1
|
Duz R, Cibuk S. Severity of Mitral Valve Stenosis - Possible Relationships With Blood Oxidant Markers and Antioxidants. Circ J 2024; 88:597-605. [PMID: 36858609 DOI: 10.1253/circj.cj-22-0750] [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: 03/03/2023]
Abstract
BACKGROUND This study examined whether the severity of mitral valve stenosis (MVS) is associated with oxidative stress (OS) markers in the blood, and other hematological and clinicodemographic parameters.Methods and Results: This prospective study was conducted between March and May 2022. Seventy-five patients with newly diagnosed MVS (25 mild, 25 moderate, 25 severe) were included. Mild, moderate, and severe MVS was defined as MV area >2, 1.5-2, and <1.5 cm2, respectively. Various OS markers and laboratory parameters were determined in venous blood samples. For predictive analyses, 2 different analyses were performed to detect patients with severe MVS and those with moderate or severe (moderate/severe) MVS. Age (P=0.388) and sex (P=0.372) distribution were similar in the 3 groups. Multiple logistic regression analysis revealed that a high white blood cell (WBC) count (P=0.023) and high malondialdehyde (P=0.010), superoxide dismutase (SOD; P=0.008), and advanced oxidation protein products (AOPP; P=0.007) levels were independently associated with severe MVS. A low platelet count (P=0.030) and high malondialdehyde (P=0.018), SOD (P=0.008), and AOPP (P=0.001) levels were independently associated with having moderate/severe MVS. The best discriminatory factors for severe MVS were SOD (cut-off >315.5 ng/mL) and glutathione (cut-off >4.7 μmol/L). CONCLUSIONS MVS severity seems to be affected by oxidant markers (malondialdehyde and AOPP), antioxidant enzymes (SOD), and inflammation-related cells (WBC and platelets). Future studies are needed to examine these relationships in larger populations.
Collapse
Affiliation(s)
- Ramazan Duz
- Department of Cardiology, Yuzuncu Yil University Faculty of Medicine
| | - Salih Cibuk
- Van Vocational Higher School of Healthcare Studies, Van Yuzuncu Yil University
| |
Collapse
|
2
|
Ntinopoulos V, Rodriguez Cetina Biefer H, Papadopoulos N, Dushaj S, Haeussler A, Dzemali O. Isolated Minimally Invasive Mitral Valve Surgery in Octogenarians: Perioperative Outcome. Gerontology 2023; 69:1211-1217. [PMID: 37647873 DOI: 10.1159/000533560] [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: 02/18/2023] [Accepted: 08/08/2023] [Indexed: 09/01/2023] Open
Abstract
INTRODUCTION Despite the feasibility, safety, and excellent outcomes of mitral valve surgery through a right mini-thoracotomy, there is data paucity about its use in octogenarians. In this study, we assess the outcomes of mitral valve surgery via right mini-thoracotomy in octogenarians. METHODS We performed a retrospective analysis of the in-hospital perioperative data of 38 octogenarian patients with severe mitral regurgitation undergoing isolated mitral valve surgery via right mini-thoracotomy from 2013 to 2021 in our institution. RESULTS The median patient age was 82 (81-83) years, and the median EuroSCORE II was 3.1% (2.3-4.9). A total of 19 (50%) patients underwent mitral valve repair. The median cardiopulmonary bypass duration was 78 (54-100) min and the median aortic cross-clamping duration was 57 (40-70) min. Two (5.3%) patients were converted to sternotomy, 1 (2.6%) underwent renal replacement therapy, 5 (13.2%) underwent reexploration for bleeding or tamponade, and 12 (31.6%) underwent permanent pacemaker implantation. The surgical repair success rate was 89.5%, with 2 (10.5%) patients requiring reoperation due to repair failure. No other patients required reoperation on the mitral valve. The median intensive care unit stay was 1 (1-2) day, and the median postoperative stay was 9.5 (8-14) days. There was no perioperative stroke or death. CONCLUSION Despite a relatively increased risk of pacemaker implantation and reexploration for bleeding, our data support the feasibility of mitral valve surgery via a right mini-thoracotomy in octogenarians, with short ischemic times, low overall in-hospital morbidity, and no mortality. Preferring replacement in mitral diseases with a high risk for repair failure could minimize reoperations in this high-risk subgroup.
