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Abdelaal SA, Abdelrahim NA, Mamdouh M, Ahmed N, Ahmed TR, Hefnawy MT, Alaqori LK, Abozaid M. Comparative effects of minimally invasive approaches vs. conventional for obese patients undergoing aortic valve replacement: a systematic review and network meta-analysis. BMC Cardiovasc Disord 2023; 23:392. [PMID: 37559011 PMCID: PMC10413702 DOI: 10.1186/s12872-023-03410-9] [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: 05/31/2023] [Accepted: 07/22/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Minimally invasive approaches like mini-thoracotomy and mini-sternotomy for Aortic Valve Replacement (AVR) showed impressive outcomes. However, their advantages for obese patients are questionable. We aimed in this network meta-analysis to compare three surgical approaches: Full sternotomy (FS), Mini-sternotomy (MS), and Mini-thoracotomy (MT) for obese patients undergoing AVR. METHODS We followed the PRISMA extension for this network meta-analysis. PubMed/Medline, Scopus, Web of Science, and Cochrane searched through March 2023 for relevant articles. The analysis was performed using R version 4.2.3. RESULTS Out of 344, 8 articles met the criteria with 1392 patients. The main outcomes assessed were perioperative mortality, re-exploration, atrial fibrillation, renal failure, ICU stay, hospital stay, cross-clamp time, and bypass time. In favor of MS, the length of ICU stay and hospital stay was significantly lower than for FS [MD -0.84, 95%CI (-1.26; -0.43)], and [MD -2.56, 95%CI (-3.90; -1.22)], respectively. Regarding peri-operative mortality, FS showed a significantly higher risk compared to MS [RR 2.28, 95%CI (1.01;5.16)]. Also, patients who underwent minimally invasive approaches; MT and MS, required less need of re-exploration compared to FS [RR 0.10, 95%CI (0.02;0.45)], and [RR 0.33, 95%CI (0.14;0.79)], respectively. However, Intraoperative timings; including aortic cross-clamp, and cardiopulmonary bypass time, were significantly lower with FS than for MS [MD -9.16, 95%CI (-1.88; -16.45)], [MD -9.61, 95%CI (-18.64; -0.59)], respectively. CONCLUSION Our network meta-analysis shows that minimally invasive approaches offer some advantages for obese patients undergoing AVR over full sternotomy. Suggesting that these approaches might be considered more beneficial alternatives for obese patients undergoing AVR.
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Affiliation(s)
| | | | | | - Nour Ahmed
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
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2
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Velders BJJ, Vriesendorp MD, Reardon MJ, Rao V, Lange R, Patel HJ, Gearhart E, Sabik JF, Klautz RJM. Minimally Invasive Aortic Valve Replacement in Contemporary Practice: Clinical and Hemodynamic Performance from a Prospective Multicenter Trial. Thorac Cardiovasc Surg 2023; 71:387-397. [PMID: 35644134 PMCID: PMC10411098 DOI: 10.1055/s-0042-1743593] [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: 09/17/2021] [Accepted: 01/04/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The advent of transcatheter aortic valve replacement (AVR) has led to an increased emphasis on reducing the invasiveness of surgical procedures. The aim of this study was to evaluate clinical outcomes and hemodynamic performance achieved with minimally invasive aortic valve replacement (MI-AVR) as compared with conventional AVR. METHODS Patients who underwent surgical AVR with the Avalus bioprosthesis, as part of a prospective multicenter non-randomized trial, were included in this analysis. Surgical approach was left to the discretion of the surgeons. Patient characteristics and clinical outcomes were compared between MI-AVR and conventional AVR groups in the entire cohort (n = 1077) and in an isolated AVR subcohort (n = 528). Propensity score adjustment was performed to estimate the effect of MI-AVR on adverse events. RESULTS Patients treated with MI-AVR were younger, had lower STS scores, and underwent concomitant procedures less often. Valve size implanted was comparable between the groups. MI-AVR was associated with longer procedural times in the isolated AVR subcohort. Postprocedural hemodynamic performance was comparable. There were no significant differences between MI-AVR and conventional AVR in early and 3-year all-cause mortality, thromboembolism, reintervention, or a composite of those endpoints within either the entire cohort or the isolated AVR subcohort. After propensity score adjustment, there remained no association between MI-AVR and the composite endpoint (hazard ratio: 0.86, 95% confidence interval: 0.47-1.55, p = 0.61). CONCLUSION Three-year outcomes after MI-AVR with the Avalus bioprosthetic valve were comparable to conventional AVR. These results provide important insights into the overall ability to reduce the invasiveness of AVR without compromising outcomes.
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Affiliation(s)
- Bart J J Velders
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Michiel D Vriesendorp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Michael J Reardon
- Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, United States
| | - Vivek Rao
- Department of Cardiovascular Surgery, Toronto General Hospital, Toronto, Canada
| | - Rüdiger Lange
- Department of Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
| | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, United States
| | - Elizabeth Gearhart
- Department of Biostatistics, Medtronic, Mounds View, Minnesota, United States
| | - Joseph F Sabik
- Department of Surgery, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
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3
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Aljalloud A, Moza A, Arias JP, Menne M, Becker M, Spetsotaki K. Conventional vs. Sutureless Aortic Valve Bioprosthesis: Is Faster Better? J Cardiovasc Dev Dis 2023; 10:311. [PMID: 37504567 PMCID: PMC10380240 DOI: 10.3390/jcdd10070311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/11/2023] [Accepted: 07/18/2023] [Indexed: 07/29/2023] Open
Abstract
Purpose: The benefits of sutureless compared to conventional aortic valve prosthesis replacement remain controversial. Supposed advantages of sutureless aortic valve replacement include shortened cross-clamp and implantation time, as well as improved overall safety and good post-operative performance. We aimed to compare the early outcomes and performance of sutureless aortic valve replacement (su-AVR) with the sutureless Perceval (Corcym, Milan, Italy) vs. the conventional AVR with a conventional counterpart, in this case, the Labcor Dokimos Plus (LDP) aortic bioprosthesis. Methods: We compared two types of aortic valve prostheses, the sutureless (Corcym, Milan, Italy) and the conventional valve Labcor Dokimos Plus (LDP), implanted between August 2014 and May 2019 in our Department of Cardiac Surgery at RWTH Aachen University Hospital. Data were collected from 141 patients who received the Perceval (Corcym, Milan, Italy) and 138 who received the Labcor Dokimos Plus (LDP) aortic bioprosthesis. After matching the two groups considering STS mortality risk and pre-operative LDH levels, 201 patients were included in our final study cohort. Seventy-one patients (17 from the Perceval group and 54 from the Dokimos group) were excluded due to the lack of complete data, particularly standardized echocardiographic data (n = 71). Primary endpoints were 30-day mortality, length of hospital stay, and pacemaker implantation. Secondary endpoints were echocardiographic parameters, major adverse cardiovascular events, and prosthesis failure (grade II aortic regurgitation, paravalvular leak with reintervention). Results: Bypass and cross-clamp time proved to be shorter in the Perceval group, while hospital stays were longer. The faster implantation had no effect on the 30-day mortality primary endpoint. Transvalvular gradients were significantly higher in the Perceval group, in addition to a smaller effective orifice area. The LDH values were remarkably higher post-operatively in the Perceval group. Conclusions: Regarding the clinical outcomes, Perceval was equivalent and not superior to the Dokimus bioprosthesis. The suitability of a Perceval prosthesis implantation must be determined on a case-by-case basis and reserved for elderly patients with increased comorbidity.
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Affiliation(s)
- Ali Aljalloud
- Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, 52074 Aachen, Germany
- Department of Cardiology, Rhein Maas Klinikum, 52146 Würselen, Germany
| | - Ajay Moza
- Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, 52074 Aachen, Germany
| | - Jessica Paola Arias
- Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, 52074 Aachen, Germany
| | - Matthias Menne
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Michael Becker
- Department of Cardiology, Rhein Maas Klinikum, 52146 Würselen, Germany
| | - Konstantina Spetsotaki
- Department of Thoracic Transplantations and Assist Devices, Cardiothoracic Surgery, University Hospital Essen, 45147 Essen, Germany
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Bombace S, Meucci MC, Fortuni F, Ilardi F, Manzo R, Canciello G, Esposito G, Grayburn PA, Losi MA, Sannino A. Beyond Aortic Stenosis: Addressing the Challenges of Multivalvular Disease Assessment. Diagnostics (Basel) 2023; 13:2102. [PMID: 37370999 DOI: 10.3390/diagnostics13122102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Aortic stenosis (AS) can often coexist with other valvular diseases or be combined with aortic regurgitation (AR), leading to unique pathophysiological conditions. The combination of affected valves can vary widely, resulting in a lack of standardized diagnostic or therapeutic approaches. Echocardiography is crucial in assessing patients with valvular heart disease (VHD), but careful consideration of the hemodynamic interactions between combined valvular defects is necessary. This is important as it may affect the reliability of commonly used echocardiographic parameters, making the diagnosis challenging. Therefore, a multimodality imaging approach, including computed tomography or cardiac magnetic resonance, is often not just beneficial but crucial. It represents the future of diagnostics in this intricate field due to its unprecedented capacity to quantify and comprehend valvular pathology. The absence of definitive data and guidelines for the therapeutic management of AS in the context of multiple valve lesions makes this condition particularly challenging. As a result, an individualized, case-by-case approach is necessary, guided primarily by the recommendations for the predominant valve lesion. This review aims to summarize the pathophysiology of AS in the context of multiple and mixed valve disease, with a focus on the hemodynamic implications, diagnostic challenges, and therapeutic options.
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Affiliation(s)
| | - Maria Chiara Meucci
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Federico Fortuni
- Department of Cardiology, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
- Department of Cardiology, San Giovanni Battista Hospital, 06034 Foligno, Italy
| | - Federica Ilardi
- Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, 80131 Naples, Italy
| | - Rachele Manzo
- Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, 80131 Naples, Italy
| | - Grazia Canciello
- Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, 80131 Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, 80131 Naples, Italy
| | - Paul A Grayburn
- Baylor Scott & White Research Institute, Plano, TX 75093, USA
| | - Maria Angela Losi
- Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, 80131 Naples, Italy
| | - Anna Sannino
- Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, 80131 Naples, Italy
- Baylor Scott & White Research Institute, Plano, TX 75093, USA
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5
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El-Andari R, White A, Fialka NM, Shan S, Manikala VK, Hong Y, Wang S. Mini-sternotomy versus full sternotomy for isolated aortic valve replacement: A single-center experience. J Card Surg 2022; 37:4579-4586. [PMID: 36378945 DOI: 10.1111/jocs.17158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/10/2022] [Accepted: 09/28/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Minimally invasive approaches to isolated aortic valve replacement (AVR) are well-described and widely utilized. While there are numerous proposed benefits, there is limited literature describing significant morbidity or mortality benefits for minimally invasive isolated AVR resulting in hesitancy in its universal adoption. In this retrospective study, we compare the 5-year outcomes of patients undergoing isolated AVR via full sternotomy (FS) or mini-sternotomy (MS). METHODS 756 patients underwent isolated AVR between 2014 and 2019. Propensity matching resulted in 142 matched pairs that received either FS or MS. The primary outcome was mortality during the follow-up period. Secondary outcomes included intraoperative variables and postoperative morbidity. RESULTS Intraoperative variables including total operative, cardiopulmonary bypass, and aortic cross-clamp times did not differ significantly between groups. Postoperative mortality was similar between the matched groups with nonsignificant differences at 30 days (2.12% vs. 1.4%, p = .657), 1 year (4.9% vs. 2.1%, p = .0.223), and 5 years (7.5% vs. 3.5%, p = .174). Rates of postoperative morbidity were comparable between groups with no significant differences. CONCLUSION This study examined the long-term outcomes of propensity-matched patients undergoing isolated AVR via FS or MS and identified no significant differences in outcomes over a 5-year follow-up period. The decision for surgical approach is multifactorial and should be decided on a case-by-case basis taking into consideration patient anatomy, surgeon experience, and comfort, as well as patient preference.
