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Watkins AR, El-Andari R, Fialka NM, Kang JJ, Hong Y, Bozso SJ, Jonker D, Moon M, Nagendran J, Nagendran J. Long-term outcomes following aortic valve replacement in bioprosthetic vs mechanical valves. Heart Lung 2024; 69:87-93. [PMID: 39369559 DOI: 10.1016/j.hrtlng.2024.09.016] [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: 07/15/2024] [Revised: 09/16/2024] [Accepted: 09/28/2024] [Indexed: 10/08/2024]
Abstract
BACKGROUND Aortic valve disease(AVD) accounts for 33 % of valvular heart disease(VHD) but causes over 60 % of VHD mortality. For surgical AVR, mechanical valves are recommended for patients <50 years old and bioprosthetic valves for those >70 years old. OBJECTIVES To investigate the long-term differences following AV replacement(AVR) comparing bioprosthetic and mechanical valves in patients aged 50-70. METHODS 4,927 patients underwent AVR, 744 of which were propensity-matched 2:1 for bioprosthetic and mechanical valves. Outcomes included mortality, morbidity, and rates of reoperation. RESULTS The average age of the propensity-matched groups was 57 and 56.7 years, and female sex accounted for 26.4 % and 25.0 % for the bioprosthetic and mechanical valve groups, respectively. Other baseline demographics and comorbidities were similar between the groups. There were no deaths at 30 days and complication rates did not differ between groups(p > 0.05). Mortality at 1, 5, and 15 years was similar between groups. Reoperation rates at 5 and 10 years did not significantly differ between bioprosthetic and mechanical valves(p = 0.84, p = 0.31), although at 15-year follow-up, patients with bioprosthetic valves were more likely to require reoperation(21.2 % versus 9.7 %, adjusted hazard ratio 3.65, 95 % confidence interval 1.07-12.5, p = 0.0.39). CONCLUSIONS Patients receiving AVR from 50 to 70 years old have similar long-term outcomes irrespective of whether they received bioprosthetic or mechanical valves, with only reoperation being significantly different at 15 years follow-up. With low rates of reoperation, mortality, and avoidance of anticoagulation, bioprosthetic valves are a reasonable option for patients 50-70 years old, although mechanical valves still provide a durability benefit for young patients.
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Affiliation(s)
- Abeline R Watkins
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Ryaan El-Andari
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Nicholas M Fialka
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jimmy Jh Kang
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Yongzhe Hong
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Sabin J Bozso
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Devilliers Jonker
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Michael Moon
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jayan Nagendran
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jeevan Nagendran
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
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Fedorov D, Bauernschmitt R, Grunebaum JP, Bauer S, Sodian R, von Hodenberg E. Interventional versus Surgical Treatment of Degenerated Freestyle Prosthesis. Thorac Cardiovasc Surg 2024; 72:188-196. [PMID: 36858066 DOI: 10.1055/s-0043-1763286] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
BACKGROUND Bioprosthetic stentless aortic valves may degenerate over time and will require replacement. This study aimed to evaluate early- and mid-term outcomes after isolated surgical redo aortic valve replacement (redo-SAVR) and transcatheter valve-in-valve implantation (TAVI-VIV) for degenerated stentless Freestyle bioprostheses. METHODS We reviewed records of 56 patients at a single center. Overall, 37 patients (66.1%) received TAVI-VIV and 19 (33.9%) received redo-SAVR. RESULTS Thirty-day survival was similar in both groups (100%). One-year survival was comparable between groups (97.3% in TAVI-VIV and 100% in redo-SAVR, p = 1.0). The difference in mid-term survival after adjusting for age and EuroScore II was not significant (p = 0.41). The incidence of pacemaker implantation after TAVI-VIV was higher than after redo-SAVR (19.4% vs. 0%, p = 0.08). CONCLUSION The 30-day and 1-year survival rates after both procedures were outstanding, irrespective of baseline characteristics. Isolated redo-SAVR should be favored in young patients, as the pacemaker implantation rate is lower. TAVI-VIV for degenerated Freestyle prosthesis can be a method of choice in elderly patients and those with high operative risk.
