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Singh SK, Levine D, Norton EL, Patel P, Kurlansky P, Rajesh K, Chung M, Olakunle O, Leshnower B, Chen EP, Takayama H. Incidence, risk factors, and long-term outcomes associated with permanent pacemaker implantation after aortic root replacement. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00624-X. [PMID: 39038780 DOI: 10.1016/j.jtcvs.2024.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 06/19/2024] [Accepted: 07/06/2024] [Indexed: 07/24/2024]
Abstract
OBJECTIVE Permanent pacemaker implantation (PPI) after aortic valve replacement is associated with long-term mortality. However, data regarding PPI after aortic root replacement (ARR) is lacking. Herein we describe the incidence, risk factors, and long-term outcomes of PPI after ARR. METHODS Consecutive patients undergoing ARR from 2005 to 2020 were selected after excluding those with endocarditis, type A dissection, or preoperative PPI. Patients requiring PPI after ARR were identified, along with the indication and timing. Independent factors associated with PPI after ARR were identified and long-term survival was assessed. RESULTS The incidence of PPI was 3.8% (n = 85) among 2240 patients undergoing ARR. PPI was performed a median of 7 days (interquartile range, 5-12 days) after ARR most commonly for complete heart block (73%). Bicuspid aortic valve (odds ratio [OR], 1.89; P = .02), female sex (OR, 1.74; P = .04), preoperative heart block (OR, 2.70; P = .02), and prior aortic valve replacement (OR, 2.18; P = .01) were independently associated with PPI while preoperative aortic insufficiency (OR, 0.52; P = .01) and valve-sparing root replacement procedure compared with bio-Bentall (OR, 0.40; P = .01) were protective. Patients requiring PPI after ARR were not at increased risk of operative or long-term mortality compared with patients not requiring PPI (P = .26); however, those undergoing PPI experienced significantly longer hospital length of stay (13 vs 7 days; P < .001). CONCLUSIONS The incidence of PPI after ARR remains low, particularly after VSRR. Preoperative conduction disturbance, prior AVR, and bicuspid aortic valve are all associated with increased risk of PPI. Although PPI is associated with longer length of stay, it is not associated with early or late mortality.
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Affiliation(s)
- Sameer K Singh
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Dov Levine
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | | | - Parth Patel
- Department of Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Paul Kurlansky
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Kavya Rajesh
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Megan Chung
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Oreoluwa Olakunle
- Department of Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Bradley Leshnower
- Department of Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Edward P Chen
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Hiroo Takayama
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY.
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Iribarne A, Alabbadi SH, Moskowitz AJ, Ailawadi G, Badhwar V, Gillinov M, Thourani VH, Allen KB, Halkos ME, Patel NC, Kramer RS, D'Alessandro D, Raymond S, Chang HL, Gupta L, Fenton KN, Taddei-Peters WC, Chu MWA, Falk V, Chikwe J, Jeffries N, Bagiella E, O'Gara PT, Gelijns AC, Egorova NN. Permanent Pacemaker Implantation and Long-Term Outcomes of Patients Undergoing Concomitant Mitral and Tricuspid Valve Surgery. J Am Coll Cardiol 2024; 83:1656-1668. [PMID: 38658105 DOI: 10.1016/j.jacc.2024.02.042] [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: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Tricuspid valve annuloplasty (TA) during mitral valve repair (MVr) is associated with increased risk of permanent pacemaker (PPM) implantation, but the magnitude of risk and long-term clinical consequences have not been firmly established. OBJECTIVES This study assesses the incidence rates of PPM implantation after isolated MVr and following MVr with TA as well as the associated long-term clinical consequences of PPM implantation. METHODS State-mandated hospital discharge databases of New York and California were queried for patients undergoing MVr (isolated or with concomitant TA) between 2004 and 2019. Patients were stratified by whether or not they received a PPM within 90 days of index surgery. After weighting by propensity score, survival, heart failure hospitalizations (HFHs), endocarditis, stroke, and reoperation were compared between patients with or without PPM. RESULTS A total of 32,736 patients underwent isolated MVr (n = 28,003) or MVr + TA (n = 4,733). Annual MVr + TA volumes increased throughout the study period (P < 0.001, trend), and PPM rates decreased (P < 0.001, trend). The incidence of PPM implantation <90 days after surgery was 7.7% for MVr and 14.0% for MVr + TA. In 90-day conditional landmark-weighted analyses, PPMs were associated with reduced long-term survival among MVr (HR: 1.96; 95% CI: 1.75-2.19; P < 0.001) and MVr + TA recipients (HR: 1.65; 95% CI: 1.28-2.14; P < 0.001). In both surgical groups, PPMs were also associated with an increased risk of HFH (HR: 1.56; 95% CI: 1.27-1.90; P < 0.001) and endocarditis (HR: 1.95; 95% CI: 1.52-2.51; P < 0.001), but not with stroke or reoperation. CONCLUSIONS Compared to isolated MVr, adding TA to MVr was associated with a higher risk of 90-day PPM implantation. In both surgical groups, PPM implantation was associated with an increase in mortality, HFH, and endocarditis.
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Affiliation(s)
- Alexander Iribarne
- Department of Cardiothoracic Surgery, Staten Island University Hospital, Northwell Health, Staten Island, New York, USA
| | - Sundos H Alabbadi
- Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Alan J Moskowitz
- Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Gorav Ailawadi
- Cardiac Surgery, Frankel Cardiovascular Center, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Keith B Allen
- Department of Cardiothoracic and Vascular Surgery, St Luke's Hospital, St Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Michael E Halkos
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Nirav C Patel
- Department of Cardiovascular and Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, New York, USA
| | - Robert S Kramer
- Division of Cardiovascular Surgery, Maine Medical Center, Portland, Maine, USA
| | - David D'Alessandro
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Samantha Raymond
- Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Helena L Chang
- Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lopa Gupta
- Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kathleen N Fenton
- Division of Cardiovascular Sciences, National Heart. Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Wendy C Taddei-Peters
- Division of Cardiovascular Sciences, National Heart. Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Michael W A Chu
- Division of Cardiac Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, Deutsche Herzzentrum Berlin, Berlin, Germany; Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany; German Centre for Cardiovascular Research, DZHK, Partner Site Berlin, Berlin, Germany
| | - Joanna Chikwe
- Department of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Neal Jeffries
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Emilia Bagiella
- Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Patrick T O'Gara
- Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Annetine C Gelijns
- Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Natalia N Egorova
- Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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3
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Sakurai Y, Mehaffey JH, Kuno T, Yokoyama Y, Takagi H, Denning DA, Kaneko T, Badhwar V. The impact of permanent pacemaker implantation on long-term survival after cardiac surgery: A systematic review and meta-analysis. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00368-4. [PMID: 38657782 DOI: 10.1016/j.jtcvs.2024.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/29/2024] [Accepted: 04/13/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES The long-term impact of permanent pacemaker (PPM) implantation on survival after cardiac surgery remains ill defined. We aimed to investigate the effect of PPM on survival and explore factors driving outcomes using meta-regression according to the type of surgery. METHODS MEDLINE, EMBASE, and the Cochrane Library Central Register of Controlled Trials were searched through October 2023 to identify studies reporting the long-term outcomes of PPM implantation. The primary outcome was all-cause mortality during follow-up. The secondary outcome was heart failure rehospitalization. The subgroup analysis and meta-regression analysis were performed according to the type of surgery. RESULTS A total of 28 studies met the inclusion criteria. 183,555 patients (n = 6298; PPM, n = 177,257; no PPM) were analyzed for all-cause mortality, with a weighted median follow-up of 79.7 months. PPM implantation was associated with increased risks of all-cause mortality during follow-up (hazard ratio, 1.22; confidence interval, 1.08-1.38, P < .01) and heart failure rehospitalization (hazard ratio, 1.24; confidence interval, 1.01-1.52, P = .04). Meta-regression demonstrated the adverse impact of PPM was less prominent in patients undergoing mitral or tricuspid valve surgery, whereas studies with a greater proportion with aortic valve replacement were associated with worse outcomes. Similarly, a greater proportion with atrioventricular block as an indication of PPM was associated with worse survival. CONCLUSIONS PPM implantation after cardiac surgery is associated with a greater risk of long-term all-cause mortality and heart failure rehospitalization. This impact is more prominent in patients undergoing aortic valve surgery or atrioventricular block as an indication than those undergoing mitral or tricuspid valve surgery.
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Affiliation(s)
- Yosuke Sakurai
- Department of Surgery, Marshall University Joan Edwards School of Medicine, Huntington, WVa
| | - J Hunter Mehaffey
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa.
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Yujiro Yokoyama
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - David A Denning
- Department of Surgery, Marshall University Joan Edwards School of Medicine, Huntington, WVa
| | - Tsuyoshi Kaneko
- Division of Cardiothoracic Surgery, Washington University in St Louis, St Louis, Mo
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
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Kassab J, Harb SC, Desai MY, Gillinov AM, Layoun H, El Dahdah J, Chedid El Helou M, Nakhla S, Elgharably H, Kapadia SR, Cremer PC, Mentias A. Incidence, Risk Factors, and Outcomes Associated With Permanent Pacemaker Implantation Following Tricuspid Valve Surgery. J Am Heart Assoc 2024; 13:e032760. [PMID: 38293932 PMCID: PMC11056159 DOI: 10.1161/jaha.123.032760] [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: 10/16/2023] [Accepted: 12/19/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Data regarding permanent pacemaker (PPM) implantation following tricuspid valve surgery (TVS) are limited. We sought to evaluate its incidence, risk factors, and outcomes. METHODS AND RESULTS Medicare beneficiaries who underwent TVS from 2013 to 2020 were identified. Patients who underwent TVS for endocarditis were excluded. The primary exposure of interest was new PPM after TVS. Outcomes included all-cause mortality and readmission with endocarditis or heart failure on follow-up. Among the 13 294 patients who underwent TVS, 2518 (18.9%) required PPM placement. Risk factors included female sex (relative risk [RR], 1.26 [95% CI, 1.17-1.36], P<0.0001), prior sternotomy (RR, 1.12 [95% CI, 1.02-1.23], P=0.02), preoperative second-degree heart block (RR, 2.20 [95% CI, 1.81-2.69], P<0.0001), right bundle-branch block (RR, 1.21 [95% CI, 1.03-1.41], P=0.019), bifascicular block (RR, 1.43 [95% CI, 1.06-1.93], P=0.02), and prior malignancy (RR, 1.23 [95% CI, 1.01-1.49], P=0.04). Tricuspid valve (TV) replacement was associated with a significantly higher risk of PPM implantation when compared with TV repair (RR, 3.20 [95% CI, 2.16-4.75], P<0.0001). After a median follow-up of 3.1 years, mortality was not different in patients who received PPM compared with patients who did not (hazard ratio [HR], 1.02 [95% CI, 0.93-1.12], P=0.7). PPM placement was not associated with a higher risk of endocarditis but was associated with a higher risk of heart failure readmission (HR, 1.28 [95% CI, 1.14-1.43], P<0.001). CONCLUSIONS PPM implantation frequently occurs after TVS, notably in female patients and patients undergoing TV replacement. Although mortality is not increased, it is associated with higher rates of heart failure rehospitalization.
