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Li X, Feng Y, Gong Y, Chen Y. Assessing the Reproducibility of Research Based on the Food and Drug Administration Manufacturer and User Facility Device Experience Data. J Patient Saf 2024; 20:e45-e58. [PMID: 38470959 DOI: 10.1097/pts.0000000000001220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
OBJECTIVE This article aims to assess the reproducibility of Manufacturer and User Facility Device Experience (MAUDE) data-driven studies by analyzing the data queries used in their research processes. METHODS Studies using MAUDE data were sourced from PubMed by searching for "MAUDE" or "Manufacturer and User Facility Device Experience" in titles or abstracts. We manually chose articles with executable queries. The reproducibility of each query was assessed by replicating it in the MAUDE Application Programming Interface. The reproducibility of a query is determined by a reproducibility coefficient that ranges from 0.95 to 1.05. This coefficient is calculated by comparing the number of medical device reports (MDRs) returned by the reproduced queries to the number of reported MDRs in the original studies. We also computed the reproducibility ratio, which is the fraction of reproducible queries in subgroups divided by the query complexity, the device category, and the presence of a data processing flow. RESULTS As of August 8, 2022, we identified 523 articles from which 336 contained queries, and 60 of these were executable. Among these, 14 queries were reproducible. Queries using a single field like product code, product class, or brand name showed higher reproducibility (50%, 33.3%, 31.3%) compared with other fields (8.3%, P = 0.037). Single-category device queries exhibited a higher reproducibility ratio than multicategory ones, but without statistical significance (27.1% versus 8.3%, P = 0.321). Studies including a data processing flow had a higher reproducibility ratio than those without, although this difference was not statistically significant (42.9% versus 17.4%, P = 0.107). CONCLUSIONS Our findings indicate that the reproducibility of queries in MAUDE data-driven studies is limited. Enhancing this requires the development of more effective MAUDE data query strategies and improved application programming interfaces.
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Affiliation(s)
- Xinyu Li
- From the Department of Computer Science, Vanderbilt University, Nashville, Tennessee
| | - Yubo Feng
- From the Department of Computer Science, Vanderbilt University, Nashville, Tennessee
| | - Yang Gong
- School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, Texas
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Baudo M, Cuko B, Ternacle J, Sicouri S, Torregrossa G, Pernot M, Busuttil O, Beurton A, Alaux A, Ouattara A, Lafitte S, Bonnet G, Leroux L, De Vincentiis C, Labrousse L, Ramlawi B, Modine T. Transcatheter valve-in-valve interventions after aortic root replacement: A systematic review. Catheter Cardiovasc Interv 2024; 103:1101-1110. [PMID: 38532517 DOI: 10.1002/ccd.31027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/08/2024] [Accepted: 03/19/2024] [Indexed: 03/28/2024]
Abstract
Structural valve deterioration after aortic root replacement (ARR) surgery may be treated by transcatheter valve-in-valve (ViV-TAVI) intervention. However, several technical challenges and outcomes are not well described. The aim of the present review was to analyze the outcomes of ViV-TAVI in deteriorated ARR. This review included studies reporting any form of transcatheter valvular intervention in patients with a previous ARR. All forms of ARR were considered, as long as the entire root was replaced. Pubmed, ScienceDirect, SciELO, DOAJ, and Cochrane library databases were searched until September 2023. Overall, 86 patients were included from 31 articles that met our inclusion criteria out of 741 potentially eligible studies. In the entire population, the mean time from ARR to reintervention was 11.0 years (range: 0.33-22). The most frequently performed techniques/grafts for ARR was homograft (67.4%) and the main indication for intervention was aortic regurgitation (69.7%). Twenty-three articles reported no postoperative complications. Six (7.0%) patients required permanent pacemaker implantation (PPI) after the ViV-TAVI procedure, and 4 (4.7%) patients had a second ViV-TAVI implant. There were three device migrations (3.5%) and 1 stroke (1.2%). Patients with previous ARR present a high surgical risk. ViV-TAVI can be considered in selected patients, despite unique technical challenges that need to be carefully addressed according to the characteristics of the previous surgery and on computed tomography analysis.
