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Makkinejad A, Monaghan K, Chen SA, Wu X, Ling C, Kim K, Fukuhara S, Patel HJ, Pagani F, Deeb GM, Yang B. Aortic Annular Enlargement vs Isolated Aortic Valve Replacement in Patients With Matched Annulus. Ann Thorac Surg 2024:S0003-4975(24)00636-2. [PMID: 39102933 DOI: 10.1016/j.athoracsur.2024.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 06/14/2024] [Accepted: 07/16/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND We aimed to determine the effect of aortic annular enlargement on the midterm outcomes of aortic valve replacement surgery by comparing patients with the same-sized (≤23 mm) native aortic annuli. METHODS From January 2011 to June 2022, 1328 patients underwent isolated aortic valve replacement-1163 without aortic annular enlargement (AVR group) and 165 with aortic annular enlargement (AVR+AAE group). Propensity score matching identified 112 pairs, controlling for native aortic annulus diameter, age, sex, diabetes, chronic lung disease, dialysis, ejection fraction, prior cardiac surgery, indication, hypertension, dyslipidemia, valve type, prior stroke, prior myocardial infarction, and case status. RESULTS Demographic and preoperative variables were similar, except body surface area was larger in the AVR+AAE group (2.1 m2 vs 1.9 m2). Median native aortic annulus diameter was 23 mm in both groups. Median prosthesis size was 25 in the AVR+AAE group and 23 in the AVR group. The AVR+AAE group had longer cardiopulmonary bypass (143 vs 111 minutes) and cross-clamp (115 vs 82 minutes) times. Incidences of perioperative complications, including operative mortality (1.8% AVR+AAE vs 3.6% AVR) were similar between groups. Survival at 6 years was 98% in the AVR+AAE group and 74% in the AVR group (P = .016). Aortic annular enlargement was an independent protective factor for midterm mortality, with a hazard ratio of 0.19 (P = .006). The rate of moderate/severe patient-prosthesis mismatch was 19% in the AVR+AAE group and 31% in the AVR group (P = .16). CONCLUSIONS Patients with small native aortic annuli (≤23 mm) undergoing isolated aortic valve replacement may benefit from aortic annular enlargement.
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Affiliation(s)
| | - Katelyn Monaghan
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Sarah A Chen
- Department of Surgery, UC Davis Health, University of California Davis, Sacramento, California
| | - Xiaoting Wu
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Carol Ling
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Karen Kim
- Division of Cardiovascular & Thoracic Surgery, Department of Surgery and Perioperative Care, University of Texas at Austin, Austin, Texas
| | - Shinichi Fukuhara
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Himanshu J Patel
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Francis Pagani
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - G Michael Deeb
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Bo Yang
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.
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2
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Sharaf OM, Beaver TM. Aortic valve 2024: Which valve for which patient? J Thorac Cardiovasc Surg 2024:S0022-5223(24)00545-2. [PMID: 38950770 DOI: 10.1016/j.jtcvs.2024.06.023] [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: 02/18/2024] [Revised: 04/17/2024] [Accepted: 06/19/2024] [Indexed: 07/03/2024]
Affiliation(s)
- Omar M Sharaf
- Division of Cardiovascular Surgery, Department of Surgery, University of Florida Health, Gainesville, Fla
| | - Thomas M Beaver
- Division of Cardiovascular Surgery, Department of Surgery, University of Florida Health, Gainesville, Fla.