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Affiliation(s)
- Joseph Kassab
- Department of Cardiovascular MedicineHeart, Vascular and Thoracic Institute, Cleveland Clinic FoundationClevelandOHUSA
| | - Serge C. Harb
- Department of Cardiovascular MedicineHeart, Vascular and Thoracic Institute, Cleveland Clinic FoundationClevelandOHUSA
| | - Milind Y. Desai
- Department of Cardiovascular MedicineHeart, Vascular and Thoracic Institute, Cleveland Clinic FoundationClevelandOHUSA
| | - A. Marc Gillinov
- Department of Cardiovascular SurgeryHeart, Vascular and Thoracic Institute, Cleveland Clinic FoundationClevelandOHUSA
| | - Habib Layoun
- Department of Cardiovascular MedicineHeart, Vascular and Thoracic Institute, Cleveland Clinic FoundationClevelandOHUSA
| | - Joseph El Dahdah
- Department of Cardiovascular MedicineHeart, Vascular and Thoracic Institute, Cleveland Clinic FoundationClevelandOHUSA
| | - Michel Chedid El Helou
- Department of Cardiovascular MedicineHeart, Vascular and Thoracic Institute, Cleveland Clinic FoundationClevelandOHUSA
| | - Shady Nakhla
- Department of Cardiovascular MedicineHeart, Vascular and Thoracic Institute, Cleveland Clinic FoundationClevelandOHUSA
| | - Haytham Elgharably
- Department of Cardiovascular SurgeryHeart, Vascular and Thoracic Institute, Cleveland Clinic FoundationClevelandOHUSA
| | - Samir R. Kapadia
- Department of Cardiovascular MedicineHeart, Vascular and Thoracic Institute, Cleveland Clinic FoundationClevelandOHUSA
| | - Paul C. Cremer
- Department of Cardiovascular MedicineHeart, Vascular and Thoracic Institute, Cleveland Clinic FoundationClevelandOHUSA
| | - Amgad Mentias
- Department of Cardiovascular MedicineHeart, Vascular and Thoracic Institute, Cleveland Clinic FoundationClevelandOHUSA
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Mokryk I, Nechai I, Stetsyuk I, Malova N, Demyanchuk V, Todurov B. Complete Aortic Valve Reconstruction with Autologous Pericardium: Analysis of Mid-Term Results of Single-Center Experience with AVNeo Procedure. Ann Thorac Cardiovasc Surg 2024; 30:24-00067. [PMID: 39198196 PMCID: PMC11357901 DOI: 10.5761/atcs.oa.24-00067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 07/17/2024] [Indexed: 09/01/2024] Open
Abstract
PURPOSE Aortic valve neocuspidization (AVNeo) is a relatively recent advancement in surgical AV replacement. Data on its performance beyond the short term are limited. We assessed the mid-term outcomes in patients undergoing AVNeo, focusing on feasibility, perioperative details, and its role in AV pathology treatment. METHODS Sixty-five consecutive patients underwent AVNeo between December 2016 and February 2018. Clinical data were prospectively collected and retrospectively analyzed. Tricuspid reconstruction with autologous pericardium was performed in all cases. Echocardiographic follow-up was conducted post-discharge, at 6 and 12 months, and annually thereafter. RESULTS The mean age was 62.6 ± 18.7 years. AVNeo was feasible in all cases. Concomitant procedures were performed in 43 (66.2%) patients. Mean bypass and cross-clamp times were 119.2 ± 30.3 and 87.1 ± 22.9 minutes, respectively. Postoperative transvalvular hemodynamics was excellent. There was one (1.5%) in-hospital death. Follow-up (mean 66.72 ± 12.77 months) was complete in 58 patients (89.2%). There were no detected valve-related or thromboembolic events. Transvalvular hemodynamic parameters were stable during the observation period: peak pressure gradient at discharge and follow-up was 15.3 ± 4.6 mmHg and 15.01 ± 6.3 mmHg, respectively (ρ = 0.346). CONCLUSIONS AVNeo demonstrated the feasibility and favorable mid-term outcomes. Studies with longer-term observation are warranted to evaluate its durability.
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Affiliation(s)
- Igor Mokryk
- Department of Adult Cardiac Surgery, Heart Institute Ministry of Healthcare of Ukraine, Kyiv, Ukraine
| | - Illia Nechai
- Department of Adult Cardiac Surgery, Heart Institute Ministry of Healthcare of Ukraine, Kyiv, Ukraine
| | - Ihor Stetsyuk
- Department of Adult Cardiac Surgery, Heart Institute Ministry of Healthcare of Ukraine, Kyiv, Ukraine
| | - Nataliia Malova
- Department of Adult Cardiac Surgery, Heart Institute Ministry of Healthcare of Ukraine, Kyiv, Ukraine
| | - Vitaly Demyanchuk
- Department of Adult Cardiac Surgery, Heart Institute Ministry of Healthcare of Ukraine, Kyiv, Ukraine
| | - Borys Todurov
- Department of Adult Cardiac Surgery, Heart Institute Ministry of Healthcare of Ukraine, Kyiv, Ukraine
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Zahr F, Lantz G. Bi-cuspid TAVR; bye or buy! Catheter Cardiovasc Interv 2023; 102:960-961. [PMID: 37890016 DOI: 10.1002/ccd.30875] [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: 09/03/2023] [Accepted: 09/30/2023] [Indexed: 10/29/2023]
Abstract
Key Points
Mid term data of TAVR in stenotic bicuspid aortic valves is promising both in term of mortality and valve performance.
Many factors should be considered before we generalize these results to all types of bicuspid native valves, TAVR valves, and patient populations.
A randomized trial to SAVR versus TAVR remains the missing piece before we solve this complex clinical equation.
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Affiliation(s)
- Firas Zahr
- Division of Cardiovascular Medicine, Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon, USA
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Shimahara Y, Honda S, Fujiyoshi T, Kamiya K, Nakano Y, Komatsu I, Yamashita J, Ogino H. Preoperative planning for transaortic septal myectomy using cardiac computed tomography in patients with subaortic septal hypertrophy associated with aortic stenosis: case series. Eur Heart J Case Rep 2023; 7:ytad276. [PMID: 37681057 PMCID: PMC10481893 DOI: 10.1093/ehjcr/ytad276] [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: 05/04/2022] [Revised: 01/17/2023] [Accepted: 06/22/2023] [Indexed: 09/09/2023]
Abstract
Background Electrocardiogram-gated cardiac computed tomography (CT) imaging enables a more accurate understanding of the patient's cardiac anatomy. Preoperative planning for transaortic septal myectomy (TASM), based on cardiac CT, may be useful in patients with subaortic septal hypertrophy associated with severe aortic stenosis (AS). Case summary Two elderly patients (age >80 years) with subaortic septal hypertrophy associated with AS underwent surgical aortic valve replacement (SAVR) and concomitant TASM after preoperative planning based on cardiac CT. Both patients showed subaortic septal hypertrophy with blood flow acceleration, left ventricular (LV) hypercontractility, and a short distance from the coaptation point of the mitral valve to the septum, resulting in possible dynamic LV outflow tract (LVOT) obstruction after resolution of AS. Optimal mid-diastolic images, selected from the 70-80% phase, were used for preoperative TASM planning. Planned sizes for myectomy based on multi-planar reconstruction were 10 × 26 × 9 mm (width × length × depth) and 10 × 25 × 9 mm for patient 1 and 2, respectively, while resected tissue size was 10 × 24 × 8 mm and 9 × 24 × 8 mm in patient 1 and 2, respectively. After TASM procedure, SAVR was performed with bioprosthetic valve. Postoperative course of both patients was uneventful with no evidence of complete atrioventricular block, septal perforation, or blood flow acceleration at the LVOT. Discussion Preoperative planning based on cardiac CT images is safe and useful for guiding adequate myectomy and preventing associated complications in patients with subaortic septal hypertrophy associated with AS.
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Affiliation(s)
- Yusuke Shimahara
- Department of Cardiovascular Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Sayaka Honda
- Department of Cardiovascular Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Toshiki Fujiyoshi
- Department of Cardiovascular Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Yu Nakano
- Department of Cardiovascular Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Ikki Komatsu
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
| | - Jun Yamashita
- Department of Cardiology, Tokyo Medical University, Tokyo, Japan
| | - Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
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Demal TJ, Weimann J, Ojeda FM, Bhadra OD, Linder M, Ludwig S, Grundmann D, Voigtländer L, Waldschmidt L, Schirmer J, Schofer N, Blankenberg S, Reichenspurner H, Conradi L, Seiffert M, Schaefer A. Temporal changes of patient characteristics over 12 years in a single-center transcatheter aortic valve implantation cohort. Clin Res Cardiol 2023; 112:691-701. [PMID: 36792752 PMCID: PMC10160189 DOI: 10.1007/s00392-023-02166-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Beneficial results of transcatheter aortic valve implantation (TAVI) compared to surgical aortic valve replacement (SAVR) in patients at all risk strata have led to substantial changes in guideline recommendations for valvular heart disease. AIM To examine influence of these guideline changes on a real-world TAVI cohort, we evaluated how risk profiles and outcomes of TAVI patients developed in our single-center patient cohort over a period of 12 years. METHODS Baseline, procedural and 30-day outcome parameters of TAVI patients were retrospectively compared between three time periods (period 1: 2008-2012, period 2: 2013-2017, period 3: 2018-2020). RESULTS Between 03/2008 and 12/2020, a total of 3678 patients underwent TAVI at our center. The median age was 81.1 years (25th, 75th percentile: 76.7, 84.9) with no significant change over time. The EuroSCORE II showed a continuous and significant decline from 5.3% (3.3, 8.6) in period 1 to 2.8% (1.7, 5.0) in period 3 (p < 0.001). Furthermore, rates of permanent pacemaker implantation, acute kidney injury, and paravalvular leakage ≥ moderate continuously declined over time. Accordingly, the 30-day mortality fell from 9.3% in period 1 to 4.3% in period 3 (p < 0.001). CONCLUSION Despite substantial guideline alterations, median patient age remained largely unchanged in our TAVI cohort over the past 12 years. Therefore, increased age still appears to be the main reason to choose TAVI over SAVR. However, risk profiles declined substantially. Significant improvements in early outcomes suggest favorable influence of less invasive access routes, improved device platforms and growing user experience.
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Affiliation(s)
- Till Joscha Demal
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany.
| | - Jessica Weimann
- Department of Cardiology, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Francisco Miguel Ojeda
- Department of Cardiology, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Oliver D Bhadra
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Matthias Linder
- Department of Cardiology, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Sebastian Ludwig
- Department of Cardiology, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - David Grundmann
- Department of Cardiology, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Lisa Voigtländer
- Department of Cardiology, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Lara Waldschmidt
- Department of Cardiology, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Johannes Schirmer
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Niklas Schofer
- Department of Cardiology, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Moritz Seiffert
- Department of Cardiology, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Andreas Schaefer
- Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
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9
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Sawatari H, Chahal AA, Ahmed R, Collinss GB, Deshpande S, Khanji MY, Provedenciae R, Khan H, Wafa SEI, Salloum MN, Karim S, Shenthar J, Cha YM, Hyman M, Brady PA, Somers VK, Padmanabhan D, Nkomo VT. Impact of Cardiac Implantable Electronic Devices on Cost and Length of Stay in Patients With Surgical Aortic Valve Replacement and Transcutaneous Aortic Valve Implantation. Am J Cardiol 2023; 192:69-78. [PMID: 36753975 DOI: 10.1016/j.amjcard.2023.01.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/08/2022] [Accepted: 01/07/2023] [Indexed: 02/09/2023]
Abstract
Surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) in aortic stenosis are associated with arrhythmic complications that can require cardiac implantable electronic device (CIED) implantation, but impact on healthcare-associated cost (HAC) and length of stay (LOS) are unknown. This study aimed to assess differences among SAVR/TAVI patients with CIED implantation on HAC and LOS. Patients hospitalized for SAVR or TAVI between 2011 and 2017 on the National Inpatient Sample database were identified and stratified according to presence/type of CIED implantation. During this period, 95,262 patients were identified; 6,435 (6.8%) patients received CIED (median [interquartile range] age: 74.0 [66.0 to 82.0] years). The median adjusted HAC was $44,271 and LOS was 6 days. CIED implantation was associated with longer LOS and higher adjusted HAC in patients with SAVR and TAVI (p <0.0001). Patients with in-hospital death and complications because of SAVR or TAVI had longer preceding in-hospital days of admission. Male patients admitted to small hospitals and the West region had the highest HAC. In conclusion, CIED implantation for arrhythmias results in higher HAC and longer LOS in patients with aortic stenosis for both SAVR and TAVI.
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Affiliation(s)
- Hiroyuki Sawatari
- Department of Perioperative and Critical Care Management, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Anwar A Chahal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Department of Cardiology, Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom; Division of Cardiac Electrophysiology, University of Pennsylvania, Philadelphia
| | - Raheel Ahmed
- Department of Cardiology, Northumbria Healthcare National Health Service Foundation Trust, Newcastle, New South Wales
| | - George B Collinss
- Department of Cardiology, Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Saurabh Deshpande
- Department of Electrophysiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Mohammed Y Khanji
- Department of Cardiology, Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Rui Provedenciae
- Department of Cardiology, Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Hassan Khan
- Emory University School of Medicine, Atlanta, Georgia
| | - Syed Emir Irfan Wafa
- Department of Cardiology, Northampton General Hospital, Northampton, Massachusetts
| | - Mohammad N Salloum
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai Queens Hospital Center, New York, New York
| | - Shahid Karim
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jayaprakash Shenthar
- Department of Electrophysiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Yong-Mei Cha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Matthew Hyman
- Division of Cardiac Electrophysiology, University of Pennsylvania, Philadelphia
| | - Peter A Brady
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Virend K Somers
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Deepak Padmanabhan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Division of Cardiac Electrophysiology, University of Pennsylvania, Philadelphia; Department of Electrophysiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
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10
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Mogilansky C, Massoudy P, Czesla M, Balan R. Conduction Disorders after Surgical Aortic Valve Replacement Using a Rapid Deployment Aortic Valve Prosthesis: Medium-Term Follow-Up. J Clin Med 2023; 12:jcm12052083. [PMID: 36902870 PMCID: PMC10004204 DOI: 10.3390/jcm12052083] [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: 01/05/2023] [Revised: 02/25/2023] [Accepted: 02/28/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND We have previously reported that the incidence of postoperative conduction disorders, especially left bundle branch block (LBBB), after implantation of a rapid deployment Intuity™ Elite aortic valve prosthesis (Edwards Lifesciences, Irvine, CA, USA), was significantly increased compared with conventional aortic valve replacement. We were now interested in how these disorders behaved at intermediate follow-up. METHODS All 87 patients who had undergone surgical aortic valve replacement (SAVR) using the rapid deployment Intuity™ Elite prosthesis and were shown to have conduction disorders at the time of hospital discharge were followed up after surgery. These patients' ECGs were recorded at least 1 year after surgery, and the persistence of the new postoperative conduction disorders was assessed. RESULTS At hospital discharge, 48.1% of the patients had developed new postoperative conduction disorders, with LBBB being the predominant conduction disturbance (36.5%). At medium-term follow-up (526 days, standard deviation (SD) = 169.6, standard error (SE) = 19.3 days, respectively), 44% of the new LBBB and 50% of the new right bundle branch block (RBBB) had disappeared. There was no new atrio-ventricular block III (AVB III) that occurred. One new pacemaker (PM) was implanted during follow-up because of AVB II Mobitz type II. CONCLUSIONS At medium-term follow-up after the implantation of a rapid deployment Intuity™ Elite aortic valve prosthesis, the number of new postoperative conduction disorders, especially LBBB, has considerably decreased but remains high. The incidence of postoperative AV block III remained stable.
