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Kang Y, Soehartono NA, Choi JW, Kim KH, Hwang HY, Kim JB, Kim HR, Lee SH, Cho YH. Recent Outcomes of Surgical Redo Aortic Valve Replacement in Prosthetic Valve Failure. Thorac Cardiovasc Surg 2024. [PMID: 38442916 DOI: 10.1055/a-2281-1897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
BACKGROUND As redo surgical aortic valve replacement (AVR) is relatively high risk, valve-in-valve transcatheter AVR has emerged as an alternative for failed prostheses. However, the majority of studies are outdated. This study assessed the current clinical outcomes of redo AVR. METHODS AND RESULTS This study enrolled 324 patients who underwent redo AVR due to prosthetic valve failure from 2010 to 2021 in four tertiary centers. The primary outcome was operative mortality. The secondary outcomes were overall survival, cardiac death, and aortic valve-related events. Logistic regression analysis, clustered Cox proportional hazards models, and competing risk analysis were used to evaluate the independent risk factors. Redo AVR was performed in 242 patients without endocarditis and 82 patients with endocarditis. Overall operative mortality was 4.6% (15 deaths). Excluding patients with endocarditis, the operative mortality of redo AVR decreased to 2.5%. Multivariate analyses demonstrated that endocarditis (hazard ratio [HR]: 3.990, p = 0.014), longer cardiopulmonary bypass time (HR: 1.006, p = 0.037), and lower left ventricular ejection fraction (LVEF) (HR: 0.956, p = 0.034) were risk factors of operative mortality. Endocarditis and lower LVEF were independent predictors of overall survival. CONCLUSION The relatively high risk of redo AVR was due to reoperation for prosthetic valve endocarditis. The outcomes of redo AVR for nonendocarditis are excellent. Our findings suggest that patients without endocarditis, especially with acceptable LVEF, can be treated safely with redo AVR.
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Affiliation(s)
- Yoonjin Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Nazla Amanda Soehartono
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Jongno-gu, Seoul, Republic of Korea
| | - Jae Woong Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyung Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hong Rae Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung Hyun Lee
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Republic of Korea
| | - Yang Hyun Cho
- Department of Thoracic and Cardiovascular Surgery, Heart Stroke Vascular Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Argaw S, Azizgolshani N, Blitzer D, Takayama H, George I, Pirelli L. Treatment options for isolated aortic valve insufficiency: a review. Front Cardiovasc Med 2024; 11:1381102. [PMID: 38665234 PMCID: PMC11043486 DOI: 10.3389/fcvm.2024.1381102] [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: 02/02/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
Aortic insufficiency (AI) is a valvular disease with increasing prevalence in older patients. The modern era provides numerous options for the management of AI which is explored here. Traditional interventions included aortic valve replacement with either mechanical or bioprosthetic aortic valves. While the former is known for its durability, it has grown out of favor due to the potential complications of anticoagulation. The preference for bioprosthetic valves is thus on the rise, especially with the advancements of transcatheter technology and the use of valve-in-valve therapy. Surgical options are also no longer limited to replacement but include complex techniques such as those required for aortic valve repair, Ozaki neocuspidization, Ross procedure and valve-sparring aortic root repair. Transcatheter options for the management of AI are not commercially available currently; however, preliminary data from ad-hoc trials, showed promising results and potential use of transcatheter technology in a variety of patients with pure AI.
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Affiliation(s)
| | | | | | | | | | - Luigi Pirelli
- Division of Cardiovascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY, United States
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3
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Narayan P, Dong T, Dimagli A, Fudulu DP, Chan J, Sinha S, Angelini GD. Impact of explanted valve type on aortic valve reoperations: nationwide UK experience. Eur J Cardiothorac Surg 2024; 65:ezae031. [PMID: 38305431 PMCID: PMC10902681 DOI: 10.1093/ejcts/ezae031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/19/2024] [Accepted: 01/29/2024] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVES This nationwide retrospective cohort study assessed the impact of the explanted valve type on reoperative outcomes in aortic valve surgery within the UK over a 23-year period. METHODS Data were sourced from the National Institute for Cardiovascular Outcomes Research (NICOR) database. All patients undergoing first-time isolated reoperative aortic valve replacement between 1996 and 2019 in the UK were included. Concomitant procedures, homograft implantation or aortic root enlargement were excluded. Propensity score matching was utilized to compare outcomes and risk factors for in-hospital mortality was evaluated through multivariable logistic regression. Final model selection was conducted using Akaike Information Criterion through bootstrapping. The primary end point was in-hospital mortality, and secondary end points included postoperative morbidities. RESULTS Out of 2371 patients, 24.9% had mechanical and 75% had bioprosthetic valves implanted during the primary procedure. Propensity matched groups of 324 patients each, were compared. In-hospital mortality for mechanical and bioprosthetic valve explants was 7.1% and 5.9%, respectively (P = 0.632). On multivariable logistic regression analysis, valve type was not a risk factor for mortality [odds ratio (OR) 0.62, 95% confidence interval (CI) 0.37-1.05; P = 0.1]. Age (OR 1.03, 95% CI 1.01-1.05; P < 0.05), left ventricular ejection fraction (OR 1.62, 95% CI 1.08-2.42; P < 0.05), creatinine ≥ 200 mg/dl (OR 2.21, 95% CI 1.17-4.04; P < 0.05) and endocarditis (OR 2.66, 95% CI 1.71-4.14; P < 0.05) emerged as risk factors for mortality. CONCLUSIONS The type of valve initially implanted (mechanical or bioprosthetic) did not determine mortality. Instead, age, left ventricular ejection fraction, renal impairment and endocarditis were significant risk factors for in-hospital mortality.
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Affiliation(s)
- Pradeep Narayan
- Department of Cardiac Surgery, Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health, Kolkata, India
| | - Tim Dong
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol University, Bristol, UK
| | - Arnaldo Dimagli
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol University, Bristol, UK
| | - Daniel P Fudulu
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol University, Bristol, UK
| | - Jeremy Chan
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol University, Bristol, UK
| | - Shubhra Sinha
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol University, Bristol, UK
| | - Gianni D Angelini
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol University, Bristol, UK
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Salsano A, Di Mauro M, Labate L, Della Corte A, Lo Presti F, De Bonis M, Trumello C, Rinaldi M, Cura Stura E, Actis Dato G, Punta G, Nicolini F, Carino D, De Vincentiis C, Garatti A, Cappabianca G, Musazzi A, Cugola D, Merlo M, Pacini D, Folesani G, Sponga S, Vendramin I, Pilozzi Casado A, Rosato F, Mikus E, Savini C, Onorati F, Luciani GB, Scrofani R, Epifani F, Musumeci F, Lio A, Colli A, Falcetta G, Nicolardi S, Zaccaria S, Vizzardi E, Pantaleo A, Minniti G, Villa E, Dalla Tomba M, Pollari F, Barili F, Parolari A, Lorusso R, Santini F. Survival and Recurrence of Endocarditis following Mechanical vs. Biological Aortic Valve Replacement for Endocarditis in Patients Aged 40 to 65 Years: Data from the INFECT-Registry. J Clin Med 2023; 13:153. [PMID: 38202159 PMCID: PMC10779833 DOI: 10.3390/jcm13010153] [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: 11/08/2023] [Revised: 12/21/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Infective endocarditis (IE) is a serious disease, and in many cases, surgery is necessary. Whether the type of prosthesis implanted for aortic valve replacement (AVR) for IE impacts patient survival is a matter of debate. The aim of the present study is to quantify differences in long-term survival and recurrence of endocarditis AVR for IE according to prosthesis type among patients aged 40 to 65 years. METHODS This was an analysis of the INFECT-REGISTRY. Trends in proportion to the use of mechanical prostheses versus biological ones over time were tested by applying the sieve bootstrapped t-test. Confounders were adjusted using the optimal full-matching propensity score. The difference in overall survival was compared using the Cox model, whereas the differences in recurrence of endocarditis were evaluated using the Gray test. RESULTS Overall, 4365 patients were diagnosed and operated on for IE from 2000 to 2021. Of these, 549, aged between 40 and 65 years, underwent AVR. A total of 268 (48.8%) received mechanical prostheses, and 281 (51.2%) received biological ones. A significant trend in the reduction of implantation of mechanical vs. biological prostheses was observed during the study period (p < 0.0001). Long-term survival was significantly higher among patients receiving a mechanical prosthesis than those receiving a biological prosthesis (hazard ratio [HR] 0.546, 95% CI: 0.322-0.926, p = 0.025). Mechanical prostheses were associated with significantly less recurrent endocarditis after AVR than biological prostheses (HR 0.268, 95%CI: 0.077-0.933, p = 0.039). CONCLUSIONS The present analysis of the INFECT-REGISTRY shows increased survival and reduced recurrence of endocarditis after a mechanical aortic valve prosthesis implant for IE in middle-aged patients.