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3
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Thourani VH, Abbas AE, Ternacle J, Hahn RT, Makkar R, Kodali SK, George I, Kapadia S, Svensson LG, Szeto WY, Herrmann HC, Ailawadi G, Leipsic J, Blanke P, Webb J, Jaber WA, Russo M, Malaisrie SC, Yadav P, Clavel MA, Khalique OK, Weissman NJ, Douglas P, Bax J, Dahou A, Xu K, Bapat V, Alu MC, Leon MB, Mack MJ, Pibarot P. Patient-Prosthesis Mismatch After Surgical Aortic Valve Replacement: Analysis of the PARTNER Trials. Ann Thorac Surg 2024; 117:1164-1171. [PMID: 38316377 DOI: 10.1016/j.athoracsur.2024.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 01/07/2024] [Accepted: 01/10/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Our objective was to compare the impact of patient-prosthesis mismatch (PPM) for 2 years after surgical aortic valve replacement within the prospective, randomized Placement of Aortic Transcatheter Valves (PARTNER) trials. METHODS Surgical aortic valve replacement patients from the PARTNER 1, 2, and 3 trials were included. PPM was classified as moderate (indexed effective orifice area ≤0.85 cm2/m2) or severe (indexed effective orifice area ≤0.65 cm2/m2). The primary endpoint was the composite of all-cause death and heart failure rehospitalization at 2 years. RESULTS By the predicted PPM method (PPMP), 59.1% had no PPM, 38.8% moderate PPM, and 2.1% severe PPM; whereas by the measured PPM method (PPMM), 42.4% had no PPM, 36.0% moderate, and 21.6% severe. Patients with no PPMP (23.6%) had a lower rate of the primary endpoint compared with patients with moderate (28.2%, P = .03) or severe PPMP (38.8%, P = .02). Using the PPMM method, there was no difference between the no (17.7%) and moderate PPMM groups (21.1%) in the primary outcome (P = .16). However, those with no PPMM or moderate PPMM were improved compared with severe PPMM (27.4%, P < .001 and P = .02, respectively). CONCLUSIONS Severe PPM analyzed by PPMP was only 2.1% for surgical aortic valve replacement patients. The PPMM method overestimated the incidence of severe PPM relative to PPMP, but was also associated with worse outcome. There was higher all-cause mortality in patients with severe PPM, thus surgical techniques to minimize PPM remain critical.
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Affiliation(s)
- Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia.
| | - Amr E Abbas
- Department of Cardiology, Beaumont Hospital, Detroit, Michigan
| | - Julien Ternacle
- Department of Cardiology, Haut-Leveque Cardiology Hospital, Bordeaux University, Pessac, France; Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec, Canada
| | - Rebecca T Hahn
- Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York; Cardiovascular Research Foundation, New York, New York
| | - Raj Makkar
- Department of Cardiology, Cedars Sinai Medical Center, Los Angeles, California
| | - Susheel K Kodali
- Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York
| | - Isaac George
- Division of Cardiac Surgery, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York
| | - Samir Kapadia
- Department of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Lars G Svensson
- Department of Cardiac Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Wilson Y Szeto
- Division of Cardiac Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Howard C Herrmann
- Division of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Jonathon Leipsic
- Department of Cardiology, University of British Columbia, Vancouver, Canada
| | - Philipp Blanke
- Department of Cardiology, University of British Columbia, Vancouver, Canada
| | - John Webb
- Department of Cardiology, University of British Columbia, Vancouver, Canada
| | - Wael A Jaber
- Department of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Mark Russo
- Division of Cardiac Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - S Chris Malaisrie
- Division of Cardiac Surgery, Northwestern University, Chicago, Illinois
| | - Pradeep Yadav
- Department of Cardiology, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia
| | - Marie-Annick Clavel
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec, Canada
| | - Omar K Khalique
- Cardiovascular Research Foundation, New York, New York; Department of Cardiology, St. Francis Hospital, Roslyn, New York
| | | | - Pamela Douglas
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Jeroen Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Ke Xu
- Edwards Lifesciences, Irvine, California
| | - Vinayak Bapat
- Department of Cardiac Surgery, Minneapolis Heart Institute, Minneapolis, Minnesota
| | - Maria C Alu
- Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York; Cardiovascular Research Foundation, New York, New York
| | - Martin B Leon
- Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York; Cardiovascular Research Foundation, New York, New York
| | - Michael J Mack
- Department of Cardiac Surgery, Baylor Scott and White Health, Dallas, Texas
| | - Philippe Pibarot
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec, Canada
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4
