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Seguel E. Cirugía cardíaca en ancianos: riesgo operatorio y alternativas de tratamiento. REVISTA MÉDICA CLÍNICA LAS CONDES 2022. [DOI: 10.1016/j.rmclc.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Hou C, Wang X, Li Y, Hei F. The Relationship Between Short-Term Mean Arterial Pressure Variability and Mortality in Critically Ill Patients. Front Cardiovasc Med 2022; 9:870711. [PMID: 35571161 PMCID: PMC9099027 DOI: 10.3389/fcvm.2022.870711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/29/2022] [Indexed: 12/19/2022] Open
Abstract
Background Increased or decreased blood pressure variability may affect the perfusion of tissues and organs, leading to acute kidney injury and death. This study was conducted to explore the relationship between mean arterial pressure variability and short- and long-term mortality in critically ill patients. Methods We used patient data from the MIMIC-III database for cohort study. According to the recorded mean arterial pressure during the first 24 h in the intensive care unit, we calculated each patient’s two variability parameters –coefficient of variation and average real variability. The primary outcome was in-hospital mortality and the secondary outcomes were 28-day mortality and 1-year mortality. We conducted smooth spline models to examine the possible nonlinear associations between blood pressure variability and mortality. According to the smoothing curve, we further developed a two-piecewise linear regression model to find out the threshold effect. Multivariable logistic regression or Cox proportional hazards model was used to evaluate the relationship. Kaplan–Meier survival analysis for 28-day and 1-year mortality was performed. Subgroup analysis explored the factors modifying the relationship between them. Results A total of 12,867 patients were enrolled in the study, 1,320 in-hospital death, 1,399 28-day death, and 2,734 1-year death occurred. The smooth spline showed death risk was the lowest when average real variability was around 7.2 mmHg. After adjusting for covariates, logistic or Cox regression showed the highest MAP variability level was strongly associated with increased mortality in the hospital (odds ratio: 1.44; 95% CI, 1.21∼1.72), at 28 days (hazard ratio: 1.28; 95% CI, 1.1∼1.5), and at 1 year (hazard ratio: 1.27; 95% CI, 1.14∼1.42) compared with the second level of average real variability group. The survival curve plot showed patients with higher average real variability had a higher risk of 28-day and 1-year mortality. This relationship remained remarkable in patients with low or high Sequential Organ Failure Assessment scores in the sensitivity analysis. The two-piecewise linear regression model showed that lower ARV was a risk factor for 28-day (HR 0.72, 95% CI, 0.57∼0.91) and 1-year mortality (HR 0.81, 95% CI, 0.68∼0.96) when ARV was less than 7.2 mmHg, higher ARV was a risk factor for 28-day mortality (HR 1.1, 95% CI, 1.04∼1.17) and 1-year mortality (HR 1.07, 95% CI, 1.02∼1.12) when ARV was greater than 7.2 mmHg. Conclusion Blood pressure variability predicts mortality in critically ill patients. Individuals with higher or lower mean arterial pressure average real variability during the first day in ICU may have an increased risk of death.
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Affiliation(s)
- Chenwei Hou
- Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Wang
- Netbrain Technologies Inc., Beijing, China
| | - Yakun Li
- Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feilong Hei
- Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- *Correspondence: Feilong Hei,
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Sanaiha Y, Benharash P. Cardiovascular Risk Assessment in Cardiac Surgery. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00006-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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4
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Ghezzi ES, Psaltis PJ, Loetscher T, Davis D, Montarello J, Lau JK, Delacroix S, Bourke A, McLoughlin J, Keage M, Keage HAD. Identifying New Factors Associated With Cognitive Decline and Delirium After Transcatheter Aortic Valve Implantation: A Study Protocol. Front Cardiovasc Med 2021; 8:657057. [PMID: 34458327 PMCID: PMC8385234 DOI: 10.3389/fcvm.2021.657057] [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: 01/22/2021] [Accepted: 07/14/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Transcatheter aortic valve implantation (TAVI) has become the standard-of-care for treatment of severe symptomatic aortic stenosis and is also being increasingly recommended for low-risk patients. While TAVI boasts positive post-procedural outcomes, it is also associated with cognitive complications, namely delirium and cognitive decline. There is a pressing need for accurate risk tools which can identify TAVI patients at risk of delirium and cognitive decline, as risk scores designed for general cardiovascular surgery fall short. The present effect-finding exploratory study will assess the utility of various measures in the context of aging and frailty in predicting who will and who will not develop delirium or cognitive impairment following TAVI. The measures we propose include gait, visual symptoms, voice, swallowing, mood and sleep. Methods: This is an observational prospective cohort study focused on identifying pre-procedural risk factors for the development of delirium and cognitive decline following TAVI. Potential risk factors will be measured prior to TAVI. Primary outcomes will be post-procedure cognitive decline and delirium. Secondary outcomes include activities of daily living, quality of life, and mortality. Delirium presence will be measured on each of the first 2 days following TAVI. All other outcomes will be assessed at 3-, 6-, and 12-months post-operatively. A series of logistic regressions will be run to investigate the relationship between potential predictors and outcomes (presence vs. absence of either delirium or cognitive decline). Discussion: This study will assess the strengths of associations between a range of measures drawn from frailty and aging literature in terms of association with cognitive decline and delirium following TAVI. Identified measures can be used in future development of TAVI risk prediction models, which are essential for the accurate identification of cognitive at-risk patients and successful application of pre-procedural interventions. Clinical Trial Registration: This trial is registered with the Australian New Zealand Clinical Trials Registry. [https://bit.ly/2PAotP5], [ACTRN12618001114235].
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Affiliation(s)
- Erica S Ghezzi
- Cognitive Ageing and Impairment Neurosciences Laboratory, Justice and Society, University of South Australia, Adelaide, SA, Australia
| | - Peter J Psaltis
- Vascular Research Centre, Lifelong Health Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.,Adelaide University Medical School, University of Adelaide, Adelaide, SA, Australia.,Department of Cardiology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Tobias Loetscher
- Cognitive Ageing and Impairment Neurosciences Laboratory, Justice and Society, University of South Australia, Adelaide, SA, Australia
| | - Daniel Davis
- MRC Unit for Lifelong Health and Ageing Unit at UCL, London, United Kingdom
| | - Joseph Montarello
- Department of Cardiology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Jerrett K Lau
- Department of Cardiology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Sinny Delacroix
- Department of Cardiology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Alice Bourke
- Department of Geriatric and Rehabilitation Medicine, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - James McLoughlin
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Megan Keage
- Centre for Neuroscience of Speech, The University of Melbourne, Melbourne, VIC, Australia.,Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, VIC, Australia
| | - Hannah A D Keage
- Cognitive Ageing and Impairment Neurosciences Laboratory, Justice and Society, University of South Australia, Adelaide, SA, Australia
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Hancock HC, Maier RH, Kasim A, Mason J, Murphy G, Goodwin A, Owens WA, Akowuah E. Mini-sternotomy versus conventional sternotomy for aortic valve replacement: a randomised controlled trial. BMJ Open 2021; 11:e041398. [PMID: 33514577 PMCID: PMC7849899 DOI: 10.1136/bmjopen-2020-041398] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To compare clinical and health economic outcomes after manubrium-limited mini-sternotomy (intervention) and conventional median sternotomy (usual care). DESIGN A single-blind, randomised controlled trial. SETTING Single centre UK National Health Service tertiary hospital. PARTICIPANTS Adult patients undergoing aortic valve replacement (AVR) surgery. INTERVENTIONS Intervention was manubrium-limited mini-sternotomy performed using a 5-7 cm midline incision. Usual care was median sternotomy performed using a midline incision from the sternal notch to the xiphisternum. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the proportion of patients who received a red cell transfusion postoperatively and within 7 days of index surgery. Secondary outcomes included proportion of patients receiving a non-red cell blood component transfusion and number of units transfused within 7 days and during index hospital stay, quality of life and cost-effectiveness analyses. RESULTS 270 patients were randomised, received surgery and contributed to the intention to treat analysis. No difference between mini and conventional sternotomy in red-cell transfusion within 7 days was found; 23/135 patients in each arm received a transfusion, OR 1.0 (95% CI 0.5 to 2.0) and risk difference 0.0 (95% CI -0.1 to 0.1). Mini-sternotomy reduced chest drain losses (mean 181.6 mL (SD 138.7) vs conventional, mean 306·9 mL (SD 348.6)); this did not reduce red-cell transfusions. Mean valve size and postoperative valve function were comparable between mini-sternotomy and conventional groups; 23 mm vs 24 mm and 6/134 moderate or severe aortic regurgitation vs 3/130, respectively. Mini-sternotomy resulted in longer bypass (82.7 min (SD 23.5) vs 59.6 min (SD 15.1)) and cross-clamp times (64.1 min (SD 17.1) vs 46·3 min (SD 10.7)). Conventional sternotomy was more cost-effective with only a 5.8% probability of mini-sternotomy being cost-effective at a willingness to pay of £20 000/QALY (Quality Adjusted Life Years). CONCLUSIONS AVR via mini-sternotomy did not reduce red blood cell transfusion within 7 days following surgery when compared with conventional sternotomy. TRIAL REGISTRATION NUMBER ISRCTN29567910; Results.