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11
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Sakata T, De La Pena C, Ohira S. Rapid-Deployment Aortic Valve Replacement: Patient Selection and Special Considerations. Vasc Health Risk Manag 2023; 19:169-180. [PMID: 37016696 PMCID: PMC10066891 DOI: 10.2147/vhrm.s374410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/07/2023] [Indexed: 03/30/2023] Open
Abstract
Sutureless or rapid deployment valves in the setting of aortic valve replacement (AVR) is an emerging surgical technique using the transcatheter valve technology, which may lead to reduction in cross-clamp time and potentially better hemodynamics compared to a stented bioprosthetic valve. The absence of subannular pledgets results to excellent hemodynamic performance with reduced turbulent flow and larger effective orifice area. However, complications from both surgical and transcatheter AVR may still occur and impact survival. The incidence of paravalvular leakage and permanent pacemaker implantation are not low. Although technical modifications can improve these outcomes, there is a learning curve effect. Therefore, technical and anatomical considerations as well as better patient selection are paramount for better outcomes. In this review, we discuss the use of sutureless or rapid deployment valves in setting of (1) complex procedures, (2) minimally invasive AVR, and (3) small aortic annulus. The advantage of sutureless or rapid deployment valves in terms of mortality remains to be clarified; therefore, it is necessary to accumulate long-term outcomes in an appropriate patient cohort.
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Affiliation(s)
- Tomoki Sakata
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Corazon De La Pena
- Department of Surgery, Division of Cardiothoracic Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Suguru Ohira
- Department of Surgery, Division of Cardiothoracic Surgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
- Correspondence: Suguru Ohira, Department of Surgery, Division of Cardiothoracic Surgery, Westchester Medical Center, New York Medical College, 100 Woods Road, Macy Pavilion, Valhalla, NY, 10595, USA, Tel +1 404 234 5433, Email
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12
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Onishi T, Komori O, Ando T, Fukutomi M, Tobaru T. Effectiveness of high implantation of SAPIEN 3 in preventing pacemaker implantation: A propensity score analysis. Arch Cardiovasc Dis 2023; 116:79-87. [PMID: 36641243 DOI: 10.1016/j.acvd.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/04/2022] [Accepted: 11/07/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND In transcatheter aortic valve implantation, high implantation on the aortic annulus may prevent conduction pathway injury, leading to a decrease in the rate of permanent pacemaker implantation. AIM To assess the impact of high implantation of SAPIEN 3 on the prevention of permanent pacemaker implantation. METHODS Since August 2020, we have performed high implantation by fluoroscopically positioning the lower part of the lucent line at the virtual basal ring line on a coplanar view before valve implantation. Patients treated before the adoption of this method were defined as the conventional group. We compared the high implantation group with the conventional group using propensity score analysis. RESULTS Overall, the high implantation group (n=95) showed a significantly shorter ventricular strut length than the conventional group (n=85): median 1.3 (interquartile range 0.2-2.4) mm vs 2.8 (1.8-4.1) mm (P<0.001). The permanent pacemaker implantation rate was significantly lower in the high implantation group than in the conventional group (2.1% vs 11.8%; P=0.009). According to 100 propensity score analyses based on multiple imputation and the selection of appropriate covariates, the median P value for the comparison of permanent pacemaker implantation rates after transcatheter aortic valve implantation between the high implantation group and the conventional group ranged between 0.001 and 0.017, indicating a more significant reduction in the permanent pacemaker implantation rate in the high implantation group than in the conventional group. Neither valve dislodgement nor the need for a second valve was observed in either group. CONCLUSIONS The high implantation of SAPIEN 3 successfully decreases ventricular strut length, reducing the permanent pacemaker implantation rate after transcatheter aortic valve implantation.
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Affiliation(s)
- Takayuki Onishi
- Department of Cardiology, Kawasaki Heart Centre, Kawasaki Saiwai Hospital, Saiwai-ku, Kawasaki-shi, 212-0014 Kanagawa, Japan.
| | - Osamu Komori
- Department of Computer and Information Science, Faculty of Science and Technology, Seikei University, Musashino-shi, 180-8633 Tokyo, Japan; School of Statistical Thinking, The Institute of Statistical Mathematics, Tachikawa, 190-8562 Tokyo, Japan
| | - Tomo Ando
- Department of Cardiology, Kawasaki Heart Centre, Kawasaki Saiwai Hospital, Saiwai-ku, Kawasaki-shi, 212-0014 Kanagawa, Japan
| | - Motoki Fukutomi
- Department of Cardiology, Kawasaki Heart Centre, Kawasaki Saiwai Hospital, Saiwai-ku, Kawasaki-shi, 212-0014 Kanagawa, Japan
| | - Tetsuya Tobaru
- Department of Cardiology, Kawasaki Heart Centre, Kawasaki Saiwai Hospital, Saiwai-ku, Kawasaki-shi, 212-0014 Kanagawa, Japan
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13
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Olsthoorn JR, Heuts S, Houterman S, Roefs M, Maessen JG, Nia PS. Does concomitant tricuspid valve surgery increase the risks of minimally invasive mitral valve surgery? A multicentre comparison based on data from The Netherlands Heart Registration. J Card Surg 2022; 37:4362-4370. [PMID: 36229944 PMCID: PMC10091696 DOI: 10.1111/jocs.17004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/29/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Mitral valve (MV) disease is often accompanied by tricuspid valve (TV) disease. The indication for concomitant TV surgery during primary MV surgery is expected to increase, especially through a minimally invasive surgical (MIS) approach. The aim of the current study is to investigate the safety of the addition of TV surgery to MV surgery in MIMVS in a nationwide registry. METHODS Patients undergoing atrioventricular valve surgery through sternotomy or MIS between 2013 and 2018 were included. Patients undergoing MV surgery only through sternotomy or MIS were used as comparison. Primary outcomes were short-term morbidity and mortality and long-term survival. Propensity score matching was used to correct for potential confounders. RESULTS The whole cohort consisted of 2698 patients. A total of 558 patients had atrioventricular double valve surgery through sternotomy and 86 through MIS. As a comparison, 1365 patients underwent MV surgery through sternotomy and 689 patients through MIS. No differences in 30- and 120-day mortality were observed between the groups, both unmatched and matched. 5-year survival did not differ for double atrioventricular valve surgery through either sternotomy or MIS in the matched population (90.1% vs. 95.3%, Log-Rank p = .12). A higher incidence of re-exploration for bleeding (n = 12 [15.2%] vs. n = 3 [3.8%], p = .02) and new onset arrhythmia (n = 35 [44.3%] vs. n = 13 [16.5%], p < .001) was observed in double valve surgery through MIS. Median length of hospital stay (LOHS) was longer in the minimally invasive double valve group (9 days [6-13]) compared with sternotomy (7 days [6-11]; p = .04). CONCLUSION No differences in short-term mortality and 5-year survival were observed when tricuspid valve was added to MV surgery in MIS or sternotomy. The addition of tricuspid valve surgery is associated with higher incidence of re-exploration for bleeding, new onset arrhythmia. A longer LOHS was observed for MIS compared to sternotomy.
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Affiliation(s)
- Jules R Olsthoorn
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Samuel Heuts
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Maaike Roefs
- Netherlands Heart Registration, Utrecht, The Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Peyman S Nia
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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14
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Bin Mahmood SU, Mori M, Amabile A, Prescher L, Forrest J, Kaple R, Geirsson A, Mangi AA. Risk factors and mortality associated with permanent pacemaker after surgical or transcatheter aortic valve replacement: Early versus late implantation. J Card Surg 2022; 37:4295-4300. [PMID: 36131523 DOI: 10.1111/jocs.16938] [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: 07/06/2022] [Revised: 08/10/2022] [Accepted: 08/17/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Inflation of transcatheter aortic valve replacement (TAVR) procedures compared to surgical aortic valve replacement (SAVR) has increased the number of patients requiring a postprocedure permanent pacemaker (PPM). We investigate the impact of PPM on mid-term mortality comparing SAVR versus TAVR procedures and risk factors for early and late (>14 days) need of PPM. METHODS We conducted a retrospective, single-center evaluation of 903 patients that underwent either SAVR or TAVR procedures at the Yale New Haven Hospital from 2012 to 2017. Patients were stratified into PPM and non-PPM groups. We performed Kaplan-Meier and Cox proportional hazard analysis to characterize mid-term mortality. Further subgroup analysis was performed to identify risk factors for early and late PPM implantation in the TAVR cohort. RESULTS There was no correlation between PPM implantation and mid-term mortality in both SAVR (hazard ratio [HR] = 0.69; confidence interval [CI] = 0.21-2.30; p = .56) and TAVR (HR = 0.70; CI = 0.42-1.17; p = .18) patients. The presence of the right bundle branch block (Odds ratio = 24.07; 95% CI = 2.34-247.64, p = .007) was associated with higher odds of early PPM requirement after TAVR procedures. CONCLUSION PPM placement after SAVR or TAVR procedures is not associated with increased mid-term mortality. In-depth characterization of risk factors for early and late PPM implantation will require further analysis in the growing TAVR patient population.
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Affiliation(s)
- Syed Usman Bin Mahmood
- Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Makoto Mori
- Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Andrea Amabile
- Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Lindsey Prescher
- Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - John Forrest
- Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Ryan Kaple
- Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Arnar Geirsson
- Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Abeel A Mangi
- Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
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15
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El Diasty M, Davies M, Fernandez AL, Ribeiro I, Payne D, Petsikas D. Does Pacemaker Implantation After Surgical Aortic Valve Replacement Impact Long-Term Morbidity and Mortality? A Focused Review. Tex Heart Inst J 2022; 49:487617. [PMID: 36252278 PMCID: PMC9632401 DOI: 10.14503/thij-20-7518] [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: 01/25/2023]
Abstract
Permanent pacing remains a serious complication that can occur in the postoperative period of surgical aortic valve replacement. The reported incidence is variable, and there are many perioperative factors that have been linked with a greater need for permanent pacing. Permanent pacing can also be associated with late lead-related and cardiac complications that can affect late outcome. However, the degree of late dependence on pacemakers is varied, and some studies have shown that a substantial proportion of patients do not need long-term pacing. Some groups have found that permanent pacing was associated with a negative impact on long-term survival in these patients. A common finding among these studies is that the groups of patients with pacemakers had higher preoperative surgical risk and comorbidity status. This makes it difficult to establish whether permanent pacing on its own represents a risk factor for late mortality or whether it is simply a marker that reflects the higher complexity and comorbidities in this group of patients.
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Affiliation(s)
- Mohammad El Diasty
- Cardiac Surgery Department, Kingston Health Science Centre, Kingston, Ontario, Canada
| | - Mark Davies
- Cardiology Department, Oxford University Hospital, Oxford, United Kingdom
| | - Angel L. Fernandez
- Cardiovascular Surgery Department, University Hospital, Santiago de Compostela, Spain
| | - Igo Ribeiro
- Cardiac Surgery Department, Kingston Health Science Centre, Kingston, Ontario, Canada
| | - Darrin Payne
- Cardiac Surgery Department, Kingston Health Science Centre, Kingston, Ontario, Canada
| | - Dimitri Petsikas
- Cardiac Surgery Department, Kingston Health Science Centre, Kingston, Ontario, Canada
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16
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Hyde EK, Throndson K, Arcinas LA, Shah AH, Hiebert B, Yamashita MH, Lee Samson D, Maric A, Love R, Poettcker D, Arora RC, Seifer CM, Kass M. Validation of the Emory Risk Score in the Transcatheter Aortic Valve Implantation Population: A Canadian Perspective. CJC Open 2022; 4:1060-1068. [PMID: 36562015 PMCID: PMC9764109 DOI: 10.1016/j.cjco.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/22/2022] [Indexed: 02/01/2023] Open
Abstract
Background Permanent pacemaker (PPM) implantation may be indicated post-transcatheter aortic valve implantation (TAVI). The Emory Risk Score (ERS) is a validated predictive risk score of the need for a PPM post-TAVI using a balloon-expandable valve. Our objectives were to determine the validity of the ERS in our local TAVI population with both balloon-expandable and self-expanding valves and to identify additional electrocardiographic (ECG) parameters predictive of the need for a PPM post-TAVI. Methods Retrospective chart and electronic database reviews were performed to collect demographic and procedural information. Two expert readers reviewed all ECGs. Independent factors associated with PPM implantation were examined with multivariable logistic regression via a stepwise selection process with calculation of the area under the receiver operating characteristic curve to assess model discrimination. Results The overall PPM implantation rate was 11.7%; rates were 9% for the Sapien 3 valves, 10% for the Evolut Pro valves, and 17% for the Evolut R valves. The ERS was found to not be predictive of need for PPM post-TAVI for the entire cohort. Right bundle branch block was the only ERS parameter independently associated with new PPM implant (8.5% vs 25%, odds ratio = 3.59, P = 0.01). No additional ECG parameters met the criteria for statistical significance. Conclusions The poor predictive value of the ERS in determining the need for a PPM post-TAVI in our patient population suggests that further refinement of a formula (or risk-calculator) is warranted. Identification of a precise risk-calculator is likely to facilitate patient mobilization and reduce inpatient healthcare resource utilization.