Collapse
Affiliation(s)
- Vasileios Ntinopoulos
- Department of Cardiac Surgery, City Hospital of Zurich - Site Triemli, Zurich, Switzerland
| | | | - Nestoras Papadopoulos
- Department of Cardiac Surgery, City Hospital of Zurich - Site Triemli, Zurich, Switzerland
| | - Stak Dushaj
- Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Achim Haeussler
- Department of Cardiac Surgery, City Hospital of Zurich - Site Triemli, Zurich, Switzerland
- Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Omer Dzemali
- Department of Cardiac Surgery, City Hospital of Zurich - Site Triemli, Zurich, Switzerland
- Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
3
|
Paille M, Senage T, Roussel JC, Manigold T, Piccoli M, Chapelet G, Le Tourneau T, Karakachoff M, Berrut G, de Decker L, Boureau AS. Association of Preoperative Geriatric Assessment With Length of Stay After Combined Cardiac Surgery. Ann Thorac Surg 2020; 112:763-769. [PMID: 33227273 DOI: 10.1016/j.athoracsur.2020.09.041] [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: 09/19/2019] [Revised: 08/22/2020] [Accepted: 09/22/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND For older patients undergoing cardiac surgery, geriatric factors are known to increase postoperative complications and prolong length of stay (LOS). Comprehensive geriatric assessment (CGA) is an evidence-based method for geriatric evaluation to develop an individualized-care plan to optimize physical, functional, and social issues. This study analyzed the association between preoperative CGA and hospital LOS after combined cardiac surgery. METHODS This retrospective monocentric study included all patients aged 75 years and greater who underwent combined cardiac surgery between 2014 and 2017. Hospital LOS, intensive care unit LOS, and postoperative complications were compared between patients with or without preoperative CGA before and after propensity-score matching. RESULTS Mean age of the 407 patients was 79.6 years; 114 underwent a preoperative CGA (28%). For 305 patients (74.9%), coronary artery bypass was associated with aortic valve replacement. After propensity-score matching, a significant difference was found between the 2 groups (preoperative CGA versus none) for in-hospital LOS (12 versus 13 days; P = .04) and intensive care unit LOS (3 versus 4 days; P = .01). In multivariable analysis, a significant association remained between hospital LOS and CGA (P = .02), renal function (P = .02), mitral replacement (P = .001), and complications (P = .001). CONCLUSIONS Our results favor the use of systematic preoperative CGA. These encouraging results need to be validated by prospective studies that assess the impact of individualized-care plan established after CGA on postoperative outcomes. With an aging population, efforts are required to determine how to implement preoperative individualized-care plans to improve postoperative outcomes for vulnerable patients undergoing cardiac surgery.
Collapse
Affiliation(s)
| | - Thomas Senage
- Department of Thoracic and Cardiovascular Surgery, Institut du Thorax, University Hospital, Nantes, France
| | - Jean-Christian Roussel
- Department of Thoracic and Cardiovascular Surgery, Institut du Thorax, University Hospital, Nantes, France; Université de Nantes, CHU Nantes, CNRS, INSERM, Institut du Thorax, Nantes, France
| | - Thibaut Manigold
- Department of Cardiology, Institut du Thorax, University Hospital, Nantes, France
| | - Matthieu Piccoli
- Department of Geriatrics, Hopital Broca, Université Paris-Descartes, Paris, France
| | | | - Thierry Le Tourneau
- Université de Nantes, CHU Nantes, CNRS, INSERM, Institut du Thorax, Nantes, France
| | | | - Gilles Berrut
- Department of Geriatrics, University Hospital, Nantes, France
| | - Laure de Decker
- Department of Geriatrics, University Hospital, Nantes, France
| | - Anne Sophie Boureau
- Department of Geriatrics, University Hospital, Nantes, France; Université de Nantes, CHU Nantes, CNRS, INSERM, Institut du Thorax, Nantes, France.
