1
|
Juarez-Casso FM, Cangut B, King KS, Lee AT, Stulak JM, Schaff HV, Greason KL. Hemodynamic Comparison of the On-X and Top Hat Mechanical Aortic Valve Prostheses. Ann Thorac Surg 2024; 118:615-622. [PMID: 38636685 DOI: 10.1016/j.athoracsur.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 02/22/2024] [Accepted: 04/02/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND There are limited data comparing hemodynamic valve function in mechanical aortic valve prostheses. This study compared the hemodynamic function of 2 commonly used mechanical aortic valve (AV) prostheses, the On-X (Artivion) and Top Hat (CarboMedics Inc) valves. METHODS This study was a retrospective analysis of 512 patients who underwent AV replacement with the On-X (n = 252; 49%) or Top Hat (n = 260; 51%) mechanical valves between 2011 and 2019. Patients were matched on the basis of selected variables. Echocardiographic data were collected preoperatively and postoperatively over a median follow-up of 1.39 years. RESULTS A total of 320 patients were matched, 160 patients in each group. Despite being matched for left ventricular outflow tract diameter, patients in the Top Hat group received a greater prevalence of smaller tissue annulus diameter valves (≤21 mm) (83% vs 38%; P < .001). Patients in the On-X group had longer aortic cross-clamp times (78 minutes vs 64 minutes; P < .001) during isolated aortic valve replacement. Discharge echocardiography showed no difference in the AV area index between both groups (1.00 cm2/m2 vs 1.02 cm2/m2; P = .377). During longer-term echocardiographic follow-up, the AV area index remained stable for both valves within their respective tissue annulus diameter groups (P = .060). CONCLUSIONS There was no difference between the 2 valves with respect to the AV area index at discharge, and hemodynamic function was stable during longer-term follow-up. The longer aortic cross-clamp time observed in the On-X group may indicate increased complexity of implantation compared with the Top Hat group.
Collapse
Affiliation(s)
| | - Busra Cangut
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Katherine S King
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Alex T Lee
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - John M Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Hartzell V Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
| |
Collapse
|
2
|
Palumbo IM, Menichelli D, Biccirè FG, Pannunzio A, Pignatelli P, Pastori D. Long-Term Risk of Hospitalization and Death in Patients With Mechanical Prosthetic Heart Valves. Am J Cardiol 2024; 228:16-23. [PMID: 39097153 DOI: 10.1016/j.amjcard.2024.07.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Revised: 07/22/2024] [Accepted: 07/25/2024] [Indexed: 08/05/2024]
Abstract
Mechanical prosthetic heart valves (MPHVs) are commonly used for valvular heart disease in patients with a long life expectancy. Few longitudinal data on the specific causes of hospitalization in patients with MPHV are available. We investigated the risk of all-cause hospitalization and mortality in patients with MPHV. We performed a prospective, observational, ongoing study including consecutive patients with MPHVs who were referred to the atherothrombosis outpatient clinic of the Policlinico Umberto I of Rome for the vitamin K antagonist management. Study end points were all-cause, cardiovascular hospitalization, and overall mortality. We included 305 patients with MPHV (38.4% women, median age 60.2 years). The site of MPHV was aortic in 53.5%, mitral in 29.5%, and mitroaortic in 17%. During a median follow-up of 57.3 months, 142 hospitalizations occurred (8.16 per 100 person-years). The most common causes of hospitalization were cardiovascular disease (3.62 per 100 person-years), infections, surgery, and bleeding. The predictors of cardiovascular hospitalization were atrial fibrillation (hazard ratio [HR] 1.75, 95% confidence interval [CI] 1.04 to 2.95, p = 0.035), previous stroke/transient ischemic attack (HR 2.96, 95% CI 1.59 to 5.48, p = 0.001), and peripheral artery disease (HR 2.42, 95% CI 1.09 to 5.36, p = 0.030). During a median follow-up of 97.2 months, 61 deaths occurred (2.43 per 100 person-years). Age was directly associated with the risk of death (HR 1.088, 95% CI 1.054 to 1.122, p <0.001), whereas the time in therapeutic range higher than the median was inversely associated (HR 0.436, 95% CI 0.242 to 0.786, p = 0.006). In conclusion, patients with MPHV had a high incidence of hospitalizations, especially cardiovascular-related. The incidence of death is high; however, it may be decreased by maintaining a good quality of anticoagulation.
Collapse
Affiliation(s)
- Ilaria M Palumbo
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Rome, Italy
| | - Danilo Menichelli
- Department of General and Specialized Surgery "Paride Stefanini," Sapienza University of Rome, Rome, Italy
| | - Flavio G Biccirè
- Department of General and Specialized Surgery "Paride Stefanini," Sapienza University of Rome, Rome, Italy
| | - Arianna Pannunzio
- Department of General and Specialized Surgery "Paride Stefanini," Sapienza University of Rome, Rome, Italy
| | - Pasquale Pignatelli
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Rome, Italy
| | - Daniele Pastori
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Rome, Italy; IRCCS Neuromed, Località Camerelle, Pozzilli, Isernia, Italy.
| |
Collapse
|
3
|
Yan G, Fan M, Zhou Y, Xie M, Shi J, Dong N, Wang Q, Qiao W. Chondroitin Sulfate Derivative Cross-Linking of Decellularized Heart Valve for the Improvement of Mechanical Properties, Hemocompatibility, and Endothelialization. ACS APPLIED MATERIALS & INTERFACES 2024; 16:35936-35948. [PMID: 38958205 DOI: 10.1021/acsami.4c03171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
Tissue-engineered heart valve (TEHV) has emerged as a prospective alternative to conventional valve prostheses. The decellularized heart valve (DHV) represents a promising TEHV scaffold that preserves the natural three-dimensional structure and retains essential biological activity. However, the limited mechanical strength, fast degradation, poor hemocompatibility, and lack of endothelialization of DHV restrict its clinical use, which is necessary for ensuring its long-term durability. Herein, we used oxidized chondroitin sulfate (ChS), one of the main components of the extracellular matrix with various biological activities, to cross-link DHV to overcome the above problems. In addition, the ChS-adipic dihydrazide was used to react with residual aldehyde groups, thus preventing potential calcification. The results indicated notable enhancements in mechanical properties and resilience against elastase and collagenase degradation in vitro as well as the ability to withstand extended periods of storage without compromising the structural integrity of valve scaffolds. Additionally, the newly cross-linked valves exhibited favorable hemocompatibility in vitro and in vivo, thereby demonstrating exceptional biocompatibility. Furthermore, the scaffolds exhibited traits of gradual degradation and resistance to calcification through a rat subcutaneous implantation model. In the rat abdominal aorta implantation model, the scaffolds demonstrated favorable endothelialization, commendable patency, and a diminished pro-inflammatory response. As a result, the newly constructed DHV scaffold offers a compelling alternative to traditional valve prostheses, which potentially advances the field of TEHV.
Collapse
Affiliation(s)
- Ge Yan
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
- Department of Cardiovascular Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430014, China
| | - Min Fan
- Hubei Key Laboratory of Bioinorganic Chemistry and Materia Medica, Hubei Engineering Research Center for Biomaterials and Medical Protective Materials, School of Chemistry and Chemical Engineering, Huazhong University of Science and Technology, Wuhan, Hubei 430074, China
| | - Ying Zhou
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
| | - Minghui Xie
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
| | - Jiawei Shi
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
| | - Qin Wang
- Hubei Key Laboratory of Bioinorganic Chemistry and Materia Medica, Hubei Engineering Research Center for Biomaterials and Medical Protective Materials, School of Chemistry and Chemical Engineering, Huazhong University of Science and Technology, Wuhan, Hubei 430074, China
- National Engineering Research Center for Nanomedicine, Wuhan, Hubei 430074, China
| | - Weihua Qiao
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
| |
Collapse
|
4
|
Sun D, Schaff HV, Greason KL, Huang Y, Bagameri G, Pochettino A, DeValeria PA, Dearani JA, Daly RC, Landolfo KP, Wiechmann RJ, Pislaru SV, Crestanello JA. Mechanical or biological prosthesis for aortic valve replacement in patients aged 45 to 74 years. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00551-8. [PMID: 38960283 DOI: 10.1016/j.jtcvs.2024.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 06/09/2024] [Accepted: 06/27/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVE The selection of valve prostheses for patients undergoing surgical aortic valve replacement remains controversial. In this study, we compared the long-term outcomes of patients undergoing aortic valve replacement with biological or mechanical aortic valve prostheses. METHODS We evaluated late results among 5762 patients aged 45 to 74 years who underwent biological or mechanical aortic valve replacement with or without concomitant coronary artery bypass from 1989 to 2019 at 4 medical centers. The Cox proportional hazards model was used to compare late survival; the age-dependent effect of prosthesis type on long-term survival was evaluated by an interaction term between age and prosthesis type. Incidences of stroke, major bleeding, and reoperation on the aortic valve after the index procedure were compared between prosthesis groups. RESULTS Overall, 61% (n = 3508) of patients received a bioprosthesis. The 30-day mortality rate was 1.7% (n = 58) in the bioprosthesis group and 1.5% (n = 34) in the mechanical group (P = .75). During a mean follow-up of 9.0 years, the adjusted risk of mortality was higher in the bioprosthesis group (hazard ratio, 1.30, P < .001). The long-term survival benefit associated with mechanical prosthesis persisted until 70 years of age. Bioprosthesis (vs mechanical prosthesis) was associated with a similar risk of stroke (P = .20), lower risk of major bleeding (P < .001), and higher risk of reoperation (P < .001). CONCLUSIONS Compared with bioprostheses, mechanical aortic valves are associated with a lower adjusted risk of long-term mortality in patients aged 70 years or less. Patients aged less than 70 years undergoing surgical aortic valve replacement should be informed of the potential survival benefit of mechanical valve substitutes.