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Affiliation(s)
- Massimo Baudo
- Department of Cardiac Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania, USA
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Besart Cuko
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Pessac, France
| | - Julien Ternacle
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Pessac, France
| | - Serge Sicouri
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Gianluca Torregrossa
- Department of Cardiac Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania, USA
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Mathieu Pernot
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Pessac, France
| | - Olivier Busuttil
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Pessac, France
| | - Antoine Beurton
- Department of Cardiovascular Anesthesia and Critical Care, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Pessac, France
| | - Anouk Alaux
- Department of Cardiovascular Anesthesia and Critical Care, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Pessac, France
| | - Alexandre Ouattara
- Department of Cardiovascular Anesthesia and Critical Care, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Pessac, France
| | - Stephane Lafitte
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Pessac, France
| | - Guillaume Bonnet
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Pessac, France
- Cardiovascular Research Foundation, New York, New York, USA
| | - Lionel Leroux
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Pessac, France
| | | | - Louis Labrousse
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Pessac, France
| | - Basel Ramlawi
- Department of Cardiac Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania, USA
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Thomas Modine
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Pessac, France
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Takei Y, Suzuki R, Shibasaki I, Tokura M, Nasuno T, Yazawa H, Wada M, Saito F, Toyoda S, Fukuda H. Transcatheter aortic valve-in-surgical aortic valve for a patient with repeated healed endocarditis: a case report. Surg Case Rep 2023; 9:155. [PMID: 37665417 PMCID: PMC10477146 DOI: 10.1186/s40792-023-01739-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/27/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Transcatheter valve replacement is contraindicated in patients with active infective endocarditis. However, few reports suggest that it could be beneficial for high-risk surgical patients with healed infective endocarditis. Here, we report a case of a surgical transcatheter aortic valve in a patient with healed repeated prosthetic valve endocarditis using a stentless valve. CASE PRESENTATION A 79-year-old female who underwent the Bentall procedure using a stentless valve and coronary artery bypass grafting for annuloaortic ectasia 22 years ago was hospitalized for stage II bioprosthetic valve failure. The patient had a history of prosthetic valve endocarditis three times: the first and second prosthetic valve endocarditis occurred 15 years ago, and the third prosthetic valve endocarditis occurred 3 years ago. The causative organisms were Campylobacter fetus and Enterococcus faecalis. With appropriate antibiotic therapy, the lesion was localized and healed completely without valve destruction; however, the patient developed rapid aortic regurgitation. Based on a review of the patient's history of prosthetic valve endocarditis, the absence of signs of infection, and clinical findings of transesophageal echocardiography and computed tomography, a diagnosis of structural valve deterioration with healed infective endocarditis was made. Subsequently, a transcatheter aortic valve in a surgical aortic valve using a balloon-expandable type was performed, because the patient had a high surgical risk of 12.7%. The patient's postoperative course was uneventful. At the 1-year follow-up, there were no signs of infection or valve abnormalities. CONCLUSIONS Transcatheter valve replacement can be a treatment option for high-risk surgical patients with healed limited lesions in infective endocarditis.
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Affiliation(s)
- Yusuke Takei
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University Graduate School of Medicine, Mibu-Machi, Shimotsugagun, Tochigi, Japan.
| | - Ryujiro Suzuki
- Department of Cardiovascular Medicine, Dokkyo Medical University Graduate School of Medicine, Mibu-Machi, Shimotsugagun, Tochigi, Japan
| | - Ikuko Shibasaki
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University Graduate School of Medicine, Mibu-Machi, Shimotsugagun, Tochigi, Japan
| | - Michiaki Tokura
- Department of Cardiovascular Medicine, Dokkyo Medical University Graduate School of Medicine, Mibu-Machi, Shimotsugagun, Tochigi, Japan
| | - Takahisa Nasuno
- Department of Cardiovascular Medicine, Dokkyo Medical University Graduate School of Medicine, Mibu-Machi, Shimotsugagun, Tochigi, Japan
| | - Hiroko Yazawa
- Department of Cardiovascular Medicine, Dokkyo Medical University Graduate School of Medicine, Mibu-Machi, Shimotsugagun, Tochigi, Japan
| | - Mayo Wada
- Department of Cardiovascular Medicine, Dokkyo Medical University Graduate School of Medicine, Mibu-Machi, Shimotsugagun, Tochigi, Japan
| | - Fumiya Saito
- Department of Cardiovascular Medicine, Dokkyo Medical University Graduate School of Medicine, Mibu-Machi, Shimotsugagun, Tochigi, Japan
| | - Shigeru Toyoda
- Department of Cardiovascular Medicine, Dokkyo Medical University Graduate School of Medicine, Mibu-Machi, Shimotsugagun, Tochigi, Japan
| | - Hirotugu Fukuda
- Department of Cardiac and Vascular Surgery, Dokkyo Medical University Graduate School of Medicine, Mibu-Machi, Shimotsugagun, Tochigi, Japan