| |
Collapse
|
4
|
Rostagno C. Heart valve disease in elderly. World J Cardiol 2019; 11:71-83. [PMID: 30820277 PMCID: PMC6391621 DOI: 10.4330/wjc.v11.i2.71] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/13/2019] [Accepted: 01/26/2019] [Indexed: 02/06/2023] Open
Abstract
The incidence of heart valve disease increases significantly with age. Degenerative abnormalities associated with severe aortic stenosis and mitral and tricuspid regurgitation are found in not less than 10% of the population aged ≥ 75 years. Surgical treatment has been considered for years to be the treatment of choice. However, it was not uncommonly associated with high perioperative morbidity and mortality due to frequent comorbidities and overall frailty conditions of these patients. Conventional risk scores such as Society of Thoracic Surgeons and European System for Cardiac Operative Risk Evaluation may underestimate the risk of surgery in elderly patients, leading to inappropriate surgical indication. On the other hand, at least 30% of patients with severe conditions are left untreated due to prohibitive surgical risk. Interventional procedures, which are in continuous development, may be actually considered for high risk patients and, as recent results suggest, also for intermediate risk patients.
Collapse
Affiliation(s)
- Carlo Rostagno
- Department of Internal Medicine, University of Florence, Florence 50134, Italy
| |
Collapse
|
5
|
Meta-Analysis Comparing Mitral Valve Repair Versus Replacement for Degenerative Mitral Regurgitation Across All Ages. Am J Cardiol 2019; 123:446-453. [PMID: 30471709 DOI: 10.1016/j.amjcard.2018.10.024] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/13/2018] [Accepted: 10/15/2018] [Indexed: 10/27/2022]
Abstract
Although current guidelines recommend mitral valve repair (MVr) over mitral valve replacement (MVR) for patients with mitral regurgitation (MR), it is unclear if it should be also recommended in elderly patients with limited life expectancy. This study was conducted to compare the results of MVr with those of MVR to determine the optimal treatment option for patients with degenerative MR, particularly according to the patient's age. A literature search of 5 electronic databases was performed. The primary outcome was all-cause mortality. The secondary outcomes included early mortality and freedom from reoperation. A metaregression analysis and subgroup analysis were performed according to the mean age of the study population. Twelve retrospective studies (2,950 and 1,252 patients in the MVr and MVR groups, respectively) were selected. Pooled analyses demonstrated that the risk of all-cause mortality was significantly higher in the MVR group than in the MVr group both in all studies and in studies presenting adjusted results (hazard ratio[95% confidence interval] = 1.57[1.39 to 1.77] and 1.53[1.34 to 1.74], respectively). This benefit was similar across all ages when the metaregression analysis and the subgroup analysis were performed (p = 0.879 and 0.123, respectively). Early mortality and risk of reoperation were also higher in the MVR group than in the MVr group (risk ratio[95% confidence interval] = 4.51[3.12 to 6.51] and hazard ratio[95% confidence interval] = 1.47[1.09 to 1.98], respectively). In conclusion, this study indicates that MVr is beneficial compared with MVR in patients with degenerative MR regardless of patients' age in terms of all-cause mortality.
