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Burzotta F, Graziani F, Trani C, Aurigemma C, Bruno P, Lombardo A, Liuzzo G, Nesta M, Lanza GA, Romagnoli E, Locorotondo G, Leone AM, Pavone N, Spalletta C, Pelargonio G, Sanna T, Aspromonte N, Cavaliere F, Crea F, Massetti M. Clinical Impact of Heart Team Decisions for Patients With Complex Valvular Heart Disease: A Large, Single-Center Experience. J Am Heart Assoc 2022; 11:e024404. [PMID: 35621200 PMCID: PMC9238748 DOI: 10.1161/jaha.121.024404] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background A multidisciplinary approach might be pivotal for the management of patients with valvular heart disease (VHD), but clinical outcome data are lacking. Methods and Results At our institution, since 2014, internal guidelines recommended heart team consultations for patients with VHD. The clinical/echocardiographic characteristics, treatment recommendations, performed treatment, and early clinical outcomes of consecutive, hospitalized patients with VHD undergoing heart team evaluation were collected. Surgical risk was prospectively assessed by the EuroSCORE II and STS‐PROM. The primary end point of the study was early mortality. A total of 1004 patients with VHD with high clinical complexity (mean age, 75 years; mean EuroSCORE II, 9.4%; mean STS‐PROM, 5.6%; 48% ischemic heart disease; 29% chronic kidney disease, 9% oncologic/hematologic diseases) were enrolled. The heart team recommended an interventional treatment for 807 (80%) patients and conservative management for 197 (20%) patients. Management crossovers occurred in only 5% of patients. The recommended intervention was cardiac surgery for 230 (23%) patients, percutaneous treatment in 516 (51%) patients, and hybrid treatment in 61 (6%) patients. Early mortality occurred in 24 patients (2.4%) and was independently predicted by aortic stenosis, left ventricular ejection fraction, pulmonary artery systolic pressure, and conservative management recommendation. In patients referred to treatment, observed early mortality (1.7%) was significantly lower (P<0.001) than expected on the bases of both the STS‐PROM (5.2%) and EuroSCORE II (9.7%). Conclusions Within the limitations of its single‐center and observational design, the present study suggests that heart team–based management of patients with complex VHD is feasible and allows referral to a wide spectrum of interventions with promising early clinical results.
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Affiliation(s)
- Francesco Burzotta
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia.,Università Cattolica del Sacro Cuore Roma Italia
| | | | - Carlo Trani
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia.,Università Cattolica del Sacro Cuore Roma Italia
| | | | - Piergiorgio Bruno
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia.,Università Cattolica del Sacro Cuore Roma Italia
| | - Antonella Lombardo
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia.,Università Cattolica del Sacro Cuore Roma Italia
| | - Giovanna Liuzzo
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia.,Università Cattolica del Sacro Cuore Roma Italia
| | - Marialisa Nesta
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia
| | - Gaetano Antonio Lanza
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia.,Università Cattolica del Sacro Cuore Roma Italia
| | - Enrico Romagnoli
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia
| | | | | | - Natalia Pavone
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia.,Università Cattolica del Sacro Cuore Roma Italia
| | | | - Gemma Pelargonio
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia.,Università Cattolica del Sacro Cuore Roma Italia
| | - Tommaso Sanna
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia.,Università Cattolica del Sacro Cuore Roma Italia
| | - Nadia Aspromonte
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia.,Università Cattolica del Sacro Cuore Roma Italia
| | - Franco Cavaliere
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia.,Università Cattolica del Sacro Cuore Roma Italia
| | - Filippo Crea
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia.,Università Cattolica del Sacro Cuore Roma Italia
| | - Massimo Massetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia.,Università Cattolica del Sacro Cuore Roma Italia
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Bazylev VV, Shmatkov MG, Pianzin AI, Morozov ZA. [Analysis of cases of repeat hi-tech medical care for non-ST-segment elevation acute coronary syndrome]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2019; 25:63-67. [PMID: 31503248 DOI: 10.33529/angid2019307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Despite implementation of antiproliferative drug-eluting stents (DES) and intention to perform maximally full myocardial revascularization during a single hospital stay even in acute coronary syndrome (ACS) the frequency of repeat interventions after endovascular revascularization remains at a sufficiently stable level. In order to examine the causes of repeat hi-tech medical care rendered by means of endovascular myocardial revascularization for acute coronary syndrome without ST-segment elevation we carried out a retrospective single-centre study. It included a total of 93 patients suffering from ischaemic heart disease (IHD), who in 2017 endured this type of medical care twice. The cases of repeat revascularization were analysed based on medical history taking, physical examination, ECG pattern, ultrasonographic examination, laboratory findings, data of electronic case report forms and video recordings of the previous and latest coronary angiographies (CAG). The obtained findings revealed the main causes of repeat hi-tech medical care rendered within 1 year by means of endovascular myocardial revascularization for acute coronary syndrome without ST-segment elevation, which were as follows: progression of atherosclerosis in the previously non-revascularized arteries, the emergence of the clinical course of ACS in borderline stenosis; the development of acute coronary syndrome in patients with a significant lesion of the coronary bed, who were scheduled for this or that reason to undergo elective staged transcutaneous coronary intervention (TCI); restenosis in the previously implanted stents.