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Affiliation(s)
- Ryaan El-Andari
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Abigail White
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Nicholas M Fialka
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Shubham Shan
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Vinod K Manikala
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Yonghze Hong
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Shaohua Wang
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
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6
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Faraz A, Fundano N, Qureshi AI, Tarar MY, Yawar B, Mohammed GDF. Comparison Between Mini-Sternotomy and Full Sternotomy for Aortic Valve Replacement: A 10-Year Retrospective Study. Cureus 2022; 14:e31627. [DOI: 10.7759/cureus.31627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2022] [Indexed: 11/19/2022] Open
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7
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Liu R, Song J, Chu J, Hu S, Wang XQ. Comparing mini-sternotomy to full median sternotomy for aortic valve replacement with propensity-matching methods. Front Surg 2022; 9:972264. [PMID: 36299570 PMCID: PMC9591805 DOI: 10.3389/fsurg.2022.972264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
Objective This study aims to compare clinical outcomes between mini-sternotomy and full median sternotomy for aortic valve replacement using propensity-matching methods. Methods From August 2014 to July 2021, a total of 1,445 patients underwent isolated aortic valve surgery, 1,247 via full median sternotomy and 198 via mini-sternotomy. To reduce the impact of potential confounding factors, a propensity score based on 18 variables is used to obtain 198 well-matched case pairs, which include 231 aortic valve regurgitations and 165 aortic stenosis cases. Result Occurrences of in-hospital mortality (P = 0.499), stroke (P > 0.999), renal failure (P = 0.760), and paravalvular leakage (P = 0.224) are similar between the two groups. No significant difference in operation, cardiopulmonary bypass, and aortic cross-clamp times are found between the two groups. However, compared with the full sternotomy group, the mini-sternotomy group has less postoperative 24-hour drainage (131.7 ± 82.8 ml, P < 0.001) and total drainage (459.3 ± 306.3 ml, P < 0.001). The median mechanical ventilation times are 9.4 [interquartile range (IQR) 5.4-15.6] and 9.8 (IQR 6.1-14.4) in mini-sternotomy and full sternotomy groups (P = 0.284), respectively. There are no significant differences in intensive care unit stay and postoperative stay between the two groups. For either aortic valve regurgitations or aortic stenosis patients, significantly less postoperative 24-h and total drainage are still found in the mini-sternotomy group compared with the full sternotomy group. Conclusions Mini-sternotomy for aortic valve replacement is a safe procedure, with not only cosmetic advantages but less postoperative drainage compared with full sternotomy. Mini-sternotomy should be considered for most aortic valve operations.
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8
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Xie XB, Dai XF, Qiu ZH, Jiang DB, Wu QS, Dong Y, Chen LW. Do obese patients benefit from isolated aortic valve replacement through a partial upper sternotomy? J Cardiothorac Surg 2022; 17:179. [PMID: 35922828 PMCID: PMC9351141 DOI: 10.1186/s13019-022-01926-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 06/11/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Controversial opinions exist for aortic valve replacement (AVR) through partial upper sternotomy in obese patients. Moreover, this study sought to investigate the potential clinical advantage of partial upper sternotomy aortic valve replacement (mini-AVR) over conventional full sternotomy aortic valve replacement (con-AVR) in obese patients. METHODS This was a retrospective and observational study. From January 2015 to December 2020, a total of 184 obese [body mass index (BMI) ≥ 30 kg m2] patients undergoing isolated primary AVR were included: 98 patients underwent conventional full sternotomy, and 86 patients underwent partial upper sternotomy. Propensity score (PS) matching was applied to eliminate the bassline imbalances in the mini-AVR and the con-AVR groups. RESULTS After one-to-one propensity score matching, two groups of 60 patients were obtained. No in-hospital death occurred in the two groups. In addition, cardiopulmonary bypass time and total operative time were similar across the 2 groups, but the aortic cross-clamp time was significantly shorter in the con-AVR group (P = .0.022). The amount of mediastinal drainage at 48 h after surgery (P = 0.018) and postoperative blood transfusions (P = 0.014) were significantly lower in the mini-AVR group. There was no difference in ventilation time (P = .0.145), but a shorter intensive care unit stay time (P = 0.021) in the mini-AVR group. CONCLUSION This study demonstrates that aortic valve replacement through a mini-AVR in obese patients is a safe and effective procedure. It outperformed con-AVR in terms of blood loss, blood product transfusion, and ICU stay.
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Affiliation(s)
- Xian-Biao Xie
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, Fujian, China.,Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, Fujian, China.,Fujian Provincial Special Reserve Talents Laboratory, Fuzhou, Fujian, China
| | - Xiao-Fu Dai
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, Fujian, China.,Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, Fujian, China.,Fujian Provincial Special Reserve Talents Laboratory, Fuzhou, Fujian, China
| | - Zhi-Huang Qiu
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, Fujian, China.,Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, Fujian, China.,Fujian Provincial Special Reserve Talents Laboratory, Fuzhou, Fujian, China
| | - De-Bin Jiang
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, Fujian, China.,Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, Fujian, China.,Fujian Provincial Special Reserve Talents Laboratory, Fuzhou, Fujian, China
| | - Qing-Song Wu
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, Fujian, China.,Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, Fujian, China.,Fujian Provincial Special Reserve Talents Laboratory, Fuzhou, Fujian, China
| | - Yi Dong
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, Fujian, China.,Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, Fujian, China.,Fujian Provincial Special Reserve Talents Laboratory, Fuzhou, Fujian, China
| | - Liang-Wan Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, Fujian, China. .,Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province University, Fuzhou, Fujian, China. .,Fujian Provincial Special Reserve Talents Laboratory, Fuzhou, Fujian, China.
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9
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Preservation of Renal Function. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00017-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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10
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Zhao Z, Yuan T, Chuang Y, Wang Y, Chang H, Bien M, Huang J, Lin N, Frerichs I, Möller K, Fu F, Yang Y. Lung ventilation distribution in patients after traditional full sternotomy and minimally invasive thoracotomy: An observational study. Acta Anaesthesiol Scand 2021; 65:877-885. [PMID: 33294975 DOI: 10.1111/aas.13759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/18/2020] [Accepted: 11/29/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of the study was to examine the post-operative ventilation distribution changes in cardiac surgical patients after traditional full sternotomy (FS) or minimally invasive thoracotomy (MIT). METHODS A total of 40 patients scheduled for FS with two-lung ventilation or MIT with one-lung ventilation were included. Ventilation distribution was measured with electrical impedance tomography (EIT) at T1, before surgery; T2, after surgery in ICU before weaning; T3, 24 hours after extubation. EIT-based parameters were calculated to assess the ventilation distribution, including the left-to-right lung ratio, ventral-to-dorsal ratio, and the global inhomogeneity index. RESULTS The global inhomogeneity index increased at T2 and T3 compared to T1 in all patients but only statistically significant in patients with MIT (FS, P = .06; MIT, P < .01). Notable decrease in the dorsal regions (FS) or in the non-ventilated side (MIT) was observed at T2. Ventilation distribution was partially improved at T3 but huge variations of recovery progresses were found in all patients regardless of the surgery types. Subgroup analysis indicated that operation duration was significantly lower in the MIT group (240 ± 40 in FS vs 205 ± 90 minutes in MIT, median ± interquartile range, P < .05) but the incidence of atrial fibrillation/flutter was significantly higher (5% in FS vs 50% in MIT, P < .01). Other exploratory outcomes showed no statistical differences. CONCLUSIONS Ventilation distribution was impaired after cardiac surgery. The recovery process of ventilation homogeneity was strongly depending on individuals so that MIT was not always superior in this aspect. EIT may help to identify the patients requiring further care after surgery.
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Affiliation(s)
- Zhanqi Zhao
- Department of Biomedical Engineering Fourth Military Medical University Xi'an China
- Institute of Technical Medicine Furtwangen University Villingen‐Schwenningen Germany
| | - Tsai‐Ming Yuan
- Department of Chest MedicineFar Eastern Memorial Hospital New Taipei City Taiwan
- School of Respiratory Therapy College of Medicine Taipei Medical University Taipei Taiwan
| | - Ya‐Hui Chuang
- Department of Chest MedicineFar Eastern Memorial Hospital New Taipei City Taiwan
| | - Yu‐Wen Wang
- Department of Chest MedicineFar Eastern Memorial Hospital New Taipei City Taiwan
| | - Hou‐Tai Chang
- Department of Critical CareFar Eastern Memorial Hospital New Taipei City Taiwan
| | - Mauo‐Ying Bien
- School of Respiratory Therapy College of Medicine Taipei Medical University Taipei Taiwan
- Division of Pulmonary Medicine Department of Internal Medicine Taipei Medical University Hospital Taipei Taiwan
| | - Jih‐Hsin Huang
- Department of Cardiac SurgeryFar Eastern Memorial Hospital New Taipei City Taiwan
| | - Nian‐Jhen Lin
- Department of Chest MedicineFar Eastern Memorial Hospital New Taipei City Taiwan
| | - Inéz Frerichs
- Department of Anaesthesiology and Intensive Care Medicine University Medical Centre of Schleswig‐Holstein Campus Kiel Germany
| | - Knut Möller
- Institute of Technical Medicine Furtwangen University Villingen‐Schwenningen Germany
| | - Feng Fu
- Department of Biomedical Engineering Fourth Military Medical University Xi'an China
| | - You‐Lan Yang
- School of Respiratory Therapy College of Medicine Taipei Medical University Taipei Taiwan
- Division of Pulmonary Medicine Department of Internal Medicine Wan Fang HospitalTaipei Medical University Taipei Taiwan
- Division of Pulmonary Medicine Department of Internal Medicine Landseed International Hospital Taoyuan City Taiwan
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11
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Jug J, Štor Z, Geršak B. Anatomical circumstances and aortic cross-clamp time in minimally invasive aortic valve replacement. Interact Cardiovasc Thorac Surg 2021; 32:204-212. [PMID: 33236100 DOI: 10.1093/icvts/ivaa251] [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: 08/03/2020] [Revised: 09/20/2020] [Accepted: 09/27/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Prolonged operative times, potentially leading to increased morbidity, are a possible drawback of minimally invasive aortic valve replacement. The aim of this study was to assess the impact of anatomical circumstances in the chest on aortic cross-clamp time. METHODS This retrospective study included 68 patients who underwent minimally invasive aortic valve replacement with the Perceval sutureless valve via right-anterior thoracotomy or with ministernotomy. Anatomical variables were measured during preoperative computer tomography scans. RESULTS Aortic cross-clamp time was shorter in those having ministernotomy than in the right-anterior thoracotomy group (41.1 vs 52.3 min; P < 0.001). Cardiopulmonary bypass (CPB) time was not significantly different between groups (P = 0.09). A multivariable linear-regression model (P = 0.018) showed the aortic dextroposition variable to be a significant predictor of the aortic cross-clamp method and CPB times (P = 0.005 and P = 0.003) independent of other anatomical variables in the right thoracotomy group (10 mm deviation from optimal position prolonged the times for 240 and 600 s). For the whole cohort, a correlation between aortic valve dimensions and operative times was found (P = 0.046, P = 0.009). A linear-regression model (P = 0.046) predicted 90 s longer aortic cross-clamp time and 231 s longer CPB time for every 1 mm smaller aortic valve diameter. CONCLUSIONS The anatomical variables are associated with the operative times in minimally invasive aortic valve replacement with sutureless valves. Considering this association, preplanning the procedure is recommended.