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Yang B, Ghita C, Makkinejad A, Green C, Wu X. Early outcomes of the Y-incision technique to enlarge the aortic annulus 3 to 4 valve sizes. J Thorac Cardiovasc Surg 2024; 167:1196-1205.e2. [PMID: 36031424 DOI: 10.1016/j.jtcvs.2022.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/16/2022] [Accepted: 07/02/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of a novel aortic annular enlargement technique. METHODS From August 2020 to February 2022, 50 consecutive cases of aortic valve replacement with Y-incision aortic annular enlargement and other combined cardiac procedures were performed primarily for severe aortic stenosis. Data were obtained through medical record review, The Society of Thoracic Surgeons database, and National Death Index data. RESULTS The median age was 65 (59, 71) years, 70% of patients were female, and 26% had previous cardiac surgery. Sixty-six percent patients had isolated aortic valve replacement. The preoperative mean gradient was 40 (30, 47) mm Hg, and the native aortic annular size was 21 (19, 23) mm. After aortic annular enlargement, the median prosthesis size was 27 (27, 29) with 54% of patients having a size 29 or the largest sized valve. The median increment of annulus enlargement was 3 (3, 4) valve sizes. 88% of patients received no blood transfusion. There were no major postoperative complications, including operative mortality, renal failure requiring permanent dialysis, mediastinitis, or reoperation for bleeding, except for 1 stroke. Three-month postoperative computed tomography aortogram showed the aortic root was enlarged from 27 (24, 30) to 40 (36, 41) mm without aortic pseudoaneurysm. The postoperative mean gradient was 7 (5, 8) mm Hg and valve area was 1.9 (1.7, 2.3) cm2 at 3 to 12 months. Mitral and tricuspid valve functions were significantly improved. Survival was 100% at 18 months. CONCLUSIONS Y-incision aortic annular enlargement was safe and effective for upsizing the aortic annulus by 3 to 4 valve sizes.
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Affiliation(s)
- Bo Yang
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich.
| | - Corina Ghita
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | | | - China Green
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Xiaoting Wu
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
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Badhwar V, Pereda D, Khaliel FH, Poffo R, Darehzereshki A, Mehaffey JH, Yan TD, Melnitchouk S, Geirsson A, Arghami A, Navia JL, Raikar GV, Weber AC, Ramzy D, Černý Š, Vojáček J, Smith RL, Bonatti J, Thourani VH, Wei LM. Outcomes following initial multicenter experience with robotic aortic valve replacement: Defining a path forward. J Thorac Cardiovasc Surg 2024; 167:1244-1250. [PMID: 38246340 DOI: 10.1016/j.jtcvs.2024.01.020] [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: 12/11/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 01/23/2024]
Affiliation(s)
- Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa.
| | - Daniel Pereda
- Department of Cardiovascular Surgery, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Feras H Khaliel
- Division of Cardiac Surgery, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Robinson Poffo
- Department of Cardiovascular Surgery, Hospital Moriah, Sao Paulo, Brazil
| | - Ali Darehzereshki
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - J Hunter Mehaffey
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - Tristan D Yan
- Department of Cardiothoracic Surgery, The Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Arnar Geirsson
- Division of Cardiac, Thoracic and Vascular Surgery, New York-Presbyterian Columbia University Medical Center, New York, NY
| | - Arman Arghami
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Jose L Navia
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Florida, Weston, Fla
| | - Goya V Raikar
- Division of Cardiothoracic Surgery, Medical College of Wisconsin, Pleasant Prairie, Wis
| | - Alberto C Weber
- Department of Cardiovascular Surgery, Herzzentrum Hislanden, Zurich, Switzerland
| | - Danny Ramzy
- Division of Cardiac Surgery, McGovern Medical School, UTHealth, Houston, Tex
| | - Štěpán Černý
- Department of Cardiac Surgery, University Hospital Motol, Prague, Czech Republic
| | - Jan Vojáček
- Department of Cardiac Surgery, University Hospital, Hradec Kralove, Czech Republic
| | - Robert L Smith
- Division of Cardiac Surgery, Baylor Scott & White Health, Plano, Tex
| | - Johannes Bonatti
- Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - Vinod H Thourani
- Department of Cardiothoracic Surgery, Piedmont Healthcare, Atlanta, Ga
| | - Lawrence M Wei
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
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6
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Goel SS, Reardon MJ. TAV-in-SAV or Redo SAVR: Are We Comparing Apples With Oranges? Am J Cardiol 2024; 215:70-71. [PMID: 38134980 DOI: 10.1016/j.amjcard.2023.12.017] [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: 12/03/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023]
Affiliation(s)
| | - Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas.
