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Shibata K, Maeda S, Kashiyama N, Nakatsuji H, Ryugo M, Tsutsumi Y, Monta O. Long-term valve performance of St Jude Medical Epic porcine bioprosthesis in aortic position. J Artif Organs 2024; 27:131-137. [PMID: 37099052 DOI: 10.1007/s10047-023-01401-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/18/2023] [Indexed: 04/27/2023]
Abstract
The aim of this study was to review long-term clinical outcomes and valve performance after Epic Supra valve implantation in aortic position. From 2011 to 2022, 44 patients (mean age 75 ± 8 years) underwent surgical aortic valve replacement (SAVR) with an Epic Supra valve at our hospital. Survival, incidence of late complications, and echocardiographic date were retrospectively analyzed. During a mean follow-up period of 6.2 ± 3.5 years, the overall survival rate was 91 ± 4% at 2 and 88 ± 5% at 5 years, while rates of freedom from major adverse cardiovascular and cerebrovascular events (MACCE) were 86 ± 5% and 83 ± 6%, respectively. There was one case of reoperation for prosthetic valve endocarditis at 6 years after the initial surgery. Echocardiographic examinations showed 5-year rates of freedom from severe structural valve deterioration (SVD) and moderate SVD of 100 and 92%, respectively. There was no significant increase in mean pressure gradient or decrease in left ventricular ejection fraction from 1 week after surgery to the late follow-up period. Long-term clinical results and durability of the Epic Supra valve in aortic position were satisfactory.
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Affiliation(s)
- Kana Shibata
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, 2-228 Shinpo, Fukui, 9100833, Japan
| | - Shusaku Maeda
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, 2-228 Shinpo, Fukui, 9100833, Japan.
| | - Noriyuki Kashiyama
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, 2-228 Shinpo, Fukui, 9100833, Japan
| | - Hiroki Nakatsuji
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, 2-228 Shinpo, Fukui, 9100833, Japan
| | - Masahiro Ryugo
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, 2-228 Shinpo, Fukui, 9100833, Japan
| | - Yasushi Tsutsumi
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, 2-228 Shinpo, Fukui, 9100833, Japan
| | - Osamu Monta
- Department of Cardiovascular Surgery, Fukui Cardiovascular Center, 2-228 Shinpo, Fukui, 9100833, Japan
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Rasheed NF, Stonebraker C, Li Z, Siddiqi U, Lee ACH, Li W, Lupo S, Cruz J, Cohen WG, Staub C, Rodgers D, Myren M, Combs P, Jeevanandam V, Hibino N. Figure of eight suture technique in aortic valve replacement decreases prosthesis-patient mismatch. J Cardiothorac Surg 2023; 18:117. [PMID: 37038197 PMCID: PMC10084672 DOI: 10.1186/s13019-023-02260-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 04/03/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND While the pledget suture technique has been the standard for surgical aortic. valve replacement (AVR), discussion continues regarding the possibility of the nonpledget suture technique to produce superior structural and hemodynamic parameters. This study aims to assess the effectiveness of the figure-of-eight suture technique in AVR, as determined by the incidence of prosthesis-patient mismatch (PPM). METHODS We reviewed records of patients (N = 629) who underwent a surgical AVR procedure between January 2011 and July 2018 at a single institution. Indexed effective orifice area values and PPM incidence were calculated from implanted valve size and patient body surface area. Incidence of none, moderate, and severe PPM was compared across AVR suture techniques. RESULTS A total of 570 pledget and 59 figure-of-eight patients were compared for incidence of PPM. Patients who received AVR with the pledget suture technique had significantly lower echocardiographic measurements of baseline ejection fraction than patients who had received AVR with the figure-of-eight suture technique (p = 0.003). Patients who received the figure-of eight suture had a 14% decrease in moderate PPM compared to patients who received the pledget suture (p = 0.022). Patients who received the figure-of-eight suture also had a significantly higher rate of no PPM (p = 0.044). CONCLUSIONS The use of the figure-of-eight suture technique in AVR can reduce the incidence of moderate PPM. While the pledget suture is the standard technique in AVR, the figure-of-eight suture technique may offer better structural and hemodynamic outcomes, especially for patients with a smaller aortic annulus.
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Affiliation(s)
- Nabeel F Rasheed
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA.
| | - Corinne Stonebraker
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA
| | - Zhaozhi Li
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA
| | - Umar Siddiqi
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA
| | - Andy C H Lee
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA
| | - Willa Li
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA
| | - Sydney Lupo
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA
| | - Jennifer Cruz
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA
| | - William G Cohen
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA
| | - Cathy Staub
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA
| | - Daniel Rodgers
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA
| | - Mark Myren
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA
| | - Pamela Combs
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA
| | - Valluvan Jeevanandam
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA
| | - Narutoshi Hibino
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA
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Wakami T, Koizumi S, Koyama T. Impact of postoperative patient-prosthesis mismatch as a risk factor for early structural valve deterioration after aortic valve replacement with Trifecta bioprosthesis. J Cardiothorac Surg 2022; 17:174. [PMID: 35804395 PMCID: PMC9270818 DOI: 10.1186/s13019-022-01918-3] [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: 12/14/2021] [Accepted: 06/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several studies have reported high rates of structural valve deterioration (SVD) in the Trifecta valves. Herein, we analyzed the midterm results of the Trifecta valve and risk factors for early SVD. METHODS We retrospectively reviewed the records of 110 patients who had undergone Trifecta implantation between January 2012 and December 2017. RESULTS We encountered seven cases of Trifecta valve failure. We performed a redo aortic valve replacement in five patients and a transcatheter aortic valve replacement in two patients. The SVD rate was 4.8% at 5 years and 6.6% at 7 years. The mean pressure gradient and peak velocity on the first postoperative echocardiogram in patients with SVD were higher than those in patients without SVD. The SVD rates with and without patient-prosthesis mismatch (PPM) were 2.8% and 12.6% at 5 years and 2.8% and 20.0% at 7 years. PPM is a risk factor for SVD. Noncoronary cusp tears were observed in all patients who had undergone redo surgery. CONCLUSIONS The most common cause of SVD was noncoronary cusp tear. Patients with PPM are at high risk of developing SVD.
