1
|
Uchino G, Murakami H, Mukohara N, Tanaka H, Nomura Y, Miyahara S, Kawashima M, Fujisue J, Tonoki S. Very-long-term outcomes of mechanical valves in mitral position focusing on valve-related complications. Interact Cardiovasc Thorac Surg 2022; 35:6595107. [PMID: 35640541 PMCID: PMC9297525 DOI: 10.1093/icvts/ivac146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/05/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gaku Uchino
- Department of Cardiovascular Surgery, Hyogo Brain and Heart Center at Himeji , Himeji, Japan
| | - Hirohisa Murakami
- Department of Cardiovascular Surgery, Hyogo Brain and Heart Center at Himeji , Himeji, Japan
| | - Nobuhiko Mukohara
- Department of Cardiovascular Surgery, Hyogo Brain and Heart Center at Himeji , Himeji, Japan
| | - Hiroshi Tanaka
- Department of Cardiovascular Surgery, Hyogo Brain and Heart Center at Himeji , Himeji, Japan
| | - Yoshikatsu Nomura
- Department of Cardiovascular Surgery, Hyogo Brain and Heart Center at Himeji , Himeji, Japan
| | - Shunsuke Miyahara
- Department of Cardiovascular Surgery, Hyogo Brain and Heart Center at Himeji , Himeji, Japan
| | - Motoharu Kawashima
- Department of Cardiovascular Surgery, Hyogo Brain and Heart Center at Himeji , Himeji, Japan
| | - Jun Fujisue
- Department of Cardiovascular Surgery, Hyogo Brain and Heart Center at Himeji , Himeji, Japan
| | - Shuto Tonoki
- Department of Cardiovascular Surgery, Hyogo Brain and Heart Center at Himeji , Himeji, Japan
| |
Collapse
|
2
|
Tayama E, Saku K, Anegawa T, Oryoji A, Negoto S. Prosthetic cardiac valves: history and review of cardiac prostheses clinically available in Japan. Surg Today 2022; 52:521-531. [PMID: 34435247 DOI: 10.1007/s00595-021-02361-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/10/2021] [Indexed: 10/20/2022]
Abstract
Recently developed prosthetic valves are reliable and essential for the treatment of valvular heart disease. The mechanical valve evolved remarkably following the introduction of pyrolite carbon material, which enabled the creation of a bileaflet form incorporated with a pivot mechanism. The improved durability of the biological valve is attributed mainly to the development of a tissue fixation process and anti-calcification treatments. However, optimal antithrombogenicity and durability have not yet been achieved for either prosthetic valve type. To select the most suitable prosthetic valve for each individual patient from among the many clinically available prosthetic valves, it is necessary to have a thorough understanding of the characteristics of each valve.
Collapse
Affiliation(s)
- Eiki Tayama
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume City, Fukuoka, 830-0011, Japan.
| | - Kosuke Saku
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume City, Fukuoka, 830-0011, Japan
| | - Tomoyuki Anegawa
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume City, Fukuoka, 830-0011, Japan
| | - Atsunobu Oryoji
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume City, Fukuoka, 830-0011, Japan
| | - Shinya Negoto
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume City, Fukuoka, 830-0011, Japan
| |
Collapse
|
3
|
Li J, Wang S, Sun H, Xu J, Dong C, Song M, Yu Q. Clinical and Surgical Evaluations of Reoperation After Mechanical Mitral Valve Replacement Due to Different Etiologies. Front Cardiovasc Med 2022; 8:778750. [PMID: 35111824 PMCID: PMC8801603 DOI: 10.3389/fcvm.2021.778750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background:This study aimed to evaluate the clinical and surgical characteristics of patients who required reoperation after mechanical mitral valve replacement (MVR).Methods:We retrospectively identified 204 consecutive patients who underwent reoperation after mechanical MVR between 2009 and 2018. Patients were categorized according the reason for reoperation (perivalvular leakage, thrombus formation, or pannus formation). The patients' medical and surgical records were studied carefully and the rates of in-hospital complications were calculated.Results:The mean age was 51±12 years and 44% of the patients were male. The reasons for reoperation were perivalvular leakage (117 patients), thrombus formation (35 patients), and pannus formation (52 patients). The most common positions for perivalvular leakage were at the 6–10 o'clock positions (proportions of ≥25% for each hour position). Most patients had an interval of >10 years between the original MVR and reoperation. The most common reoperation procedure was re-do MVR (157 patients), and 155 of these patients underwent concomitant cardiac procedures. There were 10 in-hospital deaths and 32 patients experienced complications. The 10-year survival rate was 82.2 ± 3.9% in general, and the group of lowest rate was patients with PVL (77.5 ± 5.2%). The independent risk factors were “male” (4.62, 95% CI 1.57–13.58, P = 0.005) and “Hb <9g/dL before redo MV operation” (3.45, 95% CI 1.13–10.49, P = 0.029).Conclusion:Perivalvular leakage was the most common reason for reoperation after mechanical MVR, with a low survival rate in long term follow-up relatively.