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7
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Herrmann HC, Desai ND. Incidence, Implications, and Treatment of Patients With Severe Aortic Stenosis and Small Aortic Annulus. Circulation 2024; 149:656-657. [PMID: 38408150 DOI: 10.1161/circulationaha.123.067816] [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] [Indexed: 02/28/2024]
Affiliation(s)
- Howard C Herrmann
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia
| | - Nimesh D Desai
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia
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8
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Yang B. Aortic Valve Replacement vs Aortic Valve Replacement + Annular Enlargement: Apples to Oranges? Ann Thorac Surg 2024; 117:479-480. [PMID: 36842563 DOI: 10.1016/j.athoracsur.2023.02.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/28/2023]
Affiliation(s)
- Bo Yang
- Department of Cardiac Surgery, University of Michigan, 1500 E Medical Center Dr, 5155 Frankel Cardiovascular Center, Ann Arbor, MI 48109.
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9
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Bavaria JE. The risk and reward of surgical aortic valve replacement. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00086-2. [PMID: 38278440 DOI: 10.1016/j.jtcvs.2024.01.028] [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: 10/18/2023] [Revised: 12/28/2023] [Accepted: 01/08/2024] [Indexed: 01/28/2024]
Affiliation(s)
- Joseph E Bavaria
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa.
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10
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Fazmin IT, Ali JM. Prosthesis-Patient Mismatch and Aortic Root Enlargement: Indications, Techniques and Outcomes. J Cardiovasc Dev Dis 2023; 10:373. [PMID: 37754802 PMCID: PMC10531615 DOI: 10.3390/jcdd10090373] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/28/2023] Open
Abstract
Prosthesis-patient mismatch (PPM) is defined as implanting a prosthetic that is insufficiently sized for the patient receiving it. PPM leads to high residual transvalvular gradients post-aortic valve replacement and consequently results in left ventricular dysfunction, morbidity and mortality in both the short and long term. Younger patients and patients with poor preoperative left ventricular function are more vulnerable to increased mortality secondary to PPM. There is debate over the measurement of valvular effective orifice area (EOA) and variation exists in how manufacturers report the EOA. The most reliable technique is using in vivo echocardiographic measurements to create tables of predicted EOAs for different valve sizes. PPM can be prevented surgically in patients at risk through aortic root enlargement (ARE). Established techniques include the posterior enlargement through Nicks and Manouguian procedures, and aortico-ventriculoplasty with the Konno-Rastan procedure, which allows for a greater enlargement but carries increased surgical risk. A contemporary development is the Yang procedure, which uses a Y-shaped incision created through the non- and left-coronary cusp commissure, undermining the nadirs of the non- and left-coronary cusps. Early results are promising and demonstrate an ability to safely increase the aortic root by up to two to three sizes. Aortic root enlargement thus remains a valuable and safe tool in addressing PPM, and should be considered during surgical planning.
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Kim KM, Arghami A, Habib R, Daneshmand MA, Parsons N, Elhalabi Z, Krohn C, Thourani V, Bowdish ME. The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2022 Update on Outcomes and Research. Ann Thorac Surg 2023; 115:566-574. [PMID: 36623634 DOI: 10.1016/j.athoracsur.2022.12.033] [Citation(s) in RCA: 55] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 12/05/2022] [Accepted: 12/10/2022] [Indexed: 01/08/2023]
Abstract
The Society of Thoracic Surgeons Adult Cardiac Surgery Database is the most mature and comprehensive cardiac surgery database. It is one of the most respected clinical data registries in health care, providing accurate risk-adjusted benchmarks, a foundation for quality measurement and improvement activities, and the ability to perform novel research. This report encompasses data from the years 2020 and 2021 and is the seventh in a series of reports that provide updated volumes, outcomes, database-related developments, and research summaries using the Adult Cardiac Surgery Database.