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Affiliation(s)
- Denis Fedorov
- Department of Cardiology, MediClin Herzzentrum Lahr/Baden, Lahr, Germany
| | - Robert Bauernschmitt
- Department of Cardiovascular Surgery, MediClin Herzzentrum Lahr/Baden, Lahr, Germany
- Department of Cardiovascular Surgery, UniversitätsSpital Zürich, Zurich, Switzerland
| | | | - Stefan Bauer
- Department of Cardiovascular Surgery, MediClin Herzzentrum Lahr/Baden, Lahr, Germany
| | - Ralf Sodian
- Department of Cardiovascular Surgery, MediClin Herzzentrum Lahr/Baden, Lahr, Germany
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Fukunaga N, Al-Sarraf A, Jawad K, Lafreniere-Roula M, Rao V. Early and mid-term outcomes after aortic valve intervention in patients with previous stentless or stented bioprostheses. J Cardiothorac Surg 2023; 18:34. [PMID: 36653867 PMCID: PMC9847021 DOI: 10.1186/s13019-023-02118-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 01/02/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Limited data are available concerning comparative outcomes of redo aortic valve interventions, including surgery after aortic valve replacement (AVR) with either stented or stentless bioprostheses. We investigated the comparative outcomes of redo aortic valve interventions, including surgery after AVR with either stented or stentless bioprostheses. METHODS The cohort consisted of 112 patients who underwent aortic valve intervention for infective endocarditis or structural valve deterioration between 2001 and 2020. One hundred patients received a stented valve (stented group) and 12 patients received a stentless valve (stentless group) during the initial surgery. Early and late outcomes were evaluated. RESULTS The mean [IQR] ages during the current interventions were 66 [54, 77] years in the stented group and 74 [67, 79] years in the stentless group (P = 0.13). In the stented group, aortic valve interventions included redo AVRs with stented valves (n = 54), mechanical valves (n = 26), stentless valves (n = 16), and transcatheter aortic valve implantations (n = 4). In the stentless group, redo AVRs were performed with stented valves (n = 4), mechanical valves (n = 2), stentless valves (n = 1), and transcatheter valve implantations (n = 5). Hospital mortality was observed in 2 (2%) patients in the stented group and 1 (8%) patients in the stentless group (P = 0.29). The 5-year survival was 80.8% [66.8, 88.5] in the stented group and 91.7% [53.9, 98.8] in stentless group. Statistically significant differences in thromboembolisms were observed between the groups. CONCLUSIONS No significant differences in early and mid-term outcomes (except thromboembolism) after aortic valve interventions were detected between patients with stented and stentless AVRs.
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Affiliation(s)
- Naoto Fukunaga
- grid.231844.80000 0004 0474 0428Division of Cardiovascular Surgery, 4PMB-457, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4 Canada
| | - Ali Al-Sarraf
- grid.231844.80000 0004 0474 0428Division of Cardiovascular Surgery, 4PMB-457, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4 Canada
| | - Khalil Jawad
- grid.231844.80000 0004 0474 0428Division of Cardiovascular Surgery, 4PMB-457, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4 Canada
| | - Myriam Lafreniere-Roula
- grid.231844.80000 0004 0474 0428Division of Cardiovascular Surgery, 4PMB-457, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4 Canada
| | - Vivek Rao
- grid.231844.80000 0004 0474 0428Division of Cardiovascular Surgery, 4PMB-457, Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4 Canada
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Niwa K, Yamashita K, Hirose T, Hiraga S, Fukuba R, Takemura J, Nishikawa H, Taniguchi S. Prevention of surgical adhesions with gelatine sealing sheet in a canine adhesion model. Interact Cardiovasc Thorac Surg 2022; 34:849-856. [PMID: 35015841 PMCID: PMC9070492 DOI: 10.1093/icvts/ivab370] [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: 09/12/2021] [Revised: 11/25/2021] [Accepted: 12/08/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Kosuke Niwa
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, Kashihara, Japan
- Department of Cardiovascular Surgery, Iseikai Hospital, Osaka, Japan
| | - Keigo Yamashita
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, Kashihara, Japan