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Hughes GC. Reply from the authors: Stentless versus stented bioprosthetic root replacement in the medicare population and the wisdom of crowds. J Thorac Cardiovasc Surg 2023; 166:e63-e64. [PMID: 37086236 DOI: 10.1016/j.jtcvs.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 03/20/2023] [Indexed: 04/23/2023]
Affiliation(s)
- G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Duke University, Durham, NC
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Commentary: Structural abnormalities after Freestyle full aortic root replacement: Time to accept the facts. J Thorac Cardiovasc Surg 2023; 165:1301-1302. [PMID: 34275619 DOI: 10.1016/j.jtcvs.2021.06.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 06/20/2021] [Accepted: 06/21/2021] [Indexed: 11/21/2022]
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Structural abnormalities after aortic root replacement with stentless xenograft. J Thorac Cardiovasc Surg 2023; 165:1285-1297.e6. [PMID: 34116854 DOI: 10.1016/j.jtcvs.2021.04.087] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/11/2021] [Accepted: 04/24/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE In complex and high-risk aortic root disease, the porcine Freestyle stentless bioprosthesis (Medtronic Inc, Minneapolis, Minn) is an important surgical treatment option. We aimed to determine prevalence and clinical effect of structural and functional abnormalities after full-root Freestyle implantation. METHODS Our cross-sectional 2-center study combined with clinical follow-up included 253 patients with full-root Freestyle bioprostheses implanted from 1999 to 2017. Patients underwent transthoracic echocardiography (TTE) and contrast-enhanced, electrocardiogram-gated 4-dimensional cardiac computed tomography (4DCT) at median age 70 (interquartile range, 62-75) years. After 4DCT, clinical follow-up continued throughout 2018. Median follow-up was 3.3 years before 4DCT and 1.4 years after. RESULTS We identified abnormalities in 46% of patients, including pseudoaneurysms (n = 32; 13%), moderate or severe coronary ostial stenosis (n = 54; 21%), and moderate-severe leaflet thickening or reduced leaflet motion (n = 51; 20%). TTE only identified 1 patient with pseudoaneurysm. After 4DCT, the unadjusted hazard ratio for surgical reintervention among patients with abnormal 4DCT was 4.2 (95% confidence interval, 1.2-15.3), in all, 10% required a reintervention. 4DCT abnormalities were associated with a statistically nonsignificant increased risk of death, stroke, or myocardial infarction (hazard ratio obtained using Cox proportional hazards regression analysis, 2.4; 95% confidence interval, 0.7-7.6). In all, 4.0% died, 3.6% had a myocardial infarction, and 2.0% had a stroke. CONCLUSIONS Structural and functional abnormalities of the aortic root are frequent after Freestyle implantation and TTE appears to be insufficient for follow-up. Abnormalities might be associated with increased risk of reintervention and potentially adverse clinical outcomes. Longer follow-up and larger study populations are needed to further clarify the clinical implications of abnormalities identified with 4DCT.
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Yerokun BA, Vallabhajosyula P, Vekstein AM, Grau-Sepulveda MV, Benrashid E, Xian Y, Ranney DN, Jung SH, Jacobs JP, Badhwar V, Thourani VH, Bavaria JE, Hughes GC. Long-term outcomes of aortic root operations in the United States among Medicare beneficiaries. J Thorac Cardiovasc Surg 2023; 165:554-565.e6. [PMID: 33814173 DOI: 10.1016/j.jtcvs.2021.02.068] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 01/21/2021] [Accepted: 02/12/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The best method of aortic root repair in older patients remains unknown given a lack of comparative effectiveness of long-term outcomes data. The objective of this study was to compare long-term outcomes of different surgical approaches for aortic root repair in Medicare patients using The Society of Thoracic Surgeons Adult Cardiac Surgery Database-Centers for Medicare & Medicaid Services-linked data. METHODS A retrospective cohort study was performed by querying the Society of Thoracic Surgeons Adult Cardiac Surgery Database for patients aged 65 years or more who underwent elective aortic root repair with or without aortic valve replacement. Primary long-term end points were mortality, any stroke, and aortic valve reintervention. Short-term outcomes and long-term survival were compared among each root repair strategy. Additional risk factors for mortality after aortic root repair were assessed with a multivariable Cox proportional hazards model. RESULTS A total of 4173 patients aged 65 years or more underwent elective aortic root repair. Patients were stratified by operative strategy: mechanical Bentall, stented bioprosthetic Bentall, stentless bioprosthetic Bentall, or valve-sparing root replacement. Mean follow-up was 5.0 (±4.6) years. Relative to mechanical Bentall, stented bioprosthetic Bentall (adjusted hazard ratio, 0.80; confidence interval, 0.66-0.97) and stentless bioprosthetic Bentall (adjusted hazard ratio, 0.70; confidence interval, 0.59-0.84) were associated with better long-term survival. In addition, stentless bioprosthetic Bentall (adjusted hazard ratio, 0.64; confidence interval, 0.47-0.80) and valve-sparing root replacement (adjusted hazard ratio, 0.51; confidence interval, 0.29-0.90) were associated with lower long-term risk of stroke. Aortic valve reintervention risk was 2-fold higher after valve-sparing root replacement compared with other operative strategies. CONCLUSIONS In the Medicare population, there was poorer late survival and greater late stroke risk for patients undergoing mechanical Bentall and a higher rate of reintervention for valve-sparing root replacement. Bioprosthetic Bentall may be the procedure of choice in older patients undergoing aortic root repair, particularly in the era of transcatheter aortic valve replacement.