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Affiliation(s)
- V V Bazylev
- Federal Centre of Cardiovascular Surgery under the RF Ministry of Public Health, Penza, Russia
| | - M G Shmatkov
- Federal Centre of Cardiovascular Surgery under the RF Ministry of Public Health, Penza, Russia
| | - A I Pianzin
- Federal Centre of Cardiovascular Surgery under the RF Ministry of Public Health, Penza, Russia
| | - Z A Morozov
- Federal Centre of Cardiovascular Surgery under the RF Ministry of Public Health, Penza, Russia
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Santana O, Xydas S, Williams RF, Mawad M, Heimowitz TB, Pineda AM, Goldman HS, Mihos CG. Hybrid approach of percutaneous coronary intervention followed by minimally invasive mitral valve surgery: a 5-year single-center experience. J Thorac Dis 2017; 9:S595-S601. [PMID: 28740712 DOI: 10.21037/jtd.2017.06.29] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The current study evaluated the safety and feasibility of staged ("hybrid") percutaneous coronary intervention (PCI) followed by isolated minimally invasive mitral valve (MV) surgery [PCI + minimally invasive mitral valve surgery (MIMVS)], for patients with concomitant coronary artery and MV disease. METHODS A total of 93 patients who underwent PCI + MIMVS for coronary artery and MV disease between February 2009 and April 2014 were retrospectively analyzed. RESULTS There were 54 (58.1%) men and 39 (41.9%) women. The mean age was 73±8 years, and all patients had severe mitral regurgitation. PCI was performed for single-vessel coronary artery disease in 40 (43%) patients, two-vessel in 49 (52.7%), and three-vessel in 4 (4.3%). Within a median of 48 days (IQR, 18-71) after PCI, 78 (83.9%) patients underwent primary valve surgery, and 15 (16.1%) underwent re-operative valve surgery, with 56 (60.2%) having MV replacement, and 37 (39.8%) having MV repair. Sixty-five (69.9%) patients were being treated with dual anti-platelet therapy at the time of surgery. The median number of transfused intra-operative red blood cell units was 1 (IQR, 0-2), and the intensive care unit and hospital lengths of stay were 46 hours (IQR, 27-76) and 8 days (IQR, 5-11), respectively. Post-operatively, there was 1 (1.1%) cerebrovascular accident, 2 (2.2%) patients developed acute kidney injury, and 4 (4.3%) required a re-operation for bleeding. Thirty-day mortality occurred in 4 (4.3%) patients. At a mean follow-up of 15.3±13.2 months, 3 (3.4%) patients required target-vessel revascularization. The survival rate was 89% and 85% at 1 and 3 years, respectively. CONCLUSIONS In patients with concomitant coronary artery and MV disease, PCI + MIMVS can be safely performed and is associated with good short-term and follow-up outcomes.
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Affiliation(s)
- Orlando Santana
- Division of Cardiology, The Columbia University, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Steve Xydas
- Division of Cardiac Surgery, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Roy F Williams
- Division of Cardiac Surgery, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Maurice Mawad
- Division of Cardiac Surgery, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Todd B Heimowitz
- Division of Cardiology, The Columbia University, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Andrés M Pineda
- Cardiac Catheterization Laboratory, Duke University Medical Center, Durham, UK
| | - Howard S Goldman
- Department of Anesthesia, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Christos G Mihos
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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4
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Santana O, Xydas S, Williams RF, LaPietra A, Mawad M, Rosen GP, Beohar N, Mihos CG. Outcomes of a hybrid approach of percutaneous coronary intervention followed by minimally invasive aortic valve replacement. J Thorac Dis 2017; 9:S569-S574. [PMID: 28740709 DOI: 10.21037/jtd.2017.04.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In patients requiring coronary revascularization and aortic valve replacement, a combined approach of percutaneous coronary intervention followed by minimally invasive aortic valve replacement may be a viable treatment strategy. METHODS The outcomes of 123 consecutive patients with significant coronary artery and aortic valve disease, who underwent percutaneous coronary intervention followed by elective minimally invasive aortic valve replacement between February 2009 and April 2014, were retrospectively evaluated. RESULTS The cohort consisted of 80 males and 43 females, with a mean age of 75.7±8.1 years. Drug-eluting stents were used in 69.9% of the patients, and 64.2% were on dual anti-platelet therapy at the time of aortic valve replacement. Within a median of 39 days (IQR 21-64), 83.7% of the patients underwent primary and 16.3% underwent re-operative minimally invasive aortic valve replacement. Post-operatively, there was 1 (0.8%) cerebrovascular accident, 1 patient (0.8%) required a re-operation due to bleeding, and 2 (1.6%) developed acute kidney injury. Thirty-day mortality occurred in 2 (1.6%) patients. Follow-up was available for all of the patients, and at a mean follow-up period of 14.3±12.5 months, 4 (3.3%) had an acute coronary syndrome, and 1 (0.8%) required a repeat target vessel revascularization. The actuarial survival rate at 1- and 3-year was 92.7% and 89.4%, respectively. CONCLUSIONS In a select group of patients with coronary artery and aortic valve disease, a combined approach of percutaneous coronary intervention followed by minimally invasive aortic valve replacement can be safely performed with excellent short-term and midterm outcomes.