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Affiliation(s)
- Jure Jug
- Faculty of Medicine, Chair of Surgery, University of Ljubljana, Ljubljana, Slovenia
| | - Zdravko Štor
- Department of Abdominal Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Borut Geršak
- Faculty of Medicine, Chair of Surgery, University of Ljubljana, Ljubljana, Slovenia.,Nisteri, Medicine and Research, Ljubljana, Slovenia
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12
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Cammertoni F, Bruno P, Pavone N, Farina P, Mazza A, Iafrancesco M, Nesta M, Chiariello GA, Spalletta C, Cavaliere F, Calabrese M, D'Angelo GA, Sanesi V, Conti F, D'Errico D, Massetti M. Influence of cardiopulmonary bypass set-up and management on clinical outcomes after minimally invasive aortic valve surgery. Perfusion 2021; 36:679-687. [PMID: 34080484 DOI: 10.1177/02676591211023301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Minimally invasive aortic valve replacement (MIAVR) requires changes in cannulation strategy and cardiopulmonary bypass (CPB) management when compared to the conventional approach (CAVR). We aimed at evaluating if these differences could influence perfusion-related quality parameters and impair postoperative outcomes. METHODS Overall, 339 consecutive patients underwent MIAVR or CAVR between 2014 and 2020 and were analyzed retrospectively. To account for baseline differences, a propensity-matching analysis was performed, obtaining two groups of 97 patients each. RESULTS MIAVR group had longer CPB time [107 (95-120) vs 95 (86-105) min, p = .003] than CAVR group. Of note, average pump flow rate index [2.4 (2.2-2.5) vs 2.7 (2.4-2.8) l/min/m2, p = .004] was lower in the MIAVR group. Mean arterial pressure was 73 = 9 mmHg vs 62 = 11 mmHg for the MIAVR and CAVR group, respectively (p < .001). Cell-salvaged blood was most commonly used in the MIAVR group (25.8% vs 11.3%, p = .02). Finally, CPB temperature was 32.8°C (32.1-34.8) for MIAVR group vs 34.9°C (33.2-36.1) for the CAVR group (p = .02). Postoperative complications were similar between groups. CONCLUSIONS In conclusion, despite differences in CPB parameters in patients undergoing CAVR and MIAVR, the incidences of adverse outcomes were similar. However, compared to CAVR, MIAVR was associated with shorter durations of mechanical ventilation and hospital stay as well as less transfusion of blood products.
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Affiliation(s)
- Federico Cammertoni
- Department of Cardiovascular Sciences, Cardiac Surgery Unit, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome, Italy.,Catholic University of the Sacred Heart, Rome, Italy
| | - Piergiorgio Bruno
- Department of Cardiovascular Sciences, Cardiac Surgery Unit, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome, Italy.,Catholic University of the Sacred Heart, Rome, Italy
| | - Natalia Pavone
- Department of Cardiovascular Sciences, Cardiac Surgery Unit, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome, Italy
| | - Piero Farina
- Department of Cardiovascular Sciences, Cardiac Surgery Unit, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome, Italy
| | - Andrea Mazza
- Department of Cardiovascular Sciences, Cardiac Surgery Unit, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome, Italy
| | - Mauro Iafrancesco
- Department of Cardiovascular Sciences, Cardiac Surgery Unit, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome, Italy
| | - Marialisa Nesta
- Department of Cardiovascular Sciences, Cardiac Surgery Unit, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome, Italy
| | - Giovanni A Chiariello
- Department of Cardiovascular Sciences, Cardiac Surgery Unit, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome, Italy.,Catholic University of the Sacred Heart, Rome, Italy
| | - Claudio Spalletta
- Department of Cardiovascular Sciences, Cardiac Surgery Unit, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome, Italy
| | - Franco Cavaliere
- Catholic University of the Sacred Heart, Rome, Italy.,Department of Cardiovascular Sciences, Intensive Care Unit, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome, Italy
| | - Maria Calabrese
- Department of Cardiovascular Sciences, Intensive Care Unit, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome, Italy
| | | | | | - Francesco Conti
- Department of Cardiovascular Sciences, Perfusion Unit, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome, Italy
| | - Denise D'Errico
- Department of Cardiovascular Sciences, Perfusion Unit, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome, Italy
| | - Massimo Massetti
- Department of Cardiovascular Sciences, Cardiac Surgery Unit, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome, Italy.,Catholic University of the Sacred Heart, Rome, Italy
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13
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Mortensen M, Sandvik RKNM, Svendsen ØS, Haaverstad R, Moi AL. Return to work after coronary artery bypass grafting and aortic valve replacement surgery: A scoping review. Scand J Caring Sci 2021; 36:893-909. [PMID: 34057755 DOI: 10.1111/scs.13006] [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: 06/28/2020] [Accepted: 04/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Coronary artery bypass grafting surgery and aortic valve replacement surgery are essential treatment options for people suffering from angina pectoris or aortic valve disease. Surgery aims to prolong life expectancy, improve quality of life, and facilitate participation in society for the individuals afflicted. The aim of this review was to explore the literature on work participation in patients following coronary artery bypass grafting or aortic valve replacement surgery, and to identify demographic and clinical characteristics associated with returning to work. METHODS A scoping review framework of Arksey and O'Malley was chosen. Four electronic databases: Medline, CINAHL, Embase, and Google Scholar were searched for studies in English, Swedish, Danish or Norwegian between January 1988 and January 2020. A blinded selection of articles was performed. The data were then charted and summarized by descriptive numerical analyses and categorized into themes. RESULTS Forty-five out of 432 articles were included in the final full-text analysis. Absence from work following coronary artery bypass graft grafting or aortic valve replacement surgery lasted on average 30 weeks, whereas 34% of the patients never returned to work. Being female, suffering from pre-existing depression, having limited secondary education, or low income were associated with decreased return to work rates. Previous employment was a decisive factor for returning to work after surgery. Data on return to work after aortic valve replacement were scarce. CONCLUSIONS A significant number of patients never return to work following coronary artery bypass grafting or aortic valve surgery, and the time interval until work return is longer than expected. Failure to resume work represents a threat to the patients' finances and quality of life. Nurses are in a unique position to assess work-related issues and have an active part in the multi-disciplinary facilitation of tailored occupational counselling after cardiac surgery.
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Affiliation(s)
- Michael Mortensen
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Reidun K N M Sandvik
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Øyvind S Svendsen
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Rune Haaverstad
- Section of Cardiothoracic Surgery, Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Asgjerd L Moi
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway.,Department of Plastic, Hand and Reconstructive Surgery, National Burn Centre, Haukeland University Hospital, Bergen, Norway
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14
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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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15
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Cammertoni F, Bruno P, Rosenhek R, Pavone N, Farina P, Mazza A, Iafrancesco M, Nesta M, Chiariello GA, Comerci G, Pasquini A, Cavaliere F, Guarneri S, Marzetti E, Rabini A, Piarulli A, Sanesi V, D'Errico D, Massetti M. Minimally Invasive Aortic Valve Surgery in Octogenarians: Reliable Option or Fallback Solution? INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 16:34-42. [PMID: 33320024 DOI: 10.1177/1556984520974467] [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: 11/17/2022]
Abstract
OBJECTIVE Aortic valve disease is more and more common in western countries. While percutaneous approaches should be preferred in older adults, previous reports have shown good outcomes after surgery. Moreover, advantages of minimally invasive approaches may be valuable for octogenarians. We sought to compare outcomes of conventional aortic valve replacement (CAVR) versus minimally invasive aortic valve replacement (MIAVR) in octogenarians. METHODS We retrospectively collected data of 75 consecutive octogenarians who underwent primary, elective, isolated aortic valve surgery through conventional approach (41 patients, group CAVR) or partial upper sternotomy (34 patients, group MIAVR). RESULTS Mean age was 81.9 ± 0.9 and 82.3 ± 1.1 years in CAVR and MIAVR patients, respectively (P = 0.09). MIAVR patients had lower 24-hour chest drain output (353.4 ± 207.1 vs 501.7 ± 229.9 mL, P < 0.01), shorter mechanical ventilation (9.6 ± 2.4 vs 11.3 ± 2.3 hours, P < 0.01), lower need for blood transfusions (35.3% vs 63.4%, P = 0.02), and shorter hospital stay (6.8 ± 1.6 vs 8.3 ± 4.3 days, P < 0.01). Thirty-day mortality was zero in both groups. Survival at 1, 3, and 5 years was 89.9%, 80%, and 47%, respectively, in the CAVR group, and 93.2%, 82.4%, and 61.8% in the MIAVR group, with no statistically significant differences (log-rank test, P = 0.35). CONCLUSIONS Aortic valve surgery in older patients provided excellent results, as long as appropriate candidates were selected. MIAVR was associated with shorter mechanical ventilation, reduced blood transfusions, and reduced hospitalization length, without affecting perioperative complications or mid-term survival.