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Affiliation(s)
- Babatunde A Yerokun
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Prashanth Vallabhajosyula
- Division of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Conn
| | - Andrew M Vekstein
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | | | - Ehsan Benrashid
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Ying Xian
- Duke Clinical Research Institute, Durham, NC
| | - David N Ranney
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Sin-Ho Jung
- Duke Clinical Research Institute, Durham, NC
| | | | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Heart and Vascular Center, Piedmont Heart and Vascular Institute, Atlanta, Ga
| | - Joseph E Bavaria
- Department of Surgery, University of Pennsylvania, Philadelphia, Pa
| | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
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8
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Singh N, Chaudhuri K, Nand P. Severe early aneurysmal degeneration of a Freestyle aortic root bioprosthesis in a patient with known genetic aortopathy. ANZ J Surg 2022; 93:1095-1096. [PMID: 36259718 DOI: 10.1111/ans.18126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 09/13/2022] [Accepted: 10/10/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Navneet Singh
- Green Lane Cardiothoracic Surgical Unit, Auckland City Hospital, Auckland, New Zealand
| | - Krish Chaudhuri
- Green Lane Cardiothoracic Surgical Unit, Auckland City Hospital, Auckland, New Zealand
| | - Parma Nand
- Green Lane Cardiothoracic Surgical Unit, Auckland City Hospital, Auckland, New Zealand
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9
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de Oliveira Marreiros DJ, Tomšič A, van Brakel TJ, Hamming JF, Scholte AJHA, Hjortnaes J, Klautz RJM. Computed tomography follow-up after elective proximal aortic surgery: Less is more? Am Heart J 2022; 249:66-75. [PMID: 35436505 DOI: 10.1016/j.ahj.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 03/16/2022] [Accepted: 04/07/2022] [Indexed: 06/14/2023]
Abstract
STUDY OBJECTIVE The added value of computed tomography (CT) follow-up after elective proximal aortic surgery is unclear. We evaluated the benefit of CT follow-up by assessing the incidence of aorta-related complications and reinterventions detected during routine CT follow-up. METHODS Data on 314 patients undergoing first time elective proximal aortic surgery between 2000 and 2015 were collected. The primary study end points were aorta-related complications and reinterventions, detected during routine CT follow-up. Secondary study endpoints included all aorta-related complications and reinterventions, irrespective of the mode of detection and survival. RESULTS Median CT follow-up time was 6.8 (IQR 4.1-9.8) years, during which a total of 1303 routine follow-up CT-scans (median 4, IQR 3-5) were performed. During CT follow-up, aorta-related complications were detected in 18 (5.7%) patients, of which 6 (1.6%) underwent reintervention. In total, 28 aorta-related complications were observed in 23 (7.3%) patients, of which 9 led to reintervention. In order to detect 1 aorta-related complication leading to reintervention, 218 routine follow-up CT-scans were required. The unadjusted and EuroSCORE II adjusted hazard ratios of not undergoing CT follow-up on mortality were 1.260 (95% CI 0.705-2.251) and 0.830 (95% CI 0.430-1.605), respectively. CONCLUSIONS Following first time elective proximal aortic surgery, aorta-related complications are uncommon, are not always detected during CT follow-up and, if detected, often do not result in reintervention. Therefore, a more conservative CT follow-up protocol could be considered in selected patients to reduce lifetime radiation burden and health care costs.
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Affiliation(s)
| | - Anton Tomšič
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Thomas J van Brakel
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Jaap F Hamming
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Arthur J H A Scholte
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jesper Hjortnaes
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
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10
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Butany J, Schoen FJ. Cardiac valve replacement and related interventions. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00010-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Khazaal J, Ragagni M, Parker J, Timek T, Murphy E, Heiser J, Willekes C. Freestyle Aortic Bioprostheses in Patients 60 Years old and Younger. Semin Thorac Cardiovasc Surg 2021; 34:870-877. [PMID: 34380081 DOI: 10.1053/j.semtcvs.2021.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/02/2021] [Indexed: 11/11/2022]
Abstract
Evaluate outcomes of the Freestyle stentless aortic bioprosthesis in patients 60 years old and younger. All patients, 60 years old and younger, between January 1, 1998 to December 31, 2015 who underwent implantation of a Freestyle aortic valve at a single institution were reviewed. Medical records and telephone interviews were utilized for data collection. 515 patients were identified with an average age of 51.3 years. Mean follow up was 11.1 years. 225 full root replacements and 290 subcoronary implants were performed. Overall survival, including patients with concomitant procedures, at 15 years was 63.7% (95% CI 58.3-68.5). Isolated subcoronary implants (58%,167/290) had a 15-year survival of 71.6% (95% CI 62.6-78.7) vs 78.4% (95% CI 69.7, 84.9) for isolated root replacements (63%,141/225) which was not statistically significant (P = 0.397). No significant difference in operative SVD at 15 years occurred between full root replacements 37.6% (95% CI 27.2-50.2) vs subcoronary implants 39.4% (95% CI31.1, 49.0). 110 patients required reoperation solely for intrinsic SVD. 93% (102/110) failed due to aortic insufficiency. Of reoperative interventions for SVD, 37% (41/110) of patients required urgent reoperation and 4.5% (5/110) required emergent reoperation. Pseudoaneurysms developed in six of the full root replacements. Freestyle aortic valves have a high rate of acute failure requiring urgent or emergent reintervention in patients 60 years old and younger. This has led our group to shift practice away from their implantation.
