1
|
Almaghrabi S, Michelena H, Jelenc M, Abeln KB, Ehrlich T, Schäfers HJ. Contemporary Valvular Mechanisms of Aortic Regurgitation in Tricuspid Aortic Valves: Importance in Repair Versus Replacement Strategy. J Am Heart Assoc 2024; 13:e032532. [PMID: 38686861 PMCID: PMC11179890 DOI: 10.1161/jaha.123.032532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 02/19/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND This study was performed to determine cusp causes of aortic regurgitation in patients with tricuspid aortic valves without significant aortic dilatation and define cusp pathologies amenable to surgical repair (aortic valve repair [AVr]) versus aortic valve replacement. METHODS AND RESULTS We retrospectively reviewed surgical reports of consecutive adults with tricuspid aortic valves undergoing surgery for clinically significant aortic regurgitation within a prospective registry from January 2005 to September 2019. Valvular mechanisms were determined by systematic in vivo intraoperative quantification methods. Of 516 patients, 287 (56%) underwent repair (AVr; mean±SD age, 59.9±12.4 years; 81% men) and 229 (44%) underwent replacement (aortic valve replacement; mean±SD age, 62.8±13.8 years [P=0.01 compared to AVr]; 67% men). A single valvular mechanism was present in 454 patients (88%), with cusp prolapse (46%), retraction (24%), and perforation (18%) being the most common. Prolapse involved the right cusp in 86% of cases and was more frequent in men (P<0.001). Two-dimensional transesophageal echocardiography accuracy for predicting mechanisms was 73% to 82% for the right cusp, 55% to 61% for the noncoronary cusp, and 0% for the left-coronary cusp. Cusp prolapse, younger age, and larger patient size were associated with successful AVr (all P<0.03), whereas retraction, perforation, older age, and concomitant mitral repair were associated with aortic valve replacement (all P<0.03). CONCLUSIONS Right cusp prolapse is the most frequent single valvular mechanism in patients with tricuspid aortic valve aortic regurgitation, followed by cusp retraction and perforation. The accuracy of 2-dimensional transesophageal echocardiography is limited for left and noncoronary cusp mechanistic assessment. Prolapse is associated with successful AVr, whereas retraction and perforation are associated with aortic valve replacement. With systematic intraoperative quantification methods and current surgical techniques, more than half of tricuspid aortic valve aortic regurgitation cases may be successfully repaired.
Collapse
Affiliation(s)
- Saifalislam Almaghrabi
- Department of Thoracic and Cardiovascular Surgery Saarland University Medical Center and Saarland University Homburg/Saar Germany
| | | | - Matija Jelenc
- Department of Cardiovascular Surgery University Medical Center Ljubljana Ljubljana Slovenia
| | - Karen B Abeln
- Department of Thoracic and Cardiovascular Surgery Saarland University Medical Center and Saarland University Homburg/Saar Germany
| | - Tristan Ehrlich
- Department of Thoracic and Cardiovascular Surgery Saarland University Medical Center and Saarland University Homburg/Saar Germany
| | - Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery Saarland University Medical Center and Saarland University Homburg/Saar Germany
| |
Collapse
|
2
|
Saisho H, Geisler I, Scharfschwerdt M, Sadat N, Zhang X, Puehler T, Ensminger S, Fujita B, Aboud A. Ex vivo evaluation of 3 different right ventricular outflow tract substitutes. Eur J Cardiothorac Surg 2024; 65:ezae081. [PMID: 38479833 DOI: 10.1093/ejcts/ezae081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 02/22/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVES The Ross procedure represents an excellent treatment option in younger patients with aortic stenosis but is limited by poor availability of homografts. In this study, we investigated the hydrodynamic performance of 3 different types of right ventricular outflow tract replacement with pericardium or synthetic material. METHODS Three different types of valved conduits were constructed using pericardium and/or synthetic material (Group PEPE: pericardial cusps and pericardial conduit, Group PEPR: pericardial cusps and Dacron conduit, Group PRPR: expanded polytetrafluoroethylene cusps and Dacron conduit). The conduits were designed according to the Ozaki method. Their hydrodynamic performance (effective orifice area, mean pressure gradient and leakage volume) were evaluated in a mock circulation loop at different hydrodynamic conditions. RESULTS Hydrodynamic assessment showed significantly larger effective orifice area of PEPE and