- Department of Cardiovascular Surgery, Iseikai Hospital, Osaka, Japan
| | - Tomoaki Hirose
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, Kashihara, Japan
| | - Shun Hiraga
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, Kashihara, Japan
| | - Ryohei Fukuba
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, Kashihara, Japan
| | - Junichi Takemura
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, Kashihara, Japan
| | - Hiroshi Nishikawa
- Department of Cardiovascular Surgery, Iseikai Hospital, Osaka, Japan
| | - Shigeki Taniguchi
- Department of Thoracic and Cardiovascular Surgery, Nara Medical University School of Medicine, Kashihara, Japan
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Hobbs RD, Norton EL, Wu X, Willer CJ, Hummell SL, Prager RL, Afilalo J, Hornsby WE, Yang B. Gait speed is a preoperative indicator of postoperative events after elective proximal aortic surgery. J Thorac Cardiovasc Surg 2022; 163:886-894.e1. [PMID: 32684393 PMCID: PMC8722375 DOI: 10.1016/j.jtcvs.2020.03.165] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 03/28/2020] [Accepted: 03/30/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The study objective was to evaluate whether 5-m gait speed, an established marker of frailty, is associated with postoperative events after elective proximal aortic surgery. METHODS We performed a retrospective review of 435 patients aged more than 60 years who underwent elective proximal aortic surgery, defined as surgery on the aortic root, ascending aorta, or aortic arch through median sternotomy. Patients completed a 5-m gait speed test within 30 days before surgery. We evaluated the association between categoric (slow, ≤0.83 m/s and normal, >0.83 m/s) and continuous gait speed and the likelihood of experiencing the composite outcome before and after adjustment for European System for Cardiac Operative Risk Evaluation II. The composite outcome included in-hospital mortality, renal failure, prolonged ventilation, and discharge location. Secondary outcomes were 1-year mortality and 5-year survival. RESULTS Of the study population, 30.3% (132/435) were categorized as slow. Slow walkers were significantly more likely to have in-hospital mortality, prolonged ventilation, and renal failure, and were less likely to be discharged home (all P < .05). The composite outcome was 2 times more likely to occur for slow walkers (gait speed categoric adjusted odds ratio, 2.08; 95% confidence interval, 1.27-3.40; P = .004). Moreover, a unit (1 m/s) increase in gait speed (continuous) was associated with 73% lower risk of experiencing the composite outcome (odds ratio, 0.27; 95% confidence interval, 0.11-0.68; P = .006). CONCLUSIONS Slow gait speed is a preoperative indicator of risk for postoperative events after elective proximal aortic surgery. Gait speed may be an important tool to complement existing operative risk models, and its application may identify patients who may benefit from presurgical and postsurgical rehabilitation.
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Affiliation(s)
- Reilly D Hobbs
- University of Michigan, Michigan Medicine, Ann Arbor, Mich; Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | | | - Xiaoting Wu
- University of Michigan, Michigan Medicine, Ann Arbor, Mich; Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Cristen J Willer
- University of Michigan, Michigan Medicine, Ann Arbor, Mich; Department of Internal Medicine, Michigan Medicine, Ann Arbor, Mich; Department of Biostatistics, University of Michigan, School of Public Health, Ann Arbor, Mich; Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Mich
| | - Scott L Hummell
- University of Michigan, Michigan Medicine, Ann Arbor, Mich; Department of Internal Medicine, Michigan Medicine, Ann Arbor, Mich
| | - Richard L Prager
- University of Michigan, Michigan Medicine, Ann Arbor, Mich; Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Jonathan Afilalo
- McGill University - Jewish General Hospital, Montreal, Quebec, Canada; Division of Cardiology and Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, Quebec, Canada
| | - Whitney E Hornsby
- University of Michigan, Michigan Medicine, Ann Arbor, Mich; Department of Internal Medicine, Michigan Medicine, Ann Arbor, Mich.
| | - Bo Yang
- University of Michigan, Michigan Medicine, Ann Arbor, Mich; Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich.