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Affiliation(s)
- Orlando Santana
- The Columbia University Division of Cardiology, at the Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Steve Xydas
- The Division of Cardiac Surgery, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Roy F Williams
- The Division of Cardiac Surgery, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Angelo LaPietra
- The Division of Cardiac Surgery, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Maurice Mawad
- The Division of Cardiac Surgery, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Gerald P Rosen
- The Department of Anesthesia, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Nirat Beohar
- The Columbia University Division of Cardiology, at the Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Christos G Mihos
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Outcomes of a Combined Approach of Percutaneous Coronary Revascularization and Cardiac Valve Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 12:4-8. [PMID: 28092294 DOI: 10.1097/imi.0000000000000342] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A subset of patients requiring coronary revascularization and valve surgery may benefit from a combined approach of percutaneous coronary intervention (PCI) and valve surgery, as opposed to the standard median sternotomy approach of combined coronary artery bypass and valve surgery. To evaluate its potential benefits and limitations, a literature search was performed using PubMed, EMBASE, Ovid, and the Cochrane library, through March 2016 to identify all studies involving a combined approach of PCI and valve surgery in patients with coronary artery and valvular disease. There were five studies included in the study with a total of 324 patients, of which 75 (23.1%) had a history of previous cardiac surgery. The interval between PCI and surgery ranged from simultaneous intervention to a median of 38 days (interquartile range, 18-65 days). The surgical approach performed consisted of a minimally invasive one or median sternotomy. There were 275 single valve surgery (84.9%) and 49 double-valve surgery (15.1%) with a 30-day mortality ranging from 0% to 5.5%. The 1-year survival ranged from 78% to 96%, and the follow-up period ranged from 1.3 to 5 years. Herein, we present a review of the literature using this technique.
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Santana O, Singla S, Mihos CG, Pineda AM, Stone GW, Kurlansky PA, George I, Kirtane AJ, Smith CR, Beohar N. Outcomes of a Combined Approach of Percutaneous Coronary Revascularization and Cardiac Valve Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017. [DOI: 10.1177/155698451701200102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Orlando Santana
- Columbia University Division of Cardiology at the Mount Sinai Heart Institute, Miami Beach, FL USA
| | - Sandeep Singla
- Columbia University Division of Cardiology at the Mount Sinai Heart Institute, Miami Beach, FL USA
| | - Christos G. Mihos
- Columbia University Division of Cardiology at the Mount Sinai Heart Institute, Miami Beach, FL USA
| | - Andres M. Pineda
- Columbia University Division of Cardiology at the Mount Sinai Heart Institute, Miami Beach, FL USA
| | | | | | - Isaac George
- Columbia University Medical Center, New York, NY USA
| | | | | | - Nirat Beohar
- Columbia University Division of Cardiology at the Mount Sinai Heart Institute, Miami Beach, FL USA
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7
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Belardi JA, Albertal M. To achieve, or not to achieve complete revascularization. Catheter Cardiovasc Interv 2016; 88:338-9. [PMID: 27619742 DOI: 10.1002/ccd.26709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 07/22/2016] [Indexed: 11/06/2022]
Abstract
Prior to minimally invasive valve surgery, a strategy of complete revascularization did not impact overall survival. Angiographically guided revascularization may have resulted in unnecessary procedures. A larger sample size and greater atherosclerotic burden may be needed to observe an impact with complete revascularization.
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Affiliation(s)
- Jorge A Belardi
- Department of Interventional Cardiology and Endovascular Therapeutics, Instituto Cardiovascular De Buenos Aires, Ciudad Autónoma De Buenos Aires, Argentina.
| | - Mariano Albertal
- Department of Interventional Cardiology and Endovascular Therapeutics, Instituto Cardiovascular De Buenos Aires, Ciudad Autónoma De Buenos Aires, Argentina
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