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Affiliation(s)
- Jawad Khazaal
- College of Human Medicine, Michigan State University, Grand Rapids
| | - Mary Ragagni
- Department of Cardiovascular Research, Spectrum Health, Grand Rapids
| | - Jessica Parker
- Office of Research and Education, Spectrum Health, Grand Rapids
| | - Tomasz Timek
- Department of Cardiothoracic Surgery, Spectrum Health, Grand Rapids
| | - Edward Murphy
- Department of Cardiothoracic Surgery, Spectrum Health, Grand Rapids
| | - John Heiser
- Department of Cardiothoracic Surgery, Spectrum Health, Grand Rapids
| | - Charles Willekes
- Department of Cardiothoracic Surgery, Spectrum Health, Grand Rapids.
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Dagnegård HH, Bekke K, Kolseth SM, Glaser N, Wallén C, El-Hamamsy I, Vidisson KO, Lie AS, Valentin JB, Sartipy U, Haaverstad R, Vanky F, Lefebvre L, Gudbjartsson T, Johnsen SP, Søndergaard L, Thyregod GH, Lund JT, Ihlemann N, Smerup MH. Survival after aortic root replacement with a stentless xenograft is determined by patient characteristics. J Thorac Cardiovasc Surg 2021; 164:1712-1724.e10. [PMID: 34452760 DOI: 10.1016/j.jtcvs.2021.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/08/2021] [Accepted: 07/01/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Our objective was to examine intermediate-term survival and reinterventions in unselected patients, stratified according to indication, who received a Freestyle (Medtronic Inc, Minneapolis, Minn) bioprosthesis as a full aortic root replacement. METHODS Data from medical records were retrospectively collected for patients who had aortic root replacement using Freestyle bioprostheses between 1999 and 2018 at 6 North-Atlantic centers. Survival status was extracted from national registries and results stratified according to indication for surgery. RESULTS We included 1030 implantations in 1008 patients with elective indications for surgery: aneurysm (39.8%), small root (8.3%), and other (13.8%), and urgent/emergent indications: endocarditis (26.7%) and Stanford type A aortic dissection (11.4%). Across indications, 46.3% were nonelective cases and 34.0% were reoperations. Median age was 66.0 (interquartile range, 58.0-71.8) years and median follow-up was 5.0 (interquartile range, 2.6-7.9) years. Thirty-day mortality varied from 2.9% to 27.4% depending on indication. Intermediate survival for 90-day survivors with elective indications were not different from the general population standardized for age and sex (P = .95, .83, and .16 for aneurysms, small roots, and other, respectively). In contrast, patients with endocarditis and type A dissection had excess mortality (P < .001). Freedom from valve reinterventions was 95.0% and 94.4% at 5 and 8 years, respectively. In all, 52 patients (5.2%) underwent reinterventions, most because of endocarditis. CONCLUSIONS At intermediate term follow-up this retrospective study provides further support for the use of the Freestyle bioprosthesis in the real-world setting of diverse, complex, and often high-risk aortic root replacement and suggests that outcome is determined by patient and disease, rather than by prosthesis, characteristics.
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Affiliation(s)
- Hanna H Dagnegård
- Department of Cardiothoracic Surgery, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark.
| | - Kirstine Bekke
- Department of Cardiothoracic Surgery, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Solveig M Kolseth
- Department of Heart Disease, Haukeland University Hospital and University of Bergen, Bergen, Norway
| | - Natalie Glaser
- Department of Cardiology, Södersjukhuset, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Christoffer Wallén
- Department of Cardiothoracic and Vascular Surgery, Heart Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Ismail El-Hamamsy
- Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
| | - Kristjan O Vidisson
- Department of Cardiothoracic Surgery, Landspítali University Hospital, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Asbjørn S Lie
- Department of Heart Disease, Haukeland University Hospital and University of Bergen, Bergen, Norway
| | - Jan B Valentin
- Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - Ulrik Sartipy
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Rune Haaverstad
- Department of Heart Disease, Haukeland University Hospital and University of Bergen, Bergen, Norway
| | - Farkas Vanky
- Department of Cardiothoracic and Vascular Surgery, Heart Centre, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Laurence Lefebvre
- Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
| | - Tomas Gudbjartsson
- Department of Cardiothoracic Surgery, Landspítali University Hospital, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Søren P Johnsen
- Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - Lars Søndergaard
- Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Gustav H Thyregod
- Department of Cardiothoracic Surgery, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Jens T Lund
- Cardio Thoracic Surgical Department, Green Lane Division, Auckland City Hospital, Auckland, New Zealand
| | - Nikolaj Ihlemann
- Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Morten H Smerup
- Department of Cardiothoracic Surgery, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
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Beaver TM, Manning EW. Commentary: Stentless AVR in dialysis patients - another hand on the elephant. Semin Thorac Cardiovasc Surg 2021; 34:889. [PMID: 34242753 DOI: 10.1053/j.semtcvs.2021.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 06/29/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Thomas M Beaver
- Division of Cardiovascular Surgery, University of Florida College of Medicine, Gainesville, Florida.