Collapse
Affiliation(s)
- Daokun Sun
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | | | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Ying Huang
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Gabor Bagameri
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | | | | | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Richard C Daly
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Kevin P Landolfo
- Division of Cardiovascular Surgery, Mayo Clinic, Jacksonville, Fla
| | | | - Sorin V Pislaru
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minn
| | | |
Collapse
|
5
|
Vigano G, Shyam S, Mitra SK, Pollack DKM, Mariani MA. New insights and novel perspectives in bileaflet mechanical heart valve prostheses thromboresistance. J Cardiothorac Surg 2024; 19:292. [PMID: 38760659 PMCID: PMC11100237 DOI: 10.1186/s13019-024-02786-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 04/30/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Although well-known for their thromboresistance, bileaflet mechanical heart valves (BMHV) require lifelong anti-thrombotic therapy. This must be associated with a certain level of thrombogenicity. Since both thromboresistance and thrombogenicity are explained by the blood-artificial surface or liquid-solid interactions, the aim of the present study was to explore BMHV thromboresistance from new perspectives. The wettability of BMHV pyrolytic carbon (PyC) occluders was investigated in under-liquid conditions. The submerged BMHV wettability clarifies the mechanisms involved in the thromboresistance. METHODS The PyC occluders of a SJM Regent™ BMHV were previously laser irradiated, to create a surface hierarchical nano-texture, featuring three nano-configurations. Additionally, four PyC occluders of standard BMHV (Carbomedics, SJM Regent™, Bicarbon™, On-X®), were investigated. All occluders were evaluated in under-liquid configuration, with silicon oil used as the working droplet, while water, simulating blood, was used as the surrounding liquid. The under-liquid droplet-substrate wetting interactions were analyzed using contact angle goniometry. RESULTS All the standard occluders showed very low contact angle, reflecting a pronounced affinity for non-polar molecules. No receding of the contact line could be observed for the untreated occluders. The smallest static contact angle of around 61° could be observed for On-X® valve (the only valve made of full PyC). The laser-treated occluders strongly repelled oil in underwater conditions. A drastic change in their wetting behaviour was observed depending on the surrounding fluid, displaying a hydrophobic behaviour in the presence of air (as the surrounding medium), and showing instead a hydrophilic nature, when surrounded by water. CONCLUSIONS BMHV "fear" water and blood. The intrinsic affinity of BMHV for nonpolar fluids can be translated into a tendency to repel polar fluids, such as water and blood. The blood-artificial surface interaction in BMHV is minimized. The contact between blood and BMHV surface is drastically reduced by polar-nonpolar Van der Waals forces. The "hydro/bloodphobia" of BMHV is intrinsically related to their chemical composition and their surface energy, thus their material: PyC indeed. Pertaining to thromboresistance, the surface roughness does not play a significant role. Instead, the thromboresistance of BMHV lies in molecular interactions. BMHV wettability can be tuned by altering the surface interface, by means of nanotechnology.
Collapse
Affiliation(s)
- Giorgio Vigano
- Department of Cardiothoracic Surgery, Heart Centre, University of Groningen, University Medical Centre Groningen, P.O. Box 30.001, Groningen, 9700 RB, The Netherlands.
| | - Sudip Shyam
- Micro & Nano-Scale Transport Laboratory, Waterloo Institute for Nanotechnology, Department of Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Sushanta K Mitra
- Micro & Nano-Scale Transport Laboratory, Waterloo Institute for Nanotechnology, Department of Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Daniël K M Pollack
- Department of Cardiothoracic Surgery, Heart Centre, University of Groningen, University Medical Centre Groningen, P.O. Box 30.001, Groningen, 9700 RB, The Netherlands
| | - Massimo A Mariani
- Department of Cardiothoracic Surgery, Heart Centre, University of Groningen, University Medical Centre Groningen, P.O. Box 30.001, Groningen, 9700 RB, The Netherlands
| |
Collapse
|
6
|
Song Y, Kim KT, Park SJ, Kim HR, Yoo JS, Kang PJ, Jung SH, Chung CH, Kim JB, Kim HJ. Mechanical versus Bioprosthetic Aortic Valve Replacement in Patients Aged 50 to 70 Years. J Chest Surg 2024; 57:242-251. [PMID: 38472122 PMCID: PMC11089054 DOI: 10.5090/jcs.23.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/31/2023] [Accepted: 01/15/2024] [Indexed: 03/14/2024] Open
Abstract
Background This study compared the outcomes of surgical aortic valve replacement (AVR) in patients aged 50 to 70 years based on the type of prosthetic valve used. Methods We compared patients who underwent mechanical AVR to those who underwent bioprosthetic AVR at our institution between January 2000 and March 2019. Competing risk analysis and the inverse probability of treatment weighting (IPTW) method based on propensity score were employed for comparisons. Results A total of 1,580 patients (984 patients with mechanical AVR; 596 patients with bioprosthetic AVR) were enrolled. There was no significant difference in early mortality between the mechanical AVR and bioprosthetic AVR groups (0.9% vs. 1.7%, p=0.177). After IPTW adjustment, the risk of all-cause mortality was significantly higher in the bioprosthetic AVR group than in the mechanical AVR group (hazard ratio [HR], 1.39; 95% confidence interval [CI], 1.07-1.80; p=0.014). Competing risk analysis revealed lower risks of stroke (sub-distributional hazard ratio [sHR], 0.44; 95% CI, 0.28-0.67; p<0.001) and anticoagulation- related bleeding (sHR, 0.35; 95% CI, 0.23-0.53; p<0.001) in the bioprosthetic AVR group. Conversely, the risk of aortic valve (AV) reintervention was higher in the bioprosthetic AVR group (sHR, 6.14; 95% CI, 3.17-11.93; p<0.001). Conclusion Among patients aged 50 to 70 years who underwent surgical AVR, those receiving mechanical valves showed better survival than those with bioprosthetic valves. The mechanical AVR group exhibited a higher risk of stroke and anticoagulation-related bleeding, while the bioprosthetic AVR group showed a higher risk of AV reintervention.
Collapse
Affiliation(s)
- Youngkwan Song
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Soo Jin Park
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hong Rae Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Suk Yoo
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Pil Je Kang
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Ho Jung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheol Hyun Chung
- 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
| | - Ho Jin Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
7
|
Formica F, Hernandez-Vaquero D, Tuttolomondo D, Gallingani A, Singh G, Pattuzzi C, Niccoli G, Lorusso R, Nicolini F. Results beyond 5-years of surgery or percutaneous approach in severe coronary disease. Reconstructed time-to-event meta-analysis of randomized trials. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:383-392. [PMID: 37816454 DOI: 10.1016/j.rec.2023.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/20/2023] [Indexed: 10/12/2023]
Abstract
INTRODUCTION AND OBJECTIVES There is controversy about the optimal revascularization strategy in severe coronary artery disease (CAD), including left main disease and/or multivessel disease. Several meta-analyses have analyzed the results at 5-year follow-up but there are no results after the fifth year. We conducted a systematic review and meta-analysis of randomized clinical trials, comparing results after the fifth year, between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) using drug-eluting stents in patients with severe CAD. METHODS We analyzed all clinical trials between January 2010 and January 2023. The primary endpoint was all-cause mortality. The databases of the original articles were reconstructed from Kaplan-Meier curves, simulating an individual-level meta-analysis. Comparisons were made at certain cutoff points (5 and 10 years). The 10-year restricted median survival time difference between CABG and PCI was calculated. The random effects model and the DerSimonian-Laird method were applied. RESULTS The meta-analysis included 5180 patients. During the 10-year follow-up, PCI showed a higher overall incidence of all-cause mortality (HR, 1.19; 95%CI, 1.04-1.32; P=.008)]. PCI showed an increased risk of all-cause mortality within 5 years (HR, 1.2; 95%CI, 1.06-1.53; P=.008), while no differences in the 5-10-year period were revealed (HR, 1.03; 95%CI, 0.84-1.26; P=.76). Life expectancy of CABG patients was slightly higher than that of PCI patients (2.4 months more). CONCLUSIONS In patients with severe CAD, including left main disease and/or multivessel disease, there was higher a incidence of all-cause mortality after PCI compared with CABG at 10 years of follow-up. Specifically, PCI has higher mortality during the first 5 years and comparable risk beyond 5 years.
Collapse
Affiliation(s)
- Francesco Formica
- Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | | | | | - Alan Gallingani
- Cardiac Surgery Unit, University Hospital of Parma, Parma, Italy
| | - Gurmeet Singh
- Department of Critical Care Medicine and Division of Cardiac Surgery, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Claudia Pattuzzi
- Department of Medicine and Surgery, University of Parma, Parma, Italy; Cardiac Surgery Unit, University Hospital of Parma, Parma, Italy
| | - Giampaolo Niccoli
- Department of Medicine and Surgery, University of Parma, Parma, Italy; Cardiology Unit, University Hospital of Parma, Parma, Italy
| | - Roberto Lorusso
- Cardio-Thoracic Department, Maastricht University Medical Centre, Heart and Vascular Centre, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Francesco Nicolini
- Department of Medicine and Surgery, University of Parma, Parma, Italy; Cardiac Surgery Unit, University Hospital of Parma, Parma, Italy
| |
Collapse
|
8
|
Vankayalapati DK, Segun-Omosehin O, El Ghazal N, Suresh Daniel R, El Haddad J, Mansour R, Yap N, Miangul S, Nakanishi H, Than CA. Long-Term Outcomes of Mechanical Versus Bioprosthetic Aortic Valve Replacement: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e52550. [PMID: 38371071 PMCID: PMC10870098 DOI: 10.7759/cureus.52550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 02/20/2024] Open
Abstract
This study aimed to investigate the safety and efficacy of bioprosthetic (BV) versus mechanical valves (MV) on long-term outcomes in 50- to 70-year-old aortic stenosis (AS) patients. A literature search for articles published until April 2023 yielded 13 eligible studies, with 15,320 patients divided into BV (n = 7,320) and MV (n = 8,000) cohorts. The review was registered prospectively with PROSPERO (CRD42021278777). MV demonstrated a favorable hazard ratio (HR: 1.12, 95% CI: 1.00-1.25, I2 = 60%) and higher survival rates at 5 (OR:1.13, 95% CI: 1.02-1.25, I2 = 42%) and 10 years (OR: 1.13, 95% CI: 1.05-1.23, I2 = 0%). At 15 years, stroke incidence was comparable (OR: 1.12, 95% CI: 0.98-1.27, I2 = 4%). BV showed lower bleeding events (OR: 1.7, 95% CI: 1.18-2.46, I2 = 88%), but MV replacement showed lower reoperation incidence (OR: 0.27, 95% CI: 0.18-0.42, I2 = 85%). MV appears favorable for the long-term approach in AS management compared to BV.