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Affiliation(s)
- Emily K. Hyde
- Cardiac Sciences, St. Boniface Hospital, Winnipeg, Manitoba, Canada,Corresponding author: Emily Hyde, CR1040 – 369 av. Taché Ave., Winnipeg, Manitoba R2H 2A6, Canada. Tel.: +1-204-235-3391.
| | - Karen Throndson
- Cardiac Sciences, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Liane A. Arcinas
- Department of Internal Medicine, Section of Cardiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ashish H. Shah
- Cardiac Sciences, St. Boniface Hospital, Winnipeg, Manitoba, Canada,Department of Internal Medicine, Section of Cardiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brett Hiebert
- Cardiac Sciences, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Michael H. Yamashita
- Cardiac Sciences, St. Boniface Hospital, Winnipeg, Manitoba, Canada,Department of Surgery, Section of Cardiac Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Anita Maric
- Cardiac Sciences, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Reid Love
- Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Denise Poettcker
- Cardiac Sciences, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Rakesh C. Arora
- Cardiac Sciences, St. Boniface Hospital, Winnipeg, Manitoba, Canada,Department of Surgery, Section of Cardiac Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Colette M. Seifer
- Cardiac Sciences, St. Boniface Hospital, Winnipeg, Manitoba, Canada,Department of Internal Medicine, Section of Cardiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Malek Kass
- Cardiac Sciences, St. Boniface Hospital, Winnipeg, Manitoba, Canada,Department of Internal Medicine, Section of Cardiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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17
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Vilalta V, Cediel G, Mohammadi S, López H, Kalavrouziotis D, Resta H, Dumont E, Voisine P, Philippon F, Escabia C, Borrellas A, Alperi A, Bayes-Genis A, Rodes-Cabau J. Incidence, Predictors and Prognostic Value of Permanent Pacemaker Implantation Following Sutureless Valve Implantation in Low-Risk Aortic Stenosis Patients. Eur J Cardiothorac Surg 2022; 62:6593489. [PMID: 35639725 DOI: 10.1093/ejcts/ezac307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/11/2022] [Accepted: 05/20/2022] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES SU-SAVR has been associated with higher rates of permanent pacemaker (PPM) compared with conventionally implanted aortic bioprostheses. The purpose of this study was to determine the incidence, predictors and mid-term prognostic impact of PPM after Perceval (Livanova, London, UK) SU-SAVR in low-risk patients. METHODS A total of 400 consecutive low-risk (EuroSCORE II < 4%) patients without prior pacemaker who underwent SAVR with the Perceval prosthesis from 2013 to 2019 in two centres were included. Baseline, clinical and electrocardiographic parameters, procedural characteristics, and follow-up data were collected. RESULTS PPM was required in 36 (9%) patients after SU-SAVR, with a median time between the procedure and PPM implantation of 7.5 (4.5-10.5) days. Older age and prior right bundle branch block (RBBB) were associated with an increased risk of PPM (p < 0.05 for all), but only baseline RBBB was found to be an independent predictor of new PPM requirement (Odds ratio: 2.60, 95% confidence interval: 1.15-5.81; p = 0.022). At a median follow-up of 3.4 (2.3-4.5) years, there were no differences between groups in mortality (PPM: 36%, no PPM: 22%, p = 0.105) or heart failure rehospitalization (PPM: 25%, no PPM: 21%, p = 0.839). CONCLUSIONS About 1 out of 10 low-risk patients with aortic stenosis undergoing SU-SAVR with the Perceval prosthesis required PPM implantation. Prior RBBB determined an increased risk (close to 3 times) of PPM following the procedure. PPM was not associated with a higher risk of clinical events at 3-year follow-up.
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Affiliation(s)
- Victoria Vilalta
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Germán Cediel
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Siamak Mohammadi
- Department of Cardiac Surgery, Quebec Heart & Lung Institute, Quebec City, Canada
| | - Helena López
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | - Helena Resta
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Eric Dumont
- Department of Cardiac Surgery, Quebec Heart & Lung Institute, Quebec City, Canada
| | - Pierre Voisine
- Department of Cardiac Surgery, Quebec Heart & Lung Institute, Quebec City, Canada
| | - François Philippon
- Department of Cardiology, Quebec Heart & Lung Institute, Quebec City, Canada
| | - Claudia Escabia
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Andrea Borrellas
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Alberto Alperi
- Department of Cardiology, Quebec Heart & Lung Institute, Quebec City, Canada
| | - Antoni Bayes-Genis
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Josep Rodes-Cabau
- Department of Cardiology, Quebec Heart & Lung Institute, Quebec City, Canada
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18
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Gammie JS, Hung J, Ailawadi G. Tricuspid Repair in Patients with Degenerative Mitral Regurgitation. Reply. N Engl J Med 2022; 386:1862-1863. [PMID: 35544398 DOI: 10.1056/nejmc2202775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- James S Gammie
- Johns Hopkins Heart and Vascular Institute, Baltimore, MD
| | - Judy Hung
- Massachusetts General Hospital, Boston, MA
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Mazine A, David TE, Stoklosa K, Chung J, Lafreniere-Roula M, Ouzounian M. Improved Outcomes Following the Ross Procedure Compared With Bioprosthetic Aortic Valve Replacement. J Am Coll Cardiol 2022; 79:993-1005. [PMID: 35272805 DOI: 10.1016/j.jacc.2021.12.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/15/2021] [Accepted: 12/08/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND The ideal aortic valve substitute for young and middle-aged adults remains elusive. OBJECTIVES This study sought to compare the long-term outcomes of patients undergoing the Ross procedure and those receiving bioprosthetic aortic valve replacements (AVRs). METHODS Consecutive patients aged 16-60 years who underwent a Ross procedure or surgical bioprosthetic AVR at the Toronto General Hospital between 1990 and 2014 were identified. Propensity score matching was used to account for differences in baseline characteristics. The primary outcome was all-cause mortality. Secondary outcomes included valve reintervention, valve deterioration, endocarditis, thromboembolic events, and permanent pacemaker implantation. RESULTS Propensity score matching yielded 108 pairs of patients. The median age was 41 years (IQR: 34-47 years). Baseline characteristics were similar between the matched groups. There was no operative mortality in either group. Mean follow-up was 14.5 ± 7.2 years. All-cause mortality was lower following the Ross procedure (HR: 0.35; 95% CI: 0.14-0.90; P = 0.028). Using death as a competing risk, the Ross procedure was associated with lower rates of reintervention (HR: 0.21; 95% CI: 0.10-0.41; P < 0.001), valve deterioration (HR: 0.25; 95% CI: 0.14-0.45; P < 0.001), thromboembolic events (HR: 0.15; 95% CI: 0.05-0.50; P = 0.002), and permanent pacemaker implantation (HR: 0.22; 95% CI: 0.07-0.64; P = 0.006). CONCLUSIONS In this propensity-matched study, the Ross procedure was associated with better long-term survival and freedom from adverse valve-related events compared with bioprosthetic AVR. In specialized centers with sufficient expertise, the Ross procedure should be considered the primary option for young and middle-aged adults undergoing AVR.
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Affiliation(s)
- Amine Mazine
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital and the University of Toronto, Toronto, Ontario, Canada
| | - Tirone E David
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital and the University of Toronto, Toronto, Ontario, Canada
| | - Klaudiusz Stoklosa
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital and the University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Chung
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital and the University of Toronto, Toronto, Ontario, Canada
| | - Myriam Lafreniere-Roula
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital and the University of Toronto, Toronto, Ontario, Canada
| | - Maral Ouzounian
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital and the University of Toronto, Toronto, Ontario, Canada.
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20
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Servito M, Khoury W, Payne D, Baranchuk A, El Diasty M. Long-term impact of permanent cardiac pacing after surgical aortic valve replacement: systematic review and meta-analysis. Expert Rev Cardiovasc Ther 2022; 20:81-86. [DOI: 10.1080/14779072.2022.2031981] [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: 10/19/2022]
Affiliation(s)
- Maria Servito
- Faculty of Medicine, Queen’s University, Kingston, ON, Canada
| | - William Khoury
- Faculty of Medicine, Queen’s University, Kingston, ON, Canada
| | - Darrin Payne
- Division of Cardiac Surgery, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Adrian Baranchuk
- Division of Cardiology, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Mohammad El Diasty
- Division of Cardiac Surgery, Kingston Health Sciences Centre, Kingston, ON, Canada
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21
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Dalén M, Persson M, Glaser N, Sartipy U. Permanent pacemaker implantation after On-X surgical aortic valve replacement: SWEDEHEART observational study. BMJ Open 2021; 11:e047962. [PMID: 34794986 PMCID: PMC8603281 DOI: 10.1136/bmjopen-2020-047962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Bioprosthetic aortic valves with an extended subannular component, such as transcatheter valves, exert increased compression on the cardiac conduction system and increase the risk for permanent pacemaker implantation. It is unknown if the On-X mechanical prosthetic valve, which has an elongated subannular valve housing, increases the risk of permanent pacemaker implantation following aortic valve replacement. DESIGN Observational nationwide cohort study. SETTING Swedish population-based study. PARTICIPANTS All patients aged 18-65 years who underwent primary mechanical aortic valve replacement in Sweden between 2005 and 2018. We used the Swedish Web system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies register and other Swedish national health-data registers. EXPOSURE Patients implanted with an On-X valve versus patients implanted with other bileaflet mechanical valves. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome measure was permanent pacemaker implantation within 30 days of surgery. RESULTS A total of 2602 patients were included, and 581 patients received an On-X valve and 2021 patients received a St Jude Masters/Regent (n=945) or Carbomedics Reduced valve (n=1076). In the total study population, 115 (4.4%) permanent pacemaker implantations were performed within 30 days after aortic valve replacement. In the propensity score matched population, there was no significant difference in the rate of permanent pacemaker implantation in the On-X group compared with the control group: 3.6% (95% CI: 2.4% to 5.5%) vs 4.0% (95% CI: 2.7% to 5.9%), p=0.877. CONCLUSIONS The On-X prosthetic heart valve was associated with a similarly low risk for permanent pacemaker implantation after aortic valve replacement compared with other conventional bileaflet mechanical valves. The On-X elongated subannular valve housing does not interfere with the cardiac conduction system.
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Affiliation(s)
- Magnus Dalén
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Michael Persson
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Natalie Glaser
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Stockholm South General Hospital, Stockholm, Sweden
| | - Ulrik Sartipy
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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22
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Dalén M, Persson M, Glaser N, Sartipy U. Sex and permanent pacemaker implantation after surgical aortic valve replacement. Ann Thorac Surg 2021; 114:1621-1627. [PMID: 34648811 DOI: 10.1016/j.athoracsur.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 08/23/2021] [Accepted: 09/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND We performed a nationwide population-based cohort study to investigate sex differences in rate of permanent pacemaker implantation after surgical aortic valve replacement (AVR). METHODS This study included all adult patients who underwent primary AVR in Sweden between 2005 and 2018. Study data were obtained from the SWEDEHEART register and other Swedish national health-data registers. The rate of permanent pacemaker implantation within 30 days of surgery was compared between men and women. We estimated propensity scores that was used for inverse probability of treatment weighting to account for sex differences in patient characteristics. RESULTS A total of 18131 patients were included, 11657(64%) men and 6474(36%) women. The rate of permanent pacemaker implantation did not differ between women and men (3.8% (95% CI, 3.2%-4.3%) vs. 3.7% (95%CI, 3.3%-4.1%);p=0.831). In patients <60 years of age, the rate of permanent pacemaker implantation was significantly higher in women (6.2% (95%CI, 4.3%-8.0%) vs. 3.6% (95%CI, 2.8%-4.4%);p=0.006). The odds of pacemaker implantation in patients <60 years of age was significantly higher in women (odds ratio, 1.76; 95%CI, 1.17-2.63;p=0.006). In patients aged 60-79 years and ≥80 years, the rate of pacemaker implantation did not differ between men and women. CONCLUSIONS The rate of permanent pacemaker implantation after surgical AVR in patients <60 years of age was higher in women than men. The susceptibility to conduction disturbances requiring permanent pacemaker implantation in women below 60 years warrants further investigation and should be recognized as transcatheter aortic valve replacement expands into younger patients.