Collapse
|
4
|
OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6524995. [DOI: 10.1093/ejcts/ezac073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 12/30/2021] [Accepted: 01/24/2022] [Indexed: 11/15/2022] Open
|
5
|
Perl L, Cohen A, Dadashev A, Shapira Y, Vaknin-Assa H, Yahalom V, Sagie A, Kornowski R, Hirsch R. Long-term outcomes of catheter-based intervention for clinically significant paravalvular leak. EUROINTERVENTION 2021; 17:736-743. [PMID: 33720018 PMCID: PMC9725040 DOI: 10.4244/eij-d-20-01206] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND In most centres, clinically significant percutaneous paravalvular leak (PVL) closure following valve replacement surgery is reserved for those considered high-risk for surgery. There is a paucity of data regarding the long-term outcomes of these patients. AIMS Our goals were to assess the long-term outcomes of patients undergoing percutaneous PVL closure. METHODS A total of 100 consecutive transcatheter PVL closure procedures (74 mitral, 26 aortic) were performed in 95 patients between February 2005 and August 2019 at our hospital. Data collected included procedural success rates, indication-specific outcomes and mortality. RESULTS Mean follow-up was 5.6±6.1 years, mean age 62.6±15.2 years, and 45.4% were female. The device was successfully implanted in 88 procedures (88.0%). Patients who presented with heart failure (n=57) had a significant improvement in NYHA classification (29.2% Class III/IV versus 100.0%, p<0.001). For patients who presented with haemolytic anaemia (n=38), haemoglobin increased (11.94±1.634 vs 9.72±1.49, p<0.001) and LDH levels were reduced (1,354.90±1,225.55 vs 2,039.40±1,347.20, p<0.001) following the procedure. Rates of mortality were 3.8% at 90 days, 15.6% after 1 year, and 27.2% after 5 years. CONCLUSIONS For patients who are deemed intermediate- to high-risk for repeat surgery, transcatheter PVL closure shows reasonable clinical success rates, with a significant improvement in symptoms, and a relatively low rate of periprocedural complications.
Collapse
Affiliation(s)
- Leor Perl
- Department of Cardiology, Rabin Medical Center, Beilinson Hospital, 39 Jabotinsky St, Petach Tikva, 4941492, Israel
| | - Amir Cohen
- Cardiology Department, Rabin Medical Center and “Sackler” School of Medicine, Tel Aviv University, Petach Tikva, Israel
| | - Alexander Dadashev
- Cardiology Department, Rabin Medical Center and “Sackler” School of Medicine, Tel Aviv University, Petach Tikva, Israel
| | - Yaron Shapira
- Cardiology Department, Rabin Medical Center and “Sackler” School of Medicine, Tel Aviv University, Petach Tikva, Israel
| | - Hana Vaknin-Assa
- Cardiology Department, Rabin Medical Center and “Sackler” School of Medicine, Tel Aviv University, Petach Tikva, Israel
| | - Vered Yahalom
- Blood Services & Apheresis Institute, Rabin Medical Center and “Sackler” School of Medicine, Tel Aviv University, Petach Tikva, Israel
| | - Alexander Sagie
- Cardiology Department, Rabin Medical Center and “Sackler” School of Medicine, Tel Aviv University, Petach Tikva, Israel
| | - Ran Kornowski
- Cardiology Department, Rabin Medical Center and “Sackler” School of Medicine, Tel Aviv University, Petach Tikva, Israel
| | - Rafael Hirsch
- Cardiology Department, Rabin Medical Center and “Sackler” School of Medicine, Tel Aviv University, Petach Tikva, Israel
| |
Collapse
|
6
|
Thromboembolic complications in adult congenital heart disease: the knowns and the unknowns. Clin Res Cardiol 2020; 110:1380-1391. [PMID: 33037501 DOI: 10.1007/s00392-020-01746-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 09/08/2020] [Indexed: 10/23/2022]
Abstract
Despite impressive improvement in long-term survival, adults with congenital heart disease (CHD) remain exposed to a significant cardiovascular morbidity over lifetime. Thromboembolic events (TE) are a major issue. Specific anatomic groups have been shown a particular high risk of TE, including cyanotic heart disease and Fontan circulation. Many intercurrent clinical factors add a substantial risk such as intracardiac medical devices, atrial arrhythmia, endocarditis, or pregnancy. Nevertheless, what is unknown exceeds what is known, especially regarding the management of this heterogenous patient population. Anticoagulation decision should always be individualized weighing balanced with the alternative risk of hemorrhagic complications. In this review, we aim to synthetize existing literature on TE in adults with CHD, discuss management issues, highlight gaps in knowledge, and intend to suggest high priority research.