Collapse
Affiliation(s)
| | - Omotayo Segun-Omosehin
- Cardiothoracic Surgery, St George's University of London, London, GBR
- Cardiothoracic Surgery, University of Nicosia Medical School, Nicosia, CYP
| | - Nour El Ghazal
- Cardiothoracic Surgery, St George's University of London, London, GBR
- Cardiothoracic Surgery, University of Nicosia Medical School, Nicosia, CYP
| | - Rohan Suresh Daniel
- Cardiothoracic Surgery, St George's University of London, London, GBR
- Cardiothoracic Surgery, University of Nicosia Medical School, Nicosia, CYP
| | - Joe El Haddad
- Cardiothoracic Surgery, St George's University of London, London, GBR
- Cardiothoracic Surgery, University of Nicosia Medical School, Nicosia, CYP
| | - Rania Mansour
- Cardiothoracic Surgery, St George's University of London, London, GBR
- Cardiothoracic Surgery, University of Nicosia Medical School, Nicosia, CYP
| | - Nathanael Yap
- Cardiothoracic Surgery, St George's University of London, London, GBR
- Cardiothoracic Surgery, University of Nicosia Medical School, Nicosia, CYP
| | - Shahid Miangul
- Cardiothoracic Surgery, St George's University of London, London, GBR
- Cardiothoracic Surgery, University of Nicosia Medical School, Nicosia, CYP
| | - Hayato Nakanishi
- Cardiothoracic Surgery, St George's University of London, London, GBR
- Cardiothoracic Surgery, University of Nicosia Medical School, Nicosia, CYP
| | - Christian A Than
- Biomedical Sciences, The University of Queensland, Brisbane, AUS
| |
Collapse
|
9
|
Langenaeken T, De Meester P, Verbrugghe P, Rega F, Lamberigts M, Van Hecke M, Van Hoof L, Meuris B. In vivo performance of a tri-leaflet mechanical heart valve prosthesis in an ovine model. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 37:ivad142. [PMID: 37584674 PMCID: PMC10457726 DOI: 10.1093/icvts/ivad142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/13/2023] [Accepted: 08/15/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVES We present the long-term results of a trileaflet (Triflo) versus bileaflet (On-X) mechanical valve in both aortic and pulmonary positions in a sheep model. METHODS The Triflo valve was implanted in 21 female sheep in aortic (n = 8) and pulmonary position (n = 13). The On-X valve was implanted in 7 female sheep in aortic (n = 1) and pulmonary (n = 6) positions. No antithrombotic medication of any kind was given postoperatively. In the aortic group, survival cohorts were 3 and 5 months. In the pulmonary group, survival cohorts were 10 and 20 weeks. Valve performance was assessed using haematology, echocardiography and acoustic measurements combined with post-mortem pathology analysis of the downstream organs. RESULTS The mean gradients were lower for the Triflo valve in both pulmonary [4.30 mmHg (3.70-5.73) vs 6.80 mmHg (4.63-7.96), P = 0.012] and aortic [5.1 mmHg (4.2-7.7) vs 10.7 mmHg (8.7-12.9), P = 0.007] positions. Peak gradients were lower for the Triflo valve in both pulmonary [8.05 mmHg (6.75-10.23) vs 13.15 mmHg (9.20-14.76), P = 0.005] and aortic [8.7 mmHg (7.5-12.5) vs 16.5 mmHg (14.2-19.6), P = 0.009] positions. In both positions, leaflets and housing surface were free from any deposits macro- and microscopically and comparable to nonimplanted control valves. Peripheral organs showed no signs of thrombo-embolic damage. Biochemical and haematological were comparable to preoperative. The closing click sound pressure level of the Triflo was significantly lower in both aortic [108.4 sound pressure level (102.0-115.7) vs 111.7 sound pressure level (105.5-117.0), P < 0.001] and pulmonary [103.6 sound pressure level (99.1-108.9) vs 118.5 sound pressure level (116.7-120.2), P < 0.001] position. CONCLUSIONS Preliminary in vivo results of the Triflo valve are promising in both aortic and pulmonary positions in an ovine model. Excellent haemodynamics, stable long-term function, low valve noise and no thrombo-embolic events in the absence of antithrombotic medication lay the foundation to a future clinical first-in-man trial.
Collapse
Affiliation(s)
- Tom Langenaeken
- Department of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Pieter De Meester
- Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Peter Verbrugghe
- Department of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Filip Rega
- Department of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Marie Lamberigts
- Department of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Manon Van Hecke
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Lucas Van Hoof
- Department of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Bart Meuris
- Department of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
10
|
Sigala E, Kelesi M, Terentes-Printzios D, Vasilopoulos G, Kapadohos T, Papageorgiou D, Tzatzou A, Vlachopoulos C, Stavropoulou A. Surgical Aortic Valve Replacement in Patients Aged 50 to 70 Years: Mechanical or Bioprosthetic Valve? A Systematic Review. Healthcare (Basel) 2023; 11:1771. [PMID: 37372888 DOI: 10.3390/healthcare11121771] [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: 03/27/2023] [Revised: 05/26/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Although transcatheter aortic valve implantation has emerged as a very attractive treatment option for severe aortic valve disease, surgical aortic valve replacement (SAVR) is still considered the standard-of-care, particularly in younger patients. However, selecting the appropriate type of valve prosthesis for this patient population can pose challenges. The aim of this systematic review was to investigate morbidity and mortality in patients aged 50-70 years who have undergone a first-time SAVR, and to define and compare the outcomes of mechanical valve (MV) and biological valve (BV) prosthesis. A systematic search was conducted to investigate the clinical outcomes of MVs and BVs in patients aged 50-70 years following the PRISMA guidelines. A total of 16,111 patients were included in the studies with an average follow-up of 10 years. A total of 16 studies were selected, 12 of which included propensity-score-matching (PMS) analysis and 4 of which obtained results via multivariate analysis. The vast majority (13 studies) showed no greater survival benefit in either MVs and BVs, while three studies showed an advantage of MVs over BVs. Regarding complications, bleeding was the most common adverse event in patients undergoing MV replacement, while for patients receiving BV prosthesis, it was structural valve deterioration and reoperation. Although the data suggest that the BV option could be a safe option in patients younger than 70 years, more studies with contemporary data are needed to draw firm conclusions on the risks and benefits of BV or MV in SAVR. Physicians should individualize the surgical plan based on patient characteristics.
Collapse
Affiliation(s)
- Evangelia Sigala
- Department of Nursing, University of West Attica, 12243 Athens, Greece
| | - Martha Kelesi
- Department of Nursing, University of West Attica, 12243 Athens, Greece
| | | | | | | | | | - Alexia Tzatzou
- Department of Nursing, University of West Attica, 12243 Athens, Greece
| | | | - Areti Stavropoulou
- Department of Nursing, University of West Attica, 12243 Athens, Greece
- Faculty of Health, Science, Social Care and Education, Kingston University, Kingston upon Thames KT2 7LB, UK
| |
Collapse
|
11
|
Lu R, Dismorr M, Glaser N, Sartipy U. Aortic Valve Replacement With Mechanical Valves vs Perimount Bioprostheses in 50- to 69-Year-Old Patients. JACC. ADVANCES 2023; 2:100359. [PMID: 38938255 PMCID: PMC11198651 DOI: 10.1016/j.jacadv.2023.100359] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/06/2023] [Accepted: 04/03/2023] [Indexed: 06/29/2024]
Abstract
Background Evidence is mixed regarding the most appropriate type of valve prosthesis for surgical aortic valve replacement (AVR) in patients 50 to 69 years. American and European guidelines differ. Objectives The purpose of this study was to determine the long-term all-cause mortality and complication rates after AVR in patients aged 50 to 69 years according to implantation of a Perimount bioprosthetic valve or a mechanical valve. Methods In this nationwide observational cohort study, all patients aged 50 to 69 years who underwent primary surgical AVR in Sweden 2003 to 2018 using a Perimount bioprosthesis or mechanical valve were identified from the SWEDEHEART register. Primary outcome; all-cause mortality, secondary outcomes; major bleeding, aortic valve reintervention, heart failure hospitalization, and stroke. National health-data registers were used to ascertain outcomes. Regression standardization addressed confounding. Results A total of 6,907 patients aged 50 to 69 years were included (Perimount group, n = 3,831 and mechanical valve group, n = 3,076) and 74% were men. The use of bioprostheses increased during the study period. At 15 years of follow-up, the estimated cumulative incidence of all-cause mortality was 37% (95% CI: 35%-40%) vs 45% (95% CI: 42%-48%) in the mechanical and Perimount groups, respectively (survival difference -7.9% [95% CI: -11% to -4.6%]). Patients with mechanical valves had a lower risk of aortic valve reintervention but a higher risk for bleeding. Survival difference at 15 years in ages 50 to 59 years was -15% (95% CI: -8.4% to -21%). Conclusions In patients aged 50 to 69 years who underwent surgical AVR, survival was better in those who received mechanical compared to Perimount bioprosthetic valves. While valve choice should be guided by individual patient factors and patient preference rather than by chronological age, the substantial survival advantage observed in patients with mechanical valves in ages 50 to 59 years must be recognized.
Collapse
Affiliation(s)
- Ruixin Lu
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Michael Dismorr
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Natalie Glaser
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Stockholm South General Hospital, Stockholm, Sweden
| | - Ulrik Sartipy
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
12
|
Lee G, Chikwe J, Milojevic M, Wijeysundera HC, Biondi-Zoccai G, Flather M, Gaudino MFL, Fremes SE, Tam DY. ESC/EACTS vs. ACC/AHA guidelines for the management of severe aortic stenosis. Eur Heart J 2023; 44:796-812. [PMID: 36632841 DOI: 10.1093/eurheartj/ehac803] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 11/08/2022] [Accepted: 12/19/2022] [Indexed: 01/13/2023] Open
Abstract
Aortic stenosis (AS) is a serious and complex condition, for which optimal management continues to evolve rapidly. An understanding of current clinical practice guidelines is critical to effective patient care and shared decision-making. This state of the art review of the 2021 European Society of Cardiology/European Association for Cardio-Thoracic Surgery Guidelines and 2020 American College of Cardiology/American Heart Association Guidelines compares their recommendations for AS based on the evidence to date. The European and American guidelines were generally congruent with the exception of three key distinctions. First, the European guidelines recommend intervening at a left ventricular ejection fraction of 55%, compared with 60% over serial imaging by the American guidelines for asymptomatic patients. Second, the European guidelines recommend a threshold of ≥65 years for surgical bioprosthesis, whereas the American guidelines employ multiple age categories, providing latitude for patient factors and preferences. Third, the guidelines endorse different age cut-offs for transcatheter vs. surgical aortic valve replacement, despite limited evidence. This review also discusses trends indicating a decreasing proportion of mechanical valve replacements. Finally, the review identifies gaps in the literature for areas including transcatheter aortic valve implantation in asymptomatic patients, the appropriateness of Ross procedures, concomitant coronary revascularization with aortic valve replacement, and bicuspid AS. To summarize, this state of the art review compares the latest European and American guidelines on the management of AS to highlight three areas of divergence: timing of intervention, valve selection, and surgical vs. transcatheter aortic valve replacement criteria.