| | - Eddie W Manning
- Division of Cardiovascular Surgery, University of Florida College of Medicine, Gainesville, Florida
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Melina G, De Robertis F, Gaer JA, Angeloni E, El-Hamamsy I, Bahrami T, Pepper JR, Takkenberg JJM, Yacoub MH. Long-term survival after xenograft versus homograft aortic root replacement: Results from a prospective randomized trial. J Thorac Cardiovasc Surg 2021; 161:57-65. [PMID: 31735388 DOI: 10.1016/j.jtcvs.2019.09.119] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 09/01/2019] [Accepted: 09/04/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The study objective was to investigate the long-term survival of patients undergoing xenograft versus homograft full root aortic valve replacement. METHODS A total of 166 patients requiring aortic valve surgery were randomized to undergo the Freestyle (Medtronic Inc, Minneapolis, Minn) bioprosthesis (N = 90) or a homograft (N = 76) full root aortic valve replacement between 1997 and 2005 in a single institution. Six patients randomly assigned to the homograft crossed over to the Freestyle bioprosthesis because of the unavailability of suitably sized homografts. All surgeons were required to adhere to the standard surgical technique for homograft root implantation previously described. Follow-up was 98.5% complete. RESULTS The mean age of the study population was 65 ± 8 years. Coronary artery bypass grafting was associated with root aortic valve replacement in 76 of 166 patients (46%, P = not significant between groups), and overall hospital mortality was 4.8% (8/166, P = not significant between groups). Median follow-up was 13.8 years (range, 0-21.8 years; 2033 patient-years). The Kaplan-Meier survival analysis showed that there was no significant difference in overall survival between the 2 arms at 5, 10, and 15 years. Twenty-year survival was 28.3% ± 5% for the Freestyle group versus 25.1% ± 5.7% for the homograft group (P = .90), which was comparable to the age- and sex-matched UK general population. The freedom from aortic valve reoperation at 20 years was comparable for the Freestyle group versus the homograft group (67.9% ± 8.8% vs 67.2% ± 10.3%, respectively; P = .74). CONCLUSIONS This is the first study to investigate the long-term survival of xenograft versus homograft full root aortic valve replacement from a prospective randomized trial. The observed 20-year overall survival and freedom from aortic valve reoperation serve as a benchmark for future studies on interventions for aortic valve disease in the elderly.
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Affiliation(s)
- Giovanni Melina
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom; Department of Cardiac Surgery, Ospedale Sant'Andrea, "Sapienza" Università di Roma, Rome, Italy
| | - Fabio De Robertis
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Jullien A Gaer
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Emiliano Angeloni
- Department of Cardiac Surgery, Ospedale Sant'Andrea, "Sapienza" Università di Roma, Rome, Italy
| | - Ismail El-Hamamsy
- Division of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Toufan Bahrami
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - John R Pepper
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Johanna J M Takkenberg
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
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Takaya H, Masuda S, Naganuma M, Yoshioka I, Takahashi G, Akiyama M, Adachi O, Kumagai K, Sugita S, Saiki Y. Morphometrical and biomechanical analyses of a stentless bioprosthetic valve: an implication to avoid potential primary tissue failure. Gen Thorac Cardiovasc Surg 2018; 66:523-528. [PMID: 29956049 DOI: 10.1007/s11748-018-0959-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 06/15/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Stentless bioprosthetic valves provide hemodynamic advantages over stented valves as well as excellent durability. However, some primary tissue failures in bioprostheses have been reported. This study was conducted to evaluate the morphometrical and biomechanical properties of the stentless Medtronic Freestyle™ aortic root bioprosthesis, to identify any arising problem areas, and to speculate on a potential solution. METHODS The three-dimensional heterogeneity of the stentless bioprosthesis wall was investigated using computed tomography. The ascending aorta and the right, left, and non-coronary sinuses of Valsalva were resected and examined by an indentation test to evaluate their biomechanical properties. RESULTS The non-coronary sinus of Valsalva was significantly thinner than the right sinus of Valsalva (p < 0.01). Young's modulus, calculated as an indicator of elasticity, was significantly greater at the non-coronary sinus of Valsalva (430.7 ± 374.2 kPa) than at either the left (190.6 ± 70.6 kPa, p < 0.01) or right sinuses of Valsalva (240.0 ± 56.5 kPa, p < 0.05). CONCLUSIONS Based on the morphometrical and biomechanical analyses of the stentless bioprosthesis, we demonstrated that there are differences in wall thickness and elasticity between each sinus of Valsalva. These differences suggest that the non-coronary sinus of Valsalva is the most vulnerable and at greater risk of tissue failure. The exclusion of the non-coronary sinus of Valsalva may be beneficial to mitigate the long-term risks of tissue failure in the stentless bioprosthesis.