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Affiliation(s)
- Helen C Hancock
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Rebecca H Maier
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Adetayo Kasim
- Wolfson Research Institute for Health and Wellbeing, Durham University, Stockton-on-Tees, Durham, UK
| | - James Mason
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Gavin Murphy
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Unit in Cardiovascular Medicine, University of Leicester, Leicester, UK
| | - Andrew Goodwin
- Department of Cardiothoracic Surgery, James Cook Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - W Andrew Owens
- Department of Cardiothoracic Surgery, James Cook Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Enoch Akowuah
- Department of Cardiothoracic Surgery, James Cook Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
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Guillet L, Moury PH, Bedague D, Durand M, Martin C, Payen JF, Chavanon O, Albaladejo P. Comparison of the additive, logistic european system for cardiac operative risk (EuroSCORE) with the EuroSCORE 2 to predict mortality in high-risk cardiac surgery. Ann Card Anaesth 2020; 23:277-282. [PMID: 32687082 PMCID: PMC7559960 DOI: 10.4103/aca.aca_209_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: The aim of this study was to compare the new EuroSCORE (ES) 2 prediction model in high-risk patients with the 2 other oldest additive ES (aES) and logistic ES (lES). Methods: Consecutive adult patients undergoing all cardiac surgery except heart transplantation and left ventricular assist device were included. The 3 risk scores were collected before surgery. We defined 4 high-risk groups of patients, patients ≥80 years, combined cardiac surgery, surgery of the thoracic aorta, and emergency cardiac surgery, and 2 low-risk groups, valve surgery and coronary artery bypass surgery. The predicted value of each score has been assessed by the area under the receiver operating characteristics curve (AUC). Results: The study had included 3301 patients. Thirty-day mortality was 3.9% (95% confidence interval (CI), 3.3 − 4.6%). The AUC of ES2 was 0.81 (0.77 − 0.84), 0.82 (0.78 − 0.85), 0.70 (0.64 − 0.76), 0.79 (0.74 − 0.83), 0.85 (0.83 − 0.87), and 0.88 (0.86 − 0.90) for octogenarians, thoracic aortic surgery, combined surgery, emergency surgery, coronary surgery, and valve surgery, respectively. These ES2 AUC values were higher than those obtained with the aES for octogenarians, and with the lES for octogenarians and valve surgery. The ES2 calibration was better than the aES and lES calibration for the whole population, and low-risk groups. The ES2 calibration was superior to aES and lES in high-risk groups, except for octogenarians and thoracic aortic surgery compared to lES. Conclusion: In high-risk cardiac surgery patients, ES2 only marginally improve the predicted 30-day mortality in comparison to other ES.
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Affiliation(s)
- Laura Guillet
- Department of Anaesthesia and Intensive Care, Hopital Michallon, CHU Grenoble Alpes, F-38000, France
| | - Pierre H Moury
- Department of Anaesthesia and Intensive Care, Hopital Michallon, CHU Grenoble Alpes, F-38000, France
| | - Damien Bedague
- Department of Anaesthesia and Intensive Care, Hopital Michallon, CHU Grenoble Alpes, F-38000, France
| | - Michel Durand
- Department of Anaesthesia and Intensive Care, Hopital Michallon, CHU Grenoble Alpes, F-38000, France
| | - Cécile Martin
- Department of Cardiac Surgery, Hopital Michallon, CHU Grenoble Alpes, F-38000, France
| | - Jean F Payen
- Department of Anaesthesia and Intensive Care, Hopital Michallon, CHU Grenoble Alpes, F-38000, France
| | - Olivier Chavanon
- Department of Cardiac Surgery, Hopital Michallon, CHU Grenoble Alpes, F-38000, France
| | - Pierre Albaladejo
- Department of Anaesthesia and Intensive Care, Hopital Michallon, CHU Grenoble Alpes, F-38000, France
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Packiasabapathy S, Prasad V, Rangasamy V, Popok D, Xu X, Novack V, Subramaniam B. Cardiac surgical outcome prediction by blood pressure variability indices Poincaré plot and coefficient of variation: a retrospective study. BMC Anesthesiol 2020; 20:56. [PMID: 32126969 PMCID: PMC7055104 DOI: 10.1186/s12871-020-00972-5] [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: 09/22/2019] [Accepted: 02/27/2020] [Indexed: 01/28/2023] Open
Abstract
Background Recent literature suggests a significant association between blood pressure variability (BPV) and postoperative outcomes after cardiac surgery. However, its outcome prediction ability remains unclear. Current prediction models use static preoperative patient factors. We explored the ability of Poincaré plots and coefficient of variation (CV) by measuring intraoperative BPV in predicting adverse outcomes. Methods In this retrospective, observational, cohort study, 3687 adult patients (> 18 years) undergoing cardiac surgery requiring cardio-pulmonary bypass from 2008 to 2014 were included. Blood pressure variability was computed by Poincare plots and CV. Standard descriptors (SD) SD1, SD2 were measured with Poincare plots by ellipse fitting technique. The outcomes analyzed were the 30-day mortality and postoperative renal failure. Logistic regression models adjusted for preoperative and surgical factors were constructed to evaluate the association between BPV parameters and outcomes. C-statistics were used to analyse the predictive ability. Results Analysis found that, 99 (2.7%) patients died within 30 days and 105 (2.8%) patients suffered from in-hospital renal failure. Logistic regression models including BPV parameters (standard descriptors from Poincare plots and CV) performed poorly in predicting postoperative 30-day mortality and renal failure [Concordance(C)-Statistic around 0.5]. They did not add any significant value to the standard STS risk score [C-statistic: STS alone 0.7, STS + BPV parmeters 0.7]. Conclusions In conclusion, BP variability computed from Poincare plots and CV were not predictive of mortality and renal failure in cardiac surgical patients. Patient comorbid conditions and other preoperative factors are still the gold standard for outcome prediction. Future directions include analysis of dynamic parameters such as complexity of physiological signals in identifying high risk patients and tailoring management accordingly.
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Affiliation(s)
- Senthil Packiasabapathy
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Varesh Prasad
- Harvard-Massachusetts Institute of Technology Program in Health Sciences and Technology, Cambridge, MA, USA.,Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Valluvan Rangasamy
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - David Popok
- Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Xinling Xu
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Victor Novack
- Clinical Research Center, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Balachundhar Subramaniam
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. .,Associate Professor of Anesthesia, Harvard Medical School, Ellison "Jeep" Pierce endowed chair of Anesthesia, Director, Centre for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, One Deaconess Road, CC-650, Boston, MA, 02215, USA.
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Damluji AA, Forman DE, van Diepen S, Alexander KP, Page RL, Hummel SL, Menon V, Katz JN, Albert NM, Afilalo J, Cohen MG. Older Adults in the Cardiac Intensive Care Unit: Factoring Geriatric Syndromes in the Management, Prognosis, and Process of Care: A Scientific Statement From the American Heart Association. Circulation 2020; 141:e6-e32. [DOI: 10.1161/cir.0000000000000741] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Longevity is increasing, and more adults are living to the stage of life when age-related biological factors determine a higher likelihood of cardiovascular disease in a distinctive context of concurrent geriatric conditions. Older adults with cardiovascular disease are frequently admitted to cardiac intensive care units (CICUs), where care is commensurate with high age-related cardiovascular disease risks but where the associated geriatric conditions (including multimorbidity, polypharmacy, cognitive decline and delirium, and frailty) may be inadvertently exacerbated and destabilized. The CICU environment of procedures, new medications, sensory overload, sleep deprivation, prolonged bed rest, malnourishment, and sleep is usually inherently disruptive to older patients regardless of the excellence of cardiovascular disease care. Given these fundamental and broad challenges of patient aging, CICU management priorities and associated decision-making are particularly complex and in need of enhancements. In this American Heart Association statement, we examine age-related risks and describe some of the distinctive dynamics pertinent to older adults and emerging opportunities to enhance CICU care. Relevant assessment tools are discussed, as well as the need for additional clinical research to best advance CICU care for the already dominating and still expanding population of older adults.
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Khan AA, Murtaza G, Khalid MF, Khattak F. Risk Stratification for Transcatheter Aortic Valve Replacement. Cardiol Res 2019; 10:323-330. [PMID: 31803329 PMCID: PMC6879047 DOI: 10.14740/cr966] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 11/05/2019] [Indexed: 11/17/2022] Open
Abstract
Risk assessment models developed from administrative and clinical databases are used for clinical decision making. Since these models are derived from a database, they have an inherent limitation of being as good as the data they are derived from. Many of these models under or overestimate certain clinical outcomes particularly mortality in certain group of patients. Undeniably, there is significant variability in all these models on account of patient population studied, the statistical analysis used to develop the model and the period during which these models were developed. This review aims to shed light on development and application of risk assessment models for cardiac surgery with special emphasis on risk stratification in severe aortic stenosis to select patients for transcatheter aortic valve replacement.
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Affiliation(s)
- Abdul Ahad Khan
- Division of Cardiovascular Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Ghulam Murtaza
- Division of Cardiovascular Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Muhammad F. Khalid
- Division of Cardiovascular Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Furqan Khattak
- Division of Cardiovascular Medicine, East Tennessee State University, Johnson City, TN, USA
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10
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Hancock HC, Maier RH, Kasim AS, Mason JM, Murphy GJ, Goodwin AT, Owens WA, Kirmani BH, Akowuah EF. Mini-Sternotomy Versus Conventional Sternotomy for Aortic Valve Replacement. J Am Coll Cardiol 2019; 73:2491-2492. [DOI: 10.1016/j.jacc.2019.03.462] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 03/08/2019] [Accepted: 03/19/2019] [Indexed: 11/26/2022]
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Amabili P, Wozolek A, Noirot I, Roediger L, Senard M, Donneau AF, Hubert MB, Brichant JF, Hans GA. The Edmonton Frail Scale Improves the Prediction of 30-Day Mortality in Elderly Patients Undergoing Cardiac Surgery: A Prospective Observational Study. J Cardiothorac Vasc Anesth 2019; 33:945-952. [DOI: 10.1053/j.jvca.2018.05.038] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Indexed: 11/11/2022]
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Surgical treatment of elderly patients with severe aortic stenosis in the modern era - review. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 15:188-195. [PMID: 30310399 PMCID: PMC6180026 DOI: 10.5114/kitp.2018.78445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 06/11/2018] [Indexed: 12/17/2022]
Abstract
Surgical treatment of severe aortic stenosis offers good early and long-term results, even in elderly patients. Despite the implementation of percutaneous methods for the very high-risk group, surgical valve replacement remains the gold standard. The advanced age of patients should not be the only indicator limiting the possibility of surgery. In this review we present the most important information on the results of aortic stenosis surgical treatment in the groups of older patients. New methods such as percutaneous and minimally invasive methods of surgery are also discussed. Additionally, the presented information is referred to current guidelines for the treatment of severe aortic stenosis.
