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Sazzad F, Tan YK, Chan LXB, Moideen ISBM, Gohary AE, Stevens JC, Ramanathan KR, Kofidis T. Systematic review of first-in-human and early phase clinical trials for surgically implantable biological mitral valve substitutes. J Cardiothorac Surg 2023; 18:348. [PMID: 38037117 PMCID: PMC10688009 DOI: 10.1186/s13019-023-02464-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/21/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND The aim of this review was the creation of uniform protocols to carry out and disclose First-In-Human and preliminary clinical trials of biological mitral valve replacement. The need for consistent methodology in these early trials was highlighted by the observation of significant variability in the methods and protocols used across different research. METHODS An extensive search through six major databases was carried out to retrieve First-In-Human (FIH) clinical studies evaluating surgically implanted bio-prostheses in the mitral position. RESULTS Following the PRISMA guideline, a systematic search identified 2082 published articles until March 2023. After removing duplicates (189), 1862 citations were screened, resulting in 22 eligible studies with 3332 patients for analysis. The mitral valve prostheses in these studies ranged from 21 to 37 mm, with the 29 mm size being most prevalent. Patient numbers varied, with the FIH subgroup including 31 patients and the older subgroup including 163 patients. Average study durations differed: the older subgroup lasted 4.57 years, the FIH subgroup 2.85 years, and the early phase studies spanned 8.05 years on average. CONCLUSION FIH clinical report is essential to assess the significance of clinical data required for a "de novo" surgical implant. In addition, understanding the performance of the device, and recognizing the difficulties associated with the innovation constitute important lessons. These insights could be beneficial for the development of bioprosthetic heart valves and formulating a protocol for an FIH clinical trial.
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Affiliation(s)
- Faizus Sazzad
- Department of Surgery, Yong Loo Lin School of Medicine, Centre for Translational Medicine, National University of Singapore, MD6, 14 Medical Drive, Level-8 (South), Singapore, 117599, Singapore.
| | - Ying Kiat Tan
- Department of Surgery, Yong Loo Lin School of Medicine, Centre for Translational Medicine, National University of Singapore, MD6, 14 Medical Drive, Level-8 (South), Singapore, 117599, Singapore
| | - Li Xuan Beverly Chan
- Department of Surgery, Yong Loo Lin School of Medicine, Centre for Translational Medicine, National University of Singapore, MD6, 14 Medical Drive, Level-8 (South), Singapore, 117599, Singapore
| | - Irwan Shah Bin Mohd Moideen
- Department of Surgery, Yong Loo Lin School of Medicine, Centre for Translational Medicine, National University of Singapore, MD6, 14 Medical Drive, Level-8 (South), Singapore, 117599, Singapore
| | - Abdulrahman El Gohary
- Department of Surgery, Yong Loo Lin School of Medicine, Centre for Translational Medicine, National University of Singapore, MD6, 14 Medical Drive, Level-8 (South), Singapore, 117599, Singapore
| | - John C Stevens
- Department of Surgery, Yong Loo Lin School of Medicine, Centre for Translational Medicine, National University of Singapore, MD6, 14 Medical Drive, Level-8 (South), Singapore, 117599, Singapore
| | - K R Ramanathan
- Department of Surgery, Yong Loo Lin School of Medicine, Centre for Translational Medicine, National University of Singapore, MD6, 14 Medical Drive, Level-8 (South), Singapore, 117599, Singapore
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, National University Hospital, Singapore, Singapore
| | - Theo Kofidis
- Department of Surgery, Yong Loo Lin School of Medicine, Centre for Translational Medicine, National University of Singapore, MD6, 14 Medical Drive, Level-8 (South), Singapore, 117599, Singapore
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, National University Hospital, Singapore, Singapore
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Hsiung MC, Yin WH, Lee YT, Tsao TP, Lee KC, Huang KC, Chen PE, Chiang WH, Tung TH, Wei J. Effects of Transapical Transcatheter Mitral Valve Implantation. Front Cardiovasc Med 2021; 8:633369. [PMID: 34179124 PMCID: PMC8225931 DOI: 10.3389/fcvm.2021.633369] [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: 11/25/2020] [Accepted: 04/28/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose: In this study, transapical transcatheter mitral valve-in-valve implantation (TAMVI) was compared with surgical redo mitral valve replacement (SRMVR) in terms of clinical outcomes. Methods: We retrospectively identified patients with degenerated mitral bioprosthesis or failed annuloplasty rings who underwent redo SRMVR or TAMVI at our medical center. Clinical outcomes were based on echocardiography results. Results: We retrospectively identified patients with symptomatic mitral bioprosthetic valve dysfunction (n = 58) and failed annuloplasty rings (n = 14) who underwent redo SRMVR (n = 36) or TAMVI (n = 36). The Society of Thoracic Surgeons Predicted Risk of Mortality scores were higher in the TAMVI group (median: 9.52) than in the SRMVR group (median: 5.59) (p-value = 0.02). TAMVI patients were more severe in New York Heart Association (p-value = 0.04). The total procedure time (skin to skin) and length of stay after procedures were significantly shorter in the TAMVI group, and no significant difference in mortality was noted after adjustment for confounding factors (p-value = 0.11). The overall mean mitral valve pressure gradient was lower in the TAMVI group than in the SRMVR group at 24 months (p < 0.01). Both groups presented a decrease in the severity of mitral and tricuspid regurgitation at 3–24 months. Conclusions: In conclusion, the statistical analysis is still not robust enough to make a claim that TAMVI is an appropriate alternative. The outcome of the patient appears only to be related to the patient's pre-operative STS score. Additional multi-center, longitudinal studies are warranted to adequately assess the effect of TAMVI.
