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Jolliffe J, Moten S, Tripathy A, Skillington P, Tatoulis J, Muneretto C, Di Bacco L, Galvao HBF, Goldblatt J. Perceval valve intermediate outcomes: a systematic review and meta-analysis at 5-year follow-up. J Cardiothorac Surg 2023; 18:129. [PMID: 37041628 PMCID: PMC10091543 DOI: 10.1186/s13019-023-02273-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 04/04/2023] [Indexed: 04/13/2023] Open
Abstract
OBJECTIVES New technologies for the treatment of Aortic Stenosis are evolving to minimize risk and treat an increasingly comorbid population. The Sutureless Perceval Valve is one such alternative. Whilst short-term data is promising, limited mid-term outcomes exist, until now. This is the first systematic review and meta-analysis to evaluate mid-term outcomes in the Perceval Valve in isolation. METHODS A systematic literature review of 5 databases was performed. Articles included evaluated echocardiographic and mortality outcomes beyond 5 years in patients who had undergone Perceval Valve AVR. Two reviewers extracted and reviewed the articles. Weighted estimates were performed for all post-operative and mid-term data. Aggregated Kaplan Meier curves were reconstructed from digitised images to evaluate long-term survival. RESULTS Seven observational studies were identified, with a total number of 3196 patients analysed. 30-day mortality was 2.5%. Aggregated survival at 1, 2, 3, 4 and 5 years was 93.4%, 89.4%, 84.9%, 82% and 79.5% respectively. Permanent pacemaker implantation (7.9%), severe paravalvular leak (1.6%), structural valve deterioration (1.5%), stroke (4.4%), endocarditis (1.6%) and valve explant (2.3%) were acceptable at up to mid-term follow up. Haemodynamics were also acceptable at up mid-term with mean-valve gradient (range 9-13.6 mmHg), peak-valve gradient (17.8-22.3 mmHg) and effective orifice area (1.5-1.8 cm2) across all valve sizes. Cardiopulmonary bypass (78 min) and Aortic cross clamp times (52 min) were also favourable. CONCLUSION To our knowledge, this represents the first meta-analysis to date evaluating mid-term outcomes in the Perceval Valve in isolation and demonstrates good 5-year mortality, haemodynamic and morbidity outcomes. KEY QUESTION What are the mid-term outcomes at up to 5 years follow up in Perceval Valve Aortic Valve Replacement? KEY FINDINGS Perceval Valve AVR achieves 80% freedom from mortality at 5 years with low valve gradients and minimal morbidity. KEY OUTCOMES Perceval Valve Aortic Valve Replacement has acceptable mid-term mortality, durability and haemodynamic outcomes.
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Affiliation(s)
- Jarrod Jolliffe
- Cardiothoracic Department, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, VIC, Australia.
| | - Simon Moten
- Cardiothoracic Department, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, VIC, Australia
| | - Amit Tripathy
- Cardiothoracic Department, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, VIC, Australia
| | - Peter Skillington
- Cardiothoracic Department, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, VIC, Australia
| | - James Tatoulis
- Cardiothoracic Department, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, VIC, Australia
| | | | - Lorenzo Di Bacco
- School of Cardiac Surgery, University of Brescia, Brescia, Italy
| | | | - John Goldblatt
- Cardiothoracic Department, Royal Melbourne Hospital, 300 Grattan Street Parkville, Melbourne, VIC, Australia
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Tayama E, Saku K, Anegawa T, Oryoji A, Negoto S. Prosthetic cardiac valves: history and review of cardiac prostheses clinically available in Japan. Surg Today 2022; 52:521-531. [PMID: 34435247 DOI: 10.1007/s00595-021-02361-y] [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: 12/14/2020] [Accepted: 04/10/2021] [Indexed: 10/20/2022]
Abstract
Recently developed prosthetic valves are reliable and essential for the treatment of valvular heart disease. The mechanical valve evolved remarkably following the introduction of pyrolite carbon material, which enabled the creation of a bileaflet form incorporated with a pivot mechanism. The improved durability of the biological valve is attributed mainly to the development of a tissue fixation process and anti-calcification treatments. However, optimal antithrombogenicity and durability have not yet been achieved for either prosthetic valve type. To select the most suitable prosthetic valve for each individual patient from among the many clinically available prosthetic valves, it is necessary to have a thorough understanding of the characteristics of each valve.
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Affiliation(s)
- Eiki Tayama
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume City, Fukuoka, 830-0011, Japan.
| | - Kosuke Saku
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume City, Fukuoka, 830-0011, Japan
| | - Tomoyuki Anegawa
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume City, Fukuoka, 830-0011, Japan
| | - Atsunobu Oryoji
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume City, Fukuoka, 830-0011, Japan
| | - Shinya Negoto
- Division of Cardiovascular Surgery, Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume City, Fukuoka, 830-0011, Japan
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Casenghi M, Rubbio AP, Menicanti L, Bedogni F, Testa L. Durability of surgical and transcatheter aortic bioprostheses. A review of the literature. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 42:161-170. [DOI: 10.1016/j.carrev.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/07/2022] [Accepted: 03/07/2022] [Indexed: 11/03/2022]
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Persson M, Glaser N, Nilsson J, Friberg Ö, Franco-Cereceda A, Sartipy U. Comparison of Long-term Performance of Bioprosthetic Aortic Valves in Sweden From 2003 to 2018. JAMA Netw Open 2022; 5:e220962. [PMID: 35254431 PMCID: PMC8902647 DOI: 10.1001/jamanetworkopen.2022.0962] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE The performance of bioprosthetic aortic valves is usually assessed in single valve models or head-to-head comparisons. National databases or registries offer the opportunity to investigate all available valve models in the population and allows for a comparative assessment of their performance. OBJECTIVE To analyze the long-term rates of reintervention, all-cause mortality, and heart failure hospitalization associated with commonly used bioprosthetic aortic valves and to identify valve model groups with deviation in clinical performance. DESIGN, SETTING, AND PARTICIPANTS This population-based, nationwide cohort study included all adult patients who underwent surgical aortic valve replacement (with or without concomitant coronary artery bypass surgery or ascending aortic surgery) in Sweden between January 1, 2003, and December 31, 2018. Patients were identified from the SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) registry. Patients with concomitant valve surgery, previous cardiac surgery, and previous transcatheter valve replacement were excluded. Follow-up was complete for all participants. Data were analyzed from March 9, 2020, to October 12, 2021. EXPOSURES Primary surgical aortic valve replacement with the Perimount, Mosaic/Hancock, Biocor/Epic, Mitroflow/Crown, Soprano, and Trifecta valve models. MAIN OUTCOMES AND MEASURES The primary outcome was cumulative incidence of reintervention, defined as a subsequent aortic valve operation or transcatheter valve replacement. Secondary outcomes were all-cause mortality and heart failure hospitalization. Regression standardization and flexible parametric survival models were used to account for intergroup differences. Mean follow-up time was 7.1 years, and maximum follow-up time was 16.0 years. RESULTS A total of 16 983 patients (mean [SD] age, 72.6 [8.5] years; 10 685 men [62.9%]) were included in the analysis. The Perimount valve model group had the lowest and the Mitroflow/Crown valve model group had the highest cumulative incidence of reintervention. The estimated cumulative incidence of reintervention at 10 years was 3.6% (95% CI, 3.1%-4.2%) in the Perimount valve model group and 12.2% (95% CI, 9.8%-15.1%) in the Mitroflow/Crown valve model group. The estimated incidence of reintervention at 10 years was 9.3% (95% CI, 7.3%-11.3%) in the Soprano valve model group. CONCLUSIONS AND RELEVANCE Results of this study showed that the Perimount valve was the most commonly used and had the lowest incidence of reintervention, all-cause mortality, and heart failure hospitalization, whereas the Mitroflow/Crown valve had the highest rates. These findings highlight the need for clinical vigilance in patients who receive either a Soprano or Mitroflow/Crown aortic bioprosthesis.
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Affiliation(s)
- Michael Persson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Natalie Glaser
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Stockholm South General Hospital, Stockholm, Sweden
| | - Johan Nilsson
- Department of Translational Medicine, Cardiothoracic Surgery and Bioinformatics, Lund University, Lund, Sweden
- Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Lund, Sweden
| | - Örjan Friberg
- Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden
| | - Anders Franco-Cereceda
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Ulrik Sartipy
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
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2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg 2021; 162:e183-e353. [PMID: 33972115 DOI: 10.1016/j.jtcvs.2021.04.002] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Abstract
Aortic stenosis is the most common valvular disease requiring valve replacement. Valve replacement therapies have undergone progressive evolution since the 1960s. Over the last 20 years, transcatheter aortic valve replacement has radically transformed the care of aortic stenosis, such that it is now the treatment of choice for many, particularly elderly, patients. This review provides an overview of the pathophysiology, presentation, diagnosis, indications for intervention, and current therapeutic options for aortic stenosis.