PEPR compared to PRPR under all conditions and there were no significant differences between PEPE and PEPR [for condition 2: PEPE 2.43 (2.35-2.54) cm2, PEPR: 2.42 (2.4-2.5) cm2, PRPR: 2.08 (1.97-2.21) cm2, adjusted pairwise comparisons: PEPE versus PEPR: P = 0.80, PEPE versus PRPR: P < 0.001, PEPR versus PRPR: P < 0.001]. Mean pressure gradient was significantly lower for PEPE and PEPR compared with PRPR, whereas no significant differences were seen between PEPE and PEPR. Leakage volume was significantly lower for PEPE and PEPR compared with PRPR under all conditions while leakage was similar between PEPE and PEPR. CONCLUSIONS Pulmonary graft reconstruction with pericardium cusps showed superior hydrodynamic performance compared with polytetrafluoroethylene cusps. Our results suggest that it could be considered as an alternative substitute for right ventricular outflow tract replacement during the Ross procedure.
Collapse
Affiliation(s)
- Hiroyuki Saisho
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein, Lübeck, Germany
| | - Ioana Geisler
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein, Lübeck, Germany
| | - Michael Scharfschwerdt
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein, Lübeck, Germany
| | - Najla Sadat
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein, Lübeck, Germany
| | - Xiling Zhang
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein, Lübeck, Germany
| | - Thomas Puehler
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein, Lübeck, Germany
- DZHK (German Center for cardiovascular research), Partner Site Hamburg/Kiel/Luebeck, Germany
| | - Stephan Ensminger
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein, Lübeck, Germany
- DZHK (German Center for cardiovascular research), Partner Site Hamburg/Kiel/Luebeck, Germany
| | - Buntaro Fujita
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein, Lübeck, Germany
- DZHK (German Center for cardiovascular research), Partner Site Hamburg/Kiel/Luebeck, Germany
| | - Anas Aboud
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein, Lübeck, Germany
| |
Collapse
|
3
|
Grashuis P, Khargi SD, Veen K, el Osrouti A, Bemelmans-Lalezari S, Cornette JM, Roos-Hesselink JW, Takkenberg JJ, Mokhles MM. Pregnancy outcomes in women with a mitral valve prosthesis: A systematic review and meta-analysis. JTCVS OPEN 2023; 14:102-122. [PMID: 37425470 PMCID: PMC10328972 DOI: 10.1016/j.xjon.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 04/26/2023] [Accepted: 05/02/2023] [Indexed: 07/11/2023]
Abstract
Objectives To evaluate the ongoing debate concerning the choice of valve prosthesis for women requiring mitral valve replacement (MVR) and who wish to conceive. Bioprostheses are associated with risk of early structural valve deterioration. Mechanical prostheses require lifelong anticoagulation and carry maternal and fetal risks. Also, the optimal anticoagulation regimen during pregnancy after MVR remains unclear. Methods A systematic review and meta-analysis was conducted of studies reporting on pregnancy after MVR. Valve- and anticoagulation-related maternal and fetal risks during pregnancy and 30 days' postpartum were analyzed. Results Fifteen studies reporting 722 pregnancies were included. In total, 87.2% of pregnant women had a mechanical prosthesis and 12.5% a bioprosthesis. Maternal mortality risk was 1.33% (95% confidence interval [CI], 0.69-2.56), any hemorrhage risk 6.90% (95% CI, 3.70-12.88). Valve thrombosis risk was 4.71% (95% CI, 3.06-7.26) in patients with mechanical prostheses. 3.23% (95% CI, 1.34-7.75) of the patients with bioprostheses experienced early structural valve deterioration. Of these, the mortality was 40%. Pregnancy loss risk was 29.29% (95% CI, 19.74-43.47) with mechanical prostheses versus 13.50% (95% CI, 4.31-42.30) for bioprostheses. Switching to heparin during the first trimester demonstrated a bleeding risk of 7.78% (95% CI, 3.71-16.31) versus 4.08% (95% CI, 1.17-14.28) for women on oral anticoagulants throughout pregnancy and a valve thrombosis risk of 6.99% (95% CI, 2.08-23.51) versus 2.89% (95% CI, 1.40-5.94). Administration of anticoagulant dosages greater than 5 mg resulted in a risk of fetal adverse events of 74.24% (95% CI, 56.11-98.23) versus 8.85% (95% CI, 2.70-28.99) in ≤5 mg. Conclusions A bioprosthesis seems the best option for women of childbearing age who are interested in future pregnancy after MVR. If mechanical valve replacement is preferred, the favorable anticoagulation regimen is continuous low-dose oral anticoagulants. Shared decision-making remains priority when choosing a prosthetic valve for young women.