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Affiliation(s)
- Karen M Kim
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Arman Arghami
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Robert Habib
- The Society of Thoracic Surgeons, Chicago, Illinois
| | - Mani A Daneshmand
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | | | | | - Carole Krohn
- The Society of Thoracic Surgeons, Chicago, Illinois
| | - Vinod Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia
| | - Michael E Bowdish
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
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12
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Sá MP, Van den Eynde J, Simonato M, Hirji S, Erten O, Jacquemyn X, Tasoudis P, Dokollari A, Sicouri S, Weymann A, Ruhparwar A, Arora R, Clavel MA, Pibarot P, Ramlawi B. Late outcomes of valve-in-valve transcatheter aortic valve implantation versus re-replacement: Meta-analysis of reconstructed time-to-event data. Int J Cardiol 2023; 370:112-121. [PMID: 36370873 DOI: 10.1016/j.ijcard.2022.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/19/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022]
Abstract
AIMS To evaluate all-cause mortality in ViV-TAVI versus redo SAVR in patients with failed bioprostheses. METHODS Study-level meta-analysis of reconstructed time-to-event data from Kaplan-Meier curves of non-randomized studies published by September 30, 2021. RESULTS Ten studies met our eligibility criteria and included a total of 3345 patients (1676 patients underwent ViV-TAVI and 1669 patients underwent redo SAVR). Pooling all the studies, ViV-TAVI showed a lower risk of all-cause mortality in the first 44 days [hazard ratio (HR) 0.67, 95% confidence interval (CI) 0.49-0.93, P = 0.017], with an HR reversal after 197 days favoring redo SAVR (HR 1.53; 95% CI 1.22-1.93; P < 0.001). Pooling only the matched populations (1143 pairs), ViV-TAVI showed a lower risk of all-cause mortality in the first 55 days [hazard ratio (HR) 0.63, 95% confidence interval (CI) 0.45-0.89, P < 0.001], with a reversal HR after 212 days favoring redo SAVR (HR 1.57; 95% CI 1.22-2.03; P < 0.001). The Cox regression model showed a statistically significant association of prosthesis-patient mismatch (PPM) with all-cause mortality during follow-up for ViV-TAVI (HR 1.03 per percentage increase in the study- and treatment arm-level proportion of PPM, 95% 1.02-1.05, P < 0.001). CONCLUSION ViV-TAVI is associated with a strong protective effect immediately after the procedure in comparison with redo SAVR, however, this initial advantage reverses over time and redo SAVR seems to be a protective factor for all-cause mortality after 6 months. Considering that these results are the fruit of pooling data from observational studies, they should be interpreted with caution and trials are warranted.
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Affiliation(s)
- Michel Pompeu Sá
- Department of Cardiothoracic Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, PA, USA; Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, PA, USA.
