1
|
Yun T, Kim KH, Sohn SH, Kang Y, Kim JS, Choi JW. Rapid-Deployment Aortic Valve Replacement in a Real-World All-Comers Population. Thorac Cardiovasc Surg 2023; 71:511-518. [PMID: 36216332 DOI: 10.1055/s-0042-1757241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND This study was conducted to evaluate the mid-term outcomes of rapid-deployment aortic valve replacement (AVR) using Edwards Intuity. METHODS A total of 215 patients underwent rapid-deployment AVR using Edwards Intuity at our institution. The median follow-up duration was 22 months (interquartile range, 8-36). Primary outcomes were overall survival, cumulative incidence of cardiac death, and major adverse cardiac events. Secondary outcomes were early and 1-year hemodynamic performances of the bioprosthetic valve. RESULTS The mean age was 68.6 ± 10.5 years, and EuroSCORE II was 3.09 ± 4.5. The study population included 113 patients (52.6%) with bicuspid valves (24 patients with type 0 bicuspid valves), 20 patients (9.3%) with pure aortic regurgitation, and 3 patients (1.4%) with infective endocarditis. Isolated AVR was performed in 70 patients (32.4%) and concomitant procedures were performed in 146 patients (67.6%), including aorta surgery (42.3%) and mitral valve procedure (22.3%). Operative mortality was 2.8%. Complete atrioventricular block occurred in 12 patients, but most of them were transient and only 3 patients received permanent pacemaker implantation before discharge. Overall survival at 3 years was 92.3%. Early hemodynamic data showed mean pressure gradients of 15.5 ± 5.0 and 12.7 ± 4.2 mm Hg in the 19 and 21 mm valve, respectively. One-year hemodynamics were also excellent with mean pressure gradients of 14.7 ± 5.3 and 10.7 ± 3.6 mm Hg in the 19 and 21 mm valve, respectively. CONCLUSION Based on a real-world all-comers population, rapid-deployment AVR using Edwards Intuity could be performed for various indications, including bicuspid valve, pure aortic regurgitation, and infective endocarditis, and the clinical and hemodynamic outcomes were excellent.
Collapse
Affiliation(s)
- Taeyoung Yun
- 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
| | - Suk Ho Sohn
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoonjin Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Seong Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 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
| |
Collapse
|
2
|
Dokollari A, Torregrossa G, Sicouri S, Veshti A, Margaryan R, Cameli M, Mandoli GE, Maccherini M, Montesi G, Cabrucci F, Coku L, Arora R, Li QR, Bonacchi M, Gelsomino S. Pearls, pitfalls, and surgical indications of the Intuity TM heart valve: A rapid deployment bioprosthesis. A systematic review of the literature. J Card Surg 2022; 37:5411-5417. [PMID: 36403259 DOI: 10.1111/jocs.17231] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/27/2022] [Accepted: 10/31/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To highlight short- and long-term clinical outcomes of the Intuity TM rapid deployment prosthesis for surgical aortic valve replacement. METHODS We reviewed on PubMed/MEDLINE, Embase, SciELO, LILACS, CCTR/CENTRAL, and Google Scholar for clinical trials, retrospective clinical studies, meta-analysis, and gray literature. RESULTS Fourty-five clinical studies with 12.714 patients were included in the analysis. Thirty-day mortality ranged from 3.8% for Intuity and 3.9% for transcatheter aortic valve replacement (TAVR). The incidence of paravalvular leak (PVL) (Intuity 0% and TAVR 2.17%), permanent pacemaker implantation (Intuity 11.11% and TAVR 12.5%), stroke (Intuity 2.2% and TAVR 2.6%), myocardial infarction (MI) (Intuity 0% and TAVR 1%), were all higher in the TAVR group. Compared to other sutured bioprosthesis (SB), mortality ranged from 0% to 3.9% for Intuity and 0%-6.9% for SB. Long-term cardiac mortality ranged from 0.9% to 1.55% for Intuity and 1.4%-3.3% for the Perceval valve. The incidence of PVL (Intuity 0.24%-0.7% and Perceval 0%-1%), endocarditis (Intuity 0.2%-0.7% and Perceval 1.6%-6.6%), stroke (Intuity 0.36%-1.4% and Perceval 0%-0.8%), MI (Intuity 0.07%-0.26%), and SVD (Intuity 0.12%-0.7% and Perceval 0%) were comparable. Compared to standard full sternotomy (SFS), minimally invasive surgery (MINV) mortality ranged from 0% to 4.3% for MINV and 0%-2.1% for SFS. Hospital costs outcomes ranged from $37,187-$44,368 for the Intuity, $69,389 for TAVR, and $13,543 for SB. Intuity short-term mortality ranged between 0.9% and 12.4% while long-term mortality ranged between 2.6% and 20%. CONCLUSIONS This manuscript provides a 360° overview of the current rapid deployments, sutureless, and TAVR prosthesis.