Collapse
Affiliation(s)
- Pepijn Grashuis
- Department of Cardiothoracic Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Shanti D.M. Khargi
- Department of Cardiothoracic Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Kevin Veen
- Department of Cardiothoracic Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Azzeddine el Osrouti
- Department of Cardiothoracic Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | - Jérôme M.J. Cornette
- Department of Obstetrics and Fetal Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | | | - Mostafa M. Mokhles
- Department of Cardiothoracic Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
- Department of Cardiothoracic Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| |
Collapse
|
4
|
Lausberg HF, Schäfers HJ. Recent innovations in aortic valve surgery: True progress? TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2023; 31:155-160. [PMID: 37484648 PMCID: PMC10357859 DOI: 10.5606/tgkdc.dergisi.2023.98551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/16/2023] [Indexed: 07/25/2023]
Affiliation(s)
- Henning F. Lausberg
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Germany
| | - Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Germany
| |
Collapse
|
5
|
Saisho H, Scharfschwerdt M, Schaller T, Sadat N, Aboud A, Ensminger S, Fujita B. Ex vivo evaluation of the Ozaki procedure in comparison with the native aortic valve and prosthetic valves. Interact Cardiovasc Thorac Surg 2022; 35:6650697. [PMID: 35895002 PMCID: PMC9443990 DOI: 10.1093/icvts/ivac199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/14/2022] [Accepted: 07/26/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Hiroyuki Saisho
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein , Lübeck, Germany
- University of Lübeck , Lübeck, Germany
| | - Michael Scharfschwerdt
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein , Lübeck, Germany
- University of Lübeck , Lübeck, Germany
| | - Tim Schaller
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein , Lübeck, Germany
- University of Lübeck , Lübeck, Germany
| | - Najla Sadat
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein , Lübeck, Germany
- University of Lübeck , Lübeck, Germany
- DZHK (German Centre for Cardiovascular Research—Partner Site Hamburg/Kiel/Lübeck) , Germany
| | - Anas Aboud
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein , Lübeck, Germany
- University of Lübeck , Lübeck, Germany
| | - Stephan Ensminger
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein , Lübeck, Germany
- University of Lübeck , Lübeck, Germany
- DZHK (German Centre for Cardiovascular Research—Partner Site Hamburg/Kiel/Lübeck) , Germany
| | - Buntaro Fujita
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein , Lübeck, Germany
- University of Lübeck , Lübeck, Germany
- DZHK (German Centre for Cardiovascular Research—Partner Site Hamburg/Kiel/Lübeck) , Germany
| |
Collapse
|
6
|
The role of mechanical valves in the aortic position in the era of bioprostheses and TAVR: Evidence-based appraisal and focus on the On-X valve. Prog Cardiovasc Dis 2022; 72:31-40. [PMID: 35738422 DOI: 10.1016/j.pcad.2022.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 06/05/2022] [Indexed: 11/24/2022]
Abstract
Patients who need a prosthetic aortic heart valve may decide, working with their cardiologist and cardiac surgeon, among a variety of options: surgical or transcatheter approach, bioprosthetic or mechanical valve, or a Ross procedure if suitable to their age and anatomy. This review article examines the evidence for survival benefit with mechanical aortic valves, discusses bioprosthetic structural valve degeneration and its consequences, and considers the risks of redo aortic valve surgery or subsequent valve-in-valve (ViV) transcatheter intervention. It highlights the unique characteristics of the On-X aortic valve, including the US Food and Drug Administration approved and American College of Cardiology/American Heart Association guideline supported reduced anticoagulation target INR of 1.5 to 2.0, and discusses the PROACT Xa trial comparing apixaban vs warfarin anticoagulation. The choice of prosthetic valve should be individualized, carefully considering each patient's unique circumstances. In that context, the On-X aortic valve offers a potential lifetime solution without need for a repeat operation, while minimizing the risks of long-term anticoagulation. In an era of enthusiasm for bioprosthetic and transcatheter-based approaches, the option of a second-generation bileaflet mechanical valve with optimized hemodynamics-the On-X aortic valve-may well align with patient expectations.
