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Kreibich M, Kaier K, von Zur Mühlen C, Siepe M, Zehender M, Bode C, Beyersdorf F, Stachon P, Bothe W. In-hospital outcomes of patients undergoing concomitant aortic and mitral valve replacement in Germany. Interact Cardiovasc Thorac Surg 2021; 34:349-353. [PMID: 34907441 PMCID: PMC8860409 DOI: 10.1093/icvts/ivab352] [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: 05/17/2021] [Revised: 10/26/2021] [Accepted: 11/20/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To evaluate in-hospital outcomes of concomitant mitral valve replacement (MVR) in patients undergoing conventional aortic valve replacement due to aortic stenosis in a nationwide cohort. METHODS Administrative data from all patients with aortic stenosis undergoing conventional aortic and concomitant MVR (reason for MVR not specified) between 2017 and 2018 in Germany were analysed. RESULTS A total of 2597 patients with a preoperative logistic EuroScore of 9.81 (standard deviation: 8.56) were identified. In-hospital mortality was 6.8%. An in-hospital stroke occurred in 3.4%, acute kidney injury in 16.3%, prolonged mechanical ventilation of more than 48 h in 16.3%, postoperative delirium in 15.8% and postoperative pacemaker implantation in 7.6% of the patients. Mean hospital stay was 16.5 (standard deviation: 12.1) days. Age [odds ratio (OR): 1.03; P = 0.019], New York Heart Association class III or IV (OR: 1.63; P = 0.012), previous cardiac surgery (OR: 2.85, P = 0.002), peripheral vascular disease (OR: 2.01, P = 0.031), pulmonary hypertension (OR: 1.63, P = 0.042) and impaired renal function (glomerular filtration rate <15, OR: 3.58, P = 0.001; glomerular filtration rate <30, OR: 2.51, P = 0.037) were identified as independent predictors for in-hospital mortality. CONCLUSIONS In this nationwide analysis, concomitant aortic and MVR was associated with acceptable in-hospital mortality, morbidity and length of in-hospital stay. The regression analyses may help to identify high-risk patients and further optimize treatment strategies.
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Affiliation(s)
- Maximilian Kreibich
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Klaus Kaier
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Constantin von Zur Mühlen
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Departments of Cardiology and Angiology I, University Heart Center Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Faculty of Medicine, Center of Big Data Analysis in Cardiology (CeBAC), Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
| | - Matthias Siepe
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Manfred Zehender
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Departments of Cardiology and Angiology I, University Heart Center Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Faculty of Medicine, Center of Big Data Analysis in Cardiology (CeBAC), Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
| | - Christoph Bode
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Departments of Cardiology and Angiology I, University Heart Center Freiburg, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Stachon
- Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Departments of Cardiology and Angiology I, University Heart Center Freiburg, Freiburg, Germany.,Department of Cardiology and Angiology I, Faculty of Medicine, Center of Big Data Analysis in Cardiology (CeBAC), Heart Center Freiburg University, University of Freiburg, Freiburg, Germany
| | - Wolfgang Bothe
- Department of Cardiovascular Surgery, University Heart Center Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Howard C, Ponnapalli A, Shaikh S, Idhrees M, Bashir M. Non-A non-B aortic dissection: A literature review. J Card Surg 2021; 36:1806-1813. [PMID: 33547714 DOI: 10.1111/jocs.15349] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 01/09/2021] [Indexed: 01/16/2023]
Abstract
Non-A non-B aortic dissections are an infrequent occurrence and represent a small proportion of aortic dissections. Treating this life-threatening medical emergency often requires surgeons to undertake some one of the most challenging surgical or endovascular cases in medicine. This literature review aims to define and classify non-A non-B dissections, describe their epidemiology as well as their pathology. This review also aims to discuss the range of surgical techniques employed in their treatment and management and to investigate the patient outcomes associated with each technique.
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Affiliation(s)
- Callum Howard
- Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, UK
| | - Anuradha Ponnapalli
- Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, UK
| | - Safwan Shaikh
- Dentistry and Biomedical Sciences, Queen's University Belfast School of Medicine, Queen's University Belfast, Belfast, UK
| | - Mohammed Idhrees
- Institute of Cardiac and Aortic Disorders, SRM Institutes for Medical Science (SIMS Hospital), Chennai, Tamil Nadu, India
| | - Mohammad Bashir
- Department of Vascular and Endovascular Surgery, Royal Blackburn Teaching Hospital, Blackburn, UK
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Roselli EE, Svensson LG. Commentary: When balancing risks of thoracic endovascular aortic repair, renal dysfunction weighs heavily. J Thorac Cardiovasc Surg 2019; 159:414-415. [PMID: 30929986 DOI: 10.1016/j.jtcvs.2019.02.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 02/12/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Eric E Roselli
- Department of Thoracic and Cardiovascular Surgery, Aorta Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Aorta Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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