1
|
Nakayama T, Nakamura Y, Shikata F, Ushijima M, Yasumoto Y, Yoshiyama D, Kuroda M, Sawa S, Tsuruta R, Furutachi A, Narita T, Ito Y. Thrombocytopenia Following Perceval Sutureless Aortic Valve Replacement in Asian Patients. Circ J 2024; 88:549-558. [PMID: 36709983 DOI: 10.1253/circj.cj-22-0587] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND This study analyzed the safety and performance of the Perceval valve for aortic valve replacement (AVR) in patients at 1 year after undergoing aortic stenosis (AS) treatment, and its effect on significant declines in the platelet count during the immediate postoperative period. METHODS AND RESULTS Data were collected retrospectively for the initial 121 patients (median age 77 years; 47.1% females) who underwent Perceval sutureless AVR between May 2019 and July 2022. Implantation was successful in all (100%), with median cross-clamp and CPB times of 59 and 100 min, respectively. Postoperative thrombocytopenia (platelet count <50×103/μL) was noted in 80 (66.1%) patients. Multivariate analysis showed advanced age (>80 years), preoperative low platelet count (<200×103/μL), and a sternotomy approach as significant risk factors for postoperative thrombocytopenia. One (0.8%) patient died within 30 days after the procedure. The 2-year site-reported event rate was 14% (n=17) for all-cause mortality, 0.8% (n=1) for cardiac mortality, 4.1% (n=5) for stroke, and 1.7% (n=2) for endocarditis and valve-related reoperation; there were no instances of paravalvular leakage or structural valve deterioration. CONCLUSIONS Thrombocytopenia was common after Perceval sutureless AVR, although its impact was not significant. Although Perceval sutureless AVR was found to be a safe and effective option, preoperative assessment of potential bleeding should be performed and the Perceval valve should not be used for patients with a high bleeding risk.
Collapse
Affiliation(s)
- Taisuke Nakayama
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital
| | | | - Fumiaki Shikata
- Department of Cardiovascular Surgery, Kitasato University School of Medicine
| | - Masaki Ushijima
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital
| | - Yuto Yasumoto
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital
| | - Daiki Yoshiyama
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital
| | - Miho Kuroda
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital
| | - Shintaro Sawa
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital
| | - Ryo Tsuruta
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital
| | - Akira Furutachi
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital
| | - Takuya Narita
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital
| | - Yujiro Ito
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital
| |
Collapse
|
2
|
Tanaka D, Zulfiqar A, Mazine A. Going all in: left ventricular outflow tract, aortic root and intervalvular fibrous body reconstruction for extensive infective endocarditis. EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY : OFFICIAL JOURNAL OF THE EUROPEAN ASSOCIATION FOR CARDIO-THORACIC SURGERY 2022; 62:6619558. [PMID: 35766862 DOI: 10.1093/ejcts/ezac367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 06/27/2022] [Indexed: 11/14/2022]
Affiliation(s)
- Dustin Tanaka
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Amna Zulfiqar
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Amine Mazine
- Division of Cardiac Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
3
|
Takaki H, Hashizume K, Ikebata K, Ohno M. Root-commando operation for a ruptured left ventricular outflow tract. Interact Cardiovasc Thorac Surg 2022; 35:ivac036. [PMID: 35237810 PMCID: PMC10634616 DOI: 10.1093/icvts/ivac036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/21/2022] [Accepted: 01/31/2022] [Indexed: 12/17/2023] Open
Abstract
Prosthetic valve endocarditis, especially when complicated by an aortic root abscess and a left ventricular outflow tract rupture, is a life-threatening condition. We present a case of infective prosthetic aortic valve endocarditis with a ruptured left ventricular outflow tract successfully treated with a root-commando operation using a secure anastomosis for reconstruction of the damaged aortic annulus.