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Affiliation(s)
- Marko T Boskovski
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA
| | - Thomas G Gleason
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA
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Marsico R, Zakkar M, Bruno VD, Mansour S, Bryan AJ, Angelini GD. The impact of patient-prosthesis mismatch on early and long-term survival after aortic replacement with the Edwards Perimount valve: A propensity score-matched analysis. J Card Surg 2021; 36:2269-2276. [PMID: 33821500 DOI: 10.1111/jocs.15534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND To investigate the impact of severe patient-prosthesis mismatch (PPM) related to the Edwards Lifesciences Perimount (EP) bioprosthesis in the aortic position on early in-hospital outcomes and long-term survival. METHODS A total of 5964 consecutive patients underwent aortic valve replacement at the Bristol Heart Institute between 1998 and 2014, 2667 representing the cohort of this study received EP. PPM was defined severe as EOAi < 0.65 cm2 /m2 . To minimize bias, propensity score matching was conducted and two groups A and B (without and with severe PPM) of 320 patients with similar preoperative characteristics were matched. We assessed early in-hospital outcomes including CVA, re-exploration for bleeding, low cardiac output, wound infection, acute renal injury, length of hospital stay, and long-term survival for both groups in unmatched and matched populations. RESULTS In the unmatched analysis, 18.3% of patients had severe PPM. Severe PPM was not associated with increased in-hospital mortality (4.5% vs. 2.9%, respectively, p = .09) or any other early adverse outcomes except increased length of hospital stay (10.57 ± 8.2 vs. 11.7 ± 9.4, respectively, p = .01). Long-term survival differed significantly between groups at 2 and 8 years (91.8% vs. 91.4% and 60.5% vs. 55.7%, respectively, p = .02). Matched analysis showed no differences between the groups in early health outcomes and overall survival at 2 and 8 years was also similar (89.7% vs. 91% and 57.3% vs. 58%, group A vs. B, respectively p = .9). CONCLUSION Presence of PPM does not seem to affect early in-hospital outcomes or late survival when using EP in patients undergoing aortic valve replacement.
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Affiliation(s)
- Roberto Marsico
- Faculty of Health Sciences, Bristol Heart Institute, Bristol Royal Infirmary, University of Bristol, Bristol, UK
| | - Mustafa Zakkar
- Department of Cardiovascular Sciences, Clinical Sciences Wing, University of Leicester, Glenfield Hospital, Leicester, UK
| | - Vito D Bruno
- Faculty of Health Sciences, Bristol Heart Institute, Bristol Royal Infirmary, University of Bristol, Bristol, UK
| | - Sherif Mansour
- Department of Cardiovascular Sciences, Clinical Sciences Wing, University of Leicester, Glenfield Hospital, Leicester, UK
| | - Alan J Bryan
- Faculty of Health Sciences, Bristol Heart Institute, Bristol Royal Infirmary, University of Bristol, Bristol, UK
| | - Gianni D Angelini
- Faculty of Health Sciences, Bristol Heart Institute, Bristol Royal Infirmary, University of Bristol, Bristol, UK
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 143:e72-e227. [PMID: 33332150 DOI: 10.1161/cir.0000000000000923] [Citation(s) in RCA: 527] [Impact Index Per Article: 175.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 77:e25-e197. [PMID: 33342586 DOI: 10.1016/j.jacc.2020.11.018] [Citation(s) in RCA: 721] [Impact Index Per Article: 240.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Chowdhury UK, Singh S, George N, Kapoor PM, Sankhyan LK, Sengupta S, Vaswani P, Angadi S, Chittimuri C. Technical Details of Aortic Valve Replacement using Carpentier–Edwards PERIMOUNT Magna Ease Aortic Bioprosthesis in a Sexagenarian Patient with Severe Calcific Aortic Stenosis: A Video Presentation. JOURNAL OF CARDIAC CRITICAL CARE TSS 2020. [DOI: 10.1055/s-0040-1721189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Ujjwal K. Chowdhury
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Sukhjeet Singh
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Niwin George
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Poonam Malhotra Kapoor
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | | | - Sanjoy Sengupta
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Prateek Vaswani
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Suryalok Angadi
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Chaitanya Chittimuri
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
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Rajab TK, Ali JM, Hernández-Sánchez J, Mackie J, Grimaudo V, Sinichino S, Mills C, Rana B, Dunning J, Abu-Omar Y. Mid-term follow-up after aortic valve replacement with the Carpentier Edwards Magna Ease prosthesis. J Cardiothorac Surg 2020; 15:209. [PMID: 32746882 PMCID: PMC7397680 DOI: 10.1186/s13019-020-01248-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 07/20/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Approximately 250,000 heart valve operations are performed annually worldwide. An intensive research and development effort has led to progressively more advanced heart valve prostheses. The Carpentier-Edwards Perimount Magna Ease (CEPME) prosthesis represents the latest iteration of the Edwards Perimount series of aortic tissue valves. The current study aims to evaluate the midterm performance of this bioprosthesis. METHODS Five hundred and eighteen patients with aortic stenosis underwent aortic valve replacement with the CEPME valve at Papworth Hospital between August 2008 and November 2011. After a minimum of 3 years from the index operation, eligible patients were retrospectively and consecutively recruited to participate. Recruitment was closed after 100 eligible patients had completed all study assessments. Investigations at follow-up included echocardiography, and NYHA status. Primary endpoints included valve performance measures. RESULTS The mean age was 72 years, 64% were male and median follow-up was 5.1 years. NYHA status had improved in 66% of patients. The average postoperative peak and mean pressure gradients decreased by 51.2 mmHg (64.5%) and 31.8 mmHg (59.4%), with a significant improvement in NYHA status. The frequency of moderate aortic regurgitation was 3%. There was no evidence for structural valve deterioration. CONCLUSIONS The CEPME has excellent mid-term durability. Its use effectively improves haemodynamics and functional capacity.
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Affiliation(s)
- Taufiek K Rajab
- Department of Cardiac Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Jason M Ali
- Department of Cardiac Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Jules Hernández-Sánchez
- Papworth Trial Unit Collaboration, Papworth Hospital, Cambridge, UK
- Biostatistics Unit, Cambridge Institute of Public Health, Cambridge, UK
| | - Jennifer Mackie
- Papworth Trial Unit Collaboration, Papworth Hospital, Cambridge, UK
| | - Vincenzo Grimaudo
- Edwards Lifesciences SA, Route de l'Etraz 70, 1260, Nyon, Switzerland
| | - Silvia Sinichino
- Edwards Lifesciences SA, Route de l'Etraz 70, 1260, Nyon, Switzerland
| | - Christine Mills
- Papworth Trial Unit Collaboration, Papworth Hospital, Cambridge, UK
| | - Bushra Rana
- Department of Cardiology, Papworth Hospital, Cambridge, UK
| | - John Dunning
- Department of Cardiac Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Yasir Abu-Omar
- Department of Cardiac Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK.
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Boskovski MT, Nguyen TC, McCabe JM, Kaneko T. Outcomes of Transcatheter Aortic Valve Replacement in Patients With Severe Aortic Stenosis. JAMA Surg 2020; 155:69-77. [DOI: 10.1001/jamasurg.2019.4449] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Marko T. Boskovski
- Division of Cardiac Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Tom C. Nguyen
- Department of Cardiothoracic and Vascular Surgery, University of Texas at Houston
| | | | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
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Lam KY, Koene B, Timmermans N, Soliman-Hamad M, van Straten A. Reintervention After Aortic Valve Replacement: Comparison of 3 Aortic Bioprostheses. Ann Thorac Surg 2019; 110:615-621. [PMID: 31846642 DOI: 10.1016/j.athoracsur.2019.10.060] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/17/2019] [Accepted: 10/18/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND The decision to implant a biological valve prosthesis is influenced by the issue of durability. We investigated the rate and the cause of reintervention in 3 different aortic valve bioprostheses. METHODS The study included all patients who underwent aortic valve replacement with a biological valve prosthesis between October 2009 and December 2018. Three different bioprostheses were compared: Carpentier-Edwards (CE) Magna Ease (Edwards Lifesciences, Irvine, CA), Trifecta (St. Jude Medical, St Paul, MN), and Mitroflow (LivaNova, London, United Kingdom). The primary end point was the rate of explantation. The degree of event-free survival and possible predictors for reintervention were also analyzed using Cox regression analysis. RESULTS In total, 2004 biological aortic valves were implanted, including 923 CE, 719 Trifecta, and 362 Mitroflow bioprostheses. The CE group had a significantly higher degree of event-free survival (917 [99.3%]) compared with the Trifecta (685 [95.3%]) and Mitroflow (340 [93.9%]) groups (P < .0001). The only cause of reintervention in the CE group was prosthetic valve endocarditis (6 [100%]), whereas structural valve deterioration was the most common cause of reintervention in the Trifecta (14 [41.2%]) and Mitroflow (14 [63.6%]) groups. Cox regression analysis revealed that age (hazard ratio [HR] 0.9; 95% confidence interval [CI], 0.9-0.9; P < .0001) and type of prosthesis (Trifecta: HR, 6.3; 95% CI, 2.6-15.2; P < .0001; Mitroflow: HR, 6.0, 95% CI, 2.4-15.1; P < .0001) were associated with lower event-free survival. CONCLUSIONS The freedom from reintervention after implantation of the CE bioprosthesis is significantly greater than that of the Trifecta and Mitroflow bioprostheses. Further investigations with larger patient populations and long-term follow-up are required to establish their durability and long-term efficacy.