Collapse
Affiliation(s)
- Grace Lee
- Temerty Faculty of Medicine, 1 King's College Circle, Toronto, ON M5S1A8, Canada
| | - Joanna Chikwe
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 San Vicente Blvd a3600, Los Angeles, CA 90048, USA
| | - Milan Milojevic
- Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Heroja Milana Tepića 1, Belgrade, Serbia.,Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Harindra C Wijeysundera
- Schulich Heart Program, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, M4N 3M5, University of Toronto, Toronto, ON, Canada
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Piazzale Aldo Moro, 5, 00185 Roma RM, Italy.,Mediterranea Cardiocentro, Via Orazio, 2, 80122 Napoli, NA, Italy
| | - Marcus Flather
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK
| | - Mario F L Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, 1300 York Ave, NY New York, USA
| | - Stephen E Fremes
- Division of Cardiac Surgery, Schulich Heart Centre, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Derrick Y Tam
- Division of Cardiac Surgery, University of Toronto, 200 Elizabeth St., Toronto, ON M5G 2C4, Canada
| |
Collapse
|
13
|
Jiang Y, Wang S, Bian J, Chen S, Shao Y. Mechanical versus Bioprosthetic Aortic Valve Replacement in Middle-Aged Adults: A Systematic Review and Meta-Analysis. J Cardiovasc Dev Dis 2023; 10:jcdd10020090. [PMID: 36826586 PMCID: PMC9965629 DOI: 10.3390/jcdd10020090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/06/2023] [Accepted: 02/18/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Mechanical prostheses and bioprosthetic prostheses have their own advantages and disadvantages. Mechanical ones are recommended for younger patients (<50 years old), and bioprosthetic ones are recommended for older patients (>70 years old). There is still debate regarding which kind of prosthesis is better for middle-aged patients (50 to 70 years old) receiving aortic valve replacement (AVR). To solve this problem, we conducted this meta-analysis. Given that only one randomized controlled trial (RCT) study was included, we conducted a subgroup analysis of RCT and propensity score matching (PSM) retrospective studies to reduce the bias. METHODS We systematically searched articles related to clinical outcomes of mechanical and bioprosthetic prostheses in middle-aged patients receiving AVR in the PubMed, Cochrane Library, and China National Knowledge Infrastructure (CNKI) databases. The published date was up to 1 October 2022. Studies were excluded if not only middle-aged patients were included, or if they lacked direct comparisons between mechanical and bioprosthetic prostheses. RESULTS In total, 22 studies with 32,298 patients were included in the final analysis. The results show that patients aged between 50 and 70 receiving AVR with mechanical prostheses achieved better long-term survival and fewer reoperations and valve-related events but suffered more with bleeding events. No significant difference could be found in terms of early mortality and long-term cardiac death. The same results could be observed in the subgroup analysis of RCT and PSM retrospective studies. CONCLUSION Both mechanical and bioprosthetic prostheses are beneficial to middle-aged patients undertaking AVR procedures. However, mechanical prostheses show better clinical outcomes in long-term survival and comorbidities. Individual recommendation is still necessary.
Collapse
Affiliation(s)
- Yefan Jiang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road, No. 300, Nanjing 210000, China
| | - Song Wang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road, No. 300, Nanjing 210000, China
| | - Jinhui Bian
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road, No. 300, Nanjing 210000, China
| | - Si Chen
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Road, No. 1277, Wuhan 430022, China
- Correspondence: (S.C.); (Y.S.); Tel.: +86-027-85351611 (S.C.); +86-025-68303574 (Y.S.)
| | - Yongfeng Shao
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Guangzhou Road, No. 300, Nanjing 210000, China
- Correspondence: (S.C.); (Y.S.); Tel.: +86-027-85351611 (S.C.); +86-025-68303574 (Y.S.)
| |
Collapse
|
14
|
Biological versus mechanical prostheses for aortic valve replacement. J Thorac Cardiovasc Surg 2023; 165:609-617.e7. [PMID: 33712230 DOI: 10.1016/j.jtcvs.2021.01.118] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 01/19/2021] [Accepted: 01/26/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Long-term real-world outcomes are critical for informing decisions about biological (Bio) or mechanical (Mech) prostheses for aortic valve replacement, particularly in patients aged between 50 and 65 years. The objective was to compare long-term survival and major adverse cardiac and cardiovascular events (ie, stroke, reoperation, and major bleeding) within this population. METHODS This was a multicenter observational study including all patients aged between 50 and 65 years who underwent an aortic valve replacement because of severe isolated aortic stenosis between the years 2000 and 2018. A total of 5215 patients from 27 Spanish hospitals were registered with a follow-up of 15 years. Multivariable analyses, including a 2:1 propensity score matching (1822 Mech and 911 Bio) and competing risks analyses were applied. RESULTS Bio prostheses were implanted in 19% of patients (n = 992). No significant differences were observed between matched groups in long-term survival (hazard ratio [HR], 1.14; 95% confidence interval [CI], 0.88-1.47; P = .33). Stroke rates were higher for Mech prostheses, but not significant (HR, 0.72; 95% CI, 0.50-1.03; P = .07). Finally, higher rates of major bleeding were found in the Mech group (HR, 0.65; 95% CI, 0.49-0.87; P = .004), whereas reoperation was more frequent among the Bio group (HR, 3.04; 95% CI, 1.80-5.14; P < .001). Bio prostheses increased from 13% in the period from 2000 to 2008 to 24% in 2009 to 2018. CONCLUSIONS Long-term survival was comparable among groups in patients between 50 and 65 years of age. Mech prostheses were associated with a higher risk of major bleeding, whereas Bio prostheses entailed higher reoperation rates. Bio prostheses seem a reasonable choice for patients between 50 and 65 years in Spain.
Collapse
|
15
|
Commentary: It's better to be alone than in bad company…at least for bioprosthesis. J Thorac Cardiovasc Surg 2023; 165:618-619. [PMID: 33714575 DOI: 10.1016/j.jtcvs.2021.02.048] [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: 02/06/2021] [Revised: 02/06/2021] [Accepted: 02/08/2021] [Indexed: 01/18/2023]
|
16
|
Carapinha JL, Iliescu VA, Dorobantu LF, Turcu-Stiolica A, Deckert J, White A, Salem A, Parasca C. Budget impact analysis of a bovine pericardial aortic bioprosthesis versus mechanical aortic valve replacement in adult patients with aortic stenosis in Romania. J Med Econ 2023; 26:998-1008. [PMID: 37505934 DOI: 10.1080/13696998.2023.2242188] [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: 04/11/2023] [Revised: 07/15/2023] [Accepted: 07/25/2023] [Indexed: 07/30/2023]
Abstract
AIMS An analysis of the budget impact of using a bovine pericardial aortic bioprosthesis (BPAB) or a mechanical valve (MV) in aortic stenosis (AS) patients in Romania. MATERIALS AND METHODS A decision-tree with a partitioned survival model was used to predict the financial outcomes of using either a BPAB (the Carpentier-Edwards Perimount Magna Ease Valve) or MV in aortic valve replacement (AVR) procedure over a 5-year period. The budget impact of various resource consumption including disabling strokes, reoperations, minor thromboembolic events, major bleeding, endocarditis, anticoagulation treatment and monitoring, and echocardiogram assessments were compared for both types of valves. One-way sensitivity analyses (OWSA) were conducted on the input costs and probabilities. RESULTS The use of BPAB compared to MV approaches budget neutrality due to incremental savings year-on-year. The initial surgical procedure and reoperation costs for BPAB are offset by savings in acenocoumarol use, disabling strokes, major bleeding, minor thromboembolic events, and anticoagulation complications. The cost of the initial procedure per patient is 460 euros higher for a BPAB due to the higher valve acquisition cost, although this is partially offset by a shorter hospital stay. The OWSA shows that the total procedure costs, including the hospital stay, are the primary cost drivers in the model. LIMITATIONS Results are limited by cost data aggregation in the DRG system, exclusion of costs for consumables and capital equipment use, possible underestimation of outpatient complication costs, age-related variations of event rates, and valve durability. CONCLUSIONS Adopting BPAB as a treatment option for AS patients in Romania can lead to cost savings and long-term economic benefits. By mitigating procedure costs and increasing anticoagulation treatment costs, BPAB offers a budget-neutral option that can help healthcare providers, policymakers, and patients alike manage the growing burden of AS in Romania.
Collapse
Affiliation(s)
- João L Carapinha
- Northeastern University School of Pharmacy, Boston, United States of America
- Syenza, Anaheim, United States of America
| | - Vlad A Iliescu
- University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | | | | | | | | | - Adham Salem
- Edwards Lifesciences, Dubai, United Arab Emirates
| | - Catalina Parasca
- "Prof. Dr. C.C. Iliescu" Institute for Cardiovascular Diseases, Bucharest, Romania
| |
Collapse
|
17
|
Kim M, Kim HR, Lee SH, Lee S, Joo H. Aortic valve replacement in patients aged 50 to 69 years: Analysis using Korean National Big Data. J Card Surg 2022; 37:3623-3630. [PMID: 36054455 PMCID: PMC9825912 DOI: 10.1111/jocs.16908] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND The aim of this study was to compare the clinical outcomes and long-term survival in patients who underwent isolated aortic valve replacement (AVR) with mechanical versus bioprosthetic valves. METHODS Patients aged 50-69 years who had undergone AVR from 2002 to 2018 were identified and their characteristics were collected from Korean National Health Information Database formed by the National Health Insurance Service, Republic of Korea. Of the 5792 patients, 1060 patients were excluded due to missing values on characteristics. Of the 4732 study patients, 1945 patients (41.1%) had received bioprosthetic valves (Group B) and 2787 patients (58.9%) had received mechanical valves (Group M). A propensity score-matched analysis was performed to match 1429 patients in each group. Data on mortality, cardiac mortality, reoperations, cerebrovascular accidents, and bleeding complications were obtained. RESULTS The overall survival rates at 5 and 10 years postoperatively were 87.8% and 75.2% in the matched Group B and 91.2% and 76.7% in the matched Group M, respectively (p = .140). Freedom from cardiac death rates at postoperative 5 and 10 years were 95.6% and 92.4% in the matched Group B and 96.0% and 92.1% in the matched Group M, respectively (p = .540). The cumulative incidence of reoperation was higher in the matched Group B than in the matched Group M (p = .007), and the cumulative incidence of major bleeding was higher in the matched Group M than in the matched Group B (p = .039). CONCLUSION In patients aged 50-69 years who underwent isolated AVR, the patients who received bioprosthetic valves showed similar cardiac mortality-free survival and long-term survival rates to the patients who received mechanical valves.