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Affiliation(s)
- Federico Cammertoni
- 60234 Cardiac Surgery Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Piergiorgio Bruno
- 60234 Cardiac Surgery Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Raphael Rosenhek
- 27271 Department of Cardiology, Vienna General Hospital, Medical University of Vienna, Austria
| | - Natalia Pavone
- 60234 Cardiac Surgery Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Piero Farina
- 60234 Cardiac Surgery Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Andrea Mazza
- 60234 Cardiac Surgery Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Mauro Iafrancesco
- 60234 Cardiac Surgery Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Marialisa Nesta
- 60234 Cardiac Surgery Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,60234 Catholic University of the Sacred Heart, Rome, Italy
| | | | - Gianluca Comerci
- 60234 Cardiac Surgery Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Annalisa Pasquini
- 60234 Cardiac Surgery Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Franco Cavaliere
- 60234 Catholic University of the Sacred Heart, Rome, Italy.,60234 Intensive Care Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Sergio Guarneri
- 60234 Intensive Care Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Emanuele Marzetti
- 60234 Catholic University of the Sacred Heart, Rome, Italy.,60234 Neurosciences and Orthopedics, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Rome, Italy
| | - Alessia Rabini
- 60234 Physical Medicine and Rehabilitation Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Alessandra Piarulli
- Clinical Psychology Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Valerio Sanesi
- 60234 Catholic University of the Sacred Heart, Rome, Italy
| | - Denise D'Errico
- Perfusion Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Massimo Massetti
- 60234 Cardiac Surgery Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.,60234 Catholic University of the Sacred Heart, Rome, Italy
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16
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Alnajar A, Chatterjee S, Chou BP, Khabsa M, Rippstein M, Lee VV, La Pietra A, Lamelas J. Current Surgical Risk Scores Overestimate Risk in Minimally Invasive Aortic Valve Replacement. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 16:43-51. [PMID: 33269957 DOI: 10.1177/1556984520971775] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Risk-scoring systems for surgical aortic valve replacement (AVR) were largely derived from sternotomy cases. We evaluated the accuracy of current risk scores in predicting outcomes after minimally invasive AVR (mini-AVR). Because transcatheter AVR (TAVR) is being considered for use in low-risk patients with aortic stenosis, accurate mini-AVR risk assessment is necessary. METHODS We reviewed 1,018 consecutive isolated mini-AVR cases (2009 to 2015). After excluding patients with Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) scores ≥4, we calculated each patient's European System for Cardiac Operative Risk Evaluation (EuroSCORE) II, TAVR Risk Score (TAVR-RS), and age, creatinine, and ejection fraction score (ACEF). We compared all 4 scores' accuracy in predicting mini-AVR 30-day mortality by computing each score's observed-to-expected mortality ratio (O:E). Area under the receiver operating characteristic (ROC) curves tested discrimination, and the Hosmer-Lemeshow goodness-of-fit tested calibration. RESULTS Among 941 patients (mean age, 72 ± 12 years), 6 deaths occurred within 30 days (actual mortality rate, 0.6%). All 4 scoring systems overpredicted expected mortality after mini-AVR: ACEF (1.4%), EuroSCORE II (1.9%), STS-PROM (2.0%), and TAVR-RS (2.1%). STS-PROM best estimated risk for patients with STS-PROM scores 0 to <1 (0.6 O:E), ACEF for patients with STS-PROM scores 2 to <3 (0.6 O:E), and TAVR-RS for patients with STS-PROM scores 3 to <4 (0.7 O:E). ROC curves showed only fair discrimination and calibration across all risk scores. CONCLUSIONS In low-risk patients who underwent mini-AVR, current surgical scoring systems overpredicted mortality 2-to-3-fold. Alternative dedicated scoring systems for mini-AVR are needed for more accurate outcomes assessment.
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Affiliation(s)
- Ahmed Alnajar
- 158424 Division of Cardiothoracic Surgery, University of Miami, FL, USA
| | - Subhasis Chatterjee
- 3989 Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.,14644 Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, USA
| | - Brendan P Chou
- 3989 Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Mariam Khabsa
- 3989 Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Madeline Rippstein
- 3989 Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Vei-Vei Lee
- 14644 Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, USA
| | - Angelo La Pietra
- 5258 Division of Cardiothoracic Surgery, Mount Sinai Medical Center and Heart Institute, Miami Beach, FL, USA
| | - Joseph Lamelas
- 158424 Division of Cardiothoracic Surgery, University of Miami, FL, USA.,3989 Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.,14644 Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, USA.,5258 Division of Cardiothoracic Surgery, Mount Sinai Medical Center and Heart Institute, Miami Beach, FL, USA
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17
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D'Onofrio A, Tessari C, Lorenzoni G, Cibin G, Martinelli G, Alamanni F, Polvani G, Solinas M, Massetti M, Merlo M, Vendramin I, Di Eusanio M, Mignosa C, Mangino D, Russo C, Rinaldi M, Pacini D, Salvador L, Antona C, Maselli D, De Paulis R, Luzi G, Alfieri O, De Filippo CM, Portoghese M, Musumeci F, Colli A, Gregori D, Gerosa G. Minimally Invasive vs Conventional Aortic Valve Replacement With Rapid-Deployment Bioprostheses. Ann Thorac Surg 2020; 111:1916-1922. [PMID: 33039363 DOI: 10.1016/j.athoracsur.2020.06.150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/13/2020] [Accepted: 06/29/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The aim of this multicenter retrospective study was to compare early and midterm clinical and hemodynamic results of aortic valve replacement with rapid-deployment bioprostheses performed through conventional full-sternotomy vs mini-sternotomy. METHODS Data from the Italian multicenter registry of aortic valve replacement with rapid-deployment bioprostheses (INTU-ITA registry) were analyzed. Patients were divided into 2 groups: full sternotomy (FS) and ministernotomy (MS). Primary endpoint was the comparison of early and midterm mortality. Secondary endpoints were: comparison of intraoperative variables, complications, and hemodynamic performance. A propensity score weighting approach was used for data analysis. RESULTS A total of 1057 patients were analyzed: 435 (41.2%) and 622 (58.8%) in group FS and MS, respectively. Thirty-day mortality was 1.6% and 0.6% in FS and MS groups, respectively (P = .074). cardiopulmonary bypass time was 78.5 minutes and 83 minutes in FS and MS groups, respectively (P = .414). In the overall cohort, the incidence of intraoperative complications and of device success was 3.8% (40 patients) and 95.9% (1014 patients), respectively, with no significant differences between groups. Survival at 1, 3, and 5 years was 94.1%, 98.1%, 88.5% and 91.8%, 85.2%, and 84.8% in FS and MS groups, respectively (P = .412). The 2 groups showed similar postoperative gradients (median mean gradient, FS: 10.0 mm Hg, MS: 11.0 mm Hg; P = .170) and also similar incidence of patient-prosthesis mismatch (FS: 7%, MS: 6.4%, P = .647). CONCLUSIONS According to our data, rapid-deployment bioprostheses allow the performance of minimally invasive aortic valve replacement with similar surgical times and similar clinical and hemodynamic outcomes to conventional surgery and should be considered the first choice in these procedures.
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Affiliation(s)
- Augusto D'Onofrio
- Department of Cardiac Surgery, University Hospital of Padova, Padova, Italy.
| | - Chiara Tessari
- Department of Cardiac Surgery, University Hospital of Padova, Padova, Italy
| | - Giulia Lorenzoni
- Department of Cardiac Surgery, University Hospital of Padova, Padova, Italy
| | - Giorgia Cibin
- Department of Cardiac Surgery, University Hospital of Padova, Padova, Italy
| | | | - Francesco Alamanni
- Department of Cardiac Surgery, Centro Cardiologico Monzino, Milan, Italy
| | - Gianluca Polvani
- Department of Cardiac Surgery, Centro Cardiologico Monzino, Milan, Italy
| | - Marco Solinas
- Department of Cardiac Surgery, Ospedale del Cuore "G. Pasquinucci", Massa, Italy
| | - Massimo Massetti
- Department of Cardiac Surgery, Policlinico Universitario Agostino Gemelli, Catholic University, Rome, Italy
| | - Maurizio Merlo
- Department of Cardiac Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Igor Vendramin
- Department of Cardiac Surgery, S. Maria della Misericordia Hospital, University of Udine, Udine, Italy
| | | | - Carmelo Mignosa
- Department of Cardiac Surgery, G.B. Morgagni Hospital, Catania, Italy
| | - Domenico Mangino
- Department of Cardiac Surgery, L'Angelo Hospital, Mestre-Venezia, Italy
| | - Claudio Russo
- Department of Cardiac Surgery, Niguarda Hospital, Milan, Italy
| | - Mauro Rinaldi
- Department of Cardiac Surgery, University Hospital of Turin, Turin, Italy
| | - Davide Pacini
- Department of Cardiac Surgery, University Hospital of Bologna, Bologna, Italy
| | - Loris Salvador
- Department of Cardiac Surgery, San Bortolo Hospital, Vicenza, Italy
| | - Carlo Antona
- Department of Cardiac Surgery, Sacco Hospital, Milan, Italy
| | - Daniele Maselli
- Department of Cardiac Surgery, S. Anna Hospital, Catanzaro, Italy
| | | | - Giampaolo Luzi
- Department of Cardiac Surgery, San Carlo Hospital, Potenza, Italy
| | - Ottavio Alfieri
- Department of Cardiac Surgery, San Raffaele University Hospital, Milano, Italy
| | | | - Michele Portoghese
- Department of Cardiac Surgery, Santissima Annunziata Hospital, Sassari, Italy
| | | | - Andrea Colli
- Department of Cardiac Surgery, University Hospital of Pisa, Pisa, Italy
| | - Dario Gregori
- Department of Cardiac Surgery, University Hospital of Padova, Padova, Italy
| | - Gino Gerosa
- Department of Cardiac Surgery, University Hospital of Padova, Padova, Italy
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18
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Chien S, Clark C, Maheshwari S, Koutsogiannidis CP, Zamvar V, Giordano V, Lim K, Pessotto R. Benefits of rapid deployment aortic valve replacement with a mini upper sternotomy. J Cardiothorac Surg 2020; 15:226. [PMID: 32847577 PMCID: PMC7448500 DOI: 10.1186/s13019-020-01268-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 08/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Surgical aortic valve replacement (AVR) is currently deemed the gold standard of care for patients with severe aortic stenosis. Currently, most AVRs are safely performed through a full median sternotomy approach. With an increasingly elderly and high-risk patient population, major advances in valve technology and surgical technique have been introduced to reduce perioperative risk and post-operative complications associated with the full sternotomy approach, in order to ensure surgical AVR remains the gold standard. For example, minimally invasive approaches (most commonly via mini sternotomy) have been developed to improve patient outcomes. The advent of rapid deployment valve technology has also been shown to improve morbidity and mortality by reducing cardiopulmonary bypass and aortic cross-clamp times, as well as facilitating the use of minimal access approaches. Rapid deployment valves were introduced into our department at the Royal Infirmary of Edinburgh in 2014. The aim of this study is to investigate if utilising the combination of rapid deployment valves and a mini sternotomy minimally invasive approach resulted in improved outcomes in various patient subgroups. METHODS Over a 3-year period, we identified 714 patients who underwent isolated AVR in our centre. They were divided into two groups: 61 patients (8.5%) were identified who received rapid deployment AVR via J-shaped mini upper sternotomy (MIRDAVR group), whilst 653 patients (91.5%) were identified who received either a full sternotomy (using a conventional prosthesis or rapid deployment valve) or minimally invasive approach using a conventional valve (CONVAVR group). We retrospectively analysed data from our cardiac surgery database, including pre-operative demographics, intraoperative times and postoperative outcomes. Outcomes were also compared in two different subgroups: octogenarians and high-risk patients. RESULTS Pre-operative demographics showed that there were significantly more female and elderly patients in the MIRDAVR group. The MIRDAVR group had significantly reduced cardiopulmonary bypass (63.7 min vs. 104 min, p = 0.0001) and aortic cross-clamp times (47.3 min vs. 80.1 min, p = 0.0001) compared to the CONVAVR group. These results were particularly significant in the octogenarian population, who also had a reduced length of ICU stay (30.9 h vs. 65.6 h, p = 0.049). In high-risk patients (i.e. logistic EuroSCORE I > 10%), minimally invasive-rapid deployment aortic valve replacement is still beneficial and is also characterized by significantly shorter cardiopulmonary bypass time (69.1 min vs. 96.1 min, p = 0.03). However, post-operative correlations, such as length of ICU stay, become no more significant, likely due to serious co-morbidities in this patient group. CONCLUSION We have demonstrated that minimally invasive rapid deployment aortic valve replacement is associated with significantly reduced cardiopulmonary bypass and aortic cross-clamp times. This correlation is much stronger in the octogenarian population, who were also found to have significantly reduced length of ICU stay. Our study raises the suggestion that this approach should be utilised more frequently in clinical practice, particularly in octogenarian patients.
