1
|
Baudo M, Sicouri S, Yamashita Y, Ridwan K, Kadri A, Goldman SM, Rodriguez R, Gnall EM, Coady PM, Reardon MJ, Gada H, Gray WA, Ramlawi B. Improved Hemodynamics With Self-Expanding Compared to Balloon-Expandable Transcatheter Aortic Valve Implantation in Small Annulus Patients: A Propensity-Matched Analysis. Am J Cardiol 2024; 221:9-18. [PMID: 38636627 DOI: 10.1016/j.amjcard.2024.03.042] [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: 02/05/2024] [Revised: 02/28/2024] [Accepted: 03/30/2024] [Indexed: 04/20/2024]
Abstract
Patients with small aortic annuli (SAA) pose a challenge in patients undergoing aortic valve replacement because of the potential for prosthesis-patient mismatch (PPM). This study aimed to compare the clinical and hemodynamic outcomes of self-expandable valve (SEV) versus balloon-expandable valve (BEV) transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis and SAA. All patients who underwent TAVI for severe native aortic stenosis with a SAA between January 2018 and December 2022 were retrospectively included in the study from a single center. Propensity score matching was performed to balance the baseline characteristics. Bioprosthesis valve dysfunction was based on modified Valve Academic Research Consortium 3 criteria. A total of 1,170 TAVI procedures were performed between 2018 and 2022. After applying the exclusion criteria, 332 patients reported a SAA at computed tomography scan, and the matching created 109 balanced pairs. Echocardiographic data at discharge showed higher mean transvalvular gradients (p <0.001), higher grades of mitral regurgitation (p = 0.029), and lower ejection fraction (p <0.043) in BEVs than SEVs. At follow-up, significant differences favoring the SEV group regarding bioprosthesis valve dysfunction were observed (p = 0.002), especially in terms of severe PPM (p = 0.046) and at least moderate structural valve deterioration (p = 0.040). In conclusion, TAVI in patients with SAA using a BEV was associated with lower valve areas, higher mean pressure gradients, and PPM (including severe) than a SEV. Short- and midterm all-cause and cardiac-related mortality did not differ between the 2 groups. Future randomized studies with extended follow-ups are warranted to validate these outcomes.
Collapse
Affiliation(s)
- Massimo Baudo
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania; Department of Cardiac Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania.
| | - Serge Sicouri
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania
| | - Yoshiyuki Yamashita
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania; Department of Cardiac Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania
| | - Khalid Ridwan
- Department of Cardiac Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania
| | - Amer Kadri
- Department of Interventional Cardiology, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania
| | - Scott M Goldman
- Department of Cardiac Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania
| | - Roberto Rodriguez
- Department of Cardiac Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania
| | - Eric M Gnall
- Department of Interventional Cardiology, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania
| | - Paul M Coady
- Department of Interventional Cardiology, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania
| | - Michael J Reardon
- Department of Cardiovascular Surgery, Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Hemal Gada
- Structural Heart Program, University of Pittsburgh Medical Center Pinnacle Health, Harrisburg, Pennsylvania
| | - William A Gray
- Department of Interventional Cardiology, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania
| | - Basel Ramlawi
- Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, Pennsylvania; Department of Cardiac Surgery, Lankenau Heart Institute, Main Line Health, Wynnewood, Pennsylvania
| |
Collapse
|
2
|
Thourani VH, Abbas AE, Ternacle J, Hahn RT, Makkar R, Kodali SK, George I, Kapadia S, Svensson LG, Szeto WY, Herrmann HC, Ailawadi G, Leipsic J, Blanke P, Webb J, Jaber WA, Russo M, Malaisrie SC, Yadav P, Clavel MA, Khalique OK, Weissman NJ, Douglas P, Bax J, Dahou A, Xu K, Bapat V, Alu MC, Leon MB, Mack MJ, Pibarot P. Patient-Prosthesis Mismatch After Surgical Aortic Valve Replacement: Analysis of the PARTNER Trials. Ann Thorac Surg 2024; 117:1164-1171. [PMID: 38316377 DOI: 10.1016/j.athoracsur.2024.01.023] [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: 02/10/2022] [Revised: 01/07/2024] [Accepted: 01/10/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Our objective was to compare the impact of patient-prosthesis mismatch (PPM) for 2 years after surgical aortic valve replacement within the prospective, randomized Placement of Aortic Transcatheter Valves (PARTNER) trials. METHODS Surgical aortic valve replacement patients from the PARTNER 1, 2, and 3 trials were included. PPM was classified as moderate (indexed effective orifice area ≤0.85 cm2/m2) or severe (indexed effective orifice area ≤0.65 cm2/m2). The primary endpoint was the composite of all-cause death and heart failure rehospitalization at 2 years. RESULTS By the predicted PPM method (PPMP), 59.1% had no PPM, 38.8% moderate PPM, and 2.1% severe PPM; whereas by the measured PPM method (PPMM), 42.4% had no PPM, 36.0% moderate, and 21.6% severe. Patients with no PPMP (23.6%) had a lower rate of the primary endpoint compared with patients with moderate (28.2%, P = .03) or severe PPMP (38.8%, P = .02). Using the PPMM method, there was no difference between the no (17.7%) and moderate PPMM groups (21.1%) in the primary outcome (P = .16). However, those with no PPMM or moderate PPMM were improved compared with severe PPMM (27.4%, P < .001 and P = .02, respectively). CONCLUSIONS Severe PPM analyzed by PPMP was only 2.1% for surgical aortic valve replacement patients. The PPMM method overestimated the incidence of severe PPM relative to PPMP, but was also associated with worse outcome. There was higher all-cause mortality in patients with severe PPM, thus surgical techniques to minimize PPM remain critical.
Collapse
Affiliation(s)
- Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia.
| | - Amr E Abbas
- Department of Cardiology, Beaumont Hospital, Detroit, Michigan
| | - Julien Ternacle
- Department of Cardiology, Haut-Leveque Cardiology Hospital, Bordeaux University, Pessac, France; Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec, Canada
| | - Rebecca T Hahn
- Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York; Cardiovascular Research Foundation, New York, New York
| | - Raj Makkar
- Department of Cardiology, Cedars Sinai Medical Center, Los Angeles, California
| | - Susheel K Kodali
- Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York
| | - Isaac George
- Division of Cardiac Surgery, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York
| | - Samir Kapadia
- Department of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Lars G Svensson
- Department of Cardiac Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Wilson Y Szeto
- Division of Cardiac Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Howard C Herrmann
- Division of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Jonathon Leipsic
- Department of Cardiology, University of British Columbia, Vancouver, Canada
| | - Philipp Blanke
- Department of Cardiology, University of British Columbia, Vancouver, Canada
| | - John Webb
- Department of Cardiology, University of British Columbia, Vancouver, Canada
| | - Wael A Jaber
- Department of Cardiology, Cleveland Clinic, Cleveland, Ohio
| | - Mark Russo
- Division of Cardiac Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - S Chris Malaisrie
- Division of Cardiac Surgery, Northwestern University, Chicago, Illinois
| | - Pradeep Yadav
- Department of Cardiology, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia
| | - Marie-Annick Clavel
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec, Canada
| | - Omar K Khalique
- Cardiovascular Research Foundation, New York, New York; Department of Cardiology, St. Francis Hospital, Roslyn, New York
| | | | - Pamela Douglas
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Jeroen Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Ke Xu
- Edwards Lifesciences, Irvine, California
| | - Vinayak Bapat
- Department of Cardiac Surgery, Minneapolis Heart Institute, Minneapolis, Minnesota
| | - Maria C Alu
- Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York; Cardiovascular Research Foundation, New York, New York
| | - Martin B Leon
- Division of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York; Cardiovascular Research Foundation, New York, New York
| | - Michael J Mack
- Department of Cardiac Surgery, Baylor Scott and White Health, Dallas, Texas
| | - Philippe Pibarot
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec, Canada
| |
Collapse
|
3
|
Mazine A, Ouzounian M. Optimizing Aortic Valve Replacement Through the Hawthorne Effect. Ann Thorac Surg 2024; 117:1162-1163. [PMID: 38608744 DOI: 10.1016/j.athoracsur.2024.03.031] [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: 03/23/2024] [Accepted: 03/30/2024] [Indexed: 04/14/2024]
Affiliation(s)
- Amine Mazine
- Division of Cardiovascular Surgery, Department of Surgery, University of Toronto, Toronto General Hospital, 200 Elizabeth St, 4N-464, Toronto, ON M5G2C4, Canada
| | - Maral Ouzounian
- Division of Cardiovascular Surgery, Department of Surgery, University of Toronto, Toronto General Hospital, 200 Elizabeth St, 4N-464, Toronto, ON M5G2C4, Canada.
| |
Collapse
|
4
|
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:S0003-4975(24)00287-X. [PMID: 38636685 DOI: 10.1016/j.athoracsur.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [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
|
5
|
Arabkhani B, Gonthier S, Lorenz V, Deschamps S, Jahanyar J, Boute M, Vancraeynest D, Mastrobuoni S, Khoury GE, de Kerchove L. Continuous or interrupted pledgeted suture technique in stented bioprosthetic aortic valve replacement: a comparison of in-hospital outcomes. J Cardiothorac Surg 2024; 19:174. [PMID: 38576006 PMCID: PMC10996201 DOI: 10.1186/s13019-024-02754-3] [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: 11/14/2023] [Accepted: 03/29/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND There is ambiguity in the literature regarding the continuous suture technique (CST) for aortic valve replacement (AVR). At our center, there has been a gradual shift towards CST over the interrupted pledgeted technique (IPT). This study aims at comparing outcomes for both techniques. METHODS We performed a retrospective analysis of a single-center study of patients undergoing AVR between January 2011 and July 2020. Patients were divided into two groups: Continuous suture technique and interrupted pledget-reinforced sutures. The pre-operative and In-hospital clinical characteristics and echocardiographic hemodynamics (i.e. transvalvular gradients and paravalvular leakage) were compared between CST and IPT. RESULTS We compared 791 patients with CST to 568 patients with IPT (median age: 73 and 74 years, respectively, p = 0.02). In CST there were 35% concomitant procedure vs. 31% in IPT (p = 0.16). Early mortality was 3.2% in CST versus 4.8% in IPT (p = 0.15), and a second cross-clamp due to a paravalvular-leak in 0.5% vs. 1.2%, respectively (p = 0.22). The CST was not associated with new-onset conduction-blocks mandating pacemaker implants(OR 1.07, 95% CI 0.54-2.14; P = 0.85). The postoperative gradients on echocardiography were lower in CST compared to IPT, especially in smaller annuli (peak gradients: 15.7mmHg vs. 20.5mmHg, in valve size < 23 mm, p < 0.001). CONCLUSIONS The continuous suture technique was associated with lower postoperative gradients and shorter cross-clamp time compared to interrupted pledgeted technique. Differences in paravalvular leaks were non-significant, although slightly less in the continuous suture technique. There were no further differences in valve-related complications. Hence, continues suture technique is safe, with better hemodynamics compared to the interrupted pledgeted technique. This may be of clinical importance, especially in smaller size annular size.
Collapse
Affiliation(s)
- Bardia Arabkhani
- Department of Cardiovascular and Thoracic surgery, UC Louvain Saint Luc, Brussels, Belgium.
- Department of Cardio-Thoracic Surgery, Erasmus Medical Center (EMC), Dr. Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands.
| | - Sebastien Gonthier
- Department of Cardiovascular and Thoracic surgery, UC Louvain Saint Luc, Brussels, Belgium
| | - Veronica Lorenz
- Department of Cardiovascular and Thoracic surgery, UC Louvain Saint Luc, Brussels, Belgium
| | - Samuel Deschamps
- Department of Cardiovascular and Thoracic surgery, UC Louvain Saint Luc, Brussels, Belgium
| | - Jama Jahanyar
- Department of Cardiovascular and Thoracic surgery, UC Louvain Saint Luc, Brussels, Belgium
- Division of Cardiothoracic Surgery, Department of Surgery, Queen's Heart Institute, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Marin Boute
- Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, and IREC/CARD UCLouvain, Brussels, B-1200, Belgium
| | - David Vancraeynest
- Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, and IREC/CARD UCLouvain, Brussels, B-1200, Belgium
| | - Stefano Mastrobuoni
- Department of Cardiovascular and Thoracic surgery, UC Louvain Saint Luc, Brussels, Belgium
| | - Gebrine El Khoury
- Department of Cardiovascular and Thoracic surgery, UC Louvain Saint Luc, Brussels, Belgium
| | - Laurent de Kerchove
- Department of Cardiovascular and Thoracic surgery, UC Louvain Saint Luc, Brussels, Belgium
| |
Collapse
|
6
|
Sá MP, Jacquemyn X, Van den Eynde J, Chu D, Serna‐Gallegos D, Ebels T, Clavel M, Pibarot P, Sultan I. Impact of Prosthesis-Patient Mismatch After Surgical Aortic Valve Replacement: Systematic Review and Meta-Analysis of Reconstructed Time-to-Event Data of 122 989 Patients With 592 952 Patient-Years. J Am Heart Assoc 2024; 13:e033176. [PMID: 38533939 PMCID: PMC11179750 DOI: 10.1161/jaha.123.033176] [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: 10/17/2023] [Accepted: 02/28/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND It remains controversial whether prosthesis-patient mismatch (PPM) impacts long-term outcomes after surgical aortic valve replacement. We aimed to evaluate the association of PPM with mortality, rehospitalizations, and aortic valve reinterventions. METHODS AND RESULTS We performed a systematic review with meta-analysis of reconstructed time-to-event data of studies published by March 2023 (according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Sixty-five studies met our eligibility criteria and included 122 989 patients (any PPM: 68 332 patients, 55.6%). At 25 years of follow-up, the survival rates were 11.8% and 20.6% in patients with and without any PPM, respectively (hazard ratio [HR], 1.16 [95% CI, 1.13-1.18], P<0.001). At 20 years of follow-up, the survival rates were 19.5%, 12.1%, and 8.8% in patients with no, moderate, and severe PPM, respectively (moderate versus no PPM: HR, 1.09 [95% CI, 1.06-1.11], P<0.001; severe versus no PPM: HR, 1.29 [95% CI, 1.24-1.35], P<0.001). PPM was associated with higher risk of cardiac death, heart failure-related hospitalizations, and aortic valve reinterventions over time (P<0.001). Statistically significant associations between PPM and worse survival were observed regardless of valve type (bioprosthetic versus mechanical valves), contemporary PPM definitions unadjusted and adjusted for body mass index, and PPM quantification method (in vitro, in vivo, Doppler echocardiography). Our meta-regression analysis revealed that populations with more women tend to have higher HRs for all-cause death associated with PPM. CONCLUSIONS The results of the present study suggest that any degree of PPM is associated with poorer long-term outcomes following surgical aortic valve replacement and provide support for implementation of preventive strategies to avoid PPM after surgical aortic valve replacement.