Collapse
Affiliation(s)
- Min‐Seok Kim
- Department of Thoracic and Cardiovascular Surgery, Cardiovascular Center, Myongji HospitalHanyang University College of MedicineSeoulKorea
| | - Hae Rim Kim
- Department of Statistics, College of Natural ScienceUniversity of SeoulSeoulKorea
| | - Seung Hyun Lee
- Division of Cardiovascular Surgery, Severance Cardiovascular HospitalYonsei University College of MedicineSeoulKorea
| | - Sak Lee
- Division of Cardiovascular Surgery, Severance Cardiovascular HospitalYonsei University College of MedicineSeoulKorea
| | - Hyun‐Chel Joo
- Division of Cardiovascular Surgery, Severance Cardiovascular HospitalYonsei University College of MedicineSeoulKorea
| |
Collapse
|
18
|
Impact of Three Different Processing Techniques on the Strength and Structure of Juvenile Ovine Pulmonary Homografts. Polymers (Basel) 2022; 14:polym14153036. [PMID: 35894000 PMCID: PMC9332750 DOI: 10.3390/polym14153036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/15/2022] [Accepted: 06/20/2022] [Indexed: 01/27/2023] Open
Abstract
Homografts are routinely stored by cryopreservation; however, donor cells and remnants contribute to immunogenicity. Although decellularization strategies can address immunogenicity, additional fixation might be required to maintain strength. This study investigated the effect of cryopreservation, decellularization, and decellularization with additional glutaraldhyde fixation on the strength and structure of ovine pulmonary homografts harvested 48 h post-mortem. Cells and cellular remnants were present for the cryopreserved group, while the decellularized groups were acellular. The decellularized group had large interfibrillar spaces in the extracellular matrix with uniform collagen distribution, while the additional fixation led to the collagen network becoming dense and compacted. The collagen of the cryopreserved group was collapsed and appeared disrupted and fractured. There were no significant differences in strength and elasticity between the groups. Compared to cryopreservation, decellularization without fixation can be considered an alternative processing technique to maintain a well-organized collagen matrix and tissue strength of homografts.
Collapse
|
19
|
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
|
20
|
Rowse PG, Schaff HV. Controversy pro: Mechanical AVR for better long-term survival of 50-70 years old. Prog Cardiovasc Dis 2022; 72:26-30. [PMID: 35724705 DOI: 10.1016/j.pcad.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 06/12/2022] [Indexed: 11/27/2022]
Abstract
Selection of the most appropriate type of aortic valve prosthesis (mechanical or biologic) for patients 50-70 years of age is a matter of frequent debate. The purpose of this article is to review overlooked concepts and misconceptions in valve-related complications, prosthesis durability, and late survival to aid decision making in contemporary practice. A trend favoring improved long-term survival was found among patients who receive a mechanical prosthesis compared to a biologic substitute. Additionally, an acceptably low rate of long-term valve-related thromboembolism and hemorrhage was found among those with mechanical prostheses. Implantation of a biologic valve substitute did not appear to reduce the risk of thromboembolism, may not eliminate the need for long-term anticoagulation and may be associated with an increased risk of late mortality. These findings may aid providers (and patients) in the preoperative consultation and seem to support consideration of a mechanical heart valve substitute over a biologic valve for patients 50-70 years age.
Collapse
Affiliation(s)
- Phillip G Rowse
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Hartzell V Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
21
|
Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Rafael Sádaba J, Tribouilloy C, Wojakowski W. Guía ESC/EACTS 2021 sobre el diagnóstico y tratamiento de las valvulopatías. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
22
|
Asadi H, Hedayat M, Borazjani I. The Effects of Implantation Orientation of a Bileaflet Mechanical Heart Valve in an Anatomic Left Ventricle-Aorta Configuration. J Biomech Eng 2022; 144:1140397. [PMID: 35466356 DOI: 10.1115/1.4054411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Indexed: 11/08/2022]
Abstract
We have performed three-dimensional high-resolution numerical simulations of a bi-leaflet mechanical heart valve (BMHV) implanted at different orientations in an anatomic left ventricle-aorta obtained from magnetic resonance imaging (MRI) of a volunteer. The thoroughly validated overset curvilinear-immersed boundary (overset-CURVIB) fluid-structure interaction (FSI) flow solver is used in which the aorta and LV are discretized with boundary-conforming and non-conforming curvilinear grids, respectively. The motion of the LV wall is prescribed based on a lumped parameter model while the motion of the leaflets are calculated using a strong coupled FSI algorithm enhanced with Aitken convergence technique. We carried out simulations for three valve orientations, which differ from each other by 45 degrees and compared the leaflet motion and flow field for multiple cycles. Our results show reproducible and relatively symmetrical opening for all valve orientations. The presence of small-scale vortical structures after peak systole, cause significant cycle-to-cycle variations in valve kinematics during the closing phase for all valve orientations. Furthermore, our results show that valve orientation does not have a significant effect on the distribution of viscous shear stress in the ascending aorta. Additionally, two different mathematical activation models including linear level of activation and Soares model are used to quantify the platelet activation in the ascending aorta. The results show that the valve orientation does not significantly affect (less than 8%) the total platelet activation in the ascending aorta.
Collapse
Affiliation(s)
- Hossein Asadi
- J. Mike Walker '66 Department of Mechanical Engineering, Texas A&M University, College Station, Texas 77843, USA
| | - Mohammadali Hedayat
- J. Mike Walker '66 Department of Mechanical Engineering, Texas A&M University, College Station, Texas 77843, USA
| | - Iman Borazjani
- J. Mike Walker '66 Department of Mechanical Engineering, Texas A&M University, College Station, Texas 77843, USA
| |
Collapse
|
23
|
Tasoudis PT, Varvoglis DN, Vitkos E, Mylonas KS, Sá MP, Ikonomidis JS, Caranasos TG, Athanasiou T. Mechanical versus Bioprosthetic Valve for Aortic Valve Replacement: Systematic Review and Meta-Analysis of Reconstructed Individual Participant Data. Eur J Cardiothorac Surg 2022; 62:6571808. [PMID: 35445694 DOI: 10.1093/ejcts/ezac268] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/14/2022] [Accepted: 04/18/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To compare biological versus mechanical aortic valve replacement. METHODS We searched MEDLINE, Scopus, and Cochrane Library databases for randomized clinical trials and propensity-score matched studies published by October 14th, 2021 according to PRISMA statement. Individual patient data on overall survival were extracted. One- and two-stage survival analyses, and random-effects meta-analyses were conducted. RESULTS 25 studies were identified, incorporating 8,721 bioprosthetic and 8,962 mechanical valves:. In the one-stage meta-analysis, mechanical valves cumulatively demonstrated decreased hazard for mortality (Hazard Ratio [HR] : 0.79, 95% Confidence interval [CI] : 0.74-0.84, p < 0.0001). Overall survival was similar between the compared arms for patients <50 years old (HR: 0.88, 95% CI : 0.71-1.1, p = 0.216), increased in the mechanical valve arm for patients 50-70 years old (HR : 0.76, 95% CI : 0.70-0.83, p < 0.0001), and increased in the bioprosthetic arm for patients >70 years old (HR : 1.35, 95% CI : 1.17-1.57, p < 0.0001). Meta-regression analysis revealed that the survival in the 50-70 years old group was not influenced by the publication year of the individual studies. No statistically significant difference was observed regarding in-hospital mortality, post-operative strokes and post-operative reoperation. All-cause mortality was found decreased in the mechanical group, cardiac mortality was comparable between the two groups, major bleeding rates were increased in the mechanical valve group, and reoperation rates were increased in the bioprosthetic valve group. CONCLUSIONS Survival rates seem to not be influenced by the type of prosthesis in patients <50 years old. A survival advantage in favour of mechanical valves is observed in patients 50-70 years old, while in patients >70 years old bioprosthetic valves offer better survival outcomes.
Collapse
Affiliation(s)
- Panagiotis T Tasoudis
- Department of Cardiothoracic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece; Surgery Working Group, Society of Junior Doctors, Athens, Greece
| | - Dimitrios N Varvoglis
- Department of Cardiothoracic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece; Surgery Working Group, Society of Junior Doctors, Athens, Greece
| | - Evangelos Vitkos
- Department of Cardiothoracic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece; Surgery Working Group, Society of Junior Doctors, Athens, Greece
| | | | - Michel Pompeu Sá
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - John S Ikonomidis
- Professor of Surgery, Chief, Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine, University of North Carolina, at Chapel Hill Chapel Hill, NC
| | - Thomas G Caranasos
- Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, W2 1NY, UK, Department of Cardiothoracic Surgery, University Hospital of Larissa, Biopolis, Larissa, Greece, 41110
| |
Collapse
|
24
|
Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. EUROINTERVENTION 2022; 17:e1126-e1196. [PMID: 34931612 PMCID: PMC9725093 DOI: 10.4244/eij-e-21-00009] [Citation(s) in RCA: 106] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
25
|
Menichelli D, Poli D, Antonucci E, Biccirè FG, Palareti G, Pignatelli P, Pastori D. Bleeding and mortality risk in patients implanted with mechanical prosthetic heart valves with and without thrombocytopenia. Insights from the nationwide PLECTRUM registry. Platelets 2022; 33:1018-1023. [PMID: 35021929 DOI: 10.1080/09537104.2022.2026909] [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: 10/19/2022]
Abstract
Previous studies showed that mechanical prosthetic heart valve (MPHV) patients may develop thrombocytopenia, but its association with clinical outcomes has not been investigated. We enrolled 1,663 patients with available platelet count from the multicenter nationwide retrospective PLECTRUM registry to investigate the association of thrombocytopenia with all-cause mortality and major bleeding (MB) in patients implanted with MPHV. Thrombocytopenia was defined by platelet count <150 × 109/L. Overall, 44.9% of patients were women and the mean age was 56.7 years. At baseline, 184 (11.1%) patients had thrombocytopenia. Patients with thrombocytopenia were more frequently men and elderly. Platelet count showed an age-dependent decline in men but not in women. We found an increased risk of death in patients with age ≥ 65 years, with a low anticoagulation quality, concomitant arterial hypertension, heart failure, a higher INR range, or with thrombocytopenia (OR 1.739, 95%CI 1.048-2.886, p = .032). At multivariable logistic regression, patients with age ≥65 years, concomitant AF and thrombocytopenia (OR 1.907, 95%CI 1.219-2.983, p = .005) had an increased risk of MBs. In MPHV patients, thrombocytopenia is associated with an increased risk of death and MB. There is a growing need for a sex- and age-specific threshold to define platelet count in adult patients.