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Yamauchi T, Hiroshi T, Toda K, Sawa Y. Surgical Aortic Valve Replacement in Octogenerians in the Era of Transcatheter Aortic Valve Replacement. Circ J 2018; 82:1592-1597. [PMID: 29669969 DOI: 10.1253/circj.cj-17-1340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The hospital mortality rate in >80-year-old patients undergoing surgical aortic valve replacement (SAVR) is reportedly satisfactory, but how such patients' functional status both at discharge and during the postoperative hospitalization period might affect their quality of life and medical costs remains unclear.Methods and Results:The adverse events of 161 patients aged >80 years who underwent SAVR with or without coronary artery bypass grafting were retrospectively investigated. Adverse events were defined as hospital death, a long hospital stay (>60 days) attributable to major complications or requirement for rehabilitation, or a depressed status at discharge (modified Rankin scale score >4). A total of 18.6% of patients developed adverse events, and their hospital mortality rate was 4.3%. Logistic regression analysis revealed that a perfusion time >3 h (P=0.0331; odds ratio, 2.685) and EuroSCORE II >10% (P<0.0001; odds ratio, 8.232) were significant risk factors for adverse events. The average medical cost was approximately 1.5-fold higher in patients with adverse events (¥8,360,880 vs. ¥5,234,660, P=0.0016). CONCLUSIONS Clinical findings focusing on status at discharge and during postoperative hospitalization of SAVR in patients aged >80 years was relatively high compared with hospital mortality, especially in patients with a longer perfusion time and high EuroSCORE. Further studies are necessary to define the indications for SAVR in patients aged >80 years in the era of transcatheter AVR.
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Affiliation(s)
- Takashi Yamauchi
- Department of Cardiovascular Surgery, Dokkyo Medical University Saitama Medical Center
| | - Takano Hiroshi
- Department of Cardiovascular Surgery, Dokkyo Medical University Saitama Medical Center
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
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15
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Improvement of Risk Prediction After Transcatheter Aortic Valve Replacement by Combining Frailty With Conventional Risk Scores. JACC Cardiovasc Interv 2018; 11:395-403. [PMID: 29471953 DOI: 10.1016/j.jcin.2017.11.012] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/06/2017] [Accepted: 11/09/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES This study sought to evaluate whether frailty improves mortality prediction in combination with the conventional scores. BACKGROUND European System for Cardiac Operative Risk Evaluation (EuroSCORE) or Society of Thoracic Surgeons (STS) score have not been evaluated in combined models with frailty for mortality prediction after transcatheter aortic valve replacement (TAVR). METHODS This prospective cohort comprised 330 consecutive TAVR patients ≥70 years of age. Conventional scores and a frailty index (based on assessment of cognition, mobility, nutrition, and activities of daily living) were evaluated to predict 1-year all-cause mortality using Cox proportional hazards regression (providing hazard ratios [HRs] with confidence intervals [CIs]) and measures of test performance (providing likelihood ratio [LR] chi-square test statistic and C-statistic [CS]). RESULTS All risk scores were predictive of the outcome (EuroSCORE, HR: 1.90 [95% CI: 1.45 to 2.48], LR chi-square test statistic 19.29, C-statistic 0.67; STS score, HR: 1.51 [95% CI: 1.21 to 1.88], LR chi-square test statistic 11.05, C-statistic 0.64; frailty index, HR: 3.29 [95% CI: 1.98 to 5.47], LR chi-square test statistic 22.28, C-statistic 0.66). A combination of the frailty index with either EuroSCORE (LR chi-square test statistic 38.27, C-statistic 0.72) or STS score (LR chi-square test statistic 28.71, C-statistic 0.68) improved mortality prediction. The frailty index accounted for 58.2% and 77.6% of the predictive information in the combined model with EuroSCORE and STS score, respectively. Net reclassification improvement and integrated discrimination improvement confirmed that the added frailty index improved risk prediction. CONCLUSIONS This is the first study showing that the assessment of frailty significantly enhances prediction of 1-year mortality after TAVR in combined risk models with conventional risk scores and relevantly contributes to this improvement.
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Huygens SA, Takkenberg JJM, Rutten-van Mölken MPMH. Systematic review of model-based economic evaluations of heart valve implantations. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:241-255. [PMID: 28265822 PMCID: PMC5813051 DOI: 10.1007/s10198-017-0880-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 02/16/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To review the evidence on the cost-effectiveness of heart valve implantations generated by decision analytic models and to assess their methodological quality. METHODS A systematic review was performed including model-based cost-effectiveness analyses of heart valve implantations. Study and model characteristics and cost-effectiveness results were extracted and the methodological quality was assessed using the Philips checklist. RESULTS Fourteen decision-analytic models regarding the cost-effectiveness of heart valve implantations were identified. In most studies transcatheter aortic valve implantation (TAVI) was cost-effective compared to standard treatment (ST) in inoperable or high-risk operable patients (ICER range 18,421-120,779 €) and in all studies surgical aortic valve replacement (SAVR) was cost-effective compared to ST in operable patients (ICER range 14,108-40,944 €), but the results were not consistent on the cost-effectiveness of TAVI versus SAVR in high-risk operable patients (ICER range: dominant to dominated by SAVR). Mechanical mitral valve replacement (MVR) had the lowest costs per success compared to mitral valve repair and biological MVR. The methodological quality of the studies was moderate to good. CONCLUSION This review showed that improvements can be made in the description and justification of methods and data sources, sensitivity analysis on extrapolation of results, subgroup analyses, consideration of methodological and structural uncertainty, and consistency (i.e. validity) of the models. There are several opportunities for future decision-analytic models of the cost-effectiveness of heart valve implantations: considering heart valve implantations in other valve positions besides the aortic valve, using a societal perspective, and developing patient-simulation models to investigate the impact of patient characteristics on outcomes.
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Affiliation(s)
- Simone A Huygens
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
- Department of Health Policy and Management/Institute for Medical Technology Assessment, Erasmus University Rotterdam, Bayle Building, Campus Woudestein, PO Box 1738, 3000 DR, Rotterdam, The Netherlands.
| | - Johanna J M Takkenberg
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Maureen P M H Rutten-van Mölken
- Department of Health Policy and Management/Institute for Medical Technology Assessment, Erasmus University Rotterdam, Bayle Building, Campus Woudestein, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
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Mariathas M, Rawlins J, Curzen N. Transcatheter aortic valve implantation: where are we now? Future Cardiol 2017; 13:551-566. [DOI: 10.2217/fca-2017-0056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) was first used in clinical practice in 2002. Since 2002, there has been a rapid increase in TAVI activity in patients with symptomatic severe aortic stenosis. This has been supported by systematic randomized data comparing TAVI against the gold standard treatment for the last 50 years’ surgical aortic valve replacement. TAVI is now currently a recommended therapeutic intervention in the treatment of severe aortic stenosis patients who are deemed either high risk or inoperable. The indications for TAVI continue to expand. Within this review we will focus on the current guidelines for TAVI, the evidence for it, the complications of TAVI, postprocedure care, the technology available to clinicians now and finally the future perspectives for TAVI.
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Affiliation(s)
- Mark Mariathas
- Coronary Research Group, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
- Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK
| | - John Rawlins
- Coronary Research Group, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
| | - Nick Curzen
- Coronary Research Group, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK
- Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK
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18
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Stundl A, Lünstedt NS, Courtz F, Freitag-Wolf S, Frey N, Holdenrieder S, Zur B, Grube E, Nickenig G, Werner N, Frank D, Sinning JM. Soluble ST2 for Risk Stratification and the Prediction of Mortality in Patients Undergoing Transcatheter Aortic Valve Implantation. Am J Cardiol 2017; 120:986-993. [PMID: 28739033 DOI: 10.1016/j.amjcard.2017.06.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/23/2017] [Accepted: 06/07/2017] [Indexed: 11/19/2022]
Abstract
This study aimed to assess the prognostic value of soluble ST2 (sST2) for risk stratification in patients undergoing transcatheter aortic valve implantation (TAVI). In 461 patients undergoing TAVI, sST2 was determined at baseline and categorized into quartiles. An optimum cutoff of 29 ng/ml was calculated. Primary end point was 1-year all-cause mortality. Results were validated in an independent cohort. Patients with sST2 >29 ng/ml had an increased 30-day (9.7% vs 4.6%, p = 0.043) and 1-year mortality (38.1% vs 21.8%, p = 0.001). In accordance, patients with N-terminal pro-brain natriuretic peptide (NT-proBNP) >8145 pg/ml revealed a comparable 30-day mortality (7.9% vs 4.7%, p = 0.189) and 1-year mortality (39.5% vs 21.0%, p <0.001). In univariate regression analysis, sST2 and NT-proBNP were associated with increased mortality risk. In multivariate regression analysis, independent predictors of mortality were logistic EuroSCORE, chronic renal failure, left ventricular ejection fraction, and sST2. In receiver operating characteristic curve analysis, sST2 did not provide incremental prognostic information beyond that obtained from surgical risk scores such as the STS-PROM or NT-proBNP. Similar findings could be achieved in an independent validation cohort. In conclusion, sST2 is independently associated with adverse outcome after TAVI but was not superior to NT-proBNP or surgical risk scores for the prediction of postprocedural outcomes.
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Affiliation(s)
- Anja Stundl
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Nina-Sophie Lünstedt
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Florian Courtz
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Sandra Freitag-Wolf
- Institute of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Norbert Frey
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany
| | | | - Berndt Zur
- Institute of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany
| | - Eberhard Grube
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Nikos Werner
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Derk Frank
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany
| | - Jan-Malte Sinning
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany.