Collapse
|
7
|
Hatoum H, Ahn S, Lilly S, Maureira P, Crestanello J, Thourani VH, Dasi LP. Flow dynamics of surgical and transcatheter aortic valves: Past to present. JTCVS OPEN 2022; 9:43-56. [PMID: 36003460 PMCID: PMC9390780 DOI: 10.1016/j.xjon.2022.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 01/12/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Hoda Hatoum
- Department of Biomedical Engineering, Michigan Technological University, Houghton, Mich
- Health Research Institute, Center of Biocomputing and Digital Health and Institute of Computing and Cybernetics, Michigan Technological University, Houghton, Mich
- Center of Biocomputing and Digital Health, Michigan Technological University, Houghton, Mich
- Address for reprints: Hoda Hatoum, PhD, Department of Biomedical Engineering, Michigan Technological University, 1400 Townsend Dr, Houghton, MI 49931.
| | - Sunyoung Ahn
- Department of Biomedical Engineering, Michigan Technological University, Houghton, Mich
| | - Scott Lilly
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio
| | - Pablo Maureira
- Department of Cardiovascular Surgery, CHU de Nancy, Nancy, France
| | - Juan Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Vinod H. Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Ga
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Ga
| |
Collapse
|
8
|
Meijs TA, Minderhoud SCS, Muller SA, de Winter RJ, Mulder BJM, van Melle JP, Hoendermis ES, van Dijk APJ, Zuithoff NPA, Krings GJ, Doevendans PA, Witsenburg M, Roos‐Hesselink JW, van den Bosch AE, Bouma BJ, Voskuil M. Cardiovascular Morbidity and Mortality in Adult Patients With Repaired Aortic Coarctation. J Am Heart Assoc 2021; 10:e023199. [PMID: 34755532 PMCID: PMC8751912 DOI: 10.1161/jaha.121.023199] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background The long-term burden of cardiovascular disease after repair of coarctation of the aorta (CoA) has not been elucidated. We aimed to determine the incidence of and risk factors for cardiovascular events in adult patients with repaired CoA. Additionally, mortality rates were compared between adults with repaired CoA and the general population. Methods and Results Using the Dutch Congenital Corvitia (CONCOR) registry, patients aged ≥16 years with previous surgical or transcatheter CoA repair from 5 tertiary referral centers were included. Cardiovascular events were recorded, comprising coronary artery disease, stroke/transient ischemic attack, aortic complications, arrhythmias, heart failure hospitalizations, endocarditis, and cardiovascular death. In total, 920 patients (median age, 24 years [range 16-74 years]) were included. After a mean follow-up of 9.3±5.1 years, 191 patients (21%) experienced at least 1 cardiovascular event. A total of 270 cardiovascular events occurred, of which aortic complications and arrhythmias were most frequent. Older age at initial CoA repair (hazard ratio [HR], 1.017; 95% CI, 1.000-1.033 [P=0.048]) and elevated left ventricular mass index (HR, 1.009; 95% CI, 1.005-1.013 [P<0.001]) were independently associated with an increased risk of cardiovascular events. The mortality rate was 3.3 times higher than expected based on an age- and sex-matched cohort from the Dutch general population (standardized mortality ratio, 3.3; 95% CI, 2.3-4.4 [P<0.001]). Conclusions This large, prospective cohort of adults with repaired CoA showed a high burden of cardiovascular events, particularly aortic complications and arrhythmias, during long-term follow-up. Older age at initial CoA repair and elevated left ventricular mass index were independent risk factors for the occurrence of cardiovascular events. Mortality was 3.3-fold higher compared with the general population. These results advocate stringent follow-up after CoA repair and emphasize the need for improved preventive strategies.