Collapse
Affiliation(s)
- Michel Pompeu Sá
- Department of Cardiothoracic SurgeryUniversity of PittsburghPAUSA
- University of Pittsburgh Medical CenterUPMC Heart and Vascular InstitutePittsburghPAUSA
| | | | | | - Danny Chu
- Department of Cardiothoracic SurgeryUniversity of PittsburghPAUSA
- University of Pittsburgh Medical CenterUPMC Heart and Vascular InstitutePittsburghPAUSA
| | - Derek Serna‐Gallegos
- Department of Cardiothoracic SurgeryUniversity of PittsburghPAUSA
- University of Pittsburgh Medical CenterUPMC Heart and Vascular InstitutePittsburghPAUSA
| | - Tjark Ebels
- Department of Cardiothoracic Surgery, University Medical Center GroningenUniversity of GroningenThe Netherlands
| | - Marie‐Annick Clavel
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de QuébecQuébec CityQuébecCanada
- Department of Medicine, Faculty of MedicineUniversité LavalQuébec CityQuébecCanada
| | - Philippe Pibarot
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de QuébecQuébec CityQuébecCanada
- Department of Medicine, Faculty of MedicineUniversité LavalQuébec CityQuébecCanada
| | - Ibrahim Sultan
- Department of Cardiothoracic SurgeryUniversity of PittsburghPAUSA
- University of Pittsburgh Medical CenterUPMC Heart and Vascular InstitutePittsburghPAUSA
| |
Collapse
|
7
|
Ntinopoulos V, Biefer HRC, Dushaj S, Rings L, Fleckenstein P, Dzemali O, Haeussler A. Prosthesis-Patient Mismatch after Aortic Valve Replacement with the Mosaic Ultra Bioprosthesis. Thorac Cardiovasc Surg 2024; 72:197-204. [PMID: 37031679 DOI: 10.1055/s-0043-1768033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
BACKGROUND Several studies have reported high rates of prosthesis-patient mismatch (PPM) after aortic valve replacement (AVR) with the Mosaic prosthesis. This work assesses the incidence of PPM after AVR with a modified version of the Mosaic prosthesis, the Mosaic Ultra. METHODS We performed a retrospective analysis of the data of 532 patients who underwent AVR with implantation of the Mosaic Ultra prosthesis in the period 2007-2016 in our institution. Patients were classified according to their indexed effective orifice area (EOAi) to severe (EOAi < 0.65 cm2/m2), moderate (EOAi 0.65-0.85 cm2/m2), and absent/mild PPM (EOAi > 0.85 cm2/m2). In-hospital postoperative outcomes and the impact of PPM on mean transvalvular pressure gradient after stratification by prosthesis size were assessed. RESULTS Overall, 3 (0.6%) patients had severe, 92 (17.3%) moderate, and 437 (82.1%) absent/mild PPM. There was a significant difference in PPM proportions (moderate/severe vs absent/mild PPM) across different prosthesis sizes overall (p < 0.0001), observing gradually increasing rates of PPM with decreasing prosthesis sizes. Patients with moderate/severe PPM had higher mean transvalvular pressure gradients (19 [13-25] vs 13 [10-17] mm Hg, p < 0.0001) than patients with absent/mild PPM. There was a significant difference in mean transvalvular pressure gradient between the different aortic valve prosthesis sizes overall (p < 0.0001), observing gradually increasing gradients with decreasing prosthesis sizes. CONCLUSION Patients undergoing AVR with the smaller sized (19, 21, and 23 mm) Mosaic Ultra aortic valve prostheses exhibit a higher risk for moderate/severe PPM and higher mean aortic transvalvular pressure gradients than patients receiving the larger sized (25, 27, and 29 mm) prostheses.
Collapse
Affiliation(s)
- Vasileios Ntinopoulos
- Department of Cardiac Surgery, City Hospital of Zurich, Triemli, Zurich, Switzerland
| | | | - Stak Dushaj
- Department of Cardiac Surgery, City Hospital of Zurich, Triemli, Zurich, Switzerland
| | - Laura Rings
- Department of Cardiac Surgery, City Hospital of Zurich, Triemli, Zurich, Switzerland
| | - Philine Fleckenstein
- Department of Cardiac Surgery, City Hospital of Zurich, Triemli, Zurich, Switzerland
| | - Omer Dzemali
- Department of Cardiac Surgery, City Hospital of Zurich, Triemli, Zurich, Switzerland
| | - Achim Haeussler
- Department of Cardiac Surgery, City Hospital of Zurich, Triemli, Zurich, Switzerland
| |
Collapse
|
8
|
Fialka NM, EL-Andari R, Wang S, Dokollari A, Kent WDT, Fatehi Hassanabad A. The Perceval Sutureless Bioprosthetic Aortic Valve: Evolution of Surgical Valve Technology. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2024; 19:125-135. [PMID: 38465600 PMCID: PMC11055413 DOI: 10.1177/15569845241231989] [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] [Indexed: 03/12/2024]
Abstract
OBJECTIVE The surgical treatment of aortic stenosis continues to evolve, and sutureless aortic valve replacement (SUAVR) is an emerging technology. With the Perceval S (Corcym, London, UK) as the only true sutureless valve on the market, the objective of this review is to analyze the current literature on Perceval S. Focusing on valve design and deployment as well as applications of the technology for challenging pathology, clinical outcomes are assessed, including a comparison with transcatheter AVR (TAVR). METHODS PubMed and MEDLINE were searched by 3 authors for studies analyzing SUAVR from inception to May 19, 2023. RESULTS SUAVR facilitates minimally invasive surgery and offers an alternative strategy for patients with small aortic annuli. It also has a time-saving advantage for patients who require complex operations. SUAVR results in excellent long-term morbidity, mortality, durability, and hemodynamic function. In comparison with conventional surgical AVR (SAVR), SUAVR does have a greater risk of postoperative pacemaker implantation; however, increasing user experience and refinements in implantation technique have contributed to reductions in this outcome. SUAVR results in morbidity and mortality that is similar to rapid-deployment AVR. Midterm outcomes are superior to TAVR; however, further robust investigation into all of these comparisons is ultimately necessary. CONCLUSIONS SUAVR bridges the gap in technology between SAVR and TAVR. The application of this exciting technology will undoubtedly grow in the coming years, during which additional investigation is paramount to optimize preoperative planning, valve deployment, and reintervention strategies.
Collapse
Affiliation(s)
- Nicholas M. Fialka
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Ryaan EL-Andari
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Shaohua Wang
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Aleksander Dokollari
- Section of Cardiac Surgery, St. Boniface Hospital, University of Manitoba, Winnipeg, MB, Canada
| | - William D. T. Kent
- Section of Cardiac Surgery, Division of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, AB, Canada
| | - Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Division of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, AB, Canada
| |
Collapse
|
9
|
Powers A, Lavoie N, Le Nezet E, Clavel MA. Unique Aspects of Women's Valvular Heart Diseases: Impact for Diagnosis and Treatment. CJC Open 2024; 6:503-516. [PMID: 38487043 PMCID: PMC10935694 DOI: 10.1016/j.cjco.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/15/2023] [Indexed: 03/17/2024] Open
Abstract
Valvular heart diseases (VHDs) are a major cause of cardiovascular morbidity and mortality worldwide. As degenerative and functional mechanisms represent the main etiologies in high-income countries are degenerative and functional, while in low income countries etiologie is mostly rheumatic. Although therapeutic options have evolved considerably in recent years, women are consistently diagnosed at later stages of their disease, are delayed in receiving surgical referrals, and exhibit worse postoperative outcomes, compared to men. This difference is a result of the historical underrepresentation of women in studies from which current guidelines were developed. However, in recent years, important research, including more female patients, has been conducted and has highlighted substantial sex-specific differences in the etiology, diagnosis, and treatment of VHDs. Systematic consideration of these sex-specific differences in VHD patients is crucial for providing equitable healthcare and optimizing clinical outcomes in both female and male patients. Hence, this review aims to explore implications of sex-specific particularities for diagnosis, treatment options, and outcomes in women with VHDs.
Collapse
Affiliation(s)
- Andréanne Powers
- Institut Universitaire de Cardiologie et de Pneumologie de Québec—Université Laval, Québec, Québec, Canada
| | - Nicolas Lavoie
- Institut Universitaire de Cardiologie et de Pneumologie de Québec—Université Laval, Québec, Québec, Canada
- Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Emma Le Nezet
- Institut Universitaire de Cardiologie et de Pneumologie de Québec—Université Laval, Québec, Québec, Canada
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec—Université Laval, Québec, Québec, Canada
| |
Collapse
|
10
|
Dasi A, Lee B, Polsani V, Yadav P, Dasi LP, Thourani VH. Predicting pressure gradient using artificial intelligence for transcatheter aortic valve replacement. JTCVS Tech 2024; 23:5-17. [PMID: 38352010 PMCID: PMC10859647 DOI: 10.1016/j.xjtc.2023.11.011] [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: 07/30/2023] [Revised: 10/29/2023] [Accepted: 11/09/2023] [Indexed: 02/16/2024] Open
Abstract
Objective After transcatheter aortic valve replacement, the mean transvalvular pressure gradient indicates the effectiveness of the therapy. The objective is to develop artificial intelligence to predict the post-transcatheter aortic valve replacement aortic valve pressure gradient and aortic valve area from preprocedural echocardiography and computed tomography data. Methods A retrospective study was conducted on patients who underwent transcatheter aortic valve replacement due to aortic valve stenosis. A total of 1091 patients were analyzed for pressure gradient predictions (mean age 76.8 ± 9.2 years, 57.8% male), and 1063 patients were analyzed for aortic valve area predictions (mean age 76.7 ± 9.3 years, 57.2% male). An artificial intelligence learning model was trained (training: n = 663 patients, validation: n = 206 patients) and tested (testing: n = 222 patients) to predict pressure gradient, and a separate artificial intelligence learning model was trained (training: n = 640 patients, validation: n = 218 patients) and tested (testing: n = 205 patients) for predicting aortic valve area. Results The mean absolute error for pressure gradient and aortic valve area predictions was 3.0 mm Hg and 0.45 cm2, respectively. Valve sheath size, body surface area, and age were determined to be the top 3 predictors for pressure gradient, and valve sheath size, left ventricular ejection fraction, and aortic annulus mean diameter were identified to be the top 3 predictors of post-transcatheter aortic valve replacement aortic valve area. A training dataset size of more than 500 patients demonstrated good robustness of the artificial intelligence models for pressure gradient and aortic valve area. Conclusions The artificial intelligence-based algorithm has demonstrated potential in predicting post-transcatheter aortic valve replacement transvalvular pressure gradient predictions for patients with aortic valve stenosis. Further studies are necessary to differentiate pressure gradient between valve types.