Collapse
Affiliation(s)
- Aleksander Dokollari
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA.,Department of Cardiothoracic Surgery, Lankenau Medical Center, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Gianluca Torregrossa
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA.,Department of Cardiothoracic Surgery, Lankenau Medical Center, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Serge Sicouri
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Altin Veshti
- Department of Cardiac Surgery, Mother Teresa Hospital, University of Tirana, Tirana, Albania
| | - Rafik Margaryan
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Matteo Cameli
- Department of Experimental and Clinical Medicine, Cardiac Surgery Unit, University of Florence, Firenze, Italy
| | - Giulia Elena Mandoli
- Department of Experimental and Clinical Medicine, Cardiac Surgery Unit, University of Florence, Firenze, Italy
| | - Massimo Maccherini
- Department of Experimental and Clinical Medicine, Cardiac Surgery Unit, University of Florence, Firenze, Italy
| | - Gianfranco Montesi
- Department of Experimental and Clinical Medicine, Cardiac Surgery Unit, University of Florence, Firenze, Italy
| | - Francesco Cabrucci
- Department of Cardiac Surgery/Cardiology, University of Siena, Siena, Italy
| | - Lindita Coku
- Department of Cardiac Surgery, Appalachian Regional Health, University of Kentucky, Hazard, Kentucky, USA
| | - Rakesh Arora
- Department of Surgery, Section of Cardiac Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Qiao Ri Li
- 2010 Vision Associates, Toronto, Ontario, Canada
| | - Massimo Bonacchi
- Department of Cardiac Surgery/Cardiology, University of Siena, Siena, Italy
| | - Sandro Gelsomino
- Department of Cardiac Surgery, CARIM Maastricht Medical University, Maastricht, Netherlands
| |
Collapse
|
3
|
Iacovelli F, Desario P, Cafaro A, Pignatelli A, Alemanni R, Montesanti R, Bortone AS, De Cillis E, De Palo M, Bardi L, Martinelli GL, Tesorio T, Cassese M, Contegiacomo G. The hemodynamic performance of balloon-expandable aortic bioprostheses in the elderly: a comparison between rapid deployment and transcatheter implantation. Hellenic J Cardiol 2022; 68:9-16. [PMID: 35863727 DOI: 10.1016/j.hjc.2022.07.006] [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: 03/13/2022] [Revised: 07/01/2022] [Accepted: 07/11/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Surgical aortic valve replacement with a rapid deployment valve (RDV) is a relatively recent treatment option. Aim of this study was to compare the hemodynamic performance of balloon-expandable (BE)-RDVs and BE-transcatheter heart valves (THVs) in a high surgical risk and frail-elderly population. METHODS BE-THVs and BE-RDVs were respectively implanted in 138 and 47 patients, all older than 75 years and with a Canadian Study of Health and Aging category of 5 or above. Echocardiographic assessment was performed at discharge and at six months. RESULTS At discharge, transprosthetic pressure gradients and indexed effective orifice area (iEOA) were similar in both cohorts. At six-month follow-up, BE-RDV showed lower peak (14.69 vs 20.86 mmHg; p <0.001) and mean (7.82 vs 11.83 mmHg; p <0.001) gradients, as well as larger iEOA (1.05 vs 0.84 cm2/m2; p <0.001). Similar findings were also shown considering only small sized valves. Moderate-to-severe paravalvular leakage was more prevalent in BE-THVs at discharge (14.49 vs 0.00%; p=0.032) and, considering exclusively small prostheses, at six months too (57.69 vs 15.00%; p=0.014). Nevertheless, BE-THVs determined amelioration in left ventricular ejection fraction (53.79 vs 60.14%; p <0.001), pulmonary artery systolic pressure (35.81 vs 33.15 mmHg; p=0.042) and tricuspid regurgitation severity (40.58 vs 19.57%; p=0.031) from discharge to mid-term follow-up. CONCLUSIONS BE-RDVs showed better hemodynamic performance, especially when implanted in small annulus. Despite their worse baseline conditions, transcatheter patients still exhibited a greater improvement of their echocardiographic profile at mid-term follow-up.
Collapse
Affiliation(s)
- Fortunato Iacovelli
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Piazza Giulio Cesare 11, 70124 Bari, Italy; Division of Cardiology, "SS. Annunziata" Hospital, Via Francesco Bruno 1, 74121 Taranto, Italy.
| | - Paolo Desario
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Alessandro Cafaro
- Division of Cardiology, "V. Fazzi" Hospital, Piazza Filippo Muratore, 73100 Lecce, Italy.
| | - Antonio Pignatelli
- Interventional Cardiology Service, "Anthea" Clinic, GVM Care & Research, Via Camillo Rosalba 35/37, 70124 Bari, Italy.
| | - Rossella Alemanni
- Division of Heart Surgery, Emergency and Critical Care Department, "Casa Sollievo della Sofferenza" Research Hospital, Viale Cappuccini, 71013 San Giovanni Rotondo, Italy.
| | - Rosamaria Montesanti
- Division of Heart Surgery, Emergency and Critical Care Department, "Casa Sollievo della Sofferenza" Research Hospital, Viale Cappuccini, 71013 San Giovanni Rotondo, Italy.
| | - Alessandro Santo Bortone
- Division of University Heart Surgery, Cardiothoracic Department, Policlinico University Hospital, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Emanuela De Cillis
- Division of University Heart Surgery, Cardiothoracic Department, Policlinico University Hospital, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Micaela De Palo
- Division of University Heart Surgery, Cardiothoracic Department, Policlinico University Hospital, Piazza Giulio Cesare 11, 70124 Bari, Italy.
| | - Luca Bardi
- Division of Cardiology, Department of Advanced Biomedical Sciences, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy.
| | - Gian Luca Martinelli
- Division of Heart Surgery, Cardiovascular Department, "MultiMedica" Research Hospital, Via Milanese 300, 20099 Sesto San Giovanni, Italy.
| | - Tullio Tesorio
- Interventional Cardiology Service, "Montevergine" Clinic, Via Mario Malzoni, 83013 Mercogliano, Italy.
| | - Mauro Cassese
- Division of Heart Surgery, Emergency and Critical Care Department, "Casa Sollievo della Sofferenza" Research Hospital, Viale Cappuccini, 71013 San Giovanni Rotondo, Italy.
| | - Gaetano Contegiacomo
- Interventional Cardiology Service, "Anthea" Clinic, GVM Care & Research, Via Camillo Rosalba 35/37, 70124 Bari, Italy.
