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania.,The Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
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176
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Bicuspid aortic valve morphology and aortic valvular outflow jets: an experimental analysis using an MRI-compatible pulsatile flow circulation system. Sci Rep 2021; 11:2066. [PMID: 33483580 PMCID: PMC7822932 DOI: 10.1038/s41598-021-81845-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 01/05/2021] [Indexed: 11/08/2022] Open
Abstract
The characteristics of aortic valvular outflow jet affect aortopathy in the bicuspid aortic valve (BAV). This study aimed to elucidate the effects of BAV morphology on the aortic valvular outflow jets. Morphotype-specific valve-devising apparatuses were developed to create aortic valve models. A magnetic resonance imaging-compatible pulsatile flow circulation system was developed to quantify the outflow jet. The eccentricity and circulation values of the peak systolic jet were compared among tricuspid aortic valve (TAV), three asymmetric BAVs, and two symmetric BAVs. The results showed mean aortic flow and leakage did not differ among the five BAVs (six samples, each). Asymmetric BAVs demonstrated the eccentric outflow jets directed to the aortic wall facing the smaller leaflets. In the asymmetric BAV with the smaller leaflet facing the right-anterior, left-posterior, and left-anterior quadrants of the aorta, the outflow jets exclusively impinged on the outer curvature of the ascending aorta, proximal arch, and the supra-valvular aortic wall, respectively. Symmetric BAVs demonstrated mildly eccentric outflow jets that did not impinge on the aortic wall. The circulation values at peak systole increased in asymmetric BAVs. The bicuspid symmetry and the position of smaller leaflet were determinant factors of the characteristics of aortic valvular outflow jet.
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177
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Fischlein T, Meuris B, Folliguet T, Hakim-Meibodi K, Misfeld M, Carrel T, Zembala M, Cerutti E, Asch FM, Haverich A. Midterm outcomes with a sutureless aortic bioprosthesis in a prospective multicenter cohort study. J Thorac Cardiovasc Surg 2021; 164:1772-1780.e11. [PMID: 33597099 DOI: 10.1016/j.jtcvs.2020.12.109] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 11/27/2020] [Accepted: 12/03/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The objective of this study was to report midterm clinical outcomes with a self-expandable sutureless aortic valve. METHODS Between 2010 and 2013, 658 patients at 25 European institutions received the Perceval sutureless valve (LivaNova Plc, London, United Kingdom). Mean follow-up was 3.8 years; late cumulative follow-up was 2325.2 patient-years. RESULTS The mean age of the population was 78.3 ± 5.6 years and 40.0% (n = 263) were 80 years of age or older; mean Society of Thoracic Surgeons-Predicted Risk of Mortality score was 7.2 ± 7.4. Concomitant procedures were performed in 31.5% (n = 207) of patients. Overall duration of cardiopulmonary bypass time was 64.8 ± 25.2 minutes and aortic cross-clamping time was 40.7 ± 18.1 minutes. Thirty-day all-cause mortality was 3.7% (23 patients), with an observed:expected ratio of 0.51. Overall survival was 91.6% at 1 year, 88.5% at 2 years, and 72.7% at 5 years. Peak and mean gradients remained stable during follow-up, and were 17.8 ± 11.3 mm Hg and 9.0 ± 6.3 mm Hg, respectively, at 5 years. Preoperatively, 33.4% of those who received the Perceval valve (n = 210) were in New York Heart Association functional class I or II versus 93.1% (n = 242) at 5 years. CONCLUSIONS This series, representing, to our knowledge, the longest follow-up with sutureless technology in a prospective, multicenter study, shows that aortic replacement using sutureless valves is associated with low mortality and morbidity and good hemodynamic performance.
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Affiliation(s)
- Theodor Fischlein
- Klinikum Nürnberg, Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany.
| | - Bart Meuris
- Cardiac Surgery, UZ Gasthuisberg, Leuven, Belgium
| | - Thierry Folliguet
- Cardiac Surgery and Transplantation, Hôpital Henri Mondor assistance Publique Hôpitaux de Paris, Paris, France
| | - Kavous Hakim-Meibodi
- Department of Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Martin Misfeld
- Department of Cardiac Surgery, Herzzentrum Universitaet Leipzig, Klinik fur Herzchirurgie, Leipzig, Germany; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Marian Zembala
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, School of Medicine, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Elisa Cerutti
- Clinical Affairs Department, LivaNova plc, London, United Kingdom
| | - Federico M Asch
- MedStar Health Research Institute, Washington Hospital Center, Washington, DC
| | - Axel Haverich
- Cardio-thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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178
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Di Mauro M, Raviola E, Guarracini S, Di Marco M, Lorusso R, Calafiore AM. Is surgery the fair competitor for MitraClip? J Card Surg 2021; 36:1120-1122. [PMID: 33428264 DOI: 10.1111/jocs.15295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 12/14/2020] [Indexed: 12/01/2022]
Abstract
In the last decades, the overlapping areas of intervention between cardiac surgeons and interventional cardiologists are rocketing, especially in the field of treatment of heart valve disease. But, while for the aortic valve the competition, even for nonhigh risk patients, has become tightened, in the context of mitral regurgitation, the surgery seems to not have competitors. In fact looking the results of studies published so far, a question arises: Is surgery the fair competitor for the Mitraclip? The meta-analysis by Abdul Khader et al. summarized few evidences present in this field, only 11 observational studies and 1 randomized trial, providing an awesome response: "NO." Is therefore not a case if recently two trials, MITRA-FR and COAPT, chose to use as competitor for MitraClip, more rightly, medical therapy instead of surgery. In conclusions, in case of mitral regurgitation (MR), surgery is still largely the gold standard treatment and so MitraClip cannot be mention at all as competitor of surgery. It can be the right choice of case of primary MR where patients showed high risk for surgery. In case of secondary MR, especially with large and poor left ventricle we should wait for a clear answer on its role, yet.
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Affiliation(s)
- Michele Di Mauro
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Eliana Raviola
- Department of Cardiac Surgery, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
| | | | - Massimo Di Marco
- Department of Cardiology, "Santo Spirito" Hospital, Pescara, Italy
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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179
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Carino D, Lapenna E, Ascione G, Ruggeri S, Del Forno B, Castiglioni A, Alfieri O, De Bonis M. Is mitral annuloplasty an effective treatment for severe atrial functional mitral regurgitation? J Card Surg 2021; 36:596-602. [PMID: 33386760 DOI: 10.1111/jocs.15273] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/04/2020] [Accepted: 12/18/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Unlike secondary mitral regurgitation (MR) in the setting of left ventricular disease, results of surgical treatment of severe atrial functional MR has remained largely unspoken. The aim of this study is to analyze short to midterm results of isolated ring annuloplasty in patients with severe atrial functional MR, in comparison with a matched cohort of patients with secondary MR. METHODS A retrospective review of our Institutional database was carried out to find all patients fulfilling strict echocardiographic criteria to define atrial functional MR. A control group of patients with MR secondary to ventricular disease was selected. All patients underwent mitral repair by means of isolated ring annuloplasty. Mortality, reoperation for severe MR, and recurrence of MR were assessed by clinical and echocardiographic follow-up. Cumulative incidence function (CIF) of recurrence of MR using death and reoperation as the competitive risk was used. RESULTS Twenty patients were selected for the study group and 25 for the control group. There were no differences between the two groups in terms of mortality and reoperation rate. At 2 years, the CIF of recurrence of MR ≥ 3+ and ≥ 2+ was significantly higher in patients with secondary MR compared to patients with atrial functional MR (20.8 ± 8.29% vs 5.9 ± 5.71% and 45.8 ± 10.17% vs 5.9 ± 5.71%) CONCLUSION: In patients with severe atrial functional MR, mitral valve repair by means of isolated ring annuloplasty seems a more effective and durable treatment as compared to patients with MR secondary to ventricular disease. Larger cohorts with longer follow up are needed to confirm these results.