Collapse
Affiliation(s)
- Timion A. Meijs
- Department of CardiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | | | - Steven A. Muller
- Department of CardiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Robbert J. de Winter
- Department of CardiologyAmsterdam UMC, Location Academic Medical CenterAmsterdamThe Netherlands
| | - Barbara J. M. Mulder
- Department of CardiologyAmsterdam UMC, Location Academic Medical CenterAmsterdamThe Netherlands
| | - Joost P. van Melle
- Department of CardiologyUniversity Medical Center GroningenGroningenThe Netherlands
| | - Elke S. Hoendermis
- Department of CardiologyUniversity Medical Center GroningenGroningenThe Netherlands
| | - Arie P. J. van Dijk
- Department of CardiologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Nicolaas P. A. Zuithoff
- Department of Epidemiology and BiostatisticsJulius Center for Health Sciences and Primary CareUtrechtThe Netherlands
| | - Gregor J. Krings
- Department of Pediatric CardiologyWilhelmina Children’s HospitalUtrechtThe Netherlands
| | - Pieter A. Doevendans
- Department of CardiologyUniversity Medical Center UtrechtUtrechtThe Netherlands,Department of CardiologyCentral Military HospitalUtrechtThe Netherlands,Netherlands Heart InstituteUtrechtThe Netherlands
| | | | | | | | - Berto J. Bouma
- Department of CardiologyAmsterdam UMC, Location Academic Medical CenterAmsterdamThe Netherlands
| | - Michiel Voskuil
- Department of CardiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| |
Collapse
|
9
|
Abstract
Purpose of Review Preservation or repair of the aortic valve has evolved dynamically in the past 20 years. It leads to a high freedom from valve-related complications if an adequate valve durability can be achieved; it may possibly also improve survival. To date, little structured information is available about which valves can be repaired and which should better be replaced. Recent Findings For surgical decision-making, the size of the aortic root is important and the anatomy of the aortic valve must be considered. In the presence of root aneurysm, most tricuspid and bicuspid aortic valves can be preserved. In aortic regurgitation and normal aortic dimensions, the majority of tricuspid and bicuspid aortic valves can be repaired with good long-term durability. In bicuspid aortic valves, the morphologic characteristics must be taken into consideration. Unicuspid and quadricuspid aortic valves can be repaired in selected cases. Generally, cusp calcification is a sign of a poor substrate for repair; the same is true for cusp retraction and cusp destruction due to active endocarditis. They are associated with limited valve durability. Summary Using current concepts, many non-calcified aortic valves can be repaired. Modern imaging, in particular three-dimensional transesophageal echocardiography (TEE), should be able to define repairable aortic valves with a high probability.