| |
Collapse
|
4
|
Laufer G, Strauch JT, Terp KA, Salinas M, Arribas JM, Massetti M, Andreas M, Young CP. Real-world 6-month outcomes of minimally invasive aortic valve replacement with the EDWARDS INTUITY Elite valve system. Interact Cardiovasc Thorac Surg 2022; 35:6565358. [PMID: 35394527 PMCID: PMC9631962 DOI: 10.1093/icvts/ivac083] [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: 07/27/2021] [Revised: 02/18/2021] [Accepted: 04/01/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Günther Laufer
- Department of Cardiac Surgery, Medical University of Vienna/Cardiac Surgery , Vienna, Austria
| | - Justus T Strauch
- Department of Cardiothoracic Surgery, University Hospital Bergmannsheil Bochum , Bochum, Germany
| | - Kim A Terp
- Department of Cardiac Surgery, Aarhus University Hospital Skejby , Aarhus, Denmark
| | - Marco Salinas
- Department of Cardiac Surgery, Ospedale Del Cuore G.Pasquinucci , Massa, Italy
| | - Jose M Arribas
- Department of Cardiac Surgery, Hospital Clínico Universitario Virgen de la Arrixaca , El Palmar, Murcia, Spain
| | - Massimo Massetti
- Department of Cardiovascular Sciences, Catholic University of Sacred Heart—Rome , Rome, Italy
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna , Vienna, Austria
| | | |
Collapse
|
5
|
Taboada-Martín R, Arribas-Leal JM, Esteve-Pastor MA, Abellán Alemán J, Marín F, Rivera-Caravaca JM, Cánovas-Lopez SJ. Comparison of Aortic Gradient and Ventricular Mass after Valve Replacement for Aortic Stenosis with Rapid Deployment, Sutureless, and Conventional Bioprostheses. Cardiology 2021; 146:656-666. [PMID: 34120109 DOI: 10.1159/000516465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 04/07/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The use of rapid deployment and sutureless aortic prostheses is increasing. Previous reports have shown promising results on haemodynamic performance and mortality rates. However, the impact of these bioprostheses on left ventricular mass (LVM) regression remains unknown. We decided to study the changes in remodelling and LVM regression in isolated severe aortic stenosis treated with conventional or Perceval® or Intuity® valves. METHOD AND RESULTS From January 2011 to January 2016, 324 bioprostheses were implanted in our centre. The collected characteristics were divided into 3 groups: conventional valves, Perceval®, and Intuity®, and they were analysed after 12 months. There were 183 conventional valves (56%), 72 Perceval® (22%), and 69 Intuity® (21.2%). The statistical analysis showed significant differences in transprosthetic postoperative peak gradient (23 [18-29] mm Hg vs. 21 [16-29] mm Hg and 18 [14-24] mm Hg, p < 0.001), ventricular mass electrical criteria regression (Sokolow and Cornell products), and 1-year survival (90 vs. 93% and 97%, log rank p value = 0.04) in conventional, Perceval®, and Intuity® groups. CONCLUSIONS We observed differences in haemodynamic, electrocardiographic, and echocardiographic parameters related to the different types of prosthesis. Patients with the Intuity® prosthesis had the highest reduction in peak aortic gradient and the higher ventricular mass regression. Besides, patients with the Intuity® prosthesis had less risk of mortality during follow-up than the other two groups. Further studies are needed to confirm these findings.
Collapse
Affiliation(s)
- Rubén Taboada-Martín
- Department of Cardiovascular Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain
| | - José María Arribas-Leal
- Department of Cardiovascular Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain
| | - María Asunción Esteve-Pastor
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, IMIB-Arrixaca, CIBERCV, Murcia, Spain
| | | | - Francisco Marín
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, IMIB-Arrixaca, CIBERCV, Murcia, Spain
| | - José Miguel Rivera-Caravaca
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, IMIB-Arrixaca, CIBERCV, Murcia, Spain
| | - Sergio Juan Cánovas-Lopez
- Department of Cardiovascular Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain
| |
Collapse
|
6
|
Klop IDG, Kougioumtzoglou AM, Kloppenburg GTL, van Putte BP, Sprangers MAG, Klein P, Nieuwkerk PT. Short-term outcome of the intuity rapid deployment prosthesis: a systematic review and meta-analysis. Interact Cardiovasc Thorac Surg 2021; 31:427-436. [PMID: 32910171 DOI: 10.1093/icvts/ivaa131] [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: 02/28/2020] [Revised: 05/15/2020] [Accepted: 06/17/2020] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES Limited access aortic valve replacement is an alternative approach for the treatment of calcified aortic valve disease. To facilitate limited access aortic valve replacement, rapid deployment valve prostheses have been developed aiming to reduce surgical impact. This systematic review gives an overview of current literature regarding the INTUITY or INTUITY Elite rapid deployment biological valve prosthesis. METHODS Cochrane, Embase and MEDLINE were searched to identify relevant studies. All studies reporting on patients who underwent isolated or combined surgical aortic valve replacement with the INTUITY or INTUITY Elite valve prosthesis were considered eligible. Primary end points were technical success rate, 30-day mortality, cerebrovascular accident, paravalvular leak and permanent pacemaker implantation. Secondary end points included procedural data such as aortic cross-clamping time, cardiopulmonary bypass time and procedural approach. RESULTS A total of 16 articles fulfilled the inclusion and exclusion criteria and comprised 4.184 patients. Thirty-day mortality was 2.7% (1.9-3.7%), cerebrovascular accident 2.6% (1.4-4.7%), permanent pacemaker implantation 7.9% (6.6-9.5%) and severe postoperative paravalvular leak requiring a reintervention 3.3% (1.7-6.1%). Technical success rate varied between 93.9% and 100%. Conventional median sternotomy was most commonly performed, ranging from 21.7% to 89.6%. Upper hemi-sternotomy was performed more often than anterior right thoracotomy, ranging from 10.4% to 63.3% and 2.2% to 26.1%. The mean transvalvular pressure gradient ranged between 9.0 and 10.3 mmHg at 1 year postoperatively. CONCLUSIONS This review demonstrates that the technical success rate of the INTUITY or INTUITY Elite rapid deployment valve system is high, also in limited access aortic valve replacement. Mortality and cerebrovascular accident rates are low, but the need for postoperative permanent pacemaker implantation and reintervention rate for paravalvular leakage is increased.