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Affiliation(s)
- Antonio Salsano
- Division of Cardiac Surgery, Ospedale Policlinico San Martino, 16132 Genoa, Italy;
- DISC Department, University of Genoa, 16126 Genoa, Italy
| | - Michele Di Mauro
- CARIM Maastricht University, 6229 ER Maastricht, The Netherlands;
| | - Laura Labate
- Department of Health Sciences (DISSAL), University of Genoa, 16126 Genoa, Italy;
- Infectious Diseases Unit, Ospedale Policlinico San Martino-IRCCS, 16132 Genoa, Italy
| | - Alessandro Della Corte
- Unit of Cardiac Surgery, Department of Translational Medical Sciences, Monaldi Hospital, University of Campania “L. Vanvitelli”, 80131 Naples, Italy; (A.D.C.); (F.L.P.)
| | - Federica Lo Presti
- Unit of Cardiac Surgery, Department of Translational Medical Sciences, Monaldi Hospital, University of Campania “L. Vanvitelli”, 80131 Naples, Italy; (A.D.C.); (F.L.P.)
| | - Michele De Bonis
- IRCCS Ospedale San Raffaele, Division of Cardiac Surgery, Università Vita-Salute San Raffaele, 20132 Milan, Italy; (M.D.B.)
| | - Cinzia Trumello
- IRCCS Ospedale San Raffaele, Division of Cardiac Surgery, Università Vita-Salute San Raffaele, 20132 Milan, Italy; (M.D.B.)
| | - Mauro Rinaldi
- Cardiac Surgery, Molinette Hospital, University of Turin, 10124 Turin, Italy; (M.R.)
| | - Erik Cura Stura
- Cardiac Surgery, Molinette Hospital, University of Turin, 10124 Turin, Italy; (M.R.)
| | | | - Giuseppe Punta
- Cardiac Surgery, Mauriziano Hospital, 10128 Turin, Italy; (G.A.D.); (G.P.)
| | - Francesco Nicolini
- Cardiac Surgery, Maggiore University Hospital, University of Parma, 43121 Parma, Italy; (F.N.); (D.C.)
| | - Davide Carino
- Cardiac Surgery, Maggiore University Hospital, University of Parma, 43121 Parma, Italy; (F.N.); (D.C.)
| | - Carlo De Vincentiis
- Cardiac Surgery, San Donato IRCCS Hospital, San Donato Milanese, 20097 Milan, Italy; (C.D.V.); (A.G.)
| | - Andrea Garatti
- Cardiac Surgery, San Donato IRCCS Hospital, San Donato Milanese, 20097 Milan, Italy; (C.D.V.); (A.G.)
| | | | - Andrea Musazzi
- Cardiac Surgery, University Hospital, 21100 Varese, Italy; (G.C.); (A.M.)
| | - Diego Cugola
- Cardiac Surgery, AO Papa Giovanni XXIII, 24127 Bergamo, Italy; (D.C.); (M.M.)
| | - Maurizio Merlo
- Cardiac Surgery, AO Papa Giovanni XXIII, 24127 Bergamo, Italy; (D.C.); (M.M.)
| | - Davide Pacini
- Cardiac Surgery, S. Orsola-Malpighi University Hospital, University of Bologna, 40126 Bologna, Italy; (D.P.); (G.F.)
| | - Gianluca Folesani
- Cardiac Surgery, S. Orsola-Malpighi University Hospital, University of Bologna, 40126 Bologna, Italy; (D.P.); (G.F.)
| | - Sandro Sponga
- Cardiac Surgery, S. Maria Misericordia Hospital, University of Udine, 33100 Udine, Italy (I.V.)
| | - Igor Vendramin
- Cardiac Surgery, S. Maria Misericordia Hospital, University of Udine, 33100 Udine, Italy (I.V.)
| | | | - Francesco Rosato
- Cardiac Surgery, S. Croce Hospital, 12100 Cuneo, Italy; (A.P.C.); (F.R.); (F.B.)
| | - Elisa Mikus
- GVM Care & Research, Maria Cecilia Hospital, 48033 Cotignola, Italy; (E.M.); (C.S.)
| | - Carlo Savini
- GVM Care & Research, Maria Cecilia Hospital, 48033 Cotignola, Italy; (E.M.); (C.S.)
| | - Francesco Onorati
- Cardiac Surgery, University Hospital, University of Verona, 37129 Verona, Italy; (F.O.); (G.B.L.)
| | | | - Roberto Scrofani
- Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milano, Italy; (R.S.); (F.E.)
| | - Francesco Epifani
- Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20122 Milano, Italy; (R.S.); (F.E.)
| | - Francesco Musumeci
- Cardiac Surgery, San Camillo-Forlanini Hospital, 00152 Rome, Italy; (F.M.); (A.L.)
| | - Antonio Lio
- Cardiac Surgery, San Camillo-Forlanini Hospital, 00152 Rome, Italy; (F.M.); (A.L.)
| | - Andrea Colli
- Cardiac Surgery, AO Pisana University Hospital, University of Pisa, 56126 Pisa, Italy; (A.C.); (G.F.)
| | - Giosuè Falcetta
- Cardiac Surgery, AO Pisana University Hospital, University of Pisa, 56126 Pisa, Italy; (A.C.); (G.F.)
| | | | - Salvatore Zaccaria
- Cardiac Surgery, Vito Fazzi Hospital, 73100 Lecce, Italy; (S.N.); (S.Z.)
| | | | - Antonio Pantaleo
- Department of Cardiac Surgery, Azienda ULSS2 Ca’ Foncello Hospital, 31100 Treviso, Italy; (A.P.); (G.M.)
| | - Giuseppe Minniti
- Department of Cardiac Surgery, Azienda ULSS2 Ca’ Foncello Hospital, 31100 Treviso, Italy; (A.P.); (G.M.)
| | - Emmanuel Villa
- Department of Cardiac Surgery, Poliambulanza Foundation Hospital, 25124 Brescia, Italy; (E.V.); (M.D.T.)
| | - Margherita Dalla Tomba
- Department of Cardiac Surgery, Poliambulanza Foundation Hospital, 25124 Brescia, Italy; (E.V.); (M.D.T.)
| | - Francesco Pollari
- Cardiac Surgery, Klinikum Nürnberg–Paracelsus Medical University, 90419 Nuremberg, Germany;
| | - Fabio Barili
- Cardiac Surgery, S. Croce Hospital, 12100 Cuneo, Italy; (A.P.C.); (F.R.); (F.B.)
| | - Alessandro Parolari
- Department of Universitary Cardiac Surgery and Translational Research, IRCCS Policlinico S. Donato, University of Milan, 20122 Milan, Italy
- Department of Biomedical Sciences for Health, Università di Milano, 20122 Milan, Italy
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands;
| | - Francesco Santini
- Division of Cardiac Surgery, Ospedale Policlinico San Martino, 16132 Genoa, Italy;
- DISC Department, University of Genoa, 16126 Genoa, Italy
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Narayan P, Dimagli A, Fudulu DP, Sinha S, Dong T, Chan J, Angelini GD. Risk Factors and Outcomes of Reoperative Surgical Aortic Valve Replacement in the United Kingdom. Ann Thorac Surg 2023; 116:759-766. [PMID: 36716908 DOI: 10.1016/j.athoracsur.2022.12.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 12/07/2022] [Accepted: 12/29/2022] [Indexed: 01/29/2023]
Abstract
BACKGROUND Mortality after reoperative aortic valve surgery continues to decline but remains high compared with primary isolated replacement. We sought to examine temporal trends, morbidity, and mortality among patients undergoing isolated first-time reoperative aortic valve surgery. METHODS The study included all patients undergoing reoperative aortic valve surgery in the United Kingdom between January 2007 and March 2019. Patients undergoing isolated reoperative aortic valve replacement (AVR) were compared with a propensity matched cohort of patients undergoing isolated primary AVR. Outcomes measured included inhospital mortality, neurologic dysfunction, postoperative dialysis, deep sternal wound infections, and hospital length of stay. RESULTS During the study period, 40,858 primary isolated AVRs and 3015 first-time isolated reoperative AVRs were carried out in the United Kingdom. In the propensity matched reoperative group, median age of participants was 69.8 years (60.8-76.2) with median duration between the initial surgery and the reoperation being 7.69 years. Overall mortality was 3.1% (94) for reoperative AVR compared with 1.9% (56) for primary AVR. Mortality of both primary and reoperative AVR declined during the study period. Reoperation, age, New York Heart Association class, and chronic kidney disease were independently associated with early mortality. CONCLUSIONS Reoperative isolated AVR can be performed with acceptable inhospital mortality and provides a benchmark against which alternative strategies should be compared.
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Affiliation(s)
- Pradeep Narayan
- Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health, Mukundapur, Kolkata, West Bengal, India
| | - Arnaldo Dimagli
- Bristol Heart Institute, Bristol University, Bristol, United Kingdom
| | - Daniel P Fudulu
- Bristol Heart Institute, Bristol University, Bristol, United Kingdom
| | - Shubhra Sinha
- Bristol Heart Institute, Bristol University, Bristol, United Kingdom
| | - Tim Dong
- Bristol Heart Institute, Bristol University, Bristol, United Kingdom
| | - Jeremy Chan
- Bristol Heart Institute, Bristol University, Bristol, United Kingdom
| | - Gianni D Angelini
- Bristol Heart Institute, Bristol University, Bristol, United Kingdom.
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Mahboubi R, Kakavand M, Soltesz EG, Rajeswaran J, Blackstone EH, Svensson LG, Johnston DR. The decreasing risk of reoperative aortic valve replacement: Implications for valve choice and transcatheter therapy. J Thorac Cardiovasc Surg 2023; 166:1043-1053.e7. [PMID: 35397951 DOI: 10.1016/j.jtcvs.2022.02.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 12/31/2021] [Accepted: 02/10/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Increasing use of bioprostheses for surgical aortic valve replacement (SAVR) in younger patients, together with wider use of transcatheter aortic valve replacement, necessitates understanding risks associated with surgical valve reintervention. Therefore, we sought to identify risks of reoperative SAVR compared with those of primary isolated SAVR. METHODS From January 1980 to July 2017, 7037 patients underwent nonemergency isolated SAVR, with 753 reoperations and 6284 primary isolated operations. These 2 groups were propensity score-matched on 46 preoperative variables, yielding 581 patient pairs for comparing outcomes. RESULTS Among propensity score-matched patients, aortic clamp time (median 63 vs 52 minutes; P < .0001), cardiopulmonary bypass time (median 88 vs 67 minutes; P < .0001), and postoperative stay (median 7.1 vs 6.9 days; P = .003) were longer for reoperative SAVR than primary isolated SAVR. Hospital mortality after reoperative SAVR decreased from 3.4% in 1985 to 1.3% in 2011, similar to that of primary isolated SAVR. Occurrence of stroke, deep sternal wound infection, and new renal dialysis was similar. Blood transfusion (67% vs 36%; P < .0001) and reoperations for bleeding/tamponade (6.4% vs 3.1%; P = .009) were more common after reoperative SAVR. Survival at 1, 5, 10, and 20 years was 94%, 82%, 64%, and 33% after reoperative SAVR and 95%, 86%, 72%, and 46% after elective primary isolated SAVR. CONCLUSIONS Risk of mortality and morbidity after reoperative SAVR has declined and is now similar to that of primary isolated SAVR. Decisions regarding prosthesis choice and SAVR versus transcatheter aortic valve replacement should be made in the context of lifelong disease management rather than avoidance of reoperation.