Collapse
Affiliation(s)
- Anoushka Dasi
- Department of Biomedical Engineering, Ohio State University, Columbus, Ohio
| | - Beom Lee
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Ga
| | | | - Pradeep Yadav
- Department of Cardiac Surgery, Piedmont Heart Institute, Atlanta, Ga
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Ga
| | - Vinod H. Thourani
- Department of Cardiac Surgery, Piedmont Heart Institute, Atlanta, Ga
| |
Collapse
|
11
|
Velders BJ, Vriesendorp MD, Asch FM, Dagenais F, Lange R, Reardon MJ, Rao V, Sabik JF, Groenwold RH, Klautz RJ. Do postoperative hemodynamic parameters add prognostic value for mortality after surgical aortic valve replacement? JTCVS OPEN 2024; 17:47-54. [PMID: 38420548 PMCID: PMC10897662 DOI: 10.1016/j.xjon.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 11/04/2023] [Accepted: 11/13/2023] [Indexed: 03/02/2024]
Abstract
Background Although various hemodynamic parameters to assess prosthetic performance are available, prosthesis-patient mismatch (PPM) is defined exclusively by effective orifice area (EOA) index thresholds. Adjusting for the Society of Thoracic Surgeons predicted risk of mortality (STS PROM), we aimed to explore the added value of postoperative hemodynamic parameters for the prediction of all-cause mortality at 5 years after aortic valve replacement. Methods Data were obtained from the Pericardial Surgical Aortic Valve Replacement (PERIGON) Pivotal Trial, a multicenter prospective cohort study examining the performance of the Avalus bioprosthesis. Candidate predictors were assessed at the first follow-up visit; patients who had no echocardiography data, withdrew consent, or died before this visit were excluded. Candidate predictors included peak jet velocity, mean pressure gradient, EOA, predicted and measured EOA index, Doppler velocity index, indexed internal prosthesis orifice area, and categories for PPM. The performance of Cox models was investigated using the c-statistic and net reclassification improvement (NRI), among other tools. Results A total of 1118 patients received the study valve, of whom 1022 were eligible for the present analysis. In univariable analysis, STS PROM was the sole significant predictor of all-cause mortality (hazard ratio, 1.40; 95% confidence interval, 1.26-1.55). When extending the STS PROM with single hemodynamic parameters, neither the c-statistics nor the NRIs demonstrated added prognostic value compared to a model with STS PROM alone. Similar findings were observed when multiple hemodynamic parameters were added. Conclusions The STS PROM was found to be the main predictor of patient prognosis. The additional prognostic value of postoperative hemodynamic parameters for the prediction of all-cause mortality was limited.
Collapse
Affiliation(s)
- Bart J.J. Velders
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Michiel D. Vriesendorp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Federico M. Asch
- Cardiovascular Core Laboratories, MedStar Health Research Institute, Washington, DC
| | - Francois Dagenais
- Division of Cardiac Surgery, Quebec Heart and Lung Institute, Quebec, Quebec, Canada
| | - Rüdiger Lange
- Department of Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
| | - Michael J. Reardon
- Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Tex
| | - Vivek Rao
- Department of Cardiovascular Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | - Joseph F. Sabik
- Department of Surgery, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Rolf H.H. Groenwold
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Biomedical Data Science, Leiden University Medical Center, Leiden, The Netherlands
| | - Robert J.M. Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
12
|
Zoghbi WA, Jone PN, Chamsi-Pasha MA, Chen T, Collins KA, Desai MY, Grayburn P, Groves DW, Hahn RT, Little SH, Kruse E, Sanborn D, Shah SB, Sugeng L, Swaminathan M, Thaden J, Thavendiranathan P, Tsang W, Weir-McCall JR, Gill E. Guidelines for the Evaluation of Prosthetic Valve Function With Cardiovascular Imaging: A Report From the American Society of Echocardiography Developed in Collaboration With the Society for Cardiovascular Magnetic Resonance and the Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr 2024; 37:2-63. [PMID: 38182282 DOI: 10.1016/j.echo.2023.10.004] [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] [Indexed: 01/07/2024]
Abstract
In patients with significant cardiac valvular disease, intervention with either valve repair or valve replacement may be inevitable. Although valve repair is frequently performed, especially for mitral and tricuspid regurgitation, valve replacement remains common, particularly in adults. Diagnostic methods are often needed to assess the function of the prosthesis. Echocardiography is the first-line method for noninvasive evaluation of prosthetic valve function. The transthoracic approach is complemented with two-dimensional and three-dimensional transesophageal echocardiography for further refinement of valve morphology and function when needed. More recently, advances in computed tomography and cardiac magnetic resonance have enhanced their roles in evaluating valvular heart disease. This document offers a review of the echocardiographic techniques used and provides recommendations and general guidelines for evaluation of prosthetic valve function on the basis of the scientific literature and consensus of a panel of experts. This guideline discusses the role of advanced imaging with transesophageal echocardiography, cardiac computed tomography, and cardiac magnetic resonance in evaluating prosthetic valve structure, function, and regurgitation. It replaces the 2009 American Society of Echocardiography guideline on prosthetic valves and complements the 2019 guideline on the evaluation of valvular regurgitation after percutaneous valve repair or replacement.
Collapse
Affiliation(s)
- William A Zoghbi
- Houston Methodist Hospital, DeBakey Heart & Vascular Center, Houston, Texas.
| | - Pei-Ni Jone
- Lurie Children's Hospital, Northwestern University, Chicago, Illinois
| | | | - Tiffany Chen
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Milind Y Desai
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Paul Grayburn
- Baylor Scott & White Health, University of Texas Southwestern, Dallas, Texas
| | - Daniel W Groves
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Rebecca T Hahn
- Columbia University Irving Medical Center, New York, New York
| | - Stephen H Little
- Houston Methodist Hospital, DeBakey Heart & Vascular Center, Houston, Texas
| | - Eric Kruse
- University of Chicago Medical Center, Chicago, Illinois
| | | | - Sangeeta B Shah
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Lissa Sugeng
- North Shore University Hospital, Manhasset, New York
| | - Madhav Swaminathan
- Cardiothoracic Anesthesiology and Critical Care Medicine, Duke University, Durham, North Carolina
| | | | | | - Wendy Tsang
- University of Toronto, Toronto, Ontario, Canada
| | | | - Edward Gill
- University of Colorado School of Medicine, Aurora, Colorado
| |
Collapse
|
13
|
Levesque T, Eltchaninoff H, Chabannes R, Barbe T, Dosseh O, Tron C, Bettinger N, Bouhzam N, Hemery T, le Pessec G, Fauvel C, Cribier A, Pibarot P, Durand E. Impact of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement. Can J Cardiol 2024; 40:113-122. [PMID: 37726077 DOI: 10.1016/j.cjca.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/31/2023] [Accepted: 09/09/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Data on the long-term impact of prosthesis-patient mismatch (PPM) on outcomes after transcatheter aortic valve replacement (TAVR) remain sparse. We therefore aimed to investigate the incidence, predictive factors, and long-term prognostic impact of PPM on bioprosthesis durability and mortality. METHODS This was a single-centre retrospective study including 2117 patients who underwent TAVR for aortic stenosis from 2002 to 2022. Moderate PPM was defined by indexed effective orifice area (iEOA) > 0.65 and ≤ 0.85 cm2/m2 (> 0.55 and ≤ 0.70 cm2/m2 if BMI ≥ 30 kg/m2) and severe PPM by an iEOA ≤ 0.65 cm2/m2 (≤ 0.55 cm2/m2 If BMI ≥ 30 kg/m2). RESULTS There were 351 patients (16.6%) with PPM, including 39 patients (1.8%) with severe PPM and 312 patients (14.7%) with moderate PPM. The mean follow-up duration was 31.2 ± 26.5 months. Factors independently associated with the occurrence of PPM were body surface area (odds ratio [OR] 3.32, 95% confidence interval [CI] 1.32-8.35; P = 0.01), valve-in-valve TAVR (OR 6.12, 95% CI 2.29-16.08; P < 0.001), small annulus (OR 2.42, 95% CI 1.41-4.07; P = 0.001), and the use of a balloon-expandable valve (OR 4.17, 95% CI 2.17-8.33; P < 0.001). PPM was associated with increased risk of mortality (hazard ratio [HR] 1.3, 95% CI 1.1-1.5, P = 0.004) and valve thrombosis (HR 4.2, 95% CI 1.4-12.6, P = 0.01), and a trend towards increased risk of structural valve deterioration (HR 1.7, 95% CI 0.9-2.9; P = 0.08). CONCLUSIONS The results of this study suggest that PPM has a negative long-term impact on outcomes after TAVR. These findings emphasise the importance of preventing PPM.
Collapse
Affiliation(s)
- Thomas Levesque
- Department of Cardiology, Normandie University, UNIROUEN, U1096, CHU Rouen, Rouen, France
| | - Hélène Eltchaninoff
- Department of Cardiology, Normandie University, UNIROUEN, U1096, CHU Rouen, Rouen, France
| | - Romain Chabannes
- Department of Cardiology, Normandie University, UNIROUEN, U1096, CHU Rouen, Rouen, France
| | - Thomas Barbe
- Department of Cardiology, Normandie University, UNIROUEN, U1096, CHU Rouen, Rouen, France
| | - Olivier Dosseh
- Department of Cardiology, Normandie University, UNIROUEN, U1096, CHU Rouen, Rouen, France
| | - Christophe Tron
- Department of Cardiology, Normandie University, UNIROUEN, U1096, CHU Rouen, Rouen, France
| | - Nicolas Bettinger
- Department of Cardiology, Normandie University, UNIROUEN, U1096, CHU Rouen, Rouen, France
| | - Najime Bouhzam
- Department of Cardiology, Normandie University, UNIROUEN, U1096, CHU Rouen, Rouen, France
| | - Thibaut Hemery
- Department of Cardiology, Normandie University, UNIROUEN, U1096, CHU Rouen, Rouen, France
| | - Guillaume le Pessec
- Department of Cardiology, Normandie University, UNIROUEN, U1096, CHU Rouen, Rouen, France
| | - Charles Fauvel
- Department of Cardiology, Normandie University, UNIROUEN, U1096, CHU Rouen, Rouen, France
| | - Alain Cribier
- Department of Cardiology, Normandie University, UNIROUEN, U1096, CHU Rouen, Rouen, France
| | - Philippe Pibarot
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Québec, Canada
| | - Eric Durand
- Department of Cardiology, Normandie University, UNIROUEN, U1096, CHU Rouen, Rouen, France.
| |
Collapse
|
14
|
Sohn SH, Kang Y, Kim JS, Choi JW, Lee JH, Kim JS, Lim C, Hwang HY. A Controlled Trial Comparing One-Year Hemodynamics of Two Bovine Pericardial Valves. Thorac Cardiovasc Surg 2023. [PMID: 37884030 DOI: 10.1055/a-2199-2087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
BACKGROUND This randomized controlled trial was designed to compare 1-year hemodynamic performances and clinical outcomes after aortic valve replacement (AVR) using a recently introduced (the AVALUS group) and worldwide used (the CEPME group) bovine pericardial bioprostheses. METHODS Patients were screened to enroll 70 patients in each group based on a noninferiority design. The primary endpoint of the trial was the mean pressure gradient across the aortic valve (AVMPG) at 1 year after surgery. One-year echocardiographic data were obtained from 92.1% (129 of 140 patients) of the study patients. RESULTS There were no differences in baseline characteristics, including sex and body surface area (1.64 ± 0.18 vs. 1.65 ± 0.15 m2) between the groups. The AVMPG on 1-year echocardiography was 14.0 ± 4.3 and 13.9 ± 5.1 mmHg in the AVALUS and CEPME groups, respectively (the p-value for noninferiority was 0.0004). In the subgroup analyses for the respective size of the prostheses, AVMPG of the 19-mm prostheses was significantly lower in the AVALUS group than in the CEPME group (14.0 ± 4.3 vs. 20.0 ± 4.7 mmHg, p = 0.012), whereas those of the other sizes were not significantly different between the two groups. There were no significant differences in the effective orifice area (1.49 ± 0.40 vs. 1.53 ± 0.38 cm2, p = 0.500) or effective orifice area index (0.91 ± 0.22 vs 0.93 ± 0.23 cm2/m2, p = 0.570) in all the patients, or in the subgroup analysis for the 19-mm prosthesis. There were no differences in the 1-year clinical outcomes between the two groups. CONCLUSION The 1-year hemodynamic and clinical outcomes of the AVALUS group were noninferior to those of the CEPME group (NCT03796442).
Collapse
Affiliation(s)
- Suk Ho Sohn
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoonjin Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Seong Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae Woong Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae Hang Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Jun Sung Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Cheong Lim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
15
|
Sohn SH, Kim JS, Choi JW, Lee JH, Kim JS, Lim C, Hwang HY. Preliminary Report from a Randomized Controlled Trial Comparing Two Bovine Pericardial Valves. Thorac Cardiovasc Surg 2023; 71:648-655. [PMID: 35917824 DOI: 10.1055/s-0042-1753494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND A randomized controlled trial was designed to compare 1-year hemodynamic profiles and clinical outcomes after bioprosthetic aortic valve replacement (AVR) using a recently introduced (study group) and world-widely used (control group) bovine pericardial bioprostheses. This study evaluated early postoperative outcomes as a preliminary analysis. METHODS The primary end point of the trial was the mean pressure gradient across the aortic valve (AVMPG) at 1 year after surgery. Patients were screened to enroll 70 patients in each group based on a noninferiority design. Early postoperative hemodynamic and clinical outcomes were compared between the two groups. RESULTS There were no differences in baseline characteristics, including sex and body surface area (1.64 ± 0.18 vs. 1.65 ± 0.15 m2) between the two groups. The AVMPG on early postoperative echocardiography was 15.2 ± 4.6 mm Hg and 16.5 ± 6.2 mm Hg in the study and control groups, respectively (p = 0.177). Although AVMPG of the 19 mm prostheses was lower in the study group than in the control group (17.0 ± 6.3 mm Hg vs. 22.8 ± 6.6 mm Hg, p = 0.039), there were no significant differences in the effective orifice area in all patients (1.57 ± 0.41 cm2 vs. 1.53 ± 0.34 cm2, p = 0.568), and each valve size. The effective orifice area index was also similar between the two groups in overall (p = 0.352), and in each valve size. There were no significant differences in clinical outcomes including operative mortality and postoperative complications between the two groups. CONCLUSION Early postoperative hemodynamic and clinical results after AVR using a recently introduced bovine pericardial valve were comparable with those using the control valve (NCT03796442).