Collapse
Affiliation(s)
| | - Athiná M Kougioumtzoglou
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, Netherlands
| | | | - Bart P van Putte
- Department of Cardiothoracic Surgery, St. Antonius Ziekenhuis, Nieuwegein, Netherlands.,Department of Cardiothoracic Surgery, Amsterdam University Medical Centers, Academic Medical Center, Amsterdam, Netherlands
| | - Mirjam A G Sprangers
- Department of Psychology, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Patrick Klein
- Department of Cardiothoracic Surgery, St. Antonius Ziekenhuis, Nieuwegein, Netherlands
| | - Pythia T Nieuwkerk
- Department of Psychology, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| |
Collapse
|
7
|
Choi JW, Kim HJ, Kim JB, Lee S, Lim C, Chang BC, Suh Y, Lee NR, Hwang HY. Early and Two-year Outcomes after Sutureless and Conventional Aortic Valve Replacement: a Nationwide Population-based Study. J Korean Med Sci 2021; 36:e57. [PMID: 33686809 PMCID: PMC7940122 DOI: 10.3346/jkms.2021.36.e57] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 12/20/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND We compared early and 2-year clinical outcomes of sutureless aortic valve replacement (SAVR) with conventional aortic valve replacement (CAVR) in a nationwide study based on claims data. METHODS From December 2016 to November 2018, 3,173 patients underwent bioprosthetic aortic valve replacements. SAVR and CAVR were performed in 641 and 2,532 patients, respectively. Propensity score-matched analysis was performed in 640 patient pairs. RESULTS Operative mortality rate was 2.8% without significant differences between the SAVR (3.4%) and CAVR (2.3%) groups (P = 0.324). There were no significant differences in postoperative morbidities between the groups except for permanent pacemaker (PPM) implantation. PPM implantation rate was significantly higher in the SAVR (3.8%) than in the CAVR group (0.9%) (P < 0.001). One- and two-year overall survival was 89.1% and 87.5%, respectively, without significant differences between the groups (SAVR group vs. CAVR grouP = 89.9% and 90.5% vs. 87.2% and 88.7%, respectively; P = 0.475). There were no significant differences in the cumulative incidence of cardiac death, stroke, aortic valve reoperation and infective endocarditis between the groups. Cumulative PPM implantation incidence at 6 months in the CAVR was 1.1%, and no patient required PPM implantation after 6 months. In the SAVR, the cumulative PPM implantation incidence at 0.5, one, and two years was 3.9%, 5.0% and 5.6%, respectively. The cumulative PPM implantation rate was higher in the SAVR group than in the CAVR group (P < 0.001). CONCLUSION Early and 2-year clinical outcomes between SAVR and CAVR were not different except for a high rate of permanent pacemaker implantation in the SAVR group.
Collapse
Affiliation(s)
- Jae Woong Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ho Jin Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sak Lee
- Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Seoul, Korea
| | - Cheong Lim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Byung Chul Chang
- Department of Thoracic and Cardiovascular Surgery, CHA Bundang Medical Center, Seongnam, Korea
| | - Youshin Suh
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Na Rae Lee
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea.
| | - Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
| |
Collapse
|
8
|
Perera-Gonzalez M, Kiss A, Kaiser P, Holzweber M, Nagel F, Watzinger S, Acar E, Szabo PL, Gonçalves IF, Weber L, Pilz PM, Budinsky L, Helbich T, Podesser BK. The Role of Tenascin C in Cardiac Reverse Remodeling Following Banding-Debanding of the Ascending Aorta. Int J Mol Sci 2021; 22:ijms22042023. [PMID: 33670747 PMCID: PMC7921966 DOI: 10.3390/ijms22042023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/08/2021] [Accepted: 02/11/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Tenascin-C (TN-C) plays a maladaptive role in left ventricular (LV) hypertrophy following pressure overload. However, the role of TN-C in LV regression following mechanical unloading is unknown. Methods: LV hypertrophy was induced by transverse aortic constriction for 10 weeks followed by debanding for 2 weeks in wild type (Wt) and TN-C knockout (TN-C KO) mice. Cardiac function was assessed by serial magnetic resonance imaging. The expression of fibrotic markers and drivers (angiotensin-converting enzyme-1, ACE-1) was determined in LV tissue as well as human cardiac fibroblasts (HCFs) after TN-C treatment. Results: Chronic pressure overload resulted in a significant decline in cardiac function associated with LV dilation as well as upregulation of TN-C, collagen 1 (Col 1), and ACE-1 in Wt as compared to TN-C KO mice. Reverse remodeling in Wt mice partially improved cardiac function and fibrotic marker expression; however, TN-C protein expression remained unchanged. In HCF, TN-C strongly induced the upregulation of ACE 1 and Col 1. Conclusions: Pressure overload, when lasting long enough to induce HF, has less potential for reverse remodeling in mice. This may be due to significant upregulation of TN-C expression, which stimulates ACE 1, Col 1, and alpha-smooth muscle actin (α-SMA) upregulation in fibroblasts. Consequently, addressing TN-C in LV hypertrophy might open a new window for future therapeutics.
Collapse
Affiliation(s)
- Mireia Perera-Gonzalez
- Ludwig Boltzmann Institute for Cardiovascular Research at the Center for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria; (M.P.-G.); (A.K.); (P.K.); (M.H.); (F.N.); (S.W.); eylem-@hotmail.com (E.A.); (P.L.S.); (I.F.G.); (L.W.); (P.M.P.)
- Bioengineering and Aerospace Engineering Department, Carlos III University of Madrid, 28911 Madrid, Spain
| | - Attila Kiss
- Ludwig Boltzmann Institute for Cardiovascular Research at the Center for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria; (M.P.-G.); (A.K.); (P.K.); (M.H.); (F.N.); (S.W.); eylem-@hotmail.com (E.A.); (P.L.S.); (I.F.G.); (L.W.); (P.M.P.)
| | - Philipp Kaiser
- Ludwig Boltzmann Institute for Cardiovascular Research at the Center for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria; (M.P.-G.); (A.K.); (P.K.); (M.H.); (F.N.); (S.W.); eylem-@hotmail.com (E.A.); (P.L.S.); (I.F.G.); (L.W.); (P.M.P.)
| | - Michael Holzweber
- Ludwig Boltzmann Institute for Cardiovascular Research at the Center for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria; (M.P.-G.); (A.K.); (P.K.); (M.H.); (F.N.); (S.W.); eylem-@hotmail.com (E.A.); (P.L.S.); (I.F.G.); (L.W.); (P.M.P.)
| | - Felix Nagel
- Ludwig Boltzmann Institute for Cardiovascular Research at the Center for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria; (M.P.-G.); (A.K.); (P.K.); (M.H.); (F.N.); (S.W.); eylem-@hotmail.com (E.A.); (P.L.S.); (I.F.G.); (L.W.); (P.M.P.)