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Affiliation(s)
- Rashed Mahboubi
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Mona Kakavand
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Edward G Soltesz
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; The Aortic Valve Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jeevanantham Rajeswaran
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; The Aortic Valve Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Douglas R Johnston
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; The Aortic Valve Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
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7
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Sotade OT, Falster MO, Pearson SA, Jorm LR, Sedrakyan A. Comparison of long-term outcomes of bioprosthetic and mechanical aortic valve replacement in patients younger than 65 years. J Thorac Cardiovasc Surg 2023; 166:728-737.e13. [PMID: 35216820 DOI: 10.1016/j.jtcvs.2022.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 12/07/2021] [Accepted: 01/11/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The objectives of this study were to compare rates of mortality and reoperations for patients aged younger than 65 years who underwent surgical aortic valve replacement (AVR). AVR with a bioprosthetic valve (BV) is increasing among younger patients, however evidence to inform the choice between BV or mechanical valve is limited. METHODS We performed a retrospective cohort study using linked hospital and mortality data from Australia, for 3969 AVR patients between 2003 and 2018. We compared outcomes for valves in inverse probability of treatment-weighted cohorts, stratified according to age (18-54 years; 55-64 years). We used weighted Cox regression models to estimate hazard ratios (HRs) and weighted cumulative incidence function for subdistribution hazards, for follow-up intervals: 0 to 10 and >10 to 15 years. RESULTS Among patients aged 55 to 64 years, there was no difference in mortality at 0 to 10 years. However, at >10 to 15 years, mortality was higher among BV recipients (HR, 1.56; 95% CI, 1.01-2.42). There was no difference among patients aged 18 to 54 years. Reoperation rates for patients aged 55 to 64 years did not differ according to valve type at 0 to 10 years, but were higher for BV than mechanical valve at >10 to 15 years (HR, 2.87; 95% CI, 1.69-4.86). For patients aged 18 to 54 years, reoperation rates were consistently higher for BV at both time intervals (HR, 2.54 [95% CI, 1.03-6.25] and HR, 4.48 [95% CI, 2.15-9.32], respectively). CONCLUSIONS Patients aged 55 to 64 years who received a BV had a higher risk of mortality beyond 10 years. Rates of reoperations were higher among patients implanted with a BV in the entire cohort. Further investigation of long-term outcomes among patients with a BV is necessary. Continuous long-term monitoring of BV technologies will ensure evidence-based decision-making and regulation.
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Affiliation(s)
| | - Michael O Falster
- Faculty of Medicine, Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Sallie-Anne Pearson
- Faculty of Medicine, Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Louisa R Jorm
- Faculty of Medicine, Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Art Sedrakyan
- Department of Population Health Sciences, and Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
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8
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Biological versus mechanical prostheses for aortic valve replacement. J Thorac Cardiovasc Surg 2023; 165:609-617.e7. [PMID: 33712230 DOI: 10.1016/j.jtcvs.2021.01.118] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 01/19/2021] [Accepted: 01/26/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Long-term real-world outcomes are critical for informing decisions about biological (Bio) or mechanical (Mech) prostheses for aortic valve replacement, particularly in patients aged between 50 and 65 years. The objective was to compare long-term survival and major adverse cardiac and cardiovascular events (ie, stroke, reoperation, and major bleeding) within this population. METHODS This was a multicenter observational study including all patients aged between 50 and 65 years who underwent an aortic valve replacement because of severe isolated aortic stenosis between the years 2000 and 2018. A total of 5215 patients from 27 Spanish hospitals were registered with a follow-up of 15 years. Multivariable analyses, including a 2:1 propensity score matching (1822 Mech and 911 Bio) and competing risks analyses were applied. RESULTS Bio prostheses were implanted in 19% of patients (n = 992). No significant differences were observed between matched groups in long-term survival (hazard ratio [HR], 1.14; 95% confidence interval [CI], 0.88-1.47; P = .33). Stroke rates were higher for Mech prostheses, but not significant (HR, 0.72; 95% CI, 0.50-1.03; P = .07). Finally, higher rates of major bleeding were found in the Mech group (HR, 0.65; 95% CI, 0.49-0.87; P = .004), whereas reoperation was more frequent among the Bio group (HR, 3.04; 95% CI, 1.80-5.14; P < .001). Bio prostheses increased from 13% in the period from 2000 to 2008 to 24% in 2009 to 2018. CONCLUSIONS Long-term survival was comparable among groups in patients between 50 and 65 years of age. Mech prostheses were associated with a higher risk of major bleeding, whereas Bio prostheses entailed higher reoperation rates. Bio prostheses seem a reasonable choice for patients between 50 and 65 years in Spain.
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Keshishi M, Fatima R, Seidman MA, Butany J, Ouzounian M, Chung J. Comparison of modes of failure and clinical outcomes between explanted porcine and bovine pericardial bioprosthetic valves. Cardiovasc Pathol 2023; 65:107516. [PMID: 36621556 DOI: 10.1016/j.carpath.2022.107516] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To compare pathological and hemodynamic modes of failure and operative outcomes between explanted porcine and bovine pericardial bioprosthetic valves. METHODS Patients who underwent explantation of their bioprosthetic valves at Toronto General Hospital from 2007 to 2019 were identified. Retrospective chart review was conducted to attain demographic information, operative outcomes, and echocardiography and pathology reports. RESULTS A total of 278 patients underwent explantation of their porcine (n=183) or bovine pericardial (n=95) valves. A greater proportion of the porcine group had severe regurgitation, compared to the bovine group (45.3% vs. 19.8%, p<.001). Porcine valves had higher rates of cusp flail (19.4% vs. 3.3%, p<.001). The rates of moderate or worse stenosis were higher among bovine pericardial valves (37.9% vs. 15.8%, p<.001). On pathologic examination, the porcine valves exhibited more cusp tears (67.6% vs. 50.5%, p=.006), while higher incidences of calcification were found in the bovine group (p<.001). Rate of stroke was higher during the explantation procedure of the bovine valves (5.3% vs. 0.5%, p=.040). CONCLUSIONS The primary mode of failure was regurgitation in porcine valves due to cusp tears and stenosis in bovine valves due to calcification. Establishing a clear understanding of failure modes based on valve material may improve design and guide valve selection at the time of surgery.
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Affiliation(s)
- Melanie Keshishi
- Division of Cardiac Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Rubab Fatima
- Division of Cardiac Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Michael A Seidman
- Laboratory Medicine Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Jagdish Butany
- Laboratory Medicine Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Maral Ouzounian
- Division of Cardiac Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Jennifer Chung
- Division of Cardiac Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
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10
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Baman JR, Medhekar AN, Malaisrie SC, McCarthy P, Davidson CJ, Bonow RO. Management Challenges in Patients Younger Than 65 Years With Severe Aortic Valve Disease. JAMA Cardiol 2022; 8:281-289. [PMID: 36542365 DOI: 10.1001/jamacardio.2022.4770] [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] [Indexed: 12/24/2022]
Abstract
ImportanceThe management of aortic valve disease, including aortic stenosis and aortic regurgitation (AR), in younger adult patients (age &lt;65 years) is complex, and the optimal strategy is often unclear, contingent on multiple anatomic and holistic factors.ObservationsTraditional surgical approaches carry significant considerations, including compulsory lifelong anticoagulation for patients who receive a mechanical aortic valve replacement (AVR) and the risk of structural valvular deterioration and need for subsequent valve intervention in those who receive a bioprosthetic AVR. These factors are magnified in young adults who are considering pregnancy, for whom issues of anticoagulation and valve longevity are heightened. The Ross procedure has emerged as a promising alternative; however, its adoption is limited to highly specialized centers. Valve repair is an option for selected patients with AR. These treatment options offer varying degrees of durability and are associated with different risks and complications, especially for younger adult patients. Patient-centered care from a multidisciplinary valve team allows for discussion of the optimal timing of intervention and the advantages and disadvantages of the various treatment options.Conclusions and RelevanceThe management of severe aortic valve disease in adults younger than 65 years is complex, and there are numerous considerations with each management decision. While mechanical AVR and bioprosthetic AVR have historically been the standards of care, other options are emerging for selected patients but are not yet generalizable beyond specialized surgical centers. A detailed discussion by members of the multidisciplinary heart team and the patient is an integral part of the shared decision-making process.
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Affiliation(s)
- Jayson R. Baman
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ankit N. Medhekar
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - S. Chris Malaisrie
- Department of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Patrick McCarthy
- Department of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Charles J. Davidson
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Robert O. Bonow
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Editor, JAMA Cardiology
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11
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Looking Back to Look Forward: What to Expect in a Redo Surgery for a Bioprosthesis Replacement. J Clin Med 2022; 11:jcm11237104. [PMID: 36498675 PMCID: PMC9735554 DOI: 10.3390/jcm11237104] [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: 10/13/2022] [Revised: 11/24/2022] [Accepted: 11/29/2022] [Indexed: 12/02/2022] Open
Abstract
Redo surgeries are becoming more common because of an increased rate of bioprosthesis implantation. We performed a retrospective study on patients who underwent redo replacement of an aortic and/or mitral bioprosthesis between 2005 and 2018 to evaluate intra-hospital mortality and morbidity. Univariate analysis was performed on the propensity score variables to determine predictors of mortality. A total of 180 patients were enrolled in the study: Group A (replacement of aortic bioprosthesis) with 136 patients (75.56%) and group B (replacement of mitral bioprosthesis ± aortic bioprosthesis) with 44 patients (24.44%). NYHA class ≥ 3 and female sex were significantly more common in group B. Cardiopulmonary-bypass time and aortic cross-clamping time in group A and group B were, respectively, 154.95 ± 74.35 and 190.25 ± 77.44 (p = 0.0005) and 115.99 ± 53.54 and 144.91 ± 52.53 (p = 0.0004). Overall mortality was 8.89%. After propensity score adjustment, Group B was confirmed to have an increased risk of death (OR 3.32 CI 95% 1.02−10.88 p < 0.0001), gastrointestinal complications (OR 7.784 CI 95% 1.005−60.282 p < 0.0002) and pulmonary complications (OR 2.381 CI 95% 1.038−5.46 p < 0.0001). At the univariate analysis, endocarditis, cardiopulmonary-bypass and aortic cross clamping time, NYHA class ≥ 3 and urgency setting were significantly associated to death. Intra-hospital outcomes were acceptable regarding mortality and complications. Patients who need redo surgery on mitral bioprosthesis have an increased risk of post-operative pulmonary and gastrointestinal complications and mortality. Therefore the choice of mitral bioprosthesis at time of first surgery should be carefully evaluated.