Collapse
|
6
|
Shang X, Lu R, Liu M, Xiao S, Dong N. Mitral valve repair versus replacement in elderly patients: a systematic review and meta-analysis. J Thorac Dis 2017; 9:3045-3051. [PMID: 29221278 DOI: 10.21037/jtd.2017.08.43] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Although mitral valve repair (MVP) is generally accepted as the standard treatment for mitral valve disease, in older patients, there is increasing debate about whether MVP is superior to mitral valve replacement (MVR). We, therefore, performed a meta-analysis to compare MVP vs. MVR in the elderly population. Methods We systematically searched PubMed, the Cochrane Library, and Scopus up to February 2017 and scrutinized the references of relevant literatures. Only studies of MVP vs. MVR in the elderly patients (aged 70 years or older) that were published after 2000 were included. Results The retrieval process yielded seven observational clinical studies with 1,809 patients. Compared with MVR, MVP was associated with a significantly reduced 30-day mortality [risk ratio (RR): 0.40, 95% confidence interval (CI): 0.25-0.64], with shorter duration of postoperative hospital stay (days) (weighted mean difference: -1.47, 95% CI: -2.47--0.48) and less postoperative complications (RR: 0.69, 95% CI: 0.56-0.86). In addition, our study also demonstrated improved 1-year (RR: 1.16, 95% CI: 1.08-1.24) and 5-year (RR: 1.26, 95% CI: 1.13-1.41) survival rates following MVP. There was no difference in reoperations between these two surgery approaches. Conclusions The present meta-analysis indicates that elderly patients who receive MVP have better early and late outcomes than those undergoing MVR. MVP may be the preferred strategy for mitral valve surgery in the elderly population.
Collapse
Affiliation(s)
- Xiaoke Shang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Rong Lu
- Department of Intensive Care Unit, Wuhan No. 1 Hospital, Wuhan 430022, China
| | - Mei Liu
- Department of Intensive Care Unit, Wuhan No. 1 Hospital, Wuhan 430022, China
| | - Shuna Xiao
- Pediatric Intensive Care Unit, Hubei Maternal and Child Health Hospital, Wuhan 430022, China
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| |
Collapse
|
7
|
Alozie A, Paranskaya L, Westphal B, Kaminski A, Sherif M, Sindt M, Kische S, Schubert J, Diedrich D, Ince H, Steinhoff G, Öner A. Clinical outcomes of conventional surgery versus MitraClip® therapy for moderate to severe symptomatic mitral valve regurgitation in the elderly population: an institutional experience. BMC Cardiovasc Disord 2017; 17:85. [PMID: 28320316 PMCID: PMC5360063 DOI: 10.1186/s12872-017-0523-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 03/11/2017] [Indexed: 01/27/2023] Open
Abstract
Background The aim of this study was to compare treatment of moderate to severe symptomatic mitral regurgitation (MR) with either conventional surgery or the mitral valve edge-to-edge device (MitraClip®) in very elderly patients. The newly introduced MitraClip device has demonstrated promising acute results in treating this patient cohort. Also noteworthy is the fact that patients who otherwise would have been denied surgery are increasingly referred for treatment with the MitraClip device. We sought to review our institutional experience, comparing outcomes in both surgical and MitraClip arms of treatment in the elderly population with symptomatic MR. Methods From October 2008 through October 2014, 136 consecutive patients aged ≥ 80 with moderate to severe symptomatic MR were scheduled for either conventional surgery or MitraClip intervention. 56 patients ≥ 80 were operated for symptomatic MR and 80 patients ≥ 80 were treated with the mitraClip device. Patients suitable for this study were identified from our hospital database. Patients ≥80 with moderate/severe symptomatic MR treated with either conventional surgery or the MitraClip device were eligible for our analysis. We compared the surgical patient cohort with the mitraClip patient cohort after eliminating patients that did not meet our inclusion criteria. Forty-two patients were identified from the conventional cohort who were then compared with 42 patients from the mitraClip cohort. Forty-two patients (50%) underwent mitral valve repair or replacement (40.5% functional MR, 59.5% organic/mixed MR) and 42 patients (50%) underwent MitraClip intervention (50% functional MR, 50% organic/mixed MR). Associated procedures in the conventional surgical group were myocardial revascularization 38%, pulmonary vein ablation 23.8%, left atrial appendage resection 52.4% and PFO occlusion 11.9%. Results Patients who underwent MitraClip treatment were though slightly older but the differences did not attain statistical significance (mean, 82.2 ± 1.65 vs 81.7 ± 1.35 years, p = 0,100), had lower LVEF (mean, 47.6 ± 14.2 vs 53.4 ± 14.3, p = 0.072), lower logistic EuroScore II (mean, 11.3 ± 5.63 vs 12.1 ± 10.6, p = 0.655) but higher STS risk score (mean, 11.8 ± 6.7 vs 8.1 ± 5.6, p = 0.008) respectively compared to surgical patients. Procedural success was 100% vs 96% in surgery and MitraClip groups respectively. Thirty -day mortality was 7.1% vs 4.8% (p = 1.000) in surgery and MitraClip group respectively. Residual postoperative MR ≥2 at discharge was present in none of the patients treated surgically, whereas this was the case in 10 (23.8%) patients treated with the MitraClip device. At 1 year a cumulative number of four (9.52%) patients died in the surgical group vs 9 (21.4%) patients who died in the MitraClip group. Conclusions Elderly patients presenting with moderate to severe symptomatic MR may either be treated by conventional surgery or with the MitraClip device with acceptable acute outcomes. The decision for treatment with the MitraClip device should not depend on age alone rather on cumulative risk of conventional surgery. Concomitant cardiac pathologies, often times treated simultaneously during surgery for symptomatic MR may be omitted, if patients are scheduled outright to MitraClip treatment. The effect of concomitant cardiac pathologies left untreated at the time of interventional mitral valve repair on outcome after MitraClip therapy remain widely unknown.