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Affiliation(s)
- Ka Yan Lam
- Heart Center, Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, the Netherlands.
| | - Bart Koene
- Heart Center, Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, the Netherlands
| | - Naomi Timmermans
- Heart Center, Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, the Netherlands
| | - Mohamed Soliman-Hamad
- Heart Center, Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, the Netherlands
| | - Albert van Straten
- Heart Center, Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, the Netherlands
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Cetinkaya A, Poggenpohl J, Bramlage K, Hein S, Doss M, Bramlage P, Schönburg M, Richter M. Long-term outcome after mitral valve replacement using biological versus mechanical valves. J Cardiothorac Surg 2019; 14:120. [PMID: 31253187 PMCID: PMC6599286 DOI: 10.1186/s13019-019-0943-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 06/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study compared long-term outcomes of biological and mechanical mitral valve replacement (MVR) in patients requiring replacement of the mitral valve where repair was not feasible. METHODS A single-centre registry of patients receiving MVR between 2005 and 2015 was established. Thirty-day mortality and long-term outcomes were analysed and compared. RESULTS Three hundred twenty four patients underwent MVR (265 biological; 59 mechanical valves). Patients receiving biological valves were older (p < 0.001), had a higher log EuroSCORE (p < 0.001) and received less minimally invasive surgery (p < 0.001). Immediate procedural mortality was 1.9%, which only occurred in the biological valve group. At 30 days, 9.0% of patients had died, 4.0% experienced stroke, 8.0% received a pacemaker and 10.5% suffered an acute renal failure. The rate of re-thoracotomy (14.2%) was lower in the biological (12.5%) than in the mechanical valve group (22.0%; adjOR 0.45 [0.20-1.00]; p = 0.050). Frequent long-term complications were stroke (9.2%) and bleeding (4.8%), with bleeding complications being higher in the mechanical valve group (p = 0.009). During the follow-up period biological valves showed a numerically higher survival rate during the first years, which shifted after 3 years in favour of mechanical valves. At 10 years, survival rates were 62.4% vs. 77.1% in the biological and mechanical valve groups (p = 0.769). Hazard ratio after adjustment was 0.833 (95% CI 0.430-1.615). CONCLUSION These data confirm that mechanical valve implantation is associated with an increased risk of bleeding. While there was a potential survival benefit during the first years after surgery for patients receiving a biological valves the difference became insignificant after a follow-up of 10 years.
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Affiliation(s)
- Ayse Cetinkaya
- Department of Cardiac Surgery, Kerckhoff-Heart Center Bad Nauheim, 61231, Bad Nauheim, Germany
| | - Julia Poggenpohl
- Department of Cardiac Surgery, Kerckhoff-Heart Center Bad Nauheim, 61231, Bad Nauheim, Germany
| | - Karin Bramlage
- Institute for Pharmacology and Preventive Medicine, Bahnhofstraße 20, 49661, Cloppenburg, Germany
| | - Stefan Hein
- Department of Cardiac Surgery, Kerckhoff-Heart Center Bad Nauheim, 61231, Bad Nauheim, Germany
| | - Mirko Doss
- Department of Cardiac Surgery, Kerckhoff-Heart Center Bad Nauheim, 61231, Bad Nauheim, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Bahnhofstraße 20, 49661, Cloppenburg, Germany.
| | - Markus Schönburg
- Department of Cardiac Surgery, Kerckhoff-Heart Center Bad Nauheim, 61231, Bad Nauheim, Germany
| | - Manfred Richter
- Department of Cardiac Surgery, Kerckhoff-Heart Center Bad Nauheim, 61231, Bad Nauheim, Germany
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Schlömicher M, Bechtel M, Taghiyev Z, Naraghi H, Haldenwang PL, Moustafine V, Strauch JT. Intermediate Outcomes after Rapid Deployment Aortic Valve Replacement in Multiple Valve Surgery. Thorac Cardiovasc Surg 2019; 68:595-601. [PMID: 31003239 DOI: 10.1055/s-0039-1685178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Multiple valve surgery is associated with significant higher operative risks. Reduced cross-clamp and cardiopulmonary bypass times in multiple valve surgery may potentially be beneficial as they can be considered independent risk factors for increased morbidity and mortality following cardiac surgery. We report first intermediate outcomes of the Edwards Intuity valve system (Edwards Lifesciences, Irvine, California, United States) in combined procedures METHODS: Fifty-eight patients underwent rapid deployment aortic valve replacement with concomitant mitral valve surgery between January 2014 and November 2017 in our institution. The valve was assessed echocardiographically after 12 months. The median follow-up was 1.7 years with a cumulative follow-up time of 115.3 patient years. RESULTS The mean age was 73.5 ± 6.2 years and the mean logistic Euroscore was 11.6 ± 3.1%. Concomitant mitral valve repair was performed in 43 cases (74.1%), and mitral valve replacement in 15 cases (19.0%). The mean cross-clamp time was 93 ± 21 minutes along with a mean bypass time of 118 ± 24 minutes. All-cause mortality after 30 days was 8.6%. Overall actuarial survival at 1 year was 87.2 ± 4.5% and after 2 years 82.8 ± 5.3%, respectively. CONCLUSIONS Rapid deployment aortic valve replacement in multiple valve surgery can be performed safely with good intermediate outcomes in elderly, high-risk patients.
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Affiliation(s)
- Markus Schlömicher
- Berufsgenossenschaftliches Universitatsklinikum Bergmannsheil - Klinik für Herz- und Thoraxchirurgie, Bochum, Nordrhein-Westfalen, Germany
| | - Matthias Bechtel
- Berufsgenossenschaftliches Universitatsklinikum Bergmannsheil - Klinik für Herz- und Thoraxchirurgie, Bochum, Nordrhein-Westfalen, Germany
| | - Zulfugar Taghiyev
- Berufsgenossenschaftliches Universitatsklinikum Bergmannsheil - Klinik für Herz- und Thoraxchirurgie, Bochum, Nordrhein-Westfalen, Germany
| | - Hamid Naraghi
- Berufsgenossenschaftliches Universitatsklinikum Bergmannsheil - Klinik für Herz- und Thoraxchirurgie, Bochum, Nordrhein-Westfalen, Germany
| | - Peter Lukas Haldenwang
- Berufsgenossenschaftliches Universitatsklinikum Bergmannsheil - Klinik für Herz- und Thoraxchirurgie, Bochum, Nordrhein-Westfalen, Germany
| | - Vadim Moustafine
- Berufsgenossenschaftliches Universitatsklinikum Bergmannsheil - Klinik für Herz- und Thoraxchirurgie, Bochum, Nordrhein-Westfalen, Germany
| | - Justus T Strauch
- Berufsgenossenschaftliches Universitatsklinikum Bergmannsheil - Klinik für Herz- und Thoraxchirurgie, Bochum, Nordrhein-Westfalen, Germany
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16
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Amorim PA, Diab M, Walther M, Färber G, Hagendorff A, Bonow RO, Doenst T. Limitations in the Assessment of Prosthesis-Patient Mismatch. Thorac Cardiovasc Surg 2019; 68:550-556. [DOI: 10.1055/s-0038-1676814] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Abstract
Background Prosthesis-patient mismatch (PPM) after aortic valve replacement (AVR) may affect survival but data are conflicting. It is assessed by relating effective orifice area (EOA) to body surface area (EOAi). EOA is patient-specific as the result of flow-velocity times area at the individual patient's outflow tract levels (LVOTA) divided by trans-prosthetic flow velocity. However, some studies use projected EOAs (i.e., valve size associated EOAs from other patient populations) to assess how PPM affects outcome.
Methods We analyzed 76 studies addressing hemodynamic outcome and/or mortality after bioprosthetic AVR.
Results In 48 studies, projected or measured EOA for calculation of EOAi and PPM assessment was used (of which 25 demonstrated an effect on survival). We identified 28 additional studies providing measured EOA values and the corresponding Bernoulli's pressure gradients after AVR. Despite EOA being a patient-specific parameter, 77% of studies assessing a PPM impact on survival used projected EOAs. The 28 studies are providing measured EOA values and the corresponding Bernoulli's pressure gradients in patients after AVR showed a highly significant, linear relationship between EOA and Bernoulli's gradient. Considering this relationship, it is surprising that relating EOA to body surface area (BSA) (EOAi) is standard but relating pressure gradients to BSA is not.
Conclusion We conclude that the majority of studies assessing PPM have used false assumptions because EOA is a patient-specific parameter and cannot be transferred to other patients. In addition, the use of EOAi to assess PPM may not be appropriate and could explain the inconsistent relation between PPM and survival in previous studies.
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Affiliation(s)
- Paulo A. Amorim
- Department of Cardiothoracic Surgery, Friedrich Schiller University Jena, Jena, Germany
| | - Mahmoud Diab
- Department of Cardiothoracic Surgery, Friedrich Schiller University Jena, Jena, Germany
| | - Mario Walther
- Department of Basic Sciences, University of Applied Sciences Jena, Jena, Germany
| | - Gloria Färber
- Department of Cardiothoracic Surgery, Friedrich Schiller University Jena, Jena, Germany
| | - Andreas Hagendorff
- Department of Internal Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Robert O. Bonow
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine Chicago, Chicago, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich Schiller University Jena, Jena, Germany
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17
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Complementary Role of the Computed Biomodelling through Finite Element Analysis and Computed Tomography for Diagnosis of Transcatheter Heart Valve Thrombosis. BIOMED RESEARCH INTERNATIONAL 2018; 2018:1346308. [PMID: 30426001 PMCID: PMC6217904 DOI: 10.1155/2018/1346308] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 09/04/2018] [Accepted: 10/02/2018] [Indexed: 11/24/2022]
Abstract
Introduction The TAVR procedure is associated with a substantial risk of thrombosis. Current guidelines recommend catheter-based aortic valve implantation for prohibitive-high-risk patients with severe aortic valve stenosis but acknowledge that the aetiology and mechanism of thrombosis are unclear. Methods From 2015 to 2018, 607 patients with severe aortic valve stenosis underwent either self-expandable or balloon-expandable catheter-based aortic valve implantation at our institute. A complementary study was designed to support computed tomography as a predictor of complications using an advanced biomodelling process through finite element analysis (FEA). The primary evaluation of study was the thrombosis of the valve at 12 months. Results At 12 months, 546 patients had normal valvular function. 61 patients had THVT while 6 showed thrombosis and dislodgement with deterioration to NYHA Class IV requiring rehospitalization. The FEA biomodelling revealed a strong link between solid uncrushed calcifications, delayed dislodgement of TAVR and late thrombosis. We observed an interesting phenomenon of fibrosis/calcification originating at the level of the misplaced valve, which was the primary cause of coronary obstruction. Conclusion The use of cardiac CT and predictive biomodelling should be integrated into routine practice for the selection of TAVR candidates and as a predictor of negative outcomes given the lack of accurate investigations available. This would assist in effective decision-making and diagnosis especially in a high-risk cohort of patients.