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12
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Marin-Cuartas M, de Waha S, Saeed D, Misfeld M, Kiefer P, Borger MA. Considerations for Reoperative Heart Valve Surgery. STRUCTURAL HEART 2022. [DOI: 10.1016/j.shj.2022.100098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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13
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Daly D. Principlist approach to multiple heart valve replacements for patients with intravenous drug use-induced endocarditis. JOURNAL OF MEDICAL ETHICS 2022; 48:medethics-2021-107685. [PMID: 35732422 DOI: 10.1136/medethics-2021-107685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 05/23/2022] [Indexed: 06/15/2023]
Abstract
Medical professionals often deny patients who inject opioids a second or third heart valve replacement, even if such a surgery is medically indicated. However, such a position is not well defended. As this paper demonstrates, the ethical literature on the topic too often fails to develop and apply an ethical lens to analyse the issue of multiple valve replacements. This paper addresses this lacuna by analysing the case of Mr Walsh, a composite case which protects the identity of any one patient, through the principlist approach of Beauchamp and Childress. It argues that the hospital should offer Mr Walsh, a second valve replacement because the procedure is: medically indicated, autonomously requested, non-maleficent, beneficent and does not violate a formal account of justice. The paper concludes with clinical ethical guidelines for valve surgery for patients with opioid use disorder.
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Affiliation(s)
- Daniel Daly
- School of Theology and Ministry, Boston College, Brighton, Massachusetts, USA
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14
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Quader M, Wolfe L, Median A, Fonner C, Ailawadi G, Crosby I, Speir A, Rich J, Lapar D, Kasirajan V. Isolated aortic valve replacement with bio-prostheses in patients age 50 to 65 years: a decade of statewide data on cost and patient outcomes. THE JOURNAL OF CARDIOVASCULAR SURGERY 2022; 63:382-389. [PMID: 25216214 DOI: 10.23736/s0021-9509.20.08338-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Guidelines for choice of replacement valve-mechanical versus bio-prosthetic, are well established for patients aged <50 and >65 years. We studied the trends and implications of aortic valve replacement (AVR) with mechanical versus bioprosthetic valve in patients aged 50 to 65 years. METHODS STS and cost database of 17 centers for isolated AVR surgery were analyzed by dividing them into bioprosthetic valve (BV) or mechanical valve (MV) groups. RESULTS From 2002 to 2011, 3,690 patients had AVR, 18.6% with MV and 81.4% with BV. Use of BV for all ages increased from 71.5% in 2002 to 87% in 2011. There were 1127 (30.5%) patients in the age group 50-65 years. Use of BV in this group almost doubled, 39.6% in 2002 to 76.8% in 2011. Mean age of patients in BV group was higher (59.2±4.2 years vs. 56.7±4.3 years, P≤0.0001). Preoperative renal failure, heart failure and chronic obstructive pulmonary disease favored use of BV, whereas preoperative atrial fibrillation favored AVR with MV. Mortality (MV 2.2% vs. BV 2.36%) and other postoperative outcomes between the groups were similar. Cost of valve replacement increased for both groups (MV $26,191 in 2002 to $42,592 in 2011; BV $27,404 in 2002 to $44,257 in 2011). CONCLUSIONS Use of bioprostheses for AVR has increased; this change is more pronounced in patients aged 50-65 years. Specific preoperative risk factors influence the choice of valve for AVR. Postoperative outcomes between the two groups were similar. Long-term implications of this changing practice, in particular, reoperation for bioprosthetic valve degeneration should be examined.
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Affiliation(s)
- Mohammed Quader
- Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, VA, USA -
| | - Luke Wolfe
- Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Angel Median
- Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Gorav Ailawadi
- Division of Cardiothoracic Surgery, University of Virginia Health Sciences, Charlottesville, VA, USA
| | - Ivan Crosby
- Division of Cardiothoracic Surgery, University of Virginia Health Sciences, Charlottesville, VA, USA
| | | | - Jeffrey Rich
- Mid Atlantic Cardiothoracic Surgery Ltd., Norfolk, VA, USA
| | - Damien Lapar
- Division of Cardiothoracic Surgery, University of Virginia Health Sciences, Charlottesville, VA, USA
| | - Vigneshwar Kasirajan
- Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, VA, USA
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15
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Surgical Aortic Valve Replacement-Age-Dependent Choice of Prosthesis Type. J Clin Med 2021; 10:jcm10235554. [PMID: 34884256 PMCID: PMC8658378 DOI: 10.3390/jcm10235554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Recently, the use of surgically implanted aortic bioprostheses has been favoured in younger patients. We aimed to analyse the long-term survival and postoperative MACCE (Major Adverse Cardiovascular and Cerebral Event) rates in patients after isolated aortic valve replacement. Methods: We conducted a single-centre observational retrospective study, including all consecutive patients with isolated aortic valve replacement. 1:1 propensity score matching of the preoperative baseline characteristics was performed. Results: A total of 2172 patients were enrolled in the study. After propensity score matching the study included 428 patients: 214 biological vs. 214 mechanical prostheses, divided into two subgroups: group A < 60 years and group B > 60 years. The mean follow-up time was 7.6 ± 3.9 years. Estimated survival was 97 ± 1.9% and 89 ± 3.4% at 10 years for biological and mechanical prosthesis, respectively in group A (p = 0.06). In group B the survival at 10 years was 79.1 ± 5.8% and 69.8 ± 4.4% for biological and mechanical prosthesis, respectively (p = 0.83). In group A, patients with a bioprosthesis exhibited a tendency for higher cumulative incidence MACCE rates compared to patients with a mechanical prosthesis, p = 0.83 (bio 7.3 ± 5.3% vs. mech 4.6 ± 2.2% at 10 years). In group B, patients with a mechanical prosthesis showed a tendency for higher cumulative incidence MACCE rates compared to patients with bioprosthesis, p = 0.86 (bio 4.3 ± 3.1% vs. mech 9.1 ± 3.1% at 10 years). Conclusions: Long-term survival after surgical aortic valve replacement is similar in patients with a biological and mechanical prosthesis, independent of the patients’ age. Moreover, younger patients (<60 years) with bioprosthesis showed a survival benefit, compared to patients with mechanical prosthesis in this age group.
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16
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Bamford P, Said C, Al-Omary MS, Bhagwandeen R, Boyle A. Aortic Valve Replacement Rates in Australia from 2004 to 2019. Intern Med J 2021; 53:525-530. [PMID: 34780091 DOI: 10.1111/imj.15624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/09/2021] [Accepted: 11/09/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Several surgical and percutaneous treatments are available for patients with aortic valve disease. AIM Our aim is to establish whether trends in aortic valve replacements (AVR) in Australia reflect recent evidence. METHODS Using Australian Institute of Health and Welfare data, this study counted all AVR and balloon aortic valvuloplasty (BAV) procedures conducted in all Australian hospitals from 2004 to 2019. Linear regression analysis was performed to determine whether age-adjusted rates had changed over the study period. RESULTS There were 80,883 AVRs performed. 66% were men and 64% were over aged 70. Absolute rates of AVR increased from 3,631 to 7,277 with a significant 22% age-adjusted rise seen (1.9% increase per year (+0.26 per 100,000 per year, 95% CI 0.19 - 0.34); p < 0.001). This trend was more pronounced in men than women and in over 80 year-olds (+0.23 per 100,000 per year, p < 0.001). Proportion of mechanical AVRs implanted fell from 38.4% to 8.6% (p<0.001). 2,683 transcatheter aortic valve implantation (TAVI) procedures were performed in 2019, representing a 52% annual increase from 2014. BAV increased from 66 procedures in 2004 to 862 in 2019. CONCLUSION Rates of AVR have increased significantly over the past 16 years, particularly in the elderly. Despite international guideline recommendations, fewer mechanical AVRs are being used in younger cohorts. The uptake in TAVI rates might reflect evidence that suggests it is a safe alternative, at least in the medium term. BAV has also seen a resurgence during this time period. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Paul Bamford
- John Hunter Hospital, Newcastle, New South Wales.,University of Newcastle, Newcastle, New South Wales
| | | | - Mohammed S Al-Omary
- John Hunter Hospital, Newcastle, New South Wales.,University of Newcastle, Newcastle, New South Wales
| | - Rohan Bhagwandeen
- John Hunter Hospital, Newcastle, New South Wales.,University of Newcastle, Newcastle, New South Wales
| | - Andrew Boyle
- John Hunter Hospital, Newcastle, New South Wales.,University of Newcastle, Newcastle, New South Wales
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17
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Christ T, Borck R, Dushe S, Sündermann SH, Falk V, Grubitzsch H. Propensity matched long-term analysis of mechanical versus stentless aortic valve replacement in the younger patient. Eur J Cardiothorac Surg 2021; 60:276-283. [PMID: 33693656 DOI: 10.1093/ejcts/ezab090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/13/2021] [Accepted: 01/22/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The choice of prosthesis for aortic valve replacement (AVR) in younger patients remains controversial. Stentless AVR was introduced 3 decades ago, with the aim of better haemodynamics and durability than stented xenografts. The objective of this analysis was to compare the long-term outcomes to mechanical prostheses in younger patients (age ≤60 years). METHODS All adult patients who underwent AVR due to aortic valve stenosis and/or insufficiency between 1993 and 2002 were identified. After the exclusion of patients with congenital heart defects, aortic dissections and Ross-procedures, 158 patients with stentless valves and 226 patients with bi-leaflet mechanical valves were finally included in this analysis. Sixty-six patient pairs could be included in a propensity matched analysis. Mortality and morbidity including stroke, bleeding, endocarditis and reoperation were analysed. RESULTS Group baseline characteristics and operative data did not differ significantly after propensity matching. Hospital mortality was 0.0% in the stentless and 1.5% in the mechanical group. Total patient years/median follow-up was 2029.1/15.4 years (completeness: 100.0%, range: 0-25 years). After 20 years, actuarial survival was 47.0 ± 6.4% in the stentless and 53.3 ± 6.6% in mechanical group (P = 0.69). Bleeding, endocarditis and stroke occurred rarely and did not differ significantly between groups. After 20 years, actuarial overall freedom-from-reoperation was 45.1 ± 8.2% in the stentless group and 90.4 ± 4.1% in the mechanical group (P < 0.001). Hospital mortality while reoperation was 7.4% in the stentless group and 0% in the mechanical group (P = 1.0). CONCLUSIONS Long-term morbidity and mortality of stentless and mechanical aortic valves were statistically not different besides a significantly higher reoperation rate after stentless AVR combined with a probably higher risk of in-hospital mortality. Thus, mechanical AVR should remain the procedure of choice in younger patients.
