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Doenst T, Gaudino MF. Commentary: Hear no evil, see no evil-except with 4-dimensional cardiac computed tomography! J Thorac Cardiovasc Surg 2023; 165:1298-1299. [PMID: 34049706 DOI: 10.1016/j.jtcvs.2021.05.012] [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: 05/05/2021] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, University Hospital, Jena, Germany
| | - Mario F Gaudino
- Department of Cardiothoracic Surgery at New York Presbyterian, Weill Cornell Medical Center, New York, NY.
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How Strong Can We Pull? Critical Thresholds for Traction Forces on the Aortic Annulus: Measurements on Fresh Porcine Hearts. Medicina (B Aires) 2022; 58:medicina58081055. [PMID: 36013522 PMCID: PMC9415296 DOI: 10.3390/medicina58081055] [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: 06/29/2022] [Revised: 07/28/2022] [Accepted: 08/02/2022] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives: Friable or infected tissue remains a challenge in surgical aortic valve replacement. We recently described the “Caput medusae” method, in which circumferential tourniquets temporarily secure the prosthesis and are then gently knotted. Tourniquets have been shown to develop significantly less force than knots. The current study investigates the critical threshold forces for tissue damage to the aortic annulus. Materials and Methods: In 14 fresh porcine hearts, the aortic valve leaflets were removed and several pledgeted sutures were placed along the annulus at defined locations. The hearts were mounted in a self-constructed device. Incremental traction force was applied to every suture and continuously recorded. The movement of each Teflon pledget was filmed with a high-speed camera. Forces at the moment of pledget “cut-in” as well as complete “tear-out” were determined from the recordings. Results: The average threshold force was determined 9.31 ± 6.04 N for cut-in and 20.41 ± 10.02 N for tear-out. Detailed analysis showed that the right coronary region had lower threshold forces than the other regions (4.77 ± 3.28 N (range, 1.67–12.75 N) vs. 10.67 ± 6.04 N (1.62–26.00 N) for cut-in and 10.67 ± 4.04 N (5.40–18.64 N) vs. 23.33 ± 9.42 N (9.22–51.23 N) for tear-out). The findings are discussed in conjunction with the knot and tourniquet forces from our previous study. Conclusions: Even in healthy tissue, moderate forces can reach a critical level at which a Teflon pledget will cut into the annulus, while a complete tear-out is unlikely. The right coronary portion is more susceptible to damage than the remaining regions. When compared to previous data, forces during manual knotting may exceed the critical cut-in level, while rubber tourniquets may provide a higher safety margin against tissue rupture.
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Matteucci M, Ferrarese S, Cantore C, Mantovani V, Pedroni G, Cappabianca G, Corazzari C, Kowalewski M, Severgnini P, Lorusso R, Beghi C. Early paravalvular leak after conventional mitral valve replacement: A single-center analysis. J Card Surg 2022; 37:1559-1566. [PMID: 35289962 PMCID: PMC9314703 DOI: 10.1111/jocs.16422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/02/2022] [Accepted: 02/13/2022] [Indexed: 12/01/2022]
Abstract
Introduction Paravalvular leak (PVL) is a well‐recognized complication after mitral valve replacement (MVR). However, there are only a few studies analyzing leak occurrence and postoperative results after surgical MVR. The aim of this study was to assess the rate and determinants of early mitral PVL and to evaluate the impact on survival. Methods We performed a retrospective analysis involving patients who underwent MVR from January 2012 to December 2019 at our Institution. Postoperative transthoracic echocardiography evaluation was done for all subjects before hospital discharge. Multivariable analysis was carried out by constructing a logistic regression model to identify predictors for PVL occurrence. Results Four hundred ninety‐four patients were enrolled. Operative mortality was 4.9%. Early mitral PVL was found in 16 patients (3.2%); the majority were mild (75%). Leaks occurred more frequently along the posterior segment of the mitral valve annulus (62.5%). Only one individual with moderate‐to‐severe PVL underwent reoperation during the same hospital admission. Multivariable analysis revealed that preoperative diagnosis of infective endocarditis was the only factor associated with early leak after MVR (odds ratio: 4.96; 95% confidence interval: 1.45–16.99; p = .011). Overall mortality at follow‐up (mean follow‐up time: 4.7 [SD: 2.5] years) was 19.6% and favored patients without early mitral PVL. Conclusion The incidence of early PVL after MVR is low. PVL is usually mild and develop more frequently along the posterior segment of the mitral valve annulus. Preoperative diagnosis of infective endocarditis increases the risk of PVL formation.