| | | | | | - Sameer Hirji
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ozgun Erten
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, PA, USA
| | - Xander Jacquemyn
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Panagiotis Tasoudis
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, PA, USA
| | - Alexander Dokollari
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, PA, USA
| | - Serge Sicouri
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, PA, USA
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Rakesh Arora
- Department of Surgery, Section of Cardiac Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marie-Annick Clavel
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Québec, Canada; Department of Medicine, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
| | - Philippe Pibarot
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Québec, Canada; Department of Medicine, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
| | - Basel Ramlawi
- Department of Cardiothoracic Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, PA, USA; Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, PA, USA
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13
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Herrmann HC, Pibarot P, Wu C, Hahn RT, Tang GHL, Abbas AE, Playford D, Ruel M, Jilaihawi H, Sathananthan J, Wood DA, De Paulis R, Bax JJ, Rodes-Cabau J, Cameron DE, Chen T, Del Nido PJ, Dweck MR, Kaneko T, Latib A, Moat N, Modine T, Popma JJ, Raben J, Smith RL, Tchetche D, Thomas MR, Vincent F, Yoganathan A, Zuckerman B, Mack MJ, Leon MB. Bioprosthetic Aortic Valve Hemodynamics: Definitions, Outcomes, and Evidence Gaps: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 80:527-544. [PMID: 35902177 DOI: 10.1016/j.jacc.2022.06.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/19/2022] [Accepted: 06/01/2022] [Indexed: 12/23/2022]
Abstract
A virtual workshop was organized by the Heart Valve Collaboratory to identify areas of expert consensus, areas of disagreement, and evidence gaps related to bioprosthetic aortic valve hemodynamics. Impaired functional performance of bioprosthetic aortic valve replacement is associated with adverse patient outcomes; however, this assessment is complicated by the lack of standardization for labelling, definitions, and measurement techniques, both after surgical and transcatheter valve replacement. Echocardiography remains the standard assessment methodology because of its ease of performance, widespread availability, ability to do serial measurements over time, and correlation with outcomes. Management of a high gradient after replacement requires integration of the patient's clinical status, physical examination, and multimodality imaging in addition to shared patient decisions regarding treatment options. Future priorities that are underway include efforts to standardize prosthesis sizing and labelling for both surgical and transcatheter valves as well as trials to characterize the consequences of adverse hemodynamics.
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Affiliation(s)
- Howard C Herrmann
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Philippe Pibarot
- Department of Medicine, Québec Heart and Lung Institute, Laval University, Québec City, Quebec, Canada
| | - Changfu Wu
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Rebecca T Hahn
- Columbia University Medical Center, New York, New York, USA
| | | | - Amr E Abbas
- Beaumont Hospital Royal Oak, Royal Oak, Michigan, USA
| | - David Playford
- The University of Notre Dame, Fremantle, Western Australia, Australia
| | - Marc Ruel
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Hasan Jilaihawi
- Heart Valve Center, NYU Langone Health, New York, New York, USA
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - David A Wood
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Jeroen J Bax
- Leiden University Medical Centre, Leiden, the Netherlands
| | - Josep Rodes-Cabau
- Department of Medicine, Québec Heart and Lung Institute, Laval University, Québec City, Quebec, Canada
| | - Duke E Cameron
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Tiffany Chen
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pedro J Del Nido
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Tsuyoshi Kaneko
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Neil Moat
- Abbott Structural Heart, Santa Clara, California, USA
| | - Thomas Modine
- Hopital Cardiologique de Haut Leveque, Bordeaux, France
| | | | - Jamie Raben
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Robert L Smith
- Baylor Scott and White, The Heart Hospital, Plano, Texas, USA
| | | | | | | | - Ajit Yoganathan
- Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
| | - Bram Zuckerman
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Michael J Mack
- Baylor Scott and White, The Heart Hospital, Plano, Texas, USA
| | - Martin B Leon
- Columbia University Medical Center, New York, New York, USA
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14
