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Pocar M, Barbero C, Marro M, Ferrante L, Costamagna A, Fazio L, La Torre M, Boffini M, Salizzoni S, Rinaldi M. Homograft Aortic Root Replacement for Destructive Prosthetic Valve Endocarditis: Results in the Current Era. J Clin Med 2024; 13:4532. [PMID: 39124799 PMCID: PMC11313369 DOI: 10.3390/jcm13154532] [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: 05/02/2024] [Revised: 06/27/2024] [Accepted: 07/04/2024] [Indexed: 08/12/2024] Open
Abstract
Background: Destructive aortic prosthetic valve endocarditis portends a high morbidity and mortality, and requires complex high-risk surgery. Homograft root replacement is the most radical and biocompatible operation and, thus, the preferred option. Methods: A retrospective analysis was conducted on 61 consecutive patients who underwent a cardiac reoperation comprising homograft aortic root replacement since 2010. The probabilities of survival were calculated with the Kaplan-Meier method, whereas multivariable regression served to outline the predictors of adverse events. The endpoints were operative/late death, perioperative low cardiac output and renal failure, and reoperations. Results: The operative (cumulative hospital and 30-day) mortality was 13%. The baseline aspartate transaminase (AST) and associated mitral procedures were predictive of operative death (p = 0.048, OR [95% CIs] = 1.03 [1-1.06]) and perioperative low cardiac output, respectively (p = 0.04, OR [95% CIs] = 21.3 [2.7-168.9] for valve replacement). The latter occurred in 12 (20%) patients, despite a normal ejection fraction. Survival estimates (±SE) at 3 months, 6 months, 1 year, and 3 years after surgery were 86.3 ± 4.7%, 82.0 ± 4.9%, 75.2 ± 5.6, and 70.0 ± 6.3%, respectively. Survival was significantly lower in the case of AST ≥ 40 IU/L (p = 0.04) and aortic cross-clamp time ≥ 180 min (p = 0.01), but not when excluding operative survivors. Five patients required early (two out of the five, within 3 months) or late (three out of the five) reoperation. Conclusions: Homograft aortic root replacement for destructive prosthetic valve endocarditis can currently be performed with a near 90% operative survival and reasonable 3-year mortality and reoperation rate. AST might serve to additionally stratify the operative risk.
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Affiliation(s)
- Marco Pocar
- Division of Cardiac Surgery and Cardiothoracic Transplantation, Città della Salute e della Scienza, 10126 Turin, Italy; (C.B.); (L.F.); (M.L.T.); (M.B.); (S.S.)
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Cristina Barbero
- Division of Cardiac Surgery and Cardiothoracic Transplantation, Città della Salute e della Scienza, 10126 Turin, Italy; (C.B.); (L.F.); (M.L.T.); (M.B.); (S.S.)
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
| | - Matteo Marro
- Division of Cardiac Surgery and Cardiothoracic Transplantation, Città della Salute e della Scienza, 10126 Turin, Italy; (C.B.); (L.F.); (M.L.T.); (M.B.); (S.S.)
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
| | - Luisa Ferrante
- Division of Cardiac Surgery and Cardiothoracic Transplantation, Città della Salute e della Scienza, 10126 Turin, Italy; (C.B.); (L.F.); (M.L.T.); (M.B.); (S.S.)
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
| | - Andrea Costamagna
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
- Cardiac Intensive Care Unit, Department of Anaesthesia, Intensive Care and Emergency, Città della Salute e della Scienza, 10126 Turin, Italy
| | - Luigina Fazio
- Tissue Bank, Città della Salute e della Scienza, 10126 Turin, Italy
| | - Michele La Torre
- Division of Cardiac Surgery and Cardiothoracic Transplantation, Città della Salute e della Scienza, 10126 Turin, Italy; (C.B.); (L.F.); (M.L.T.); (M.B.); (S.S.)
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
| | - Massimo Boffini
- Division of Cardiac Surgery and Cardiothoracic Transplantation, Città della Salute e della Scienza, 10126 Turin, Italy; (C.B.); (L.F.); (M.L.T.); (M.B.); (S.S.)