Collapse
Affiliation(s)
- Anthony Alozie
- Department of Cardiac Surgery, Heart Center Rostock, Schillingallee 35, 18057, Rostock, Germany.
| | - Liliya Paranskaya
- Department of Cardiology, Heart Center Rostock, Ernst-Heydemannstrasse 6, 18057, Rostock, Germany
| | - Bernd Westphal
- Department of Cardiac Surgery, Heart Center Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Alexander Kaminski
- Department of Cardiac Surgery, Heart Center Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Mohammad Sherif
- Department of Cardiology, Heart Center Rostock, Ernst-Heydemannstrasse 6, 18057, Rostock, Germany
| | - Magnus Sindt
- Department of Cardiac Surgery, Heart Center Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Stephan Kische
- Kardiologie und Konservative Intensivmedizin, Landsbergerallee 49, 10249, Berlin, Germany
| | - Jochen Schubert
- Department of Anesthesiology and Intensive Care Medicine, Heart Center Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Doreen Diedrich
- Institute For Biostatistics and Informatics in Medicine And Ageing Research, Ernst Heydemanstr. 8, 18057, Rostock, Germany
| | - Hüseyin Ince
- Department of Cardiology, Heart Center Rostock, Ernst-Heydemannstrasse 6, 18057, Rostock, Germany
| | - Gustav Steinhoff
- Department of Cardiac Surgery, Heart Center Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Alper Öner
- Department of Cardiology, Heart Center Rostock, Ernst-Heydemannstrasse 6, 18057, Rostock, Germany
| |
Collapse
|
8
|
Feng W, Coady M. Epicardial Tachosil Patch Repair of Ventricular Rupture in a 90-Year-Old After Mitral Valve Replacement. Ann Thorac Surg 2017; 101:2361-3. [PMID: 27211944 DOI: 10.1016/j.athoracsur.2015.07.066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 07/07/2015] [Accepted: 07/20/2015] [Indexed: 10/21/2022]
Abstract
We report our experience with emergent treatment of ventricular rupture following a mitral valve replacement in a 90 year-old male. The repair was performed using a Tachosil patch (Baxter Health Care Corporation, Westlake Village, California), a fibrin sealant coated on an equine collagen sponge, and BioGlue (Cryolife, Kenneson, GA) and bovine pericardium (Edwards Lifesciences, Irvine, CA). Aside from early ventricular dysfunction requiring a low-dose dopamine infusion, this patient's recovery was uneventful. Follow-up echocardiograms demonstrated no gross anatomic abnormality at the repair site, and steady improvement in his ventricular function.