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19
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Using a multidimensional prognostic index (MPI) based on comprehensive geriatric assessment (CGA) to predict mortality in elderly undergoing transcatheter aortic valve implantation. Int J Cardiol 2017; 236:381-386. [DOI: 10.1016/j.ijcard.2017.02.048] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/11/2017] [Accepted: 02/13/2017] [Indexed: 11/20/2022]
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Porizka M, Kunstyr J, Vanek T, Nejedly M, Buckova J, Mokrejs J, Mosna F. Postoperative Outcome of High-Risk Octogenarians Undergoing Cardiac Surgery: A Multicenter Observational Retrospective Study. Ann Thorac Cardiovasc Surg 2017; 23:188-195. [PMID: 28539544 DOI: 10.5761/atcs.oa.16-00280] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Cardiac surgery in octogenarians with severely deteriorated functional status is increasingly common, but outcome data are still limited. The aim of this study was to compare postoperative outcome, survival, and quality of life of low-, medium-, and high-risk octogenarians undergoing cardiac surgery. METHODS In all, 285 Czech octogenarians who underwent any cardiac surgical procedure between January 2011 and December 2012 were included in the study. Five out of all twelve national adult cardiac surgical centers participated in the study, representing almost half of all octogenarians operated in our country in that period. Patients' perioperative data were analyzed retrospectively. Follow-up was performed by interviewing patients by telephone. RESULTS There was higher 30-day mortality (20% vs. 6.4% vs. 5.2%, respectively, p <0.001), lower 2-year survival (60% vs. 84.0% vs. 85.4%, respectively, p <0.05), and lower Karnofsky score (44.4 vs. 70.1 vs. 70.6, respectively, p <0.001) in high-risk group compared with medium- and low-risk groups, respectively. Greater improvement in New York Heart Association (NYHA) status was noted in high- and medium-risk groups compared with low-risk group (51% vs. 45% vs. 24%, respectively, p <0.05). CONCLUSION High perioperative mortality, poor 2-year survival, and low postoperative quality of life have been observed in high-risk octogenarians undergoing cardiac surgery.
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Affiliation(s)
- Michal Porizka
- General University Hospital, Department of Anaesthesiology, Resuscitation and Intensive Medicine, The First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Jan Kunstyr
- General University Hospital, Department of Anaesthesiology, Resuscitation and Intensive Medicine, The First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Tomas Vanek
- University Hospital Kralovske Vinohrady, Department of Cardiac Surgery, Third Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Michal Nejedly
- University Hospital Kralovske Vinohrady, Department of Cardiac Surgery, Third Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Jana Buckova
- Na Homolce Hospital, Department of Cardiology, Prague, Czech Republic
| | - Jiri Mokrejs
- Faculty Hospital Pilsen, Department of Cardiac Surgery, Charles University in Prague, Pilsen-Bory, Czech Republic
| | - Frantisek Mosna
- Motol University Hospital, Department of Anaesthesiology and Intensive Care Medicine, The Second Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
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Pulignano G, Gulizia MM, Baldasseroni S, Bedogni F, Cioffi G, Indolfi C, Romeo F, Murrone A, Musumeci F, Parolari A, Patanè L, Pino PG, Mongiardo A, Spaccarotella C, Di Bartolomeo R, Musumeci G. ANMCO/SIC/SICI-GISE/SICCH Executive Summary of Consensus Document on Risk Stratification in elderly patients with aortic stenosis before surgery or transcatheter aortic valve replacement. Eur Heart J Suppl 2017; 19:D354-D369. [PMID: 28751850 PMCID: PMC5520760 DOI: 10.1093/eurheartj/sux012] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Aortic stenosis is one of the most frequent valvular diseases in developed countries, and its impact on public health resources and assistance is increasing. A substantial proportion of elderly people with severe aortic stenosis is not eligible to surgery because of the advanced age, frailty, and multiple co-morbidities. Transcatheter aortic valve implantation (TAVI) enables the treatment of very elderly patients at high or prohibitive surgical risk considered ineligible for surgery and with an acceptable life expectancy. However, a significant percentage of patients die or show no improvement in quality of life (QOL) in the follow-up. In the decision-making process, it is important to determine: (i) whether and how much frailty of the patient influences the risk of procedures; (ii) how the QOL and the individual patient's survival are influenced by aortic valve disease or from other associated conditions; and (iii) whether a geriatric specialist intervention to evaluate and correct frailty or other diseases with their potential or already manifest disabilities can improve the outcome of surgery or TAVI. Consequently, in addition to risk stratification with conventional tools, a number of factors including multi-morbidity, disability, frailty, and cognitive function should be considered, in order to assess the expected benefit of both surgery and TAVI. The pre-operative optimization through a multidisciplinary approach with a Heart Team can counteract the multiple damage (cardiac, neurological, muscular, respiratory, and kidney) that can potentially aggravate the reduced physiological reserves characteristic of frailty. The systematic application in clinical practice of multidimensional assessment instruments of frailty and cognitive function in the screening and the adoption of specific care pathways should facilitate this task.
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Affiliation(s)
- Giovanni Pulignano
- Cardiology Department 1, Ospedale San Camillo-Forlanini, Via O. Regnoli, 8 00152 Rome, Italy
| | - Michele Massimo Gulizia
- Cardiology Department, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi" Catania, Italy
| | | | - Francesco Bedogni
- CCU-Cardiology Unit, IRCCS Policlinico San Donato, San Donato Milanese (Milano), Italy
| | - Giovanni Cioffi
- Cardiology and Medicine Unit, Casa di Cura Villa Bianca, Trento, Italy
| | - Ciro Indolfi
- Cardiology Unit- Campus Universitario, Azienda Ospedaliera Universitaria Mater Domini, Catanzaro, Italy
| | - Francesco Romeo
- Cardiology and Interventional Cardiology Department, Policlinico "Tor Vergata", Rome, Italy
| | - Adriano Murrone
- Cardiology and Cardiovascular Pathophysiology Department, Azienda Ospedaliera di Perugia, Perugia, Italy
| | | | - Alessandro Parolari
- Heart Surgery Unit, Centro Cardiologico Monzino IRCCS, Università degli Studi, Milano, Italy
| | - Leonardo Patanè
- Cardiology Cardiac Surgery Department (Centro Cuore), Centro Clinico Diagnostico G.B. Morgagni, Pedara (Catania), Italy
| | | | - Annalisa Mongiardo
- Cardiology Unit- Campus Universitario, Azienda Ospedaliera Universitaria Mater Domini, Catanzaro, Italy
| | - Carmen Spaccarotella
- Cardiology Unit- Campus Universitario, Azienda Ospedaliera Universitaria Mater Domini, Catanzaro, Italy
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Wang TKM, Choi DHM, Ramanathan T, Ruygrok PN. Aortic Valve Replacement With or Without Concurrent Coronary Artery Bypass Grafting in Octogenarians: Eight-Year Cohort Study. Heart Lung Circ 2017; 26:82-87. [DOI: 10.1016/j.hlc.2016.04.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 04/26/2016] [Accepted: 04/29/2016] [Indexed: 11/26/2022]
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23
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Heijmans JH, Lancé MD. Fast track minimally invasive aortic valve surgery: patient selection and optimizing. Eur Heart J Suppl 2017. [DOI: 10.1093/eurheartj/suw056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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24
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Kawaguchi AT, Collet JP, Cluzel P, Makri R, Laali M, DeFrance C, Furuya H, Murakami A, Leprince P. Preoperative Risk Levels and Vascular Access in Transcatheter Aortic Valve Implantation-A Single-Institute Analysis. Artif Organs 2016; 41:130-138. [PMID: 27654027 DOI: 10.1111/aor.12754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 02/26/2016] [Accepted: 03/10/2016] [Indexed: 01/02/2023]
Abstract
Although transcatheter aortic valve implantation (TAVI) has been indicated for patients with high surgical risk, indications for or against the procedure become more difficult as vascular access becomes more proximal and/or invasive in order to accommodate patients with even higher risks. We compared preoperative factors including the European System for Cardiac Operative Risk Evaluation (EuroSCORE) and Society of Thoracic Surgeons Predicted Risk of Mortality (STS) score with postoperative survival in 195 patients undergoing TAVI during 2.5 years (January 2010 to June 2012), when vascular access routes were developed from iliofemoral (IL/Fm access, n = 149), axillo-clavicular, apical, and direct aortic approaches (alternative access, n = 46). Logistic regression analyses showed that alternative access was associated with reduced 30-day survival (P = 0.024), while high surgical risk (>15% in both EuroSCORE and STS score) was associated with reduced 1-year survival (P = 0.046). Thus, patients treated via IL/Fm access had acceptable outcome regardless of preoperative risk levels while patients with low surgical risk (<15%) had favorable outcome irrespective of access route. Since the remaining patients with combined risk factors, high preoperative risk level (>15%) requiring alternative access, had a prohibitive risk in our experience, they might have been considered untreatable or not amenable even to TAVI and offered medical or alternative managements.
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Affiliation(s)
- Akira T Kawaguchi
- Université Pierre et Curie Paris VI, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.,Tokai University School of Medicine, Isehara
| | - Jean Philippe Collet
- Université Pierre et Curie Paris VI, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Philippe Cluzel
- Université Pierre et Curie Paris VI, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Ralouka Makri
- Université Pierre et Curie Paris VI, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Mojgan Laali
- Université Pierre et Curie Paris VI, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Catherine DeFrance
- Université Pierre et Curie Paris VI, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | | | | | - Pascal Leprince
- Université Pierre et Curie Paris VI, Assistance Publique Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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25
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[Aortic valve replacement in the elderly]. Z Gerontol Geriatr 2016; 49:639-656. [PMID: 27518151 DOI: 10.1007/s00391-016-1112-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 05/27/2016] [Accepted: 06/29/2016] [Indexed: 11/27/2022]
Abstract
The treatment of severe symptomatic aortic valve stenosis by conventional aortic valve replacement (AVR) or by transcatheter aortic valve implantation (TAVI) has a good perinterventional prognosis even for patients of advanced age. Having a heart team select the best management strategies based on current guidelines for each individual patient is essential for success. Especially in elderly and increasingly multimorbid patients with sometimes severe preconditions, the detection of functional deficits is relevant not only for the mortality but also for perioperative and postoperative complications as well as the functional outcome. Various methods of geriatric assessment are important supplements to standard risk scores. The aim is to implement targeted interventions to minimize the risk factors and to improve the prognosis for elderly patients. The aim of this article is to provide an overview of the current therapy options for aortic valve replacement and to summarize current aspects of treatment options for elderly patients.