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Affiliation(s)
- Siobhan Chien
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK.
| | - Callum Clark
- Department of General Medicine, University Hospital Hairmyres, East Kilbride, UK
| | | | | | - Vipin Zamvar
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK
| | - Vincenzo Giordano
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK
| | - Kelvin Lim
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK
| | - Renzo Pessotto
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK
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19
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Santarpino G, Berretta P, Kappert U, Teoh K, Mignosa C, Meuris B, Villa E, Albertini A, Carrel TP, Misfeld M, Martinelli G, Phan K, Miceli A, Folliguet T, Shrestha M, Solinas M, Andreas M, Savini C, Yan T, Fischlein T, Di Eusanio M. Minimally Invasive Redo Aortic Valve Replacement: Results From a Multicentric Registry (SURD-IR). Ann Thorac Surg 2020; 110:553-557. [PMID: 31954690 DOI: 10.1016/j.athoracsur.2019.11.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 10/29/2019] [Accepted: 11/06/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Reoperation for aortic valve replacement can be challenging and is usually associated with an increased risk for complications and mortality. The study aim was to report the results of a multicenter cohort of patients who underwent minimally invasive reoperative aortic valve replacement with a sutureless or rapid-deployment prosthesis. METHODS From 2007 to 2018 data from 3651 patients were retrospectively collected from the Sutureless and Rapid-Deployment Aortic Valve Replacement International Registry. Of them, 63 patients who had previously undergone cardiac surgery represented the study population. In-hospital clinical and echocardiographic outcomes were recorded. RESULTS Mean age of the selected 63 patients was 75.3 ± 7.8 years and logistic EuroSCORE 10.1. Surgery was performed by ministernotomy in 43 patients (68.3%) and by anterior right thoracotomy in 20 (31.7%); 31 patients (49.2%) received the Perceval valve (Livanova PLC, London, UK) and 32 (50.8%) the Intuity valve (Edwards Lifesciences, Irvine, CA). Mean cross-clamp time was 57.8 ± 23.2 minutes and cardiopulmonary bypass time 95.0 ± 34.3 minutes. Neither conversion to full sternotomy nor in-hospital deaths occurred. Postoperative events were ischemic cerebral events in 3 patients (4.8%), need for pacemaker implantation in 2 (3.6%), bleeding requiring reoperation in 5 (8.9%), and dialysis in 1 (1.6%). Median intensive care unit stay was 1 day, and median length of hospital stay was 10 days. On echocardiographic evaluation 1 patient showed a significant postoperative aortic regurgitation. CONCLUSIONS Minimally invasive reoperative aortic valve replacement with a sutureless or rapid-deployment prosthesis is a safe and feasible treatment strategy, resulting in fast recovery and improved postoperative outcome with no mortality and an acceptable complication rate.
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Affiliation(s)
- Giuseppe Santarpino
- Città di Lecce Hospital, GVM Care & Research, Lecce, Italy; Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany; Cardiac Surgery Unit, Department of Experimental and Clinical Medicine-University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Paolo Berretta
- Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ospedali Riuniti, Ancona, Italy.
| | - Utz Kappert
- Department of Cardiac Surgery, University Heart Centre Dresden, Dresden, Germany
| | - Kevin Teoh
- Southlake Regional Health Centre, Ontario, Canada
| | - Carmelo Mignosa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
| | - Bart Meuris
- Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium
| | | | - Alberto Albertini
- Cardiovascular Surgery Unit, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Thierry P Carrel
- Department of Cardiovascular Surgery, University of Bern, Bern, Switzerland
| | - Martin Misfeld
- University Clinic for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | | | | | - Antonio Miceli
- Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals, IRCCS Gruppo San Donato, Milan, Italy
| | | | | | - Marco Solinas
- Pasquinucci Heart Hospital, G. Monasterio Foundation, Massa, Italy
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Carlo Savini
- Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy
| | - Tristan Yan
- The Collaborative Research (CORE) Group; Macquarie University, Sydney, Australia
| | - Theodor Fischlein
- Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany
| | - Marco Di Eusanio
- Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ospedali Riuniti, Ancona, Italy; The Collaborative Research (CORE) Group
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El Gamel A. Minimal Access Aortic Root Surgery: An "Elite Sport" or Is it for Everyone? Heart Lung Circ 2019; 28:1767-1769. [PMID: 31813479 DOI: 10.1016/j.hlc.2019.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Adam El Gamel
- Waikato Cardiothoracic Unit, Waikato Hospital, Hamilton, New Zealand; Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand; University of Waikato Medical Research Centre, The University of Waikato, New Zealand.
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Krishnan S, Sharma A, Subramani S, Arora L, Mohananey D, Villablanca P, Ramakrishna H. Analysis of Neurologic Complications After Surgical Versus Transcatheter Aortic Valve Replacement. J Cardiothorac Vasc Anesth 2019; 33:3182-3195. [DOI: 10.1053/j.jvca.2018.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Indexed: 11/11/2022]
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Rosseĭkin EV, Kobzev EE, Bazylev VV. Minimally invasive Ozaki technique. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2019; 25:142-155. [PMID: 31503259 DOI: 10.33529/angi02019319] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Implantation of a mechanical or biological graft remains the gold standard in treatment of patients with aortic valve pathology. However, the necessity of taking anticoagulants, the problem of graft durability, the risk for thromboembolic and haemorrhagic complications, prosthetic infective endocarditis impel surgeons to search for and develop new technologies. One of such new techniques is prosthetic repair of the aortic valve using autologous pericardium according to the S. Ozaki operation. This procedure makes it possible to form an aortic valve with excellent haemodynamic characteristics and low frequency of re-do operations in both the early and remote periods. Current trends are towards exponential growth of minimally invasive cardiosurgical interventions. Upper partial sternotomy is one of the most commonly used techniques in surgery of the aortic valve. The results of previous studies demonstrated that a minimally invasive approach apart from a good cosmetic effect has a series of advantages over full sternotomy by the in-hospital and remote outcomes. On the other hand, a minimally invasive access is associated with limited surgical exposure and tight operative field and is therefore technically more complicated than the operation via full sternotomy. In our retrospective study we compared the clinical outcomes of the minimally invasive Ozaki technique (Ozaki Mini Group, n=30) and full sternotomy (Ozaki Full Group, n=112). Because of differences between the groups by the clinical and demographic parameters in order to ensure maximum comparability we conducted computer-assisted propensity score matching, resulting in formation of 2 groups consisting of 30 patients each. The primary outcome measures of the study were 30-day all-cause mortality and postoperative major adverse cardiac events (myocardial infarction, stroke). As additional categorical outcomes we examined new-onset atrial fibrillation and renal failure, resternotomy, prolonged (>24 h) assisted artificial pulmonary ventilation, mediastinitis/sternal instability. Secondary outcome measures were as follows: the duration of the operation, duration of myocardial ischaemia and artificial circulation, blood loss, requirement for transfusion of donor blood components.
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Affiliation(s)
- E V Rosseĭkin
- Federal Centre of Cardiovascular Surgery under the RF Ministry of Public Health, Penza, Russia
| | - E E Kobzev
- Federal Centre of Cardiovascular Surgery under the RF Ministry of Public Health, Penza, Russia
| | - V V Bazylev
- Federal Centre of Cardiovascular Surgery under the RF Ministry of Public Health, Penza, Russia
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Bruno P, Cammertoni F, Rosenhek R, Mazza A, Pavone N, Iafrancesco M, Nesta M, Chiariello GA, Spalletta C, Graziano G, Sanesi V, D’Errico D, Massetti M. Improved Patient Recovery With Minimally Invasive Aortic Valve Surgery: A Propensity-Matched Study. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 14:419-427. [DOI: 10.1177/1556984519868715] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective Despite conflicting evidence available, minimally invasive aortic valve replacement (MIAVR) is increasingly used as an alternative to full sternotomy. We sought to compare early outcomes of aortic valve replacement through a full sternotomy (conventional aortic valve replacement [CAVR]) and upper ministernotomy (MIAVR). Methods We analyzed 297 patients having undergone primary, elective, isolated MIAVR or CAVR between January 2014 and June 2018. Following propensity score matching, 120 patients remained in each group. Results MIAVR required longer bypass (93 ± 26 vs 81 ± 24 minutes, P < 0.01) and operative times (214 ± 39 vs 182 ± 37 minutes, P < 0.01). However, aortic cross-clamp times were comparable (57 ± 17 vs 54 ± 14 minutes for MIAVR and CAVR, respectively, P = 0.14). MIAVR had less 24-hour blood loss (253 ± 204 vs 323 ± 296 mL, P = 0.03), less red blood cells transfusions [1.4 packs (1.1 o 1.9) vs 2.1 packs (1.8 to 2.7), P = 0.01], and shorter assisted ventilation time (7.1 ± 3.3 vs 9.7 ± 3.8 hours, P < 0.01) when compared to CAVR. These results led to significantly shorter intensive care unit and hospital stays for MIAVR patients (2.5 ± 1.3 vs 3.4 ± 1.1 days, P < 0.01 and 6.9 ± 4.1 vs 8.2 ± 4.8 days, P = 0.03, respectively). Thirty-day mortality and clinical outcomes did not differ significantly among groups. Conclusions MIAVR through upper ministernotomy was shown to be as safe and reliable as CAVR. Patient recovery time was improved by shortening mechanical ventilation and reducing blood loss and transfusions. These results may be significant for high-risk patients undergoing aortic valve surgery.
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Affiliation(s)
- Piergiorgio Bruno
- Department of Cardiovascular Sciences, Cardiac Surgery Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Federico Cammertoni
- Department of Cardiovascular Sciences, Cardiac Surgery Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Raphael Rosenhek
- Department of Cardiology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Andrea Mazza
- Department of Cardiovascular Sciences, Cardiac Surgery Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Natalia Pavone
- Department of Cardiovascular Sciences, Cardiac Surgery Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Mauro Iafrancesco
- Department of Cardiovascular Sciences, Cardiac Surgery Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Marialisa Nesta
- Department of Cardiovascular Sciences, Cardiac Surgery Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | | | | | | | | | - Denise D’Errico
- Department of Cardiovascular Sciences, Perfusion Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Massimo Massetti
- Department of Cardiovascular Sciences, Cardiac Surgery Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
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Zhao D, Wei L, Zhu S, Zhang Z, Liu H, Yang Y, Wang Y, Ji Q, Wang C. Combined Mitral and Aortic Valve Procedure via Right Mini-Thoracotomy versus Full Median Sternotomy. Int Heart J 2019; 60:336-344. [DOI: 10.1536/ihj.18-186] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Dong Zhao
- Department of Cardiovascular Surgery, Zhongshan Hospital Fudan University
| | - Lai Wei
- Department of Cardiovascular Surgery, Zhongshan Hospital Fudan University
| | - Shijie Zhu
- Department of Cardiovascular Surgery, Zhongshan Hospital Fudan University
| | - Zhiqi Zhang
- Department of Cardiovascular Surgery, Zhongshan Hospital Fudan University
| | - Huan Liu
- Department of Cardiovascular Surgery, Zhongshan Hospital Fudan University
| | - Ye Yang
- Department of Cardiovascular Surgery, Zhongshan Hospital Fudan University
| | - YuLin Wang
- Department of Cardiovascular Surgery, Zhongshan Hospital Fudan University
| | - Qiang Ji
- Department of Cardiovascular Surgery, Zhongshan Hospital Fudan University
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25
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Jahangiri M, Hussain A, Akowuah E. Minimally invasive surgical aortic valve replacement. Heart 2019; 105:s10-s15. [DOI: 10.1136/heartjnl-2018-313512] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 10/12/2018] [Accepted: 10/16/2018] [Indexed: 11/03/2022] Open
Abstract
Minimally invasive aortic valve replacement (MIAVR) is defined as a surgical aortic valve replacement which involves smaller chest incisions as opposed to full sternotomy. It is performed using cardiopulmonary bypass with cardiac arrest. It benefits from potential advantages of a less invasive procedure. To date, over 14 000 MIAVR have been reported in the literature. Due to heterogeneity of the studies, different surgical techniques and mainly the non-randomised nature of these studies comparing MIAVR with conventional aortic valve replacement, it is difficult to draw definitive conclusions. The two main techniques of MIAVR are mini-sternotomy and right anterior mini-thoracotomy. Both techniques with other less common forms of MIAVR will be discussed in this review. The advantages, disadvantages and surgical pitfalls will be discussed. Some of the advantages include shorter intensive care and hospital stay, reduced perioperative blood loss, less pain, improved respiratory function and cosmesis. The possible disadvantage of longer bypass and cross-clamp times may be counter balanced by the recent sutureless and rapid deployment valves. Despite some of the benefits, MIAVR has not been adopted by a significant proportion of the surgeons possibly related to the learning curve and requirements for re-training. As MIAVR becomes more common, randomised trials comparing this technique with transcatheter aortic valve implantation is warranted. In addition, assessing quality of life including return to work and functional capacity is needed.