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18
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Schlömicher M, Taghiyev Z, AlJabery Y, Haldenwang PL, Zumholz M, Sikole M, Useini D, Naraghi H, Moustafine V, Bechtel M, Strauch JT. Rapid deployment aortic valve replacement in a minimal access setting: intermediate clinical and echocardiographic outcomes†. Eur J Cardiothorac Surg 2018; 54:354-360. [DOI: 10.1093/ejcts/ezy023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 01/07/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Markus Schlömicher
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Zulfugar Taghiyev
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Yazan AlJabery
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Peter Lukas Haldenwang
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Michael Zumholz
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Magdalena Sikole
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Dritan Useini
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Hamid Naraghi
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Vadim Moustafine
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Matthias Bechtel
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
| | - Justus Thomas Strauch
- Department of Cardiothoracic Surgery, Ruhr-University Hospital Bergmannsheil, Bochum, Germany
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19
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Bioprosthetic Aortic Valve Durability: A Meta-Regression of Published Studies. Ann Thorac Surg 2017; 104:1080-1087. [DOI: 10.1016/j.athoracsur.2017.02.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 01/12/2017] [Accepted: 02/06/2017] [Indexed: 11/17/2022]
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20
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Abstract
Patients with inoperable, high-risk, and intermediate-risk aortic stenosis can now be treated with transcatheter aortic valve replacement. Centers for Medicare and Medicaid Services and the Food and Drug Administration selectively choose centers based on experience and require a collaborative, multidisciplinary team approach in the treatment and decision making for these patients. The work-up has been streamlined. Gated multislice computed tomography angiogram has emerged as the gold standard for assessment of valve anatomy and sizing of the transcatheter heart valve. Assessment of risk has evolved to include a more comprehensive functional and frailty evaluation. Long term-results are needed before the expansion of transcatheter aortic valve replacement into the low-risk category.
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Affiliation(s)
- John H Braxton
- Structural Heart Services, Marshfield Clinic, Saint Joseph Hospital, 1000 North Oak Avenue, Section 2C2, Marshfield, WI 54449, USA.
| | - Kelly S Rasmussen
- Structural Heart Services, Department of Cardiology, Marshfield Clinic, Saint Joseph Hospital, 1000 North Oak Avenue, Section 2C2, Marshfield, WI 54449, USA
| | - Milind S Shah
- Structural Heart Services, Section of Cardiology, Marshfield Clinic, Saint Joseph Hospital, 1000 North Oak Avenue, Section 2C2, Marshfield, WI 54449, USA
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21
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Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Fleisher LA, Jneid H, Mack MJ, McLeod CJ, O'Gara PT, Rigolin VH, Sundt TM, Thompson A. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2017; 135:e1159-e1195. [PMID: 28298458 DOI: 10.1161/cir.0000000000000503] [Citation(s) in RCA: 1404] [Impact Index Per Article: 200.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | | | - Robert O Bonow
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
| | - Blase A Carabello
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
| | - John P Erwin
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
| | - Lee A Fleisher
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
| | - Hani Jneid
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
| | - Michael J Mack
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
| | - Christopher J McLeod
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
| | - Patrick T O'Gara
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
| | - Vera H Rigolin
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
| | - Thoralf M Sundt
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
| | - Annemarie Thompson
- Focused Update writing group members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information. ACC/AHA Representative. ACC/AHA Task Force on Clinical Practice Guidelines Liaison. SCAI Representative. STS Representative. ASE Representative. AATS Representative. SCA Representative
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22
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Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Fleisher LA, Jneid H, Mack MJ, McLeod CJ, O'Gara PT, Rigolin VH, Sundt TM, Thompson A. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2017; 70:252-289. [PMID: 28315732 DOI: 10.1016/j.jacc.2017.03.011] [Citation(s) in RCA: 1830] [Impact Index Per Article: 261.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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23
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24
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Jamieson WRE, Germann E, Aupart MR, Neville PH, Marchand MA, Fradet GJ. 15-Year Comparison of Supra-Annular Porcine and PERIMOUNT Aortic Bioprostheses. Asian Cardiovasc Thorac Ann 2016; 14:200-5. [PMID: 16714695 DOI: 10.1177/021849230601400306] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The second-generation Carpentier-Edwards bioprostheses, the supra-annular porcine valve and the PERIMOUNT pericardial valve, have been evaluated longitudinally for several years. This study compared clinical performance over 15 years. Aortic valve replacement was performed with a supra-annular porcine valve in 1,823 patients (group 1) aged 19–89 years (mean, 68.9 ± 10.9 years) and with a PERIMOUNT pericardial bioprosthesis in 1,430 patients (group 2) aged 16–90 years (mean, 69.5 ± 10.4 years). The groups were similar except for concomitant coronary artery bypass in 43% of group 1 and 18% of group 2 ( p < 0.001). Overall survival at 15 years was 29.3% ± 1.5% for group 1 and 35.2% ± 3.1% for group 2 ( p = 0.0009). The actual freedom from valve-related mortality was 88.5% ± 0.9% for group 1 and 84.9% ± 1.7% for group 2. The actual freedom from structural valve deterioration at 15 years was similar overall, and for patients aged > 60 years, between the groups, but was dissimilar (group 2 > group 1) for age ≤ 60 years. The predictors of structural valve deterioration were valve type (group 1 > group 2), sex (male > female), age, and concomitant coronary artery bypass. Both bioprostheses provided satisfactory clinical performance at 15 years after aortic valve replacement.
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Affiliation(s)
- W R Eric Jamieson
- Division of Cardiovascular Surgery, Department of Surgery, University of British Columbia, Vancouver, Canada.
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25
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Simonato M, Webb J, Kornowski R, Vahanian A, Frerker C, Nissen H, Bleiziffer S, Duncan A, Rodés-Cabau J, Attizzani GF, Horlick E, Latib A, Bekeredjian R, Barbanti M, Lefevre T, Cerillo A, Hernández JM, Bruschi G, Spargias K, Iadanza A, Brecker S, Palma JH, Finkelstein A, Abdel-Wahab M, Lemos P, Petronio AS, Champagnac D, Sinning JM, Salizzoni S, Napodano M, Fiorina C, Marzocchi A, Leon M, Dvir D. Transcatheter Replacement of Failed Bioprosthetic Valves. Circ Cardiovasc Interv 2016; 9:CIRCINTERVENTIONS.115.003651. [DOI: 10.1161/circinterventions.115.003651] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 04/29/2016] [Indexed: 11/16/2022]
Abstract
Background—
Transcatheter valve implantation inside failed bioprosthetic surgical valves (valve-in-valve [ViV]) may offer an advantage over reoperation. Supra-annular transcatheter valve position may be advantageous in achieving better hemodynamics after ViV. Our objective was to define targets for implantation that would improve hemodynamics after ViV.
Methods and Results—
Cases from the Valve-in-Valve International Data (VIVID) registry were analyzed using centralized core laboratory assessment blinded to clinical events. Multivariate analysis was performed to identify independent predictors of elevated postprocedural gradients (mean ≥20 mm Hg). Optimal implantation depths were defined by receiver operating characteristic curve. A total of 292 consecutive patients (age, 78.9±8.7 years; 60.3% male; 157 CoreValve Evolut and 135 Sapien XT) were evaluated. High implantation was associated with significantly lower rates of elevated gradients in comparison with low implantation (CoreValve Evolut, 15% versus 34.2%;
P
=0.03 and Sapien XT, 18.5% versus 43.5%;
P
=0.03, respectively). Optimal implantation depths were defined: CoreValve Evolut, 0 to 5 mm; Sapien XT, 0 to 2 mm (0–10% frame height); sensitivities, 91.3% and 88.5%, respectively. The strongest independent correlate for elevated gradients after ViV was device position (high: odds ratio, 0.22; confidence interval, 0.1–0.52;
P
=0.001), in addition to type of device used (CoreValve Evolut: odds ratio, 0.5; confidence interval, 0.28–0.88;
P
=0.02) and surgical valve mechanism of failure (stenosis/mixed baseline failure: odds ratio, 3.12; confidence interval, 1.51–6.45;
P
=0.002).
Conclusions—
High implantation inside failed bioprosthetic valves is a strong independent correlate of lower postprocedural gradients in both self- and balloon-expandable transcatheter valves. These clinical evaluations support specific implantation targets to optimize hemodynamics after ViV.