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Stentless valves for bicuspid and tricuspid aortic valve disease. JTCVS OPEN 2021; 8:177-188. [PMID: 36004130 PMCID: PMC9390591 DOI: 10.1016/j.xjon.2021.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 09/21/2021] [Indexed: 11/20/2022]
Abstract
Objective To determine long-term survival and reoperation rate in patients with a bicuspid aortic valve (BAV) and patients with a tricuspid aortic valve (TAV) after stentless aortic valve replacement (AVR)/aortic root replacement (ARR). Methods Between 1992 and 2014, 1293 patients underwent first AVR/ARR with a stentless aortic valve using the modified inclusion operating technique, including 741 patients with a TAV and 552 with a BAV. Using propensity scoring with 26 variables, 330 matched pairs were identified with AVR with or without ascending aorta/arch replacement. Data were obtained through chart review, surveys, and the National Death Index. Results Patient demographics were similar in the propensity score–matched groups. Both groups had similar cardiopulmonary bypass, cross-clamp, and hypothermia circulatory arrest times, cerebral protection strategies, and rate of aortic arch replacement. The median size of implanted valves was similar (BAV: 27 mm [range, 25-29 mm] vs TAV: 27 mm [range, 25-27 mm]). Compared with the TAV group, the BAV group had a shorter hospital stay (6 days vs 7 days; P = .001) but similar 30-day mortality (1.8% vs 1.2%). The BAV group had better long-term (15-year) survival (46% vs 33%; P = .002) but a higher cumulative incidence of reoperation for structural valve deterioration (15-year: 15% vs 11%; P = .048). Cox proportional hazard analysis identified a BAV as a protective factor for long-term mortality (hazard ratio [HR], 0.71; 95% CI, 0.56-0.91; P = .006), but a risk factor for reoperation due to structural valve deterioration (HR, 1.4 [95% CI, 0.8-2.6; P = .27] in the matched cohort and 2.2 [95% CI, 1.3-3.7; P = .004] in the unmatched cohort). Conclusions The BAV patients had better long-term survival but a higher reoperation rate compared with TAV patients after stentless AVR. Our findings suggest caution in the use of bioprostheses for BAV patients.
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7
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Wojnarski CM, Moraca RJ. Commentary: Stentless valve for bicuspid aortic valve replacement: Some answers just lead to more questions. JTCVS OPEN 2021; 8:191-192. [PMID: 36004126 PMCID: PMC9390319 DOI: 10.1016/j.xjon.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Charles M. Wojnarski
- Section of Cardiac Surgery, Department of Surgery, Virginia Mason Medical Center, Seattle, Wash
| | - Robert J. Moraca
- Section of Cardiac Surgery, Department of Surgery, Virginia Mason Medical Center, Seattle, Wash
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8
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Christ T, Sündermann SH, Falk V, Grubitzsch H. Reply to Jasinski et al. Eur J Cardiothorac Surg 2021; 61:730-731. [PMID: 34718500 DOI: 10.1093/ejcts/ezab465] [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: 09/08/2021] [Accepted: 09/14/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Torsten Christ
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Cardiovascular Surgery, Berlin, Germany
| | - Simon Harald Sündermann
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Cardiovascular Surgery, Berlin, Germany.,German Heart Center Berlin, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany.,German Center for Cardiovascular Research, Partner Site, Berlin, Germany
| | - Volkmar Falk
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Cardiovascular Surgery, Berlin, Germany.,German Heart Center Berlin, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany.,German Center for Cardiovascular Research, Partner Site, Berlin, Germany.,Swiss Federal Institute of Technology (ETH) Zurich, Department of Health Science and Technology, Zurich, Switzerland
| | - Herko Grubitzsch
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Department of Cardiovascular Surgery, Berlin, Germany
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9
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Jasinski M, Kosiorowska K, Berezowski M. Stentless valve implantation remains a viable option. Eur J Cardiothorac Surg 2021; 61:730. [PMID: 34718494 DOI: 10.1093/ejcts/ezab423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/10/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Marek Jasinski
- Department of Cardiac Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Kinga Kosiorowska
- Department of Cardiac Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Mikolaj Berezowski
- Department of Cardiac Surgery, Wroclaw Medical University, Wroclaw, Poland
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10
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Balsam LB. Commentary: The Shrinking Role of the Freestyle Aortic Bioprostheses in Younger Patients. Semin Thorac Cardiovasc Surg 2021; 34:878-879. [PMID: 34500073 DOI: 10.1053/j.semtcvs.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 09/01/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Leora B Balsam
- Division of Cardiac Surgery, UMass Memorial Medical Center, Worcester, Massachusetts.