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Affiliation(s)
- Magnus Dalén
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
| | - Michael Persson
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Natalie Glaser
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Stockholm South General Hospital, Stockholm, Sweden
| | - Ulrik Sartipy
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Ravaux JM, Van Kuijk SMJ, Di Mauro M, Vernooy K, Bidar E, Mariani S, Dato GA, Van′t Hof AW, Veenstra L, Kats S, Houterman S, Maessen JG, Lorusso R. Incidence and predictors of permanent pacemaker implantation after surgical aortic v alve replacement: Data of the Netherlands Heart Registration (NHR). J Card Surg 2021; 36:3519-3527. [PMID: 34250647 PMCID: PMC8518121 DOI: 10.1111/jocs.15803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/19/2021] [Accepted: 06/21/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Permanent pacemaker implantation (PPI) after surgical aortic valve replacement (SAVR) remains a frequent complication. Predictors, however, have been mainly investigated in single-center studies. Therefore, nationwide data were used to identify patients-and procedural risk factors for postoperative PPI. MATERIALS AND METHODS Data were retrospectively collected from the Netherlands Heart Registration (NHR). Patients enrolled in the NHR undergoing isolated SAVR from 2013 to 2019 were analyzed. Primary endpoint was in-hospital PPI during hospitalization after SAVR. RESULTS From the NHR database, 5600 patients with symptomatic aortic valve stenosis were included in the study. Crude incidence of post-SAVR PPI was 4.0%. Backward regression analysis identified previous cardiac surgery (odds ratio [OR]: 1.80; 95% confidence interval [CI]: 1.18-2.76), extra-corporeal circulation time (OR: 1.01; 95% CI: 1.00-1.01), vasopressor use (OR: 2.66; 95% CI: 1.79-3.96) and in-hospital cardiac conduction abnormalities (OR: 4.48; 95% CI: 3.36-5.98) as potential predictors for PPI. Across the time, PPI after SAVR significantly increased (OR: 1.11; 95% CI: 1.03-1.21). CONCLUSIONS From this nationwide analysis, PPI after SAVR remains a low but increasingly frequent complication. Several predictive factors for postoperative PPI after SAVR have been identified and might be useful for patient informed consent about potential adverse event rate.
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Affiliation(s)
- Justine M. Ravaux
- Department of Cardio‐Thoracic Surgery, Heart and Vascular CentreMaastricht University Medical Centre (MUMC)MaastrichtThe Netherlands
| | - Sander MJ Van Kuijk
- Department of Cardio‐Thoracic Surgery, Heart and Vascular CentreMaastricht University Medical Centre (MUMC)MaastrichtThe Netherlands
| | - Michele Di Mauro
- Department of Cardio‐Thoracic Surgery, Heart and Vascular CentreMaastricht University Medical Centre (MUMC)MaastrichtThe Netherlands
| | - Kevin Vernooy
- Department of CardiologyMaastricht University Medical Centre (MUMC)MaastrichtThe Netherlands
- Cardiovascular Research Institute Maastricht (CARIM)Maastricht University Medical CenterMaastrichtThe Netherlands
- Department of CardiologyRadboud University Medical Center (Radboudumc)Nijmegenthe Netherlands
| | - Elham Bidar
- Department of Cardio‐Thoracic Surgery, Heart and Vascular CentreMaastricht University Medical Centre (MUMC)MaastrichtThe Netherlands
| | - Silvia Mariani
- Department of Cardio‐Thoracic Surgery, Heart and Vascular CentreMaastricht University Medical Centre (MUMC)MaastrichtThe Netherlands
| | - Giulia Actis Dato
- Department of Cardio‐Thoracic Surgery, Heart and Vascular CentreMaastricht University Medical Centre (MUMC)MaastrichtThe Netherlands
| | - Arnoud W Van′t Hof
- Department of CardiologyMaastricht University Medical Centre (MUMC)MaastrichtThe Netherlands
- Cardiovascular Research Institute Maastricht (CARIM)Maastricht University Medical CenterMaastrichtThe Netherlands
| | - Leo Veenstra
- Department of CardiologyMaastricht University Medical Centre (MUMC)MaastrichtThe Netherlands
| | - Suzanne Kats
- Department of Cardio‐Thoracic Surgery, Heart and Vascular CentreMaastricht University Medical Centre (MUMC)MaastrichtThe Netherlands
| | | | - Jos G Maessen
- Department of Cardio‐Thoracic Surgery, Heart and Vascular CentreMaastricht University Medical Centre (MUMC)MaastrichtThe Netherlands
- Cardiovascular Research Institute Maastricht (CARIM)Maastricht University Medical CenterMaastrichtThe Netherlands
| | - Roberto Lorusso
- Department of Cardio‐Thoracic Surgery, Heart and Vascular CentreMaastricht University Medical Centre (MUMC)MaastrichtThe Netherlands
- Cardiovascular Research Institute Maastricht (CARIM)Maastricht University Medical CenterMaastrichtThe Netherlands
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24
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Rapetto F, Bruno VD. Commentary: Permanent pacemaker implantation after cardiac surgery: Are we getting distracted by the usual suspects? JTCVS OPEN 2021; 7:167-168. [PMID: 36003699 PMCID: PMC9390154 DOI: 10.1016/j.xjon.2021.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 06/21/2021] [Accepted: 06/29/2021] [Indexed: 11/22/2022]
Affiliation(s)
- Filippo Rapetto
- Address for reprints: Filippo Rapetto, MD, Division of Cardiac Surgery, Bristol Heart Institute, Marlborough St, Bristol BS2 8HW, United Kingdom.
| | - Vito D. Bruno
- Division of Cardiac Surgery, Bristol Heart Institute, Bristol, United Kingdom
- Translational Health Sciences, University of Bristol, Bristol, United Kingdom
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25
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Timek TA. Commentary: If you start me up…I may never stop? JTCVS OPEN 2021; 7:165-166. [PMID: 36003722 PMCID: PMC9390626 DOI: 10.1016/j.xjon.2021.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 07/18/2021] [Accepted: 07/19/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Tomasz A. Timek
- Address for reprints: Tomasz A. Timek, MD, PhD, Division of Cardiothoracic Surgery, Spectrum Health, 100 Michigan Ave NE, Grand Rapids, MI 49503.
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26
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Bianco V, Kilic A, Aranda-Michel E, Serna-Gallegos D, Dunn-Lewis C, Chen S, Thoma F, Navid F, Sultan I. Permanent pacemaker placement following valve surgery is not independently associated with worse outcomes. JTCVS OPEN 2021; 7:157-164. [PMID: 36003744 PMCID: PMC9390660 DOI: 10.1016/j.xjon.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 06/01/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Valentino Bianco
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - Arman Kilic
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Edgar Aranda-Michel
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - Derek Serna-Gallegos
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - Courtenay Dunn-Lewis
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - Shangzhen Chen
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Floyd Thoma
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Forozan Navid
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
- Address for reprints: Ibrahim Sultan, MD, Division of Cardiac Surgery, Department of Cardiothoracic Surgery, Center for Thoracic Aortic Disease, University of Pittsburgh, Heart and Vascular Institute, University of Pittsburgh Medical Center, 5200 Centre Ave, Suite 715, Pittsburgh, PA 15232.
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27
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Glaser N, Persson M, Dalén M, Sartipy U. Long-term Outcomes Associated With Permanent Pacemaker Implantation After Surgical Aortic Valve Replacement. JAMA Netw Open 2021; 4:e2116564. [PMID: 34255050 PMCID: PMC8278270 DOI: 10.1001/jamanetworkopen.2021.16564] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Prior studies investigating the long-term clinical outcomes of patients who have undergone permanent pacemaker implantation after aortic valve replacement reported conflicting results. OBJECTIVE To investigate long-term outcomes after primary surgical aortic valve replacement among patients who underwent postoperative permanent pacemaker implantation. DESIGN, SETTING, AND PARTICIPANTS This cohort study included all patients who underwent surgical aortic valve replacement in Sweden from 1997 to 2018. All patients who underwent primary surgical aortic valve replacement in Sweden and survived the first 30 days after surgical treatment were included. Patients who underwent preoperative permanent pacemaker implantation, concomitant surgical treatment for another valve, or emergency surgical treatment were excluded. Patients who underwent concomitant coronary artery bypass grafting or surgical treatment of the ascending aorta were included. Follow-up data were complete for all patients. Data were analyzed from October through December 2020. EXPOSURES Patients underwent implantation of a permanent pacemaker or implantable cardioverter defibrillator within 30 days after aortic valve replacement. MAIN OUTCOMES AND MEASURES The primary outcome was all-cause mortality. RESULTS Among 24 983 patients who underwent surgical aortic valve replacement, 849 patients (3.4%) underwent permanent pacemaker implantation within 30 days after surgical treatment and 24 134 patients (96.6%) did not receive pacemakers in that time. The mean (SD) age of the total study population was 69.7 (10.8) years, and 9209 patients were women (36.9%). The mean (SD) and maximum follow-up periods were 7.3 (5.0) years and 22.0 years, respectively. At 10 years and 20 years after surgical treatment, the Kaplan-Meier estimated survival rates were 52.8% and 18.0% in the pacemaker group, respectively, and 57.5% and 19.6% in the nonpacemaker group, respectively. All-cause mortality was statistically significantly increased in the pacemaker group compared with the nonpacemaker group (hazard ratio [HR], 1.14; 95% CI, 1.01-1.29; P = .03), and so was risk of heart failure hospitalization (HR, 1.58; 95% CI, 1.31-1.89; P < .001). No statistically significant increase was found in the risk of endocarditis in the pacemaker group. CONCLUSIONS AND RELEVANCE This study found that there were increased risks of all-cause mortality and heart failure hospitalization among patients who underwent permanent pacemaker implantation after surgical aortic valve replacement, suggesting that these risks are important considerations, especially in an era when transcatheter aortic valve replacement is used in younger patients at lower risk of adverse surgical outcomes. These findings further suggest that future research should investigate how to avoid permanent pacemaker dependency after surgical and transcatheter aortic valve replacement.
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Affiliation(s)
- Natalie Glaser
- Department of Cardiology, Stockholm South General Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Michael Persson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Dalén
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Ulrik Sartipy
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
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28
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Chi MC, Hung KC, Chang SH, Wu VCC, Chou AH, Chan YH, Lin CP, Chang CH, Chu PH, Chen SW. Effect of Permanent Pacemaker Implantation After Valve Surgery on Long-Term Outcomes. Circ J 2021; 85:1027-1034. [PMID: 33746153 DOI: 10.1253/circj.cj-20-0905] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Patients are prone to permanent pacemaker implantation (PPM) after valve surgery, yet current data on the effects of postoperative PPM are scarce and large-scale studies are lacking. The aim of this study was to determine rates and long-term outcomes of PPM after cardiac valve surgery. METHODS AND RESULTS A total of 24,014 patients who received valve surgery from 2000 to 2013 were identified from the Taiwan National Health Insurance Research Database. The number of valve surgeries and the proportion of PPM implantations after valve surgery increased (P<0.001). After 1 : 5 propensity score matching, 602 and 3,010 patients were categorized to the PPM and non-PPM groups, respectively. Late outcomes included all-cause mortality, cardiovascular death, sepsis, and readmission due to any cause. The mean follow up was 4.3 years. PPM was associated with a higher all-cause mortality rate (33.6% vs. 29.8%; hazard ratio [HR], 1.14; 95% confidence interval [CI], 0.98-1.32), though not significant at the threshold of P<0.05. PPM was also associated with higher all-cause mortality rates in subgroups that received mitral valve (MV) replacement surgery, combined aortic valve replacement (AVR) with MV surgeries, and combined AVR with tricuspid valve surgeries. CONCLUSIONS The PPM rate after valve surgery is increasing, and is associated with short-term adverse effects. Patients with PPM may have a higher long-term mortality rate.