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Fukuda N, Ueno H, Hirai T, Inoue H, Kinugawa K. Transcatheter aortic valve implantation in an elderly man with severe aortic stenosis and high surgical risk. Nihon Ronen Igakkai Zasshi 2016; 53:158-63. [PMID: 27250223 DOI: 10.3143/geriatrics.53.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
An 85-year-old man with severe aortic stenosis (transaortic peak velocity 4.4 m/s, mean gradient 46 mmHg and valve area 0.71 cm(2)) was admitted to our hospital due to mild exertional dyspnea (NYHA class II). He had received low-dose prednisolone (5 mg/day) plus tacrolimus hydrate (1.5 mg/day) for rheumatic arthritis and interstitial pneumonia. Although aortic valve replacement was indicated, he was considered at high risk to undergo open heart surgery because of reduced pulmonary function (FEV1.0%, 77.2%) and long-term treatment with immunosuppressive drugs. After a multidisciplinary heart team conference, the decision was made to perform transfemoral transcatheter aortic valve implantation (TAVI) using a SAPIEN XT 26 mm valve. TAVI was completed in 105 minutes without any complications. After the procedure, his symptom was improved and his activity of daily life was maintained, and he was ambulatory the next day. Aortic stenosis by degenerative calcification is becoming increasingly common as the Japanese population ages. TAVI has been used to treat patients with concomitant diseases and at high risk of open heart surgery. We herein report a case with rheumatic arthritis and interstitial pneumonia that underwent successful TAVI.
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Affiliation(s)
- Nobuyuki Fukuda
- Second Department of Internal Medicine, University of Toyama
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27
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Grabert S, Lange R, Bleiziffer S. Incidence and causes of silent and symptomatic stroke following surgical and transcatheter aortic valve replacement: a comprehensive review. Interact Cardiovasc Thorac Surg 2016; 23:469-76. [PMID: 27241049 DOI: 10.1093/icvts/ivw142] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 04/11/2016] [Indexed: 12/24/2022] Open
Abstract
Stroke associated with aortic valve replacement in calcific aortic stenosis, either via transcatheter implantation (TAVR) or via surgical replacement (SAVR), is one of the most devastating complications. However, data concerning the clinical impact and incidence of clinical and silent stroke complicating SAVR and TAVR are varying. This comprehensive review of the literature explores the genuine incidence of neurological events after these procedures. Additionally, potential factors responsible for the discrepancies in stroke rates in the current literature are analysed and a lack of uniform neurological definitions and standardized neurological assessments revealed. Current stroke rates after TAVR show a decline from 7 to 1.7-4.8% in recent studies. Randomized studies comparing TAVR with SAVR yielded initially a significantly higher stroke rate after TAVR procedures as opposed to SAVR. Recently published data showed opposite results with strokes being higher following SAVR. Current data concerning stroke after surgical valve replacement report significantly higher rates of clinical strokes (17%) than previously mentioned in the literature (≤4.9%). Silent cerebral lesions were detected in 68-93% after TAVR and 38-54% after SAVR. A broader application of cerebral protection devices may help to reduce embolic cerebral events.
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Affiliation(s)
- Stephanie Grabert
- Department of Cardiovascular Surgery, German Heart Center Munich, Clinic at the Technical University, Munich, Germany
| | - Rüdiger Lange
- Department of Cardiovascular Surgery, German Heart Center Munich, Clinic at the Technical University, Munich, Germany
| | - Sabine Bleiziffer
- Department of Cardiovascular Surgery, German Heart Center Munich, Clinic at the Technical University, Munich, Germany
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28
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Expectation and Quality of Life after Aortic Valve Replacement over 85 Years of Age Match those of the Contemporary General Population. Int J Artif Organs 2016; 39:56-62. [DOI: 10.5301/ijao.5000473] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2016] [Indexed: 11/20/2022]
Abstract
Background In the transcatheter aortic valve implantation (TAVI) years, very elderly patients with aortic stenosis (AS) are referred to surgery with reluctance despite excellent hospital outcomes. A poorly assessed outcome of discharged survivors might further overlook the actual efficacy of the surgical strategy in this cohort. We thus evaluated life-expectancy and functional results in discharged survivors over 85 years operated on for AS. Methods Between January 2001 and December 2013, 57 consecutive patients aged ≥85 years underwent aortic valve replacement (AVR) with or without concomitant procedures at our institution. Late survival rate (SR), New York Heart Associaion (NYHA) functional class and quality of life (RAND SF-36) were assessed. SR and quality of life (QoL) were than compared to the contemporary general population matched for age and gender, as calculated by the Italian National Institute of Statistics. Results Overall in-hospital mortality was 8.8% (5 pts). In patients without concomitant coronary artery bypass grafting (CABG), in-hospital mortality was 2.9%. Survival at 5 and 9 years was 57.7 ± 8.4% and 17.9 ± 11.4%, respectively. No predictors of late mortality including concomitant CABG were identified at Cox analysis. The mean NYHA class for long-term survivors improved from 3.1 to 1.6 (p<0.001). Survivors reported better QoL-scores compared to the age- and gender-matched contemporary general population in 4 RAND SF-36 domains. Life-expectancy resulted comparable to that predicted for the age and gender-matched general population. Conclusions Isolated AVR in patients aged ≥85 years can be performed with acceptable risk. Survivors improve in NYHA class and, when compared to age- and gender-matched individuals, show a similar life expectancy and a no lower QoL.
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29
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Orkaby AR, Forman DE. Assessing Risks and Benefits of Invasive Cardiac Procedures in Patients with Advanced Multimorbidity. Clin Geriatr Med 2016; 32:359-71. [PMID: 27113152 DOI: 10.1016/j.cger.2016.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Age-related cardiovascular disease in older adults is more likely to occur in combination with other age-related diseases, with mounting interactive complexity as multiple morbidities accumulate. Although invasive cardiac procedures are frequently recommended for cardiovascular disease, their value is less certain in the context of age-related intricacies of care. Tools for risk assessment before invasive procedures are insensitive to risks corresponding to the unique challenges of older adults. Recognizing multimorbidity and other age-related risks provides opportunities to intervene and moderate dangers. By refocusing risk assessment in terms of patient-centered goals, the fundamental utility of invasive cardiac procedures may be reconsidered and alternative therapies prioritized.
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Affiliation(s)
- Ariela R Orkaby
- Division of Cardiology, VA Boston Healthcare System, 400 Veterans of Foreign Wars Pkwy, West Roxbury, MA 02132, USA; Division of Aging, Brigham & Women's Hospital, 1620 Tremont Street, Boston, MA 02120, USA
| | - Daniel E Forman
- Section of Geriatric Cardiology, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Suite 500, Pittsburgh, PA 15213, USA; Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, University Dr C, Pittsburgh, PA 15240, USA.
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Cappabianca G, Ferrarese S, Musazzi A, Terrieri F, Corazzari C, Matteucci M, Beghi C. Predictive factors of long-term survival in the octogenarian undergoing surgical aortic valve replacement: 12-year single-centre follow-up. Heart Vessels 2016; 31:1798-1805. [PMID: 26843194 DOI: 10.1007/s00380-016-0804-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 01/22/2016] [Indexed: 11/27/2022]
Abstract
The improvement of life expectancy created more surgical candidates with severe symptomatic aortic stenosis and age >80. Therefore, the main objective of this observational, retrospective single-centre study is to compare the long-term survival of octogenarians that have undergone surgical aortic valve replacement (AVR) to the survival of the general population of the same age and to establish whether any perioperative characteristics can anticipate a poor long-term result, limiting the prognostic advantage of the procedure at this age. From 2000 to 2014, 264 octogenarians underwent AVR at our institution. Perioperative data were retrieved from our institutional database and patients were followed up by telephonic interviews. The follow-up ranged between 2 months and 14.9 years (mean 4.1 ± 3.1 years) and the completeness was 99.2 %. Logistic multivariate analysis and Cox regression were respectively applied to identify the risk factors of in-hospital mortality and follow-up survival. Our patient population ages ranged between 80 and 88 years. Isolated AVR (I-AVR) was performed in 136 patients (51.5 %) whereas combined AVR (C-AVR) in 128 patients (48.5 %). Elective procedures were 93.1 %. Logistic EuroSCORE was 15.4 ± 10.6. In-hospital mortality was 4.5 %. Predictive factors of in-hospital mortality were the non-elective priority of the procedure (OR 5.7, CI 1.28-25.7, p = 0.02), cardiopulmonary bypass time (OR 1.02, CI 1.01-1.03, p = 0.004) and age (OR 1.36, CI 1.01-1.84, p = 0.04). Follow-up survival at 1, 4, 8 and 12 years was 93.4 % ± 1.6 %, 72.1 % ± 3.3 %, 39.1 % ± 4.8 % and 20.1 % ± 5.7 %, respectively. The long-term survival of these patients was not statistically different from the survival of an age/gender-matched general population living in the same geographic region (p = 0.52). Predictive factors of poor long-term survival were diabetes mellitus (HR 1.55, CI 1.01-2.46, p = 0.05), preoperative creatinine >200 μmol/L (HR 2.07, CI 1.21-3.53, p = 0.007) and preoperative atrial fibrillation (HR 1.79, CI 1.14-2.80, p = 0.01). In our experience, AVR can be safely performed in octogenarians. After a successful operation, the survival of these patients returns similar to the general population. Nevertheless, the preoperative presence of major comorbidities such as diabetes mellitus, renal dysfunction and atrial fibrillation significantly impact on long-term results.