Collapse
Affiliation(s)
- Danilo Menichelli
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Daniela Poli
- Thrombosis Centre, Azienda Ospedaliero - Universitaria Careggi, Florence, Italy
| | | | - Flavio Giuseppe Biccirè
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.,Department of General and Specialized Surgery "Paride Stefanini", Sapienza University of Rome, Viale del Policlinico, Rome, Italy
| | | | - Pasquale Pignatelli
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Daniele Pastori
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | | |
Collapse
|
26
|
OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6524995. [DOI: 10.1093/ejcts/ezac073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 12/30/2021] [Accepted: 01/24/2022] [Indexed: 11/15/2022] Open
|
27
|
OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6523883. [DOI: 10.1093/ejcts/ezac056] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/12/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
|
28
|
Lazar HL. MECHANICAL VS BIOPROSTHETIC AORTIC VALVE REPLACEMENT IN PATIENTS YOUNGER THAN 70 YEARS OF AGE---WHICH PROSTHESIS IS BEST? Can J Cardiol 2021; 38:300-302. [PMID: 34974137 DOI: 10.1016/j.cjca.2021.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 12/27/2021] [Accepted: 12/28/2021] [Indexed: 11/02/2022] Open
Affiliation(s)
- Harold L Lazar
- Division of Cardiac Surgery, the Boston University School of Medicine, Boston, MA.
| |
Collapse
|
29
|
Mechanical vs. bioprosthetic aortic valve replacement in patients younger than 70 years of age - a hazard ratio meta-analysis. Can J Cardiol 2021; 38:355-364. [PMID: 34954316 DOI: 10.1016/j.cjca.2021.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/08/2021] [Accepted: 12/15/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The choice between mechanical valves (MV) and bioprosthetic valves (BV) in patients undergoing aortic valve surgery is complex, requiring a balance between the inferior durability of BV and the indicated long-term anticoagulation therapy with MV. This is especially challenging in middle age group (<70 years of age) that has seen an increased use of BV over recent years. METHODS A meta-analysis of randomized controlled trials (RCTs), observational studies using propensity score matching (PSM) and inverse-probability-weighing (IPW) was conducted to examine the clinical outcomes of patients <70 years of age undergoing aortic valve replacement. Primary outcome was overall long-term mortality. Secondary outcomes included bleeding events, re-operation, systemic thromboembolism, and cerebrovascular accident (CVA). RESULTS Fifteen studies (1 RCT, 12 PSM, and 2 IPW studies, aggregated sample size 16,876 patients) were included. Median follow-up was 7.8 years. Mortality was higher with BV vs. MV (HR 1.22 [1.00-1.49]), as was re-operation (HR 3.05 [2.22-4.19]). Bleeding risk was lower with BV (HR 0.58 [0.48-0.69]), and the risk of stroke was similar in both valve types (HR 0.96 [0.83-1.11]) CONCLUSIONS: In this broadest meta-analysis comparing BV and MV, results suggest a survival benefit for MV in patients < 70 years of age. This should lead to reassessment of current patterns used in the choice of valves for patients <70 among the cardiothoracic surgery community.
Collapse
|
30
|
Surgical Aortic Valve Replacement-Age-Dependent Choice of Prosthesis Type. J Clin Med 2021; 10:jcm10235554. [PMID: 34884256 PMCID: PMC8658378 DOI: 10.3390/jcm10235554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Recently, the use of surgically implanted aortic bioprostheses has been favoured in younger patients. We aimed to analyse the long-term survival and postoperative MACCE (Major Adverse Cardiovascular and Cerebral Event) rates in patients after isolated aortic valve replacement. Methods: We conducted a single-centre observational retrospective study, including all consecutive patients with isolated aortic valve replacement. 1:1 propensity score matching of the preoperative baseline characteristics was performed. Results: A total of 2172 patients were enrolled in the study. After propensity score matching the study included 428 patients: 214 biological vs. 214 mechanical prostheses, divided into two subgroups: group A < 60 years and group B > 60 years. The mean follow-up time was 7.6 ± 3.9 years. Estimated survival was 97 ± 1.9% and 89 ± 3.4% at 10 years for biological and mechanical prosthesis, respectively in group A (p = 0.06). In group B the survival at 10 years was 79.1 ± 5.8% and 69.8 ± 4.4% for biological and mechanical prosthesis, respectively (p = 0.83). In group A, patients with a bioprosthesis exhibited a tendency for higher cumulative incidence MACCE rates compared to patients with a mechanical prosthesis, p = 0.83 (bio 7.3 ± 5.3% vs. mech 4.6 ± 2.2% at 10 years). In group B, patients with a mechanical prosthesis showed a tendency for higher cumulative incidence MACCE rates compared to patients with bioprosthesis, p = 0.86 (bio 4.3 ± 3.1% vs. mech 9.1 ± 3.1% at 10 years). Conclusions: Long-term survival after surgical aortic valve replacement is similar in patients with a biological and mechanical prosthesis, independent of the patients’ age. Moreover, younger patients (<60 years) with bioprosthesis showed a survival benefit, compared to patients with mechanical prosthesis in this age group.
Collapse
|
31
|
Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg 2021; 60:727-800. [PMID: 34453161 DOI: 10.1093/ejcts/ezab389] [Citation(s) in RCA: 310] [Impact Index Per Article: 103.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
|
32
|
Rodríguez-Caulo EA, Hernández-Vaquero D. Stentless bioprosthesis for young patients: are they worth it? Eur J Cardiothorac Surg 2021; 60:284-285. [PMID: 33837385 DOI: 10.1093/ejcts/ezab133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
33
|
Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 2021; 43:561-632. [PMID: 34453165 DOI: 10.1093/eurheartj/ehab395] [Citation(s) in RCA: 2208] [Impact Index Per Article: 736.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
|
34
|
Marin-Cuartas M, Davierwala PM. Reply to Tourmousoglou. Eur J Cardiothorac Surg 2021; 60:206. [PMID: 33501932 DOI: 10.1093/ejcts/ezab011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 12/20/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
- Mateo Marin-Cuartas
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Piroze M Davierwala
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| |
Collapse
|
35
|
Pastori D, Poli D, Antonucci E, Menichelli D, Violi F, Palareti G, Pignatelli P. Sex-based difference in anticoagulated patients with mechanical prosthetic heart valves and long-term mortality risk. Int J Clin Pract 2021; 75:e14064. [PMID: 33533555 DOI: 10.1111/ijcp.14064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/17/2021] [Accepted: 01/29/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Vitamin K antagonists (VKAs) reduce thromboembolism in patients with mechanical prosthetic heart valves (MPHV). It is unclear whether a sex-based difference in MPHV patients regarding valve site, anticoagulation quality, and mortality risk does exist. METHODS We analysed 2111 MPHV patients from the nationwide PLECTRUM study promoted by the Italian Federation of Anticoagulation Clinics (FCSA). We analysed the site of MPHV, anticoagulation quality, as assessed by the time in therapeutic range (TiTR), and mortality risk in women and men. RESULTS The mean age of the patients was 56.8 ± 12.3 years. Women were older with a lower prevalence of ischemic heart disease and smoking habit and a higher prevalence of atrial fibrillation at baseline. Aortic MPHV was more frequent in men (74.7% vs 43.3%, P < .001), whereas mitral (41.1% vs 17.6%, P < .001) and mitro-aortic (15.6% vs 7.7%, P < .001) MPVH in women. The association between female sex and mitral/mitro-aortic site remained at multivariable logistic regression analysis (Odds Ratio 3.623, 95% Confidence Interval [CI] 2.947-4.455, P < .001). Regarding anticoagulation quality, women showed lower mean TiTR (63.0 ± 19.4 vs 57.5 ± 19.2, P < .001), and a higher proportion of TiTR < 60% (54.9% vs 43.3%, P < .001). During a mean follow-up of 123 months (21 665 pt-years), 152 deaths occurred (0.7%/year); 83 in the aortic (0.63%/year) and 69 in the mitral/mitro-aortic (0.81%/year) group. At multivariable Cox proportional hazard regression analysis, female sex was not associated with mortality (HR 0.953, 95%CI 0.678 1.340, P = .783). CONCLUSIONS Female sex is independently associated with mitral/mitro-aortic MPHV. Despite a lower TiTR in women, mortality risk did not differ between the two groups.