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Affiliation(s)
- Davide Carino
- Department of Cardiac Surgery, IRCCS San Raffaele Scientific institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Elisabetta Lapenna
- Department of Cardiac Surgery, IRCCS San Raffaele Scientific institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Guido Ascione
- Department of Cardiac Surgery, IRCCS San Raffaele Scientific institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Stefania Ruggeri
- Department of Cardiac Surgery, IRCCS San Raffaele Scientific institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Benedetto Del Forno
- Department of Cardiac Surgery, IRCCS San Raffaele Scientific institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Castiglioni
- Department of Cardiac Surgery, IRCCS San Raffaele Scientific institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Ottavio Alfieri
- Department of Cardiac Surgery, IRCCS San Raffaele Scientific institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Michele De Bonis
- Department of Cardiac Surgery, IRCCS San Raffaele Scientific institute, Vita-Salute San Raffaele University, Milan, Italy
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180
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Wayne SL, Zimmet AD. Surgical Management of Heart Failure. Curr Cardiol Rev 2021; 17:e160721192831. [PMID: 33855948 PMCID: PMC8950451 DOI: 10.2174/1573403x17666210414094452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 10/12/2020] [Accepted: 10/12/2020] [Indexed: 11/22/2022] Open
Abstract
Optimal management of heart failure is collaborative, with the involvement of specialist heart failure physicians, nurses, interventionalists, and surgeons. In addition to medical optimisation and cardiac resynchronisation therapy, surgery plays a valuable role in many patients. We herein study the evidence and the role of surgical intervention in functional mitral regurgitation, coronary revascularisation in ischaemic cardiomyopathy, and surgical ventricular reconstruction. Additionally, we describe techniques of temporary and durable mechanical circulatory support, with their relative advantages and disadvantages, and applications. Finally, we describe the history and nomenclature around heart transplants, their indications, techniques, present-day outcomes, complications, and new developments in the field.
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Affiliation(s)
- Stephanie L. Wayne
- CJOB Department of Cardiothoracic Surgery, Alfred Health, Melbourne, Victoria, Australia
| | - Adam D. Zimmet
- CJOB Department of Cardiothoracic Surgery, Alfred Health, Melbourne, Victoria, Australia
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181
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Immohr MB, Sugimura Y, Aubin H, Rellecke P, Boeken U, Lichtenberg A, Akhyari P. Iron deficiency does not impair the outcome after elective coronary artery bypass and aortic valve procedures. J Card Surg 2020; 36:542-550. [PMID: 33345354 DOI: 10.1111/jocs.15254] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/25/2020] [Accepted: 12/01/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY: Iron deficiency (ID), a common malnutrition, has been linked to impaired prognosis in patients with congestive heart failure. It remains unclear whether ID also affects the outcome after elective cardiac surgery. METHODS A total of 378 consecutive patients undergoing either coronary artery bypass grafting (CABG) or surgical aortic valve replacement (SAVR) were prospectively enrolled, and blood samples were taken before surgery for analysis of iron metabolism. Incidence of major adverse cardiovascular and cerebrovascular events (MACCE) was defined as the primary endpoint of the study. RESULTS ID (ferritin < 100 ng/ml or ferritin = 100-299 ng/ml and transferrin saturation < 20%) was common in cardiac surgery patients (ID, n = 265, 70%) and related to significant decreased preoperative hemoglobin values (ID: 13.6 ± 1.6 g/dl, Non-ID: 14.3 ± 1.5 g/dl, p < 0.01). We did not observe any differences in the postoperative outcome of the two groups. The incidence of MACCE was 4.9% in patients with ID and 8.8% in Non-ID (p = 0.16). In-hospital mortality (ID: 1.9%, Non-ID: 4.4%, p = 0.17) and stroke (ID: 1.1%, Non-ID: 1.8%, p = 0.64) were also not altered by ID. In addition, intensive care unit and hospital stay, perioperative blood transfusions as well as perioperative morbidities, such as acute kidney injury, low cardiac output syndrome, major bleeding complication, and sternal wound infections were comparable in patients with and without ID. CONCLUSIONS The majority of patients undergoing elective CABG or SAVR suffer from ID; however, we found no significant differences in regard to MACCE and postoperative morbidity between ID and non-ID patients.
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Affiliation(s)
- Moritz B Immohr
- Department of Cardiac Surgery, Heinrich-Heine-University Medical School, Düsseldorf, Germany
| | - Yukiharu Sugimura
- Department of Cardiac Surgery, Heinrich-Heine-University Medical School, Düsseldorf, Germany
| | - Hug Aubin
- Department of Cardiac Surgery, Heinrich-Heine-University Medical School, Düsseldorf, Germany
| | - Philipp Rellecke
- Department of Cardiac Surgery, Heinrich-Heine-University Medical School, Düsseldorf, Germany
| | - Udo Boeken
- Department of Cardiac Surgery, Heinrich-Heine-University Medical School, Düsseldorf, Germany
| | - Artur Lichtenberg
- Department of Cardiac Surgery, Heinrich-Heine-University Medical School, Düsseldorf, Germany
| | - Payam Akhyari
- Department of Cardiac Surgery, Heinrich-Heine-University Medical School, Düsseldorf, Germany
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182
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Mazur P, Natorska J, Ząbczyk M, Krzych Ł, Litwinowicz R, Kędziora A, Kapelak B, Undas A. Von Willebrand factor in aortic or mitral valve stenosis and bleeding after heart valve surgery. Thromb Res 2020; 198:190-195. [PMID: 33360153 DOI: 10.1016/j.thromres.2020.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/05/2020] [Accepted: 12/09/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Low von Willebrand factor (VWF) increases the risk of bleeding. The objective was to assess the influence of VWF on bleeding after valvular surgery. METHODS We studied 82 consecutive patients in median age of 65.5 years with severe isolated aortic stenosis (AS, n = 62) or mitral stenosis (MS, n = 20), undergoing heart valve surgery in extracorporeal circulation. Preoperatively, we assessed VWF antigen (VWF:Ag) and activity (VWF:RCo), a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 (ADAMTS13), and fibrinolysis inhibitors. RESULTS Compared with AS, MS patients were more frequently female (80 vs. 55%, p = 0.045) with atrial fibrillation (AF) (80 vs. 8%, p < 0.0001), with no difference in age or comorbidities. Median postoperative drainage was 420 ml for AS, and 425 ml for MS (p = 0.37). Patients with AS had lower VWF:RCo (125.8 [88.5-160.8] vs. 188.0 [140.3-207.3] IU/dl, p = 0.003) and VWF:Ag (135.8 [112.0-171.2] vs. 191.7 [147.3-236.4] IU/dl, p = 0.01) than MS patients. Mean VWF:RCo/Ag ratio was 0.88 ± 0.17, with no intergroup differences. ADAMTS13 levels and activity were similar in both groups. In AS, both VWF:RCo and VWF:Ag correlated inversely with maximal (r = -0.39, p = 0.0003 and r = -0.39, p = 0.0004, respectively) and mean (r = -0.40, p = 0.0004 and r = -0.39, p = 0.0006, respectively) transvalvular pressure gradients. There was no difference in perioperative bleeding between patients following mitral and aortic valve surgery, and bleeding was not associated with VWF:Ag or VWF:RCo. CONCLUSIONS In severe AS, VWF levels and activity correlate inversely with transvalvular pressure gradients, and are lower than in severe degenerative MS, but do not affect blood loss after valvular surgery in extracorporeal circulation.