Collapse
Affiliation(s)
- Suk Ho Sohn
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji Seong Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae Woong Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae Hang Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jun Sung Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Cheong Lim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| |
Collapse
|
16
|
Brown JA, Yousef S, Toma C, Kliner D, Serna-Gallegos D, Makani A, West D, Wang Y, Thoma F, Pompeu Sá M, Sultan I. Self-Expanding Transcatheter Aortic Valves Optimize Transvalvular Hemodynamics Independent of Intra- Versus Supra-Annular Design. Am J Cardiol 2023; 207:48-53. [PMID: 37722201 DOI: 10.1016/j.amjcard.2023.08.120] [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: 06/11/2023] [Revised: 08/14/2023] [Accepted: 08/20/2023] [Indexed: 09/20/2023]
Abstract
This study sought to characterize transvalvular hemodynamics during the first 30 days after transcatheter aortic valve implantation (TAVI) across various transcatheter heart valves (THVs), while adjusting for annular dimensions. This was an observational study of TAVIs from September 2021 to October 2022. The primary outcome was mean transvalvular pressure gradient (TVPG), measured using transthoracic echocardiography at day 0, day 1, and day 30 post-TAVI, and were compared across 3 THV, including the self-expandable intra-annular Portico (Abbott Vascular, Santa Clara, California) valve, the balloon-expandable SAPIEN 3 Ultra (Edwards Lifesciences, Irvine, California), and the self-expandable supra-annular Evolut Pro+ (Medtronic, Minneapolis, Minnesota). A total of 560 patients who underwent TAVI were identified, of which 106 (18.9%) received a Portico THV, 176 (31.4%) received a SAPIEN THV, and 278 (49.6%) received an Evolut THV. For Portico THV, the TVPG on day 0 increased from 6.0 (4.7 to 9.0) to 7.0 (6.0 to 10.0) by day 30 (p = 0.009). For SAPIEN THV, the TVPG on day 0 increased from 6.5 (5.0 to 8.0) to 12.0 (9.0 to 15.0) by day 30 (p <0.001). For Evolut THV, the TVPG on day 0 increased from 6.0 (5.0 to 9.0) to 7.2 (5.0 to 10.0) by day 30 (p = 0.001). Adjusting for time and annular diameter in a multivariable mixed effects model, the SAPIEN group had a significantly greater increase in TVPG over time than the Evolut reference group (p <0.001), while there was no difference in the change of TVPG over time for the Portico group vs. the Evolut group (p = 0.874). In conclusion, compared with balloon-expandable valves, self-expanding THV may optimize transvalvular hemodynamics across all annular diameters, independent of their supra-annular and intra-annular design.
Collapse
Affiliation(s)
- James A Brown
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sarah Yousef
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Catalin Toma
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Division of Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dustin Kliner
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Division of Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Derek Serna-Gallegos
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Amber Makani
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Division of Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David West
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Yisi Wang
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Floyd Thoma
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Michel Pompeu Sá
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| |
Collapse
|
17
|
Matkovic M, Aleksic N, Bilbija I, Antic A, Lazovic JM, Cubrilo M, Milojevic A, Zivkovic I, Putnik S. Clinical Impact of Patient-Prosthesis Mismatch After Aortic Valve Replacement With a Mechanical or Biological Prosthesis. Tex Heart Inst J 2023; 50:e228048. [PMID: 37867308 PMCID: PMC10658167 DOI: 10.14503/thij-22-8048] [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] [Indexed: 10/24/2023]
Abstract
BACKGROUND Patient-prosthesis mismatch (PPM) may impair functional capacity and survival after aortic valve replacement. This study aimed to investigate the impact of PPM on long-term survival and quality of life after mechanical and biological aortic valve replacement. METHODS This study included 595 consecutive patients who had undergone isolated aortic valve replacement. Patients were divided into 2 groups according to prosthesis type. The baseline and operative characteristics, survival rates, complications, and quality of life of the groups with and without PPM were compared for up to 6 years. The PPM calculation was performed using the effective orifice area value provided by the manufacturer divided by the patient's body surface area. RESULTS The moderate to severe PPM rates were 69.8% and 3.7% after biological and mechanical prosthesis implantation, respectively. Mean survival for patients in the biological group who had PPM was statistically significantly shorter (50.2 months [95% CI, 45.2-55.3]) than for patients in the biological group without PPM (60.1 months [95% CI, 55.7-64.4]; P = .04). In the mechanical prosthesis group, there was no difference in mean survival between the subgroup with PPM (66.6 months [95% CI, 58.3-74.9]) and the subgroup without PPM (64.9 months [95% CI, 62.6-67.2]; P = .50). A quality-of-life questionnaire's scores did not differ between the groups. CONCLUSION Mismatch is common after biological valve implantation and statistically significantly affects long-term survival and quality of life. If the risk of PPM after implantation of a biological prosthesis is suspected, adopting strategies to avoid PPM at the time of surgery is warranted.
Collapse
Affiliation(s)
- Milos Matkovic
- Department for Cardiac Surgery, Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nemanja Aleksic
- Department for Cardiac Surgery, Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ilija Bilbija
- Department for Cardiac Surgery, Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ana Antic
- Department for Cardiac Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - Jelena Milin Lazovic
- Department for Biostatistics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marko Cubrilo
- Department for Cardiac Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | | | - Igor Zivkovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department for Cardiac Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Svetozar Putnik
- Department for Cardiac Surgery, Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
18
|
Amirghofran AA, Salimi M, Kamran H, Bazrafshan H, Navaei MR, Shokrollahi A, Nirooei E, Edraki M, Amoozgar H, Ajami G, Arabi H. Long-term outcomes of the classic Konno-Rastan procedure in paediatric and adult patients: impact of aortic annulus size on patient outcomes. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 37:ivad151. [PMID: 37665750 DOI: 10.1093/icvts/ivad151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 07/14/2023] [Accepted: 09/02/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVES The classic Konno-Rastan procedure may yield different outcomes regarding aortic annulus diameters ≤15 mm and larger. Focusing on the effect of the diameter of the aortic annulus, we described the long-term outcomes of our patients. METHODS The outcomes of paediatric and adult patients who underwent surgery from 2000 to 2021 were studied retrospectively. The patient population was divided into 2 groups with aortic annulus diameters ≤15 mm and >15, and the outcomes were compared between the 2 groups. RESULTS A total of 48 patients, with a mean age of 12.24 ± 9.42 years (2-53 years) and a median follow-up duration of 8 years (7 months to 20 years) with an IQR of 5.5, were enrolled. The mean peak instantaneous pressure gradient was 78.97 ± 25.29 mmHg, which decreased to 21.43 mmHg (P-value = 0.012). The maximum left ventricular outflow tract gradient at the last follow-up was 28.21 mmHg, with the exception of 1 case with a gradient of 68.45 mmHg. The mean diameter of the aortic annulus was 15.34 ± 3.87 mm (8-23 mm), and the mean prosthetic valve size was 20.31 mm, which was 5 mm (33%) larger than the native annulus diameter. The overall mortality rate was 6.3%, with 1 death in the hospital and 2 in the first year after the surgery. The major complication rate, including mortality, heart block and reintervention, was higher in patients with ≤15 mm annulus (P-value = 0.028.) However, there was no difference between the 2 groups in follow-up. Four (8%) late cardiac reoperations were performed, none of which were related to our surgeries. CONCLUSIONS Kono-Rastan surgery for patients with aortic valve diameter of ≤15 mm can be performed with acceptable long-term outcomes.
Collapse
Affiliation(s)
| | - Maryam Salimi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hooman Kamran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamed Bazrafshan
- Cardiac Surgery Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Ali Shokrollahi
- Cardiac Surgery Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Elahe Nirooei
- Cardiac Surgery Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammadreza Edraki
- Pediatric Cardiology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Amoozgar
- Pediatric Cardiology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Gholamhossein Ajami
- Pediatric Cardiology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Arabi
- Cardiac Surgery Department, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
19
|
Anakaputhur Rajan VK, Kaskar A, Selvam S, Rao R, Mehra S, Kumaran T, Shetty V. Aortic valve replacement in small aortic root- Bi-leaflet mechanical valve is superior to a Mono-leaflet mechanical valve. Indian J Thorac Cardiovasc Surg 2023:1-9. [PMID: 37359507 PMCID: PMC10199289 DOI: 10.1007/s12055-023-01520-9] [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: 02/18/2023] [Revised: 04/08/2023] [Accepted: 04/11/2023] [Indexed: 06/28/2023] Open
Abstract
Background Patient prosthetic mismatch is a serious but avoidable complication of surgical aortic valve replacement (SAVR) complicated by a small aortic annulus. This study aims to compare early and midterm outcomes following aortic valve replacement (AVR) with a mono-leaflet (ML) valve and a bi-leaflet (BL) valve in a small aortic root. Methods and selection From January 1st, 2017 to December 31st, 2019, 98 patients diagnosed with small aortic root underwent isolated aortic valve replacement with either TTK Chitra valve (Mono-leaflet/ ML group) or St. Jude medical valve (Bi-leaflet/ BL group) of size 17/ 19 mm. Echocardiography was analyzed from medical records and telephonic follow-up. Results Baseline parameters were comparable. The ML group had 42 patients and the BL group had 56 patients. Aortic cross-clamp time, the incidence of severe patient prosthetic mismatch (p = 0.002) and mean, peak pressure gradients were high in the ML group. Duration of ventilation, intensive care unit (ICU) stay, the incidence of stroke, need for intra-aortic balloon pump, permanent pacemaker, dialysis, and left ventricular mass index in echocardiography were comparable between the two groups postoperatively. There was no early mortality in both group. Survival at the end of 5 years was 57 ± 14.4% in the ML group; 91.8 ± 4% in the BL group (p = 0.005). Univariate and multivariate analysis revealed elderly age as a risk factor for mortality. Conclusion We conclude that aortic valve replacement without any root widening procedure, using a small-sized mechanical valve provides acceptable early outcomes. Bi-leaflet mechanical valves provide better hemodynamics and survival percentage.
Collapse
Affiliation(s)
- Venkatesa Kumar Anakaputhur Rajan
- Department of Cardiothoracic Surgery, Narayana Institute of Cardiac Sciences, Narayana Health, #258/A, Bommasandra Industrial Area, Anekal Taluk, Bangalore, 560099 Karnataka India
| | - Ameya Kaskar
- Department of Cardiothoracic Surgery, Narayana Institute of Cardiac Sciences, Narayana Health, #258/A, Bommasandra Industrial Area, Anekal Taluk, Bangalore, 560099 Karnataka India
| | - Sendur Selvam
- Department of Cardiothoracic Surgery, Narayana Institute of Cardiac Sciences, Narayana Health, #258/A, Bommasandra Industrial Area, Anekal Taluk, Bangalore, 560099 Karnataka India
| | - Rahul Rao
- Department of Cardiothoracic Surgery, Narayana Institute of Cardiac Sciences, Narayana Health, #258/A, Bommasandra Industrial Area, Anekal Taluk, Bangalore, 560099 Karnataka India
| | - Siddhant Mehra
- Department of Cardiothoracic Surgery, Narayana Institute of Cardiac Sciences, Narayana Health, #258/A, Bommasandra Industrial Area, Anekal Taluk, Bangalore, 560099 Karnataka India
| | - Thiruthani Kumaran
- Department of Cardiothoracic Surgery, Narayana Institute of Cardiac Sciences, Narayana Health, #258/A, Bommasandra Industrial Area, Anekal Taluk, Bangalore, 560099 Karnataka India
| | - Varun Shetty
- Department of Cardiothoracic Surgery, Narayana Institute of Cardiac Sciences, Narayana Health, #258/A, Bommasandra Industrial Area, Anekal Taluk, Bangalore, 560099 Karnataka India
| |
Collapse
|
20
|
Grigorescu AE, Anghel A, Buriman DG, Feier H. Acquired Von Willebrand Factor Deficiency at Patient-Prosthesis Mismatch after AVR Procedure-A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050954. [PMID: 37241186 DOI: 10.3390/medicina59050954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/29/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023]
Abstract
Acquired von Willebrand factor deficiency has been described in patients with aortic valve stenosis due to high shear forces developed during passage through the narrowed valve orifice, which determines structural changes in this molecule. Similar flow conditions are present in patients with an aortic prosthesis that presents a patient-prosthesis mismatch. Patient-prosthesis mismatch is described by the smaller effective orifice area of the prosthesis than the native valve, which would probably determine similar changes in the molecules of the von Willebrand factor, leading to acquiring von Willebrand deficiency.