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Affiliation(s)
| | - Wei-Hsian Yin
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Yung-Tsai Lee
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan.,School of Medicine, Institute of Microbiology and Immunology, National Yang Ming University, Taipei, Taiwan
| | - Tien-Ping Tsao
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Kuo-Chen Lee
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Defense Medical Center, Taipei, Taiwan
| | | | - Pei-En Chen
- Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan.,Taiwan Association of Health Industry Management and Development, Taipei, Taiwan
| | | | - Tao-Hsin Tung
- Department of Medical Research and Education, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Jeng Wei
- Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Defense Medical Center, Taipei, Taiwan
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Kono T, Takagi K, Saku K, Kikusaki S, Zaima Y, Shojima T, Takaseya T, Arinaga K, Tayama E. Evaluation of hemodynamics after mitral valve replacement with the St Jude Medical Epic bioprosthesis: a Japanese single-center experience. J Artif Organs 2021; 24:458-464. [PMID: 33770272 DOI: 10.1007/s10047-021-01262-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/17/2021] [Indexed: 11/28/2022]
Abstract
To assess the early hemodynamics after mitral valve replacement (MVR) using the St Jude Medical (SJM) Epic bioprosthesis. MVR was performed using the SJM Epic bioprosthesis in 35 patients from June 2018 to April 2020; three patients were excluded because the postoperative transthoracic echocardiography (TTE) data were unavailable. Data from postoperative TTE at 1 week and 3 months after the procedure were reviewed. The mean mitral pressure gradient (mMPG) was calculated using a continuous wave Doppler method. Left ventricular outflow tract (LVOT) was calculated using a pulse wave Doppler method. The effective orifice area (EOA) was measured from pressure half time. There were 12 men (37.5%) and 20 women (62.5%) with a mean age of 75.9 years (61-88 years). The mean body surface area was 1.51 ± 0.22 cm2. The 25 mm and 27 mm valves were used in more than 50% of cases. The mMPG was 4.9 ± 1.7 mmHg and 5.4 ± 1.6 mmHg at 1 week and 3 months after surgery, respectively. EOA was 2.18 ± 0.50 cm2 and 2.31 ± 0.59 cm2 at 1 week and 3 months after surgery, respectively. The peak velocity of the LVOT (n = 22) was 103.3 ± 21.3 cm/s and 106.8 ± 27.4 cm/s at 1 week and 3 months after surgery, respectively. No findings suggested paravalvular regurgitation and LVOT obstruction. Using the SJM Epic bioprosthesis in MVR resulted in satisfactory hemodynamics in the early postoperative period, even with small valve sizes. Further accumulation of cases and evidence, including mid- to long-term results, is required in the future.