Collapse
Affiliation(s)
- Hidenobu Takaki
- Department of Cardiovascular Surgery, Saiseikai Utsunomiya Hospital, 911-1 Takebayashicho, Utsunomiya, Tochigi, 321-0974, Japan
| | - Kenichi Hashizume
- Department of Cardiovascular Surgery, Saiseikai Utsunomiya Hospital, 911-1 Takebayashicho, Utsunomiya, Tochigi, 321-0974, Japan
| | - Koki Ikebata
- Department of Cardiovascular Surgery, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masatoshi Ohno
- Department of Cardiovascular Surgery, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| |
Collapse
|
4
|
El-Sayed Ahmad A, Salamate S, Amer M, Abdullaahi A, Bayram A, Sirat S, Bakhtiary F. Modification of Reconstruction of Left Ventricular Outflow Tract, Aortic Root and the Intervalvular Fibrous Body for Extensive Infective Endocarditis: A Single Center Experience. Eur J Cardiothorac Surg 2022; 62:6588715. [PMID: 35587170 DOI: 10.1093/ejcts/ezac311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 03/13/2022] [Accepted: 05/15/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Extensive infective endocarditis stays a serious life-threatening disease with high mortality and morbidity. The aim of this study is to analyze our experience with our modified surgical technique for extensive infective endocarditis during the last 4 years. METHODS Between March 2017 and February 2021, all patients with extensive infective endocarditis required our modified technique consisting of a radical surgical resection of all infected cardiac tissues, the replacement of infected valves, and a reconstruction of the intervalvular fibrous body, the aortic root and the left ventricular outflow tract with modified elephant trunk were included in this study. RESULTS Our modified technique was performed on 41 patients during the study period. The age median was 74 (IQR: 66.5 - 76.5) and 61.0% (n = 25) were female. 33 patients (80.5%) were in New York Heart Association Class III-IV and 7 patients (17.1%) in cardiogenic shock. The median logistic EuroSCORE II as predicted risk of mortality was 35% (IQR: 28% - 78%). Median cardiopulmonary bypass time and cross-clamping time were 126 (IQR: 86.5-191) min and 78 (IQR: 55.5-108) min, respectively. Intraoperative mortality and 30-day mortality were 4.8% (2 patients) and 19.5% (8 patients), respectively. Low cardiac output with necessity for mechanical support, stroke and new renal dialysis developed in 9.8% (4 patients), 17.1% (7 patients), and 22.0% (9 patients), respectively. New pacemaker implantation was noted in 39.0% (16 patients). Intensive care stay and hospital stay had medians of 6 (IQR: 5-12) and 14 (IQR: 12.5-20.5) days, respectively. One-year mortality and 4-years mortality were 34.1% (14 patients) and 39.0% (16 patients), respectively. Kaplan-Meier survival estimates were 60.3% (95% CI: 46.2 - 78.6%) at 3 years. CONCLUSIONS Our modified technique can be performed in patients with extensive infective endocarditis with acceptable early and mid-term morbidity and mortality. We believe that this technique is an available option for this ill-fated group of patients.
Collapse
Affiliation(s)
- Ali El-Sayed Ahmad
- Division of Cardiac Surgery, Heart Centre Siegburg-Wuppertal, University Witten-Herdecke, Germany
| | - Saad Salamate
- Division of Cardiac Surgery, Heart Centre Siegburg-Wuppertal, University Witten-Herdecke, Germany
| | - Mohamed Amer
- Division of Cardiac Surgery, Heart Centre Siegburg-Wuppertal, University Witten-Herdecke, Germany
| | - Abdisalan Abdullaahi
- Division of Cardiac Surgery, Heart Centre Siegburg-Wuppertal, University Witten-Herdecke, Germany
| | - Ali Bayram
- Division of Cardiac Surgery, Heart Centre Siegburg-Wuppertal, University Witten-Herdecke, Germany
| | - Sami Sirat
- Division of Cardiac Surgery, Heart Centre Siegburg-Wuppertal, University Witten-Herdecke, Germany
| | - Farhad Bakhtiary
- Division of Cardiac Surgery, Heart Centre Siegburg-Wuppertal, University Witten-Herdecke, Germany.,Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| |
Collapse
|
5
|
Bakhtiary F, El-Sayed Ahmad A, Borger M. Modified Reconstruction of Left Ventricular Outflow Tract Till Proximal Ascending Aorta as Reversed Elephant Trunk in Extensive Infective Endocarditis Surgery: Reply. Ann Thorac Surg 2020; 111:380-381. [PMID: 32891657 DOI: 10.1016/j.athoracsur.2020.06.090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Farhad Bakhtiary
- Division of Cardiac Surgery, Heart Center Siegburg-Wuppertal, University Witten-Herdecke, Ringstr. 49, 53721 Siegburg, Germany.
| | - Ali El-Sayed Ahmad
- Division of Cardiac Surgery, Heart Center Siegburg-Wuppertal, University Witten-Herdecke, Ringstr. 49, 53721 Siegburg, Germany
| | - Michael Borger
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| |
Collapse
|
6
|
Nakamura Y. Graft Insertion Technique to Obtain Better Surgical Field. Ann Thorac Surg 2020; 111:380. [PMID: 32497640 DOI: 10.1016/j.athoracsur.2020.04.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/24/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Yoshitsugu Nakamura
- Department of Cardiovascular Surgery, Chiba-Nishi General Hospital, 107-1 Kanegasaku Matsudo, Chiba 270-2251, Japan.