Collapse
Affiliation(s)
- Daniele Pastori
- I Clinica Medica, Atherothrombosis Centre, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Daniela Poli
- Thrombosis Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | | | - Danilo Menichelli
- I Clinica Medica, Atherothrombosis Centre, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Francesco Violi
- I Clinica Medica, Atherothrombosis Centre, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Pasquale Pignatelli
- I Clinica Medica, Atherothrombosis Centre, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
36
|
Hernandez-Vaquero D, Rodriguez-Caulo E, Vigil-Escalera C, Blanco-Herrera O, Berastegui E, Arias-Dachary J, Souaf S, Parody G, Laguna G, Adsuar A, Castellá M, Valderrama JF, Pulitani I, Cánovas S, Ferreiro A, García-Valentín A, Carnero M, Pareja P, Corrales JA, Blázquez JA, Macías D, Fletcher-Sanfeliu D, Martínez D, Martín E, Martín M, Margarit J, Hernández-Estefanía R, Monguió E, Otero J, Silva J. Differences in life expectancy between men and women after aortic valve replacement. Eur J Cardiothorac Surg 2021; 60:681-688. [PMID: 33772276 DOI: 10.1093/ejcts/ezab140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/18/2021] [Accepted: 01/24/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Some researchers have observed an increased number of deaths during the follow-up of young patients who undergo aortic valve replacement due to severe aortic stenosis, suggesting that this procedure does not restore their life expectancy. Our goal was to confirm these findings and explore sex-based differences. METHODS All patients between 50 and 65 years of age who underwent isolated aortic valve replacement in 27 Spanish centres during an 18-year period were included. We compared observed and expected survival at 15 years of follow-up and estimated the cumulative incidence of death from a competing risks point of view. We stratified by sex and analysed if being a woman was an independent risk factor for death. RESULTS For men, the observed survival at 10 and 15 years of follow-up was 85% [95% confidence interval (CI) 83.6%-86.4%] and 72.3% (95% CI 69.7%-74.7%), respectively whereas the expected survival was 88.1% and 78.8%. For women, the observed survival at 10 and 15 years was 85% (95% CI 82.8%-86.9%) and 73% (95% CI 69.1%-76.4%), whereas the expected survival was 94.6% and 89.4%. At 15 years of follow-up, the cumulative incidence of death due to the disease in men and women was 8.2% and 16.7%, respectively. In addition, being a woman was an independent risk factor for death (hazard ratio = 1.23 (95% CI 1.02-1.48; P = 0.03). CONCLUSIONS After the aortic valve replacement, men and women do not have their life expectancy restored, but this loss is much higher in women than in men. In addition, being a woman is a risk factor for long-term death. Reasons for these findings are unknown and must be investigated.
Collapse
Affiliation(s)
| | | | | | | | - Elisabet Berastegui
- Cardiovascular Surgery Department, Germans Trias I Pujol Hospital, Badalona, Spain
| | - Javier Arias-Dachary
- Cardiovascular Surgery Department, Reina Sofia University Hospital, Cordoba, Spain
| | - Souhayla Souaf
- Cardiovascular Surgery Department, Clinic University Hospital, Santiago de Compostela, Spain
| | - Gertrudis Parody
- Cardiovascular Surgery Department, Virgen de la Macarena University Hospital, Sevilla, Spain
| | - Gregorio Laguna
- Cardiovascular Surgery Department, Clinic University Hospital, Valladolid, Spain
| | - Alejandro Adsuar
- Cardiovascular Surgery Department, Virgen del Rocio University Hospital, Sevilla, Spain
| | - Manel Castellá
- Cardiovascular Surgery Department, Clinic Hospital, University of Barcelona, Spain
| | - José F Valderrama
- Cardiovascular Surgery Department, Regional de Malaga University Hospital, Spain
| | - Ivana Pulitani
- Cardiovascular Surgery Department, Marques de Valdecilla University Hospital, Santander, Spain
| | - Sergio Cánovas
- Cardiovascular Surgery Department, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - Andrea Ferreiro
- Cardiovascular Surgery Department, Virgen de las Nieves University Hospital, Granada, Spain
| | | | - Manuel Carnero
- Cardiovascular Surgery Department, San Carlos University Hospital, Madrid, Spain
| | - Pilar Pareja
- Cardiovascular Surgery Department, Virgen de la Salud University Hospital, Toledo, Spain
| | - José A Corrales
- Cardiovascular Surgery Department, Badajoz University Hospital, Badajoz, Spain
| | - José A Blázquez
- Cardiovascular Surgery Department, La Paz University Hospital, Madrid, Spain
| | - Diego Macías
- Cardiovascular Surgery Department, Puerta del Mar University Hospital, Cadiz, Spain
| | | | - Daniel Martínez
- Cardiovascular Surgery Department, Puerta del Hierro University Hospital, Madrid, Spain
| | - Elio Martín
- Cardiovascular Surgery Department, Leon University Hospital, Leon, Spain
| | - Miren Martín
- Cardiovascular Surgery Department, Ramon y Cajal University Hospital, Madrid, Spain
| | - Juan Margarit
- Cardiovascular Surgery Department, De la Ribera Public University Hospital, Alzira, Spain
| | | | - Emilio Monguió
- Cardiovascular Surgery Department, La Princesa University Hospital, Madrid, Spain
| | - Juan Otero
- Cardiovascular Surgery Department, Virgen de la Victoria University Hospital, Malaga, Spain
| | - Jacobo Silva
- Cardiac Surgery Department, Central University Hospital of Asturias, Oviedo, Spain
| |
Collapse
|
37
|
A systematic review of the cost-effectiveness of heart valve replacement with a mechanical versus biological prosthesis in patients with heart valvular disease. Heart Fail Rev 2021; 25:495-503. [PMID: 31823104 DOI: 10.1007/s10741-019-09897-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Heart valve disease (HVD) affects 2.5% of the US population and one million individuals aged 65 years and older in the UK. Given its burden, the aim of the present review was to assess the cost-effectiveness of heart valve replacement with mechanical versus biological prosthesis in HVD patients. We performed a systematic search in various electronic databases from January 1990 to June 2019. Five out of 542 articles were entered into the study, from which 2 papers were subsequently excluded not meeting the minimum number of items of the CHEERS checklist. Quality-Adjusted Life Year, Life Years Gained, and the Incremental Cost-Effectiveness Ratio (ICER) regarding the type of replaced heart valve were extracted and reported. Studies were conducted in three different countries (Iran, France, and USA). ICER ranged from $1253 in Iran to €54,634 in France. Survival rate of mitral mechanical versus biological valves at 10 and 20 years was 72.9% versus 76.0% and 51% versus 30%, respectively. Survival rate at 20 years in patients undergoing atrial valve replacement was 20%. Ten- and 20-year death rates for biological valves were higher with respect to mechanical prosthesis (15.5% versus 8.4% at 10 years), with this difference becoming more relevant at 20 years (36.9% versus 13.9%). Due to higher ICER, mortality rate, and lower success rates in the long term for biological prostheses compared to mechanical ones, these appear to be more suitable for older patients (aged ≥ 70 years).
Collapse
|
38
|
2020 update of the Austrian Society of Cardiology (ÖKG) and the Austrian Society of Cardiac Surgery (ÖGHTG) on the position statement of the ÖKG and ÖGHTG for transcatheter aortic valve implantation 2011. Wien Klin Wochenschr 2021; 133:750-761. [PMID: 33755758 DOI: 10.1007/s00508-021-01820-3] [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: 06/06/2020] [Accepted: 01/21/2021] [Indexed: 10/21/2022]
Abstract
This position statement is an update to the 2011 consensus statement of the Austrian Society of Cardiology (ÖKG) and the Austrian Society of Cardiac Surgery (ÖGTHG) for transfemoral transcatheter aortic valve implantation.Due to a number of recently published studies, broadening of indications and recommendations of medical societies and our own national developments, the ÖKG and the ÖGHTG wish to combine the 2017 ESC/EACTS guidelines for the management of valvular heart disease with a national position paper and to focus on certain details for the application in Austria. Thus, this position statement serves as a supplement and further interpretation of the international guidelines.
Collapse
|
39
|
Greason KL. Repeat surgical aortic valve replacement: Don't stick a fork in it just yet. J Thorac Cardiovasc Surg 2021; 163:940-943. [PMID: 33685729 DOI: 10.1016/j.jtcvs.2020.12.147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 11/17/2020] [Accepted: 12/21/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
| |
Collapse
|
40
|
Sotade OT, Falster M, Girardi LN, Pearson SA, Jorm LR. Age-stratified outcomes of bioprosthetic and mechanical aortic valve replacements in an Australian cohort of 13 377 patients. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2020; 2:e000036. [PMID: 35047791 PMCID: PMC8749260 DOI: 10.1136/bmjsit-2020-000036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/26/2020] [Accepted: 08/06/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To quantify age-stratified outcomes of bioprosthetic valve (BV) and mechanical valve (MV) surgical aortic valve replacement (AVR) in Australian patients. DESIGN Retrospective cohort study using population-based linked hospital morbidity and mortality data. SETTING Public and private hospitals. PARTICIPANTS Patients aged 18 years and over undergoing AVR from 2001 to 2013, stratified by age (18-64 years; 65+ years). MAIN OUTCOME MEASURES Age-standardized index AVR rates; rates and multivariable-adjusted (age, sex, Charlson Comorbidity Index) incidence rate ratios (IRRs) for reoperation, incident cardiovascular events (hospitalization or death for acute myocardial infarction (AMI), stroke, major hemorrhage or thromboembolism) and mortality (cardiovascular and all-cause). RESULTS Our cohort comprised 13 377 patients, of whom 3464 (26%) were aged 18-64 years. Annual age-standardized AVR rates increased by 2.7% with BV implants increasing in both age groups. After 5 years of follow-up, patients implanted with BV had lower rates of stroke (IRR: 0.40, 95% CI 0.27 to 0.60) and hemorrhage (IRR: 0.36, 95% CI 0.26 to 0.50). Among patients 65+ years, those implanted with BV had lower rates of AMI, hemorrhage, and cardiovascular and all-cause mortality than those implanted with MV (IRR: 0.71, 95% CI 0.53 to 0.96; IRR: 0.77, 95% CI 0.62 to 0.95; IRR: 0.80, 95% CI 0.69 to 0.92 and IRR: 0.85, 95% CI 0.74 to 0.97, respectively). After 6-10 years of follow-up, reoperation rates among patients 18-64 years were markedly higher in those implanted with BV compared with MV (IRR: 5.48, 95% CI 2.38 to 12.62) and rates of AMI were lower among patients implanted with BV compared with MV (IRR: 0.49, 95% CI 0.26 to 0.94). Among patients 65+ years rates of cardiovascular and all-cause mortality remained significantly lower for patients implanted with BV compared with MV. CONCLUSIONS This study provides real-world evidence of AVR use and outcomes. Use of BV implants is increasing irrespective of age. Valve choice in younger patients requires thorough evaluation of patient factors influencing both short-term outcomes and longer-term risks of reoperation, stroke and hemorrhage.