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Affiliation(s)
- Matheus Simonato
- From the Centre for Heart Valve Innovation, Department of Cardiology, St. Paul’s Hospital, Vancouver, Canada (M.S., J.W., D.D.); Division of Cardiovascular Surgery, Escola Paulista de Medicina—UNIFESP, São Paulo, Brazil (M.S., J.H.P.); Interventional Cardiology Institute, Cardiology Department, Rabin Medical Center, Petah Tivka, Israel (R.K.); Cardiology Department, Hôpital Bichat-Claude Bernard, Paris, France (A.V.); Department of Cardiology, Asklepios Klinik, Hamburg, Germany (C. Frerker)
| | - John Webb
- From the Centre for Heart Valve Innovation, Department of Cardiology, St. Paul’s Hospital, Vancouver, Canada (M.S., J.W., D.D.); Division of Cardiovascular Surgery, Escola Paulista de Medicina—UNIFESP, São Paulo, Brazil (M.S., J.H.P.); Interventional Cardiology Institute, Cardiology Department, Rabin Medical Center, Petah Tivka, Israel (R.K.); Cardiology Department, Hôpital Bichat-Claude Bernard, Paris, France (A.V.); Department of Cardiology, Asklepios Klinik, Hamburg, Germany (C. Frerker)
| | - Ran Kornowski
- From the Centre for Heart Valve Innovation, Department of Cardiology, St. Paul’s Hospital, Vancouver, Canada (M.S., J.W., D.D.); Division of Cardiovascular Surgery, Escola Paulista de Medicina—UNIFESP, São Paulo, Brazil (M.S., J.H.P.); Interventional Cardiology Institute, Cardiology Department, Rabin Medical Center, Petah Tivka, Israel (R.K.); Cardiology Department, Hôpital Bichat-Claude Bernard, Paris, France (A.V.); Department of Cardiology, Asklepios Klinik, Hamburg, Germany (C. Frerker)
| | - Alec Vahanian
- From the Centre for Heart Valve Innovation, Department of Cardiology, St. Paul’s Hospital, Vancouver, Canada (M.S., J.W., D.D.); Division of Cardiovascular Surgery, Escola Paulista de Medicina—UNIFESP, São Paulo, Brazil (M.S., J.H.P.); Interventional Cardiology Institute, Cardiology Department, Rabin Medical Center, Petah Tivka, Israel (R.K.); Cardiology Department, Hôpital Bichat-Claude Bernard, Paris, France (A.V.); Department of Cardiology, Asklepios Klinik, Hamburg, Germany (C. Frerker)
| | - Christian Frerker
- From the Centre for Heart Valve Innovation, Department of Cardiology, St. Paul’s Hospital, Vancouver, Canada (M.S., J.W., D.D.); Division of Cardiovascular Surgery, Escola Paulista de Medicina—UNIFESP, São Paulo, Brazil (M.S., J.H.P.); Interventional Cardiology Institute, Cardiology Department, Rabin Medical Center, Petah Tivka, Israel (R.K.); Cardiology Department, Hôpital Bichat-Claude Bernard, Paris, France (A.V.); Department of Cardiology, Asklepios Klinik, Hamburg, Germany (C. Frerker)
| | - Henrik Nissen
- From the Centre for Heart Valve Innovation, Department of Cardiology, St. Paul’s Hospital, Vancouver, Canada (M.S., J.W., D.D.); Division of Cardiovascular Surgery, Escola Paulista de Medicina—UNIFESP, São Paulo, Brazil (M.S., J.H.P.); Interventional Cardiology Institute, Cardiology Department, Rabin Medical Center, Petah Tivka, Israel (R.K.); Cardiology Department, Hôpital Bichat-Claude Bernard, Paris, France (A.V.); Department of Cardiology, Asklepios Klinik, Hamburg, Germany (C. Frerker)
| | - Sabine Bleiziffer
- From the Centre for Heart Valve Innovation, Department of Cardiology, St. Paul’s Hospital, Vancouver, Canada (M.S., J.W., D.D.); Division of Cardiovascular Surgery, Escola Paulista de Medicina—UNIFESP, São Paulo, Brazil (M.S., J.H.P.); Interventional Cardiology Institute, Cardiology Department, Rabin Medical Center, Petah Tivka, Israel (R.K.); Cardiology Department, Hôpital Bichat-Claude Bernard, Paris, France (A.V.); Department of Cardiology, Asklepios Klinik, Hamburg, Germany (C. Frerker)
| | - Alison Duncan
- From the Centre for Heart Valve Innovation, Department of Cardiology, St. Paul’s Hospital, Vancouver, Canada (M.S., J.W., D.D.); Division of Cardiovascular Surgery, Escola Paulista de Medicina—UNIFESP, São Paulo, Brazil (M.S., J.H.P.); Interventional Cardiology Institute, Cardiology Department, Rabin Medical Center, Petah Tivka, Israel (R.K.); Cardiology Department, Hôpital Bichat-Claude Bernard, Paris, France (A.V.); Department of Cardiology, Asklepios Klinik, Hamburg, Germany (C. Frerker)
| | - Josep Rodés-Cabau
- From the Centre for Heart Valve Innovation, Department of Cardiology, St. Paul’s Hospital, Vancouver, Canada (M.S., J.W., D.D.); Division of Cardiovascular Surgery, Escola Paulista de Medicina—UNIFESP, São Paulo, Brazil (M.S., J.H.P.); Interventional Cardiology Institute, Cardiology Department, Rabin Medical Center, Petah Tivka, Israel (R.K.); Cardiology Department, Hôpital Bichat-Claude Bernard, Paris, France (A.V.); Department of Cardiology, Asklepios Klinik, Hamburg, Germany (C. Frerker)
| | - Guilherme F. Attizzani
- From the Centre for Heart Valve Innovation, Department of Cardiology, St. Paul’s Hospital, Vancouver, Canada (M.S., J.W., D.D.); Division of Cardiovascular Surgery, Escola Paulista de Medicina—UNIFESP, São Paulo, Brazil (M.S., J.H.P.); Interventional Cardiology Institute, Cardiology Department, Rabin Medical Center, Petah Tivka, Israel (R.K.); Cardiology Department, Hôpital Bichat-Claude Bernard, Paris, France (A.V.); Department of Cardiology, Asklepios Klinik, Hamburg, Germany (C. Frerker)
| | - Eric Horlick
- From the Centre for Heart Valve Innovation, Department of Cardiology, St. Paul’s Hospital, Vancouver, Canada (M.S., J.W., D.D.); Division of Cardiovascular Surgery, Escola Paulista de Medicina—UNIFESP, São Paulo, Brazil (M.S., J.H.P.); Interventional Cardiology Institute, Cardiology Department, Rabin Medical Center, Petah Tivka, Israel (R.K.); Cardiology Department, Hôpital Bichat-Claude Bernard, Paris, France (A.V.); Department of Cardiology, Asklepios Klinik, Hamburg, Germany (C. Frerker)
| | - Azeem Latib
- From the Centre for Heart Valve Innovation, Department of Cardiology, St. Paul’s Hospital, Vancouver, Canada (M.S., J.W., D.D.); Division of Cardiovascular Surgery, Escola Paulista de Medicina—UNIFESP, São Paulo, Brazil (M.S., J.H.P.); Interventional Cardiology Institute, Cardiology Department, Rabin Medical Center, Petah Tivka, Israel (R.K.); Cardiology Department, Hôpital Bichat-Claude Bernard, Paris, France (A.V.); Department of Cardiology, Asklepios Klinik, Hamburg, Germany (C. Frerker)
| | - Raffi Bekeredjian
- From the Centre for Heart Valve Innovation, Department of Cardiology, St. Paul’s Hospital, Vancouver, Canada (M.S., J.W., D.D.); Division of Cardiovascular Surgery, Escola Paulista de Medicina—UNIFESP, São Paulo, Brazil (M.S., J.H.P.); Interventional Cardiology Institute, Cardiology Department, Rabin Medical Center, Petah Tivka, Israel (R.K.); Cardiology Department, Hôpital Bichat-Claude Bernard, Paris, France (A.V.); Department of Cardiology, Asklepios Klinik, Hamburg, Germany (C. Frerker)
| | - Marco Barbanti
- From the Centre for Heart Valve Innovation, Department of Cardiology, St. Paul’s Hospital, Vancouver, Canada (M.S., J.W., D.D.); Division of Cardiovascular Surgery, Escola Paulista de Medicina—UNIFESP, São Paulo, Brazil (M.S., J.H.P.); Interventional Cardiology Institute, Cardiology Department, Rabin Medical Center, Petah Tivka, Israel (R.K.); Cardiology Department, Hôpital Bichat-Claude Bernard, Paris, France (A.V.); Department of Cardiology, Asklepios Klinik, Hamburg, Germany (C. Frerker)
| | - Thierry Lefevre
- From the Centre for Heart Valve Innovation, Department of Cardiology, St. Paul’s Hospital, Vancouver, Canada (M.S., J.W., D.D.); Division of Cardiovascular Surgery, Escola Paulista de Medicina—UNIFESP, São Paulo, Brazil (M.S., J.H.P.); Interventional Cardiology Institute, Cardiology Department, Rabin Medical Center, Petah Tivka, Israel (R.K.); Cardiology Department, Hôpital Bichat-Claude Bernard, Paris, France (A.V.); Department of Cardiology, Asklepios Klinik, Hamburg, Germany (C. Frerker)
| | - Alfredo Cerillo