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26
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Girdauskas E, Petersen J, Sachweh J, Kozlik-Feldmann R, Sinning C, Rickers C, von Kodolitsch Y, Reichenspurner H. Aortic valve repair in adult congenital heart disease. Cardiovasc Diagn Ther 2019; 8:789-798. [PMID: 30740326 DOI: 10.21037/cdt.2018.11.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Aortic valve repair in adult congenital heart disease (ACHD) went through a major development during the last two decades to become an increasingly established treatment option in experienced heart valve repair centers. This mini-review addresses valve-sparing treatment strategies in the two most common clinical entities of patients with adult congenital aortic valve disease, namely those presenting with bicuspid (BAV) and unicuspid (UAV) aortic valve disease. Both diseases are integral components of the continuum of congenital aortic valve diseases and represent one of the most common reasons of cardiovascular morbidity in young and otherwise healthy adult patients. The review will highlight the most important advantages of aortic valve sparing procedures as compared to the conventional valve replacement strategy. New treatment aspects will be reviewed including minimally-invasive surgical approaches for aortic valve repair as well as modern protocols of enhanced perioperative recovery which will potentially improve the perioperative recovery and quality of life of the patients undergoing valve-sparing surgical procedures in the future.
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Affiliation(s)
- Evaldas Girdauskas
- Department of Cardiac and Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.,German Center of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Johannes Petersen
- Department of Cardiac and Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.,German Center of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Jörg Sachweh
- Department of Pediatric Cardiology and Cardiac Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Rainer Kozlik-Feldmann
- Department of Pediatric Cardiology and Cardiac Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Christoph Sinning
- German Center of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.,Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Carsten Rickers
- Department of Pediatric Cardiology and Cardiac Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Yskert von Kodolitsch
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiac and Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.,German Center of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
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Akbulut M, Arslan O, Ak A, Tas S, Cekmecelioglu D, Sismanoglu M, Tuncer A. Innominate vein cannulation: easy but neglected technique. J Cardiovasc Thorac Res 2019; 10:187-191. [PMID: 30680075 PMCID: PMC6335992 DOI: 10.15171/jcvtr.2018.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 11/19/2018] [Indexed: 11/15/2022] Open
Abstract
Introduction: Our experience in minimally invasive procedures and improvement of graft
technology enables easy and successful operation carried out even with complex thoracic aortic
diseases from limited surgical area. However, it should be more than one incision or cannulation
site for such intervention. We aimed to present our experience and results of 23 patients who
has ascending aorta and aortic arch pathologies of which we operated with J-shaped partial
sternotomy and innominate vein cannulation.
Methods: From January 2014 to January 2016, 23 patients with aorta and aortic valve pathologies
who underwent aortic surgery with J-shaped partial sternotomy and innominate vein cannulation
included. Operation findings, cardiopulmonary bypass (CPB) values, postoperative results,
surgical mortality and morbidity rates, late conversion to full sternotomy rates, ICU and hospital
length of stay were evaluated.
Results: The mean age of the patients was 53.7±12 (range 19-68) and 18 (78.2%) were males.
Arcus aorta debranching applied to 4 patients (17.3%) and one of these procedures was frozen
elephant trunk procedure (4.3%). Neither mortality nor cerebrovascular accident occurred. Mean
CPB peak flow was 4.6±0.4 L/min, mean flow index calculated as 2.01±0.38 L/min/m2 and there
was no CPB problem intraoperatively. Innominate vein ligation was carried out in 5 patients but
no complication was seen except one who had left arm swelling treated with elevation.
Conclusion: Innominate vein cannulation with J-shaped partial sternotomy is a reliable and easily
applicable method providing effective utilization of limited operative field not only in ascending
aorta and aortic arch operations but also with the advancements of hybrid systems used in
descending aorta pathologies.
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Affiliation(s)
- Mustafa Akbulut
- Kosuyolu Kartal Heart Training and Research Hospital, Department of Cardiovascular Surgery, Istanbul, Turkey
| | - Ozgur Arslan
- Kosuyolu Kartal Heart Training and Research Hospital, Department of Cardiovascular Surgery, Istanbul, Turkey
| | - Adnan Ak
- Kosuyolu Kartal Heart Training and Research Hospital, Department of Cardiovascular Surgery, Istanbul, Turkey
| | - Serpil Tas
- Kosuyolu Kartal Heart Training and Research Hospital, Department of Cardiovascular Surgery, Istanbul, Turkey
| | - Davut Cekmecelioglu
- Kosuyolu Kartal Heart Training and Research Hospital, Department of Cardiovascular Surgery, Istanbul, Turkey
| | - Mesut Sismanoglu
- Kosuyolu Kartal Heart Training and Research Hospital, Department of Cardiovascular Surgery, Istanbul, Turkey
| | - Altug Tuncer
- Kosuyolu Kartal Heart Training and Research Hospital, Department of Cardiovascular Surgery, Istanbul, Turkey
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Young CP, Sinha S, Vohra HA. Outcomes of minimally invasive aortic valve replacement surgery. Eur J Cardiothorac Surg 2019; 53:ii19-ii23. [PMID: 29718235 DOI: 10.1093/ejcts/ezy186] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 04/06/2018] [Indexed: 11/13/2022] Open
Abstract
Minimally invasive aortic valve replacement has been used for more than 20 years, but its uptake has been limited. The volumes have increased steadily over the last 10 years, but it is still not regarded as a mainstream procedure. The issue, to some extent, is due to the lack of perceived evidence that minimal access incisions confer any benefit other than cosmetic appearance. In this article, the current literature on minimally invasive aortic valve replacement is reviewed, and it is concluded that benefits are demonstrable, particularly in higher risk, comorbid settings.
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Affiliation(s)
| | - Shubhra Sinha
- The Bristol Heart Institute, Bristol Royal Infirmary, Marlborough Street, Bristol BS2 8HW, UK
| | - Hunaid A Vohra
- The Bristol Heart Institute, Bristol Royal Infirmary, Marlborough Street, Bristol BS2 8HW, UK
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Ministernotomy or sternotomy in isolated aortic valve replacement? Early results. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 15:213-218. [PMID: 30647743 PMCID: PMC6329886 DOI: 10.5114/kitp.2018.80916] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 09/01/2018] [Indexed: 12/20/2022]
Abstract
Introduction Aortic valve replacement (AVR) is the gold standard in treating symptomatic aortic valve defects. To improve the healing process and limit the trauma, the minimally invasive approach was introduced. Aim To compare the peri- and post-operative results of aortic valve replacement performed via conventional full sternotomy (con-AVR) and of AVR performed via partial upper sternotomy (mini-AVR). Material and methods The total study population was divided into 2 demographically homogeneous groups: mini-AVR (n = 74) and con-AVR (n = 76). There were no statistically significant differences in preoperative echocardiography. Results Aortic cross-clamp time and cardiopulmonary bypass time were significantly longer in the mini-AVR group. Shorter mechanical ventilation time, hospital stay and lower postoperative drainage were observed in the mini-AVR group (p < 0.05). Biological prostheses were more frequently implanted in the mini-AVR group (p < 0.05). Patients from the mini-AVR group reported less postoperative pain. No significant differences were found in the diameter of the implanted aortic prosthesis, the amount of inotropic agents and painkillers, postoperative left ventricular ejection fraction (LVEF), medium and maximum transvalvular gradient or the number of transfused blood units. There were no differences in the frequency of postoperative complications such as mortality, stroke, atrial fibrillation, renal failure, wound infection, sternal instability, or the need for rethoracotomy. Conclusions Ministernotomy for AVR is a safe method and does not increase morbidity and mortality. It significantly reduces post-operative blood loss and shortens hospital stay. Ministernotomy can be successfully used as an alternative method to sternotomy.
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Nair SK, Sudarshan CD, Thorpe BS, Singh J, Pillay T, Catarino P, Valchanov K, Codispoti M, Dunning J, Abu-Omar Y, Moorjani N, Matthews C, Freeman CJ, Fox-Rushby JA, Sharples LD. Mini-Stern Trial: A randomized trial comparing mini-sternotomy to full median sternotomy for aortic valve replacement. J Thorac Cardiovasc Surg 2018; 156:2124-2132.e31. [DOI: 10.1016/j.jtcvs.2018.05.057] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 04/23/2018] [Accepted: 05/15/2018] [Indexed: 11/24/2022]
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Chang C, Raza S, Altarabsheh SE, Delozier S, Sharma UM, Zia A, Khan MS, Neudecker M, Markowitz AH, Sabik JF, Deo SV. Minimally Invasive Approaches to Surgical Aortic Valve Replacement: A Meta-Analysis. Ann Thorac Surg 2018; 106:1881-1889. [DOI: 10.1016/j.athoracsur.2018.07.018] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/18/2018] [Accepted: 07/03/2018] [Indexed: 11/25/2022]
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Nešpor D, Ondrášek J, Štěrba J, Kára T, Němec P. Our experience with surgical minimally invasive aortic valve replacement. COR ET VASA 2018. [DOI: 10.1016/j.crvasa.2017.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Doenst T, Diab M, Sponholz C, Bauer M, Färber G. The Opportunities and Limitations of Minimally Invasive Cardiac Surgery. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 114:777-784. [PMID: 29229038 DOI: 10.3238/arztebl.2017.0777] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 04/05/2017] [Accepted: 09/13/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Over the past two decades, minimally invasive techniques for classic heart valve surgery and isolated bypass surgery have been developed that enable access to the heart via partial sternotomy for most aortic valve procedures and via sternotomy-free mini-thoracotomy for other procedures. METHODS We review the current evidence on minimally invasive cardiac surgery on the basis of pertinent randomized studies and database studies retrieved by a selective search in the MEDLINE and PubMed Central databases, as well as by the Google Scholar search engine. RESULTS A PubMed search employing the search term "minimally invasive cardiac surgery" yielded nearly 10 000 hits, among which there were 7 prospective, randomized, controlled trials (RCTs) on aortic valve replacement, with a total of 477 patients, and 3 RCTs on mitral valve surgery, with a total of 340 patients. Only limited reports of specified centers are currently available for multiple valvular procedures and multiple coronary artery bypass procedures. The RCTs reveal that the minimally invasive techniques are associated with fewer wound infections and faster mobilization, without any difference in survival. Minimally invasive procedures are technically demanding and have certain anatomical prerequisites, such as appropriate coronary morphology for multiple bypass operations and the position of the aorta in the chest for sternotomy-free aortic valve procedures. The articles reviewed here were presumably affected by selection bias, in that patients in the published studies were preselected, and there may have been negative studies that were not published at all. CONCLUSION Specialized surgeons and centers can now carry out many cardiac valvular and bypass operations via minithoracotomy rather than sternotomy. According to current evidence, these minimally invasive techniques yield results that are at least as good as classic open-heart surgery.