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11
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Khazaal J, Ragagni M, Parker J, Timek T, Murphy E, Heiser J, Willekes C. Freestyle Aortic Bioprostheses in Patients 60 Years old and Younger. Semin Thorac Cardiovasc Surg 2021; 34:870-877. [PMID: 34380081 DOI: 10.1053/j.semtcvs.2021.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/02/2021] [Indexed: 11/11/2022]
Abstract
Evaluate outcomes of the Freestyle stentless aortic bioprosthesis in patients 60 years old and younger. All patients, 60 years old and younger, between January 1, 1998 to December 31, 2015 who underwent implantation of a Freestyle aortic valve at a single institution were reviewed. Medical records and telephone interviews were utilized for data collection. 515 patients were identified with an average age of 51.3 years. Mean follow up was 11.1 years. 225 full root replacements and 290 subcoronary implants were performed. Overall survival, including patients with concomitant procedures, at 15 years was 63.7% (95% CI 58.3-68.5). Isolated subcoronary implants (58%,167/290) had a 15-year survival of 71.6% (95% CI 62.6-78.7) vs 78.4% (95% CI 69.7, 84.9) for isolated root replacements (63%,141/225) which was not statistically significant (P = 0.397). No significant difference in operative SVD at 15 years occurred between full root replacements 37.6% (95% CI 27.2-50.2) vs subcoronary implants 39.4% (95% CI31.1, 49.0). 110 patients required reoperation solely for intrinsic SVD. 93% (102/110) failed due to aortic insufficiency. Of reoperative interventions for SVD, 37% (41/110) of patients required urgent reoperation and 4.5% (5/110) required emergent reoperation. Pseudoaneurysms developed in six of the full root replacements. Freestyle aortic valves have a high rate of acute failure requiring urgent or emergent reintervention in patients 60 years old and younger. This has led our group to shift practice away from their implantation.
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Affiliation(s)
- Jawad Khazaal
- College of Human Medicine, Michigan State University, Grand Rapids
| | - Mary Ragagni
- Department of Cardiovascular Research, Spectrum Health, Grand Rapids
| | - Jessica Parker
- Office of Research and Education, Spectrum Health, Grand Rapids
| | - Tomasz Timek
- Department of Cardiothoracic Surgery, Spectrum Health, Grand Rapids
| | - Edward Murphy
- Department of Cardiothoracic Surgery, Spectrum Health, Grand Rapids
| | - John Heiser
- Department of Cardiothoracic Surgery, Spectrum Health, Grand Rapids
| | - Charles Willekes
- Department of Cardiothoracic Surgery, Spectrum Health, Grand Rapids.
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Abstract
Aortic stenosis is the most common valvular disease requiring valve replacement. Valve replacement therapies have undergone progressive evolution since the 1960s. Over the last 20 years, transcatheter aortic valve replacement has radically transformed the care of aortic stenosis, such that it is now the treatment of choice for many, particularly elderly, patients. This review provides an overview of the pathophysiology, presentation, diagnosis, indications for intervention, and current therapeutic options for aortic stenosis.
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Affiliation(s)
- Marko T Boskovski
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA
| | - Thomas G Gleason
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA
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13
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Brescia AA, Bolling SF, Yang B. Commentary: Expanded options for dialysis-dependent patients requiring valve replacement in the transcatheter era. J Thorac Cardiovasc Surg 2020; 163:2072-2073. [PMID: 32800372 DOI: 10.1016/j.jtcvs.2020.06.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 06/14/2020] [Indexed: 10/24/2022]
Affiliation(s)
| | - Steven F Bolling
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Bo Yang
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
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14
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Reich H, Roselli EE. Defining the Limits of Valve-in-Valve Transcatheter Aortic Valve Replacement for Degenerated Freestyle Bioprosthesis. Ann Thorac Surg 2020; 110:1957-1958. [PMID: 32585205 DOI: 10.1016/j.athoracsur.2020.04.136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 04/30/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Heidi Reich
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195.