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Affiliation(s)
- Tatsuto Wakami
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima Minamimachi Chuoku Kobeshi Hyogoken, Kobe, 650-047, Japan
| | - Shigeki Koizumi
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima Minamimachi Chuoku Kobeshi Hyogoken, Kobe, 650-047, Japan
| | - Tadaaki Koyama
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima Minamimachi Chuoku Kobeshi Hyogoken, Kobe, 650-047, Japan.
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Tadokoro N, Fukushima S, Shimahara Y, Matsumoto Y, Yamashita K, Kawamoto N, Minami K, Kobayashi J, Fujita T. Trifecta vs. Magna for Aortic Valve Replacement ― Differences in Clinical Outcome and Valve Hemodynamics ―. Circ J 2018; 82:2767-2775. [DOI: 10.1253/circj.cj-18-0744] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Naoki Tadokoro
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Satsuki Fukushima
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Yusuke Shimahara
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Yorihiko Matsumoto
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kizuku Yamashita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Naonori Kawamoto
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kimito Minami
- Department of Surgical Intensive Care, National Cerebral and Cardiovascular Center
| | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
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Subramaniam K, Nazarnia S. Prosthesis-patient mismatch - what cardiac anesthesiologists need to know? Ann Card Anaesth 2017; 20:234-242. [PMID: 28393786 PMCID: PMC5408531 DOI: 10.4103/aca.aca_9_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Prosthesis-patient Mismatch (PPM) is not uncommon with an incidence reported up to 70% after aortic valve (AV) replacement. Severe forms of PPM are less common (up to 20%); PPM can lead to increased short- and long-term morbidity and mortality. It is important to discriminate PPM from other forms of prosthetic valve dysfunction. Sometimes, prosthetic valve degenerative disease may coexist with PPM. Echocardiography plays an important role in the prevention and diagnosis of PPM. Preemptive strategies to prevent PPM include insertion of newer generation prosthetic valves with better hemodynamic characteristics, stentless prosthesis, aortic root enlargement to insert a larger prosthesis, aortic homograft, and transcutaneous AV implantation. We present an illustrative case and review the literature on PPM pertinent to anesthesiologists.
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Guo L, Zheng J, Chen L, Li R, Ma L, Ni Y, Zhao H. Impact of prosthesis-patient mismatch on short-term outcomes after aortic valve replacement: a retrospective analysis in East China. J Cardiothorac Surg 2017; 12:42. [PMID: 28545592 PMCID: PMC5445281 DOI: 10.1186/s13019-017-0596-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 05/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prosthesis-patient mismatch (PPM) may affect the clinical outcomes of patients undergoing aortic valve replacement (AVR). We aimed to determine the incidence of PPM, its effect on short-term mortality, and the factors contributing to PPM in China. METHODS We retrospectively examined all consecutive patients with isolated or concomitant AVR at our hospital between January 1, 2013 and December 31, 2015. PPM was defined as an effective orifice area index (EOAi) of ≤ 0.85 cm2/m2. The baseline, echocardiographic, operative, and outcome data of all patients were collected from the national database. RESULTS A total of 869 patients were included in the study. PPM was detected in 15.9% (138/869) of the patients. Four patients (0.5%) met the criteria for severe PPM. Patients with PPM were older and had a higher prevalence of diabetes, coronary heart disease, aortic stenosis (AS), and preoperative left ventricular dysfunction but a lower incidence of smoking history and aortic regurgitation. Logistic regression analysis showed that female gender (P < 0.001), AS (P = 0.014), higher body mass index (BMI) (P < 0.001), and bioprosthesis (P < 0.001) were independent predictors of PPM. We also found that PPM (P = 0.005) was associated with 30-day all-cause mortality, along with smoking history (P = 0.001) and low preoperative left ventricular ejection fraction (LVEF) (P = 0.004). CONCLUSIONS PPM is associated with high short-term mortality after AVR in China. Female gender, aortic stenosis, bioprosthesis, and high BMI are risk factors for the incidence of PPM.
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Affiliation(s)
- Lei Guo
- Department of Thoracic and Cardiovascular Surgery, First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Junnan Zheng
- Department of Thoracic and Cardiovascular Surgery, First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Liangwei Chen
- Department of Thoracic and Cardiovascular Surgery, First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Renyuan Li
- Department of Thoracic and Cardiovascular Surgery, First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Liang Ma
- Department of Thoracic and Cardiovascular Surgery, First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Yiming Ni
- Department of Thoracic and Cardiovascular Surgery, First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Haige Zhao
- Department of Thoracic and Cardiovascular Surgery, First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China. .,Department of Cardiothoracic Surgery, the First Affiliated Hospital, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, China.
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