- Department of Cardiac Surgery, University Hospital St. Poelten, 3100 St. Poelten, Austria
| | - Simon Watzinger
- Ludwig Boltzmann Institute for Cardiovascular Research at the Center for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria; (M.P.-G.); (A.K.); (P.K.); (M.H.); (F.N.); (S.W.); eylem-@hotmail.com (E.A.); (P.L.S.); (I.F.G.); (L.W.); (P.M.P.)
| | - Eylem Acar
- Ludwig Boltzmann Institute for Cardiovascular Research at the Center for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria; (M.P.-G.); (A.K.); (P.K.); (M.H.); (F.N.); (S.W.); eylem-@hotmail.com (E.A.); (P.L.S.); (I.F.G.); (L.W.); (P.M.P.)
| | - Petra Lujza Szabo
- Ludwig Boltzmann Institute for Cardiovascular Research at the Center for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria; (M.P.-G.); (A.K.); (P.K.); (M.H.); (F.N.); (S.W.); eylem-@hotmail.com (E.A.); (P.L.S.); (I.F.G.); (L.W.); (P.M.P.)
| | - Inês Fonseca Gonçalves
- Ludwig Boltzmann Institute for Cardiovascular Research at the Center for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria; (M.P.-G.); (A.K.); (P.K.); (M.H.); (F.N.); (S.W.); eylem-@hotmail.com (E.A.); (P.L.S.); (I.F.G.); (L.W.); (P.M.P.)
| | - Lukas Weber
- Ludwig Boltzmann Institute for Cardiovascular Research at the Center for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria; (M.P.-G.); (A.K.); (P.K.); (M.H.); (F.N.); (S.W.); eylem-@hotmail.com (E.A.); (P.L.S.); (I.F.G.); (L.W.); (P.M.P.)
| | - Patrick Michael Pilz
- Ludwig Boltzmann Institute for Cardiovascular Research at the Center for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria; (M.P.-G.); (A.K.); (P.K.); (M.H.); (F.N.); (S.W.); eylem-@hotmail.com (E.A.); (P.L.S.); (I.F.G.); (L.W.); (P.M.P.)
| | - Lubos Budinsky
- Preclinical Imaging Lab at the Center of Biomedical Research, Department of Radiology, Medical University of Vienna, 1090 Vienna, Austria; (L.B.); (T.H.)
| | - Thomas Helbich
- Preclinical Imaging Lab at the Center of Biomedical Research, Department of Radiology, Medical University of Vienna, 1090 Vienna, Austria; (L.B.); (T.H.)
| | - Bruno Karl Podesser
- Ludwig Boltzmann Institute for Cardiovascular Research at the Center for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria; (M.P.-G.); (A.K.); (P.K.); (M.H.); (F.N.); (S.W.); eylem-@hotmail.com (E.A.); (P.L.S.); (I.F.G.); (L.W.); (P.M.P.)
- Department of Cardiac Surgery, University Hospital St. Poelten, 3100 St. Poelten, Austria
- Correspondence: ; Tel.: +43-1-40400-52210
| |
Collapse
|
9
|
Radiomics signature on CECT as a predictive factor for invasiveness of lung adenocarcinoma manifesting as subcentimeter ground glass nodules. Sci Rep 2021; 11:3633. [PMID: 33574448 PMCID: PMC7878798 DOI: 10.1038/s41598-021-83167-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 01/25/2021] [Indexed: 12/12/2022] Open
Abstract
Controversy and challenges remain regarding the cognition of lung adenocarcinomas presented as subcentimeter ground glass nodules (GGNs). Postoperative lymphatic involvement or intrapulmonary metastasis is found in approximately 15% to 20% of these cases. This study aimed to develop and validate a radiomics signature to identify the invasiveness of lung adenocarcinoma appearing as subcentimeter ground glass nodules. We retrospectively enrolled 318 subcentimeter GGNs with histopathology-confirmed adenocarcinomas in situ (AIS), minimally invasive adenocarcinomas (MIA) and invasive adenocarcinomas (IAC). The radiomics features were extracted from manual segmentation based on contrast-enhanced CT (CECT) and non-contrast enhanced CT (NCECT) images after imaging preprocessing. The Lasso algorithm was applied to construct radiomics signatures. The predictive performance of radiomics models was evaluated by receiver operating characteristic (ROC) analysis. A radiographic-radiomics combined nomogram was developed to evaluate its clinical utility. The radiomics signature on CECT (AUC: 0.896 [95% CI 0.815–0.977]) performed better than the radiomics signature on NCECT data (AUC: 0.851[95% CI 0.712–0.989]) in the validation set. An individualized prediction nomogram was developed using radiomics model on CECT and radiographic model including type, shape and vascular change. The C index of the nomogram was 0.915 in the training set and 0.881 in the validation set, demonstrating good discrimination. Decision curve analysis (DCA) revealed that the proposed model was clinically useful. The radiomics signature built on CECT could provide additional benefit to promote the preoperative prediction of invasiveness in patients with subcentimeter lung adenocarcinomas.