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Affiliation(s)
- Torsten Christ
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Robin Borck
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Simon Dushe
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Simon Harald Sündermann
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, German Heart Centre Berlin, Berlin, Germany.,German Center for Cardiovascular Research, Partner Site, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, German Heart Centre Berlin, Berlin, Germany.,German Center for Cardiovascular Research, Partner Site, Berlin, Germany.,Department of Health Science and Technology, Swiss Federal Institute of Technology (ETH) Zurich, Zurich, Switzerland
| | - Herko Grubitzsch
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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18
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Watanabe T, Tokunaga N, Maruno K, Yoshida H, Kuinose M. Redo aortic valve replacement due to early structural valve deterioration in a trifecta valve: A case report. Int J Surg Case Rep 2021; 86:106381. [PMID: 34507197 PMCID: PMC8433234 DOI: 10.1016/j.ijscr.2021.106381] [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: 07/24/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction and importance While the number of SAVR cases has been increasing for patients below their sixties due to the improvement of bioprosthetic valves, some early structural valve deterioration (SVD) in Trifecta valves has been reported. Case presentation We present a case of a female who presented with sudden shortness of breath. Ultrasonography diagnosed SVD. We performed redo aortic valve replacement due to SVD in Trifecta valve. With our surgical technique we could remove the bioprosthetic valve easily. Clinical discussion We could easily remove the mounted prosthetic valve along with the titanium band. These cases may emerge with acute heart failure due to sudden massive aortic regurgitation, not like the gradual progression of stenosis due to calcification. Conclusion The postoperative course in Trifecta recipients must be followed carefully. Early structural valve deterioration with Trifecta valve Postoperative patients using Trifecta valve should be carefully followed up. Mounted Trifecta valve could easily be removed along with titanium band.
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Affiliation(s)
- Tatsuya Watanabe
- Department of General Surgery, Kawasaki Medical School General Medical Center, 2-6-1, Nakasange, Kita-ku, Okayama 700-8505, Japan.
| | - Noriyuki Tokunaga
- Department of General Surgery, Kawasaki Medical School General Medical Center, 2-6-1, Nakasange, Kita-ku, Okayama 700-8505, Japan
| | - Keita Maruno
- Department of General Surgery, Kawasaki Medical School General Medical Center, 2-6-1, Nakasange, Kita-ku, Okayama 700-8505, Japan
| | - Hideo Yoshida
- Department of General Surgery, Kawasaki Medical School General Medical Center, 2-6-1, Nakasange, Kita-ku, Okayama 700-8505, Japan
| | - Masahiko Kuinose
- Department of General Surgery, Kawasaki Medical School General Medical Center, 2-6-1, Nakasange, Kita-ku, Okayama 700-8505, Japan
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19
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Abeln KB, Chauvette V, Poirier N, Matsushima S, El-Hamamsy I, Schäfers HJ. Ross operation after failure of aortic valve repair. Ann Cardiothorac Surg 2021; 10:476-484. [PMID: 34422559 DOI: 10.21037/acs-2020-rp-19] [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: 09/10/2020] [Accepted: 01/22/2021] [Indexed: 11/06/2022]
Abstract
Background Repair failure remains one of the most important complications of aortic valve reconstruction. Young patients might benefit from a Ross procedure in such a scenario, provided it can be performed safely and with adequate durability. The aim of this study was to assess the safety and clinical outcomes of a Ross operation following a failed repair. Methods Between 1996 and 2019, 80 patients (male, 76%; mean age, 31±13 years) underwent a Ross procedure after a median of 6.6 (1.7-15.9) years following an initial aortic valve repair. The previous valve repair was performed for unicuspid (53%), bicuspid (39%), tricuspid (7%), and quadricuspid morphology (1%). Median follow-up after the Ross operation was 2.8 (0.964-13.25) years, mean 5±5 years (92% complete). Results Median cardiopulmonary bypass and cross-clamp times were 144 [106-154] minutes and 98 [79-113] minutes, respectively. Thirty-two patients (40%) required a concomitant procedure, most commonly, an ascending aortic replacement (n=23). There were no peri-operative deaths, myocardial infarctions, or neurological complications. There was one late death from a non-cardiac cause. At 10 years, overall survival was 99%±1%, similar to that of an age- and gender-matched population. Nine patients required re-intervention after their Ross procedure (five on the autograft and four on the pulmonary conduit). The autograft re-interventions were valve-sparing procedures in all patients. The cumulative incidence of re-intervention on the autograft at 8 years was 5.1%±3.1%. Conclusions The stepwise strategy of an initial valve repair followed by Ross operation represents a safe and valid option for failed aortic valve repair. It is associated with low peri-operative morbidity. Mid-term survival is excellent, similar to that of a matched general population. The probability of re-intervention after the Ross procedure appears similar to that of a primary Ross operation, deeming it a warranted consideration in cases of failed aortic valve repair.
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Affiliation(s)
- Karen B Abeln
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg (Saar), Germany
| | - Vincent Chauvette
- Division of Cardiac Surgery, Montreal Heart Institute, Université de Montreal, Montreal, Canada
| | - Nancy Poirier
- Division of Cardiac Surgery, Montreal Heart Institute, Université de Montreal, Montreal, Canada
| | | | - Ismail El-Hamamsy
- Department of Cardiothoracic Surgery, The Mount Sinai Medical Center, New York, NY, USA
| | - Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg (Saar), Germany
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20
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The First 100 Cases of Two Innovations Combined: Video-Assisted Minimally Invasive Aortic Valve Replacement Through Right Anterior Mini-Thoracotomy Using a Novel Aortic Prosthesis. Adv Ther 2021; 38:2435-2446. [PMID: 33788152 PMCID: PMC8010499 DOI: 10.1007/s12325-021-01705-x] [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: 02/17/2021] [Accepted: 03/10/2021] [Indexed: 11/25/2022]
Abstract
Introduction Aortic valve replacement (AVR) via right anterior mini-thoracotomy (RAMT) is less traumatic than via other surgical routes; using a novel aortic valve may confer long-term resistance against valve deterioration, and thus be useful in younger, more active patients. Here we aim to validate using the INSPIRIS RESILIA valve with minimally invasive RAMT. Methods Between April 2017 and June 2019, 100 patients underwent video-assisted minimally invasive AVR by RAMT, using the INSPIRIS RESILIA aortic valve. Cannulation for cardiopulmonary bypass (CPB) was through femoral vessels. Clinical data were prospectively entered into our institutional database. Results Cardiopulmonary bypass (CPB) and cross-clamping times were 79 ± 38 and 41 ± 17 min. Surgical access was successful in 100% of cases. There were no cases of intraoperative mortality, 30-day mortality, cerebrovascular events, rethoracotomy for bleeding, valve-related reoperation, right internal mammary artery injury, or conversion to sternotomy. Intensive care and hospital stays were 2 ± 1 and 6 ± 3 days, respectively. One patient had a pacemaker fitted. Postoperative dialysis was necessary in one patient. Trace to mild aortic valve regurgitation occurred in two patients. No structural valve deterioration (SVD) and paravalvular leak were seen. At 1-year follow-up mean effective orifice area (EOA) was 1.8 ± 0.1 cm2, peak gradient was 22.1 ± 3.1 mmHg, and mean gradient was 11.5 ± 2.3 mmHg. Conclusion Our preliminary experience suggests that RAMT for AVR using the INSPIRIS RESILIA aortic valve is safe, effective, and reproducible. Larger studies are needed to evaluate the long-term efficacy and durability of this new valve.
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21
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Wojnarski CM, Chodavadia PA, Barac YD, Armstrong JL, Vekstein AM, Haney JC, Gaca JG, Chad Hughes G, Glower DD. Long-term outcomes of aortic root replacement for endocarditis. J Card Surg 2021; 36:1969-1978. [PMID: 33651483 DOI: 10.1111/jocs.15472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/08/2021] [Accepted: 01/09/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Infective endocarditis (IE) involving the aortic valve and root is associated with high risk requiring thoughtful surgical decision-making. The impact of valve and conduit choices and patient factors on long-term outcomes in this patient population is poorly documented. METHODS From January 1976 to December 2013, 485 patients underwent aortic root and valve replacement at a single institution. Cox's proportional hazard model identified predictors of long-term survival and cumulative incidence functions were compared to assess need for reoperation with death as a competing risk. RESULTS Median age at time of operation was 56.6 years (interquartile range: 23.1) with the indication for operation being endocarditis in 14.6% (n = 71). Stentless root replacement was used in 70% IE versus 34% non-IE (p < .001). Endocarditis at time of root replacement did not have a significant impact on survival through 15 years (IE: 37.3% vs. non-IE: 42.5%; log-rank; p = .13). After multivariable adjustment, survival was similar between patients with and without endocarditis (hazard ratio: 1.1; 95% confidence interval: [0.77, 1.62]; p = .57). Freedom from reoperation at 15 years did not vary significantly by endocarditis status (IE: 95.9% vs. non-IE: 73.6%; p = .07). Among endocarditis patients, freedom from reoperation at 10 years was similar between homograft and stentless bioprosthetic conduits (95.3% vs. 88.5%; log-rank; K-sample; p = .46). CONCLUSIONS In a sample with frequent use of stentless prostheses, aortic root replacement for infective endocarditis had acceptable risk and long-term survival similar to root replacement for other indications. In the setting of endocarditis, root replacement with homograft or stentless bioprosthetic root has excellent durability through 15 years.