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
| | - Stefano Salizzoni
- Division of Cardiac Surgery and Cardiothoracic Transplantation, Città della Salute e della Scienza, 10126 Turin, Italy; (C.B.); (L.F.); (M.L.T.); (M.B.); (S.S.)
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
| | - Mauro Rinaldi
- Division of Cardiac Surgery and Cardiothoracic Transplantation, Città della Salute e della Scienza, 10126 Turin, Italy; (C.B.); (L.F.); (M.L.T.); (M.B.); (S.S.)
- Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
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2
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Baudo M, Cuko B, Ternacle J, Sicouri S, Torregrossa G, Pernot M, Busuttil O, Beurton A, Alaux A, Ouattara A, Lafitte S, Bonnet G, Leroux L, De Vincentiis C, Labrousse L, Ramlawi B, Modine T. Transcatheter valve-in-valve interventions after aortic root replacement: A systematic review. Catheter Cardiovasc Interv 2024; 103:1101-1110. [PMID: 38532517 DOI: 10.1002/ccd.31027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/08/2024] [Accepted: 03/19/2024] [Indexed: 03/28/2024]
Abstract
Structural valve deterioration after aortic root replacement (ARR) surgery may be treated by transcatheter valve-in-valve (ViV-TAVI) intervention. However, several technical challenges and outcomes are not well described. The aim of the present review was to analyze the outcomes of ViV-TAVI in deteriorated ARR. This review included studies reporting any form of transcatheter valvular intervention in patients with a previous ARR. All forms of ARR were considered, as long as the entire root was replaced. Pubmed, ScienceDirect, SciELO, DOAJ, and Cochrane library databases were searched until September 2023. Overall, 86 patients were included from 31 articles that met our inclusion criteria out of 741 potentially eligible studies. In the entire population, the mean time from ARR to reintervention was 11.0 years (range: 0.33-22). The most frequently performed techniques/grafts for ARR was homograft (67.4%) and the main indication for intervention was aortic regurgitation (69.7%). Twenty-three articles reported no postoperative complications. Six (7.0%) patients required permanent pacemaker implantation (PPI) after the ViV-TAVI procedure, and 4 (4.7%) patients had a second ViV-TAVI implant. There were three device migrations (3.5%) and 1 stroke (1.2%). Patients with previous ARR present a high surgical risk. ViV-TAVI can be considered in selected patients, despite unique technical challenges that need to be carefully addressed according to the characteristics of the previous surgery and on computed tomography analysis.
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Affiliation(s)
- Massimo Baudo
- Department of Cardiac Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania, USA
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Besart Cuko
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Pessac, France
| | - Julien Ternacle
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Pessac, France
| | - Serge Sicouri
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Gianluca Torregrossa
- Department of Cardiac Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania, USA
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Mathieu Pernot
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Pessac, France
| | - Olivier Busuttil
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Pessac, France
| | - Antoine Beurton
- Department of Cardiovascular Anesthesia and Critical Care, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Pessac, France
| | - Anouk Alaux
- Department of Cardiovascular Anesthesia and Critical Care, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Pessac, France
| | - Alexandre Ouattara
- Department of Cardiovascular Anesthesia and Critical Care, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Pessac, France
| | - Stephane Lafitte
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Pessac, France
| | - Guillaume Bonnet
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Pessac, France
- Cardiovascular Research Foundation, New York, New York, USA
| | - Lionel Leroux
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Pessac, France
| | | | - Louis Labrousse
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Pessac, France
| | - Basel Ramlawi
- Department of Cardiac Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania, USA
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Thomas Modine
- Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Pessac, France
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3