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Affiliation(s)
- Hiroki Takaya
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryocho, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
| | - Shinya Masuda
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryocho, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Masaaki Naganuma
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryocho, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Ichiro Yoshioka
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryocho, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Goro Takahashi
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryocho, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Masatoshi Akiyama
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryocho, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Osamu Adachi
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryocho, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Kiichiro Kumagai
- Research Division of Sciences for Aortic Disease, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shukei Sugita
- Biomechanics Laboratory, Department of Mechanical Engineering, Graduate School of Engineering, Nagoya Institute of Technology, Nagoya, Japan
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryocho, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
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Soynov IA, Zhuravleva IY, Kulyabin YY, Nichay NR, Afanasyev AV, Aleshkevich NP, Bogachev-Prokofiev AV, Karaskov AM. [Valved conduits in pediatric cardiac surgery]. Khirurgiia (Mosk) 2018:75-81. [PMID: 29376963 DOI: 10.17116/hirurgia2018175-81] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- I A Soynov
- Meshalkin Siberian Federal Biomedical Research Center of Healthcare Ministry of the Russian Federation, Novosibirsk, Russia
| | - I Yu Zhuravleva
- Meshalkin Siberian Federal Biomedical Research Center of Healthcare Ministry of the Russian Federation, Novosibirsk, Russia
| | - Yu Yu Kulyabin
- Meshalkin Siberian Federal Biomedical Research Center of Healthcare Ministry of the Russian Federation, Novosibirsk, Russia
| | - N R Nichay
- Meshalkin Siberian Federal Biomedical Research Center of Healthcare Ministry of the Russian Federation, Novosibirsk, Russia
| | - A V Afanasyev
- Meshalkin Siberian Federal Biomedical Research Center of Healthcare Ministry of the Russian Federation, Novosibirsk, Russia
| | - N P Aleshkevich
- Meshalkin Siberian Federal Biomedical Research Center of Healthcare Ministry of the Russian Federation, Novosibirsk, Russia
| | - A V Bogachev-Prokofiev
- Meshalkin Siberian Federal Biomedical Research Center of Healthcare Ministry of the Russian Federation, Novosibirsk, Russia
| | - A M Karaskov
- Meshalkin Siberian Federal Biomedical Research Center of Healthcare Ministry of the Russian Federation, Novosibirsk, Russia
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Sang SLW, Beute T, Heiser J, Berkompas D, Fanning J, Merhi W. Early Outcomes for Valve-in-valve Transcatheter Aortic Valve Replacement in Degenerative Freestyle Bioprostheses. Semin Thorac Cardiovasc Surg 2018; 30:262-268. [DOI: 10.1053/j.semtcvs.2017.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2017] [Indexed: 11/11/2022]
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18
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Characteristics and outcomes of patients with postoperative cardiovascular pseudoaneurysms. J Thorac Cardiovasc Surg 2017; 153:43-50. [DOI: 10.1016/j.jtcvs.2016.08.065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/18/2016] [Accepted: 08/30/2016] [Indexed: 11/23/2022]
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Iribarne A, Keenan J, Benrashid E, Wang H, Meza JM, Ganapathi A, Gaca JG, Kim HW, Hurwitz LM, Hughes GC. Imaging Surveillance After Proximal Aortic Operations: Is it Necessary? Ann Thorac Surg 2016; 103:734-741. [PMID: 27677566 DOI: 10.1016/j.athoracsur.2016.06.085] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 06/16/2016] [Accepted: 06/22/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND Current guidelines for imaging surveillance after proximal aortic repair are not evidence based. This study sought to characterize the incidence and causes of reintervention after proximal aortic operations to provide data to guide the frequency and duration of postoperative surveillance. METHODS Data on all patients undergoing proximal aortic operations (ascending, with or without root, with or without aortic valve replacement, or with or without arch) during a 9-year period (n = 869) at a single institution were prospectively collected. Patients who required reintervention on the proximal or distal aorta were identified and causes for reintervention determined. Planned two-stage repairs and index procedures done at other hospitals were excluded. The primary end point was the time to the first reintervention, and competing-risk Cox regression was used to model reintervention risk. RESULTS Reinterventions occurred in 4.3% of patients (n = 37), with 48.6% (n = 18) involving the proximal aorta and 51.4% (n = 19) the distal. Median time to reintervention was 2.8 years (interquartile range, 1.5 to 3.6 years). For index aneurysm cases, reintervention for aneurysm of the descending/thoracoabdominal aorta and root were most common. Of the 6 root aneurysms/pseudoaneurysms, 5 (83%) were due to degeneration of a stentless porcine aortic root. For index type A dissections, reintervention for aneurysm of the descending/thoracoabdominal aorta and arch were most common. The mean duration of follow up was 4.2 ± 2.5 years. The 9-year actuarial freedom from reintervention was 92.9%. Cox regression showed index type A dissection was a significant predictor of time to aortic reintervention (hazard ratio, 2.01; 95% confidence interval, 1.04 to 3.9; p = 0.038). CONCLUSIONS Reinterventions after proximal aortic operations are uncommon; most occur within 3 years of the index operation and involve the proximal and distal aorta nearly equally. Patients with type A dissection or stentless porcine roots require aggressive surveillance, whereas a more liberal approach is suitable for patients without such risk factors. This strategy may reduce the lifetime radiation burden and health care costs.