Collapse
|
7
|
Mechanical valves in the pulmonary position: An international retrospective analysis. J Thorac Cardiovasc Surg 2017; 154:1371-1378.e1. [DOI: 10.1016/j.jtcvs.2017.04.072] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 03/23/2017] [Accepted: 04/12/2017] [Indexed: 12/21/2022]
|
8
|
Kappetein AP, Head SJ. The Clinical Reality With Uncertain Consequences of Biological Valve Thrombosis. J Am Coll Cardiol 2016; 68:2070-2072. [PMID: 27810045 DOI: 10.1016/j.jacc.2016.08.042] [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: 08/29/2016] [Accepted: 08/31/2016] [Indexed: 10/20/2022]
Affiliation(s)
| | - Stuart J Head
- Department of Thoracic Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands
| |
Collapse
|
9
|
Bileaflet mechanical valve replacement: an assessment of outcomes with 30 years of follow-up. Interact Cardiovasc Thorac Surg 2016; 23:599-607. [DOI: 10.1093/icvts/ivw196] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 04/19/2016] [Indexed: 11/14/2022] Open
|
10
|
Nishida T, Sonoda H, Oishi Y, Tanoue Y, Tatewaki H, Shiokawa Y, Tominaga R. Long-Term Comparison of Three Types of Aortic St. Jude Medical Mechanical Prosthesis in Japanese Patients. Circ J 2015; 79:2193-200. [PMID: 26248571 DOI: 10.1253/circj.cj-15-0268] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The long-term results achieved with aortic St. Jude Medical (SJM) mechanical prostheses in various age groups of Japanese patients have not been previously compared or reported. METHODS AND RESULTS Since 1981, a total of 240 SJM valves were implanted in 79 patients using the Standard model, in 58 patients with the Hemodynamic Plus model, and in 103 patients with the Regent model for aortic valve replacement (AVR). Follow-up was completed for 2,397 patient-years in 97.5% of the patients, among whom the effect of age was compared, and the subjects were divided into younger (<65 years) and older (≥65 years) groups. Hospital mortality rate was 2.5%. No structural valve deterioration was observed during the follow-up period. In addition, no significant differences were observed in long-term survival between the 3 models. In contrast, significantly better rates of freedom from all-cause death (P<0.0001), valve-related death (P=0.0018) and valve-related morbidity (P=0.0021), including bleeding events (P=0.0007), were observed in the younger group (n=157, 50.6±1.0 years old) than in the older group (n=83, 72.5±0.7 years old). CONCLUSIONS All types of SJM valve used for single AVR achieved satisfactory early and long-term results in each age group even 25 years after surgery. When selecting this prosthesis for elderly patients, however, relatively worse performance may be expected compared with that observed in younger patients.
Collapse
Affiliation(s)
- Takahiro Nishida
- Department of Cardiovascular Surgery, Kyushu University Graduate School of Medical Sciences
| | | | | | | | | | | | | |
Collapse
|
11
|
Taramasso M, Maisano F, Denti P, Guidotti A, Sticchi A, Pozzoli A, Buzzatti N, De Bonis M, La Canna G, Alfieri O. Surgical treatment of paravalvular leak: Long-term results in a single-center experience (up to 14 years). J Thorac Cardiovasc Surg 2014; 149:1270-5. [PMID: 25648478 DOI: 10.1016/j.jtcvs.2014.12.041] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 11/28/2014] [Accepted: 12/15/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The aim of this study is to report the long-term outcomes (median follow-up time, 7 years; range, 1 month to 14 years) of patients who underwent surgery for paravalvular leak in our single-center experience. METHODS From October 2000 to November 2007, 122 consecutive patients underwent surgery for symptomatic paravalvular leak (40 patients with aortic paravalvular leak; 82 with mitral paravalvular leak). In 7 patients (5.7%, all mitral), surgery was performed on the beating heart through a right thoracotomy. In 35% of patients, multiple paravalvular leaks were present. RESULTS The mean age of patients was 62 ± 11 years, and European System for Cardiac Operative Risk Evaluation II was 7.2% ± 6%. Most of the patients were in New York Heart Association functional class III or IV (60%). Symptomatic hemolysis was present in 31% of the patients, and 41% of the patients had more than 1 previous cardiac operation. Paravalvular leak repair was feasible in 79 patients (65%), whereas in 43 patients (35%) prosthesis re-replacement was required. Thirty-day mortality was 10.7% (13/122 patients; 5% for aortic paravalvular leak and 13% for mitral paravalvular leak; P = .1); 2 patients (1.6%) with residual severe mitral paravalvular leak underwent successful redo surgery before discharge. Median length of stay was 7 days. Overall actuarial survival was 39% ± 6% at 12 years; freedom from cardiac death was 54% ± 7% at 12 years. Only 1 patient underwent redo surgery during follow-up. Multivariable analysis identified preoperative chronic renal failure (hazard ratio, 2.6; 95% confidence interval, 1.4-4.9; P = .03) and more than 1 previous cardiac reoperation (hazard ratio, 2.3; 95% confidence interval, 1.3-4; P = .03) as independent predictors of death at follow-up. CONCLUSIONS The operative mortality of surgical treatment of paravalvular leak is still high. Long-term outcomes remain suboptimal in these challenging patients, especially in the presence of multiple previous cardiac operations and associated co-pathologies. These results support the importance of alternative therapeutic options.