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Affiliation(s)
- Mu-Chieh Chi
- Department of Medicine, Chang Gung University
- Chang Gung Memorial Hospital, Linkou Medical Center Shin Kong Wu Ho-Su Memorial Hospital
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University
| | - Kuo-Chun Hung
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memory Hospital, Linkou Branch, Chang Gung University College of Medicine
| | - Shang-Hung Chang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memory Hospital, Linkou Branch, Chang Gung University College of Medicine
| | - Victor Chien-Chia Wu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memory Hospital, Linkou Branch, Chang Gung University College of Medicine
| | - An-Hsun Chou
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University
| | - Yi-Hsin Chan
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memory Hospital, Linkou Branch, Chang Gung University College of Medicine
| | - Chia-Pin Lin
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memory Hospital, Linkou Branch, Chang Gung University College of Medicine
| | - Chih-Hsiang Chang
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, College of Medicine, Chang Gung University
| | - Pao-Hsien Chu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memory Hospital, Linkou Branch, Chang Gung University College of Medicine
| | - Shao-Wei Chen
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, College of Medicine, Chang Gung University
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29
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Tanaka D, Tam DY, Fremes SE. Commentary: Rapid Deployment Does Not Necessarily Warrant Rapid Adoption. Semin Thorac Cardiovasc Surg 2021; 34:462-464. [PMID: 34089823 DOI: 10.1053/j.semtcvs.2021.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 05/27/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Dustin Tanaka
- Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Derrick Y Tam
- Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Stephen E Fremes
- Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
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30
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Tanaka D, Nedadur R, Yanagawa B. Rapid deployment valves: Another tool in the toolbox. J Card Surg 2021; 36:2834-2835. [PMID: 34060136 DOI: 10.1111/jocs.15668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 05/15/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Dustin Tanaka
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Rashmi Nedadur
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Bobby Yanagawa
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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31
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Navaratnarajah M, Luthra S, Ohri S. Transcatheter aortic valve implantation in low-risk patients: A case of rational over exuberance. The time is not now. Asian Cardiovasc Thorac Ann 2021; 29:836-847. [PMID: 34034507 DOI: 10.1177/02184923211018589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Review of evidence and concerns, relating to extension of transcatheter aortic valve implantation usage to low-risk patients. METHODS Comprehensive literature review was conducted identifying articles relating to transcatheter aortic valve implantation. RESULTS Transcatheter aortic valve implantation is effective in patients with aortic stenosis. Currently, long-term durability and cost-effectiveness are unproven, anticoagulation requirement undefined, permanent pacemaker implantation and paravalvular leak rates higher than following surgical aortic valve replacement. CONCLUSIONS Current evidence supporting transcatheter aortic valve implantation usage in low-risk patients is insufficient. Extending use now, to this large young patient population is premature, and should be delayed.
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Affiliation(s)
| | - Suvitesh Luthra
- Department of Cardiac Surgery, Southampton University Hospital, Southampton, UK
| | - Sunil Ohri
- Department of Cardiac Surgery, Southampton University Hospital, Southampton, UK
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Shah B, Amir Niaz M, Saidullah S, Zaman F, Mumtaz H, Ghazanfar A. Innovation in Permanent Pacemaker's Implantation Technique: Trans-Axillary Approach. Cureus 2021; 13:e14436. [PMID: 33996301 PMCID: PMC8115185 DOI: 10.7759/cureus.14436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Permanent pacemakers' (PPM) implantation is an integral part of electrophysiology and general cardiology. The implantation technique has evolved a lot since the first implantation. Several innovations have been undertaken to improve the effectiveness, life of the transplant, and patient outcomes. In this study, we introduced a new implantation technique to improve the procedure and possibly reduce the rate of complication. METHODS This study was conducted from January 2016 to February 2017 in Hayatabad Medical Complex, Peshawar. Patients destined for implantation of PPM based on a clinical treatment plan, after proper explanation of the procedure, were brought to the catheterization laboratory. Venogram of the upper limb performed. Patients were scrubbed and draped. The axillary vein was approached via the Seldinger technique. About 2 to 3 cm superolateral to the puncture site, a skin incision was made and subcutaneous pocket constructed, and a guidewire external end was pulled in from inside the pocket keeping the venous end at the place. Subsequently, in a routine way, lead was placed, secured and the wound was closed in layers. RESULTS A total of 690 PPM were implanted under the study. About 290 devices were implanted in the conventional way and 380 devices via the trans-axillary approach. The mean implantation time was less than 30 minutes via the trans-axillary approach. Immediate and delayed complications of the procedure were minimal. CONCLUSION Trans-axillary approach holds some significant advantages over the conventional technique. The subcutaneous pocket and venous puncture successfully reduce the burden of foreign material, minimize the tension on the wound, shorten implantation time and reduce the chances of erosion of the device.
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Affiliation(s)
- Bakhtawar Shah
- Division of Clinical Cardiac Electrophysiology, Department of Cardiology, Hayatabad Medical Complex, Peshawar, PAK
| | | | - Shahab Saidullah
- Clinical Cardiac Electrophysiology, Pakistan Instituite of Medical Sciences, Islamabad, PAK
| | - Farrukh Zaman
- Diabetes and Endocrinology, Kahutta Research Laboratory (KRL) Hospital, Islamabad, PAK
| | - Hassan Mumtaz
- Urology, Guys and St Thomas Hospital, London, GBR
- General Medicine, Surrey Docks Health Center, London, GBR
- Surgery, Kahutta Research Laboratory (KRL) Hospital, Islamabad, PAK
| | - Aamir Ghazanfar
- Vascular Surgery, Kahutta Research Laboratory (KRL) Hospital, Islamabad, PAK
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Choi JW, Kim HJ, Kim JB, Lee S, Lim C, Chang BC, Suh Y, Lee NR, Hwang HY. Early and Two-year Outcomes after Sutureless and Conventional Aortic Valve Replacement: a Nationwide Population-based Study. J Korean Med Sci 2021; 36:e57. [PMID: 33686809 PMCID: PMC7940122 DOI: 10.3346/jkms.2021.36.e57] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 12/20/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND We compared early and 2-year clinical outcomes of sutureless aortic valve replacement (SAVR) with conventional aortic valve replacement (CAVR) in a nationwide study based on claims data. METHODS From December 2016 to November 2018, 3,173 patients underwent bioprosthetic aortic valve replacements. SAVR and CAVR were performed in 641 and 2,532 patients, respectively. Propensity score-matched analysis was performed in 640 patient pairs. RESULTS Operative mortality rate was 2.8% without significant differences between the SAVR (3.4%) and CAVR (2.3%) groups (P = 0.324). There were no significant differences in postoperative morbidities between the groups except for permanent pacemaker (PPM) implantation. PPM implantation rate was significantly higher in the SAVR (3.8%) than in the CAVR group (0.9%) (P < 0.001). One- and two-year overall survival was 89.1% and 87.5%, respectively, without significant differences between the groups (SAVR group vs. CAVR grouP = 89.9% and 90.5% vs. 87.2% and 88.7%, respectively; P = 0.475). There were no significant differences in the cumulative incidence of cardiac death, stroke, aortic valve reoperation and infective endocarditis between the groups. Cumulative PPM implantation incidence at 6 months in the CAVR was 1.1%, and no patient required PPM implantation after 6 months. In the SAVR, the cumulative PPM implantation incidence at 0.5, one, and two years was 3.9%, 5.0% and 5.6%, respectively. The cumulative PPM implantation rate was higher in the SAVR group than in the CAVR group (P < 0.001). CONCLUSION Early and 2-year clinical outcomes between SAVR and CAVR were not different except for a high rate of permanent pacemaker implantation in the SAVR group.
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Affiliation(s)
- Jae Woong Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ho Jin Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sak Lee
- Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Seoul, Korea
| | - Cheong Lim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Byung Chul Chang
- Department of Thoracic and Cardiovascular Surgery, CHA Bundang Medical Center, Seongnam, Korea
| | - Youshin Suh
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Na Rae Lee
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea.
| | - Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
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Beller JP, Tyerman Z, Mehaffey JH, Hawkins RB, Charles EJ, Yarboro LT, Teman NR, Wancheck T, Ailawadi G, Mehta NK. Early Versus Delayed Pacemaker for Heart Block After Valve Surgery: A Cost-Effectiveness Analysis. J Surg Res 2021; 259:154-162. [PMID: 33279841 PMCID: PMC7897291 DOI: 10.1016/j.jss.2020.11.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND A significant percentage of patients who acutely develop high-grade atrioventricular block after valve surgery will ultimately recover, yet the ability to predict recovery is limited. The purpose of this analysis was to evaluate the cost-effectiveness of two different management strategies for the timing of permanent pacemaker implantation for new heart block after valve surgery. METHODS A cost-effectiveness model was developed using costs and probabilities of short- and long-term complications of pacemaker placement, short-term atrioventricular node recovery, intensive care unit stays, and long-term follow-up. We aggregated the total expected cost and utility of each option over a 20-y period. Quality-adjusted survival with a pacemaker was estimated from the literature and institutional patient-reported outcomes. Primary decision analysis was based on an expected recovery rate of 36.7% at 12 d with timing of pacemaker implantation: early placement (5 d) versus watchful waiting for 12 d. RESULTS A strategy of watchful waiting was more costly ($171,798 ± $45,695 versus $165,436 ± $52,923; P < 0.0001) but had a higher utility (9.05 ± 1.36 versus 8.55 ± 1.33 quality-adjusted life years; P < 0.0001) than an early pacemaker implantation strategy. The incremental cost-effectiveness ratio of watchful waiting was $12,724 per quality-adjusted life year. The results are sensitive to differences in quality-adjusted survival and rates of recovery of atrioventricular node function. CONCLUSIONS Watchful waiting for pacemaker insertion is a cost-effective management strategy compared with early placement for acute atrioventricular block after valve surgery. Although this is cost-effective from a population perspective, clinical risk scores predicting recovery will aid in personalized decision-making.
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Affiliation(s)
- Jared P Beller
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia.
| | - Zachary Tyerman
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - J Hunter Mehaffey
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Robert B Hawkins
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Eric J Charles
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Leora T Yarboro
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Nicholas R Teman
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Tanya Wancheck
- Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Gorav Ailawadi
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Nishaki K Mehta
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, Charlottesville, Virginia
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Kunioka S, Fujita K, Iwasa S, Kamiya H, Yamazaki K, Tsukui H. Non-pledget commissural suture technique to avoid atrioventricular block. Gen Thorac Cardiovasc Surg 2021; 69:906-908. [PMID: 33608837 DOI: 10.1007/s11748-021-01605-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/06/2020] [Indexed: 11/28/2022]
Abstract
Here, we report our unique "non-pledget commissural suture technique" to avoid complete atrioventricular block during surgical aortic valve replacement, whereby all commissural stiches are made in a figure-of-eight fashion without a pledget. Then, standard stiches in a non-everting fashion are made using pledget sutures and a prosthetic valve is implanted at the supra-annular position. Among 152 evaluated patients, only five patients experienced complications, including three left bundle branch blocks, one postoperative pacemaker implantation, and one moderate paravalvular leak. Based on the high success rate, our technique may be a reasonable alternative for surgical aortic valve replacement.
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Affiliation(s)
- Shingo Kunioka
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa, 078-8510, Japan.
| | - Kishu Fujita
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa, 078-8510, Japan
| | - Shizuko Iwasa
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa, 078-8510, Japan
| | - Hiroyuki Kamiya
- Department of Cardiac Surgery, Asahikawa Medical University, Hokkaido, Japan
| | - Kenji Yamazaki
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa, 078-8510, Japan
| | - Hiroyuki Tsukui
- Department of Cardiothoracic Surgery, Excela Health Westmoreland Hospital, Greensburg, PA, USA
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Ailawadi G. Time for a More Sophisticated Approach for Young Aortic Stenosis Patients. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:22-23. [PMID: 33522845 DOI: 10.1177/1556984521991529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Gorav Ailawadi
- 21614 Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
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Schaefer A, Schofer N, Goßling A, Seiffert M, Schirmer J, Deuschl F, Schneeberger Y, Voigtländer L, Detter C, Schaefer U, Blankenberg S, Reichenspurner H, Conradi L, Westermann D. Transcatheter aortic valve implantation versus surgical aortic valve replacement in low-risk patients: a propensity score-matched analysis. Eur J Cardiothorac Surg 2020; 56:1131-1139. [PMID: 31566209 DOI: 10.1093/ejcts/ezz245] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/07/2019] [Accepted: 08/14/2019] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES The aim of the study was to determine the differences in outcomes of surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) in low-risk patients. METHODS All patients with a logistic EuroSCORE II <4% who underwent transfemoral TAVI between 2008 and 2016 (n = 955) or SAVR between 2009 and 2014 (n = 886) at our centre were included. One hundred and nine patients per group were available for propensity score matching. RESULTS Mortality during the 30-day follow-up showed no differences (SAVR vs TAVI: 1.1% vs 1.8%, P = 1.0) but the rates of permanent pacemaker implantation (0.0 vs 14.8%, P < 0.001) and paravalvular leakage ≥ moderate (0.0 vs 7.0%, P = 0.017) were higher in TAVI patients. No difference was found regarding postoperative effective orifice area and transvalvular pressure gradients. Although, the 1-year survival was similar between both groups; 3- and 5-year survival was significantly inferior in the TAVI patient cohort. CONCLUSIONS TAVI yielded similar short-term outcomes compared with SAVR despite higher rates of permanent pacemaker implantation and paravalvular leakage ≥ moderate, but inferior long-term survival. Poorer long-term outcomes of the TAVI patient cohort were attributable to a more comorbid TAVI population. This emphasizes the need for long-term results from randomized controlled trials before TAVI can be broadly expanded to younger low-risk patients.