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Affiliation(s)
- Charles M Wojnarski
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Yaron D Barac
- Division of Cardiovascular and Thoracic Surgery, Rabin Medical Center, Petah Tikva, Israel
| | | | - Andrew M Vekstein
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - John C Haney
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Jeffrey G Gaca
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - G Chad Hughes
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Donald D Glower
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
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22
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Clark A, Malaisrie SC. Failed bioprosthetic valve approaches: Transcatheter aortic valve replacement approach. J Thorac Cardiovasc Surg 2021; 163:1795-1798. [PMID: 33685735 DOI: 10.1016/j.jtcvs.2020.12.148] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/11/2020] [Accepted: 12/22/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Aaron Clark
- Division of Cardiac Surgery, Department of Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine and Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - S Chris Malaisrie
- Division of Cardiac Surgery, Department of Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine and Northwestern University Feinberg School of Medicine, Chicago, Ill.
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23
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Greason KL. Repeat surgical aortic valve replacement: Don't stick a fork in it just yet. J Thorac Cardiovasc Surg 2021; 163:940-943. [PMID: 33685729 DOI: 10.1016/j.jtcvs.2020.12.147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 11/17/2020] [Accepted: 12/21/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
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24
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Attia T, Yang Y, Svensson LG, Toth AJ, Rajeswaran J, Blackstone EH, Johnston DR. Similar long-term survival after isolated bioprosthetic versus mechanical aortic valve replacement: A propensity-matched analysis. J Thorac Cardiovasc Surg 2021; 164:1444-1455.e4. [PMID: 33892946 DOI: 10.1016/j.jtcvs.2020.11.181] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 08/26/2020] [Accepted: 11/02/2020] [Indexed: 10/31/2022]
Abstract
OBJECTIVES Improved durability and preference to avoid anticoagulation have led to increasing use of bioprostheses in younger patients despite the need for eventual reoperation. Therefore, we compared in-hospital complications, reoperation, and survival after bioprosthetic and mechanical aortic valve replacement. METHODS From January 1990 to January 2020, 6143 patients underwent isolated aortic valve replacement at Cleveland Clinic; 637 patients received a mechanical prosthesis and 5506 a bioprosthesis. Propensity matching identified 527 well-matched pairs (83% of possible matches) for comparison of perioperative outcomes. The average age of patients was 54 years in the bioprosthesis group and 55 years in the mechanical prosthesis group. Random Forest machine-learning analysis was performed to compare survival using the entire cohort of 6143 patients. RESULTS Among matched patients, major in-hospital complications, including stroke, deep sternal wound infection, and reoperation for bleeding, were similar, as was in-hospital mortality (2 in the bioprosthesis group [0.38%] vs 3 in the mechanical prosthesis group [0.57%]; P > .9). Patients receiving a bioprosthesis had shorter hospital stays (median 6 vs 7 days, P < .0001). Fifty-one patients (32% at 14 years) in the bioprosthesis group and 17 patients in the mechanical prosthesis group (8% at 14 years) underwent reoperation (P [log-rank] < .0001); 5-year survival after reoperation was 85% versus 82% (P = .6). Risk-adjusted Random Forest prediction of 18-year survival was 60% in the bioprosthetic group and 58% in the mechanical prosthesis group. CONCLUSIONS Aortic valve bioprostheses are associated with excellent short-term outcomes and 18-year survival similar to that of patients receiving mechanical valves. Reoperation does not adversely affect survival. These results suggest that risk for reoperation alone should not deter the use of bioprostheses in younger patients.
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Affiliation(s)
- Tamer Attia
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland, Ohio
| | - Yanzhi Yang
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Research Institute, Cleveland, Ohio
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland, Ohio
| | - Andrew J Toth
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | | | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland, Ohio; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Douglas R Johnston
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland, Ohio.
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Nappi F, Spadaccio C, Moon MR. A management framework for left sided endocarditis: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1627. [PMID: 33437826 PMCID: PMC7791223 DOI: 10.21037/atm-20-4439] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Left sided endocarditis (LSE) can include the entirety or portion of mitral and/or aortic valve and the structures in their anatomical contiguity and represent a significant portion of emergency surgical activity. Literature and guidelines on the management of LSE relies mainly on observational studies given the difficulty in designing randomized trials in emergency settings. Heart teams (HT) are often called in to difficult decisions on the most appropriate strategy to adopted in case of LSE. Decision-making should take into account the localization and the extension of the infection, patient preoperative status and comorbidities, presence of a previous valve prosthesis and best timing for surgery. Despite evidence suggests that early surgery may improve survival in patients with complicated infective endocarditis (IE), an increased risk of recurrence and postoperative valvular dysfunctions has been reported. The most important factors associated with long-term outcomes are preoperative multiorgan failure, prosthetic mechanical valve IE, vegetation size ≥15 mm, and timing of surgical treatment. Importantly, up to one third of potential candidates do not undergo surgery and these patients experience extremely high mortality rates. Another important point regards the choice of the optimal valve substitute to be used according to the different clinical situation. The lack of RCT in this field and the difficulty to design this type of studies in the case of non-elective conditions further complicates the possibility to achieve a univocal consensus on the best strategy to be adopted in each form of LSE and further validation studies are needed. On the basis of the current evidences a decisional algorithm is proposed summarizing all the crucial aspects in the management of LSE.
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Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
| | - Cristiano Spadaccio
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Glasgow, UK.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Marc R Moon
- Department of Cardiac Thoracic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
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26
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Scherman J, Zilla P. Poorly suited heart valve prostheses heighten the plight of patients with rheumatic heart disease. Int J Cardiol 2020; 318:104-114. [DOI: 10.1016/j.ijcard.2020.05.073] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 05/13/2020] [Accepted: 05/22/2020] [Indexed: 12/12/2022]
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27
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Izumi C, Eishi K, Ashihara K, Arita T, Otsuji Y, Kunihara T, Komiya T, Shibata T, Seo Y, Daimon M, Takanashi S, Tanaka H, Nakatani S, Ninami H, Nishi H, Hayashida K, Yaku H, Yamaguchi J, Yamamoto K, Watanabe H, Abe Y, Amaki M, Amano M, Obase K, Tabata M, Miura T, Miyake M, Murata M, Watanabe N, Akasaka T, Okita Y, Kimura T, Sawa Y, Yoshida K. JCS/JSCS/JATS/JSVS 2020 Guidelines on the Management of Valvular Heart Disease. Circ J 2020; 84:2037-2119. [DOI: 10.1253/circj.cj-20-0135] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kiyoyuki Eishi
- Division of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Kyomi Ashihara
- Department of Cardiology, Tokyo Women’s Medical University Hospital
| | - Takeshi Arita
- Division of Cardiovascular Medicine Heart & Neuro-Vascular Center, Fukuoka Wajiro
| | - Yutaka Otsuji
- Department of Cardiology, Hospital of University of Occupational and Environmental Health
| | - Takashi Kunihara
- Department of Cardiac Surgery, The Jikei University School of Medicine
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka City University Postgraduate of Medicine
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Masao Daimon
- Department of Clinical Laboratory/Cardiology, The University of Tokyo Hospital
| | | | | | - Satoshi Nakatani
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | - Hiroshi Ninami
- Department of Cardiac Surgery, Tokyo Women’s Medical University
| | - Hiroyuki Nishi
- Department of Cardiovascular Surgery, Osaka General Medical Center
| | | | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | | | - Kazuhiro Yamamoto
- Division of Cardiovascular Medicine, Endocrinology and Metabolism, Faculty of Medicine, Tottori University
| | | | - Yukio Abe
- Department of Cardiology, Osaka City General Hospital
| | - Makoto Amaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Masashi Amano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kikuko Obase
- Division of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center
| | - Takashi Miura
- Division of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | | | - Mitsushige Murata
- Department of Laboratory Medicine, Tokai University Hachioji Hospital
| | - Nozomi Watanabe
- Department of Cardiology, Miyazaki Medical Association Hospital
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Yutaka Okita
- Department of Cardiovascular Surgery, Takatsuki Hospital
| | - Takeshi Kimura
- Department of Cardiology, Kyoto University Graduate School of Medicine
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Kiyoshi Yoshida
- Department of Cardiology, Sakakibara Heart Institute of Okayama
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28
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Borger MA, Raschpichler M, Makkar R. Repeat Aortic Valve Surgery or Transcatheter Valve-in-Valve Therapy. J Am Coll Cardiol 2020; 76:500-502. [DOI: 10.1016/j.jacc.2020.06.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/22/2020] [Indexed: 11/26/2022]
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29
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Huckaby LV, Sultan I, Gleason TG, Chen S, Thoma F, Navid F, Kilic A. Outcomes of tissue versus mechanical aortic valve replacement in patients 50 to 70 years of age. J Card Surg 2020; 35:2589-2597. [PMID: 32652638 DOI: 10.1111/jocs.14844] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Societal guidelines suggest that aortic valve replacement (AVR) in patients age 50 to 70 years can be performed with either bioprosthetic or mechanical valves. This study reviewed outcomes between these valve types among patients aged 50 to 70 years undergoing AVR. METHODS We examined adult patients 50 to 70 years undergoing isolated AVR with a mechanical or bioprosthetic valve at a single institution between 2010 and 2018. Kaplan-Meier analysis was used to evaluate longitudinal survival and multivariable Cox regression analysis was used for risk adjustment. A propensity-matched analysis was performed as well. RESULTS A total of 723 patients underwent isolated AVR with 467 (64.6%) receiving a bioprosthetic valve. At baseline, patients undergoing bioprosthetic AVR were older (median 65 vs 60 years; P < .001). One-year survival was comparable, however, survival at 5 years was significantly higher among patients undergoing mechanical AVR (95.5% vs 82.6%; P = .010). Among the 196 matched pairs, bioprosthetic AVR was associated with an increased adjusted hazard for death (hazards ratio, 3.29; P < .001). Additionally, 5-year freedom from stroke and bleeding were similar following matching, though mechanical AVR was associated with a greater freedom from repeat valve intervention (97.5% vs 92.9%; P = .020). CONCLUSION In patients age 50 to 70, mechanical AVR is associated with improved long-term survival and freedom from repeat aortic valve intervention. Further large cohort studies should be performed to explore the potential benefits of mechanical valve replacement in this age range.