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Affiliation(s)
- Giangiuseppe Cappabianca
- Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Viale Borri 57, 21100, Varese, Italy.
| | - Sandro Ferrarese
- Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Viale Borri 57, 21100, Varese, Italy
| | - Andrea Musazzi
- Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Viale Borri 57, 21100, Varese, Italy
| | - Francesco Terrieri
- Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Viale Borri 57, 21100, Varese, Italy
| | - Claudio Corazzari
- Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Viale Borri 57, 21100, Varese, Italy
| | - Matteo Matteucci
- Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Viale Borri 57, 21100, Varese, Italy
| | - Cesare Beghi
- Department of Cardiac Surgery, Circolo Hospital, University of Insubria, Viale Borri 57, 21100, Varese, Italy
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Ruiz-Morales J, Ivanova-Georgieva R, Fernández-Hidalgo N, García-Cabrera E, Miró JM, Muñoz P, Almirante B, Plata-Ciézar A, González-Ramallo V, Gálvez-Acebal J, Fariñas MC, Bravo-Ferrer JM, Goenaga-Sánchez MA, Hidalgo-Tenorio C, Goikoetxea-Agirre J, de Alarcón-González A. Left-sided infective endocarditis in patients with liver cirrhosis. J Infect 2015; 71:627-41. [PMID: 26408206 DOI: 10.1016/j.jinf.2015.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 09/05/2015] [Accepted: 09/07/2015] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To evaluate the course of left-sided infective endocarditis (LsIE) in patients with liver cirrhosis (LC) analyzing its influence on mortality and the impact of surgery. METHODS Prospective cohort study, conducted from 1984 to 2013 in 26 Spanish hospitals. RESULTS A total of 3.136 patients with LsIE were enrolled and 308 had LC: 151 Child-Pugh A, 103 B, 34 C and 20 were excluded because of unknown stage. Mortality was significantly higher in the patients with LsIE and LC (42.5% vs. 28.4%; p < 0.01) and this condition was in general an independent worse factor for outcome (HR 1.51, 95% CI: 1.23-1.85; p < 0.001). However, patients in stage A had similar mortality to patients without cirrhosis (31.8% vs. 28.4% p = NS) and in this stage heart surgery had a protective effect (28% in operated patients vs. 60% in non-operated when it was indicated). Mortality was significantly higher in stages B (52.4%) and C (52.9%) and the prognosis was better for patients in stage B who underwent surgery immediately (mortality 50%) compared to those where surgery was delayed (58%) or not performed (74%). Only one patient in stage C underwent surgery. CONCLUSIONS Patients with liver cirrhosis and infective endocarditis have a poorer prognosis only in stages B and C. Early surgery must be performed in stages A and although in selected patients in stage B when indicated.
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Affiliation(s)
- J Ruiz-Morales
- UGC de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain.
| | - R Ivanova-Georgieva
- Servicio de Medicina Interna, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain.
| | - N Fernández-Hidalgo
- Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain.
| | - E García-Cabrera
- UGC de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
| | - Jose M Miró
- Hospital Clinic - IDIBAPS, Servicio de Enfermedades Infecciosas y Microbiología, Universidad de Barcelona, Barcelona, Spain.
| | - P Muñoz
- Servicio de Microbiología y Enfermedades infecciosas, H. Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain.
| | - B Almirante
- Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain.
| | - A Plata-Ciézar
- UGC de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital General Universitario, Málaga, Spain.
| | - V González-Ramallo
- Unidad de Hospitalización a Domicilio, H. Universitario Gregorio Marañón, Madrid, Spain.
| | - J Gálvez-Acebal
- UGC de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Universitario Virgen Macarena, Sevilla, Spain.
| | - M C Fariñas
- Servicio de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain.
| | - J M Bravo-Ferrer
- Servicio de Enfermedades Infecciosas, Complejo Hospitalario Universitario Juan Canalejo, A Coruña, Spain.
| | - M A Goenaga-Sánchez
- Servicio de Enfermedades Infecciosas, Hospital Universitario Donosti, San Sebastián, Spain.
| | - C Hidalgo-Tenorio
- Servicio de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves, Granada, Spain.
| | - J Goikoetxea-Agirre
- Servicio de Enfermedades Infecciosas, Hospital Universitario Cruces, Bilbao, Spain.
| | - A de Alarcón-González
- UGC de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
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Thyregod HGH, Møller CH, Søndergaard L, Gluud C, Steinbrüchel DA. Transcatheter versus optimal medical treatment and surgical aortic valve replacement for aortic valve stenosis. Hippokratia 2015. [DOI: 10.1002/14651858.cd010488.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Hans GH Thyregod
- Rigshospitalet, Copenhagen University Hospital; Department of Cardiothoracic Surgery, RT 2152; Blegdamsvej 9 Copenhagen Copenhagen Denmark 2100
| | - Christian H Møller
- Rigshospitalet, Copenhagen University Hospital; Department of Cardiothoracic Surgery; Blegdamsvej 9 Copenhagen Denmark 2100
| | - Lars Søndergaard
- Rigshospitalet, Copenhagen University Hospital; Department of Cardiology; Copenhagen Copenhagen Denmark 2100
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University Hospital; The Cochrane Hepato-Biliary Group; Blegdamsvej 9 Copenhagen Denmark DK-2100
| | - Daniel A Steinbrüchel
- Rigshospitalet, Copenhagen University Hospital; Department of Cardiothoracic Surgery; Blegdamsvej 9 Copenhagen Denmark 2100
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Aortic valve replacement for severe aortic stenosis in octogenarians: Patient outcomes and comparison of operative risk scores. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.repce.2015.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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34
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Aortic valve replacement for severe aortic stenosis in octogenarians: Patient outcomes and comparison of operative risk scores. Rev Port Cardiol 2015; 34:439-46. [DOI: 10.1016/j.repc.2015.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 01/02/2015] [Indexed: 11/17/2022] Open
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Cockburn J, Singh MS, Rafi NHM, Dooley M, Hutchinson N, Hill A, Trivedi U, de Belder A, Hildick-Smith D. Poor mobility predicts adverse outcome better than other frailty indices in patients undergoing transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2015; 86:1271-7. [PMID: 26119601 DOI: 10.1002/ccd.25991] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 04/04/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Surgical risk scoring systems are poor at predicting outcome in patients undergoing transcatheter aortic valve implantation (TAVI). Frailty indices might more accurately predict outcome. AIMS To examine multiple frailty indices as markers of performance to see whether they predict outcomes both in the shorter (30 days) and longer terms (5 years) in patients who have undergone TAVI. METHODS Frailty indices (Mobility; Brighton Mobility Index, New York Heart Association (NYHA), Karnofsky Performance Index, Canadian Study Health Association (CSHA) clinical frailty scale, and Katz Index of Dependence) were assessed in 312 consecutive TAVI patients. Mortality tracking was obtained from the Office of National Statistics as of May 2014. RESULTS Mean age was 81.2 ± 7.0 years; 53.2% were male. Mean Logistic EuroSCORE and STS were 17.4 ± 9.4 and 4.6 ± 2.8, respectively. Mean peak aortic valve gradient and aortic valve area were 79.1 ± 28.0 mm Hg and 0.72 ± 0.25 cm(2) , respectively. 30-day mortality was 4.8%; long-term mortality (maximum 5.8 years, mean 2.2 ± 1.5 years) was 25.3%. Both univariate and multivariate analyses confirmed poor mobility (defined as severe impairment of mobility secondary to musculoskeletal or neurological dysfunction (Euroscore II risk)), as the best predictor of adverse outcome over both the short-term (OR 4.03, 95% CI (1.36-11.96), P = 0.012 (30 days)) and longer term (OR 2.15, 95% CI (1.33-3.48), P = 0.002, (2.2 ± 1.5 years.)). CONCLUSION Poor mobility predicts worse survival among patients undergoing TAVI, both in the shorter and longer terms. Our data suggest that mobility impairment, of either neurological or musculoskeletal etiology, is an appropriate screening measure when considering patients for TAVI.
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Affiliation(s)
- James Cockburn
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Meera Sundar Singh
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Nur Hanis Mohammed Rafi
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Maureen Dooley
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Nevil Hutchinson
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Andrew Hill
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Uday Trivedi
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Adam de Belder
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
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36
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Aortic valve surgery in octogenarians: Risk factors and long-term impact. Rev Clin Esp 2015. [DOI: 10.1016/j.rceng.2014.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Gilmanov D, Farneti PA, Ferrarini M, Santarelli F, Murzi M, Miceli A, Solinas M, Glauber M. Full sternotomy versus right anterior minithoracotomy for isolated aortic valve replacement in octogenarians: a propensity-matched study. Interact Cardiovasc Thorac Surg 2015; 20:732-41; discussion 741. [DOI: 10.1093/icvts/ivv030] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 01/23/2015] [Indexed: 11/12/2022] Open
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Lehmann S, Merk DR, Etz CD, Seeburger J, Schroeter T, Oberbach A, Uhlemann M, Hoellriegel R, Haensig M, Leontyev S, Garbade J, Misfeld M, Mohr FW. Minimally invasive aortic valve replacement: the Leipzig experience. Ann Cardiothorac Surg 2015; 4:49-56. [PMID: 25694976 DOI: 10.3978/j.issn.2225-319x.2014.11.03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 09/18/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND Minimally invasive techniques are progressively challenging traditional approaches in cardiothoracic surgery. Minimally invasive aortic valve replacement (AVR) has become a routine procedure at our institution. METHODS We retrospectively analyzed all patients undergoing minimally invasive isolated AVR between January 2003 and March 2014, at our institution. Mean follow-up was 4.7±4.3 years (range: 0-18 years) and was 99.8% complete. RESULTS There were 1,714 patients who received an isolated minimally invasive AVR. The mean (± SD) patient age was 65±12.8 years, ejection fraction 60%±12% and log EuroSCORE 5.3%±5.1%. Mean cross-clamp time was 58±18 minutes and mean cardiopulmonary bypass (CPB) time was 82.9±26.7 minutes. Thirty-day survival was 97.8%±0.4%, and 69.4%±1.7% at 10-years. The multivariate analysis revealed age at surgery [P=0.016; odds ratio (OR), 1.1], length of surgery time (P=0.002; OR, 1.01), female gender (P=0.023; OR, 3.54), preoperative myocardial infarction (MI) (P=0.006; OR, 7.87), preoperative stroke (P=0.001; OR, 13.76) and preoperative liver failure (P=0.015; OR, 10.28) as independent risk factors for mortality. Cox-regression analysis revealed the following predictors for long term mortality: age over 75 years (P<0.001; OR, 3.5), preoperative dialysis (P<0.01; OR, 2.14), ejection fraction less than 30% (P=0.003; OR, 3.28) and urgent or emergency operation (P<0.001; OR, 2.3). CONCLUSIONS Minimally invasive AVR can be performed safely and effectively with very few perioperative complications. The early and long-term outcomes in these patients are acceptable.