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Affiliation(s)
- Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller Universität Jena; Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Friedrich-Schiller Universität Jena
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Aljalloud A, Shoaib M, Egron S, Arias J, Tewarie L, Schnoering H, Lotfi S, Goetzenich A, Hatam N, Pott D, Zhong Z, Steinseifer U, Zayat R, Autschbach R. The flutter-by effect: a comprehensive study of the fluttering cusps of the Perceval heart valve prosthesis. Interact Cardiovasc Thorac Surg 2018; 27:664-670. [PMID: 29788476 DOI: 10.1093/icvts/ivy162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 04/15/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Sutureless aortic valve prostheses are gaining popularity due to the substantial reduction in cross-clamp time. In this study, we report our observations on the cusp-fluttering phenomenon of the Perceval bioprosthesis (LivaNova, London, UK) using a combination of technical and medical perspectives. METHODS Between August 2014 and December 2016, a total of 108 patients (69% women) with a mean age of 78 years had aortic valve replacement using the Perceval bioprosthesis (34 combined procedures). All patients underwent transoesophageal echocardiography (TOE) intraoperatively. TOE was performed postoperatively to detect paravalvular leakage and to measure gradients, acceleration time, Doppler velocity indices (Vmax and LVOT/Vmax AV) and effective orifice area indices. In addition, a TOE examination was performed in 21 patients postoperatively. Data were collected retrospectively from our hospital database. RESULTS The retrospective evaluation of the intraoperative TOE examinations revealed consistent fluttering in all patients with the Perceval bioprosthesis. The echocardiographic postoperative measurements showed a mean effective orifice area index of 0.91 ± 0.12 cm2/m2. The overall mean pressure and peak pressure gradients were in a higher range (13.5 ± 5.1 mmHg and 25.5 ± 8.6 mmHg, respectively), whereas acceleration time (62.8 ± 16.4 ms) and Doppler velocity indices (0.43 ± 0.11) were within the normal range according to the American Society of Echocardiography or european association of echocardiography (EAE) guidelines. The 2-dimensional TOE in Motion Mode (M-Mode) that was performed in patients with elevated lactate dehydrogenase (LDH) levels revealed remarkable fluttering of the cusps of the Perceval bioprosthesis. CONCLUSIONS In our study cohort, we observed the fluttering phenomenon in all patients who received the Perceval bioprosthesis, which was correlated with elevated LDH levels and higher pressure gradients.
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Affiliation(s)
- Ali Aljalloud
- Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | - Mohamed Shoaib
- Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | - Sandrine Egron
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Aachen, Germany
| | - Jessica Arias
- Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | - Lachmandath Tewarie
- Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | - Heike Schnoering
- Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | - Shahram Lotfi
- Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | - Andreas Goetzenich
- Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | - Nima Hatam
- Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | - Desiree Pott
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Aachen, Germany
| | - Zhaoyang Zhong
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Aachen, Germany
| | - Ulrich Steinseifer
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, RWTH Aachen University, Aachen, Germany.,Monash Institute of Medical Engineering, Monash University, Melbourne, Australia
| | - Rachad Zayat
- Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | - Ruediger Autschbach
- Department of Thoracic and Cardiovascular Surgery, RWTH University Hospital Aachen, Aachen, Germany
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Giordano R, Cantinotti M, Comentale G, Di Tommaso L, Iannelli G, Pilato E, Palma G. Right thoracotomy for aortic valve replacement in the adolescents with bicuspid aortic valve. CONGENIT HEART DIS 2018; 14:162-166. [PMID: 30298987 DOI: 10.1111/chd.12680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 09/03/2018] [Accepted: 09/12/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND In this study, we compared our experience about early and midterm follow-up outcomes for right anterolateral minithoracotomy (RAMT) vs full sternotomy (FS) in surgical aortic valve replacement (AVR) among adolescents with bicuspid aortic valve (BAV). METHODS Patients were retrospectively enrolled from January 2008 to December 2017. Inclusion criteria were patients with BAV who had to undergo to AVR. They were divided in two groups: RAMT and FS. The choice of RAMT was based on individual surgeon's preferences or when expressly requested by patient that was informed of nonconventional approach. RESULTS We enrolled 61 patients, 23 in RAMT group and 38 in FS group. The mean age was 15.6 ± 1.7 years for RAMT group and 16.1 ± 1.5 years for FS group (P = .23). The RAMT group had a higher prevalence of female gender (P = .04). The patients in the RAMT group had longer cardiopulmonary bypass (115.2 ± 18.5 vs 102.2 ± 16.5 min; P = .006) and cross-clamp time (78.6 ± 18.1 vs 74.3 ± 15.2 min; P = .01). No patients required intraoperative conversion to FS. No differences were found in ventilation times, postoperative intensive care unit (ICU), and hospital length of stay for both groups. Follow-up echocardiograms were available for all patients at median of 5.2 years (range 0.5-9.6 years, median 5.4 years for RAMT and 5.1 for FS) and no patient required reoperation for aortic prosthesis malfunction. CONCLUSIONS Our study shows that RAMT is safe and effective as FS. Although the RAMT operation takes slightly more operation time, it is not associated with major adverse effects.
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Affiliation(s)
- Raffaele Giordano
- Department of Advanced Biomedical Science, Division of Adult and Pediatric Cardiac Surgery, University of Naples Federico II, Naples, Italy
| | | | - Giuseppe Comentale
- Department of Advanced Biomedical Science, Division of Adult and Pediatric Cardiac Surgery, University of Naples Federico II, Naples, Italy
| | - Luigi Di Tommaso
- Department of Advanced Biomedical Science, Division of Adult and Pediatric Cardiac Surgery, University of Naples Federico II, Naples, Italy
| | - Gabriele Iannelli
- Department of Advanced Biomedical Science, Division of Adult and Pediatric Cardiac Surgery, University of Naples Federico II, Naples, Italy
| | - Emanuele Pilato
- Department of Advanced Biomedical Science, Division of Adult and Pediatric Cardiac Surgery, University of Naples Federico II, Naples, Italy
| | - Gaetano Palma
- Department of Advanced Biomedical Science, Division of Adult and Pediatric Cardiac Surgery, University of Naples Federico II, Naples, Italy
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Furukawa N, Kuss O, Emmel E, Scholtz S, Scholtz W, Fujita B, Ensminger S, Gummert JF, Börgermann J. Minimally invasive versus transapical versus transfemoral aortic valve implantation: A one-to-one-to-one propensity score-matched analysis. J Thorac Cardiovasc Surg 2018; 156:1825-1834. [PMID: 29861110 DOI: 10.1016/j.jtcvs.2018.04.104] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 04/25/2018] [Accepted: 04/25/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Although transcatheter aortic valve implantation was the treatment of choice in inoperable and high-risk patients, the effect of transcatheter aortic valve implantation relative to conventional aortic valve replacement via ministernotomy in patients with moderate surgical risk remains unclear. METHODS We consecutively enrolled patients who underwent minimally invasive aortic valve replacements via ministernotomy (n = 1929), transapical (n = 607), and transfemoral (n = 1273) aortic valve implantations from a single center during the period from July 2009 to July 2017. Of those, we conducted a 1:1:1 propensity score matching according to 23 preoperative risk factors. RESULTS We were able to find 177 triplets (n = 531). The median European System for Cardiac Operative Risk Evaluation II was 3.0% versus 3.4% versus 2.9%, and Society of Thoracic Surgeons Predicted Risk of Mortality was 3.2% versus 3.6% versus 3.4%, respectively. According to the Valve Academic Research Consortium 2 criteria, there were no significant periprocedural differences regarding 30-day mortality (2.3% minimally invasive aortic valve replacement vs 4.5% transapical transcatheter aortic valve implantation vs 1.7% transfemoral transcatheter aortic valve implantation, P = .34), stroke (1.1% minimally invasive aortic valve replacement vs 0.6% transapical transcatheter aortic valve implantation vs 1.7% transfemoral transcatheter aortic valve implantation, P = .84), or myocardial infarction (0.6% minimally invasive aortic valve replacement vs 0.0% transapical transcatheter aortic valve implantation vs 0.0% transfemoral transcatheter aortic valve implantation, P = .83). Both intensive care and hospitalization times were significantly longer in the transapical group. Regarding midterm survival, transapical transcatheter aortic valve implantation was associated with a tendency toward a less favorable outcome (hazard ratio, 1.48; 95% confidence interval, 0.95-2.31; P = .17) compared with minimally invasive aortic valve replacement. CONCLUSIONS In this real-world propensity score-matched minimally invasive aortic valve replacement, transapical transcatheter aortic valve implantation, transfemoral transcatheter aortic valve implantation cohort of intermediate-risk patients, early mortality was not significantly different, whereas the rates of periprocedural complications were different depending on the approach. During follow-up, there was a tendency in the transapical transcatheter aortic valve implantation group toward a less favorable survival outcome, although there was no significant difference among the 3 groups.
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Affiliation(s)
- Nobuyuki Furukawa
- Clinic of Cardiothoracic Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany.
| | - Oliver Kuss
- Institute of Medical Statistics, Heinrich-Heine-University, Medical Faculty, Düsseldorf, Germany; German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Institute for Biometry and Epidemiology, Düsseldorf, Germany
| | - Eric Emmel
- Clinic of Cardiothoracic Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Smita Scholtz
- Clinic of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Werner Scholtz
- Clinic of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Buntaro Fujita
- Clinic of Cardiothoracic Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Stephan Ensminger
- Clinic of Cardiothoracic Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Jan F Gummert
- Clinic of Cardiothoracic Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Jochen Börgermann
- Clinic of Cardiothoracic Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
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Minimally invasive aortic valve replacement: is the effort justified? Indian J Thorac Cardiovasc Surg 2018. [DOI: 10.1007/s12055-017-0640-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Ferreira RTR, Rocha e Silva R, Marchi E. Aortic Valve Replacement: Treatment by Sternotomy versus Minimally Invasive Approach. Braz J Cardiovasc Surg 2017; 31:422-427. [PMID: 28076618 PMCID: PMC5407136 DOI: 10.5935/1678-9741.20160085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 10/17/2016] [Indexed: 11/20/2022] Open
Abstract
Objective To compare the results of aortic valve replacement with access by sternotomy
or minimally invasive approach. Methods Retrospective analysis of medical records of 37 patients undergoing aortic
valve replacement by sternotomy or minimally invasive approach, with
emphasis on the comparison of time of cardiopulmonary bypass and aortic
clamping, volume of surgical bleeding, time of mechanical ventilation, need
for blood transfusion, incidence of atrial fibrillation, length of stay in
intensive care unit, time of hospital discharge, short-term mortality and
presence of surgical wound infection. Results Sternotomy was used in 22 patients and minimally invasive surgery in 15
patients. The minimally invasive approach had significantly higher time
values of cardiopulmonary bypass (114.3±23.9 versus
86.7±19.8min.; P=0.003), aortic clamping
(87.4±19.2 versus 61.4±12.9 min.;
P<0.001) and mechanical ventilation
(287.3±138.9 versus 153.9±118.6 min.;
P=0.003). No difference was found in outcomes surgical
bleeding volume, need for blood transfusion, incidence of atrial
fibrillation, length of stay in intensive care unit and time of hospital
discharge. No cases of short-term mortality or surgical wound infection were
documented. Conclusion The less invasive approach presented with longer times of cardiopulmonary
bypass, aortic clamping and mechanical ventilation than sternotomy, however
without prejudice to the length of stay in intensive care unit, time of
hospital discharge and morbidity.