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Singh SK, Levine D, Patel P, Norton E, Wang C, Kurlansky P, Childress P, Chung M, Olakunle O, George I, Leshnower B, Chen EP, Takayama H. Reintervention after valve-sparing aortic root replacement: A comprehensive analysis of 781 David V procedures. J Thorac Cardiovasc Surg 2024; 167:1229-1238.e7. [PMID: 37156363 DOI: 10.1016/j.jtcvs.2023.04.013] [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: 03/05/2023] [Revised: 04/05/2023] [Accepted: 04/12/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Studies of reintervention after valve-sparing aortic root replacement (VSRR) are limited by sample size and failure to evaluate all types of reinterventions, including distal aorta and transcatheter interventions. In this report, reintervention after VSRR using a large patient cohort was comprehensively analyzed. METHODS In a series involving 2 academic aortic centers, 781 consecutive patients from 2005 to 2020 undergoing David V VSRR for aortic aneurysm (91%) or dissection (9%) were included. Median age was 50 years, and 23% had a bicuspid aortic valve (AV). Median follow-up was 7.0 years. Open or transcatheter reintervention on the AV, proximal, or distal thoracic aorta was identified. Cumulative incidence was calculated, and subdistribution hazard models identified factors associated with reintervention. Time-dependent incidence of reintervention was plotted using risk-hazard functions. RESULTS Sixty-eight reinterventions (57 open, 11 transcatheter) were performed. Reinterventions were divided by indication into degenerative AV (n = 26, including 1 transcatheter aortic valve replacement), endocarditis (n = 11), proximal aorta (n = 8), and distal aorta (n = 23, including 10 thoracic endovascular aortic repairs). Risk of reintervention for endocarditis peaked 1 to 3 years after VSRR, whereas other indications had stable, low rates of occurrence throughout the follow-up period. The cumulative incidence of reintervention was 12.5% whereas the cumulative incidence of AV reintervention was 7.0% at 10 years and was associated with residual postoperative aortic insufficiency. In-hospital mortality after reintervention was 3%. CONCLUSIONS Reintervention rates after VSRR are relatively low in long-term follow-up and can be performed with acceptable operative risk. The majority of reinterventions are performed for indications other than AV degeneration, with the timing of reintervention varying by the specific clinical indication.
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Affiliation(s)
- Sameer K Singh
- Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Irving Medical Center, New York, NY
| | - Dov Levine
- Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Irving Medical Center, New York, NY
| | - Parth Patel
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Elizabeth Norton
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Chunhui Wang
- Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Irving Medical Center, New York, NY
| | - Paul Kurlansky
- Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Irving Medical Center, New York, NY
| | - Patra Childress
- Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Irving Medical Center, New York, NY
| | - Megan Chung
- Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Irving Medical Center, New York, NY
| | - Oreoluwa Olakunle
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Isaac George
- Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Irving Medical Center, New York, NY
| | - Bradley Leshnower
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC
| | - Hiroo Takayama
- Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Irving Medical Center, New York, NY.
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4
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Ram E, Lau C, Dimagli A, Gaudino M, Girardi LN. Valve Sparing vs Composite Valve Graft Root Replacement: Propensity Score-Matched Analysis. Ann Thorac Surg 2024; 117:69-76. [PMID: 37541560 DOI: 10.1016/j.athoracsur.2023.05.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 04/25/2023] [Accepted: 05/30/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND Both valve-sparing root replacement and composite valve graft (CVG) are acceptable options in aortic root replacement. We compare outcomes of these 2 approaches and durability of the aortic valve. METHODS A consecutive 1635 patients without acute dissection underwent primary aortic root replacement from 1997 to 2022; 473 (29%) underwent valve-sparing root replacement, and 1162 (71%) received CVG. Propensity score matching was used to reduce baseline differences. RESULTS The CVG group was older (59 ± 14 years vs 49 ± 14 years; P < .001) with more comorbidities, such as hypertension (88.4% vs 66.4%; P < .001), diabetes (7% vs 1.7%; P < .001), ischemic heart disease (5.1% vs 1.3%; P = .001), pulmonary disease (6.6% vs 1.3%; P < .001), renal impairment (8.6% vs 1.3%; P < .001), class III-IV heart failure (35% vs 9.2%; P < .001), bicuspid aortic valves (44.8% vs 24.1%; P < .001), and severe aortic insufficiency (50.2% vs 13.2%; P < .001). Operative mortality was 0.4% (0% in valve sparing); incidence of major postoperative complications was 2.9% (3.6% vs 1.1%; P = .009). Ten-year survival was 93.1% (91.2% vs 97.7%; hazard ratio [HR], 1.7; 95% CI, 0.9-3.3; P = .120). Mean follow-up was 65 ± 60 months; aortic valve reoperations were similar (5.8% vs 5.7%; HR, 0.8; 95% CI, 0.4-1.4; P = .401). Recurrent moderate-severe aortic insufficiency was less prevalent in CVG (6.1% vs 11.1%; HR, 0.14; 95% CI, 0.07-0.27; P < .001). Propensity score matching identified 225 pairs. There was no difference in 10-year survival or reoperations. Recurrent moderate-severe aortic insufficiency was higher with valve sparing. CONCLUSIONS Both valve-sparing operations and CVG provide excellent early and late outcomes out to 10 years. Valve sparing is associated with a higher risk for development of aortic insufficiency but no difference in reoperations.