Collapse
Affiliation(s)
- Andrei Emanuel Grigorescu
- Department of Cardiology, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
- Research Center of the Institute of Cardiovascular and Heart Disease of Timisoara, 300310 Timisoara, Romania
- Division of Cardiovascular Surgery, Institute for Cardiovascular Diseases, 300391 Timisoara, Romania
- Doctoral School Medicine-Pharmacy, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Andrei Anghel
- Department of Biochemistry, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Darius Gheorghe Buriman
- Division of Cardiovascular Surgery, Institute for Cardiovascular Diseases, 300391 Timisoara, Romania
- Doctoral School Medicine-Pharmacy, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
- Center for Translational Research and Systems Medicine, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
| | - Horea Feier
- Department of Cardiology, "Victor Babes" University of Medicine and Pharmacy Timisoara, 300041 Timisoara, Romania
- Research Center of the Institute of Cardiovascular and Heart Disease of Timisoara, 300310 Timisoara, Romania
- Division of Cardiovascular Surgery, Institute for Cardiovascular Diseases, 300391 Timisoara, Romania
| |
Collapse
|
21
|
Angellotti D, Manzo R, Castiello DS, Immobile Molaro M, Mariani A, Iapicca C, Nappa D, Simonetti F, Avvedimento M, Leone A, Canonico ME, Spaccarotella CAM, Franzone A, Ilardi F, Esposito G, Piccolo R. Echocardiographic Evaluation after Transcatheter Aortic Valve Implantation: A Comprehensive Review. Life (Basel) 2023; 13:1079. [PMID: 37240724 PMCID: PMC10221682 DOI: 10.3390/life13051079] [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: 03/06/2023] [Revised: 04/19/2023] [Accepted: 04/23/2023] [Indexed: 05/28/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is an increasingly popular treatment option for patients with severe aortic stenosis. Recent advancements in technology and imaging tools have significantly contributed to the success of TAVI procedures. Echocardiography plays a pivotal role in the evaluation of TAVI patients, both before and after the procedure. This review aims to provide an overview of the most recent technical advancements in echocardiography and their use in the follow-up of TAVI patients. In particular, the focus will be on the examination of the influence of TAVI on left and right ventricular function, which is frequently accompanied by other structural and functional alterations. Echocardiography has proven to be key also in detecting valve deterioration during extended follow-up. This review will provide valuable insights into the technical advancements in echocardiography and their role in the follow-up of TAVI patients.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| |
Collapse
|
22
|
Rasheed NF, Stonebraker C, Li Z, Siddiqi U, Lee ACH, Li W, Lupo S, Cruz J, Cohen WG, Staub C, Rodgers D, Myren M, Combs P, Jeevanandam V, Hibino N. Figure of eight suture technique in aortic valve replacement decreases prosthesis-patient mismatch. J Cardiothorac Surg 2023; 18:117. [PMID: 37038197 PMCID: PMC10084672 DOI: 10.1186/s13019-023-02260-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 04/03/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND While the pledget suture technique has been the standard for surgical aortic. valve replacement (AVR), discussion continues regarding the possibility of the nonpledget suture technique to produce superior structural and hemodynamic parameters. This study aims to assess the effectiveness of the figure-of-eight suture technique in AVR, as determined by the incidence of prosthesis-patient mismatch (PPM). METHODS We reviewed records of patients (N = 629) who underwent a surgical AVR procedure between January 2011 and July 2018 at a single institution. Indexed effective orifice area values and PPM incidence were calculated from implanted valve size and patient body surface area. Incidence of none, moderate, and severe PPM was compared across AVR suture techniques. RESULTS A total of 570 pledget and 59 figure-of-eight patients were compared for incidence of PPM. Patients who received AVR with the pledget suture technique had significantly lower echocardiographic measurements of baseline ejection fraction than patients who had received AVR with the figure-of-eight suture technique (p = 0.003). Patients who received the figure-of eight suture had a 14% decrease in moderate PPM compared to patients who received the pledget suture (p = 0.022). Patients who received the figure-of-eight suture also had a significantly higher rate of no PPM (p = 0.044). CONCLUSIONS The use of the figure-of-eight suture technique in AVR can reduce the incidence of moderate PPM. While the pledget suture is the standard technique in AVR, the figure-of-eight suture technique may offer better structural and hemodynamic outcomes, especially for patients with a smaller aortic annulus.
Collapse
Affiliation(s)
- Nabeel F Rasheed
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA.
| | - Corinne Stonebraker
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA
| | - Zhaozhi Li
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA
| | - Umar Siddiqi
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA
| | - Andy C H Lee
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA
| | - Willa Li
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA
| | - Sydney Lupo
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA
| | - Jennifer Cruz
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA
| | - William G Cohen
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA
| | - Cathy Staub
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA
| | - Daniel Rodgers
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA
| | - Mark Myren
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA
| | - Pamela Combs
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA
| | - Valluvan Jeevanandam
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA
| | - Narutoshi Hibino
- Department of Surgery, Division of Cardiothoracic Surgery, University of Chicago, 1109 Ashley Lane, Inverness, IL, 60010, USA
| |
Collapse
|
23
|
Sá MP, Jacquemyn X, Van den Eynde J, Tasoudis P, Dokollari A, Torregrossa G, Sicouri S, Clavel MA, Pibarot P, Ramlawi B. Impact of Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement: Meta-Analysis of Kaplan-Meier-Derived Individual Patient Data. JACC Cardiovasc Imaging 2023; 16:298-310. [PMID: 36648055 DOI: 10.1016/j.jcmg.2022.07.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/07/2022] [Accepted: 07/15/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND It remains controversial whether prosthesis-patient mismatch (PPM) (in general considered moderate if indexed effective orifice area is 0.65-0.85 cm2/m2 and severe when <0.65 cm2/m2) affects the outcomes after transcatheter aortic valve replacement (TAVR). OBJECTIVES The purpose of this study is to evaluate the time-varying effects and association of PPM with the risk of overall mortality. METHODS Study-level meta-analysis of reconstructed time-to-event data from Kaplan-Meier curves of studies published by December 30, 2021. RESULTS In total, 23 studies met our eligibility criteria and included a total of 81,969 patients included in the Kaplan-Meier curves (19,612 with PPM and 62,357 without PPM). Patients with moderate/severe PPM had a significantly higher risk of mortality compared with those without PPM (HR: 1.09 [95% CI: 1.04-1.14]; P < 0.001). In the first 30 months after the procedure, mortality rates were significantly higher in the moderate/severe PPM group (HR: 1.1 [95% CI: 1.05-1.16]; P < 0.001). In contrast, the landmark analysis beyond 30 months yielded a reversal of the HR (0.83 [95% CI: 0.68-1.01]; P = 0.064), but without statistical significance. In the sensitivity analysis, although the authors observed that severe PPM showed higher risk of mortality in comparison with no PPM (HR: 1.25 [95% CI: 1.16-1.36]; P < 0.001), they did not observe a statistically significant difference for mortality between moderate PPM and no PPM (HR: 1.03 [95% CI: 0.96-1.10]; P = 0.398). CONCLUSIONS Severe PPM, but not moderate PPM, was associated with higher risk of mortality following TAVR. These results provide support to implementation of preventive strategies to avoid severe PPM following TAVR.
Collapse
Affiliation(s)
- Michel Pompeu Sá
- Department of Cardiothoracic Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania, USA; Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA.
| | - Xander Jacquemyn
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | | | - Panagiotis Tasoudis
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Aleksander Dokollari
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Gianluca Torregrossa
- Department of Cardiothoracic Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania, USA; Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Serge Sicouri
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Marie-Annick Clavel
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Québec, Canada; Department of Medicine, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
| | - Philippe Pibarot
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Québec, Canada; Department of Medicine, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
| | - Basel Ramlawi
- Department of Cardiothoracic Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania, USA; Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| |
Collapse
|
24
|
Gillam LD. Prosthesis-Patient Mismatch Following Transcatheter Aortic Valve Replacement: A New Analytic Approach Provides New Insights. JACC Cardiovasc Imaging 2023; 16:311-313. [PMID: 36123288 DOI: 10.1016/j.jcmg.2022.08.010] [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: 08/02/2022] [Accepted: 08/24/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Linda D Gillam
- Department of Cardiovascular Medicine, Gagnon Cardiovascular Institute at Morristown Medical Center, Atlantic Health System, Morristown, New Jersey, USA.
| |
Collapse
|
25
|
Sengupta PP, Tokodi M. Prosthesis-Patient Mismatch After TAVR: The New Flow of Information. JACC Cardiovasc Imaging 2023; 16:10-12. [PMID: 36599556 DOI: 10.1016/j.jcmg.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 10/20/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Partho P Sengupta
- Division of Cardiovascular Diseases and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
| | - Márton Tokodi
- Division of Cardiovascular Diseases and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| |
Collapse
|
26
|
Pińska M, Frączek-Jucha M, Gackowski A, Nessler J. THE DIETARY HABITS AND NUTRITION BELIEFS OF PATIENTS WITH AORTIC STENOSIS. POLSKI MERKURIUSZ LEKARSKI : ORGAN POLSKIEGO TOWARZYSTWA LEKARSKIEGO 2023; 51:107-111. [PMID: 37254756 DOI: 10.36740/merkur202302101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Aim: The analysis of dietary knowledge and habits of patients with aortic stenosis, both prior to and post valve implantation. PATIENTS AND METHODS Materials and methods: Patient with diagnosed moderate or severe aortic stenosis were included into the study. Telephonic dietary interview was performed. It was based on the standard KomPAN questionnaire developed and validated by the Behavioural Nutrition Team, Committee of Human Nutrition of Polish Academy of Sciences. RESULTS Results: The analysis was conducted in 94 consecutive patients. The pro-health diet index was 4.87 points (3.7; 5.96), while the optimal level was defined as 20 points. The 12.8% of the respondents had low knowledge about nutrition, 79.8% - moderate and 7.4% - good. From 94 patients, 37 had the patientprosthesis mismatch and overweight. The 35.1% of patients with the patient-prosthesis mismatch and overweight considered their nutritional habits as bad, 62.2% as moderate and 2.7% as good. In a group of patients without the patient-prosthesis mismatch the self-opinion about diet was bad in 20.8%, moderate in 72.9% and good in 6.3%. CONCLUSION Conclusions: Dietary habits and nutritional knowledge in patients with aortic stenosis are inadequate. However, awareness of bad dietary habits in patients who are overweight and have patient-prosthesis mismatch is better compared to the remaining group of patients. The proper dietary education is needed in all patients with aortic stenosis.
Collapse
Affiliation(s)
- Małgorzata Pińska
- JAGIELLONIAN UNIVERSITY MEDICAL COLLEGE, INSTITUTE OF CARDIOLOGY, DEPARTMENT OF CORONARY DISEASE AND HEART FAILURE, CRACOW, POLAND; JOHN PAUL II HOSPITAL, DEPARTMENT OF CORONARY DISEASE AND HEART FAILURE, CRACOW, POLAND
| | - Magdalena Frączek-Jucha
- JAGIELLONIAN UNIVERSITY MEDICAL COLLEGE, FACULTY OF HEALTH SCIENCES, DEPARTMENT OF EMERGENCY MEDICAL CARE, CRACOW, POLAND; JOHN PAUL II HOSPITAL, DEPARTMENT OF CORONARY DISEASE AND HEART FAILURE, CRACOW, POLAND
| | - Andrzej Gackowski
- JAGIELLONIAN UNIVERSITY MEDICAL COLLEGE, INSTITUTE OF CARDIOLOGY, DEPARTMENT OF CORONARY DISEASE AND HEART FAILURE, CRACOW, POLAND; JOHN PAUL II HOSPITAL, DEPARTMENT OF CORONARY DISEASE AND HEART FAILURE, CRACOW, POLAND; JOHN PAUL II HOSPITAL, NONINVASIVE CARDIOVASCULAR LABORATORY, CRACOW, POLAND
| | - Jadwiga Nessler
- JAGIELLONIAN UNIVERSITY MEDICAL COLLEGE, INSTITUTE OF CARDIOLOGY, DEPARTMENT OF CORONARY DISEASE AND HEART FAILURE, CRACOW, POLAND; JOHN PAUL II HOSPITAL, DEPARTMENT OF CORONARY DISEASE AND HEART FAILURE, CRACOW, POLAND
| |
Collapse
|
27
|
Yousef S, Serna-Gallegos D, Brown JA, Ogami T, Wang Y, Thoma FW, Chu D, Bonatti J, Kaczorowski D, Yoon P, Sultan I. Outcomes of Root Enlargement Vs Root Replacement for Aortic Stenosis. Ann Thorac Surg 2022; 115:1180-1187. [PMID: 36584836 DOI: 10.1016/j.athoracsur.2022.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/14/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Stentless aortic root replacement (ARR) and aortic root enlargement (ARE) are established strategies to avoid prosthesis-patient mismatch in patients with aortic stenosis (AS) and small annuli. We sought to compare outcomes of these 2 procedures. METHODS This was an observational study using an institutional database of aortic valve replacements from 2010 to 2021. The study compared patients who underwent ARE vs ARR for AS. Those with endocarditis or aortic aneurysms were excluded. Postoperative outcomes were compared between groups. Kaplan-Meier survival estimation and multivariable Cox regression for survival were performed. Cumulative incidence functions were generated for all-cause readmissions. RESULTS A total of 533 patients underwent either ARE or ARR for AS. Of these, 193 (36.2%) underwent ARE and 340 (63.8%) underwent ARR with a stentless xenograft. There were no significant differences in operative mortality, stroke, length of stay, or new-onset renal failure requiring dialysis. There were also no significant differences in aortic valve reintervention rates (3.1% vs 1.8%; P = .314). Patients in the ARR group had larger valves implanted, larger indexed effective orifice areas, lower rates of prosthesis-patient mismatch, and lower transprosthetic gradients (P < .001). Median follow-up was 5.02 (2.70-7.8) years. Kaplan-Meier survival estimates were comparable, and on multivariable Cox regression, ARR vs ARE was not significantly associated with an increased hazard of death (hazard ratio, 1.00; 95% CI, 0.69-1.45; P = .996). Cumulative incidence estimates for all-cause readmissions were also comparable between groups. CONCLUSIONS ARE and stentless xenograft ARR for AS were associated with comparable postoperative complications, aortic valve reinterventions, freedom from readmission, and 5-year survival.