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Affiliation(s)
- Lauren V Huckaby
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ibrahim Sultan
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Thomas G Gleason
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Shangzhen Chen
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Floyd Thoma
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Forozan Navid
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Arman Kilic
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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30
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MacGillivray TE, Reardon MJ. Reoperation After Transcatheter Aortic Valve Replacement: Breaking Up Is Hard to Do. JACC Cardiovasc Interv 2020; 13:1526-1528. [PMID: 32535009 DOI: 10.1016/j.jcin.2020.04.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/28/2020] [Indexed: 11/17/2022]
Affiliation(s)
| | - Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, Texas.
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31
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D'Onofrio A, Gerosa G. Transcatheter valve-in-valve implantation for degenerated aortic bioprostheses: Still not ready for prime-time. Int J Cardiol 2020; 300:117-118. [PMID: 31810813 DOI: 10.1016/j.ijcard.2019.11.097] [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: 10/22/2019] [Accepted: 11/11/2019] [Indexed: 11/15/2022]
Affiliation(s)
| | - Gino Gerosa
- Division of Cardiac Surgery, University of Padova, Italy
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32
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Current evidence for prosthesis selection: What can we really say? J Thorac Cardiovasc Surg 2019; 158:368-375. [DOI: 10.1016/j.jtcvs.2019.03.094] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 03/05/2019] [Accepted: 03/07/2019] [Indexed: 01/22/2023]
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Attias D, Nejjari M, Nappi F, Dreyfus J, Eleid MF, Rihal CS. How to treat severe symptomatic structural valve deterioration of aortic surgical bioprosthesis: transcatheter valve-in-valve implantation or redo valve surgery? Eur J Cardiothorac Surg 2019; 54:977-985. [PMID: 29868728 DOI: 10.1093/ejcts/ezy204] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 04/22/2018] [Indexed: 11/12/2022] Open
Abstract
The optimal management of aortic surgical bioprosthesis presenting with severe symptomatic structural valve deterioration is currently a matter of debate. Over the past 20 years, the number of implanted bioprostheses worldwide has been rapidly increasing at the expense of mechanical prostheses. A large proportion of patients, however, will require intervention for bioprosthesis structural valve deterioration. Current options for older patients who often have severe comorbidities include either transcatheter valve-in-valve (TVIV) implantation or redo valve surgery. The emergence of TVIV implantation, which is perceived to be less invasive than redo valve surgery, offers an effective alternative to surgery for these patients with proven safety and efficacy in high-risk patient groups including elderly and frail patients. A potential caveat to this strategy is that results of long-term follow-up after TVIV implantation are limited. Redo surgery is sometimes preferable, especially for young patients with a smaller-sized aortic bioprosthesis. With the emergence of TVIV implantation and the long experience of redo valve surgery, we currently have 2 complementary treatment modalities, allowing a tailor-made and patient-orientated intervention. In the heart team, the decision-making should be based on several factors including type of bioprosthesis failure, age, comorbidities, operative risk, anatomical factors, anticipated risks and benefits of each alternative, patient's choice and local experience. The aim of this review is to provide a framework for individualized optimal treatment strategies in patients with failed aortic surgical bioprosthesis.
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Affiliation(s)
- David Attias
- Department of Cardiology, Centre Cardiologique du Nord, Saint Denis, France
| | - Mohammed Nejjari
- Department of Cardiology, Centre Cardiologique du Nord, Saint Denis, France
| | - Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord, Saint Denis, France
| | - Julien Dreyfus
- Department of Cardiology, Centre Cardiologique du Nord, Saint Denis, France
| | - Mackram F Eleid
- Department of Cardiovascular Diseases and Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Charanjit S Rihal
- Department of Cardiovascular Diseases and Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
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34
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Prosthetic Valve Removal Technique Using Ultrasonic Scalpel. Ann Thorac Surg 2019; 108:e273-e274. [PMID: 31233719 DOI: 10.1016/j.athoracsur.2019.04.105] [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: 04/01/2019] [Accepted: 04/26/2019] [Indexed: 11/21/2022]
Abstract
Prosthetic valve removal for reoperative valve replacement is time consuming and has a risk of damage to the heart because of severe adhesions. Prosthetic valves can be removed quickly, easily, and safely by using an ultrasonic scalpel (Harmonic Scalpel, Ethicon Endo-Surgery, Cincinnati, OH). The space between the prosthesis and the native annulus was carefully dissected using Harmonic Synergy blades connected to an Ethicon Gen11 Generator at energy level 5. The average time for prosthetic valve removal using an ultrasonic scalpel was 6 minutes 11 seconds. No patient required new permanent pacemaker implantation.
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35
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Dayan V, Arocena MJ, Fernandez A, Silva E, Zerpa DP. Previous Cardiac Surgery: a Predictor of Mortality in Aortic Valve Replacement? Braz J Cardiovasc Surg 2019; 34:173-178. [PMID: 30916127 PMCID: PMC6436787 DOI: 10.21470/1678-9741-2018-0251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/19/2018] [Indexed: 11/24/2022] Open
Abstract
Introduction Previous cardiac surgery (PCS) is a risk factor for operative mortality in
pa-tients undergoing reoperative aortic valve replacement (AVR) and may be
influenced by the volume of patients in each center. The aim of this study
was to evaluate the results of AVR in patients with previous cardiac surgery
in a low volume cardiac center (400 cases per year). Methods Between January 2006 and December 2016, 854 patients underwent isolated AVR
surgery at our institution. Of these, 70 had PCS. Propensity match (PM) was
per-formed to balance basal covariates. Operative mortality and survival
were the primary outcomes. Results The PCS and first-time surgery (FTS) groups had significant differences in
base-line characteristics (PCS group were older, higher incidence of
hypertension, endocarditis, NYHA III/IV, lower LVEF, higher creatinine and
higher EuroSCORE). In the unmatched population, patients with PCS had higher
operative mortality (17.1% vs. 4.6%,
P=0.001). In the PM groups, this difference was not
significant (12.5% and 3.6%, P=0.08). The only independent
predictors for operative mortality found in the PCS group were age and
fe-male gender. Age and diabetes were identified as the only independent
predictors of sur-vival. Conclusion PCS was not a predictor for operative mortality nor long-term survival in
pa-tients undergoing isolated aortic valve replacement.
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Affiliation(s)
- Victor Dayan
- Instituto Nacional de Cirugía Cardíaca. Montevideo, Uruguay
| | | | | | - Eloísa Silva
- Instituto Nacional de Cirugía Cardíaca. Montevideo, Uruguay
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Scherman J, Manganyi R, Human P, Pennel T, Brooks A, Brink J, Zilla P. Isolated mechanical aortic valve replacement in rheumatic patients in a low- to middle-income country. J Thorac Cardiovasc Surg 2019; 157:886-893. [DOI: 10.1016/j.jtcvs.2018.06.083] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 05/29/2018] [Accepted: 06/15/2018] [Indexed: 01/03/2023]
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Bavaria JE, Tommaso CL, Brindis RG, Carroll JD, Deeb GM, Feldman TE, Gleason TG, Horlick EM, Kavinsky CJ, Kumbhani DJ, Miller DC, Seals AA, Shahian DM, Shemin RJ, Sundt TM, Thourani VH. 2018 AATS/ACC/SCAI/STS Expert Consensus Systems of Care Document: Operator and institutional recommendations and requirements for transcatheter aortic valve replacement. J Thorac Cardiovasc Surg 2019; 157:e77-e111. [DOI: 10.1016/j.jtcvs.2018.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Milewski RK, Habertheuer A, Bavaria JE, Fuller S, Desai ND, Szeto WY, Korutla V, Vallabhajosyula P. Selection of prosthetic aortic valve and root replacement in patients younger than age 30 years. J Thorac Cardiovasc Surg 2019; 157:714-725. [DOI: 10.1016/j.jtcvs.2018.06.102] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 05/22/2018] [Accepted: 06/11/2018] [Indexed: 10/27/2022]
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Rodríguez-Caulo EA, Macías D, Adsuar A, Ferreiro A, Arias-Dachary J, Parody G, Fernández F, Daroca T, Rodríguez-Mora F, Garrido JM, Muñoz-Carvajal I, Barquero JM, Valderrama JF, Melero JM. Biological or mechanical prostheses for isolated aortic valve replacement in patients aged 50–65 years: the ANDALVALVE study. Eur J Cardiothorac Surg 2019; 55:1160-1167. [DOI: 10.1093/ejcts/ezy459] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/07/2018] [Accepted: 11/22/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Emiliano A Rodríguez-Caulo
- Cardiovascular Surgery Service, University Hospital Virgen de la Victoria, Málaga CIBERCV Cardiovascular Diseases, Health Institute Carlos III, Madrid, Spain
| | - Diego Macías
- Cardiovascular Surgery Service, University Hospital Puerta del Mar, Cádiz, Spain
| | - Alejandro Adsuar
- Cardiovascular Surgery Service, University Hospital Virgen del Rocío, Sevilla, Spain
| | - Andrea Ferreiro
- Cardiovascular Surgery Service, University Hospital Virgen de las Nieves, Granada, Spain
| | | | - Gertrudis Parody
- Cardiovascular Surgery Service, University Hospital Virgen Macarena, Sevilla, Spain
| | - Frank Fernández
- Cardiovascular Surgery Service, Regional University Hospital, Málaga, Spain
| | - Tomás Daroca
- Cardiovascular Surgery Service, University Hospital Puerta del Mar, Cádiz, Spain
| | - Felipe Rodríguez-Mora
- Cardiovascular Surgery Service, University Hospital Virgen del Rocío, Sevilla, Spain
| | - José M Garrido
- Cardiovascular Surgery Service, University Hospital Virgen de las Nieves, Granada, Spain
| | | | - José M Barquero
- Cardiovascular Surgery Service, University Hospital Virgen Macarena, Sevilla, Spain
| | - José F Valderrama
- Cardiovascular Surgery Service, Regional University Hospital, Málaga, Spain
| | - José M Melero
- Cardiovascular Surgery Service, University Hospital Virgen de la Victoria, Málaga CIBERCV Cardiovascular Diseases, Health Institute Carlos III, Madrid, Spain
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Bavaria JE, Tommaso CL, Brindis RG, Carroll JD, Michael Deeb G, Feldman TE, Gleason TG, Horlick EM, Kavinsky CJ, Kumbhani DJ, Craig Miller D, Allen Seals A, Shahian DM, Shemin RJ, Sundt TM, Thourani VH. 2018 AATS/ACC/SCAI/STS expert consensus systems of care document: Operator and institutional recommendations and requirements for transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2019; 93:E153-E184. [DOI: 10.1002/ccd.27811] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 06/10/2018] [Indexed: 11/10/2022]
Affiliation(s)
| | - Carl L. Tommaso
- Society for Cardiovascular Angiography and Interventions Representative
| | | | | | | | - Ted E. Feldman
- Society for Cardiovascular Angiography and Interventions Representative
| | | | - Eric M. Horlick
- Society for Cardiovascular Angiography and Interventions Representative
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Bavaria JE, Tommaso CL, Brindis RG, Carroll JD, Deeb GM, Feldman TE, Gleason TG, Horlick EM, Kavinsky CJ, Kumbhani DJ, Miller DC, Seals AA, Shahian DM, Shemin RJ, Sundt TM, Thourani VH. 2018 AATS/ACC/SCAI/STS Expert Consensus Systems of Care Document: Operator and Institutional Recommendations and Requirements for Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2019; 73:340-374. [DOI: 10.1016/j.jacc.2018.07.002] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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42
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Ramaiah C. Reoperations on Thoracic Aorta and Aortic Root: Surgical Technique and Pitfalls. Int J Angiol 2018; 27:138-143. [PMID: 30154632 DOI: 10.1055/s-0038-1649514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
Repeat operations involving the aortic root, ascending aorta, and arch (proximal aorta) are technically challenging. These procedures are associated with higher operative mortality and morbidity. A dedicated surgical team with special skill set is essential to manage these complex patients. Redo root and proximal aortic procedures can be done with acceptable risk in most patients with attention to details involving the surgical procedure, patient selection, and perioperative management.