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Affiliation(s)
- Eilon Ram
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Christopher Lau
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Arnaldo Dimagli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
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5
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Vekstein AM, Wojnarski CM, Weissler EH, Williams AR, Plichta RP, Schroder JN, Hughes GC. Selective Sinus Replacement for Aortic Root Aneurysm: Durable Approach in Selected Patients. Ann Thorac Surg 2023; 115:378-385. [PMID: 35872034 DOI: 10.1016/j.athoracsur.2022.05.071] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/15/2022] [Accepted: 05/09/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Selective sinus replacement (SSR) allows a tailored repair approach in patients with sinus of Valsalva or asymmetric aortic root aneurysm. SSR avoids the need for coronary reimplantation for nondiseased sinuses and shortens operative time, although potential for late growth of retained sinuses exists. This study describes selection of patients and assesses operative outcomes and late root dimensions after SSR. METHODS From 2006 to 2020, 60 patients underwent SSR at a single referral institution. Mixed effect models were used to assess trajectory of postoperative growth of remaining sinuses, adjusting for age of the patient, valve morphology, and baseline root diameter. RESULTS Median age of the patients was 57 (interquartile range [IQR], 48-65) years. Twenty-four (40%) had a bicuspid aortic valve. Most patients (n = 55 [92%]) underwent single sinus replacement (n = 46 noncoronary, n = 9 right), whereas 5 (8%) underwent repair of both the right and noncoronary sinuses. Concomitant aortic valve replacement was performed in 15 patients (25%); aortic valve repair with internal ring annuloplasty or cusp plication was performed in 37 (62%). There was no operative death, stroke, renal failure, or respiratory failure. Median preoperative root diameter was 53 mm (IQR, 51-56 mm) vs 42 mm (IQR, 39-45 mm) at median imaging follow-up of 34 (IQR, 13-49) months. Rate of midterm root growth was 0.2 mm/y, and there were no late root reinterventions. CONCLUSIONS For patients with sinus of Valsalva or asymmetric root aneurysm, SSR is associated with excellent operative outcomes, and midterm follow-up suggests that the technique is durable. Longer term follow-up is needed to confirm continued stability of the aortic root.
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Affiliation(s)
- Andrew M Vekstein
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Charles M Wojnarski
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - E Hope Weissler
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Adam R Williams
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Ryan P Plichta
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Jacob N Schroder
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
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Nardi P, Pisano C, Bassano C, Bertoldo F, Salvati AC, Buioni D, Trombetti D, Asta L, Scognamiglio M, Altieri C, Ruvolo G. Bentall Operation: Early Surgical Results, Seven-Year Outcomes, and Risk Factors Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:212. [PMID: 36612535 PMCID: PMC9820033 DOI: 10.3390/ijerph20010212] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
Aim: To analyze early and mid-term outcomes of the Bentall operation. Methods: Two hundred and seventeen patients (mean age 65.6 ± 15.9 years, males/females 172/45) underwent Bentall operation in a 7-year period (January 2015−December 2021), on average, 30 Bentall operations occurred per year, using biological (n = 104) or mechanical (n = 113) valved conduits for the treatment of ascending aorta−aortic root aneurysms. Associate procedures were performed in 58 patients (26.7%); coronary artery bypass grafting (CABG) in 35 (16%). Mean follow-up was 55.2 ± 24 (median 60.2) months. Cox model analysis was used to assess risk factors, Kaplan−Meier and log-rank tests were used to assess different survival rates. Results: Operative mortality was 1.38%. At 7 years, survival, freedom from cardiac death, and event-free survival were 93% ± 2%, 99% ± 1%, and 81% ± 5%. NYHA class (p < 0.0001), trans-aortic valve mean (p < 0.0001) and maximum (p < 0.000) gradients, left ventricular hypertrophy (p < 0.05), and pulmonary arterial pressure (p = 0.002) significantly improved vs. preoperative values. Concomitant CABG during Bentall operation independently affected late outcomes (HR 1.9−2.3; p-values < 0.05). Late survival was affected by concomitant CABG (84% ± 