Collapse
Affiliation(s)
- Sarah Yousef
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Derek Serna-Gallegos
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - James A Brown
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Takuya Ogami
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yisi Wang
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Floyd W Thoma
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Danny Chu
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Johannes Bonatti
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - David Kaczorowski
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Pyongsoo Yoon
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| |
Collapse
|
28
|
Chen JS, Huang JH, Chiu KM, Chiang CY. Extent of Left Ventricular Mass Regression and Impact of Global Left Ventricular Afterload on Cardiac Events and Mortality after Aortic Valve Replacement. J Clin Med 2022; 11:jcm11247482. [PMID: 36556098 PMCID: PMC9783780 DOI: 10.3390/jcm11247482] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Patient-prosthesis mismatch (PPM) causes a high transvalvular pressure gradient and residual left ventricular (LV) hypertrophy, consequently influencing long-term results. This study aimed to find the relationships between hemodynamic parameters and LV mass regression and determine the risk predictors of major adverse cardiovascular and cerebral events (MACCE) after aortic valve replacement (AVR) for aortic stenosis. Methods and Results: Preoperative and postoperative Doppler echocardiography data were evaluated for 120 patients after AVR. The patients' mean age was 67.7 years; 55% of the patients were male. Forty-four (37%) patients suffered from MACCE during a mean follow-up period of 3.6 ± 2 years. The following hemodynamic parameters at follow-up were associated with lower relative indexed LV mass (LVMI) regression: lower postoperative indexed effective orifice area, greater mean transvalvular pressure gradient (MPG), greater stroke work loss (SWL), and concentric or eccentric LV remodeling mode. The following hemodynamic parameters at follow-up were associated with a higher risk of MACCE: higher valvuloarterial impedance (ZVA), greater SWL, greater MPG, greater relative wall thickness, greater LVMI, and hypertrophic LV remodeling mode. Lower relative LVMI regression was associated with a higher risk of MACCE (hazard ratio, 1.01: 95% confidence interval, 1.003-1.03). The corresponding cutoff of relative LVMI regression was -14%. Conclusions: Changes in hemodynamic parameters were independently associated with relative LVMI regression. Impaired reverse remodeling and persistent residual LV hypertrophy were independent risk predictors of MACCE. An LVMI regression lower than 14% indicated higher MACCE. A postoperative ZVA greater than 3.5 mmHg/mL/m2 was an independent risk predictor of cardiac events and mortality after AVR. Preventive strategies should be used at the time of the operation to avoid PPM.
Collapse
Affiliation(s)
- Jer-Shen Chen
- Department of Cardiovascular Surgery, Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei City 220216, Taiwan
- Department of Healthcare Administration, Asian Eastern University of Science and Technology, New Taipei City 220303, Taiwan
| | - Jih-Hsin Huang
- Department of Cardiovascular Surgery, Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei City 220216, Taiwan
- Department of Applied Cosmetology, LeeMing Institute of Technology, New Taipei City 243083, Taiwan
| | - Kuan-Ming Chiu
- Department of Cardiovascular Surgery, Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei City 220216, Taiwan
- Department of Electrical Engineering, Yuan Ze University, Taoyuan 320315, Taiwan
| | - Chih-Yao Chiang
- Department of Cardiovascular Surgery, Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei City 220216, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, School of Medicine, National Defense Medical Center, Taipei 114201, Taiwan
- Correspondence: ; Tel.: +886-2-7728-1618; Fax: +886-2-7738-6057
| |
Collapse
|
29
|
Rubens FD, Clarke AE, Lee DS, Wells GA, Sun LY. Population study of sex-based outcomes after surgical aortic valve replacement. CJC Open 2022; 5:220-229. [PMID: 37013069 PMCID: PMC10066438 DOI: 10.1016/j.cjco.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Background Surgical aortic valve replacement (SAVR) is a key strategy for the treatment of aortic valve disease. However, studies have involved primarily male patients, and whether the benefits of this approach can be extrapolated to female patients is unclear. Methods Clinical and administrative datasets for 12,207 patients undergoing isolated SAVR in Ontario from 2008 to 2019 were linked. Male and female patients were balanced using inverse probability treatment weighting. Mortality, endocarditis, and major hemorrhagic and thrombotic events, as well as 2 composite outcomes-major adverse cerebral and cardiovascular events (MACCE) and patient-derived adverse cardiovascular and noncardiovascular events (PACE)-and their component events, were compared in the weighted groups with a stratified log-rank test. Results A total of 7485 male patients and 4722 female patients were included in the study. Median follow-up was 5.2 years in both sexes. All-cause mortality did not differ between sexes (hazard ratio [HR] 0.949 [95% confidence interval {CI} 0.851-1.059]). Male sex was associated with an increased risk of new-onset dialysis (HR 0.689 [95% CI 0.488-0.974]). Female sex was associated with a significantly increased risk of both new-onset heart failure (HR 1.211 [95% CI 1.051-1.394], P = 0.0081) and heart failure hospitalization (HR 1.200 [95% CI 1.036-1.390], P = 0.015). No statistically significant differences were seen in any of the other secondary outcomes between sexes. Conclusions This population health study demonstrated that survival did not differ between male and female patients undergoing SAVR. Significant sex-related differences were found in the risk of heart failure and new-onset dialysis, but these findings should be considered exploratory and require further study.
Collapse
|
30
|
Herrmann HC, Pibarot P, Wu C, Hahn RT, Tang GHL, Abbas AE, Playford D, Ruel M, Jilaihawi H, Sathananthan J, Wood DA, De Paulis R, Bax JJ, Rodes-Cabau J, Cameron DE, Chen T, Del Nido PJ, Dweck MR, Kaneko T, Latib A, Moat N, Modine T, Popma JJ, Raben J, Smith RL, Tchetche D, Thomas MR, Vincent F, Yoganathan A, Zuckerman B, Mack MJ, Leon MB. Bioprosthetic Aortic Valve Hemodynamics: Definitions, Outcomes, and Evidence Gaps: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 80:527-544. [PMID: 35902177 DOI: 10.1016/j.jacc.2022.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/19/2022] [Accepted: 06/01/2022] [Indexed: 12/23/2022]
Abstract
A virtual workshop was organized by the Heart Valve Collaboratory to identify areas of expert consensus, areas of disagreement, and evidence gaps related to bioprosthetic aortic valve hemodynamics. Impaired functional performance of bioprosthetic aortic valve replacement is associated with adverse patient outcomes; however, this assessment is complicated by the lack of standardization for labelling, definitions, and measurement techniques, both after surgical and transcatheter valve replacement. Echocardiography remains the standard assessment methodology because of its ease of performance, widespread availability, ability to do serial measurements over time, and correlation with outcomes. Management of a high gradient after replacement requires integration of the patient's clinical status, physical examination, and multimodality imaging in addition to shared patient decisions regarding treatment options. Future priorities that are underway include efforts to standardize prosthesis sizing and labelling for both surgical and transcatheter valves as well as trials to characterize the consequences of adverse hemodynamics.
Collapse
Affiliation(s)
- Howard C Herrmann
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Philippe Pibarot
- Department of Medicine, Québec Heart and Lung Institute, Laval University, Québec City, Quebec, Canada
| | - Changfu Wu
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Rebecca T Hahn
- Columbia University Medical Center, New York, New York, USA
| | | | - Amr E Abbas
- Beaumont Hospital Royal Oak, Royal Oak, Michigan, USA
| | - David Playford
- The University of Notre Dame, Fremantle, Western Australia, Australia
| | - Marc Ruel
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Hasan Jilaihawi
- Heart Valve Center, NYU Langone Health, New York, New York, USA
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - David A Wood
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Jeroen J Bax
- Leiden University Medical Centre, Leiden, the Netherlands
| | - Josep Rodes-Cabau
- Department of Medicine, Québec Heart and Lung Institute, Laval University, Québec City, Quebec, Canada
| | - Duke E Cameron
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Tiffany Chen
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pedro J Del Nido
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Tsuyoshi Kaneko
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Neil Moat
- Abbott Structural Heart, Santa Clara, California, USA
| | - Thomas Modine
- Hopital Cardiologique de Haut Leveque, Bordeaux, France
| | | | - Jamie Raben
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Robert L Smith
- Baylor Scott and White, The Heart Hospital, Plano, Texas, USA
| | | | | | | | - Ajit Yoganathan
- Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
| | - Bram Zuckerman
- U.S. Food and Drug Administration, Silver Spring, Maryland, USA
| | - Michael J Mack
- Baylor Scott and White, The Heart Hospital, Plano, Texas, USA
| | - Martin B Leon
- Columbia University Medical Center, New York, New York, USA
| | | |
Collapse
|
31
|
Chiarito M, Spirito A, Nicolas J, Selberg A, Stefanini G, Colombo A, Reimers B, Kini A, Sharma SK, Dangas GD, Mehran R. Evolving Devices and Material in Transcatheter Aortic Valve Replacement: What to Use and for Whom. J Clin Med 2022; 11:jcm11154445. [PMID: 35956061 PMCID: PMC9369546 DOI: 10.3390/jcm11154445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 02/04/2023] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of aortic stenosis, providing a viable alternative to surgical aortic valve replacement (SAVR) for patients deemed to be at prohibitive surgical risk, but also for selected patients at intermediate or low surgical risk. Nonetheless, there still exist uncertainties regarding the optimal management of patients undergoing TAVR. The selection of the optimal bioprosthetic valve for each patient represents one of the most challenging dilemmas for clinicians, given the large number of currently available devices. Limited follow-up data from landmark clinical trials comparing TAVR with SAVR, coupled with the typically elderly and frail population of patients undergoing TAVR, has led to inconclusive data on valve durability. Recommendations about the use of one device over another in given each patient’s clinical and procedural characteristics are largely based on expert consensus. This review aims to evaluate the available evidence on the performance of different devices in the presence of specific clinical and anatomic features, with a focus on patient, procedural, and device features that have demonstrated a relevant impact on the risk of poor hemodynamic valve performance and adverse clinical events.
Collapse
Affiliation(s)
- Mauro Chiarito
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA; (M.C.); (J.N.); (A.S.); (A.S.); (A.K.); (S.K.S.); (G.D.D.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Italy; (G.S.); (A.C.); (B.R.)
| | - Alessandro Spirito
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA; (M.C.); (J.N.); (A.S.); (A.S.); (A.K.); (S.K.S.); (G.D.D.)
| | - Johny Nicolas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA; (M.C.); (J.N.); (A.S.); (A.S.); (A.K.); (S.K.S.); (G.D.D.)
| | - Alexandra Selberg
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA; (M.C.); (J.N.); (A.S.); (A.S.); (A.K.); (S.K.S.); (G.D.D.)
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Italy; (G.S.); (A.C.); (B.R.)
- Istituti di Ricovero e Cura a Carattere Scientifico, Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Italy
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Italy; (G.S.); (A.C.); (B.R.)
- Istituti di Ricovero e Cura a Carattere Scientifico, Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Italy
| | - Bernhard Reimers
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Italy; (G.S.); (A.C.); (B.R.)
- Istituti di Ricovero e Cura a Carattere Scientifico, Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Italy
| | - Annapoorna Kini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA; (M.C.); (J.N.); (A.S.); (A.S.); (A.K.); (S.K.S.); (G.D.D.)
| | - Samin K. Sharma
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA; (M.C.); (J.N.); (A.S.); (A.S.); (A.K.); (S.K.S.); (G.D.D.)
| | - George D. Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA; (M.C.); (J.N.); (A.S.); (A.S.); (A.K.); (S.K.S.); (G.D.D.)
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA; (M.C.); (J.N.); (A.S.); (A.S.); (A.K.); (S.K.S.); (G.D.D.)
- Correspondence: ; Tel.: +1-(212)-659-9649; Fax: +1-(646)-537-8547
| |
Collapse
|
32
|
Esmailie F, Razavi A, Yeats B, Sivakumar SK, Chen H, Samaee M, Shah IA, Veneziani A, Yadav P, Thourani VH, Dasi LP. Biomechanics of Transcatheter Aortic Valve Replacement Complications and Computational Predictive Modeling. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2022; 6:100032. [PMID: 37273734 PMCID: PMC10236878 DOI: 10.1016/j.shj.2022.100032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/09/2021] [Accepted: 11/03/2021] [Indexed: 06/06/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) is a rapidly growing field enabling replacement of diseased aortic valves without the need for open heart surgery. However, due to the nature of the procedure and nonremoval of the diseased tissue, there are rates of complications ranging from tissue rupture and coronary obstruction to paravalvular leak, valve thrombosis, and permanent pacemaker implantation. In recent years, computational modeling has shown a great deal of promise in its capabilities to understand the biomechanical implications of TAVR as well as help preoperatively predict risks inherent to device-patient-specific anatomy biomechanical interaction. This includes intricate replication of stent and leaflet designs and tested and validated simulated deployments with structural and fluid mechanical simulations. This review outlines current biomechanical understanding of device-related complications from TAVR and related predictive strategies using computational modeling. An outlook on future modeling strategies highlighting reduced order modeling which could significantly reduce the high time and cost that are required for computational prediction of TAVR outcomes is presented in this review paper. A summary of current commercial/in-development software is presented in the final section.