| | - Eric E Roselli
- Aorta Center, Aortic Valve Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
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15
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Midterm Outcomes for Valve-in-Valve Transcatheter Aortic Valve Replacement in the Failed Freestyle Bioprosthesis. Ann Thorac Surg 2020; 110:1951-1957. [PMID: 32442615 DOI: 10.1016/j.athoracsur.2020.03.116] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/07/2020] [Accepted: 03/27/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) is acceptable in patients at high risk for reoperation. Studies suggest that ViV TAVR in stentless valves may be technically more challenging. This study sought to evaluate midterm outcomes for ViV TAVR in the degenerative Freestyle ((Medtronic, Minneapolis, MN)) stentless bioprosthesis. METHODS Between October 2014 and January 2019, 56 patients underwent ViV TAVR for a failed Freestyle valve at a single institution using a commercially available self-expanding transcatheter aortic valve. Patient baseline characteristics and clinical outcomes data were collected retrospectively. Valve Academic Research Consortium-2 definitions were applied. RESULTS Mean patient age was 75 ± 8 years and The Society of Thoracic Surgeons mean risk score was 9% ± 8%. The predominant mode of Freestyle valve failure was regurgitation (77%), and 36 patients (64%) required urgent intervention for refractory acute heart failure. Device success using a self-expanding TAVR was 82%, with 6 cases (11%) requiring deployment of two transcatheter valves. There were 3 operative mortalities (5%). At 30-day follow-up, no patient had greater than moderate perivalvular regurgitation. Device success was higher in the later patients compared with patients done earlier (P = .02). Mean aortic valve gradients at 30 days and 1 year were 11 ± 8 and 9 ± 8 mm Hg, respectively. For patients alive beyond day 30, 3-year survival was 82%. CONCLUSIONS Performing ViV TAVR in the Freestyle valve using a self-expanding transcatheter valve presents a technical challenge, but may be feasible with good midterm results. Procedural success is associated with an early hazard learning curve.
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Influence of Age on Longevity of a Stentless Aortic Valve. Ann Thorac Surg 2019; 110:500-507. [PMID: 31877296 DOI: 10.1016/j.athoracsur.2019.10.085] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 10/24/2019] [Accepted: 10/28/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND The longevity of a stentless valve in a younger population (20-60 years old) is unknown. METHODS From 1992 to 2015, 1947 patients underwent aortic valve/root replacement for aortic stenosis, insufficiency, root aneurysm, or aortic dissection with stentless bioprostheses (median size, 26 mm). At operation 105 patients were <40 years old, 528 were 40 to 59, 860 were 60 to 74, and 454 were ≥75 years. The data were obtained through chart review, administered surveys, and the National Death Index. RESULTS The 30-day mortality rate was 2.6%. During follow-up 807 patients (41%) died before reoperation, 993 (51%) were alive without reoperations because of deterioration, and 113 patients (5.8%) underwent reoperation for structural valve deterioration. After adjusting death and reoperation for non-structural valve deterioration causes as competing risks, the cumulative incidence of reoperation was significantly different between the younger groups (<40, 40-59) and the older groups (60-74, ≥75; P < .0001) but not inside the younger (<40 vs 40-59) or older (60-74 vs ≥75) group. The significant hazard ratio of reoperation for <40 versus ≥75 years of age was 12, <40 versus 60 to 74 was 4, 40 to 59 versus 60 to 74 was 3, and 40 to 59 versus ≥75 was 9 (P ≤ .01). The 10- and 15-year survival in the entire cohort was 53% and 29%, respectively. CONCLUSIONS The stentless aortic valve provides satisfactory durability as a conduit for aortic valve/root replacement for patients who prefer a bioprosthesis. However it should be judiciously considered for patients younger than 60 years because of an increased incidence of reoperation for structural valve deterioration.
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Schneider AW, Hazekamp MG, Versteegh MIM, de Weger A, Holman ER, Klautz RJM, Bruggemans EF, Braun J. Reinterventions after freestyle stentless aortic valve replacement: an assessment of procedural risks. Eur J Cardiothorac Surg 2019; 56:1117-1123. [PMID: 31424504 PMCID: PMC6911150 DOI: 10.1093/ejcts/ezz222] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 07/04/2019] [Accepted: 07/10/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Repeat aortic valve interventions after previous stentless aortic valve replacement (AVR) are considered technically challenging with an increased perioperative risk, especially after full-root replacement. We analysed our experience with reinterventions after stentless AVR. METHODS A total of 75 patients with previous AVR using a Freestyle stentless bioprosthesis (31 subcoronary, 15 root-inclusion and 29 full-root replacement) underwent reintervention in our centre from 1993 until December 2018. Periprocedural data were retrospectively collected from the department database and follow-up data were prospectively collected. RESULTS Median age was 62 years (interquartile range 47-72 years). Indications for reintervention were structural valve deterioration (SVD) in 47, non-SVD in 13 and endocarditis in 15 patients. Urgent surgery was required in 24 (32%) patients. Reinterventions were surgical AVR in 16 (21%), root replacement in 51 (68%) and transcatheter AVR in 8 (11%) patients. Early mortality was 9.3% (n = 7), but decreased to zero in the past decade in 28 patients undergoing elective reoperation. Per indication, early mortality was 9% for SVD, 8% for non-SVD and 13% for endocarditis. Aortic root replacement had the lowest early mortality rate (6%), followed by surgical AVR (13%) and transcatheter AVR (25%, 2 patients with coronary artery obstruction). Pacemaker implantation rate was 7%. Overall survival rate at 10 years was 69% (95% confidence interval 53-81%). CONCLUSIONS Repeat aortic valve interventions after stentless AVR carry an increased, but acceptable, early mortality risk. Transcatheter valve-in-valve procedures after stentless AVR require careful consideration of prosthesis leaflet position to prevent obstruction of the coronary arteries.