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Affiliation(s)
- Sven Lehmann
- 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Denis R Merk
- 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Christian D Etz
- 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Joerg Seeburger
- 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Thomas Schroeter
- 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Andreas Oberbach
- 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Madlen Uhlemann
- 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Robert Hoellriegel
- 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Martin Haensig
- 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Sergey Leontyev
- 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Jens Garbade
- 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Martin Misfeld
- 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Friedrich W Mohr
- 1 Department of Cardiac Surgery, 2 Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
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Saffioti S, Burzotta F, Coluccia V, Trani C, Bruno P, Massetti M, Crea F. Usefulness of EuroSCORE systems for risk stratification. J Cardiovasc Med (Hagerstown) 2015; 16:90-9. [DOI: 10.2459/jcm.0000000000000065] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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40
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Cioffi G, Tomasi C, Rossi A, Nistri S, Tarantini L, Faden G, Mazzone C, Di Lenarda A, Ettori F, Stefenelli C, Faggiano P. Does treatment assignment influence the prognosis of patients with symptomatic severe aortic stenosis? Cardiovasc Ultrasound 2015; 13:2. [PMID: 25575911 PMCID: PMC4298079 DOI: 10.1186/1476-7120-13-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 12/16/2014] [Indexed: 01/20/2023] Open
Abstract
Objective Aortic valve replacement (AVR) is the standard therapy in patients with symptomatic aortic stenosis (AS). In high surgical risk patients, alternative therapeutic options to medical treatment (MT) such as trans-catheter aortic valve implantation (TAVI) or balloon aortic valvuloplasty (BAV) have been proposed. In this study we evaluated whether treatment assignment influences per se the prognosis of these subjects. Patients and methods Criteria for treatment assignment were based on patient’s clinical conditions, Logistic EuroSCORE and other co-morbidities ignored by EuroSCORE. Due to baseline clinical differences between patients with diverse treatment assignment, we used propensity score matching to achieve balance. Results 368 patients were studied: 141 underwent AVR, 127 TAVI, 49 BAV and 51 MT. 84 events (deaths for all causes) occurred during 14 months of follow-up: 11 AVR (8%), 26 TAVI (20%), 18 MT (35%), 29 BAV group (59%). Traditional Cox analysis identified treatment assignment as independent predictor of events (HR 1.82 [CI 1.10-3.25]) together with lower left ventricular ejection fraction, impaired renal function and history of heart failure. Matched Cox analysis by propensity score confirmed treatment assignment as an independent prognosticator of events (HR 1.90 [CI 1.27-2.85]), and showed similar rate events in TAVI and AVR patients, while it was significantly increased in BAV and MT patients. Conclusions Treatment assignment may influence outcome of symptomatic patients with AS.
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Affiliation(s)
- Giovanni Cioffi
- Department of Cardiology, Villa Bianca Hospital Trento, Via Piave 78, 38100 Trento, Italy.
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Akhtar S, Morris B, Roy R, Balogun SA. Case 3-2015: preventing adverse outcomes in the very elderly cardiac surgical patients. J Cardiothorac Vasc Anesth 2014; 29:510-21. [PMID: 25440648 DOI: 10.1053/j.jvca.2014.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Shamsuddin Akhtar
- Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut.
| | - Benjamin Morris
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Raymond Roy
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Seki A Balogun
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
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The relative performance characteristics of the logistic European System for Cardiac Operative Risk Evaluation score and the Society of Thoracic Surgeons score in the Placement of Aortic Transcatheter Valves trial. J Thorac Cardiovasc Surg 2014; 148:2830-7.e1. [DOI: 10.1016/j.jtcvs.2014.04.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 03/17/2014] [Accepted: 04/04/2014] [Indexed: 11/23/2022]
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Wang W, Bagshaw SM, Norris CM, Zibdawi R, Zibdawi M, MacArthur R. Association between older age and outcome after cardiac surgery: a population-based cohort study. J Cardiothorac Surg 2014; 9:177. [PMID: 25761494 PMCID: PMC4255435 DOI: 10.1186/s13019-014-0177-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 10/30/2014] [Indexed: 11/29/2022] Open
Abstract
Objective Octogenarians (aged ≥ 80 years) are increasingly being referred for cardiac surgery. We aimed to describe the morbidity, mortality, and health services utilization of octogenarians undergoing elective cardiac surgery. Methods Retrospective population-based cohort study of adult patients receiving elective cardiac surgery between January 1 2004 and December 31 2009. Primary exposure was age ≥80 years. Outcomes were 30-day, 1- and 5-year mortality, post-operative complications, and ICU/hospital lengths of stay. Multi-variable logistic and Cox regression analyses were used to explore the association between older age and outcome. Results Of 6,843 patients receiving cardiac surgery, 544 (7.9%) were octogenarians. There was an increasing trend in the proportion of octogenarians undergoing surgery during the study period (0.3% per year, P = 0.073). Octogenarians were more likely to have combined procedures (valve plus coronary artery bypass or multiple valves) compared with younger strata (p < 0.001). Crude 30-day, 1-year and 5-year mortality for octogenarians were 3.7%, 10.8% and 29.0%, respectively. Compared to younger strata, octogenarians had higher adjusted 30-day (OR 4.83, 95%CI 1.30-17.92; P = 0.018) and 1-year mortality (OR 4.92; 95% CI, 2.32-10.46. P<0.001). Post-operative complications were more likely among octogenarians. Octogenarians had longer post-operative stays in ICU and hospital, and higher rates of ICU readmission (P < 0.001 for all). After multi-variable adjustment, age ≧ 80 years was an independent predictor of death at 30-days and 1 year. Conclusions Octogenarians are increasingly referred for elective cardiac surgery with more combined procedures. Compared to younger patients, octogenarians have a higher risk of post-operative complications, consume greater resources, and have worse but acceptable short and long-term survival. Electronic supplementary material The online version of this article (doi:10.1186/s13019-014-0177-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wei Wang
- Division of Cardiac Surgery, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
| | - Sean M Bagshaw
- Division of Cardiac Surgery, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada. .,Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada. .,Division of Critical Care Medicine, Clinical Sciences Building, 2-124E, 8440 - 112 Street, Edmonton, Alberta, T6G 2B7, Canada.
| | - Colleen M Norris
- Division of Cardiac Surgery, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada. .,Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada. .,Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
| | - Rami Zibdawi
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
| | - Mohamad Zibdawi
- Division of Cardiac Surgery, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada. .,Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
| | - Roderick MacArthur
- Division of Cardiac Surgery, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
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Poullis M, Pullan M, Chalmers J, Mediratta N. The validity of the original EuroSCORE and EuroSCORE II in patients over the age of seventy. Interact Cardiovasc Thorac Surg 2014; 20:172-7. [DOI: 10.1093/icvts/ivu345] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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[Transcatheter aortic valve implantation]. Ann Cardiol Angeiol (Paris) 2014; 63:422-7. [PMID: 25450991 DOI: 10.1016/j.ancard.2014.09.031] [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: 11/20/2022]
Abstract
As the French population is aging, a growing number of elderly patients with symptomatic severe aortic stenosis are going to require therapeutic management. Approximately 30 to 40 % of these patients do not undergo surgical treatment and a high proportion is considered to be at high risk for surgery. The transluminal aortic valve implantation technique has been increasingly used over the past few years, thus providing a solution to a major therapeutic issue in our industrialized countries. Thanks to major randomized studies such as the PARTNER US trial, this treatment has been approved for high-risk patients. Expertise and new devices are now opening the way to intermediate risk population.
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Carrascal Y, Valenzuela H, Laguna G, Pareja P, Blanco M, Ortega C. Aortic valve surgery in octogenarians: Risk factors and long-term impact. Rev Clin Esp 2014; 215:148-55. [PMID: 25278434 DOI: 10.1016/j.rce.2014.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 07/15/2014] [Accepted: 07/29/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVES To understand the risk factors and long-term impact and results of aortic valve surgery in patients over age 80. PATIENTS AND METHODS We consecutively evaluated 255 octogenarians who were operated on between 2000 and 2013 and referred for aortic valve disease (isolated or combined with coronary artery disease), which, even when associated with other diseases, was the primary cause of the patient's functional limitation. RESULTS The mortality rate decreased from 14.08% (2000-2004) to 7.7% (isolated valve surgery, 4.4%; with coronary bypass, 3.3%) (2010-2013). The independent risk factors associated with mortality were urgent surgery, combined procedures, peripheral vascular disease, a postsurgery hematocrit level <24% and the need for transfusion. More than 50% of the patients experienced a postoperative complication. Blood product transfusions were associated with renal and respiratory failure, and preoperative anemia was associated with an increased rate of myocardial infarction and stroke. Survival at 1, 3, 5 and 10 years was 79.5, 74.3, 63.6 and 30.5%, respectively, with 91.5% of patients in NYHA functional class I-II. Long-term survival was lower for cases of preoperative left ventricular dysfunction. The EuroSCORE I logistics score was not useful for our population as a predictor of mortality or of medium to long-term survival. CONCLUSIONS The morbidity and mortality of aortic valve surgery for patients over age 80 has decreased in recent years, although it remains higher when valve surgery is combined with coronary surgery. The presence of preoperative left ventricular dysfunction decreases long-term survival.