Collapse
Affiliation(s)
- Fateme Esmailie
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University School of Medicine, Atlanta, Georgia, USA
| | - Atefeh Razavi
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University School of Medicine, Atlanta, Georgia, USA
| | - Breandan Yeats
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sri Krishna Sivakumar
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University School of Medicine, Atlanta, Georgia, USA
| | - Huang Chen
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University School of Medicine, Atlanta, Georgia, USA
| | - Milad Samaee
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University School of Medicine, Atlanta, Georgia, USA
| | - Imran A. Shah
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University School of Medicine, Atlanta, Georgia, USA
| | - Alessandro Veneziani
- Department of Mathematics, Department of Computer Science, Emory University, Atlanta, Georgia, USA
| | - Pradeep Yadav
- Department of Cardiology, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Vinod H. Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Lakshmi Prasad Dasi
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University School of Medicine, Atlanta, Georgia, USA
| |
Collapse
|
33
|
Lim OZH, Mai AS, Ng CH, Tang A, Chin YH, Kong G, Ho YJ, Ong J, Tay E, Kuntjoro I, Chew NWS, Lim Y. Meta-Analysis Comparing Risk Factors, Incidence, and Outcomes of Patients With Versus Without Prosthesis-Patient Mismatch Following Transcatheter Aortic Valve Implantation. Am J Cardiol 2022; 170:91-99. [PMID: 35193765 DOI: 10.1016/j.amjcard.2022.01.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 01/03/2022] [Accepted: 01/17/2022] [Indexed: 11/01/2022]
Abstract
Current guidelines on the management of patients with aortic valvular disease have widened the use of transcatheter aortic valve implantation (TAVI) with an emphasis on avoidance of prosthesis-patient mismatch (PPM). This study sought to examine the incidence, risk factors, and all-cause mortality of PPM after TAVI. Medline and Embase databases were searched from inception to August 10, 2021. Patients were compared along 2 arms: (1) any degree of PPM and those without PPM, (2) severe PPM, and nonsevere PPM. A total of 22 articles involving 115,442 patients after TAVI were included. Pooled incidence for any degree of PPM was 30.1% and 10.7% in severe PPM. Incidence was significantly higher (p <0.001) for any degree of PPM in Europe (33.1%) and North America (34.4%) compared with Asia (10.4%). Incidence of severe PPM was higher (p = 0.015) in older generation (13.6%) compared with current-generation valves (6.3%). Severe PPM increased the risk of all-cause mortality relative to nonsevere PPM (hazard ratio: 1.86, 95% confidence interval: 1.05 to 3.29, p = 0.034). Patients of younger age, increased body surface area, lower left ventricular ejection fraction, and classified New York Heart Association Class III/IV were at greater risk of both any degree and severe PPM. Smaller prosthesis size increased the risk of any degree of PPM, whereas postdilation and larger prostheses were protective factors. In conclusion, all-cause mortality was significantly affected in severe PPM compared with nonsevere cases, whereas this excess mortality was not observed between those with any degree of PPM and those without. Closer attention to patient and bioprosthetic valve factors is required to minimize the occurrence of severe PPM.
Collapse
|
34
|
Bortolotti U, Vendramin I, Livi U. SURGICAL AORTIC VALVE REPLACEMENT optimizing the small aortic annulus size. Eur J Cardiothorac Surg 2022; 62:6572343. [PMID: 35451461 DOI: 10.1093/ejcts/ezac256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/22/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Uberto Bortolotti
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Igor Vendramin
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| | - Ugolino Livi
- Cardiothoracic Department, University Hospital of Udine, Udine, Italy
| |
Collapse
|
35
|
Perdoncin E, Paone G, Byku I. Valve-in-valve Transcatheter Aortic Valve Replacement for Failed Surgical Valves and Adjunctive Therapies. US CARDIOLOGY REVIEW 2022. [DOI: 10.15420/usc.2021.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
While redo surgical aortic valve replacement has traditionally been the gold standard for the treatment of failed surgical valves, valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) has arisen as a viable, less invasive option with the potential for improved short-term morbidity and mortality. Retrospective registry data regarding ViV TAVR outcomes have been encouraging, with excellent 1-year mortality, and sustained valve performance and quality of life improvement out to 3 years. Operators must be comfortable with CT analysis for procedural planning, and be able to identify and troubleshoot patients who are at risk for coronary obstruction and patient prosthesis mismatch. The authors provide a review of clinical outcomes associated with ViV TAVR, procedural planning recommendations, and strategies to overcome technical challenges that can occur during ViV TAVR.
Collapse
Affiliation(s)
- Emily Perdoncin
- Structural Heart and Valve Center, Division of Cardiology, Emory University, Atlanta, GA
| | - Gaetano Paone
- Structural Heart and Valve Center, Division of Cardiothoracic Surgery, Emory University, Atlanta, GA
| | - Isida Byku
- Structural Heart and Valve Center, Division of Cardiology, Emory University, Atlanta, GA
| |
Collapse
|
36
|
Cotrim CA, Café H, João I, Cotrim N, Guardado J, Cordeiro P, Cotrim H, Baquero L. Exercise stress echocardiography: Where are we now? World J Cardiol 2022; 14:64-82. [PMID: 35316975 PMCID: PMC8900523 DOI: 10.4330/wjc.v14.i2.64] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/04/2021] [Accepted: 01/29/2022] [Indexed: 02/06/2023] Open
Abstract
Exercise stress echocardiography (ESE) is a widely used diagnostic test in cardiology departments. ESE is mainly used to study patients with coronary artery disease; however, it has increasingly been used in other clinical scenarios including valve pathology, congenital heart disease, hypertrophic and dilated cardiomyopathies, athlete evaluations, diastolic function evaluation, and pulmonary circulation study. In our laboratories, we use an established methodology in which cardiac function is evaluated while exercising on a treadmill. After completing the exercise regimen, patients remain in a standing position or lie down on the left lateral decubitus, depending on the clinical questions to be answered for further evaluation. This method increases the quality and quantity of information obtained. Here, we present the various methods of exercise stress echocardiography and our experience in many clinical arenas in detail. We also present alternatives to ESE that may be used and their advantages and disadvantages. We review recent advances in ESE and future directions for this established method in the study of cardiac patients and underline the advantage of using a diagnostic tool that is radiation-free.
Collapse
Affiliation(s)
| | - Hugo Café
- Faculdade de Medicina, Algarve University, Faro 8005-139, Portugal
| | - Isabel João
- Department of Cardiology, Garcia de Orta Hospital, Almada 2805-267, Portugal
| | - Nuno Cotrim
- Department of Medicine, Garcia de Orta Hospital, Almada 2805-267, Portugal
| | - Jorge Guardado
- Cardiovascular Unit, UCARDIO, Centro Clinico, Riachos 2350-325, Portugal
| | - Pedro Cordeiro
- Department of Cardiology, Hospital Particular do Algarve, Faro 8005-226, Portugal
| | - Hortense Cotrim
- Faculdade de Medicina, Algarve University, Faro 8005-139, Portugal
| | - Luis Baquero
- Heart Center, Hospital da Cruz Vermelha Portuguesa, Lisboa 1549-008, Portugal
| |
Collapse
|
37
|
Joury A, Duran A, Stewart M, Gilliland YE, Spindel SM, Qamruddin S. Prosthesis-patient mismatch following aortic and mitral valves replacement – A comprehensive review. Prog Cardiovasc Dis 2022; 72:84-92. [PMID: 35235847 DOI: 10.1016/j.pcad.2022.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Abdulaziz Joury
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA, United States of America; King Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia.
| | - Antonio Duran
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA, United States of America; Ochsner Clinical School, New Orleans, LA, United States of America.
| | - Merrill Stewart
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA, United States of America; Ochsner Clinical School, New Orleans, LA, United States of America.
| | - Yvonne E Gilliland
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA, United States of America; Ochsner Clinical School, New Orleans, LA, United States of America
| | - Stephen M Spindel
- Ochsner Clinical School, New Orleans, LA, United States of America; Division of Cardiothoracic Surgery, Ochsner Medical Center, New Orleans, LA, United States of America.
| | - Salima Qamruddin
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA, United States of America; Ochsner Clinical School, New Orleans, LA, United States of America.
| |
Collapse
|
38
|
Patient–Prosthesis Mismatch in Contemporary Small-Size Mechanical Prostheses Does Not Impact Survival at 10 Years. J Cardiovasc Dev Dis 2022; 9:jcdd9020048. [PMID: 35200701 PMCID: PMC8877093 DOI: 10.3390/jcdd9020048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/19/2022] [Accepted: 01/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The effect of PPM in mechanical prostheses on long-term survival is not well-established. Methods: Patients who received a 21 mm or smaller aortic valve between 2000 and 2011 were retrospectively analyzed (n = 416). Propensity matching was used in order to account for baseline differences in patient subgroups (PPM vs. no PPM; severe PPM vs. no severe PPM). Results: Five- and ten-year survival was 78 ± 3.52% and 64.51 ± 4.51% in patients with PPM, versus 83.3 ± 3.12% and 69.37 ± 4.36% in patients without (p = 0.28) when analyzed at 10.39 ± 5.25 years after the primary procedure. Independent risk factors for impaired survival, after matching, were age, serum creatinine, and severe pulmonary hypertension. Five- and ten-year survival in patients with severe PPM was 73.34 ± 6.01% and 61.76 ± 8.17%, respectively, versus 74.72 ± 5.68% and 67.50 ± 7.09% in those without (p = 0.49), at 8.82 ± 5.17 years after SAVR. Age was the only independent variable that influenced long-term survival when severe PPM was added to the model. Conclusions: PPM or severe PPM does not impact long-term survival up to 10 years in mechanical valve recipients when matching for preoperative variables.
Collapse
|
39
|
OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6563500. [DOI: 10.1093/ejcts/ezac195] [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: 09/07/2021] [Revised: 02/23/2022] [Accepted: 03/15/2022] [Indexed: 11/13/2022] Open
|
40
|
Reply: Prosthesis−patient mismatch: No consensus yet. JTCVS OPEN 2021; 8:247-248. [PMID: 36004140 PMCID: PMC9390170 DOI: 10.1016/j.xjon.2021.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
41
|
Reply: Relating the indexed effective orifice area and mean transprosthesis gradient to define patient–prosthesis mismatch: Are we sure a relationship exists? JTCVS OPEN 2021; 8:245-246. [PMID: 36004061 PMCID: PMC9390387 DOI: 10.1016/j.xjon.2021.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
42
|
Vriesendorp MD, Klautz RJM. Reply from authors: Prosthesis–patient mismatch is not synonymous with elevated transvalvular pressure gradient. JTCVS OPEN 2021; 8:249-250. [PMID: 36004174 PMCID: PMC9390339 DOI: 10.1016/j.xjon.2021.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Michiel D Vriesendorp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
43
|
Vriesendorp MD, Groenwold RH, Herrmann HC, Head SJ, De Lind Van Wijngaarden RA, Vriesendorp PA, Kappetein AP, Klautz RJ. The Clinical Implications of Body Surface Area as a Poor Proxy for Cardiac Output. STRUCTURAL HEART 2021. [DOI: 10.1080/24748706.2021.1968089] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
44
|
Geicu L, Busuttil O, D’Ostrevy N, Pernot M, Benali W, Labrousse L, Modine T. Updates on the Latest Surgical Approach of the Aortic Stenosis. J Clin Med 2021; 10:jcm10215140. [PMID: 34768660 PMCID: PMC8584939 DOI: 10.3390/jcm10215140] [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: 10/18/2021] [Revised: 10/26/2021] [Accepted: 10/29/2021] [Indexed: 11/16/2022] Open
Abstract
Over the last twenty years, we marked significant progresses in the field of tissue engineering and the development of new aortic valve structural and delivery systems. These continuous iterations on the field, have completely changed the surgical indications and approaches for AVR. Nowadays, therapeutic decisions are endorsed by international guidelines; however, new technical advances need a new integrated approach. The clinical scenarios issued from the interaction between the Guidelines and the newest approaches and technologies are regularly on debate by the Heart Team. We will present some of our most encountered situations and the pattern of our therapeutic decisions. To easily navigate through Guidelines and clinical scenarios, we reported in this review a simplified and easy to use Clinical decision-making algorithm that may be a valuable tool in our daily practice.
Collapse
Affiliation(s)
- Lucian Geicu
- Department of Cardiac Surgery, Montreal Heart Institute, Montreal University, Montreal, QC H1T 1C8, Canada; (L.G.); (W.B.)
| | - Olivier Busuttil
- Unité Médico-Chirurgicale, Hôpital Haut Lévêque, CHU de Bordeaux, CEDEX, 33604 Pessac, France; (O.B.); (M.P.); (L.L.)
| | - Nicolas D’Ostrevy
- Cardiac Surgery Department, CHU de Clermont Ferrand, 63003 Clermont Ferrand, France;
| | - Mathieu Pernot
- Unité Médico-Chirurgicale, Hôpital Haut Lévêque, CHU de Bordeaux, CEDEX, 33604 Pessac, France; (O.B.); (M.P.); (L.L.)
| | - Walid Benali
- Department of Cardiac Surgery, Montreal Heart Institute, Montreal University, Montreal, QC H1T 1C8, Canada; (L.G.); (W.B.)
| | - Louis Labrousse
- Unité Médico-Chirurgicale, Hôpital Haut Lévêque, CHU de Bordeaux, CEDEX, 33604 Pessac, France; (O.B.); (M.P.); (L.L.)
| | - Thomas Modine
- Unité Médico-Chirurgicale, Hôpital Haut Lévêque, CHU de Bordeaux, CEDEX, 33604 Pessac, France; (O.B.); (M.P.); (L.L.)