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Affiliation(s)
- Andreas Schaefer
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Niklas Schofer
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Alina Goßling
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Moritz Seiffert
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Johannes Schirmer
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Florian Deuschl
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Yvonne Schneeberger
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Lisa Voigtländer
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Christian Detter
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Ulrich Schaefer
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | | | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Dirk Westermann
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
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Reich H, Ramzy D. Sutureless and Rapid Deployment Valves: How Many Years of Survival is an 18-minute Reduction in Cross-Clamp Time Worth? Ann Thorac Surg 2020; 111:1891-1892. [PMID: 33188756 DOI: 10.1016/j.athoracsur.2020.08.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/13/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Heidi Reich
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Danny Ramzy
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, 127S San Vicente Blvd, Ste A3105, Los Angeles, CA 90048.
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39
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Muneretto C, Di Bacco L. Reply: The truth lies: Transcatheter aortic valve implantation trials on patients at intermediate risk. J Thorac Cardiovasc Surg 2020; 163:e240-e241. [PMID: 33277037 DOI: 10.1016/j.jtcvs.2020.10.049] [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: 09/17/2020] [Revised: 09/17/2020] [Accepted: 10/06/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Claudio Muneretto
- Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy
| | - Lorenzo Di Bacco
- Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy
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Flynn CD, Williams ML, Chakos A, Hirst L, Muston B, Tian DH. Sutureless valve and rapid deployment valves: a systematic review and meta-analysis of comparative studies. Ann Cardiothorac Surg 2020; 9:364-374. [PMID: 33102175 DOI: 10.21037/acs-2020-surd-27] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background The treatment of aortic valve disease is the most common valvular surgery in industrialized nations, with 3-9% of the population over the age of eighty having at least moderate aortic stenosis. As transcatheter aortic valve replacement (TAVR) has become more established, newer surgical prostheses have been developed with a variety of anchoring systems that do not rely solely on sutures to hold the valve in an appropriate position. The Edwards Intuity valve is a bovine pericardial prosthesis that is modelled on the widely implanted Perimount MagnaEase aortic prosthesis. The Perceval valve is a bovine pericardial valve attached to a self-expanding nitinol stent, which uses the radial force exerted on the patient's aortic annulus and aortic root by the stent portion to hold the valve in position. This meta-analysis compares the outcomes of comparative studies of these two valve systems. Methods This systematic review and meta-analysis compares the outcomes of rapid deployment valves (RDV) and sutureless valves (SURD) and was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations and guidance. The search strategy interrogated six electronic databases. Outcomes measured included all-cause mortality at latest follow up, stroke, cross-clamp and cardiopulmonary bypass (CPB) times, pacemaker implantation rates, paravalvular leak and post-operative transvalvular gradient. Results The search strategy identified 407 unique papers for initial assessment with seven studies qualifying for inclusion in the analysis. The outcomes of 4,076 patients (1,650 RDV, 2,426 SURD) were included. There was no difference in mortality, stroke or moderate or worse paravalvular regurgitation between the two groups. SURD had significantly shorter CPB time by 15.7 minutes [95% confidence interval (CI): 4.2-27.1; P=0.007] and a shorter cross-clamp time by 11.3 minutes (95% CI: 6.3-16.3; P<0.001) compared to RDV. RDV had a lower post-operative transvalvular gradient by 2.5 mmHg (95% CI: 1.2-3.8; P<0.001) and a lower rate of mild paravalvular regurgitation (OR 2.51; 95% CI: 1.435-4.768; P=0.004). Conclusions Both valve types have an adequate safety profile and are comparable to conventional sutured prostheses. There was a significant reduction in cross-clamp and CPB times associated with SURD. This may be of benefit for patients requiring multiple concomitant procedures and increases the utility of minimally invasive valve replacement. However, SURD was associated with higher post-operative transvalvular gradients and a higher incidence of paravalvular regurgitation.
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Affiliation(s)
- Campbell D Flynn
- Department of Cardiothoracic Surgery, Epworth Hospital, Richmond, Melbourne, Australia.,The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Michael L Williams
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.,Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia.,The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia.,University of Sydney, Sydney, Australia
| | - Adam Chakos
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Lucy Hirst
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Benjamin Muston
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - David H Tian
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.,Department of Anaesthesia and Perioperative Medicine, Westmead Hospital, Sydney, Australia.,Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
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Biancari F, Pykäri J, Savontaus M, Laine M, Husso A, Virtanen M, Maaranen P, Niemelä M, Mäkikallio T, Tauriainen T, Eskola M, Raivio P, Valtola A, Juvonen T, Airaksinen J. Early and late pace-maker implantation after transcatheter and surgical aortic valve replacement. Catheter Cardiovasc Interv 2020; 97:E560-E568. [PMID: 32767643 DOI: 10.1002/ccd.29177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/06/2020] [Accepted: 07/19/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Conduction defects requiring permanent pacemaker (PPM) implantation are frequent complications occurring after surgical (SAVR) and transcatheter aortic valve replacement (TAVR). METHODS Patients who underwent TAVR or SAVR with a bioprosthesis from the nationwide FinnValve registry were the subjects of this study. Patients with prior PPM, who received a sutureless prosthesis, or required cardiac resynchronization therapy or implantable cardioverter defibrillator were excluded from this analysis. RESULTS Four thousand and ten patients underwent SAVR and 1,897 underwent TAVR. TAVR had an increased risk of PPM implantation at 30-day (10.1% vs. 3.5%, unadjusted OR 3.11, 95%CI 2.56-3.87) and 5-year (15.7% vs. 8.6%, unadjusted SHR, 2.12, 95%CI 1.81-2.48) compared to SAVR. PPM implantation within 30 days from the index procedure did not increase the risk of 5-year mortality after either SAVR or TAVR. Among 1,042 propensity score matched pairs, TAVR had an increased risk of PPM implantation at 30-day (9.9% vs. 4.7%, p < .0001) and 5-year (14.7% vs. 11.4%, p = .001), but late (>30 days) PPM implantation at 5-year (4.7% vs. 6.9% SHR 0.72, 95%CI 0.47-1.10) was comparable to SAVR. The types of prosthesis had an impact on 30-day PPM implantation after TAVR, but not on late (>30 days) PPM implantation. CONCLUSIONS Although the risk of 30-day PPM implantation is higher after TAVR compared to SAVR, late (>30 days) PPM implantation was comparable with these treatment methods. PPM implantation within 30 days did not affect late survival.
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Affiliation(s)
- Fausto Biancari
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.,Heart Center, Turku University Hospital, and University of Turku, Turku, Finland.,Research Unit of Surgery, Anesthesiology and Critical Care, University of Oulu, Oulu, Finland
| | - Jouni Pykäri
- Heart Center, Turku University Hospital, and University of Turku, Turku, Finland
| | - Mikko Savontaus
- Heart Center, Turku University Hospital, and University of Turku, Turku, Finland
| | - Mika Laine
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | | | - Marko Virtanen
- Heart Hospital, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Pasi Maaranen
- Heart Hospital, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Matti Niemelä
- Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
| | - Timo Mäkikallio
- Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
| | - Tuomas Tauriainen
- Research Unit of Surgery, Anesthesiology and Critical Care, University of Oulu, Oulu, Finland
| | - Markku Eskola
- Heart Hospital, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Peter Raivio
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Antti Valtola
- Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Tatu Juvonen
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.,Research Unit of Surgery, Anesthesiology and Critical Care, University of Oulu, Oulu, Finland
| | - Juhani Airaksinen
- Heart Center, Turku University Hospital, and University of Turku, Turku, Finland
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Andersson C, Schou M, Gislason GH, Køber L, Torp-Pedersen C, Monahan KM. Long-term risk of heart failure and mortality following mitral valve surgery in patients with and without right ventricular pacemaker. J Card Surg 2020; 35:2598-2604. [PMID: 32652752 DOI: 10.1111/jocs.14847] [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: 11/26/2022]
Abstract
OBJECTIVES Patients undergoing mitral valve surgery are at risk of developing postoperative conduction blocks and have a high incidence of heart failure (HF). Mitral valve surgery often results in reduced left ventricular systolic ejection fraction following surgery and the imposition of dyssynchrony with right ventricular (RV) pacing may further compromise stroke volume. Our aim was to investigate the risks of HF and mortality in patients with vs without RV pacemaker placement (PPM) after mitral valve surgery. METHODS Using Danish nationwide databases, we identified all patients undergoing mitral valve repair or replacement surgery between 1997 and 2017, who were free from HF at baseline. The association of PPM implanted within 30 days following surgery with long-term risks of HF and mortality was investigated by multivariable Cox regression models. RESULTS Of 4072 patients (33% female), 248 (6%) had a PPM implanted at 30-day postsurgery. Patients with PPM were older (68 vs 63 years), had a higher prevalence of concomitant aortic valve surgery (15% vs 11%), ischemic heart disease (13% vs 8%), and atrial fibrillation (19% vs 12%), compared with patients without PPM. Over a median follow-up of 5 years, 68 (27%) vs 825 (22%) patients with vs without PPM developed HF and 74 (30%) vs 1018 (27%) died. In multivariable-adjusted models, the hazard ratios associated with PPM were 1.00 (0.78-1.30), P = .93 for HF, and .96 (0.76-1.21), P = .72 for mortality. CONCLUSIONS Postoperative implantation of a permanent RV pacemaker does not alter the long-term risks of HF and mortality following mitral valve surgery.
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Affiliation(s)
- Charlotte Andersson
- Department of Medicine, Section of Cardiovascular Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.,Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University, Gentofte, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University, Gentofte, Denmark
| | - Gunnar H Gislason
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen University, Gentofte, Denmark.,The Danish Heart Foundation, Copenhagen, Denmark
| | - Lars Køber
- The Heart Center, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Clinical Investigation and Cardiology, Nordsjaellands Hospital, Hillerød, Denmark
| | - Kevin M Monahan
- Department of Medicine, Section of Cardiovascular Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
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Luthra S, Leiva-Juárez MM, Ohri SK. Surgical vs transfemoral aortic valve replacement in low-risk patients: An updated meta-analysis of trial and registry data. J Card Surg 2020; 35:2264-2274. [PMID: 32652702 DOI: 10.1111/jocs.14802] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Transfemoral aortic valve replacement (TAVR) has been studied extensively in patients with improving safety and efficacy in high to intermediate-risk patients with aortic stenosis. TAVR has been now approved for patients with low surgical risk. OBJECTIVE The purpose of this study is to integrate the evidence from randomized controlled trials (RCT) and large registry data comparing TAVR to surgical aortic valve repair (SAVR). METHODS Seven studies (three RCTs, one post hoc study of a RCT, and three registries) were included. Incidence rate ratios (IRR) of outcomes of interest (overall mortality, 30-day mortality, cardiovascular death, stroke, pacemaker implantation [PPMI], myocardial infarction, moderate-severe paravalvular leak [PVL], and re-intervention) were compared using a random-effects model. RESULTS The pooled analysis included 24 819 patients (TAVR, 8227 and SAVR, 16 592). 2,952 (11.9%) patients were from RCTs and 21 867 (88.1%) were registry patients. Thirty-day mortality was lower in TAVR (logIRR, -0.43; 95% CI. -0.61 to -0.25; P < .001), whereas the rate of moderate-severe PVL (logIRR, 1.44; 95% CI, 0.58-2.3; P < .001) and PPMI (logIRR, 1.13; 95% CI, 1.02-1.24; P < .001) were higher. There were no significant differences in the rates of overall mortality, reintervention, cardiovascular death, myocardial infarction, or stroke between SAVR and TAVR. CONCLUSIONS Early mortality is higher in SAVR while rates of PVL and PPMI are substantially higher in TAVR. There is no significant advantage with TAVR for overall survival, cardiovascular death, stroke, MI, and re-intervention rates.
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Affiliation(s)
- Suvitesh Luthra
- Wessex Cardiothoracic Centre, Southampton University Hospitals NHS Trust, Southampton, UK
| | - Miguel M Leiva-Juárez
- Department of Surgery, Brookdale University Hospital and Medical Center, Brooklyn, New York
| | - Sunil K Ohri
- Wessex Cardiothoracic Centre, Southampton University Hospitals NHS Trust, Southampton, UK
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Seo J, Kim DY, Cho I, Hong GR, Ha JW, Shim CY. Prevalence, predictors, and prognosis of tricuspid regurgitation following permanent pacemaker implantation. PLoS One 2020; 15:e0235230. [PMID: 32589674 PMCID: PMC7319337 DOI: 10.1371/journal.pone.0235230] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/10/2020] [Indexed: 01/08/2023] Open
Abstract
This study aimed to investigate the prevalence and clinical significance of lead-related tricuspid regurgitation (TR) in patients with permanent pacemaker (PM). A total of 2,533 patients who underwent permanent PM implantation between January 2008 and December 2017 in a single center were retrospectively reviewed. Among them, 429 patients who underwent transthoracic echocardiography within 90 days before implantation and were followed up at least 3 months after PM implantation were included. Patients who had pre-existing grade 3 or 4 TR, had a single atrial lead, or had undergone tricuspid valve surgery before PM implantation were excluded. Occurrence of PM-related TR (PMTR) was defined as worsening of TR by at least 2 grades on follow-up echocardiography. Cardiovascular outcomes were defined as the composite of cardiovascular death and hospitalization for heart failure. During the median follow-up of 855 days, 42 (9.8%) patients had PMTR and 86 (20.0%) presented with cardiovascular outcomes. In the multivariate logistic regression analysis, the presence of atrial fibrillation (hazard ratio [HR]: 2.07, 95% confidence interval [CI]: 1.27–4.09, p = 0.037]) and history of open-heart surgery (HR: 3.34, 95% CI: 1.68–6.68, p<0.001) were independently associated with PMTR. Patients with PMTR showed significantly higher cardiovascular events than those without (45.2 vs. 17.3%, log-rank p<0.001). Furthermore, PMTR was independently associated with the primary outcome (HR: 2.45, 95% CI: 1.43–4.22, p = 0.001). In conclusion, the occurrence of TR in patients with permanent PM is not uncommon. PMTR is associated with atrial fibrillation, the history of open-heart surgery, and poorer cardiovascular outcomes.