- From the Centre for Heart Valve Innovation, Department of Cardiology, St. Paul’s Hospital, Vancouver, Canada (M.S., J.W., D.D.); Division of Cardiovascular Surgery, Escola Paulista de Medicina—UNIFESP, São Paulo, Brazil (M.S., J.H.P.); Interventional Cardiology Institute, Cardiology Department, Rabin Medical Center, Petah Tivka, Israel (R.K.); Cardiology Department, Hôpital Bichat-Claude Bernard, Paris, France (A.V.); Department of Cardiology, Asklepios Klinik, Hamburg, Germany (C. Frerker)
| | - José María Hernández
- From the Centre for Heart Valve Innovation, Department of Cardiology, St. Paul’s Hospital, Vancouver, Canada (M.S., J.W., D.D.); Division of Cardiovascular Surgery, Escola Paulista de Medicina—UNIFESP, São Paulo, Brazil (M.S., J.H.P.); Interventional Cardiology Institute, Cardiology Department, Rabin Medical Center, Petah Tivka, Israel (R.K.); Cardiology Department, Hôpital Bichat-Claude Bernard, Paris, France (A.V.); Department of Cardiology, Asklepios Klinik, Hamburg, Germany (C. Frerker)
| | - Giuseppe Bruschi
- From the Centre for Heart Valve Innovation, Department of Cardiology, St. Paul’s Hospital, Vancouver, Canada (M.S., J.W., D.D.); Division of Cardiovascular Surgery, Escola Paulista de Medicina—UNIFESP, São Paulo, Brazil (M.S., J.H.P.); Interventional Cardiology Institute, Cardiology Department, Rabin Medical Center, Petah Tivka, Israel (R.K.); Cardiology Department, Hôpital Bichat-Claude Bernard, Paris, France (A.V.); Department of Cardiology, Asklepios Klinik, Hamburg, Germany (C. Frerker)
| | - Konstantinos Spargias
- From the Centre for Heart Valve Innovation, Department of Cardiology, St. Paul’s Hospital, Vancouver, Canada (M.S., J.W., D.D.); Division of Cardiovascular Surgery, Escola Paulista de Medicina—UNIFESP, São Paulo, Brazil (M.S., J.H.P.); Interventional Cardiology Institute, Cardiology Department, Rabin Medical Center, Petah Tivka, Israel (R.K.); Cardiology Department, Hôpital Bichat-Claude Bernard, Paris, France (A.V.); Department of Cardiology, Asklepios Klinik, Hamburg, Germany (C. Frerker)
| | - Alessandro Iadanza
- From the Centre for Heart Valve Innovation, Department of Cardiology, St. Paul’s Hospital, Vancouver, Canada (M.S., J.W., D.D.); Division of Cardiovascular Surgery, Escola Paulista de Medicina—UNIFESP, São Paulo, Brazil (M.S., J.H.P.); Interventional Cardiology Institute, Cardiology Department, Rabin Medical Center, Petah Tivka, Israel (R.K.); Cardiology Department, Hôpital Bichat-Claude Bernard, Paris, France (A.V.); Department of Cardiology, Asklepios Klinik, Hamburg, Germany (C. Frerker)
| | - Stephen Brecker
- From the Centre for Heart Valve Innovation, Department of Cardiology, St. Paul’s Hospital, Vancouver, Canada (M.S., J.W., D.D.); Division of Cardiovascular Surgery, Escola Paulista de Medicina—UNIFESP, São Paulo, Brazil (M.S., J.H.P.); Interventional Cardiology Institute, Cardiology Department, Rabin Medical Center, Petah Tivka, Israel (R.K.); Cardiology Department, Hôpital Bichat-Claude Bernard, Paris, France (A.V.); Department of Cardiology, Asklepios Klinik, Hamburg, Germany (C. Frerker)
| | - José Honório Palma
- From the Centre for Heart Valve Innovation, Department of Cardiology, St. Paul’s Hospital, Vancouver, Canada (M.S., J.W., D.D.); Division of Cardiovascular Surgery, Escola Paulista de Medicina—UNIFESP, São Paulo, Brazil (M.S., J.H.P.); Interventional Cardiology Institute, Cardiology Department, Rabin Medical Center, Petah Tivka, Israel (R.K.); Cardiology Department, Hôpital Bichat-Claude Bernard, Paris, France (A.V.); Department of Cardiology, Asklepios Klinik, Hamburg, Germany (C. Frerker)
| | - Ariel Finkelstein
- From the Centre for Heart Valve Innovation, Department of Cardiology, St. Paul’s Hospital, Vancouver, Canada (M.S., J.W., D.D.); Division of Cardiovascular Surgery, Escola Paulista de Medicina—UNIFESP, São Paulo, Brazil (M.S., J.H.P.); Interventional Cardiology Institute, Cardiology Department, Rabin Medical Center, Petah Tivka, Israel (R.K.); Cardiology Department, Hôpital Bichat-Claude Bernard, Paris, France (A.V.); Department of Cardiology, Asklepios Klinik, Hamburg, Germany (C. Frerker)
| | - Mohamed Abdel-Wahab
- From the Centre for Heart Valve Innovation, Department of Cardiology, St. Paul’s Hospital, Vancouver, Canada (M.S., J.W., D.D.); Division of Cardiovascular Surgery, Escola Paulista de Medicina—UNIFESP, São Paulo, Brazil (M.S., J.H.P.); Interventional Cardiology Institute, Cardiology Department, Rabin Medical Center, Petah Tivka, Israel (R.K.); Cardiology Department, Hôpital Bichat-Claude Bernard, Paris, France (A.V.); Department of Cardiology, Asklepios Klinik, Hamburg, Germany (C. Frerker)
| | - Pedro Lemos
- From the Centre for Heart Valve Innovation, Department of Cardiology, St. Paul’s Hospital, Vancouver, Canada (M.S., J.W., D.D.); Division of Cardiovascular Surgery, Escola Paulista de Medicina—UNIFESP, São Paulo, Brazil (M.S., J.H.P.); Interventional Cardiology Institute, Cardiology Department, Rabin Medical Center, Petah Tivka, Israel (R.K.); Cardiology Department, Hôpital Bichat-Claude Bernard, Paris, France (A.V.); Department of Cardiology, Asklepios Klinik, Hamburg, Germany (C. Frerker)
| | - Anna Sonia Petronio
- From the Centre for Heart Valve Innovation, Department of Cardiology, St. Paul’s Hospital, Vancouver, Canada (M.S., J.W., D.D.); Division of Cardiovascular Surgery, Escola Paulista de Medicina—UNIFESP, São Paulo, Brazil (M.S., J.H.P.); Interventional Cardiology Institute, Cardiology Department, Rabin Medical Center, Petah Tivka, Israel (R.K.); Cardiology Department, Hôpital Bichat-Claude Bernard, Paris, France (A.V.); Department of Cardiology, Asklepios Klinik, Hamburg, Germany (C. Frerker)
| | - Didier Champagnac
- From the Centre for Heart Valve Innovation, Department of Cardiology, St. Paul’s Hospital, Vancouver, Canada (M.S., J.W., D.D.); Division of Cardiovascular Surgery, Escola Paulista de Medicina—UNIFESP, São Paulo, Brazil (M.S., J.H.P.); Interventional Cardiology Institute, Cardiology Department, Rabin Medical Center, Petah Tivka, Israel (R.K.); Cardiology Department, Hôpital Bichat-Claude Bernard, Paris, France (A.V.); Department of Cardiology, Asklepios Klinik, Hamburg, Germany (C. Frerker)
| | - Jan-Malte Sinning
- From the Centre for Heart Valve Innovation, Department of Cardiology, St. Paul’s Hospital, Vancouver, Canada (M.S., J.W., D.D.); Division of Cardiovascular Surgery, Escola Paulista de Medicina—UNIFESP, São Paulo, Brazil (M.S., J.H.P.); Interventional Cardiology Institute, Cardiology Department, Rabin Medical Center, Petah Tivka, Israel (R.K.); Cardiology Department, Hôpital Bichat-Claude Bernard, Paris, France (A.V.); Department of Cardiology, Asklepios Klinik, Hamburg, Germany (C. Frerker)
| | - Stefano Salizzoni
- From the Centre for Heart Valve Innovation, Department of Cardiology, St. Paul’s Hospital, Vancouver, Canada (M.S., J.W., D.D.); Division of Cardiovascular Surgery, Escola Paulista de Medicina—UNIFESP, São Paulo, Brazil (M.S., J.H.P.); Interventional Cardiology Institute, Cardiology Department, Rabin Medical Center, Petah Tivka, Israel (R.K.); Cardiology Department, Hôpital Bichat-Claude Bernard, Paris, France (A.V.); Department of Cardiology, Asklepios Klinik, Hamburg, Germany (C. Frerker)
| | - Massimo Napodano
- From the Centre for Heart Valve Innovation, Department of Cardiology, St. Paul’s Hospital, Vancouver, Canada (M.S., J.W., D.D.); Division of Cardiovascular Surgery, Escola Paulista de Medicina—UNIFESP, São Paulo, Brazil (M.S., J.H.P.); Interventional Cardiology Institute, Cardiology Department, Rabin Medical Center, Petah Tivka, Israel (R.K.); Cardiology Department, Hôpital Bichat-Claude Bernard, Paris, France (A.V.); Department of Cardiology, Asklepios Klinik, Hamburg, Germany (C. Frerker)
| | - Claudia Fiorina