8% vs. 95% ± 2%, p = 0.04), preoperative myocardial infarction (91% ± 9% vs. 97% ± 2%, p = 0.02), and biological vs. mechanical prostheses valved conduits (91% ± 9% vs. 95% ± 3%, p = 0.02). Event-free survival also was affected by concomitant CABG (62% ± 14% vs. 85% ± 5%, p = 0.005) and biological prostheses (78% ± 8% vs. 84% ± 6%, p = 0.06). Freedom from endocarditis−redo operation was 83% ± 9% for biological prostheses vs. 89% ± 6% for mechanical prostheses (p = 0.49). Conclusions: Low rates of operative mortality and late complications make Bentall operation the gold standard for the treatment of ascending aorta−aortic root aneurysms. Coronary ischemic disease affects late outcomes. Biological prostheses should be preferred for the elderly.
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Affiliation(s)
- Paolo Nardi
- Cardiac Surgery Division, Tor Vergata University Hospital, Tor Vergata University, 00133 Rome, Italy
| | - Calogera Pisano
- Cardiac Surgery Division, Tor Vergata University Hospital, Tor Vergata University, 00133 Rome, Italy
| | - Carlo Bassano
- Cardiac Surgery Division, Tor Vergata University Hospital, Tor Vergata University, 00133 Rome, Italy
| | - Fabio Bertoldo
- Cardiac Surgery Division, Tor Vergata University Hospital, Tor Vergata University, 00133 Rome, Italy
| | | | - Dario Buioni
- Cardiac Surgery Division, Tor Vergata University Hospital, Tor Vergata University, 00133 Rome, Italy
| | - Daniele Trombetti
- Cardiac Surgery Division, Tor Vergata University Hospital, Tor Vergata University, 00133 Rome, Italy
| | - Laura Asta
- Cardiac Surgery Division, Tor Vergata University Hospital, Tor Vergata University, 00133 Rome, Italy
| | - Mattia Scognamiglio
- Cardiac Surgery Division, Tor Vergata University Hospital, Tor Vergata University, 00133 Rome, Italy
| | - Claudia Altieri
- Cardiology Unit of the Cardiac Surgery Division, Tor Vergata University Hospital, Tor Vergata University, 00133 Rome, Italy
| | - Giovanni Ruvolo
- Cardiac Surgery Division, Tor Vergata University Hospital, Tor Vergata University, 00133 Rome, Italy
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7
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Osada H, Kanemitsu H, Sakai J, Kumagai M, Yamazaki K, Minatoya K. Asymptomatic pseudoaneurysm 8 years after valve-sparing aortic root replacement. JTCVS Tech 2022; 14:48-49. [PMID: 35967214 PMCID: PMC9367199 DOI: 10.1016/j.xjtc.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/09/2022] [Indexed: 11/06/2022] Open
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8
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de Oliveira Marreiros DJ, Tomšič A, van Brakel TJ, Hamming JF, Scholte AJHA, Hjortnaes J, Klautz RJM. Computed tomography follow-up after elective proximal aortic surgery: Less is more? Am Heart J 2022; 249:66-75. [PMID: 35436505 DOI: 10.1016/j.ahj.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 03/16/2022] [Accepted: 04/07/2022] [Indexed: 06/14/2023]
Abstract
STUDY OBJECTIVE The added value of computed tomography (CT) follow-up after elective proximal aortic surgery is unclear. We evaluated the benefit of CT follow-up by assessing the incidence of aorta-related complications and reinterventions detected during routine CT follow-up. METHODS Data on 314 patients undergoing first time elective proximal aortic surgery between 2000 and 2015 were collected. The primary study end points were aorta-related complications and reinterventions, detected during routine CT follow-up. Secondary study endpoints included all aorta-related complications and reinterventions, irrespective of the mode of detection and survival. RESULTS Median CT follow-up time was 6.8 (IQR 4.1-9.8) years, during which a total of 1303 routine follow-up CT-scans (median 4, IQR 3-5) were performed. During CT follow-up, aorta-related complications were detected in 18 (5.7%) patients, of which 6 (1.6%) underwent reintervention. In total, 28 aorta-related complications were observed in 23 (7.3%) patients, of which 9 led to reintervention. In order to detect 1 aorta-related complication leading to reintervention, 218 routine follow-up CT-scans were required. The unadjusted and EuroSCORE II adjusted hazard ratios of not undergoing CT follow-up on mortality were 1.260 (95% CI 0.705-2.251) and 0.830 (95% CI 0.430-1.605), respectively. CONCLUSIONS Following first time elective proximal aortic surgery, aorta-related complications are uncommon, are not always detected during CT follow-up and, if detected, often do not result in reintervention. Therefore, a more conservative CT follow-up protocol could be considered in selected patients to reduce lifetime radiation burden and health care costs.