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Affiliation(s)
- Alexander Iribarne
- Section of Cardiac Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Jeffrey Keenan
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Ehsan Benrashid
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Hanghang Wang
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - James M Meza
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Asvin Ganapathi
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Jeffrey G Gaca
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Han W Kim
- Division of Cardiology, Duke Cardiovascular Magnetic Resonance Center, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Lynne M Hurwitz
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
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Keeling B, Chen EP. The real root-cause analysis: Optimizing surgical options in the current era. J Thorac Cardiovasc Surg 2015; 150:1026-7. [PMID: 26434701 DOI: 10.1016/j.jtcvs.2015.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 09/02/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Brent Keeling
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Edward P Chen
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga.
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21
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Vassiliades TA, Kon N, Dion RA. Regarding Freestyle Pseudoaneurysms. Ann Thorac Surg 2015; 100:1507-8. [DOI: 10.1016/j.athoracsur.2015.02.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 02/17/2015] [Accepted: 02/23/2015] [Indexed: 11/28/2022]
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23
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Sherrah AG, Jeremy RW, Puranik R, Bannon PG, Hendel PN, Bayfield MS, Wilson MK, Brady PW, Marshman D, Mathur MN, Brereton RJ, Edwards JR, Stuklis RG, Worthington M, Vallely MP. Long Term Outcomes Following Freestyle Stentless Aortic Bioprosthesis Implantation: An Australian Experience. Heart Lung Circ 2015; 25:82-8. [PMID: 26146198 DOI: 10.1016/j.hlc.2015.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 04/30/2015] [Accepted: 05/06/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Freestyle stentless bioprosthesis (FSB) has been demonstrated to be a durable prosthesis in the aortic position. We present data following Freestyle implantation for up to 10 years post-operatively and compare this with previously published results. METHODS A retrospective cohort analysis of 237 patients following FSB implantation occurred at five Australian hospitals. Follow-up data included clinical and echocardiographic outcomes. RESULTS The cohort was 81.4% male with age 63.2±13.0 years and was followed for a mean of 2.4±2.3 years (range 0-10.9 years, total 569 patient-years). The FSB was implanted as a full aortic root replacement in 87.8% patients. The 30-day all cause mortality was 4.2% (2.0% for elective surgery). Cumulative survival at one, five and 10 years was 91.7±1.9%, 82.8±3.8% and 56.5±10.5%, respectively. Freedom from re-intervention at one, five and 10 years was 99.5±0.5%, 91.6±3.7% and 72.3±10.5%, respectively. At latest echocardiographic review (mean 2.3±2.1 years post-operatively), 92.6% had trivial or no aortic regurgitation. Predictors of post-operative mortality included active endocarditis, acute aortic dissection and peripheral vascular disease. CONCLUSIONS We report acceptable short and long term outcomes following FSB implantation in a cohort of comparatively younger patients with thoracic aortic disease. The durability of this bioprosthesis in the younger population remains to be confirmed.
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Affiliation(s)
- Andrew G Sherrah
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, NSW, Australia
| | - Richmond W Jeremy
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Rajesh Puranik
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Paul G Bannon
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, NSW, Australia; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - P Nicholas Hendel
- The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, NSW, Australia; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Matthew S Bayfield
- The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, NSW, Australia; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Michael K Wilson
- The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, NSW, Australia; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia
| | - Peter W Brady
- Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, NSW, Australia
| | - David Marshman
- Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Manu N Mathur
- Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, NSW, Australia
| | - R John Brereton
- Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, NSW, Australia
| | - James R Edwards
- Darcy Sutherland Cardiothoracic Surgical Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Robert G Stuklis
- Darcy Sutherland Cardiothoracic Surgical Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Michael Worthington
- Darcy Sutherland Cardiothoracic Surgical Unit, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Michael P Vallely
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, NSW, Australia; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia.
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