Collapse
Affiliation(s)
- William Feng
- Division of Cardiac Surgery, Department of Surgery, Stamford Hospital, Stamford, Connecticut.
| | - Michael Coady
- Division of Cardiac Surgery, Department of Surgery, Stamford Hospital, Stamford, Connecticut
| |
Collapse
|
9
|
Ramot Y, Rousselle SD, Yellin N, Willenz U, Sabag I, Avner A, Nyska A. Biocompatibility and Systemic Safety of a Novel Implantable Annuloplasty Ring for the Treatment of Mitral Regurgitation in a Minipig Model. Toxicol Pathol 2016; 44:655-62. [DOI: 10.1177/0192623315627217] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Prosthetic annuloplasty rings are a common treatment modality for mitral regurgitation, and recently, percutaneous implantation techniques have gained popularity due to their favorable safety profile. Although in common use, biocompatibility of annuloplasty rings has been reported only sparsely in the literature, and none of these reports used the percutaneous technique of implantation. We report on the biocompatibility and the systemic safety of a novel transcatheter mitral valve annuloplasty ring (AMEND™) in 6 minipigs. This device is composed of a nitinol tube surrounded by a braided polyethylene terephthalate fabric tube. The device produced no adverse inflammatory response, showing gradual integration between the metal ring and the fabric by normal host fibrocellular response, leading to complete neoendocardium coverage. There was no evidence for adverse reactions, rejection, or intolerance in the valvular structure. In 2 animals, hemopericardium resulted from the implantation procedure, leading to right-sided cardiac insufficiency with pulmonary edema and liver congestion. The findings reported herein can serve as a case study for the expected healing pathology reactions after implantation of transcatheter mitral valve annuloplasty rings.
Collapse
Affiliation(s)
- Yuval Ramot
- Hadassah—Hebrew University Medical Center, Jerusalem, Israel
| | | | | | - Udi Willenz
- The Institute of Animal Research, Kibbutz Lahav, Israel
| | - Itai Sabag
- The Institute of Animal Research, Kibbutz Lahav, Israel
| | | | - Abraham Nyska
- Tel Aviv University and Consultant in Toxicologic Pathology, Timrat, Israel
| |
Collapse
|
10
|
Castellant P, Didier R, Bezon E, Couturaud F, Eltchaninoff H, Iung B, Donzeau-Gouge P, Chevreul K, Fajadet J, Leprince P, Leguerrier A, Lievre M, Prat A, Teiger E, Laskar M, Boschat J, Gilard M. Comparison of Outcome of Transcatheter Aortic Valve Implantation With Versus Without Previous Coronary Artery Bypass Grafting (from the FRANCE 2 Registry). Am J Cardiol 2015; 116:420-5. [PMID: 26071993 DOI: 10.1016/j.amjcard.2015.04.057] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 04/21/2015] [Accepted: 04/21/2015] [Indexed: 10/23/2022]
Abstract
Previous coronary artery bypass grafting (CABG) increases operative risk in conventional valve replacement. Transcatheter aortic valve implantation (TAVI) has been shown to be successful in high-risk patient subgroups. The present study compared outcome and overall survival in patients who underwent TAVI with and without history of CABG. From January 2010 to December 2011, 683 of the 3,761 patients selected for TAVI in 34 French centers (18%) had a history of CABG. Outcomes (mortality and complications) were collected prospectively according to the Valve Academic Research Consortium (VARC) criteria. Patients with previous CABG were younger, with higher rates of diabetes and vascular disease and higher logistic European System for Cardiac Operative Risk Evaluation (29.8 ± 16.4 vs 20.1 ± 13.0, p <0.001) but lower rates of pulmonary disease. Two types of valve (Edwards SAPIEN and Medtronic CoreValve) were implanted in equal proportions in the 2 groups. The 30-day and 1-year mortality rates from all causes on Kaplan-Meier analysis (9.2% vs 9.7%, p = 0.71; and 19.0% vs 20.2%, p = 0.49, respectively) did not differ according to the history of CABG. There were no significant differences in the Valve Academic Research Consortium complications (myocardial infarction, stroke or vascular, and bleeding complications). On multivariate analysis, CABG was not associated with greater 1-year post-TAVI mortality. In conclusion, previous CABG did not adversely affect outcome in patients who underwent TAVI, which may be an alternative to surgery in high-risk patients with severe aortic stenosis and history of CABG.