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Shih E, DiMaio J, Squiers JJ, Rahimighazikalayeh G, Meidan TC, Brinkman WT, Harrington KB, Schaffer JM, Ryan WH, Mack MJ. Outcomes of aortic root enlargement during isolated aortic valve replacement. J Card Surg 2022; 37:2389-2394. [DOI: 10.1111/jocs.16645] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Emily Shih
- Department of General Surgery Baylor University Medical Center Dallas Texas USA
- Baylor Scott and White Research Institute Dallas Texas USA
| | - J. Michael DiMaio
- Baylor Scott and White Research Institute Dallas Texas USA
- Department of Cardiothoracic Surgery Baylor Scott and White The Heart Hospitals Plano Texas USA
| | - John J. Squiers
- Department of General Surgery Baylor University Medical Center Dallas Texas USA
- Department of Cardiothoracic Surgery Baylor Scott and White The Heart Hospitals Plano Texas USA
| | | | | | - William T. Brinkman
- Department of Cardiothoracic Surgery Baylor Scott and White The Heart Hospitals Plano Texas USA
| | - Katherine B. Harrington
- Department of Cardiothoracic Surgery Baylor Scott and White The Heart Hospitals Plano Texas USA
| | - Justin M. Schaffer
- Department of Cardiothoracic Surgery Baylor Scott and White The Heart Hospitals Plano Texas USA
| | - William H. Ryan
- Department of Cardiothoracic Surgery Baylor Scott and White The Heart Hospitals Plano Texas USA
| | - Michael J. Mack
- Baylor Scott and White Research Institute Dallas Texas USA
- Department of Cardiothoracic Surgery Baylor Scott and White The Heart Hospitals Plano Texas USA
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15
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Pompeu Sá M, Van den Eynde J, Amabile A, Malin JH, Jacquemyn X, Tasoudis P, Sicouri S, Schena S, Torregrossa G, Ramlawi B. Late Outcomes Following Aortic Root Enlargement during Aortic Valve Replacement: Meta-Analysis with Reconstructed Time-to-Event Data. J Cardiothorac Vasc Anesth 2022; 36:3065-3073. [DOI: 10.1053/j.jvca.2022.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/15/2022] [Accepted: 04/08/2022] [Indexed: 11/11/2022]
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16
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Mehaffey JH. Aortic Annular Enlargement during Aortic Valve Replacement: Shedding Light on the Conundrum. Ann Thorac Surg 2021; 114:1526. [PMID: 34780760 DOI: 10.1016/j.athoracsur.2021.10.013] [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: 10/13/2021] [Accepted: 10/13/2021] [Indexed: 11/29/2022]
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17
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De Martino A, Milano AD, Bortolotti U. ENLARGENMENT OF THE AORTIC ANNULUS DURING AORTIC VALVE REPLACEMENT: A still unresolved conundrum. Ann Thorac Surg 2021; 114:1525-1526. [PMID: 34762871 DOI: 10.1016/j.athoracsur.2021.09.066] [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: 09/21/2021] [Accepted: 09/24/2021] [Indexed: 11/29/2022]
Affiliation(s)
| | - Aldo D Milano
- Division of Cardiac Surgery, University Hospital, Bari, Italy
| | - Uberto Bortolotti
- Division of Cardiac Surgery, University Hospital, Pisa, Italy, Largo Traiano 23 35036 Montegrotto Terme, Italy
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18
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Khoshhal Z, Tam DY, Gaudino M. Aortic root enlargement - doing too much or not enough? Ann Thorac Surg 2021; 113:699-700. [PMID: 33711297 DOI: 10.1016/j.athoracsur.2021.02.068] [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: 02/12/2021] [Accepted: 02/20/2021] [Indexed: 11/01/2022]
Affiliation(s)
- Zeyad Khoshhal
- Division of Vascular Surgery, Department of Surgery, University of Toronto
| | - Derrick Y Tam
- Division of Cardiac Surgery, Department of Surgery, University of Toronto
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine 525 East 68th Street, New York, NY 10065.
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19
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Aortic Root Enlargement - Defining Risk and Reward. Ann Thorac Surg 2021; 113:700-701. [PMID: 33711305 DOI: 10.1016/j.athoracsur.2021.03.005] [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: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 11/23/2022]
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20
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Mori M, Geirsson A. Trading the proximal risk for the distal payout in annular enlargement with aortic valve replacement. Ann Thorac Surg 2021; 112:1166-1167. [PMID: 33607050 DOI: 10.1016/j.athoracsur.2021.01.058] [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: 01/05/2021] [Accepted: 01/17/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Makoto Mori
- Division of Cardiac Surgery, Yale School of Medicine, BB204, 330 Cedar Street P.O. Box 208039, 06510
| | - Arnar Geirsson
- Division of Cardiac Surgery, Yale School of Medicine, BB204, 330 Cedar Street P.O. Box 208039, 06510.
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