Collapse
|
10
|
Cotroneo A, Novelli E, Barbieri G, Freddi R, Bobbio M, Stelian E, Visetti E, Martinelli GL. Use of an Aortic Valve Replacement Simulation Model to Understand Hospital Costs and Resource Utilization Associated With Rapid-deployment Valves. Clin Ther 2020; 42:2298-2310. [PMID: 33218741 DOI: 10.1016/j.clinthera.2020.10.008] [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: 01/26/2020] [Revised: 09/15/2020] [Accepted: 10/21/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Aortic stenosis (AS) is the most common cause of adult valvular heart disease. In the past decade, minimally invasive surgery (MIS) to treat AS has gained popularity, especially if performed in combination with rapid deployment valves (RDVs), which shorten cross-clamp time (XCT). This study examines specific outcomes and related costs of aortic valve replacement (AVR) before and after the introduction of RDVs. METHODS We used the AVR simulator, an economic model developed to correlate cost and resource utilization associated with the adoption of RDVs, to compare 2 scenarios: (1) a current scenario based on standard AVR practices and (2) a proposed scenario based on increasing use of RDVs and an MIS approach. Both scenarios involved 3 subgroups of patients treated with (1) conventional AVR, (2) MIS, and (3) AVR combined with a coronary artery bypass graft. The current scenario (status quo) involved patients treated with traditional biological valves, and the proposed scenario involved patients who underwent implantation with an RDV. The AVR simulator was fed with real-world input data to estimate complication rates and resource consumption in the proposed scenario. Real-world input data for this analysis were obtained from patients diagnosed with a symptomatic heart valve disease between 2015 and 2018, at Clinica-San-Gaudenzio, Novara, Italy. Lastly, the AVR simulator estimated hospital savings by comparing the 2 scenarios. FINDINGS A total of 132 patients underwent implantation with a traditional biological valve, and 107 were treated with a commercial valve system. The RDV was associated with an increase of 52% of patients undergoing MIS, which generated a 6.1-h reduction of XCT and a total savings of €6695. RDVs also reduced intensive care unit (ICU) and hospital ward length of stay (LOS), leading to savings of €677 and €595 per patient, respectively. Mortality and blood transfusions also improved. The savings for the hospital (related to shorter XCT, hospital ward LOS, and ICU LOS) amounted to €144.111. Our findings were consistent with data gathered from our real-word setting, and results of a sensitivity analysis indicate that our findings were robust across different possible situations. IMPLICATIONS Switching to RDVs and MIS procedures for AVRs was associated with a reduction of costs related to XCT, hospital ward LOS, and ICU LOS. Hospitals can upload literature- and experience-based clinical and cost values to the AVR simulator to estimate a hospital's performance with the introduction of RDVs compared with standard biological valves. This study was not randomized, so more extensive studies could confirm our results in the future.
Collapse
Affiliation(s)
- Attilio Cotroneo
- Clinica San Gaudenzio, Gruppo Policlinico di Monza, Novara, Italy.
| | - Eugenio Novelli
- Clinica San Gaudenzio, Gruppo Policlinico di Monza, Novara, Italy
| | | | - Rachele Freddi
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Milan, Italy
| | - Mario Bobbio
- Clinica San Gaudenzio, Gruppo Policlinico di Monza, Novara, Italy.
| | - Edmond Stelian
- Clinica San Gaudenzio, Gruppo Policlinico di Monza, Novara, Italy.
| | - Enrico Visetti
- Clinica San Gaudenzio, Gruppo Policlinico di Monza, Novara, Italy.
| | | |
Collapse
|
11
|
Amer M, Al Jawad MA, Omar A, Metwaly H. Safety and Haemodynamic Outcomes of Currently Available Suture-less Aortic Valves in Patients With Aortic Stenosis: A Meta-Analysis. Heart Lung Circ 2020; 29:1301-1309. [PMID: 32354587 DOI: 10.1016/j.hlc.2020.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 01/23/2020] [Accepted: 02/15/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Suture-less aortic valves aim to achieve better outcomes and to aid and facilitate the minimally invasive aortic valve replacement procedure by tackling the issue of cross-clamp time, which is an independent predictor of postoperative outcomes, especially in patients with serious comorbidities. By reducing the number of sutures, the time for suture placement is reduced. Our meta-analysis tried to assess the safety and haemodynamic performance of the suture-less aortic valve prostheses to ascertain their benefits as a viable alternative to current established measures. METHOD From their inceptions to February 2017, six electronic databases were searched. Relevant studies using commercially accessible suture-free valves to replace the aortic valve have been recognised. Based on the predefined endpoints, data were collected and analysed. RESULTS For incorporation in qualitative and quantitative analyses, 24 studies were recognised, with a total number of 5,073 patients undergoing suture-less aortic valve replacement. Mortality incidence at the 30-day and 12-month follow-ups were 2.5% and 2.7%, respectively, while the incidences of thromboembolic events (1.6%) and paravalvular leak (0.5%) were acceptable. CONCLUSIONS Current available evidence indicates that sutureless aortic valve replacement is a safe operation showing low mortality and complication rates, with satisfactory haemodynamic performance.