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Affiliation(s)
| | - Anton Tomšič
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Thomas J van Brakel
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Jaap F Hamming
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Arthur J H A Scholte
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jesper Hjortnaes
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
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9
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Comentale G, Pinna GB, Parisi V, Manzo R, Pilato E. Incidental finding of rare and huge asymptomatic pseudoaneurysm after Bentall procedure: A challenging case report. J Card Surg 2022; 37:1773-1775. [PMID: 35286731 DOI: 10.1111/jocs.16415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/22/2022] [Indexed: 11/30/2022]
Abstract
We report the case of a 62-year-old male who underwent urgent cardiac surgery due to the incidental finding of a huge and asymptomatic coronary button pseudoaneurysm at an 18-month outpatients clinic follow-up requiring a very complex preoperative planning.
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Affiliation(s)
- Giuseppe Comentale
- Division of Cardiac Surgery, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.,Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giovanni B Pinna
- Division of Cardiac Surgery, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Valentina Parisi
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Rachele Manzo
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Emanuele Pilato
- Division of Cardiac Surgery, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
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Valve Sparing Root Replacement versus Bio-Bentall: Inverse Propensity Weighting of 796 Patients. Ann Thorac Surg 2021; 113:1529-1535. [PMID: 34116001 DOI: 10.1016/j.athoracsur.2021.05.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/22/2021] [Accepted: 05/11/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND This large cohort, single center study aims to compare the 10-year survival and freedom from aortic valve reintervention between valve sparing root replacement (VSRR) and bioprosthetic Bentall (bio-Bentall). METHODS All patients undergoing elective VSRR or bio-Bentall for aortic root aneurysm between March 2005 through October 2019 were retrospectively reviewed (n=796 [VSRR = 360]). Inverse probability of treatment weighting (IPTW) balanced clinical variables between groups. Mean follow-up was 58.0 +/- 45.4 (range 0-167) months. RESULTS After IPTW adjustment, 10-year survival did not differ between groups (VSRR: 87.0% vs bio-Bentall: 92.7%, p=0.780). Cumulative incidence of aortic valve reintervention was 5.9% for VSRR (95% CI, 2.9%-10.4%) and 10.6% for bio-Bentall (95% CI, 6.2%-16.4%, p=0.798). Fine and Gray computing risk regression model identified age at surgery (sHR 0.97, 95% CI, 0.95-0.99, p=0.015), body surface area (sHR 6.21, 95% CI, 1.97-19.59, p=0.002) and bicuspid aortic valve (sHR 2.15, 95% CI, 1.04-4.44, p =0.038) as independently associated with aortic valve reintervention. For patients ≤50-year-old, cumulative incidence of aortic valve reintervention was 16.2% for VSRR (95% CI, 7.0%-28.8%) and 17.8% for bio-Bentall (95% CI, 6.9%-32.8%)(p=0.363). CONCLUSIONS VSRR and bio-Bentall show similar excellent survival and freedom from aortic reintervention rates up to 10 years; however, a durable valve solution for young patients with bicuspid aortic valve remains a challenge.
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