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Affiliation(s)
- Y Carrascal
- Servicio de Cirugía Cardiaca, Hospital Clínico Universitario de Valladolid, Valladolid, España.
| | - H Valenzuela
- Servicio de Cirugía Cardiaca, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - G Laguna
- Servicio de Cirugía Cardiaca, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - P Pareja
- Servicio de Cirugía Cardiaca, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - M Blanco
- Servicio de Cirugía Cardiaca, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - C Ortega
- Servicio de Cirugía Cardiaca, Hospital Clínico Universitario de Valladolid, Valladolid, España
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Hashimoto M, Fukui T, Takanashi S. Surgical treatment for double-valve destruction after balloon aortic valvuloplasty in a patient with porcelain aorta. Eur J Cardiothorac Surg 2014; 48:329-31. [PMID: 25187531 DOI: 10.1093/ejcts/ezu343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 08/01/2014] [Indexed: 11/12/2022] Open
Abstract
We report a rare case of surgical treatment for double-valve destruction after balloon aortic valvuloplasty in a 90-year old female with severe aortic calcification. The patient underwent aortic balloon valvuloplasty for symptomatic aortic stenosis, resulting in severe aortic regurgitation because of injury to the right coronary cusp of the aortic valve and severe mitral regurgitation because of rupture of the chordae tendineae. She became haemodynamically unstable and required treatment with mechanical ventilation and assisted circulation. Urgent surgical treatment was planned. The patient's porcelain aorta increased the difficulty of surgery, but the procedure was carefully planned, and aortic valve replacement and mitral valve repair were performed successfully without major complications. The patient had a satisfactory postoperative course and was transferred to another hospital for rehabilitation on the 8th postoperative day.
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Affiliation(s)
- Makoto Hashimoto
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan
| | - Toshihiro Fukui
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan
| | - Shuichiro Takanashi
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan
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Hong SJ, Hong MK, Ko YG, Choi D, Hong GR, Shim JK, Kwak YL, Lee S, Chang BC, Jang Y. Multidisciplinary team approach for identifying potential candidate for transcatheter aortic valve implantation. Yonsei Med J 2014; 55:1246-52. [PMID: 25048481 PMCID: PMC4108808 DOI: 10.3349/ymj.2014.55.5.1246] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE We sought to evaluate the clinical usefulness of decision making by a multidisciplinary heart team for identifying potential candidates for transcatheter aortic valve implantation (TAVI) in patients with symptomatic severe aortic stenosis. MATERIALS AND METHODS The multidisciplinary team consisted of two interventional cardiologists, two cardiovascular surgeons, one cardiac imaging specialist, and two cardiac anesthesiologists. RESULTS Out of 60 patients who were screened as potential TAVI candidates, 31 patients were initially recommended as appropriate for TAVI, and 20 of these 31 eventually underwent TAVI. Twenty-two patients underwent surgical aortic valve replacement (AVR), and 17 patients received only medical treatment. Patients who underwent TAVI and medical therapy were older than those who underwent surgical AVR (p<0.001). The logistic Euroscore was significantly highest in the TAVI group and lowest in the surgical AVR group (p=0.012). Most patients in the TAVI group (90%) and the surgical AVR group (91%) had severe cardiac symptoms, but only 47% in the medical therapy group had severe symptoms. The cumulative percentages of survival without re-hospitalization or all-cause death at 6 months for the surgical AVR, TAVI, and medical therapy groups were 84%, 75%, and 28%, respectively (p=0.007, by log-rank). CONCLUSION TAVI was recommended in half of the potential candidates following a multidisciplinary team approach and was eventually performed in one-third of these patients. One-third of the patients who were initially considered potential candidates received surgical AVR with favorable clinical outcomes.
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Affiliation(s)
- Sung-Jin Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Myeong-Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea. ; Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Geu-Ru Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae-Kwang Shim
- Division of Anesthesiology and Pain Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Lan Kwak
- Division of Anesthesiology and Pain Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sak Lee
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byung-Chul Chang
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yangsoo Jang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea. ; Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
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Hamm CW, Möllmann H, Holzhey D, Beckmann A, Veit C, Figulla HR, Cremer J, Kuck KH, Lange R, Zahn R, Sack S, Schuler G, Walther T, Beyersdorf F, Böhm M, Heusch G, Funkat AK, Meinertz T, Neumann T, Papoutsis K, Schneider S, Welz A, Mohr FW. The German Aortic Valve Registry (GARY): in-hospital outcome. Eur Heart J 2014; 35:1588-98. [PMID: 24022003 PMCID: PMC4065384 DOI: 10.1093/eurheartj/eht381] [Citation(s) in RCA: 251] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 08/05/2013] [Accepted: 08/22/2013] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Aortic stenosis is a frequent valvular disease especially in elderly patients. Catheter-based valve implantation has emerged as a valuable treatment approach for these patients being either at very high risk for conventional surgery or even deemed inoperable. The German Aortic Valve Registry (GARY) provides data on conventional and catheter-based aortic procedures on an all-comers basis. METHODS AND RESULTS A total of 13 860 consecutive patients undergoing repair for aortic valve disease [conventional surgery and transvascular (TV) or transapical (TA) catheter-based techniques] have been enrolled in this registry during 2011 and baseline, procedural, and outcome data have been acquired. The registry summarizes the results of 6523 conventional aortic valve replacements without (AVR) and 3464 with concomitant coronary bypass surgery (AVR + CABG) as well as 2695 TV AVI and 1181 TA interventions (TA AVI). Patients undergoing catheter-based techniques were significantly older and had higher risk profiles. The stroke rate was low in all groups with 1.3% (AVR), 1.9% (AVR + CABG), 1.7% (TV AVI), and 2.3% (TA AVI). The in-hospital mortality was 2.1% (AVR) and 4.5% (AVR + CABG) for patients undergoing conventional surgery, and 5.1% (TV AVI) and AVI 7.7% (TA AVI). CONCLUSION The in-hospital outcome results of this registry show that conventional surgery yields excellent results in all risk groups and that catheter-based aortic valve replacements is an alternative to conventional surgery in high risk and elderly patients.
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Affiliation(s)
- Christian W Hamm
- Department of Cardiology, Medical Clinic I, Kerckhoff Heart and Thorax Center, University of Giessen, Benekestrasse. 2-8, Bad Nauheim 61231, Germany
| | - Helge Möllmann
- Department of Cardiology, Medical Clinic I, Kerckhoff Heart and Thorax Center, University of Giessen, Benekestrasse. 2-8, Bad Nauheim 61231, Germany
| | - David Holzhey
- Department of Cardiology, Medical Clinic I, Kerckhoff Heart and Thorax Center, University of Giessen, Benekestrasse. 2-8, Bad Nauheim 61231, Germany
| | - Andreas Beckmann
- Department of Cardiology, Medical Clinic I, Kerckhoff Heart and Thorax Center, University of Giessen, Benekestrasse. 2-8, Bad Nauheim 61231, Germany
| | - Christof Veit
- Department of Cardiology, Medical Clinic I, Kerckhoff Heart and Thorax Center, University of Giessen, Benekestrasse. 2-8, Bad Nauheim 61231, Germany
| | - Hans-Reiner Figulla
- Department of Cardiology, Medical Clinic I, Kerckhoff Heart and Thorax Center, University of Giessen, Benekestrasse. 2-8, Bad Nauheim 61231, Germany
| | - J Cremer
- Department of Cardiology, Medical Clinic I, Kerckhoff Heart and Thorax Center, University of Giessen, Benekestrasse. 2-8, Bad Nauheim 61231, Germany
| | - Karl-Heinz Kuck
- Department of Cardiology, Medical Clinic I, Kerckhoff Heart and Thorax Center, University of Giessen, Benekestrasse. 2-8, Bad Nauheim 61231, Germany
| | - Rüdiger Lange
- Department of Cardiology, Medical Clinic I, Kerckhoff Heart and Thorax Center, University of Giessen, Benekestrasse. 2-8, Bad Nauheim 61231, Germany
| | - Ralf Zahn
- Department of Cardiology, Medical Clinic I, Kerckhoff Heart and Thorax Center, University of Giessen, Benekestrasse. 2-8, Bad Nauheim 61231, Germany
| | - Stefan Sack
- Department of Cardiology, Medical Clinic I, Kerckhoff Heart and Thorax Center, University of Giessen, Benekestrasse. 2-8, Bad Nauheim 61231, Germany
| | - Gerhard Schuler
- Department of Cardiology, Medical Clinic I, Kerckhoff Heart and Thorax Center, University of Giessen, Benekestrasse. 2-8, Bad Nauheim 61231, Germany
| | - Thomas Walther
- Department of Cardiology, Medical Clinic I, Kerckhoff Heart and Thorax Center, University of Giessen, Benekestrasse. 2-8, Bad Nauheim 61231, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiology, Medical Clinic I, Kerckhoff Heart and Thorax Center, University of Giessen, Benekestrasse. 2-8, Bad Nauheim 61231, Germany
| | - Michael Böhm
- Department of Cardiology, Medical Clinic I, Kerckhoff Heart and Thorax Center, University of Giessen, Benekestrasse. 2-8, Bad Nauheim 61231, Germany
| | - Gerd Heusch
- Department of Cardiology, Medical Clinic I, Kerckhoff Heart and Thorax Center, University of Giessen, Benekestrasse. 2-8, Bad Nauheim 61231, Germany
| | - Anne-Kathrin Funkat
- Department of Cardiology, Medical Clinic I, Kerckhoff Heart and Thorax Center, University of Giessen, Benekestrasse. 2-8, Bad Nauheim 61231, Germany
| | - Thomas Meinertz
- Department of Cardiology, Medical Clinic I, Kerckhoff Heart and Thorax Center, University of Giessen, Benekestrasse. 2-8, Bad Nauheim 61231, Germany
| | - Till Neumann
- Department of Cardiology, Medical Clinic I, Kerckhoff Heart and Thorax Center, University of Giessen, Benekestrasse. 2-8, Bad Nauheim 61231, Germany
| | - Konstantinos Papoutsis
- Department of Cardiology, Medical Clinic I, Kerckhoff Heart and Thorax Center, University of Giessen, Benekestrasse. 2-8, Bad Nauheim 61231, Germany
| | - Steffen Schneider
- Department of Cardiology, Medical Clinic I, Kerckhoff Heart and Thorax Center, University of Giessen, Benekestrasse. 2-8, Bad Nauheim 61231, Germany
| | - Armin Welz
- Department of Cardiology, Medical Clinic I, Kerckhoff Heart and Thorax Center, University of Giessen, Benekestrasse. 2-8, Bad Nauheim 61231, Germany
| | - Friedrich W Mohr
- Department of Cardiology, Medical Clinic I, Kerckhoff Heart and Thorax Center, University of Giessen, Benekestrasse. 2-8, Bad Nauheim 61231, Germany
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