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Affiliation(s)
| | - Mark G Hazekamp
- Department of Cardiothoracic Surgery, LUMC, Leiden, Netherlands
| | | | - Arend de Weger
- Department of Cardiothoracic Surgery, LUMC, Leiden, Netherlands
| | | | | | | | - Jerry Braun
- Department of Cardiothoracic Surgery, LUMC, Leiden, Netherlands
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Wilder TJ, Sharma V, Koliopoulou A, McKellar SH, Selzman CH, Glotzbach JP. Rapid-deployment aortic valve replacement after aortic root replacement: A safe alternative to redo root replacement. J Card Surg 2019; 35:222-225. [PMID: 31609491 DOI: 10.1111/jocs.14278] [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: 11/27/2022]
Abstract
Reoperative aortic root replacement, following prior biologic or mechanical valved conduit aortic root prosthesis, presents a technical challenge. The rapid-deployment aortic valve prosthesis is an approved alternative to traditional bioprosthetic aortic valve replacement. We present three clinical cases in which rapid-deployment aortic valve prostheses were utilized in lieu of reoperative full aortic root replacement. All three patients recovered uneventfully. The rapid-deployment valve insertion in a prior surgical aortic root prosthesis is a safe option to avoid reoperative full aortic root replacement.
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Affiliation(s)
- Travis J Wilder
- Department of Surgery, Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
| | - Vikas Sharma
- Department of Surgery, Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
| | - Antigone Koliopoulou
- Department of Surgery, Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
| | - Stephen H McKellar
- Department of Surgery, Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
| | - Craig H Selzman
- Department of Surgery, Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
| | - Jason P Glotzbach
- Department of Surgery, Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
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Zhong C, Rokey R, Rolak S, Mesa J. Pregnancy and transcatheter aortic valve replacement in a severely stenotic Freestyle full aortic root stentless bioprosthesis. Catheter Cardiovasc Interv 2019; 95:1225-1229. [PMID: 31483554 DOI: 10.1002/ccd.28481] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/26/2019] [Accepted: 08/20/2019] [Indexed: 12/22/2022]
Abstract
Symptomatic degenerative prosthetic aortic valve stenosis during pregnancy represents a significant risk to both mother and fetus, and until recently, surgical aortic valve replacement (SAVR) during pregnancy was often the only choice for women opting to continue pregnancy. However, symptomatic severe stenosis in a pregnant woman with a degenerated full aortic root Freestyle stentless bioprosthesis (FSB) and reimplanted coronary arteries presents additional complexities that require an alternative surgical approach. In this case report, we describe the first successful transcatheter aortic valve replacement (TAVR) in SAVR for a severely stenotic degenerative FSB in a pregnant woman and subsequent delivery of a healthy infant several months later. TAVR in SAVR of a severely stenotic aortic FSB should be considered as a surgical option in symptomatic pregnant women. Short-term and long-term implications for future pregnancy should be discussed by a multidisciplinary team and with the patient.
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Affiliation(s)
- Chuyang Zhong
- Department of Internal Medicine, Marshfield Medical Center-Marshfield, Marshfield, Wisconsin
| | - Roxann Rokey
- Clinical Research Center, Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | - Stacey Rolak
- University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin
| | - Juan Mesa
- Cardiology Department, Marshfield Medical Center-Marshfield, Marshfield, Wisconsin
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