Collapse
|
10
|
Saisho H, Scharfschwerdt M, Schaller T, Reil JC, Ensminger S, Fujita B, Aboud A. An ex vivo evaluation of two different suture techniques for the Ozaki aortic neocuspidization procedure. Interact Cardiovasc Thorac Surg 2021; 33:518-524. [PMID: 34089604 DOI: 10.1093/icvts/ivab138] [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: 12/31/2020] [Revised: 03/11/2021] [Accepted: 03/31/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES We investigated the Ozaki procedure using a single interrupted suture technique (SST) and compared this with the standard continuous suture technique (CST) with regard to hydrodynamic valve performance. In addition, both techniques were compared with the native aortic valve (NAV). METHODS Effective orifice area, mean pressure gradient and leakage volume were evaluated in the NAV as well as after an Ozaki procedure using SST or CST in fresh swine aortic roots using a mock circulation loop. The NAV, SST and CST were evaluated under 4 defined hydrodynamic conditions. RESULTS Both suture techniques resulted in a similar effective orifice area under all conditions [for stroke volume of 70 ml: SST: 1.50 (1.35-1.87) vs CST: 1.57 (1.41-1.72) cm2, P = 0.8] and there were no significant differences between both suture techniques and the NAV (P > 0.05). Regarding mean pressure gradient, the Ozaki procedure with SST and CST showed no significant differences [7.23 (5.53-8.91) vs 7.04 (6.65-7.60) mmHg, P = 0.72] and there was no significant difference between both suture techniques and the NAV (P > 0.1). In leakage volume, there was no significant difference between SST and CST [4.49 (3.91-4.99) vs CST: 4.23 (3.58-4.87) ml/stroke, P = 0.34]. CONCLUSIONS The Ozaki procedure with SST performed similarly to that with CST with regard to hydrodynamic performance. Our results suggest that the Ozaki procedure can be performed with SST instead of CST, which may be useful in patients with limited surgical exposure, such as a small annulus.
Collapse
Affiliation(s)
- Hiroyuki Saisho
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig-Holstein, Lübeck, Germany.,University of Lübeck, Lübeck, Germany
| | - Michael Scharfschwerdt
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig-Holstein, Lübeck, Germany.,University of Lübeck, Lübeck, Germany
| | - Tim Schaller
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig-Holstein, Lübeck, Germany.,University of Lübeck, Lübeck, Germany
| | - Jan Christian Reil
- University of Lübeck, Lübeck, Germany.,Department of Medicine II, University Hospital of Schleswig-Holstein, Lübeck, Germany
| | - Stephan Ensminger
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig-Holstein, Lübeck, Germany.,University of Lübeck, Lübeck, Germany
| | - Buntaro Fujita
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig-Holstein, Lübeck, Germany.,University of Lübeck, Lübeck, Germany
| | - Anas Aboud
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig-Holstein, Lübeck, Germany.,University of Lübeck, Lübeck, Germany
| |
Collapse
|
11
|
Sari M, Bayram Z, Ayturk M, Bayam E, Kalkan S, Guner A, Kalcik M, Gursoy MO, Gunduz S, Ozkan M. Characteristic localization patterns of thrombus on various brands of bileaflet mitral mechanical heart valves as assessed by three-dimensional transesophageal echocardiography and their relationship with thromboembolism. Int J Cardiovasc Imaging 2021; 37:2691-2705. [PMID: 33835319 DOI: 10.1007/s10554-021-02234-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/30/2021] [Indexed: 12/24/2022]
Abstract
Three-dimensional transesophageal echocardiography (3D-TEE) provides detailed images of prosthetic valve thrombosis (PVT). However, data regarding PVT localization patterns based on 3D-TEE and their association with clinical findings among various bileaflet mitral prosthetic valve brands is lacking. The locations of thrombi were classified into 4 groups according to hinge and annulus involvement based on 3D-TEE: ring-like PVT involving entire mitral annulus (type-1), PVT involving peri-hinge(s) region and extends through some part of the annulus (type-2), PVT involving mitral annulus without involving hinge(s) region (type-3), and PVT involving only (peri)hinge(s) area (type-4). This study was conducted in 265 patients (male: 71, mean age: 46.3 ± 12.7 years) with mitral PVT, including 150 St Jude Medical (SJM), 65 Carbomedics, 29 Medtronic ATS open-pivot, and 21 Sorin bileaflet mechanical valves. There was a significant difference in most common PVT localization patterns between different prosthetic valves (type-1 for Carbomedics and Sorin; type-2 for SJM and type-3 for ATS valves; p < 0.001). Additionally, PVT involving only (peri)hinge region(s) (type-4) was mostly observed in patients with SJM valves (18%). (Peri)hinge(s) area involvement was observed in the majority of study patients (78.1%). In patients who presented with thromboembolism, the most common PVT localization pattern was type-1 (53%). Increased age, low international normalized ratio on admission, PVT with a mobile part > 2 mm, type-1 and type-4 PVT were associated with thromboembolic events. In conclusion, thrombus can be displayed in distinct locations in several types of bileaflet mechanical valves due to different design, hinge and pivot mechanisms, which can be complicated with thromboembolic events.