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Affiliation(s)
- Piotr Mazur
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; The John Paul II Hospital, Krakow, Poland.
| | - Joanna Natorska
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; The John Paul II Hospital, Krakow, Poland
| | - Michał Ząbczyk
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; The John Paul II Hospital, Krakow, Poland
| | - Łukasz Krzych
- Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland
| | - Radosław Litwinowicz
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; The John Paul II Hospital, Krakow, Poland
| | | | - Bogusław Kapelak
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; The John Paul II Hospital, Krakow, Poland
| | - Anetta Undas
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; The John Paul II Hospital, Krakow, Poland
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183
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Wu JT, Zaman JAB, Yakupoglu HY, Vennela B, Emily C, Nabeela K, Jarman J, Haldar S, Jones DG, Wajid H, Shi R, Chen Z, Markides V, Wong T. Catheter Ablation of Atrial Fibrillation in Patients With Functional Mitral Regurgitation and Left Ventricular Systolic Dysfunction. Front Cardiovasc Med 2020; 7:596491. [PMID: 33381527 PMCID: PMC7767831 DOI: 10.3389/fcvm.2020.596491] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/26/2020] [Indexed: 11/13/2022] Open
Abstract
Background: The efficacy of catheter ablation for atrial fibrillation (AF) in patients with functional mitral regurgitation (MR) and left ventricular (LV) systolic dysfunction (LVSD) is not known. The aim of the study is to determine the efficacy of catheter ablation for AF in patients with functional MR and LVSD, and to validate its effects on the severity of MR and cardiac reverse remodeling. Methods: We performed a retrospective study of 54 patients with functional MR who underwent AF ablation, including 21 (38.9%) with LVSD and 33 (61.1%) with normal LV systolic function (LVF). The primary outcomes evaluated were freedom from recurrent atrial tachyarrhythmia (ATa), severity of MR, and left atrial (LA) and LV remodeling. Results: During a mean follow-up of 20.7 ± 16.8 months, freedom from recurrent ATa was not significantly different between patients with LVSD and those with normal LVF after the first ablation (P = 0.301) and after multiple ablations (P = 0.728). Multivariable predictors of recurrent ATa were AF duration [hazard ratio (HR) 1.12, 95% confidence interval (CI) 1.01–1.25; P = 0.039), previous stroke (HR 5.28, 95% CI 1.46–19.14; P = 0.011), and estimated glomerular filtration rate (HR 0.97, 95% CI 0.95–0.99; P = 0.012). Compared with baseline, there was a significant reduction in severity of MR (P = 0.007), LA size (P < 0.001) and LV end-systolic dimension (P = 0.008), and improvement in the LV ejection fraction (P = 0.001) after restoring sinus rhythm in patients with LVSD. Conclusion: Catheter ablation is a valid option for the treatment of AF in patients with functional MR and LVSD, even though multiple procedures may be required.
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Affiliation(s)
- Jin-Tao Wu
- Heart Centre of Henan Provincial People's Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China.,Heart Rhythm Centre, The Royal Brompton and Harefield National Health Service (NHS) Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Junaid A B Zaman
- Heart Rhythm Centre, The Royal Brompton and Harefield National Health Service (NHS) Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - H Yakup Yakupoglu
- Echocardiography Department, The Royal Brompton and Harefield National Health Service (NHS) Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Boyalla Vennela
- Heart Rhythm Centre, The Royal Brompton and Harefield National Health Service (NHS) Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Cantor Emily
- Heart Rhythm Centre, The Royal Brompton and Harefield National Health Service (NHS) Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Karim Nabeela
- Heart Rhythm Centre, The Royal Brompton and Harefield National Health Service (NHS) Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Julian Jarman
- Heart Rhythm Centre, The Royal Brompton and Harefield National Health Service (NHS) Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Shouvik Haldar
- Heart Rhythm Centre, The Royal Brompton and Harefield National Health Service (NHS) Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - David Gareth Jones
- Heart Rhythm Centre, The Royal Brompton and Harefield National Health Service (NHS) Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Hussain Wajid
- Heart Rhythm Centre, The Royal Brompton and Harefield National Health Service (NHS) Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Rui Shi
- Heart Rhythm Centre, The Royal Brompton and Harefield National Health Service (NHS) Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Zhong Chen
- Heart Rhythm Centre, The Royal Brompton and Harefield National Health Service (NHS) Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Vias Markides
- Heart Rhythm Centre, The Royal Brompton and Harefield National Health Service (NHS) Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Tom Wong
- Heart Rhythm Centre, The Royal Brompton and Harefield National Health Service (NHS) Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
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Fischlein T, Folliguet T, Meuris B, Shrestha ML, Roselli EE, McGlothlin A, Kappert U, Pfeiffer S, Corbi P, Lorusso R. Sutureless versus conventional bioprostheses for aortic valve replacement in severe symptomatic aortic valve stenosis. J Thorac Cardiovasc Surg 2020; 161:920-932. [PMID: 33478837 DOI: 10.1016/j.jtcvs.2020.11.162] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Sutureless aortic valves are a novel option for aortic valve replacement. We sought to demonstrate noninferiority of sutureless versus standard bioprostheses in severe symptomatic aortic stenosis. METHODS The Perceval Sutureless Implant Versus Standard-Aortic Valve Replacement is a prospective, randomized, adaptive, open-label trial. Patients were randomized (March 2016 to September 2018) to aortic valve replacement with a sutureless or stented valve using conventional or minimally invasive approach. Primary outcome was freedom from major adverse cerebral and cardiovascular events (composite of all-cause death, myocardial infarction, stroke, or valve reintervention) at 1 year. RESULTS At 47 centers (12 countries), 910 patients were randomized to sutureless (n = 453) or conventional stented (n = 457) valves; mean ages were 75.4 ± 5.6 and 75.0 ± 6.1 years, and 50.1% and 44.9% were female, respectively. Mean ± standard deviation Society of Thoracic Surgeons scores were 2.4 ± 1.7 and 2.1 ± 1.3, and a ministernotomy approach was used in 50.4% and 47.3%, respectively. Concomitant procedures were performed with similar rates in both groups. Noninferiority was demonstrated for major adverse cerebral and cardiovascular events at 1 year, whereas aortic valve hemodynamics improved equally in both groups. Use of sutureless valves significantly reduced surgical times (mean extracorporeal circulation times: 71.0 ± 34.1 minutes vs 87.8 ± 33.9 minutes; mean crossclamp times: 48.5 ± 24.7 vs 65.2 ± 23.6; both P < .0001), but resulted in a higher rate of pacemaker implantation (11.1% vs 3.6% at 1 year). Incidences of perivalvular and central leak were similar. CONCLUSIONS Sutureless valves were noninferior to stented valves with respect to major adverse cerebral and cardiovascular events at 1 year in patients undergoing aortic valve replacement (alone or with coronary artery bypass grafting). This suggests that sutureless valves should be considered as part of a comprehensive valve program.