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Affiliation(s)
- Jiwon Seo
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Dae-Young Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Iksung Cho
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Geu-Ru Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Jong-Won Ha
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Chi Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
- * E-mail:
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Jiménez-García R, Perez-Farinos N, Miguel-Díez JD, Hernández-Barrera V, Méndez-Bailón M, Jimenez-Trujillo I, Miguel-Yanes JMD, López-de-Andrés A. National Trends in Utilization and In-Hospital Outcomes of Surgical Aortic Valve Replacements in Spain, 2001-2015. Braz J Cardiovasc Surg 2020; 35:65-74. [PMID: 32270962 PMCID: PMC7089743 DOI: 10.21470/1678-9741-2019-0181] [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] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The aims of this study were to examine the incidence and in-hospital outcomes of surgical aortic valve replacement (SAVR) and to identify factors associated with in-hospital mortality (IHM) among patients according to the type of implanted valve used in SAVR. METHODS We performed a retrospective study using the Spanish National Hospital Discharge Database, 2001-2015. We included patients who had SAVR listed as a procedure in their discharge report. RESULTS We identified 86,578 patients who underwent SAVR (52.78% mechanical and 47.22% bioprosthetic). Incidence of SAVR coding increased significantly from 11.95 cases per 100,000 inhabitants in 2001 to 17.92 in 2015 (P<0.001). Age and comorbidities increased over time (P<0.001). There was a significant increase in the frequency of concomitant coronary artery bypass grafting (CABG) and in the use of pacemaker implantation. The use of mechanical SAVR decreased and the use of bioprosthetic valves increased over time. IHM decreased over time (from 8.13% in 2001-05 to 5.39% in 2011-15). Patients who underwent mechanical SAVR had higher IHM than those who underwent bioprosthetic SAVR (7.44% vs. 6%; P<0.05). Higher IHM rates were associated with advanced age, female sex, comorbidities, concomitant CABG, and the use of mechanical SAVR (OR 1.67; 95% CI 1.57-1.77). CONCLUSION The number of SAVRs performed in Spain has increased since 2001. The use of mechanical SAVR has decreased and the use of bioprosthetic valves has increased over time. IHM has decreased over time for both types of valves and despite a concomitant increase in age and comorbidities of patients during the same period.
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Affiliation(s)
- Rodrigo Jiménez-García
- Rey Juan Carlos University Health Sciences Faculty Preventive Medicine and Public Health Teaching and Research Unit Madrid Spain Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain
| | - Napoleón Perez-Farinos
- Universidad de Málaga Faculty of Medicine Department of Public Health and Psychiatry Andalucía Spain Department of Public Health and Psychiatry, Faculty of Medicine, Universidad de Málaga, Andalucía, Spain
| | - Javier de Miguel-Díez
- Universidad Complutense de Madrid Hospital General Universitario Gregorio Marañón Respiratory Department Madrid Spain Respiratory Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Valentín Hernández-Barrera
- Rey Juan Carlos University Health Sciences Faculty Preventive Medicine and Public Health Teaching and Research Unit Madrid Spain Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain
| | - Manuel Méndez-Bailón
- Universidad Complutense de Madrid Hospital Universitario Clínico San Carlos Internal Medicine Department Madrid Spain Internal Medicine Department, Hospital Universitario Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Isabel Jimenez-Trujillo
- Rey Juan Carlos University Health Sciences Faculty Preventive Medicine and Public Health Teaching and Research Unit Madrid Spain Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain
| | - José M de Miguel-Yanes
- Hospital General Gregorio Marañon Internal Medicine Department Madrid Spain Internal Medicine Department, Hospital General Gregorio Marañon, Madrid, Spain
| | - Ana López-de-Andrés
- Rey Juan Carlos University Health Sciences Faculty Preventive Medicine and Public Health Teaching and Research Unit Madrid Spain Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain
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Viktorsson SA, Orrason AW, Vidisson KO, Gunnarsdottir AG, Johnsen A, Helgason D, Arnar DO, Geirsson A, Gudbjartsson T. Immediate and long-term need for permanent cardiac pacing following aortic valve replacement. SCAND CARDIOVASC J 2019; 54:186-191. [PMID: 31809597 DOI: 10.1080/14017431.2019.1698761] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Introduction: Atrioventricular (AV) node conduction disturbances are common following surgical aortic valve replacement (SAVR), and in some cases the patient needs a permanent pacemaker (PPM) implantation before discharge from hospital. Little is known about the long-term need for PPM and the PPM dependency of these individuals. We determined the incidence of PPM implantation before and after discharge in SAVR patients. Methods: We studied 557 consecutive patients who underwent SAVR for aortic stenosis in Iceland between 2002 and 2016. Timing and indication for PPM were registered, with a new concept, ventricular pacing proportion (VPP), defined as ventricular pacing ≥90% of the time, being used to approximate pacemaker dependency. The median follow-up time was 73 months. We plotted the cumulative incidence of pacemaker implantation, treating death as a competing risk. Results: Of the 557 patients, 22 (3.9%) received PPM in the first 30 days after surgery, most commonly for complete AV block (n = 14) or symptomatic bradycardia (n = 8); Thirty-eight other patients (6.8%) had a PPM implanted >30 days postoperatively, at a median of 43 months after surgery (range 0‒181), most often for AV block (n = 13) or sick-sinus syndrome (n = 10). The cumulative incidence of PPM implantation at 1, 5, and 10 years postoperatively was 5.0%, 9.2%, and 12.3%, respectively. During follow-up, 45.0% of the 60 patients had VPP ≥90%. Conclusion: The cumulative incidence of permanent pacemaker implantation following SAVR was about 12% at 10 years, with every other patient having VPP ≥90% during follow-up. This suggests that AV node conduction disturbances extend significantly beyond the perioperative period.
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Affiliation(s)
- Sindri A Viktorsson
- Division of Cardiothoracic Surgery, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland
| | - Andri W Orrason
- Division of Cardiothoracic Surgery, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland
| | - Kristjan O Vidisson
- Division of Cardiothoracic Surgery, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland
| | - Anna G Gunnarsdottir
- Division of Cardiothoracic Surgery, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland
| | - Arni Johnsen
- Division of Cardiothoracic Surgery, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland
| | - Dadi Helgason
- Internal Medicine Services, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland
| | - David O Arnar
- Division of Cardiology, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland
| | - Arnar Geirsson
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Tomas Gudbjartsson
- Division of Cardiothoracic Surgery, Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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Avoiding Pacemakers and Parallax. J Am Coll Cardiol 2019; 74:2621-2622. [PMID: 31753205 DOI: 10.1016/j.jacc.2019.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 10/16/2019] [Indexed: 11/23/2022]
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Rawasia WF, Usman MS, Mujeeb FA, Zafar M, Khan SU, Alkhouli M. Transcatheter Versus Surgical Aortic Valve Replacement in Low-Surgical-Risk Patients: A Meta-Analysis of Randomized-Controlled Trials and Propensity-Matched Studies. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:612-618. [PMID: 31672536 DOI: 10.1016/j.carrev.2019.09.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/27/2019] [Accepted: 09/13/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND We performed a meta-analysis of randomized trials (RCT) and propensity-matched (PSM) studies comparing transcatheter aortic valve implantation (TAVI) with surgical aortic valve replacement (SAVR) in low surgical risk patients. METHODS Published studies including low-risk patients who underwent TAVI (n = 9068) or SAVR (n = 17,388) were included. Outcomes of interest were short-term (30-day) and mid-term (1-year) mortality and major complications. RESULTS Short-term mortality was lower with TAVI vs. SAVR (1.8% vs. 2.8%, RR = 0.67, [0.56-0.80]). TAVI was associated with lower risk of atrial fibrillation (7.4% vs. 36.5%, RR = 0.21, [0.14-0.31]), and kidney injury (5.3% vs. 9%, RR = 0.45, [0.26-0.80]), but had higher incidence of vascular complications (5.5% vs. 1.4%, RR = 4.88 [1.47-16.18]), and permanent pacemaker implantation (14.9% vs. 3.4%, RR = 4.94 [3.03-8.08]). Stroke rates were similar between both interventions (1.7% vs. 2.2%, RR = 0.80 [0.54-1.18]). Mid-term all-cause mortality was similar in the pooled analysis for TAVI vs. SAVR (8.6% vs. 8.4%, RR = 0.90 [0.66-1.24]), but was lower with TAVI in RCTs (2.1% vs. 3.5%, RR = 0.61 [0.39-0.95]). Cardiovascular mortality was lower with TAVI (1.6% vs. 2.9%, RR = 0.55 [0.33-0.90]), but stroke (3% vs. 4.2%, RR = 0.69, [0.45-1.06]) and valve re-interventions rates (0.8% vs. 0.6%, RR = 1.28 [0.52-3.17]) were similar between both strategies. CONCLUSION TAVI in low surgical risk patients is associated with lower short-term morbidity and mortality compared with SAVR.
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Affiliation(s)
- Wasiq Faraz Rawasia
- West Virginia University, Heart and Vascular Institute, Morgantown, WV, United States of America
| | | | | | - Marium Zafar
- Dow University of Health Sciences, Karachi, Pakistan
| | - Safi U Khan
- West Virginia University, Heart and Vascular Institute, Morgantown, WV, United States of America
| | - Mohamad Alkhouli
- West Virginia University, Heart and Vascular Institute, Morgantown, WV, United States of America.
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Cui H, Schaff HV, Nishimura RA, Geske JB, Dearani JA, Lahr BD, Ommen SR. Conduction Abnormalities and Long-Term Mortality Following Septal Myectomy in Patients With Obstructive Hypertrophic Cardiomyopathy. J Am Coll Cardiol 2019; 74:645-655. [DOI: 10.1016/j.jacc.2019.05.053] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/16/2019] [Accepted: 05/21/2019] [Indexed: 10/26/2022]
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González Barbeito M, Estévez-Cid F, Pardo Martínez P, Velasco García de Sierra C, Iglesias Gil C, Quiñones Laguillo C, Cuenca Castillo JJ. Surgical technique modifies the postoperative atrioventricular block rate in sutureless prostheses. J Thorac Dis 2019; 11:2945-2954. [PMID: 31463124 DOI: 10.21037/jtd.2019.07.27] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The main objective was to analyse the impact of the modification of the Perceval S implantation technique on the prevalence of postoperative atrioventricular block, which requires a permanent pacemaker, in our aortic valve replacement series. In addition, we attempted to identify those risk factors that are related to the appearance of this complication. Methods Five hundred and seventy-two valve replacements were carried out with PERCEVAL S in our centre up to July 2018. Use of modified technique (n=302). Minimally invasive approach (n=340). Associated coronary surgery (n=95). Patients with pacemakers prior to surgery (n=27) and associated mitral or tricuspid valve surgery (n=26) were excluded. We analysed variables of interest that could influence the increase in postoperative atrioventricular block. Technique performed, disorders of intraventricular conduction and pre/intraoperative characteristics. The influence of the modified technique was analysed. Results Five hundred and nineteen aortic valve replacements with PERCEVAL S. Age (years) (median 77, interquartile range 8). Height (cm) (159, 13.5). Euroscore II (%) (2.25, 2.27). Postoperative atrioventricular block standard technique (n=23, 10.14%). Modified technique (n=14, 4.30%) (P=0.009). Multivariate regression analysis. Final model AUC =0.740, maximum model AUC =0.774 (P>0.05). Includes: Technique used (P=0.024), height (P=0.043) and disorders of interventricular conduction, right bundle branch block (P=0.005), trifascicular block (P=0.008). Conclusions In our experience, the modified technique significantly decreases the incidence of postoperative atrioventricular block that requires a permanent pacemaker in the aortic valve replacement with PERCEVAL S. The prior electrocardiographic presence of right bundle branch block, trifascicular block and the height of the patient are associated with an increased risk of blocking.
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Affiliation(s)
| | - Francisco Estévez-Cid
- Department of Cardiac Surgery, A Coruña University Hospital Complex, A Coruña, Spain
| | | | | | - Carmen Iglesias Gil
- Department of Cardiac Surgery, A Coruña University Hospital Complex, A Coruña, Spain
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