Collapse
Affiliation(s)
- Munevver Sari
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Denizer caddesi, Cevizli Kavsagi, Kartal, 34865, Istanbul, Turkey.
| | - Zubeyde Bayram
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Denizer caddesi, Cevizli Kavsagi, Kartal, 34865, Istanbul, Turkey
| | - Mehmet Ayturk
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Denizer caddesi, Cevizli Kavsagi, Kartal, 34865, Istanbul, Turkey
| | - Emrah Bayam
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Denizer caddesi, Cevizli Kavsagi, Kartal, 34865, Istanbul, Turkey
| | - Semih Kalkan
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Denizer caddesi, Cevizli Kavsagi, Kartal, 34865, Istanbul, Turkey
| | - Ahmet Guner
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Macit Kalcik
- Department of Cardiology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Mustafa Ozan Gursoy
- Department of Cardiology, Izmir Ataturk Training and Research Hospital, Izmir, Turkey
| | - Sabahattin Gunduz
- Department of Cardiology, VM Medikal Park Pendik Hospital, Istanbul, Turkey
| | - Mehmet Ozkan
- Department of Cardiology, Kosuyolu Kartal Heart Training and Research Hospital, Denizer caddesi, Cevizli Kavsagi, Kartal, 34865, Istanbul, Turkey
- Faculty of Health Sciences, University of Ardahan, Ardahan, Turkey
| |
Collapse
|
12
|
Clinical Outcome of Reoperation for Mechanical Prosthesis at Aortic Position. Heart Lung Circ 2021; 30:1084-1090. [PMID: 33589402 DOI: 10.1016/j.hlc.2021.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 12/19/2020] [Accepted: 01/01/2021] [Indexed: 11/22/2022]
Abstract
AIM Redo aortic valve surgery is usually associated with a high risk of mortality and complications. The aim of this study was to investigate the perioperative and long-term outcomes of reoperation after prior mechanical prosthesis implantation at the aortic position. METHOD The clinical data of 146 consecutive patients who underwent reoperation at the aortic position between 2003 and 2019 were analysed. RESULTS Mean age was 51.5±12.7 years and 69 (47.3%) were female. The median interval from prior surgery to redo aortic valve surgery was 6 years. The aetiologies were pannus formation with prosthetic aortic stenosis in 62 cases (42.5%), prosthetic valve endocarditis (PVE) in five (3.4%), PVE with perivalvular leakage (PVL) in 16 (11.0%), PVL in 45 (30.8%), thrombosis in seven (4.8%), and aortic disease in 11 (7.5%). As for surgical procedure, aortic valve replacement was performed in 81 cases (55.5%), Bentall in 34 (23.3%), PVL repair in six (4.1%), and pannus debridement in 25 (17.1%). Fourteen (14) (9.6%) patients expired perioperatively. Prolonged ventilation time and postoperative renal failure were proved to be significant independent predictors of mortality according to multivariate analysis. Overall survival was 87.8%±7.4% and 76.4%±15.1% at 5 and 10 years, respectively. Survival was 87.7%±13.7% and 84.2%±15.6% in the pannus group, and 84.5%±12.6% and 74.6%±19.4% in the non-pannus group at 5 and 10 years, respectively (p=0.951). Survival was 87.5%±14.2% and 75.8%±22.7% in the PVL group and 84.7%±11.9% and 81.6%±13.5% in the non-PVL group at 5 and 10 years, respectively (p=0.365). CONCLUSIONS Pannus formation and PVL are two major indications for reoperation of mechanical prosthesis at the aortic position. Redo aortic valve surgery has a satisfactory outcome but with a high risk of complications. Long-term survival of patients seems not to be related to the aetiology. Final decision-making of redo aortic valve surgery should be based on aetiology.