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Affiliation(s)
- Theodor Fischlein
- Klinikum Nürnberg, Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany.
| | - Thierry Folliguet
- Department of Cardiac Surgery, Hôpital Henri Mondor, Université Paris 12, Créteil, Paris, France
| | - Bart Meuris
- UZ Gasthuisberg Leuven, University Hospital, Leuven, Belgium
| | | | - Eric E Roselli
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Utz Kappert
- Herzzentrum Dresden GmbH Universitätsklinik, Dresden, Germany
| | - Steffen Pfeiffer
- Klinikum Nürnberg, Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany; Schön Klinik Vogtareuth, Vogtareuth, Germany
| | | | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart and Vascular Center, Maastricht University Medical Center (MUMC+), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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185
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Mauri V, Frohn T, Deuschl F, Mohemed K, Kuhr K, Reimann A, Körber MI, Schofer N, Adam M, Friedrichs K, Kuhn EW, Scholtz S, Rudolph V, Wahlers TCW, Baldus S, Mader N, Schäfer U, Rudolph TK. Impact of device landing zone calcification patterns on paravalvular regurgitation after transcatheter aortic valve replacement with different next-generation devices. Open Heart 2020; 7:openhrt-2019-001164. [PMID: 32393655 PMCID: PMC7223472 DOI: 10.1136/openhrt-2019-001164] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 02/18/2020] [Accepted: 03/26/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Residual paravalvular regurgitation (PVR) has been associated to adverse outcomes after transcatheter aortic valve replacement (TAVR). This study sought to evaluate the impact of device landing zone (DLZ) calcification on residual PVR after TAVR with different next-generation transcatheter heart valves. METHODS 642 patients underwent TAVR with a SAPIEN 3 (S3; n=292), ACURATE neo (NEO; n=166), Evolut R (ER; n=132) or Lotus (n=52). Extent, location and asymmetry of DLZ calcification were assessed from contrast-enhanced CT imaging and correlated to PVR at discharge. RESULTS PVR was ≥moderate in 0.7% of S3 patients, 9.6% of NEO patients, 9.8% of ER patients and 0% of Lotus patients (p<0.001), and these differences remained after matching for total DLZ calcium volume. The amount of DLZ calcium was significantly related to the degree of PVR in patients treated with S3 (p=0.045), NEO (p=0.004) and ER (p<0.001), but not in Lotus patients (p=0.698). The incidence of PVR ≥moderate increased significantly over the tertiles of DLZ calcium volume (p=0.046). On multivariable analysis, calcification of the aortic valve cusps, LVOT calcification and the use of self-expanding transcatheter aortic valve implantation (TAVI) prostheses emerged as predictors of PVR. CONCLUSIONS The susceptibility to PVR depending on the amount of calcium was mainly observed in self-expanding TAVI prostheses. Thus, DLZ calcification is an important factor to be considered in prosthesis selection for each individual patient, keeping in mind the trade-off between PVR reduction, risk of new pacemaker implantation and unfavourable valve ha emodynamics.
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Affiliation(s)
- Victor Mauri
- Heart Center, University of Cologne, Koln, Germany
| | - Thomas Frohn
- Heart Center, University of Cologne, Koln, Germany
| | - Florian Deuschl
- Departement of Cardiology, University Hospital Hamburg Eppendorf University Heart Centre, Hamburg, Hamburg, Germany
| | - Kawa Mohemed
- General und Interventional Cardiolgy/Angiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Nordrhein-Westfalen, Germany
| | - Kathrin Kuhr
- Heart Center, University of Cologne, Koln, Germany
| | | | | | - Niklas Schofer
- Departement of Cardiology, University Hospital Hamburg Eppendorf University Heart Centre, Hamburg, Hamburg, Germany
| | - Matti Adam
- Heart Center, University of Cologne, Koln, Germany
| | - Kai Friedrichs
- General und Interventional Cardiolgy/Angiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Nordrhein-Westfalen, Germany
| | - Elmar W Kuhn
- Heart Center, University of Cologne, Koln, Germany
| | - Smita Scholtz
- General und Interventional Cardiolgy/Angiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Nordrhein-Westfalen, Germany
| | - Volker Rudolph
- General und Interventional Cardiolgy/Angiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Nordrhein-Westfalen, Germany
| | - Thorsten C W Wahlers
- Department of Cardiothoracic Surgery, Klinikum der Universität zu Köln, Klinik und Poliklinik für Herz- und Thoraxchirurgie, Cologne, Germany
| | - Stephan Baldus
- Department of Internal Medicine III, University of Cologne, Cologne, Germany
| | - Navid Mader
- Department of Cardiothoracic Surgery, Klinikum der Universität zu Köln, Klinik und Poliklinik für Herz- und Thoraxchirurgie, Cologne, Germany
| | - Ulrich Schäfer
- Departement of Cardiology, University Hospital Hamburg Eppendorf University Heart Centre, Hamburg, Hamburg, Germany
| | - Tanja K Rudolph
- General und Interventional Cardiolgy/Angiology, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Nordrhein-Westfalen, Germany
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PASCAL versus MitraClip-XTR edge-to-edge device for the treatment of tricuspid regurgitation: a propensity-matched analysis. Clin Res Cardiol 2020; 110:451-459. [PMID: 33313975 PMCID: PMC7907034 DOI: 10.1007/s00392-020-01784-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/19/2020] [Indexed: 11/17/2022]
Abstract
Background Transcatheter tricuspid valve repair (TTVR) is a promising technique for the treatment of tricuspid regurgitation (TR). Data comparing the performance of novel edge-to-edge devices (PASCAL and MitraClip-XTR) are scarce. Methods We identified 80 consecutive patients who underwent TTVR using either the PASCAL or MitraClip-XTR system to treat symptomatic TR from July 2018 to June 2020. To adjust for baseline imbalances, we performed a propensity score (PS) 1:1 matching. The primary endpoint was a reduction in TR severity by at least one grade at 30 days. Results The PS-matched cohort (n = 44) was at high-surgical risk (EuroSCORE II: 7.5% [interquartile range (IQR) 4.8–12.1%]) with a mean TR grade of 4.3 ± 0.8 and median coaptation gap of 6.2 mm [IQR 3.2–9.1 mm]. The primary endpoint was similarly observed in both groups (PASCAL: 91% vs. MitraClip-XTR: 96%). Multiple device implantation was the most common form (59% vs. 82%, p = 0.19), and the occurrence of SLDA was comparable between the PASCAL and MitraClip-XTR system (5.7% [2 of 35 implanted devices] vs. 4.4% [2 of 45 implanted devices], p = 0.99). No periprocedural death or conversions to surgery occurred, and 30-day mortality (5.0% vs. 5.0%, log-rank p = 0.99) and 3-month mortality (10.0% vs. 5.0%, log-rank p = 0.56) were similar between both groups. During follow-up, functional NYHA class, 6-min walking distance, and health status improved in both groups. Conclusions Both TTVR devices, PASCAL and MitraClip-XTR, appeared feasible and comparable for an effective TR reduction. Randomized head-to-head comparisons will help to further define the appropriate scope of application of each system. Supplementary Information The online version contains supplementary material available at 10.1007/s00392-020-01784-w.