- From the Centre for Heart Valve Innovation, Department of Cardiology, St. Paul’s Hospital, Vancouver, Canada (M.S., J.W., D.D.); Division of Cardiovascular Surgery, Escola Paulista de Medicina—UNIFESP, São Paulo, Brazil (M.S., J.H.P.); Interventional Cardiology Institute, Cardiology Department, Rabin Medical Center, Petah Tivka, Israel (R.K.); Cardiology Department, Hôpital Bichat-Claude Bernard, Paris, France (A.V.); Department of Cardiology, Asklepios Klinik, Hamburg, Germany (C. Frerker)
| | - Antonio Marzocchi
- From the Centre for Heart Valve Innovation, Department of Cardiology, St. Paul’s Hospital, Vancouver, Canada (M.S., J.W., D.D.); Division of Cardiovascular Surgery, Escola Paulista de Medicina—UNIFESP, São Paulo, Brazil (M.S., J.H.P.); Interventional Cardiology Institute, Cardiology Department, Rabin Medical Center, Petah Tivka, Israel (R.K.); Cardiology Department, Hôpital Bichat-Claude Bernard, Paris, France (A.V.); Department of Cardiology, Asklepios Klinik, Hamburg, Germany (C. Frerker)
| | - Martin Leon
- From the Centre for Heart Valve Innovation, Department of Cardiology, St. Paul’s Hospital, Vancouver, Canada (M.S., J.W., D.D.); Division of Cardiovascular Surgery, Escola Paulista de Medicina—UNIFESP, São Paulo, Brazil (M.S., J.H.P.); Interventional Cardiology Institute, Cardiology Department, Rabin Medical Center, Petah Tivka, Israel (R.K.); Cardiology Department, Hôpital Bichat-Claude Bernard, Paris, France (A.V.); Department of Cardiology, Asklepios Klinik, Hamburg, Germany (C. Frerker)
| | - Danny Dvir
- From the Centre for Heart Valve Innovation, Department of Cardiology, St. Paul’s Hospital, Vancouver, Canada (M.S., J.W., D.D.); Division of Cardiovascular Surgery, Escola Paulista de Medicina—UNIFESP, São Paulo, Brazil (M.S., J.H.P.); Interventional Cardiology Institute, Cardiology Department, Rabin Medical Center, Petah Tivka, Israel (R.K.); Cardiology Department, Hôpital Bichat-Claude Bernard, Paris, France (A.V.); Department of Cardiology, Asklepios Klinik, Hamburg, Germany (C. Frerker)
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Stanger O, Bleuel I, Gisler F, Göber V, Reineke S, Gahl B, Aymard T, Englberger L, Carrel T, Tevaearai H. The Freedom Solo pericardial stentless valve: Single-center experience, outcomes, and long-term durability. J Thorac Cardiovasc Surg 2015; 150:70-7. [DOI: 10.1016/j.jtcvs.2015.01.060] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 01/08/2015] [Accepted: 01/24/2015] [Indexed: 11/30/2022]
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EFFICACY OF CARPENTIER-EDWARDS PERICARDIAL PROSTHESES: A SYSTEMATIC REVIEW AND META-ANALYSIS. Int J Technol Assess Health Care 2015; 31:19-26. [DOI: 10.1017/s0266462315000148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objectives: The Carpentier-Edwards pericardial (CEP) prostheses are the type of bioprostheses most used worldwide. Although they were designed to minimize the rate of valve deterioration and reoperation, their clinical superiority over other prostheses models still lacks confirmation. The objective of this study was to evaluate its effectiveness.Methods: We performed a systematic review and meta-analysis in the PubMed, Embase, Cochrane, and Lilacs databases. Operative mortality, overall mortality and reoperation rates after heart valve surgery were compared between the use of CEP and other cardiac prostheses. Two independent reviewers screened studies for inclusion and extracted the data. Disagreements were resolved by consensus. The GRADE criterion was used to assess the evidence quality.Results: A total of twenty-eight studies were selected, including 19,615 individuals. The studies presented a high heterogeneity and low quality of evidence what limited the reliability of the results. The pooled data from the selected studies did not demonstrate significant differences between CEP and porcine, pericardial or stentless prostheses regarding operative mortality, overall mortality and reoperation rates. However, the pooled data from 3 observational trials pointed out a higher risk for reoperation after valve replacement using CEP prostheses against mechanical prostheses (OR 4.92 [95 percent confidence interval 2.43–9.96]).Conclusions: The current data present in the literature still does not support a clinical advantage for the use of CEP prostheses over other bioprostheses. The quality of the studies in the literature is limited and further studies are needed to address if CEP prostheses will have a clinical advantage over other prostheses.
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Very Long-Term Outcomes of the Carpentier-Edwards Perimount Valve in Aortic Position. Ann Thorac Surg 2015; 99:831-7. [DOI: 10.1016/j.athoracsur.2014.09.030] [Citation(s) in RCA: 261] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 08/30/2014] [Accepted: 09/19/2014] [Indexed: 11/22/2022]
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Chirurgische Therapie der infektiösen Endokarditis. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2015. [DOI: 10.1007/s00398-014-1139-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Schlömicher M, Haldenwang PL, Moustafine V, Bechtel M, Strauch JT. Minimal access rapid deployment aortic valve replacement: Initial single-center experience and 12-month outcomes. J Thorac Cardiovasc Surg 2015; 149:434-40. [DOI: 10.1016/j.jtcvs.2014.09.118] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 09/07/2014] [Accepted: 09/27/2014] [Indexed: 01/21/2023]
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Karangelis D, Fragoulis S, Bairaktaris A. Early onset of prosthesis failure after aortic valve replacement. Perfusion 2014; 30:345-8. [PMID: 25288592 DOI: 10.1177/0267659114554328] [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: 11/15/2022]
Abstract
We report an unusual case of a 78-year-old male who underwent an aortic valve replacement with a 21 mm Labcor tissue porcine aortic valve due to symptomatic aortic stenosis of his native valve. Only 3 months after an uncomplicated postoperative course, on a routine follow-up, transthoracic echo showed restrictive motion of the non-coronary cusp, incomplete closure of the coaptation line and severe aortic regurgitation. The patient was scheduled for a new operation during which the previous prosthetic valve was explanted and a different model was used.
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Affiliation(s)
- D Karangelis
- First Department of Adult Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
| | - S Fragoulis
- First Department of Adult Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
| | - A Bairaktaris
- First Department of Adult Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
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Wu Y, Butchart EG, Borer JS, Yoganathan A, Grunkemeier GL. Clinical evaluation of new heart valve prostheses: update of objective performance criteria. Ann Thorac Surg 2014; 98:1865-74. [PMID: 25258160 DOI: 10.1016/j.athoracsur.2014.05.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 05/01/2014] [Accepted: 05/05/2014] [Indexed: 11/24/2022]
Abstract
This article summarizes the long-term clinical results of the Food and Drug Administration-approved heart valves, provides current updates to the objective performance criteria (OPC) used to evaluate new heart valve prostheses, and documents the steps that the International Organization for Standardization Committee used to arrive at the updated OPC. Data were extracted from 19 Food and Drug Administration summaries of safety and effectiveness data reports (31 series) and 56 literature articles (85 series) published from 1999 to 2012. The OPC were calculated for five valve-related complications by valve type (mechanical and bioprosthetic) and valve position (aortic and mitral).
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Affiliation(s)
- YingXing Wu
- Medical Data Research Center, Providence Health and Services, Portland, Oregon.