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Affiliation(s)
- Takanori Kono
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
| | - Kazuyoshi Takagi
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
| | - Kosuke Saku
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Satoshi Kikusaki
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Yasuyuki Zaima
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Takahiro Shojima
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Tohru Takaseya
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Koichi Arinaga
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Eiki Tayama
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
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Hiremath CS, Jain AR, Garg A, Gupta N, Mishra YK, Meharwal ZS, Thakur N, Maslekar AA, Shastri N. Clinical outcomes and hemodynamic performance of Dafodil™ aortic and mitral pericardial bioprosthesis: 1-year results from Dafodil-1 first-in-human trial. J Cardiothorac Surg 2020; 15:140. [PMID: 32539847 PMCID: PMC7294644 DOI: 10.1186/s13019-020-01154-7] [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: 03/12/2020] [Accepted: 05/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bioprosthesis has been increasingly implanted for the treatment of transvalvular disease across the world. A new Dafodil™ pericardial bioprosthesis (Meril Life Sciences Pvt. Ltd., India) recently approved by Conformité Européenne (CE) is a tri-leaflet, stented, bovine valve. The purpose of Dafodil-1 first-in-human trial was to evaluate clinical safety and performance (including hemodynamic parameters) of the Dafodil pericardial bioprosthesis in patients who underwent aortic or mitral valve replacement. METHODS This prospective, multicenter clinical trial enrolled 60 patients (Aortic: 30 patients; Mitral: 30 patients) from seven sites across India. Safety endpoints were early (≤30 days) and late (> 30 days) mortality and valve-related morbidity. The performance endpoints were hemodynamic performance, improvement in NYHA functional class, and change in the quality of life using SF-12v1 health survey. RESULTS From July 2017 to July 2018, 60 patients underwent implantation of the Dafodil pericardial bioprosthesis. Post-operatively, NYHA functional class significantly improved in all the patients (Aortic: 90% NYHA class-I and 10% NYHA class-II; Mitral: 96.55% NYHA class-I and 3.45% NYHA class-II; P < 0.001). There was no death in aortic valve replacement patients till 12-month. In mitral valve replacement patients, early mortalities occurred in three patients, and late mortality occurred in one patient; none of these were valve-related. Freedom from all-cause mortality reported was 93.33% at 12-month. Mean aortic pressure gradient decreased from 52.71 ± 24.47 mmHg [with 0.89 ± 0.70 cm2 effective orifice area (EOA)] pre-operatively to 14.49 ± 6.58 mmHg (EOA: 1.85 ± 0.27 cm2) at 12-month. Overall, the mitral mean pressure gradient and EOA were 4.41 ± 1.69 mmHg and 2.67 ± 0.48 cm2, respectively, at 12-month. Significant improvement (P < 0.05) in the patients' quality of life was reported at all follow-ups. CONCLUSIONS The clinical safety and performance of the Dafodil pericardial bioprosthesis were favourable at 12-month. Moreover, a study with a larger patient population and longer follow-up is warranted to further assess the device. TRIAL REGISTRATION Dafodil-1 trial has been prospectively registered on 10/07/2017 under Clinical Trial Registry-India (http://www.ctri.nic.in). (Registration number: CTRI/2017/07/009008).
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Affiliation(s)
- C S Hiremath
- Department of Cardiothoracic Vascular Surgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bengaluru, Karnataka, 560066, India
| | - Anil R Jain
- Department of Cardiovascular and Thoracic Surgery, Epic Hospital, Sola, Ahmedabad, Gujarat, 380081, India
| | - Anurag Garg
- Department of Cardiovascular and Thoracic Surgery, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pimpri, Pune, Maharashtra, 411018, India
| | - Nirmal Gupta
- Department of Cardiovascular and Thoracic Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226014, India
| | - Yugal K Mishra
- Department of Cardiac Science, Manipal Hospital, Dwarka, New Delhi, 110075, India
| | - Zile Singh Meharwal
- Department of Cardiovascular Surgery, Fortis Escorts Heart Institute & Research Centre, Okhla Road, New Delhi, 110025, India
| | - Nityanand Thakur
- Department of Cardiovascular and Thoracic Surgery, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Jay Prakash Narayan road, Pune, Maharashtra, 411001, India
| | - Atul A Maslekar
- Department of Cardiac Surgery - Adult, Narayana Multispeciality Hospital, Rakhial, Ahmedabad, Gujarat, 380023, India
| | - Naman Shastri
- Department of Anaesthesia and Intensive Care, Epic Hospital, Sola, Sarkhej - Gandhinagar Highway, Opp. Kargil Petrol Pump, Ahmedabad, Gujarat, 380081, India.