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Bogachev-Prokophiev AV, Ovcharov MA, Lavinykov SO, Pivkin AN, Sharifulin RM, Afanasyev AV, Sapegin AV, Zheleznev SI. Surgical Atrial Fibrillation Ablation With and Without Left Atrium Reduction for Patients Scheduled for Mitral Valve Surgery: A Prospective Randomised Study. Heart Lung Circ 2020; 30:922-931. [PMID: 33309875 DOI: 10.1016/j.hlc.2020.10.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/22/2020] [Accepted: 10/28/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The influence of left atrium (LA) enlargement on atrial arrhythmia recurrence (AAR) after surgical ablation in patients with mitral valve (MV) disease remains unresolved. OBJECTIVE Left atrial size is critical to the success of concomitant atrial fibrillation (AF) ablation in patients scheduled for MV surgery. However, a large LA should not be a limiting factor when evaluating surgical candidates with AF if they receive appropriate treatment during concomitant ablation. This randomised study assessed whether adding LA reduction (LAR) to the maze procedure for MV surgery patients can improve freedom from AAR. METHODS From September 2014 to September 2017, 140 patients were randomly assigned into two groups. The maze group underwent MV surgery with concomitant surgical AF ablation (n=70). The maze + LA reduction group underwent MV surgery with concomitant AF ablation and LA reduction procedure (n=70). Rhythm outcomes were estimated by Holter monitoring, according to Heart Rhythm Society guidelines. RESULTS The concomitant LA reduction procedure did not increase early mortality and complications rates. Significant differences in freedom from AAR were observed at 24 months (maze, 78.4%; maze + LAR group, 92.3%; p=0.025). A significant difference in LA volume was detected at discharge (p<0.0001); however, it was not significantly different at 24 months (p=0.182). CONCLUSIONS Adding LA reduction to the maze procedure led to improvements in freedom from AAR for patients with AF and LA enlargement scheduled for MV surgery. A concomitant LA reduction procedure did not increase mortality and perioperative risk.
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Affiliation(s)
| | - Michail A Ovcharov
- Heart Valves Surgery Department, E. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation.
| | - Sergey O Lavinykov
- Heart Valves Surgery Department, E. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Alexey N Pivkin
- Heart Valves Surgery Department, E. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Ravil M Sharifulin
- Heart Valves Surgery Department, E. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Alexander V Afanasyev
- Heart Valves Surgery Department, E. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Andrey V Sapegin
- Heart Valves Surgery Department, E. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Sergey I Zheleznev
- Heart Valves Surgery Department, E. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
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Adamo M, Alos B, Metra M, Lefèvre T, Swaans MJ, Gheorghe L, Tschöpe C, Krackhardt F, Alfieri O, Bouleti C. Patient with heart failure: importance to treat valvular diseases. Eur Heart J Suppl 2020; 22:P38-P41. [PMID: 33390869 PMCID: PMC7757709 DOI: 10.1093/eurheartj/suaa184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
COVID-19 pandemic is causing an unprecedented burden on healthcare resources and this includes treatment of heart failure and valvular heart diseases (VHD). Percutaneous procedures have broadened the number of patients with VHD who could be treated. However, COVID-19 pandemic has challenged their implementation. The risk of in-hospital infection, resources reallocation, reduced access to hospital caused a substantial delay of VHD treatment with an increased risk of clinical worsening and mortality. Now, the pandemic is not ended and subsequent waves are likely. Reorganization of our healthcare resources is needed, including a proper algorithm for patients' prioritization, based on the severity of their valve disease, their life expectancy, complexity of the intervention, and the resources available. A wider use of telemedicine for patients' selection and follow-up and any measurement that can shorten the duration of the hospital stay must be adopted. Patients' and healthcare staff screening for COVID-19 and all needed procedures to prevent infection will continue to be mandatory. Percutaneous procedures, compared to surgery, are associated with a lower risk of infection and a lower need for in-hospital resources, including a shorter duration of hospital stay. This may favour their adoption when the risk of viral infection is high.
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Affiliation(s)
- Marianna Adamo
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Benjamin Alos
- Department of Cardiology, University Hospital of Poitiers, Poitiers, France
| | - Marco Metra
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Thierry Lefèvre
- Department of Cardiology, Institut cardiovasculaire Paris Sud, Hopital privé Jacques Cartier, Ramsay Générale de santé, Massy, France
| | - Martins J Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Livia Gheorghe
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Carsten Tschöpe
- Department of Cardiology, Charite, Campus Virchow, Berlin, Germany
- Department of Cardiology, Berlin Center for Regenerative Therapies/Berlin Institute of Health (BCRT/BIH), Charite, Berlin, Germany
| | | | - Ottavio Alfieri
- Department of Cardiology, S. Raffaele University Hospital Milano, Milan, Italy
| | - Claire Bouleti
- Department of Cardiology, University Hospital of Poitiers, Poitiers, France
- Department of Cardiology, Clinical Investigation Center (CIC) INSERM 1402, University of Poitiers, Poitiers, France
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Al-Balah A, Naqvi D, Houbby N, Chien L, Sen S, Athanasiou T, Yousuf Salmasi M. Comparison of outcomes following transfemoral versus trans-subclavian approach for transcatheter aortic valve Implantation: A meta-analysis. IJC HEART & VASCULATURE 2020; 31:100668. [PMID: 33204819 PMCID: PMC7653062 DOI: 10.1016/j.ijcha.2020.100668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 10/18/2020] [Accepted: 10/20/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND The subclavian artery is an alternative access route for transcatheter aortic valve implantation (TAVI), with a potential advantage in patients unsuitable for traditional access routes such as the femoral artery. This study aimed to determine the safety and efficacy of the trans-subclavian (TSc) compared to the trans-femoral (TF) approach. METHODS A systematic review was conducted on two online databases: Embase and Medline. The initial search returned 508 titles. Nine observational studies were included: n = 2938 patients (2382 TF and 556 TSc). RESULTS Both TSc and TF groups were comparable for: 30-day mortality (Odds ratio, OR 0.75, 95% CI 0.49 - 1.16, p = 0.195); in-hospital stroke (OR 1.05, 95% CI 0.60-1.85, p = 0.859); myocardial infarction (OR 1.97, 95% CI 0.74-5.23, p = 0.176); paravalvular leaks (OR 1.20, 95% CI 0.76-1.90, p = 0.439); rates of postoperative permanent pacemaker implantation (OR 1.49, 95% CI 0.92-2.41, p = 0.105); in-hospital bleeding and meta-analysis demonstrated no significant difference between access points (OR 3.44, 95% CI 0.35-34.22, p = 0.292). Procedural time was found to be longer in the TSc group (SMD 1.02; 95% CI 0.815-1.219, p < 0.001). Major vascular complications were significantly higher in the TF group (OR 0.55, 95% CI 0.32-0.94, p = 0.029). Meta regression found no influence of the covariates on the outcomes. CONCLUSION Subclavian access is both a safe and feasible alternative access route for TAVI with lower risks of major vascular complications. This study supports the use of subclavian access as a viable alternative in patient groups where transfemoral TAVI is contraindicated.