Collapse
Affiliation(s)
| | - Mohammed Abd Al Jawad
- Department of Cardio-Thoracic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Ahmed Omar
- Department of Cardio-Thoracic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hany Metwaly
- Department of Cardio-Thoracic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| |
Collapse
|
12
|
Paparella D, Malvindi PG, Santarpino G, Moscarelli M, Guida P, Fattouch K, Margari V, Martinelli L, Albertini A, Speziale G. Full sternotomy and minimal access approaches for surgical aortic valve replacement: a multicentre propensity-matched study. Eur J Cardiothorac Surg 2020; 57:709-716. [PMID: 31647535 DOI: 10.1093/ejcts/ezz286] [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: 06/18/2019] [Revised: 08/31/2019] [Accepted: 09/11/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Surgical aortic valve replacement (AVR) can be performed via a full sternotomy or a minimal access approach (mini-AVR). Despite long-term experience with the procedure, mini-AVR is not routinely adopted. Our goal was to compare contemporary outcomes of mini-AVR and conventional AVR in a large multi-institutional national cohort. METHODS A total of 5801 patients from 10 different centres who had a mini-AVR (2851) or AVR (2950) from 2011 to 2017 were evaluated retrospectively. Standard aortic prostheses were used in all cases. The use of the minimally invasive approach has increased over the years. The primary outcome is the incidence of 30-day deaths following mini-AVR and AVR. Secondary outcomes are the occurrence of major complications following both procedures. Propensity-matched comparisons were performed based on the multivariable logistic regression model. RESULTS In the overall population patients who had AVR had an increased surgical risk based on the EuroSCORE, and the 30-day mortality rate was higher (1.5% and 2.3% in mini-AVR and AVR, respectively; P = 0.048). Propensity scores identified 2257 patients per group with similar baseline profiles. In the matched groups, patients who had mini-AVR, despite longer cardiopulmonary bypass (81 ± 32 vs 76 ± 28 min; P = 0.004) and cross-clamp (64 ± 24 vs 59 ± 21 min; P ≤ 0.001) times, had lower 30-day mortality rates (1.2% vs 2.0%; P = 0.036), reduced low cardiac output (0.8% vs 1.4%; P = 0.046) and reduced postoperative length of stay (9 ± 8 vs 10 ± 7 days; P = 0.004). Blood transfusions (36.4% vs 30.8%; P ≤ 0.001) and atrial fibrillation (26.0% vs 21.5%, P ≤ 0.001) were higher in patients who had the mini-AVR. CONCLUSIONS In a large multi-institutional recent cohort, minimal access approach aortic valve replacement is associated with reduced 30-day mortality rates and shorter postoperative lengths of stay compared to standard sternotomy. A prospective randomized trial is needed to overcome the possible biases of a retrospective study.
Collapse
Affiliation(s)
- Domenico Paparella
- Department of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, Bari, Italy.,Department of Emergency and Organ Transplant, University of Bari Aldo Moro, Bari, Italy
| | | | - Giuseppe Santarpino
- Department of Cardiac Surgery, Città di Lecce Hospital, GVM Care & Research, Lecce, Italy.,Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Marco Moscarelli
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy.,Department of Cardiac Surgery, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Piero Guida
- Maugeri Foundation, Cassano delle Murge, Bari, Italy
| | - Khalil Fattouch
- Department of Cardiac Surgery, Maria Eleonora Hospital, GVM Care & Research, Palermo, Italy
| | - Vito Margari
- Department of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, Bari, Italy
| | - Luigi Martinelli
- Department of Cardiac Surgery, ICLAS, GVM Care & Research, Rapallo, Italy
| | - Alberto Albertini
- Department of Cardiac Surgery, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Giuseppe Speziale
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy.,Department of Cardiac Surgery, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| |
Collapse
|
13
|
Wilder TJ, Sharma V, Koliopoulou A, McKellar SH, Selzman CH, Glotzbach JP. Rapid-deployment aortic valve replacement after aortic root replacement: A safe alternative to redo root replacement. J Card Surg 2019; 35:222-225. [PMID: 31609491 DOI: 10.1111/jocs.14278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Reoperative aortic root replacement, following prior biologic or mechanical valved conduit aortic root prosthesis, presents a technical challenge. The rapid-deployment aortic valve prosthesis is an approved alternative to traditional bioprosthetic aortic valve replacement. We present three clinical cases in which rapid-deployment aortic valve prostheses were utilized in lieu of reoperative full aortic root replacement. All three patients recovered uneventfully. The rapid-deployment valve insertion in a prior surgical aortic root prosthesis is a safe option to avoid reoperative full aortic root replacement.
Collapse
Affiliation(s)
- Travis J Wilder
- Department of Surgery, Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
| | - Vikas Sharma
- Department of Surgery, Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
| | - Antigone Koliopoulou
- Department of Surgery, Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
| | - Stephen H McKellar
- Department of Surgery, Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
| | - Craig H Selzman
- Department of Surgery, Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
| | - Jason P Glotzbach
- Department of Surgery, Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
| |
Collapse
|
14
|
A mechanistic investigation of the EDWARDS INTUITY Elite valve's hemodynamic performance. Gen Thorac Cardiovasc Surg 2019; 68:9-17. [PMID: 31250203 DOI: 10.1007/s11748-019-01154-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 05/30/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Rapid deployment surgical aortic valve replacement has emerged as an alternative to the contemporary sutured valve technique. A difference in transvalvular pressure has been observed clinically between RD-SAVR and contemporary SAVR. A mechanistic inquiry into the impact of the rapid deployment valve inflow frame design on the left ventricular outflow tract and valve hemodynamics is needed. METHODS A 23 mm EDWARDS INTUITY Elite rapid deployment valve and a control contemporary, sutured valve, a 23 mm Magna Ease valve, were implanted in an explanted human heart by an experienced cardiac surgeon. Per convention, the rapid deployment valve was implanted with three non-pledgeted, simple guiding sutures, while fifteen pledgeted, mattress sutures were used to implant the contemporary surgical valve. In vitro flow models were created from micro-computed tomography scans of the implanted valves and surrounding cardiac anatomy. Particle image velocimetry and hydrodynamic characterization experiments were conducted in the vicinity of the valves in a validated pulsatile flow loop system. RESULTS The rapid deployment and control valves were found to have mean transvalvular pressure gradients of 7.92 ± 0.37 and 10.13 ± 0.48 mmHg, respectively. The inflow frame of the rapid deployment valve formed a larger, more circular, left ventricular outflow tract compared to the control valve. Furthermore, it was found that the presence of the control valve's sub-annular pledgets compromised its velocity distribution and consequently its pressure gradient. CONCLUSIONS The rapid deployment valve's intra-annular inflow frame provides for a larger, left ventricular outflow tract, thus reducing the transvalvular pressure gradient and improving overall hemodynamic performance.