| |
Collapse
|
7
|
Kouchoukos NT, Masetti P, Stamou SC, Kulik A, Haynes M. Outcomes After Left Ventricular Outflow Tract Reconstruction With a Tube Graft for Annular Erosion. Ann Thorac Surg 2019; 109:1820-1825. [PMID: 31697908 DOI: 10.1016/j.athoracsur.2019.09.038] [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: 06/25/2019] [Revised: 08/12/2019] [Accepted: 09/09/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Aortic annular erosion is a serious complication of aortic valve endocarditis or previous aortic valve replacement. This study examined the outcomes of a technique for left ventricular outflow tract reconstruction using a polyester tube graft, followed by translocation of the aortic valve and coronary arteries. METHODS A total of 23 patients with extensive annular erosion resulting from endocarditis or previous aortic valve replacement with or without pseudoaneurysm formation, or occurring after excision of the native valve, underwent suture of a polyester tube graft in the left ventricular outflow tract below the annulus, replacement of the aortic valve and proximal ascending aorta with a composite graft, and reimplantation of the coronary arteries with the use of interposition polyester grafts. The mean age of the patients was 50 years, and 57% were men. RESULTS There were no hospital deaths. The mean duration of follow-up was 6.5 years and extended to 16 years. Actuarial survival at 1, 5, and 10 years was 86.7%, 82.2%, and 62.6%, respectively. Two patients required reoperation for a graft-graft pseudoaneurysm and for degeneration of a porcine bioprosthesis. Echocardiograms obtained at a mean of 75 months postoperatively in 15 of the 23 patients demonstrated normal left ventricular outflow tract dimensions and velocities and a mean effective valve orifice area of 1.07 cm2/m2. All coronary artery grafts were patent on angiography a mean of 40 months postoperatively in 13 patients. CONCLUSIONS Extended experience with this technique confirms its safety and effectiveness for patients with extensive destruction of the aortic annulus. It represents a suitable alternative to other currently used techniques.
Collapse
Affiliation(s)
- Nicholas T Kouchoukos
- Division of Cardiovascular and Thoracic Surgery, Missouri Baptist Medical Center, BJC Healthcare, St Louis, Missouri.
| | - Paolo Masetti
- Division of Cardiovascular and Thoracic Surgery, Missouri Baptist Medical Center, BJC Healthcare, St Louis, Missouri
| | - Sotiris C Stamou
- Division of Cardiovascular and Thoracic Surgery, Missouri Baptist Medical Center, BJC Healthcare, St Louis, Missouri
| | - Alexander Kulik
- Division of Cardiovascular and Thoracic Surgery, Missouri Baptist Medical Center, BJC Healthcare, St Louis, Missouri
| | - Marc Haynes
- Division of Cardiovascular and Thoracic Surgery, Missouri Baptist Medical Center, BJC Healthcare, St Louis, Missouri
| |
Collapse
|
8
|
Uchida T, Hamasaki A, Kuroda Y, Yamashita A, Mizumoto M, Sadahiro M. Aortic Graft Dehiscence After Valve-Sparing Root Replacement. Ann Thorac Surg 2019; 108:e169-e171. [PMID: 30794782 DOI: 10.1016/j.athoracsur.2019.01.036] [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: 10/18/2018] [Revised: 12/04/2018] [Accepted: 01/13/2019] [Indexed: 10/27/2022]
Abstract
Postoperative pseudoaneurysm of the left ventricular outflow tract is a rare but potentially lethal complication in patients after valve-sparing root replacement. This report describes a case of postoperative left ventricular outflow tract pseudoaneurysm in a 49-year-old woman with Marfan syndrome after valve-sparing aortic root replacement. Four months postoperatively, severe dehiscence of the aortic root graft resulted in a retrosternal giant pseudoaneurysm. She underwent emergency redo aortic root replacement, and the postoperative course was uneventful. Although valve-sparing aortic root replacement for aortic root dilatation is widely accepted, we must consider the possibility of postoperative pseudoaneurysms in patients with Marfan syndrome.
Collapse
Affiliation(s)
- Tetsuro Uchida
- Second Department of Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan.
| | - Azumi Hamasaki
- Second Department of Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Yoshinori Kuroda
- Second Department of Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Atsushi Yamashita
- Second Department of Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Masahiro Mizumoto
- Second Department of Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Mitsuaki Sadahiro
- Second Department of Surgery, Faculty of Medicine, Yamagata University, Yamagata, Japan
| |
Collapse
|
9
|
Bentall procedure after previous aortic valve or complete root replacement: Usefulness of self-assembled aortic valve conduit. J Thorac Cardiovasc Surg 2018; 156:89-95.e2. [DOI: 10.1016/j.jtcvs.2018.01.105] [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: 07/26/2017] [Revised: 01/04/2018] [Accepted: 01/30/2018] [Indexed: 11/23/2022]
|