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Affiliation(s)
| | - Danial Naqvi
- Faculty of Medicine, Imperial College London, UK
| | - Nour Houbby
- Faculty of Medicine, Imperial College London, UK
| | - Lueh Chien
- Faculty of Medicine, Imperial College London, UK
| | - Sayan Sen
- Department of Surgery, Imperial College London, UK
| | - Thanos Athanasiou
- Department of Cardiology, Imperial College Healthcare Trust, London, UK
| | - M. Yousuf Salmasi
- Department of Cardiology, Imperial College Healthcare Trust, London, UK
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190
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Sultan S, Pate G, Hynes N, Mylotte D. A case report of a transcarotid transcatheter aortic valve implantation with concomitant carotid endarterectomy. Eur Heart J Case Rep 2020; 4:1-6. [PMID: 33447700 PMCID: PMC7793201 DOI: 10.1093/ehjcr/ytaa379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/23/2020] [Accepted: 09/16/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND Transcarotid transcatheter aortic valve implantation (TAVI) is a worthwhile substitute in patients who might otherwise be inoperable; however, it is applied in <10% of TAVI cases. In patients with established carotid artery stenosis, the risk of complications is increased with the transcarotid access route. CASE SUMMARY We report a case of concomitant transcarotid TAVI and carotid endarterectomy (CEA) in a patient with bovine aortic arch and previous complex infrarenal EndoVascular Aortic Repair (EVAR). The integrity and positioning of the previous EVAR endograft was risked by transfemoral access. The right subclavian artery was only 4.5 mm and the left subclavian was totally occluded so transcarotid access was chosen. The patient recovered well, with no neurological deficit and was discharged home after 72 h. He was last seen and was doing well 6 months post-procedure. DISCUSSION In patients with severe aortoiliac disease, or previous aortic endografting, transfemoral access for TAVI can be challenging or even prohibitive. Alternative access sites such as transapical or transaortic are associated with added risk because they carry increased risk of major adverse cardiovascular events, longer intensive care unit and hospital stay, and increased cost. A transcaval approach for TAVI has also been reported but was not suitable for our patient due to prior EVAR. Concomitant TAVI via transcarotid access and CEA can be successful in experienced hands. This case highlights the importance of a team-based approach to complex TAVI cases in high-risk patients with complex vascular access.
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Affiliation(s)
- Sherif Sultan
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, University Hospital Galway, National University of Ireland Galway, Newcastle Rd, Galway H91 YR71, Ireland
- Department of Vascular Surgery and Endovascular Surgery, Galway Clinic, Royal College of Surgeons in Ireland Affiliated Hospitals, Doughiska, Galway H91 HHT0, Ireland
| | - Gordon Pate
- Department of Interventional Cardiology, Galway Clinic, Royal College of Surgeons in Ireland Affiliated Hospitals, Doughiska, Galway H91 HHT0, Ireland
| | - Niamh Hynes
- Department of Vascular Surgery and Endovascular Surgery, Galway Clinic, Royal College of Surgeons in Ireland Affiliated Hospitals, Doughiska, Galway H91 HHT0, Ireland
| | - Darren Mylotte
- Department of Interventional Cardiology, Galway Clinic, Royal College of Surgeons in Ireland Affiliated Hospitals, Doughiska, Galway H91 HHT0, Ireland
- Department of Cardiology, University Hospital Galway, National University of Ireland Galway, Newcastle Rd, Galway H91 YR71, Ireland
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Veulemans V, Frank D, Seoudy H, Wundram S, Piayda K, Maier O, Jung C, Polzin A, Frey N, Kelm M, Zeus T. New insights on potential permanent pacemaker predictors in TAVR using the largest self-expandable device. Cardiovasc Diagn Ther 2020; 10:1816-1826. [PMID: 33381426 DOI: 10.21037/cdt-20-680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Post-procedural conduction disorders following transcatheter aortic valve replacement (TAVR) still remain frequent, especially using the largest self-expandable device (Medtronic Corevalve Evolut RTM, 34 mm, STHV-34). We, therefore, assessed previously described, predictive factors of permanent pacemaker (PPM) implantation in the context of the STHV-34, including calcification distribution, implantation depth and membranous septum length (MSL). Methods We performed a dual centre analysis of 130 of 182 consecutive patients treated with STHV-34, further stratified into subjects without post-procedural PPM (-PPM n=100, 76.9%) and those requiring post-procedural PPM (+PPM n=30, 23.1%). These events were further analyzed by univariate and multivariate analysis according to several underlying conditions. Results Multivariate analysis only depicted previous right bundle branch block [RBBB; OR: 11.52 (2.63-50.44), P=0.001] and eccentricity index of the left ventricular outflow tract (LVOT-EI) >0.3 [OR: 3.07 (1.22-7.77), P=0.018] as highly predictive for PPM-need, being also confirmed by c-statistics [area under the curve (AUC) =0.68; 95% confidence interval (CI): 0.57-0.80; P=0.0025]. There was only moderate correlation of implantation depth over the MSL in terms of PPM prediction (r=0.23; P<0.0001). Conclusions This study offers new insights into potential PPM predictors using the STHV-34: previous RBBB and a pronounced LVOT-EI were independent predictors of PPM, while most of the previously reported determinants failed to predict PPM-need including MSL and implantation depth.
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Affiliation(s)
- Verena Veulemans
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Derk Frank
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Hatim Seoudy
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Steffen Wundram
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Kerstin Piayda
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Oliver Maier
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Christian Jung
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Amin Polzin
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Norbert Frey
- Department of Cardiology, Angiology and Pneumology, Internal Medicine III, Medical Hospital, Heidelberg University Hospital, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany.,CARID (Cardiovascular Research Institute Düsseldorf), Düsseldorf, Germany
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
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Outcomes of urgent aortic wrapping for acute type A aortic dissection. J Thorac Cardiovasc Surg 2020; 164:1412-1420. [PMID: 33419559 DOI: 10.1016/j.jtcvs.2020.10.136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/10/2020] [Accepted: 10/19/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Standard surgical repair of acute type A aortic dissection is associated with high mortality rates, especially in high-risk patients. In an attempt to improve survival in frail patients, we evaluated the outcomes after ascending aorta wrapping in a high-risk patient cohort. METHODS This single-center retrospective cohort study included all consecutive patients treated using ascending aorta wrapping for an acute type A aortic dissection from 2008 to 2019. The primary end points included 30-day mortality, survival during follow-up, and dissection-related mortality. Secondary end points included assessment of aortic remodeling after ascending aorta wrapping. Patients with an aortic anatomy suitable for adjunctive endografting of the ascending aorta were also identified. RESULTS Thirty-five consecutive patients who underwent ascending aorta wrapping were included. Their median age was 77 years (range, 46-96 years). The 30-day all-cause mortality rate was 9%. Major complications occurred in 7 patients (21%), including early reinterventions in 11 (31%). Median follow-up was 36 months (range, 2.4-106.6; interquartile range, 72). The actuarial survival at 36 months was 82%. The dissection-related mortality was 11.4%. The median aortic growth of the nonwrapped descending thoracic aorta was 3.4 mm. Computed tomography scan analysis depicted that 88% of survivors were theoretical candidates for an additional endovascular procedure to exclude the primary entry tear. CONCLUSIONS Aortic wrapping is associated with favorable early outcomes and a low rate of aortic events during follow-up. This therapeutic option should be considered for patients considered too fragile for standard surgical repair.
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193
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Grines CL, Tummala PE. Coronary Revascularization Before Transcatheter Aortic Valve Replacement: It Is Safe, But Is It Necessary? JACC Cardiovasc Interv 2020; 13:2614-2616. [PMID: 33069646 DOI: 10.1016/j.jcin.2020.08.018] [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: 08/06/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Cindy L Grines
- Northside Hospital Cardiovascular Institute, Atlanta, Georgia.