Collapse
|
13
|
Izumi C, Eishi K, Ashihara K, Arita T, Otsuji Y, Kunihara T, Komiya T, Shibata T, Seo Y, Daimon M, Takanashi S, Tanaka H, Nakatani S, Ninami H, Nishi H, Hayashida K, Yaku H, Yamaguchi J, Yamamoto K, Watanabe H, Abe Y, Amaki M, Amano M, Obase K, Tabata M, Miura T, Miyake M, Murata M, Watanabe N, Akasaka T, Okita Y, Kimura T, Sawa Y, Yoshida K. JCS/JSCS/JATS/JSVS 2020 Guidelines on the Management of Valvular Heart Disease. Circ J 2020; 84:2037-2119. [DOI: 10.1253/circj.cj-20-0135] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kiyoyuki Eishi
- Division of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Kyomi Ashihara
- Department of Cardiology, Tokyo Women’s Medical University Hospital
| | - Takeshi Arita
- Division of Cardiovascular Medicine Heart & Neuro-Vascular Center, Fukuoka Wajiro
| | - Yutaka Otsuji
- Department of Cardiology, Hospital of University of Occupational and Environmental Health
| | - Takashi Kunihara
- Department of Cardiac Surgery, The Jikei University School of Medicine
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka City University Postgraduate of Medicine
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Masao Daimon
- Department of Clinical Laboratory/Cardiology, The University of Tokyo Hospital
| | | | | | - Satoshi Nakatani
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | - Hiroshi Ninami
- Department of Cardiac Surgery, Tokyo Women’s Medical University
| | - Hiroyuki Nishi
- Department of Cardiovascular Surgery, Osaka General Medical Center
| | | | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | | | - Kazuhiro Yamamoto
- Division of Cardiovascular Medicine, Endocrinology and Metabolism, Faculty of Medicine, Tottori University
| | | | - Yukio Abe
- Department of Cardiology, Osaka City General Hospital
| | - Makoto Amaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Masashi Amano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kikuko Obase
- Division of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center
| | - Takashi Miura
- Division of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | | | - Mitsushige Murata
- Department of Laboratory Medicine, Tokai University Hachioji Hospital
| | - Nozomi Watanabe
- Department of Cardiology, Miyazaki Medical Association Hospital
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Yutaka Okita
- Department of Cardiovascular Surgery, Takatsuki Hospital
| | - Takeshi Kimura
- Department of Cardiology, Kyoto University Graduate School of Medicine
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Kiyoshi Yoshida
- Department of Cardiology, Sakakibara Heart Institute of Okayama
| | | |
Collapse
|
14
|
|
15
|
Schäfers HJ. The 10 Commandments for Aortic Valve Repair. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 14:188-198. [DOI: 10.1177/1556984519843909] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| |
Collapse
|
16
|
Formica F, D'Alessandro S, Benedetto U. Commentary: On-X and St Jude Medical mechanical prostheses-A paradoxic concept; they are equal but different! J Thorac Cardiovasc Surg 2019; 159:98-99. [PMID: 30992211 DOI: 10.1016/j.jtcvs.2019.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 03/04/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Francesco Formica
- Mechanical Circulatory Support Program, Cardiac Surgery Unit, San Gerardo Hospital, Monza, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
| | - Stefano D'Alessandro
- Cardiac Surgery Unit, Cardio-thoracic-vascular Department, San Gerardo Hospital, Monza, Italy
| | - Umberto Benedetto
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| |
Collapse
|
17
|
Emery RW, Emery AM, Krogh CC. Are we throwing the baby out with the bath water: Redux. J Thorac Cardiovasc Surg 2018; 157:223-224. [PMID: 30414778 DOI: 10.1016/j.jtcvs.2018.09.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 09/27/2018] [Accepted: 09/28/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Robert W Emery
- Department of Surgery, St Joseph's Hospital and Medical Center, St Paul, Minn.
| | - Ann M Emery
- Department of Surgery, St Joseph's Hospital and Medical Center, St Paul, Minn
| | - Christopher C Krogh
- Department of Surgery, St Joseph's Hospital and Medical Center, St Paul, Minn
| |
Collapse
|