Collapse
|
15
|
Chiariello GA, Bruno P, Villa E, Pasquini A, Pavone N, Cammertoni F, Mazza A, Colizzi C, Nesta M, Iafrancesco M, Perri G, Messina A, Troise G, Massetti M. Aortic Valve Replacement in Elderly Patients With Small Aortic Annulus: Results With Three Different Bioprostheses. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 14:27-36. [DOI: 10.1177/1556984519826430] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Aortic valve replacement (AVR) in patients with small aortic annulus (diameter ≤21 mm) is considered a challenging scenario because of technical aspects and the high risk of patient-prosthesis mismatch (PPM). The choice of the appropriate prosthesis is crucial, and at the moment, an ideal device has yet to be identified. We compare clinical and hemodynamic results after AVR with three bioprostheses with different design and characteristics. Methods We retrospectively evaluated 76 consecutive patients from two cardiac surgery centers who underwent AVR (Trifecta = 24; Edwards INTUITY Elite valve system = 26, and Perceval = 26) for severe aortic stenosis between 2013 and 2017. Patients selected were older than 75 years and with an annulus diameter ≤21 mm at preoperative echocardiogram. Reinterventions and combined procedures were excluded. Minimally invasive AVR was performed in 44 (57.8%) patients. Telephonic interview was obtained at 2.9 ± 0.5 years and echocardiographic follow-up at 2.2 ± 0.8 years. Results Clinical outcome was similar in the three groups. At follow-up, Trifecta patients presented significantly higher peak and mean transprosthetic pressure gradients ( P = 0.04 and 0.01). Effective orifice area and left ventricular mass regression were comparable, although an advantage was observed in Perceval patients without reaching the statistical significance. Incidence of moderate ( P = 0.2) and severe PPM ( P = 0.7) was comparable. Conclusions Despite higher postoperative pressure gradients observed with the Trifecta valve, all three prostheses (Trifecta, Edwards INTUITY Elite, and Perceval) have proven to be reliable when implanted in small aortic annuli, with good clinical outcome and favorable left ventricular mass regression.
Collapse
Affiliation(s)
- Giovanni A. Chiariello
- Cardiovascular Sciences Department, Foundation Polyclinic University A. Gemelli IRCCS, Rome, Italy
- Catholic University of The Sacred Heart, Rome, Italy
| | - Piergiorgio Bruno
- Cardiovascular Sciences Department, Foundation Polyclinic University A. Gemelli IRCCS, Rome, Italy
| | - Emmanuel Villa
- Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Annalisa Pasquini
- Cardiovascular Sciences Department, Foundation Polyclinic University A. Gemelli IRCCS, Rome, Italy
- Catholic University of The Sacred Heart, Rome, Italy
| | - Natalia Pavone
- Cardiovascular Sciences Department, Foundation Polyclinic University A. Gemelli IRCCS, Rome, Italy
- Catholic University of The Sacred Heart, Rome, Italy
| | - Federico Cammertoni
- Cardiovascular Sciences Department, Foundation Polyclinic University A. Gemelli IRCCS, Rome, Italy
| | - Andrea Mazza
- Cardiovascular Sciences Department, Foundation Polyclinic University A. Gemelli IRCCS, Rome, Italy
| | - Christian Colizzi
- Cardiovascular Sciences Department, Foundation Polyclinic University A. Gemelli IRCCS, Rome, Italy
| | - Marialisa Nesta
- Cardiovascular Sciences Department, Foundation Polyclinic University A. Gemelli IRCCS, Rome, Italy
- Catholic University of The Sacred Heart, Rome, Italy
| | - Mauro Iafrancesco
- Cardiovascular Sciences Department, Foundation Polyclinic University A. Gemelli IRCCS, Rome, Italy
| | - Gianluigi Perri
- Cardiovascular Sciences Department, Foundation Polyclinic University A. Gemelli IRCCS, Rome, Italy
- Catholic University of The Sacred Heart, Rome, Italy
| | - Antonio Messina
- Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Giovanni Troise
- Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Massimo Massetti
- Cardiovascular Sciences Department, Foundation Polyclinic University A. Gemelli IRCCS, Rome, Italy
- Catholic University of The Sacred Heart, Rome, Italy
| |
Collapse
|
16
|
Stonehenge technique is associated with faster aortic clamp time in group of minimally invasive aortic valve replacement via right infra-axillary thoracotomy. Gen Thorac Cardiovasc Surg 2018; 66:700-706. [PMID: 30117124 DOI: 10.1007/s11748-018-0987-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 08/01/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Trans-right axillary aortic valve replacement (TAX-AVR) remains uncommon. We developed a special method to pull the heart closer to the right chest wall to make the surgery as easy and safe as aortic valve replacement via median sternotomy. Because the retraction sutures lifting the ascending aorta and aortic root are arranged circularly around the wound, we named this technique "Stonehenge technique". METHODS We examined 47 patients who underwent aortic valve replacement through a small right infra-axillary thoracotomy as the initial surgical therapy. These patients were divided into two groups: the conventional TAX-AVR group that underwent AVR via the conventional small right axillary incision approach (n = 20) and the TAX-AVR with SH group that underwent AVR with the Stonehenge technique (n = 27). RESULTS The aortic cross-clamp and the extracorporeal circulation time were significantly shorter in the TAX-AVR with SH group than in the conventional TAX-AVR group (conventional TAX-AVR group: 125.5 ± 47.9; TAX-AVR with SH group: 96.0 ± 14.0, p = 0.004, and conventional TAX-AVR group: 163.8 ± 55.9; TAX-AVR with SH group: 140.0 ± 16.8, p = 0.04). CONCLUSION The outcomes of this technique depend on the site of the retraction sutures in the opened pericardium, direction of pull, amount of force applied, and precautions taken. If performed correctly, the ascending aorta and the root can be pulled from the wound to within the surgeon's fingers' reach, thereby reducing aortic cross-clamp and extracorporeal circulation times in group of minimally invasive aortic valve replacement via right infra-axillary thoracotomy.
Collapse
|
17
|
Mestres CA, Weber A. How do we follow up our patients? Reporting outcomes without complete follow-up data renders us on the weak side. J Thorac Cardiovasc Surg 2018; 155:586-587. [DOI: 10.1016/j.jtcvs.2017.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 10/06/2017] [Indexed: 11/29/2022]
|