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Affiliation(s)
- Chand Ramaiah
- Department of Cardiac Surgery, Saint Thomas Heart Institute, Nashville, Tennessee
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43
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Poli D, Antonucci E, Pengo V, Grifoni E, Maggini N, Testa S, Lodigiani C, Insana A, Marongiu F, Barcellona D, Paparo C, Bucherini E, Pignatelli P, Palareti G. Risk of reoperation in bioprosthetic valve patients with indication for long-term anticoagulation. Results from the observational retrospective multicentre PLECTRUM study. Open Heart 2018; 5:e000837. [PMID: 30228907 PMCID: PMC6135414 DOI: 10.1136/openhrt-2018-000837] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/19/2018] [Accepted: 07/24/2018] [Indexed: 01/15/2023] Open
Abstract
Objective Several factors should be considered when a prosthetic heart valve, bioprosthetic valve (BV) or mechanical valve is to be implanted: thrombogenicity, life expectancy and the risk of reoperation. Methods We conducted an observational retrospective multicentre study among Italian Thrombosis Centers on patients with BV on long-term vitamin K antagonist (VKA) treatment to evaluate the risk of reoperation and the rate of bleeding and thrombotic events. Results We analysed 612 patients (median age 71.8 years) with BV on long-term VKA treatment for the presence of atrial fibrillation (AF) (78.4%) or other indications (21.6%). Thirty-four major bleeding events (rate 1.1×100 patient-years) and 29 thromboembolic events (rate 0.9×100 patient-years) were recorded, and 46 patients (rate 1.5×100 patient-years) underwent reoperation. The rate of reoperation was higher among younger patients: 32.9% in patients <60 years and 3.9% in patients ≥60 years (relative risk (RR) 3.8, 95% CI 2.1 to 7.2; p=0.0001). When patients were analysed according to age <65 or ≥65 years and <75 or ≥70 years, younger patients still were at higher risk for reoperation (RR 3.1, 95% CI 1.7 to 6.0 and 3.7, 95% CI 1.7 to 8.6, respectively). Conclusions Our findings suggest that the threshold of 65 years for implanting a BV should be carefully evaluated, considering the high risk for reoperation and the high risk of AF occurrence with persisting need for long-term anticoagulation. The high risk for reoperation of young patients implanted with BV and the availability of a safer and easier way to conduct VKA treatment, such as the use of point-of-care devices, should be considered when the type of valve must be chosen.
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Affiliation(s)
- Daniela Poli
- Thrombosis Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | | | - Vittorio Pengo
- Department of Cardiac Thoracic and Vascular Sciences, Thrombosis Centre, University of Padova, Padova, Italy
| | - Elisa Grifoni
- Thrombosis Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Niccolò Maggini
- Thrombosis Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Sophie Testa
- Haemostasis and Thrombosis Centre, Hospital of Cremona, Cremona, Italy
| | | | - Antonio Insana
- Servizio Di Patologia Clinica Ospedale S. Croce Moncalieri, Moncalieri, Italy
| | - Francesco Marongiu
- Centro Emostasi, Azienda Ospedaliero Universitaria di Monserrato, Cagliari, Italy
| | - Doris Barcellona
- Centro Emostasi, Azienda Ospedaliero Universitaria di Monserrato, Cagliari, Italy
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Minimally invasive versus full sternotomy aortic valve replacement in low-risk patients: Which will stand against transcatheter aortic valve replacement? Surgery 2018; 164:282-287. [DOI: 10.1016/j.surg.2018.02.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 02/15/2018] [Accepted: 02/22/2018] [Indexed: 11/18/2022]
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45
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2018 AATS/ACC/SCAI/STS Expert Consensus Systems of Care Document: Operator and Institutional Recommendations and Requirements for Transcatheter Aortic Valve Replacement: A Joint Report of the American Association for Thoracic Surgery, American College of Cardiology, Society for Cardiovascular Angiography and Interventions, and The Society of Thoracic Surgeons. Ann Thorac Surg 2018; 107:650-684. [PMID: 30030976 DOI: 10.1016/j.athoracsur.2018.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 07/06/2018] [Indexed: 11/22/2022]
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46
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Seguimiento a largo plazo tras sustitución valvular aórtica con prótesis mecánicas o biológicas en pacientes de mediana edad. Resultados iniciales de un estudio multicéntrico. CIRUGIA CARDIOVASCULAR 2018. [DOI: 10.1016/j.circv.2018.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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47
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Rodríguez-Caulo EA, Otero-Forero JJ, Sánchez-Espín G, Mataró MJ, Guzón A, Porras C, Villaescusa J, Such M, Melero JM. 15 years outcomes following bioprosthetic versus mechanical aortic valve replacement in patients aged 50–65 years with isolated aortic stenosis. CIRUGIA CARDIOVASCULAR 2018. [DOI: 10.1016/j.circv.2018.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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48
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Fukunaga N, Sakata R, Koyama T. Short- and long-term outcomes following redo valvular surgery. J Card Surg 2018; 33:56-63. [PMID: 29399899 DOI: 10.1111/jocs.13534] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM We reviewed our experience in redo valvular surgery to evaluate trends in short- and long-term outcomes. METHODS We reviewed 414 patients (mean age, 62.8 ± 13.6 years) who underwent redo valvular surgery in the past 25 years. A total of 301 patients (54.2%) underwent first-time redo valvular surgeries; 178 (32.1%) were second redos, 60 (10.8%) were third redos, and 16 were fourth redos (2.9%). The mean follow-up period was 6.8 ± 6.3 years. RESULTS Hospital mortality was 5.8%. New York Heart Association (NYHA) class III/IV (P = 0.0007, odds ratio = 4.403) and hemodialysis (P = 0.0383, odds ratio = 7.196) were risk factors for hospital death. Long-term survival rates at 15 and 20 years were 64.7% ± 4.3% and 59.1% ± 5.0%, respectively. Predictors of late death were first time redo (P = 0.0076, hazard ratio = 0.422) and age younger than 61 years (P = 0.0005, hazard ratio = 0.229). There were significant differences in long-term survival between NYHA classes I/II and III/IV (log-rank test, P = 0.0419) and between the time from redo surgery (log-rank test, P = 0.0189) and age (log-rank test, P = 0.0001). CONCLUSIONS The hospital mortality rate for redo valve surgery has improved. Early referral for redo surgery can contribute to improving early and late outcomes.
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Affiliation(s)
- Naoto Fukunaga
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Ryuzo Sakata
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tadaaki Koyama
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
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Sundt TM. Valvular Heart Disease and Aortic Dilatation. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2018. [DOI: 10.15212/cvia.2017.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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50
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Joshi Y, Achouh P, Menasché P, Fabiani JN, Berrebi A, Carpentier A, Latremouille C, Jouan J. Multiple reoperations on the aortic valve: outcomes and implications for future potential valve-in-valve strategy†. Eur J Cardiothorac Surg 2017; 53:1251-1257. [DOI: 10.1093/ejcts/ezx469] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 11/28/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Paul Achouh
- Department of Cardiovascular Surgery, Georges Pompidou European Hospital and University Paris-Descartes, Sorbonne Paris-Cité, Paris, France
| | - Philippe Menasché
- Department of Cardiovascular Surgery, Georges Pompidou European Hospital and University Paris-Descartes, Sorbonne Paris-Cité, Paris, France
- INSERM UMR 970, Paris, France
| | - Jean-Noel Fabiani
- Department of Cardiovascular Surgery, Georges Pompidou European Hospital and University Paris-Descartes, Sorbonne Paris-Cité, Paris, France
| | - Alain Berrebi
- Department of Cardiovascular Surgery, Georges Pompidou European Hospital and University Paris-Descartes, Sorbonne Paris-Cité, Paris, France
| | - Alain Carpentier
- Department of Cardiovascular Surgery, Georges Pompidou European Hospital and University Paris-Descartes, Sorbonne Paris-Cité, Paris, France
| | - Christian Latremouille
- Department of Cardiovascular Surgery, Georges Pompidou European Hospital and University Paris-Descartes, Sorbonne Paris-Cité, Paris, France
| | - Jérôme Jouan
- Department of Cardiovascular Surgery, Georges Pompidou European Hospital and University Paris-Descartes, Sorbonne Paris-Cité, Paris, France
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