Collapse
|
11
|
Grasso C, Capodanno D, Tamburino C, Ohno Y. Current status and clinical development of transcatheter approaches for severe mitral regurgitation. Circ J 2015; 79:1164-71. [PMID: 25947004 DOI: 10.1253/circj.cj-15-0447] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Transcatheter mitral valve intervention has emerged as an effective treatment option for symptomatic severe mitral regurgitation in patients considered to be inoperable or at high operative risk for surgical mitral valve surgery. Most transcatheter approaches are modifications of existing surgical approaches. Transcatheter edge-to-edge mitral valve repair with the MitraClip system has the largest clinical experience to date, as it offers a sustained clinical benefit in selected patients. This review aims to provide an up-to-date overview of transcatheter mitral valve interventions, including leaflet repair, annuloplasty, and mitral valve implantation.
Collapse
Affiliation(s)
- Carmelo Grasso
- Department of Cardiology, Ferrarotto Hospital, University of Catania
| | | | | | | |
Collapse
|
12
|
Scandroglio AM, Finco G, Pieri M, Ascari R, Calabrò MG, Taddeo D, Isella F, Franco A, Musu M, Landoni G, Alfieri O, Zangrillo A. Cardiac surgery in 260 octogenarians: a case series. BMC Anesthesiol 2015; 15:15. [PMID: 25685057 PMCID: PMC4328195 DOI: 10.1186/1471-2253-15-15] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 01/15/2015] [Indexed: 11/21/2022] Open
Abstract
Background The elderly undergo cardiac surgery more and more frequently, often present multiple comorbidities, assume chronic therapies, and present a unique physiology. Aim of our study was to analyze the experience of a referral cardiac surgery center with all types of cardiac surgery interventions performed in patients ≥80 years old over a six years’ period. Methods A retrospective observational study performed in a university hospital. 260 patients were included in the study (3.5% of the patients undergoing cardiac surgery in the study period). Results Mean age was 82 ± 1.8 years. Eighty-five percent of patients underwent elective surgery, 15% unplanned surgery and 4.2% redo surgery. Intervention for aortic valve pathology and coronary artery bypass grafting were performed in 51% and 46% of the patients, respectively. Interventions involving the mitral valve were the 26% of the total, those on the tricuspid valve were 13% and those on the ascending aortic arch the 9.6%. Postoperative low output syndrome was identified in 44 patients (17%). Mortality was 3.9% and most of the patients (91%) were discharged from hospital in good clinical conditions. Hospital mortality was lower in planned vs unplanned surgery: 3.8% vs 14% respectively. Chronic obstructive pulmonary disease (OR 9.106, CI 2.275 – 36.450) was the unique independent predictor of mortality. Conclusions Clinicians should be aware that cardiac surgery can be safely performed at all ages, that risk stratification is mandatory and that hemodynamic treatment to avoid complications is expected. Electronic supplementary material The online version of this article (doi:10.1186/1471-2253-15-15) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Anna Mara Scandroglio
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Gabriele Finco
- Department of Medical Sciences "M. Aresu", Cagliari University, Cagliari, Italy
| | - Marina Pieri
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Roberto Ascari
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Maria Grazia Calabrò
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Daiana Taddeo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Francesca Isella
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Annalisa Franco
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
| | - Mario Musu
- Department of Medical Sciences "M. Aresu", Cagliari University, Cagliari, Italy
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy ; Vita-Salute San Raffaele University, Milan, Italy
| | - Ottavio Alfieri
- Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy ; Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy ; Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
13
|
Outcome of Redo Surgical Aortic Valve Replacement in Patients 80 Years and Older: Results From the Multicenter RECORD Initiative. Ann Thorac Surg 2014; 97:537-43. [DOI: 10.1016/j.athoracsur.2013.09.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 08/27/2013] [Accepted: 09/04/2013] [Indexed: 11/22/2022]
|
14
|
Alfieri O, Pozzoli A. Mitral valve surgery in octogenarians: insights and perspectives. J Cardiothorac Vasc Anesth 2013; 27:201-2. [PMID: 23507011 DOI: 10.1053/j.jvca.2013.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Indexed: 11/11/2022]
|