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Poulsen KB, Tjørnild MJ, Skov SN, Sharghbin M, Hanse LC, Benhassen LL, Røpcke DM, Nielsen SL, Hasenkam JM. Annular Dynamics and Leaflet Geometry in Patch Reconstruction of the Posterior Mitral Leaflet After Adding a Flexible Annuloplasty Ring. Cardiovasc Eng Technol 2020; 11:748-759. [PMID: 33200342 DOI: 10.1007/s13239-020-00502-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 11/05/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Patch reconstruction of the posterior mitral leaflet using small intestinal submucosa extracellular matrix has been successfully performed in a porcine study. The patch reconstruction, however, resulted in non-physiological systolic widening of the mitral annulus, suggesting the need for an annuloplasty ring. The objective was to characterize the impact on annular dynamics and leaflet geometry of adding a flexible annuloplasty ring to the posterior mitral leaflet patch reconstruction. METHODS Measurements were performed in an acute 80-kg porcine model, with seven pigs acting as their own controls. The posterior mitral leaflet was reconstructed with a 2-ply small intestinal submucosa extracellular matrix patch (CorMatrix®). Additionally, a Simulus® Flexible Annuloplasty Ring (Medtronic Inc., Minneapolis, MN, USA) was inserted. Mitral annular dynamics were evaluated using sonomicrometry, and leaflet geometry was described using echocardiography. RESULTS The annuloplasty ring reduced mitral annular dimensions and restricted cyclic changes in mitral annular area (126 ± 19 vs. 30 ± 13 mm2, p < 0.001), septal-lateral and commisure-commisure distances. Ring annuloplasty prevented systolic widening in the mitral annulus after posterior mitral leaflet reconstruction. The annular saddle shape and leaflet coaptation length (8.7 ± 2.3 vs. 9.7 ± 1.3 mm, p = 0.221) were comparable before and after ring insertion. CONCLUSIONS The flexible annuloplasty ring resulted in a downsized annulus with restriction of cyclic annular changes in the reconstructed mitral valve. Ring insertion preserved the annular saddle shape and coaptation length. The ring annuloplasty counteracted the non-physiological annular dynamics, and this may improve durability of the posterior mitral leaflet patch reconstruction.
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Affiliation(s)
- Karen B Poulsen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, 8200, Aarhus N, Denmark.
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
| | - Marcell J Tjørnild
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Søren N Skov
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Mona Sharghbin
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Lisa Carlson Hanse
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Leila L Benhassen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Diana M Røpcke
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Sten L Nielsen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - J Michael Hasenkam
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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195
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Hussain M, Hanna M, Rodriguez L, Griffin B, Watson C, Phelan D, Schoenhagen P, Jaber W, Cremer P, Collier P. Subthreshold Aortic Valve Calcium Scores in Severe Aortic Stenosis and Transthyretin Cardiac Amyloidosis. JACC Case Rep 2020; 2:2205-2209. [PMID: 34317140 PMCID: PMC8299830 DOI: 10.1016/j.jaccas.2020.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/29/2020] [Accepted: 10/05/2020] [Indexed: 01/15/2023]
Abstract
We have clinically observed that some patients with transthyretin cardiac amyloidosis and severe aortic stenosis may have lesser degrees of calcification than one might expect. We report a case series of 3 patients with transthyretin cardiac amyloidosis and severe aortic stenosis despite discordant aortic valve calcium scores. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Muzna Hussain
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.,School of Medicine, Dentistry, and Biomedical Sciences, Wellcome-Wolfson Institute of Experimental Medicine, Queen's University, Belfast, United Kingdom
| | - Mazen Hanna
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Leonardo Rodriguez
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brian Griffin
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Chris Watson
- School of Medicine, Dentistry, and Biomedical Sciences, Wellcome-Wolfson Institute of Experimental Medicine, Queen's University, Belfast, United Kingdom
| | - Dermot Phelan
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina
| | - Paul Schoenhagen
- Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, Ohio
| | - Wael Jaber
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Paul Cremer
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Patrick Collier
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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196
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Schaefer A, Schofer N, Goßling A, Seiffert M, Schirmer J, Deuschl F, Schneeberger Y, Voigtländer L, Detter C, Schaefer U, Blankenberg S, Reichenspurner H, Conradi L, Westermann D. Transcatheter aortic valve implantation versus surgical aortic valve replacement in low-risk patients: a propensity score-matched analysis. Eur J Cardiothorac Surg 2020; 56:1131-1139. [PMID: 31566209 DOI: 10.1093/ejcts/ezz245] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/07/2019] [Accepted: 08/14/2019] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES The aim of the study was to determine the differences in outcomes of surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) in low-risk patients. METHODS All patients with a logistic EuroSCORE II <4% who underwent transfemoral TAVI between 2008 and 2016 (n = 955) or SAVR between 2009 and 2014 (n = 886) at our centre were included. One hundred and nine patients per group were available for propensity score matching. RESULTS Mortality during the 30-day follow-up showed no differences (SAVR vs TAVI: 1.1% vs 1.8%, P = 1.0) but the rates of permanent pacemaker implantation (0.0 vs 14.8%, P < 0.001) and paravalvular leakage ≥ moderate (0.0 vs 7.0%, P = 0.017) were higher in TAVI patients. No difference was found regarding postoperative effective orifice area and transvalvular pressure gradients. Although, the 1-year survival was similar between both groups; 3- and 5-year survival was significantly inferior in the TAVI patient cohort. CONCLUSIONS TAVI yielded similar short-term outcomes compared with SAVR despite higher rates of permanent pacemaker implantation and paravalvular leakage ≥ moderate, but inferior long-term survival. Poorer long-term outcomes of the TAVI patient cohort were attributable to a more comorbid TAVI population. This emphasizes the need for long-term results from randomized controlled trials before TAVI can be broadly expanded to younger low-risk patients.
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Affiliation(s)
- Andreas Schaefer
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Niklas Schofer
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Alina Goßling
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Moritz Seiffert
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Johannes Schirmer
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Florian Deuschl
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Yvonne Schneeberger
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Lisa Voigtländer
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Christian Detter
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Ulrich Schaefer
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | | | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Dirk Westermann
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
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197
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Itzhaki Ben Zadok O, Ben-Avraham B, Shaul A, Hammer Y, Rubachevski V, Aravot D, Kornowski R, Ben-Gal T. An 18-month comparison of clinical outcomes between continuous-flow left ventricular assist devices. Eur J Cardiothorac Surg 2020; 56:1054-1061. [PMID: 31566245 DOI: 10.1093/ejcts/ezz268] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/15/2019] [Accepted: 08/29/2019] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES In this study, we aimed to determine the comparative outcomes of patients supported with continuous-flow left ventricular assist devices (LVADs): HeartMate 2 (HM2), HeartWare (HW) and HeartMate 3 (HM3) in a real-world setting. METHODS The study was an investigator-initiated comparative retrospective analysis of patients who underwent continuous-flow LVAD implantation at our institution between 2008 and 2017. The follow-up duration was 18 months after implantation. RESULTS The study included 105 continuous-flow LVAD-supported patients of whom 51% (n = 54), 24% (25) and 25% (26) underwent implantation of HM2, HW and HM3, respectively. During follow-up, patients who were supported with HM3 versus either HM2 or HW LVADs demonstrated a lower risk of stroke (0% vs 26%, P < 0.001 and 0% vs 40%, P < 0.001, respectively) and lower rates of thrombosis (0% vs 31%, P < 0.001 and 0% vs 12%, P < 0.001, respectively), findings that were consistent with their calculated haemocompatibility scores (cumulative score 5, 89 and 56 for HM3, HM2 and HW, respectively, P < 0.001). Moreover, patients supported with HM3 versus HW had fewer unplanned hospitalizations [median 1 (25th-75th interquartile range 0-2) vs 3 (interquartile range 2-4), P = 0.012]. Importantly, survival free from stroke or device exchange was higher in patients supported with HM3 compared with either the HM2 or the HW LVADs [hazard ratio (HR) 2.77, confidence interval (CI) 1.13-6.78; P = 0.026 and HR 2.70, CI 1.01-7.20; P = 0.047, respectively]. CONCLUSIONS HM3 device currently presents better prognostic and adverse events profiles when compared with the HM2 or the HW LVADs. A larger-scale head-to-head comparison between the devices is warranted in order to confirm our findings.