Collapse
Affiliation(s)
- Maurizio Taramasso
- Klinik für Herz- und Gefässchirurgie, Cardiac Surgery Department, UniversitätsSpital Zürich, Zürich, Switzerland; Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy.
| | - Francesco Maisano
- Klinik für Herz- und Gefässchirurgie, Cardiac Surgery Department, UniversitätsSpital Zürich, Zürich, Switzerland
| | - Paolo Denti
- Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Andrea Guidotti
- Klinik für Herz- und Gefässchirurgie, Cardiac Surgery Department, UniversitätsSpital Zürich, Zürich, Switzerland
| | - Alessandro Sticchi
- Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Alberto Pozzoli
- Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Nicola Buzzatti
- Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Michele De Bonis
- Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Giovanni La Canna
- Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Ottavio Alfieri
- Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy
| |
Collapse
|
12
|
Misawa Y. Valve-related complications after mechanical heart valve implantation. Surg Today 2014; 45:1205-9. [PMID: 25519937 PMCID: PMC4565860 DOI: 10.1007/s00595-014-1104-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 10/24/2014] [Indexed: 12/27/2022]
Abstract
The number of heart valve surgeries is increasing, and 19,164 patients underwent heart valve surgery in Japan in 2011. The early mortality rate has remained stable for more than 10 years. Many patients now survive for many years, with a reported 10-year survival rate of at least 60 %. However, unfavorable complications can occur after valve surgery. Valve-related complications include thromboembolisms, bleeding complications and prosthetic valve endocarditis, followed by structural and nonstructural prosthetic valve dysfunctions. Our review of studies published after 2000 revealed that the rate of all valve-related complications was 0.7-3.5 % per patient-year. Thromboembolisms occur at a rate of approximately 1 % per patient-year, and bleeding complications occur at almost 0.5 % per patient-year. Thromboembolic and hemorrhagic events related to anticoagulant therapy should be considered during life-long follow-up. The occurrence rate of endocarditis reaches 0.5 % per patient-year, with a poor postoperative survival. Structural dysfunctions have been largely overcome, and the nonstructural dysfunction rate is 0.4-1.2 % per patient-year. The nonstructural dysfunctions induced by paravalvular leaks and pannus ingrowth are also issues that need to be resolved.
Collapse
Affiliation(s)
- Yoshio Misawa
- Division of Cardiovascular Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| |
Collapse
|
13
|
Nishida T, Sonoda H, Oishi Y, Ushijima T, Tanoue Y, Nakashima A, Shiokawa Y, Tominaga R. More than 20-year experience of Bentall operation with mechanical prostheses for chronic aortic root aneurysm. Gen Thorac Cardiovasc Surg 2014; 63:78-85. [DOI: 10.1007/s11748-014-0438-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 06/05/2014] [Indexed: 10/25/2022]
|
14
|
Nishida T, Sonoda H, Oishi Y, Tatewaki H, Tanoue Y, Shiokawa Y, Tominaga R. Long-Term Results of Aortic Valve Replacement With Mechanical Prosthesis or Carpentier-Edwards Perimount Bioprosthesis in Japanese Patients According to Age. Circ J 2014; 78:2688-95. [DOI: 10.1253/circj.cj-14-0466] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Takahiro Nishida
- Department of Cardiovascular Surgery, Kyushu University Graduate School of Medical Sciences
| | - Hiromichi Sonoda
- Department of Cardiovascular Surgery, Kyushu University Graduate School of Medical Sciences
| | - Yasuhisa Oishi
- Department of Cardiovascular Surgery, Kyushu University Graduate School of Medical Sciences
| | - Hideki Tatewaki
- Department of Cardiovascular Surgery, Kyushu University Graduate School of Medical Sciences
| | - Yoshihisa Tanoue
- Department of Cardiovascular Surgery, Kyushu University Graduate School of Medical Sciences
| | - Yuichi Shiokawa
- Department of Cardiovascular Surgery, Kyushu University Graduate School of Medical Sciences
| | - Ryuji Tominaga
- Department of Cardiovascular Surgery, Kyushu University Graduate School of Medical Sciences
| |
Collapse
|