| | - Eric G Butchart
- Department of Cardiothoracic Surgery, University Hospital of Wales, Heath Park, Cardiff, United Kingdom
| | - Jeffrey S Borer
- Division of Cardiovascular Medicine and the Howard Gilman Institute for Heart Valve Diseases, State University of New York Downstate Medical Center, Brooklyn, New York
| | - Ajit Yoganathan
- School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | - Gary L Grunkemeier
- Medical Data Research Center, Providence Health and Services, Portland, Oregon
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Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O’Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, Thomas JD, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Creager MA, Curtis LH, DeMets D, Guyton RA, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, Stevenson WG, Yancy CW. 2014 AHA/ACC guideline for the management of patients with valvular heart disease. J Thorac Cardiovasc Surg 2014; 148:e1-e132. [DOI: 10.1016/j.jtcvs.2014.05.014] [Citation(s) in RCA: 631] [Impact Index Per Article: 63.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O'Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, Thomas JD. 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 129:2440-92. [PMID: 24589852 DOI: 10.1161/cir.0000000000000029] [Citation(s) in RCA: 1033] [Impact Index Per Article: 103.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O'Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, Thomas JD. 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 129:e521-643. [PMID: 24589853 DOI: 10.1161/cir.0000000000000031] [Citation(s) in RCA: 881] [Impact Index Per Article: 88.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O'Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, Thomas JD. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63:2438-88. [PMID: 24603191 DOI: 10.1016/j.jacc.2014.02.537] [Citation(s) in RCA: 1351] [Impact Index Per Article: 135.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Long-Term Clinical Outcomes 15 Years After Aortic Valve Replacement With the Freestyle Stentless Aortic Bioprosthesis. Ann Thorac Surg 2014; 97:544-51. [DOI: 10.1016/j.athoracsur.2013.08.047] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 08/19/2013] [Accepted: 08/22/2013] [Indexed: 11/19/2022]
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Al-Atassi T, Toeg H, Ruel M. Should we anticoagulate after bioprosthetic aortic valve replacement? Expert Rev Cardiovasc Ther 2014; 11:1649-57. [DOI: 10.1586/14779072.2013.839216] [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] [Indexed: 11/08/2022]
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Friedman T, Mani A, Elefteriades JA. Bicuspid aortic valve: clinical approach and scientific review of a common clinical entity. Expert Rev Cardiovasc Ther 2014; 6:235-48. [DOI: 10.1586/14779072.6.2.235] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Borger MA, Dohmen P, Misfeld M, Mohr FW. Current trends in aortic valve replacement: development of the rapid deployment EDWARDS INTUITY valve system. Expert Rev Med Devices 2014; 10:461-70. [DOI: 10.1586/17434440.2013.811828] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Chacko SJ, Ansari AH, McCarthy PM, Malaisrie SC, Andrei AC, Li Z, Lee R, McGee E, Bonow RO, Puthumana JJ. Prosthesis-Patient Mismatch in Bovine Pericardial Aortic Valves. Circ Cardiovasc Imaging 2013; 6:776-83. [DOI: 10.1161/circimaging.112.000319] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | | | | | - Zhi Li
- From the Northwestern University, Chicago, IL
| | - Richard Lee
- From the Northwestern University, Chicago, IL
| | - Edwin McGee
- From the Northwestern University, Chicago, IL
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Giannini C, De Carlo M, Guarracino F, Donne MG, Benedetti G, Verunelli F, Petronio AS. Dysfunction of a 21-mm aortic bioprosthesis treated with percutaneous implantation of a CoreValve prosthesis. J Cardiovasc Med (Hagerstown) 2013; 14:541-4. [DOI: 10.2459/jcm.0b013e328335fa67] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Bobiarski J, Newcomb AE, Elhenawy AM, Maganti M, Bos J, Hemeon S, Rao V. One-year hemodynamic comparison of Perimount Magna with St Jude Epic aortic bioprostheses. Arch Med Sci 2013; 9:445-51. [PMID: 23847665 PMCID: PMC3701989 DOI: 10.5114/aoms.2013.35479] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 01/21/2012] [Accepted: 03/11/2012] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Cardiac surgeons are using more bioprosthetic valves due to the ageing population as well as to improvements that have been made to these implants. We sought to compare the 1-year hemodynamics of two commercially available valves by echocardiographic parameters. MATERIAL AND METHODS Retrospective review of our institutional database revealed 69 patients who received either Perimount Magna (n = 33) or St Jude Epic (n = 36) valves in the aortic position with no other valve surgery between June 2004 and March 2006. All patients received transthoracic echocardiography at 1 year. Comparisons between groups were made at baseline and at 1-year follow-up. In addition, a pairwise comparison was performed in each patient to determine the change in echocardiographic parameters between baseline and follow-up. RESULTS Mean implanted valve size was similar (Magna 24.3 ±2.0 mm vs. Epic 24.1 ±2.2 mm). Pre- and intraoperative patient variables were similar between the two groups. There were lower peak and mean pressure gradients in the Magna group, both at discharge and one year after surgery. This correlated with a larger indexed effective orifice area (Magna 0.8 ±0.2 cm(2)/m(2) vs. Epic 0.67 ±0.2 cm(2)/m(2), p = 0.02). In spite of these findings, left ventricular mass regression was not different. CONCLUSIONS These findings suggest that in a series with relatively low indexed effective orifice areas, the peak and mean gradients obtained were acceptable. More clinical follow-up of these patients is required to assess the true impact of prosthesis patient mismatch.
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Affiliation(s)
- Jerzy Bobiarski
- Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
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A look at recent improvements in the durability of tissue valves. Gen Thorac Cardiovasc Surg 2013; 61:182-90. [DOI: 10.1007/s11748-013-0202-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Indexed: 10/27/2022]
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Vohra HA, Whistance RN, De Kerchove L, Punjabi P, El Khoury G. Valve-preserving surgery on the bicuspid aortic valve. Eur J Cardiothorac Surg 2013; 43:888-98. [DOI: 10.1093/ejcts/ezs664] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Al-Atassi T, Lam K, Forgie M, Boodhwani M, Rubens F, Hendry P, Masters R, Goldstein W, Bedard P, Mesana T, Ruel M. Cerebral microembolization after bioprosthetic aortic valve replacement: comparison of warfarin plus aspirin versus aspirin only. Circulation 2012; 126:S239-44. [PMID: 22965989 DOI: 10.1161/circulationaha.111.084772] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND No human physiological data exists on whether aspirin only is as effective as warfarin plus aspirin in preventing cerebral microembolization in the early postoperative period after bioprosthetic aortic valve replacement (bAVR). METHODS AND RESULTS We prospectively enrolled 56 patients who had no other indication for oral anticoagulation, who underwent bAVR and received, in an open-label fashion, either daily warfarin (for INR 2.0-3.0) plus 81 mg of aspirin (n=28) or 325 mg of aspirin only (n=28). Cerebral microembolization was quantified at 4 hours (baseline) and at 1 month postoperatively, by recording 1-hour bilateral middle cerebral artery (MCA) microembolic signals (MES). Platelet-function analysis (PFA) of closure times (CT) on collagen was also used as a marker of platelet-dependent activation. Follow-up to 1 year was complete. Preoperative demographics and baseline platelet function were equivalent in both groups. There was no mortality, stroke, or transient ischemic attack at 1 year in either group. No significant differences were found in the proportion of patients with MES among those receiving warfarin plus aspirin versus aspirin only, at baseline (68% versus 82%, respectively; P=0.4) and at 1 month (46% versus 43%; P=1.0) after bAVR. The total MES and PFA were also equivalent between groups, at baseline and follow-up. CONCLUSIONS Early after bAVR, the effects of these 2 antithrombotic regimens on cerebral microembolization and platelet function are equivalent. These data bring new mechanistic support to the premise that aspirin only may safely be used early after bAVR in patients who have no other indication for oral anticoagulation.
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Affiliation(s)
- Talal Al-Atassi
- Division of Cardiac Surgery, University of Ottawa, Ottawa, Canada
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Dell'Aquila AM, Schlarb D, Schneider SRB, Sindermann JR, Hoffmeier A, Kaleschke G, Martens S, Rukosujew A. Clinical and echocardiographic outcomes after implantation of the Trifecta aortic bioprosthesis: an initial single-centre experience. Interact Cardiovasc Thorac Surg 2012; 16:112-5. [PMID: 23159508 DOI: 10.1093/icvts/ivs460] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The Trifecta valve (St. Jude Medical) was introduced into clinical practice as a tri-leaflet stented pericardial valve designed for supra-annular placement in the aortic position. The present study aims to evaluate the preliminary results with this new bioprosthesis. METHODS Seventy patients underwent aortic valve replacement (AVR) with the Trifecta valve between August 2010 and December 2011. Thirty-three patients were male and 37 were female (52.9%). Mean age was 74.65 ± 7.63 (range 47-90 years). Prevalent cause of AVR was aortic stenosis in 64 (91.43%) patients. The mean preoperative pressure gradient was 50 ± 17 (range 20-84 mmHg), and the mean aortic valve area was 0.77 ± 0.33. Five (7.14%) patients were operated on due to aortic valve endocarditis. One patient was operated on due to isolated, severe aortic insufficiency. All patients were in New York Heart Association functional class III or IV. Twenty-eight (40%) patients underwent concomitant procedures. RESULTS Concomitant procedures were coronary artery bypass grafting (n = 25), mitral valve replacement (n = 1), ablation of atrial fibrillation (n = 1) and septal myomectomy (n = 1). There were no intraoperative deaths. The 30-day in-hospital mortality was 2.85% (2 of 70). One late death occurred during the in-hospital stay due to a multiorgan failure on postoperative day 60. There were 2 (2.85%) perioperative strokes. Mean pressure gradient decreased significantly from a preoperative value of 50 ± 17 mmHg to an intraoperative gradient of 9 ± 4 mmHg (Table 3). The mean gradients were 14, 11, 11, 8 and 6 mmHg for the 19, 21, 23, 25 and 27 mm valve size, respectively. No prosthesis dislocation, endocarditis, valve thrombosis or relevant aortic regurgitation was observed at discharge. CONCLUSIONS The initial experience with the Trifecta valve bioprosthesis shows excellent outcomes with favourable early haemodynamics. Further studies with longer follow-up are needed to confirm those preliminary results.
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Ruggieri VG, Flecher E, Anselmi A, Lelong B, Corbineau H, Verhoye JP, Langanay T, Leguerrier A. Long-Term Results of the Carpentier-Edwards Supraannular Aortic Valve Prosthesis. Ann Thorac Surg 2012; 94:1191-7. [DOI: 10.1016/j.athoracsur.2012.05.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Revised: 04/26/2012] [Accepted: 05/01/2012] [Indexed: 11/25/2022]
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Prodromo J, D'Ancona G, Amaducci A, Pilato M. Aortic Valve Repair for Aortic Insufficiency: A Review. J Cardiothorac Vasc Anesth 2012; 26:923-32. [DOI: 10.1053/j.jvca.2011.07.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Indexed: 11/11/2022]
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Mitroflow Aortic Bioprosthesis 5-Year Follow-Up: North American Prospective Multicenter Study. Ann Thorac Surg 2012; 94:1198-203. [DOI: 10.1016/j.athoracsur.2012.04.090] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 04/23/2012] [Accepted: 04/26/2012] [Indexed: 12/27/2022]
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