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Firstenberg M, Bouchard T, Subichin M. Fifty years of cardiac surgery: Innovation, evolution, and revolution in cardiovascular therapies. INTERNATIONAL JOURNAL OF ACADEMIC MEDICINE 2019. [DOI: 10.4103/ijam.ijam_49_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Patient-Prosthesis Mismatch After Mitral Valve Replacement: A Propensity Score Analysis. Ann Thorac Surg 2016; 101:1796-802. [DOI: 10.1016/j.athoracsur.2015.10.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 10/04/2015] [Accepted: 10/12/2015] [Indexed: 11/21/2022]
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Loor G, Schuster A, Cruz V, Rafael A, Stewart WJ, Diaz J, McCurry K. The Carpentier-Edwards Perimount Magna mitral valve bioprosthesis: intermediate-term efficacy and durability. J Cardiothorac Surg 2016; 11:20. [PMID: 26818795 PMCID: PMC4728780 DOI: 10.1186/s13019-016-0412-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 01/12/2016] [Indexed: 11/17/2022] Open
Abstract
Background The Carpentier-Edwards Perimount Magna mitral valve bioprosthesis (Edwards Lifesciences, Irvine, CA) is a low-profile version of the earlier Perimount valve that uses the ThermaFix process for enhanced calcium removal. The Magna valve has been in use since 2008, yet no publication, until now, has verified its intermediate-term safety and efficacy. Methods From 2008 through 2011 (our 4-year study period), 70 Magna valves were implanted in the mitral position at a single institution (the Cleveland Clinic). Echocardiograms were prospectively interpreted. For this study, we reviewed patients’ charts; endpoints included hemodynamic measurements, in-hospital morbidity and mortality, valve-related events, resource utilization, and 5-year survival rates. Results The mean patient age was 68 years; 43 % of the patients had New York Heart Association (NYHA) class III or IV disease, and 51.4 % had moderately severe, or worse, mitral regurgitation (MR). For 43 % of the patients, the Magna valve implantation was a reoperation. For 83 %, the Magna valve implantation also included a concomitant cardiac procedure. The median survival rate was 4.7 years and 90 % of patients were free from significant structural valve degeneration at 5 years. Preoperative atrial fibrillation, ischemic MR, intraaortic balloon pump placement, cardiogenic shock, cardiac arrest, and renal failure were associated with increased mortality. Right ventricular systolic pressure decreased from 50 mmHg preoperatively to 40 mmHg postoperatively, according to our matched-pair analysis (P = 0.003). Per their final echocardiogram during our study period, 98 % of surviving patients had trivial or no MR, one patient had mild MR, and one patient had severe MR. Conclusions Our 5-year experience indicates that the Magna valve offers excellent intermediate-term durability and substantial echocardiographic improvement; its low-profile design make it ideal for reoperations and for concomitant cardiac procedures, including valve replacement.
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Affiliation(s)
- Gabriel Loor
- Department of Cardiothoracic Surgery, University of Minnesota, 420 Delaware Street SE, MMC 207, Minneapolis, MN, 55455, USA.
| | | | - Vincent Cruz
- Lerner College of Medicine, Cleveland Clinic, Cleveland, USA
| | - Aldo Rafael
- Department of Cardiac Surgery, Baylor University Medical Center, Dallas, USA
| | | | - James Diaz
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, USA
| | - Kenneth McCurry
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, USA
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Blauwet LA, Malouf JF, Connolly HM, Hodge DO, Evans KN, Herges RM, Sundt TM, Miller FA. Comprehensive Echocardiographic Assessment of Normal Mitral Medtronic Hancock II, Medtronic Mosaic, and Carpentier-Edwards Perimount Bioprostheses Early after Implantation. J Am Soc Echocardiogr 2010; 23:656-66. [DOI: 10.1016/j.echo.2010.03.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Indexed: 11/26/2022]
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Totaro P, Argano V. Reply to the Editor. J Thorac Cardiovasc Surg 2008. [DOI: 10.1016/j.jtcvs.2007.10.028] [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: 11/26/2022]
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10
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Totaro P, Argano V. Patient–prosthesis mismatch after mitral valve replacement: Myth or reality? J Thorac Cardiovasc Surg 2007; 134:697-701. [PMID: 17723820 DOI: 10.1016/j.jtcvs.2007.04.