Collapse
Affiliation(s)
- Oluwadamisola Temilade Sotade
- Centre For Big Data Research in Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| | - Michael Falster
- Centre For Big Data Research in Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| | - Leonard N Girardi
- Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Sallie-Anne Pearson
- Centre For Big Data Research in Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| | - Louisa R Jorm
- Centre For Big Data Research in Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| |
Collapse
|
41
|
Pascual I, Almendárez M, Álvarez Velasco R, Adeba A, Hernández-Vaquero D, Lorca R, Díaz R, Alperi A, Cubero-Gallego H, Rozado J, Morís C, Avanzas P. Long term follow up of percutaneous treatment for degenerated Mitroflow prosthesis with self-expanding transcatheter aortic valve implantation. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:955. [PMID: 32953755 PMCID: PMC7475412 DOI: 10.21037/atm.2020.02.120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background The durability of aortic valve bioprosthesis and the structural valve deterioration (SVD) are could be treated with valve-in-valve (VIV) transcatheter aortic valve implantation (TAVI). This technique has been proven to be a feasible procedure with good results in selected patients. The aim of this work was to assess the long-term results of this TAVI with an autoexpandable valve in patients with failed Mitroflow (MF) bioprosthetic aortic valves. Methods Single center, observational and prospective study that included 65 consecutive patients with symptomatic failed MF bioprosthetic aortic valve, treated with VIV-TAVI. The primary endpoints were clinical long-term events including all-cause mortality, cardiovascular mortality, re-hospitalization due to heart failure, stroke/transient ischemic attack (TIA) and endocarditis. Secondary endpoints were the absence of SVD or patient-prosthesis mismatch (PPM) and valve hemodynamics analysis at follow-up. Results Between March 2012 to July 2019, 65 symptomatic patients (age 80.4±5.9 years) with degenerated MF valves (numbers 19: 27.7%; 21: 38.5%; 23: 21.5%; 25: 12.3%) underwent CoreValve (n=11) or Evolut R (n=54) implantation (23, 26 and 29 mm sizes). The STS predicted risk of mortality was 6.39%±5.62%. The primary combined endpoint occurred in 32.3% of the cases. A total of 13 patients (20%) died during follow-up, but 4 (7.3%) from cardiovascular causes. Two patients were reported of having a stroke/TIA and 5 readmissions for cardiovascular causes were reported (2 of them within the first 30 days). Twenty-five patients (38.5%) presented PPM during follow-up, being PPM severe in 15 (23.1%). Conclusions Self-expanding TAVI for degenerated MF bioprosthesis has favourable long-term outcomes. It is a good option in order to avoid the risks of redo surgery in selected patients.
Collapse
Affiliation(s)
- Isaac Pascual
- Heart Area, Hospital Universitario Central de Asturias, Asturias, Spain.,Functional Biology Department, University of Oviedo, Asturias, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Asturias, Spain
| | - Marcel Almendárez
- Heart Area, Hospital Universitario Central de Asturias, Asturias, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Asturias, Spain
| | - Rut Álvarez Velasco
- Heart Area, Hospital Universitario Central de Asturias, Asturias, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Asturias, Spain
| | - Antonio Adeba
- Heart Area, Hospital Universitario Central de Asturias, Asturias, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Asturias, Spain
| | - Daniel Hernández-Vaquero
- Heart Area, Hospital Universitario Central de Asturias, Asturias, Spain.,Functional Biology Department, University of Oviedo, Asturias, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Asturias, Spain
| | - Rebeca Lorca
- Heart Area, Hospital Universitario Central de Asturias, Asturias, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Asturias, Spain
| | - Rocío Díaz
- Heart Area, Hospital Universitario Central de Asturias, Asturias, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Asturias, Spain
| | - Alberto Alperi
- Heart Area, Hospital Universitario Central de Asturias, Asturias, Spain
| | - Héctor Cubero-Gallego
- Heart Area, Hospital Universitario Central de Asturias, Asturias, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Asturias, Spain
| | - Jose Rozado
- Heart Area, Hospital Universitario Central de Asturias, Asturias, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Asturias, Spain
| | - César Morís
- Heart Area, Hospital Universitario Central de Asturias, Asturias, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Asturias, Spain.,Medicine Department, University of Oviedo, Asturias, Spain
| | - Pablo Avanzas
- Heart Area, Hospital Universitario Central de Asturias, Asturias, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Asturias, Spain.,Medicine Department, University of Oviedo, Asturias, Spain
| |
Collapse
|
42
|
Hernandez-Vaquero D. Structural heart disease: the revolution. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:954. [PMID: 32953754 PMCID: PMC7475406 DOI: 10.21037/atm.2020.01.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Daniel Hernandez-Vaquero
- Department of Cardiac Surgery, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain.,Department of Phisiology, University of Oviedo, Oviedo, Spain
| |
Collapse
|
43
|
Survival After Thoracoscopic Surgery or Open Lobectomy: Systematic Review and Meta-Analysis. Ann Thorac Surg 2020; 111:302-313. [PMID: 32730840 DOI: 10.1016/j.athoracsur.2020.05.144] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/10/2020] [Accepted: 05/18/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Video-assisted thoracoscopic surgery (VATS) has been shown to reduce hospital stays and pain compared with open lobectomy to treat non-small cell lung cancer. Because of the low rate of deaths, it is difficult to show differences in survival in individual studies. The objective of this study was to compare short- and long-term mortality by means of a systematic review and meta-analysis. METHODS The reviewers systematically searched studies that compared VATS vs open lobectomy and provided data on 30-day mortality or long-term survival (>5 years). For long-term outcomes, studies included patients with the same cancer stage or, if several stages were included, the studies had to control for cancer stage in their propensity score model. A pooled odds ratio and hazard ratio (HR) was respectively calculated for short- and long-term outcomes. RESULTS A total of 33 works were identified, comprising 61,633 patients. VATS led to lower postoperative mortality (odds ratio, 0.64; 95% confidence interval [CI], 0.56 to 0.73) and higher long-term survival (HR, .88; 95% CI, 0.81 to 0.96). Disease-free survival was similar in both groups (HR, 0.94; 95% CI, 0.80 to 1.10). CONCLUSIONS For non-small cell lung cancer treated with lobectomy, VATS was associated with lower postoperative mortality and greater long-term survival compared with open lobectomy. Disease-free survival was similar between both groups.
Collapse
|
44
|
Flynn CD, Curran NP, Chan S, Zegri-Reiriz I, Tauron M, Tian DH, Pettersson GB, Coselli JS, Misfeld M, Antunes MJ, Mestres CA, Quintana E. Systematic review and meta-analysis of surgical outcomes comparing mechanical valve replacement and bioprosthetic valve replacement in infective endocarditis. Ann Cardiothorac Surg 2019; 8:587-599. [PMID: 31832349 DOI: 10.21037/acs.2019.10.03] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background Infective endocarditis (IE) is an infection involving either native or prosthetic heart valves, the endocardial surface of the heart or any implanted intracardiac devices. IE is a rare condition affecting 3-15 patients per 100,000 population. In-hospital mortality rates in patients with IE remain high at around 20% despite treatment advances. There is no consensus recommendation favoring either bioprosthetic valve or mechanical valve implantation in the setting of IE; patient age, co-morbidities and preferences should be considered selecting the replacement prosthesis. Methods A systematic review and meta-analysis of studies reporting the outcomes of patients undergoing bioprosthetic or mechanical valve replacement for infective endocarditis with data extracted for overall survival, valve reinfection rates and valve reoperation. Results Eleven relevant studies were identified, with 2,336 patients receiving a mechanical valve replacement and 2,057 patients receiving a bioprosthetic valve replacement. There was no significant difference for overall survival between patients treated with mechanical valves and those treated with bioprosthetic valves [hazard ratio (HR) 0.94, 95% confidence interval (CI): 0.73-1.21, P=0.62]. There was no significant difference in reoperation rates between patients treated with a bioprosthetic valve and those treated with a mechanical valve (HR 0.82, 95% CI: 0.34-1.98, P=0.66) and there was no significant difference in the rate of valve reinfection rates (HR 0.95, 95% CI: 0.48-1.89, P=0.89). Conclusions The presence of infective endocarditis alone should not influence the decision of which type of valve prosthesis that should be implanted. This decision should be based on patient age, co-morbidities and preferences.
Collapse
Affiliation(s)
- Campbell D Flynn
- Department of Cardiothoracic Surgery, St George Hospital, Sydney, Australia
| | - Neil P Curran
- Department of Cardiothoracic Surgery, St George Hospital, Sydney, Australia
| | - Stephanie Chan
- Department of Cardiothoracic Surgery, St George Hospital, Sydney, Australia
| | - Isabel Zegri-Reiriz
- Heart Failure and Heart Transplant Unit, Cardiology Department, Hospital de la Santa Creu i Santa Pau, Barcelona, Spain
| | - Manel Tauron
- Cardiac Surgery Department, Hospital de la Santa Creu i Santa Pau, Barcelona, Spain
| | - David H Tian
- Collaborative Research Group, Macquarie University, Sydney, Australia
| | - Gosta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, TX, USA.,Texas Heart Institute, Houston, TX, USA
| | - Martin Misfeld
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Manuel J Antunes
- Clinic of Cardiothoracic Surgery, University of Coimbra Medical School, Coimbra, Portugal
| | - Carlos A Mestres
- Department of Cardiac Surgery, University Hospital Zürich, Zürich, Switzerland.,Department of Cardiothoracic Surgery, The University of the Free State, Bloemfontein, South Africa
| | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clinic, University of Barcelona, Barcelona, Spain
| |
Collapse
|
45
|
Kurlansky P. Commentary: The future of heart valve surgery: Transcutaneous aortic valve replacement and beyond. J Thorac Cardiovasc Surg 2019; 159:428-429. [PMID: 31630838 DOI: 10.1016/j.jtcvs.2019.06.129] [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: 05/31/2019] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Paul Kurlansky
- Division of Cardiac Surgery, Columbia University, New York, NY.
| |
Collapse
|
46
|
Chikwe J, Weiss A. Commentary: The mid-life crisis of the meta-analysis. J Thorac Cardiovasc Surg 2019; 158:716-717. [PMID: 31280893 DOI: 10.1016/j.jtcvs.2018.11.045] [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: 11/13/2018] [Accepted: 11/14/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Joanna Chikwe
- Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York, NY; Department of Surgery, The State University of New York, Stony Brook, NY.
| | - Aaron Weiss
- Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York, NY
| |
Collapse
|
47
|
Glower DD. Commentary: Biologic versus mechanical valves: Wandering in the dark. J Thorac Cardiovasc Surg 2018; 158:715. [PMID: 30459104 DOI: 10.1016/j.jtcvs.2018.10.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 10/18/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Donald D Glower
- Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
| |
Collapse
|