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Affiliation(s)
- Osnat Itzhaki Ben Zadok
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ben Ben-Avraham
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviv Shaul
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoav Hammer
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Victor Rubachevski
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Cardio-Thoracic Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Dan Aravot
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Cardio-Thoracic Surgery, Rabin Medical Center, Petah Tikva, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tuvia Ben-Gal
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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198
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Otaiby MA, Al Garni TA, Alkhushail A, Almoghairi A, Samargandy S, Albabtain M, Algarni KD, Arafat AA, Khairallah H, Alamri H. The trans-septal approach in transcatheter mitral valve-in-valve implantation for degenerative bioprosthesis. J Saudi Heart Assoc 2020; 32:141-148. [PMID: 33154908 PMCID: PMC7640552 DOI: 10.37616/2212-5043.323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 01/04/2020] [Accepted: 01/17/2020] [Indexed: 11/24/2022] Open
Abstract
Background Transcatheter Mitral Valve-in-Valve Implantation (TMViVI) has recently emerged as a novel therapy for degenerated mitral valve bioprosthesis. Re-operative mitral valve surgery is associated with a substantial risk of mortality and morbidity. The objective of this study was to describe the outcomes of transcatheter mitral valve-in-valve implantations in our cardiac center. Methods Twenty-two patients underwent the valve-in-valve procedure because of bioprosthesis degeneration from March 2017 to October 2018. Clinical, echocardiographic, procedural details and survival at follow up were assessed. Results Eight patients refused re-operative cardiac surgery while others were deemed a high risk for conventional re-operative sternotomy. All patients had TMViVI performed via a trans-septal approach, and the prosthesis was implanted successfully with immediate hemodynamic improvement in 20 patients. One patient had tamponade (4.55%), two had permanent pacemaker insertion (9.09%), two patients had a renal impairment (9.09%), and three patients had vascular complications (13.64%). There was one aborted procedure for the failure to cross the tissue valve with a transcatheter valve, and one patient was converted to an emergency mitral valve surgery. All patients were discharged in NYHA class I/II and NYHA class was markedly improved at one-year follow-up (p = 0.002). Conclusions Trans-septal mitral valve-in-valve implantation can be performed safely for degenerative mitral valve bioprosthesis and with favorable early clinical and hemodynamic outcomes.
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Affiliation(s)
- Mohammed Al Otaiby
- Adult Interventional Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Turki A Al Garni
- Adult Interventional Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Abdullah Alkhushail
- Adult Interventional Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Abdulrahman Almoghairi
- Adult Interventional Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Sondos Samargandy
- Adult Interventional Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Monirah Albabtain
- Cardiology Clinical Pharmacy Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Khaled D Algarni
- Cardiac Science Department, King Saud University, Riyadh, Saudi Arabia.,Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Amr A Arafat
- Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.,Cardiothoracic Surgery Department, Tanta University, Egypt
| | - Hatim Khairallah
- Adult Interventional Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Hussein Alamri
- Cardiothoracic Surgery Department, Tanta University, Egypt
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199
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Bartus K, Litwinowicz R, Bilewska A, Stapor M, Bochenek M, Rozanski J, Sadowski J, Filip G, Kusmierczyk M, Kapelak B. Final 5-year outcomes following aortic valve replacement with a RESILIA™ tissue bioprosthesis. Eur J Cardiothorac Surg 2020; 59:434-441. [PMID: 33141188 PMCID: PMC7850021 DOI: 10.1093/ejcts/ezaa311] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/15/2020] [Accepted: 07/23/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Long-term durability of bioprosthetic valves is predominantly limited by structural valve deterioration. RESILIA™ tissue has exhibited reduced calcification in pre-clinical and early clinical studies. This study evaluated the 5-year clinical and haemodynamic outcomes of an aortic valve with this tissue. METHODS This was a prospective, non-randomized, single-arm study of 133 patients implanted with a RESILIA aortic bioprosthesis between July 2011 and February 2013 at 2 sites in Poland. Clinical outcomes and haemodynamic performance were assessed annually for 5 years post-implant. Safety events were adjudicated by a Clinical Events Committee and echocardiographic data were assessed by an independent core laboratory. RESULTS Mean patient age was 65.3 ± 13.5 years, with 34 patients (25.6%) ≤60. The mean follow-up was 4.2 ± 1.5 years. Early (≤30 days) and late (>30 days) all-cause mortality were 2.3% (N = 3) and 3.2%/late patients-years (N = 18) respectively. Early events included thromboembolism in 3 patients (2.3%). Late valve-related events included endocarditis in 1 patient, which led to explant, and valve thrombosis in another patient. There were no events of structural valve deterioration throughout the study. At 5 years, mean gradient was 14.8 ± 7.6 mmHg and effective orifice area was 1.4 ± 0.5 cm2, a marked improvement over baseline values. All New York Heart Association class III patients and most class II patients at baseline had improved classifications at 5 years. CONCLUSIONS The bioprosthesis with RESILIA tissue demonstrated a good safety profile with excellent haemodynamic performance over 5 years of follow-up. These encouraging outcomes warrant additional investigation of this novel tissue. CLINICAL TRIAL REGISTRATION NUMBER NCT01651052.
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Affiliation(s)
- Krzysztof Bartus
- John Paul II Hospital, Krakow, Poland,Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Krakow, Poland
| | - Radoslaw Litwinowicz
- John Paul II Hospital, Krakow, Poland,Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Krakow, Poland,Corresponding author. Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Jagiellonian University, Pradnicka 80, 31-202 Krakow, Poland. Tel: +48-126-143075; e-mail: (R. Litwinowicz)
| | - Agata Bilewska
- Department of Cardiac Surgery and Transplantology, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
| | | | - Maciej Bochenek
- John Paul II Hospital, Krakow, Poland,Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Krakow, Poland,Department of Heart Transplantation and Mechanical Circulatory Support, Centre for Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Jacek Rozanski
- Department of Cardiac Surgery and Transplantology, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Jerzy Sadowski
- John Paul II Hospital, Krakow, Poland,Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Krakow, Poland
| | - Grzegorz Filip
- John Paul II Hospital, Krakow, Poland,Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Krakow, Poland
| | - Mariusz Kusmierczyk
- Department of Cardiac Surgery and Transplantology, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Boguslaw Kapelak
- John Paul II Hospital, Krakow, Poland,Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Krakow, Poland
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200
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Harky A, Seyedzenouzi G, Sanghavi R, Premkumar G, Badran A. COVID-19 and its implications on patient selection for TAVI and SAVR: Are we heading into a new era? J Card Surg 2020; 36:265-267. [PMID: 33135180 DOI: 10.1111/jocs.15181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 10/19/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.,Department of Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | - Ria Sanghavi
- School of Medicine and Surgery, University Of Central Lancashire, Preston, Lancashire, UK
| | | | - Abdul Badran
- Department of Cardiothoracic Surgery, University Hospitals Southampton, Southampton, UK
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