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2007] [Revised: 03/19/2007] [Accepted: 04/11/2007] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Determining the risk of patient-prosthesis mismatch after mitral valve replacement is still controversial. In this study, we aimed to clarify incidence and clinical implications of such a complication. The accuracy of preoperative prediction of patient-prosthesis mismatch using published in vitro hemodynamic parameters was also investigated. METHODS Ninety-two patients who underwent mitral valve replacement and received Carpentier-Edwards stented bioprosthesis (Edwards Lifesciences, LLC, Irvine Calif) were enrolled. Hemodynamic performances were evaluated at discharge, and the incidence of in vivo patient-prosthesis mismatch (indexed effective orifice area < or =1.2 cm2/m2) was evaluated. Correlation between in vivo patient-prosthesis mismatch and predicted patient-prosthesis mismatch, based on previously published in vitro hemodynamic parameters, was also investigated. RESULTS Five patients died within 30 days of the operation (5.4% mortality). Mean prosthesis size was 29.8 +/- 2. Mean postoperative effective orifice area and indexed effective orifice area (2.5 +/- 0.8 cm2 and 1.5 +/- 0.4 cm2/m2, respectively) compared favorably with those predicted in vitro (2.2 +/- 0.7 cm2 and 1.3 +/- 0.5 cm2/m2, respectively). In the subgroup of patients receiving prosthesis size of 27 or smaller, the difference reached statistical significance (2.47 +/- 0.83 and 1.61 +/- 0.7 for postoperative and predicted effective orifice areas, respectively; P < .001). Postoperative patient-prosthesis mismatch was recorded in 8 patients (8.6%), comparing favorably with the predicted patient-prosthesis mismatch (39% for overall population and 80% for patients receiving prosthesis size < or = 27). No significant correlation between size of prosthesis and early hemodynamic and clinical outcomes was shown. CONCLUSIONS In our study, stented mitral bioprostheses showed satisfactory postoperative hemodynamic performance, even in smaller prosthesis sizes (< or =27 mm). Risk of in vivo postoperative patient-prosthesis mismatch seems to be less relevant than preoperative risk prediction based on in vitro data. Further studies are needed to evaluate the potential clinical impact of mitral patient-prosthesis mismatch.
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Finegan BA. Access denied; care impaired: the benefits of having online medical information available at the point-of-care. Anesth Analg 2004; 99:1450-1452. [PMID: 15502047 DOI: 10.1213/01.ane.0000132545.19806.3b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The availability of Internet-enabled computers in the operating room (OR) facilitates unparalleled physician access to current peer reviewed research, either in abstract or full text format, a development that provides physicians with an exciting opportunity to incorporate such findings into clinical practice at the point-of-care. In this report I describe how the availability of online peer reviewed medical literature altered, in one case a planned surgical procedure and, in the other, the interpretation by the anesthesiologist of the clinical significance of an intraoperative echocardiographic finding. In case one, a free, rather than an intact, internal mammary (IM) artery graft was placed to the left anterior descending coronary artery of a patient with renal failure and an ipsilateral upper extremity arteriovenous fistula. The change occurred after the full text results of a study indicating that steal could well occur during the initiation of dialysis if an intact IM was used were made available to the surgeon. In case two, the occurrence of mild central mitral regurgitation in a Carpentier-Edwards Perimount prosthetic mitral valve was confirmed to be a benign finding after a study detailing the long term performance characteristics of this valve was accessed online in the OR. The benefits and potential pitfalls of searching and interpreting online medical information are discussed.
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Affiliation(s)
- Barry A Finegan
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada
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Goetze S, Brechtken J, Agler DA, Thomas JD, Sabik JF, Jaber WA. In vivo short-term doppler hemodynamic profiles of 189 carpentier-edwards perimount pericardial bioprosthetic valves in the mitral position. J Am Soc Echocardiogr 2004; 17:981-7. [PMID: 15337964 DOI: 10.1016/j.echo.2004.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We sought to determine the hemodynamic performance of the Carpentier-Edwards Perimount pericardial valve in the mitral position. We reviewed the Doppler echocardiographic data on 189 patients (110 women; 68 +/- 12 years of age) who were implanted with this valve (7.6 days +/- 13 postoperatively) at our institution between September 2000 and May 2002. The average ejection fraction was 47%. For all valves, the peak velocity was 1.9 +/- 0.3 m/s, peak gradient was 15 +/- 4.8 mm Hg, and mean gradient was 5.8 +/- 2 mm Hg. The pressure half-time was 93 +/- 24 milliseconds, with a calculated effective orifice area of 2.5 +/- 0.6 cm2. The average effective orifice area by continuity equation (83 valves) was 1.5 +/- 0.5 cm2. The mitral regurgitation was graded mild or less in 97.5% of all valves. This is the largest series establishing the favorable hemodynamic behavior of the different sizes of a new Perimount mitral valve, and the reported data could serve as a reference.
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