- Correspondence: ; Tel.: +33-05-5679-5697
| |
Collapse
|
45
|
Choosing Between Transcatheter Aortic Valve Replacement and Surgery in the Low-Risk Transcatheter Aortic Valve Replacement Era. Interv Cardiol Clin 2021; 10:413-422. [PMID: 34593105 DOI: 10.1016/j.iccl.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The landmark results of the low surgical risk pivotal transcatheter aortic valve replacement (TAVR) trials fueled speculation that the role of surgical aortic valve replacement (SAVR) would be limited in the future. Instead, the field has pivoted away from reductive surgical risk stratification toward understanding the complex interplay of anatomy, timing, and surgical risk to optimize the lifetime management of aortic stenosis. In this review, we systematically explore the subtleties that influence the choice between TAVR and surgery in the low-risk TAVR era.
Collapse
|
46
|
Vulesevic B, Kubota N, Burwash IG, Cimadevilla C, Tubiana S, Duval X, Nguyen V, Arangalage D, Chan KL, Mulvihill EE, Beauchesne L, Messika-Zeitoun D. Size-adjusted aortic valve area: refining the definition of severe aortic stenosis. Eur Heart J Cardiovasc Imaging 2021; 22:1142-1148. [PMID: 33247914 DOI: 10.1093/ehjci/jeaa295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 10/08/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS Severe aortic valve stenosis (AS) is defined by an aortic valve area (AVA) <1 cm2 or an AVA indexed to body surface area (BSA) <0.6 cm/m2, despite little evidence supporting the latter approach and important intrinsic limitations of BSA indexation. We hypothesized that AVA indexed to height (H) might be more applicable to a wide range of populations and body morphologies and might provide a better predictive accuracy. METHODS AND RESULTS In 1298 patients with degenerative AS and preserved ejection fraction from three different countries and continents (derivation cohort), we aimed to establish an AVA/H threshold that would be equivalent to 1.0 cm2 for defining severe AS. In a distinct prospective validation cohort of 395 patients, we compared the predictive accuracy of AVA/BSA and AVA/H. Correlations between AVA and AVA/BSA or AVA/H were excellent (all R2 > 0.79) but greater with AVA/H. Regressions lines were markedly different in obese and non-obese patients with AVA/BSA (P < 0.0001) but almost identical with AVA/H (P = 0.16). AVA/BSA values that corresponded to an AVA of 1.0 cm2 were markedly different in obese and non-obese patients (0.48 and 0.59 cm2/m2) but not with AVA/H (0.61 cm2/m for both). Agreement for the diagnosis of severe AS (AVA < 1 cm2) was significantly higher with AVA/H than with AVA/BSA (P < 0.05). Similar results were observed across the three countries. An AVA/H cut-off value of 0.6 cm2/m [HR = 8.2(5.6-12.1)] provided the best predictive value for the occurrence of AS-related events [absolute AVA of 1 cm2: HR = 7.3(5.0-10.7); AVA/BSA of 0.6 cm2/m2 HR = 6.7(4.4-10.0)]. CONCLUSION In a large multinational/multiracial cohort, AVA/H was better correlated with AVA than AVA/BSA and a cut-off value of 0.6 cm2/m provided a better diagnostic and prognostic value than 0.6 cm2/m2. Our results suggest that severe AS should be defined as an AVA < 1 cm2 or an AVA/H < 0.6 cm2/m rather than a BSA-indexed value of 0.6 cm2/m2.
Collapse
Affiliation(s)
- Branka Vulesevic
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
| | - Naozumi Kubota
- Department of Cardiology, Juntendo University, Tokyo, Japan
| | - Ian G Burwash
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
| | - Claire Cimadevilla
- Department of Cardiology and Cardiac Surgery, Assistance Publique - Hôpitaux de Paris, 75018 Paris, France
| | - Sarah Tubiana
- Centre d'Investigations Cliniques, Assistance Publique - Hôpitaux de Paris, 75018 Paris, France
| | - Xavier Duval
- Centre de Ressources Biologiques, Assistance Publique - Hôpitaux de Paris, 75018 Paris, France
| | - Virginia Nguyen
- Department of Cardiology and Cardiac Surgery, Assistance Publique - Hôpitaux de Paris, 75018 Paris, France
| | - Dimitri Arangalage
- Department of Cardiology and Cardiac Surgery, Assistance Publique - Hôpitaux de Paris, 75018 Paris, France
| | - Kwan L Chan
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
| | - Erin E Mulvihill
- Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, ON K1Y 4W7, Canada
| | - Luc Beauchesne
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
| | - David Messika-Zeitoun
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
| |
Collapse
|
47
|
Durability of Transcatheter Heart Valves: Standardized Definitions and Available Data. J Clin Med 2021; 10:jcm10184180. [PMID: 34575291 PMCID: PMC8472686 DOI: 10.3390/jcm10184180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 09/05/2021] [Accepted: 09/08/2021] [Indexed: 11/16/2022] Open
Abstract
Transcatheter aortic valve replacement is a well-established alternative to surgical aortic valve replacement in high-risk patients with severe symptomatic aortic stenosis. Currently, this technique is shifting towards younger patient groups with intermediate- and low-risk profile, which raises the question about long-term durability. Despite acceptable results up to 5 years, little is currently known about valve performance beyond 5 years. Since valve deterioration, thrombosis and endocarditis seem to be the main factors affecting valve durability, precise and widely accepted definitions of these parameters were stated by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) in 2017, followed by the Valve in Valve International Data (VIVID) group definitions in 2018 and the Valve Academic Research Consortium 3 (VARC-3) definitions in 2021. Until the introduction of these definitions, interstudy comparisons were difficult due to missing uniformity. Since the release of these recommendations, an increasing number of studies have reported their data on long-term durability using these new criteria. The aim of the present article is to discuss the current definitions on bioprosthetic valve durability, and to summarize the available data on long-term durability of transcatheter aortic valves.
Collapse
|
48
|
Nicoara A, Song P, Bollen BA, Paone G, Abernathy JJ, Taylor MA, Habib RH, Del Rio JM, Lauer RE, Nussmeier NA, Glance LG, Petty JV, Mackensen GB, Vener DF, Kertai MD. The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2021 Update on Echocardiography. Ann Thorac Surg 2021; 113:13-24. [PMID: 34536378 DOI: 10.1016/j.athoracsur.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/05/2021] [Accepted: 09/07/2021] [Indexed: 11/01/2022]
Abstract
The Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database (ACSD) is the world's premier clinical outcomes registry for adult cardiac surgery and a driving force for quality improvement in cardiac surgery. Echocardiographic data provide a wealth of hemodynamic, structural, and functional data and have been part of STS ACSD data collection since its inception. An increasing body of evidence suggests that the use of echocardiography in patients undergoing cardiac surgery has a positive impact on postoperative outcomes. In this report, we describe and summarize the type and rate of reporting of echocardiography-related variables in the STS ACSD, including the Adult Cardiac Anesthesiology Module, from July 2017 to December 2019 for the most frequently performed cardiac surgical procedures. With this review, we aim to increase awareness of the importance of collecting accurate and consistent echocardiography data in the STS ACSD and to highlight opportunities for growth and improvement.
Collapse
Affiliation(s)
- Alina Nicoara
- Department of Anesthesiology, Duke University, Durham, North Carolina
| | - Pinping Song
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington
| | - Bruce A Bollen
- International Heart Institute of Montana, Missoula Anesthesiology, PC, Missoula, Montana
| | - Gaetano Paone
- Department of Surgery, Emory University, Atlanta, Georgia
| | - James Jake Abernathy
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Mark A Taylor
- Anesthesiology Institute/Cleveland Clinic Foundation, Cleveland, Ohio
| | - Robert H Habib
- STS Research Center, The Society of Thoracic Surgeons, Chicago, Illinois
| | | | - Ryan E Lauer
- Department of Anesthesiology, Loma Linda University, Loma Linda, California
| | - Nancy A Nussmeier
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Laurent G Glance
- Department of Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, New York
| | - Joseph V Petty
- CHI Health Clinic Physician Enterprise Anesthesia, CHI Health Nebraska Heart, Lincoln, Nebraska
| | - G Burkhard Mackensen
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington
| | - David F Vener
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children Hospital, Baylor College of Medicine, Houston, Texas
| | - Miklos D Kertai
- Department of Anesthesiology Vanderbilt University, Nashville, Tennessee.
| |
Collapse
|
49
|
Okamura H, Kusadokoro S, Mieno M, Kimura N, Yamaguchi A. Long-term outcomes after aortic valve replacement using a 19-mm bioprosthesis. Eur J Cardiothorac Surg 2021; 61:625-634. [PMID: 34431991 DOI: 10.1093/ejcts/ezab379] [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: 03/01/2021] [Revised: 07/01/2021] [Accepted: 07/22/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Transcatheter aortic valve replacement is known to be associated with improved haemodynamics in patients with aortic stenosis and a small aortic annulus. However, limited benchmark data are available regarding the long-term outcomes in patients treated with surgical aortic valve replacement (SAVR). We investigated the long-term outcomes of SAVR using a 19-mm bioprosthesis. METHODS This study included consecutive patients who underwent SAVR using a 19-mm bioprosthesis at our hospital between 2008 and 2012. RESULTS In a total of 132 patients, moderate and severe prosthesis-patient mismatch occurred in 36 (27.3%) and 7 patients (5.3%), respectively. The median follow-up period was 7.7 years. The overall 5- and 10-year survival rates were 79.4% and 52.9%, respectively. The 5- and 10-year freedom from major adverse valve-related events rates were 89.6% and 74.2%, respectively. Neither moderate nor severe prosthesis-patient mismatch was associated with late mortality, major adverse valve-related events or heart failure. Follow-up echocardiographic data were obtained at a median interval of 4.8 years in 80% of patients who survived ≥6 months postoperatively. Follow-up echocardiographic data showed a significantly increased left ventricular ejection fraction, decreased mean transvalvular/transprosthetic pressure gradients and a decreased mean left ventricular mass. At follow-up, we observed moderate or severe haemodynamic structural valve deterioration in 17 patients; however, structural valve deterioration did not affect late survival or freedom from major adverse valve-related events rates, or heart failure. CONCLUSIONS SAVR using the 19-mm bioprosthesis was associated with satisfactory long-term clinical and haemodynamic outcomes.
Collapse
Affiliation(s)
- Homare Okamura
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Sho Kusadokoro
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Makiko Mieno
- Department of Medical Informatics, Center for Information, Jichi Medical University, Tochigi, Japan
| | - Naoyuki Kimura
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Atsushi Yamaguchi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| |
Collapse
|
50
|
Vo AT, Nakajima T, Nguyen TTT, Nguyen NTH, Le NB, Cao TH, Nguyen DH. Aortic prosthetic size predictor in aortic valve replacement. J Cardiothorac Surg 2021; 16:221. [PMID: 34348752 PMCID: PMC8336273 DOI: 10.1186/s13019-021-01601-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/28/2021] [Indexed: 11/16/2022] Open
Abstract
Background Patient-prosthesis mismatch (PPM) is a major concern in aortic valve replacement (AVR) and leads to perioperative morbidity and rehospitalization. Predicting aortic annulus diameter pre-procedurally is crucial to managing patients with high-risk of PPM. Objectives To compare preoperative measurements of aortic annulus from echocardiography and CT scan with surgical sizing and develop an imaging-based algorithm to predict PPM.
Methods From January 2017 to December 2020, patients underwent AVR at a teaching hospital were examined. The relationship between imaging measurements with operative values was assesed using scatter plots and Pearson’s correlation coefficient. Univariable linear regression was then used to build the predictive model. Results A total of 144 patients underwent AVR during the study period. Suture types and surgical approaches were not significantly associated with prosthesis size. CT scan-based measurements showed strong correlation with prosthesis size: mean diameter (R = 0.79), perimeter-derived diameter (R = 0.76), and area-derived diameter (R = 0.75). Mechanical valve and tissue valve shared similar correlation coefficients. Prosthesis size predictive models based on CT scan were 12.89 + 0.335 × d for mean diameter, 13.275 + 0.315 × d for perimeter-derived diameter and 13.626 + 0.309 × d for area-derived diameter. Conclusions Preoperative CT scan measurements are a reliable predictor of aortic prosthesis size. Transthoracic echocardiography is a possible alternative, though it is highly performer-dependent and unable to represent the aortic annulus fully. Together, these two imaging modalities can be used to quantitatively anticipate PPM preoperatively.
Collapse
Affiliation(s)
- Anh Tuan Vo
- Department of Cardiovascular Surgery, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, 215 Hong Bang Street, District 5, Ho Chi Minh City, Vietnam
| | - Tomomi Nakajima
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Trang Thi Thu Nguyen
- Department of Cardiovascular Surgery, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, 215 Hong Bang Street, District 5, Ho Chi Minh City, Vietnam
| | - Nguyen Thoi Hai Nguyen
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nga Bich Le
- Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tri Huu Cao
- Department of Surgery, Nguyen Tri Phuong Hospital, Ho Chi Minh City, Vietnam
| | - Dinh Hoang Nguyen
- Department of Cardiovascular Surgery, University Medical Center, University of Medicine and Pharmacy at Ho Chi Minh City, 215 Hong Bang Street, District 5, Ho Chi Minh City, Vietnam. .,Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
| |
Collapse
|