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Affiliation(s)
- Matteo Matteucci
- Department of Medicine and Surgery, Cardiac Surgery Unit, Circolo Hospital, University of Insubria, Varese, Italy
| | - Sandro Ferrarese
- Department of Medicine and Surgery, Cardiac Surgery Unit, Circolo Hospital, University of Insubria, Varese, Italy
| | - Cristiano Cantore
- Department of Medicine and Surgery, Cardiac Surgery Unit, Circolo Hospital, University of Insubria, Varese, Italy
| | - Vittorio Mantovani
- Department of Medicine and Surgery, Cardiac Surgery Unit, Circolo Hospital, University of Insubria, Varese, Italy
| | - Giada Pedroni
- Department of Medicine and Surgery, Cardiac Surgery Unit, Circolo Hospital, University of Insubria, Varese, Italy
| | - Giangiuseppe Cappabianca
- Department of Medicine and Surgery, Cardiac Surgery Unit, Circolo Hospital, University of Insubria, Varese, Italy
| | - Claudio Corazzari
- Department of Medicine and Surgery, Cardiac Surgery Unit, Circolo Hospital, University of Insubria, Varese, Italy
| | - Mariusz Kowalewski
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior in Warsaw, Warsaw, Poland.,Thoracic Research Centre, Collegium Medicum, Innovative Medical Forum, Nicolaus Copernicus University, Bydgoszcsz, Poland
| | - Paolo Severgnini
- Department of Biotechnology and Sciences of Life, University of Insubria, Varese, Italy
| | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Cesare Beghi
- Department of Medicine and Surgery, Cardiac Surgery Unit, Circolo Hospital, University of Insubria, Varese, Italy
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Randall M, Betageri O, Hanayneh S, Anderson RD. Paravalvular Leak: A Systemic Review. Curr Cardiol Rev 2022; 18:e110522204571. [PMID: 35546743 PMCID: PMC9893144 DOI: 10.2174/1573403x18666220511113310] [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: 03/08/2022] [Revised: 03/10/2022] [Accepted: 03/15/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Paravalvular Leak (PVL) refers to the retrograde flow of blood in the space between an implanted cardiac valve and native tissue. These are unfortunately but luckily relatively uncommon complications of prosthetic valve replacement that, especially when moderate or severe, have important clinical consequences. OBJECTIVE Addressing PVL requires a multidisciplinary team to properly diagnose this process and choose the corrective option most likely to result in success. METHODS A comprehensive literature search was undertaken to formulate this narrative review. RESULTS This review highlights the complex nature of PVL and the promising contemporary treatments available. CONCLUSION Clinicians should be adept at recognizing PVL and characterizing it using multimodality imaging. Using the many available tools and a multidisciplinary approach should lead to favorable outcomes in patients with PVL.
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Affiliation(s)
- Morgan Randall
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Omkar Betageri
- Department of Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Seri Hanayneh
- Department of Medicine, University of Florida, Gainesville, FL 32611, USA
| | - R. David Anderson
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL 32611, USA
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Zheng J, Tao T, Davies H, Wu S, Ni Y. Four novel suture-sealing techniques to repair varying size paravalvular leaks. J Card Surg 2021; 36:3848-3850. [PMID: 34288102 DOI: 10.1111/jocs.15819] [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: 06/06/2021] [Revised: 06/28/2021] [Accepted: 07/06/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Paravalvular leak (PVL) is a well-known complication of aortic valve replacement. Currently, there is no consensus on optimal intraoperative management of patients with mild-to-moderate or moderate PVL. TECHNIQUE In this paper we present four novel surgical techniques, each combining suturing with sealing technique, to repair aortic PVLs, nullifying the need to replace the prosthesis. CONCLUSION These techniques will offer cardiac surgeons new alternatives to the repair techniques currently used.
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Affiliation(s)
- Junnan Zheng
- Department of Cardiovascular Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Tingting Tao
- Department of Cardiovascular Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Henry Davies
- Department of Vascular Surgery, School of Medicine, University of Leeds, Leeds, UK
| | - Shengjun Wu
- Department of Cardiovascular Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yiming Ni
- Department of Cardiovascular Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
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Paravalvular leak after transcatheter aortic valve implantation. Anatol J Cardiol 2020; 24:210-211. [PMID: 32870174 PMCID: PMC7585977 DOI: 10.14744/anatoljcardiol.2020.65259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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