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Affiliation(s)
| | - Roberto Rocha e Silva
- Pitangueiras Hospital, Jundiaí, SP, Brazil; Hospital Paulo Sacramento, Jundiaí, SP, Brazil and Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Evaldo Marchi
- Faculdade de Medicina de Jundiaí (FMJ), Jundiaí, SP, Brazil
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Shehada SE, Elhmidi Y, Mourad F, Wendt D, El Gabry M, Benedik J, Thielmann M, Jakob H. Minimal access versus conventional aortic valve replacement: a meta-analysis of propensity-matched studies†. Interact Cardiovasc Thorac Surg 2017; 25:624-632. [DOI: 10.1093/icvts/ivx212] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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40
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Advantages of Minimal Access Versus Conventional Aortic Valve Replacement in Elderly or Severely Obese Patients. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 12:102-108. [PMID: 28346261 DOI: 10.1097/imi.0000000000000354] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of our study was to investigate potential clinical advantages of minimal access versus conventional surgical approach in older and severely obese patients undergoing isolated aortic valve replacement (AVR). METHODS One hundred thirty-five patients undergoing isolated primary AVR were enrolled. Propensity score matching was used to compare 42 selected patients operated on ministernotomy (MS, group B) with 42 selected patients operated on full sternotomy (FS, group A). RESULTS After propensity score matching, the two groups were comparable in terms of preoperative characteristics. Cardiopulmonary bypass time was significantly longer in MS group compared with the FS group [median (95% confidence level or CL), 103 (98.7-106.4) vs 94 (83.6-99) minutes, respectively; P = 0.0019]. No significant difference was observed in aortic cross-clamp time [median (95% CL), 73 (71.1-78.2) vs 69.5 (62.7-83) minutes; P = 0.4]. Significantly shorter ventilation time [median (95% CL), 13 (12-16.4) vs 24 (22-25) hours; P = 0.00018], intensive care unit stay [median (95% CL), 1 vs 2 days; P = 0.00017], and hospital stay [median (95% CL), 8.5 (8-10.8) vs 13.5 (11.1-14) days; P = 0.00030] were shown in the MS group. The age subgroup analysis showed that statistical significance for mechanical ventilation, intensive care unit, and hospital stay was specific for patients older than 75 years. The analysis of body mass index quartile showed that statistical significance for mechanical ventilation was specific for patients in the fourth quartile. CONCLUSIONS Minimal access AVR is a reproducible, safe, and effective surgical option in patients candidate for isolated AVR, and our study suggests a faster recovery when used in severely obese or older patients.
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Bouhout I, Morgant MC, Bouchard D. Minimally Invasive Heart Valve Surgery. Can J Cardiol 2017; 33:1129-1137. [DOI: 10.1016/j.cjca.2017.05.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 05/22/2017] [Accepted: 05/22/2017] [Indexed: 11/26/2022] Open
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Moore M, Barnhart GR, Chitwood WR, Rizzo JA, Gunnarsson C, Palli SR, Grossi EA. The economic value of rapid deployment aortic valve replacement via full sternotomy. J Comp Eff Res 2017; 6:293-302. [DOI: 10.2217/cer-2016-0064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To compare the economic value of EDWARDS INTUITY Elite™ (EIE) valve system for rapid-deployment aortic valve replacement (RDAVR) in a full sternotomy (FS) approach (EIE-FS-RDAVR) versus FS-AVR using conventional stented bioprosthesis. Data & methods: A simulation model to compare each treatment's 30-day inpatient utilization and complication rates utilized: clinical end points obtained from the TRANSFORM trial patient subset (EIE-FS-RDAVR) and a best evidence review of the published literature (FS-AVR); and costs from the Premier database and published literature. Results: EIE-FS-RDAVR costs $800 less than FS-AVR per surgery episode attributable to lowered complication rates and utilization. Combined with the lower mortality, EIE-FS-RDAVR was a superior (dominant) technology versus FS-AVR. Conclusion: This preliminary investigation of EIE-FS-RDAVR versus conventional FS-AVR found the EIE valve offered superior economic value over a 30-day period. Real-world analyses with additional long-term follow-up are needed to evaluate if this result can be replicated over a longer timeframe.
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Affiliation(s)
- Matt Moore
- Edwards Lifesciences, Inc., Irvine, CA, USA
| | | | | | | | | | - Swetha R Palli
- CTI Clinical Trial & Consulting Services, Inc., Cincinnati, OH, USA
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Konertz J, Zhigalov K, Weymann A, Dohmen PM. Initial Experience with Aortic Valve Replacement via a Minimally Invasive Approach: A Comparison of Stented, Stentless and Sutureless Valves. Med Sci Monit 2017; 23:1645-1654. [PMID: 28377566 PMCID: PMC5389532 DOI: 10.12659/msm.901780] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background This study aimed to compare the short-term outcomes of MIS-AVR among 3 different types of biological heart valves. Material/Methods Complete data were obtained from 79 patients who underwent MIS-AVR between January 2010 and June 2015. Patients were divided into 3 groups: 27 patients (group A) received Medtronic 3f® (Medtronic Inc., Fridley, MN, USA), 36 patients (group B) received DokimosPlus® (LabCor Laboratórios Ltda., Belo Horizonte, Brazil) and 16 patients (group C) received Perceval® (Sorin Biomedica Cardio S.r.l., Saluggia VC, Italy) valves. Operative and postoperative parameters such as duration of operation, bypass time, duration of ventilation, morbidity, and mortality were statistically analyzed using the Kruskal-Wallis test. Hemodynamic assessment with transthoracic echocardiography was performed before discharge. Results The EuroSCORE II ranged between 0.67 and 6.94 with no significant difference between the groups. The median operative time was 166 min (range 90–230 min) in total, with significantly shorter times in group C (120 min [range 90–200]). The median total ventilation time was significantly lower in group C and significantly higher in group A. Hemodynamic evaluation demonstrated a mean maximal velocity (vmax) over the aortic valve of 2.3 m/s (range 0.9–4.3 m/s) with average mean and peak pressure gradient values of 10 mmHg (range 3–24 mmHg) and 20 mmHg (range 5–42 mmHg), respectively. Group A showed the highest values for vmax (H>5.99). No significant difference was found regarding duration of hospitalization. Mortality was 3%. Conclusions In conclusion, all 3 valves showed good perioperative results, satisfying hemodynamic performance, and low complication rates.
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Affiliation(s)
- Johanna Konertz
- Department of Cardiovascular Surgery, Charité Hospital, Medical University Berlin, Berlin, Germany
| | - Konstantin Zhigalov
- Department of Cardiovascular Surgery, Charité Hospital, Medical University Berlin, Berlin, Germany
| | - Alexander Weymann
- Department of Cardiac Surgery, University Hospital Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Pascal M Dohmen
- Department of Cardiac Surgery, University Hospital Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.,Department of Cardiothoracic Surgery, University of the Free State, Bloemfontein, South Africa
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Pisano C, Totaro P, Triolo OF, Argano V. Advantages of Minimal Access versus Conventional Aortic Valve Replacement in Elderly or Severely Obese Patients. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017. [DOI: 10.1177/155698451701200205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Calogera Pisano
- From the Unit of Cardiac Surgery, Department of Surgery and Oncology, University Hospital “P. Giaccone,” Palermo, Italy
| | - Pasquale Totaro
- From the Unit of Cardiac Surgery, Department of Surgery and Oncology, University Hospital “P. Giaccone,” Palermo, Italy
| | - Oreste Fabio Triolo
- From the Unit of Cardiac Surgery, Department of Surgery and Oncology, University Hospital “P. Giaccone,” Palermo, Italy
| | - Vincenzo Argano
- From the Unit of Cardiac Surgery, Department of Surgery and Oncology, University Hospital “P. Giaccone,” Palermo, Italy
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Schäfer T, Doose C, Fujita B, Utzenrath M, Egron S, Schmitz C, Scholtz S, Kütting M, Hakim-Meibodi K, Börgermann J, Gummert J, Steinseifer U, Ensminger S. Preclinical determination of the best functional position for transcatheter heart valves implanted in rapid deployment bioprostheses. EUROINTERVENTION 2017; 12:1706-1714. [DOI: 10.4244/eij-d-16-00237] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Moore M, Barnhart GR, Chitwood WR, Rizzo JA, Gunnarsson C, Palli SR, Grossi EA. The economic value of INTUITY in aortic valve replacement. J Med Econ 2016; 19:1011-7. [PMID: 27549435 DOI: 10.1080/13696998.2016.1220949] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The recent development of the EDWARDS INTUITY Elite™ (EIE) valve system enables the rapid deployment of a prosthetic surgical heart valve in an aortic valve replacement (AVR) procedure via both the minimally invasive (MISAVR) and conventional (CAVR) approaches. In order to understand its economic value, this study performed a cost evaluation of the EIE valve system used in a MIS rapid-deployment approach (MIS-RDAVR) vs MISAVR and CAVR, respectively, compared to standard prosthetic aortic valves. METHODS A simulation model was developed using TreeAge (and validated with MS Excel) to compare the inpatient utilization and complication costs for each treatment arm. Thirty-day clinical end-points for the MIS-RDAVR (mortality and complications) were taken from the TRANSFORM trial; and a best evidence review of the published literature was used for the MISAVR and CAVR approaches. Studies were pooled and parameter estimates were weighted by sample size in order to compare the TRANSFORM patients. Cost data (2016 USD) were taken from the Premier database. Incremental cost and cost-effectiveness was assessed and one-way/probabilistic sensitivity analyses performed to gauge the robustness of the results. RESULTS MIS-RDAVR costs $2,621 less than CAVR and had lower mortality rates, making it a superior (dominant) technology relative to CAVR. MIS-RDAVR costs $4,560 more than MISAVR, but was associated with an additional 0.20 life years-per-patient. This implies a cost-effectiveness ratio of $22,903 per-life-year-gained. Thus, MIS-RDAVR is cost-effective compared to MISAVR. CONCLUSIONS The EIE valve system deployed in a MIS approach appears to be a cost-effective technology compared to MISAVR and CAVR. When compared to CAVR it may achieve cost savings as well. These results suggest that MIS-RDAVR confers superior economic value compared to both standard MISAVR and CAVR via lowered key complication rates (re-operation, renal complications, wound infection, TIA, endocarditis) and utilization (cross-clamp time, hospital ward days).
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Affiliation(s)
| | | | | | - John A Rizzo
- d Stony Brook University , Stony Brook , NY , USA
| | - Candace Gunnarsson
- e CTI Clinical Trial and Consulting Services, Inc. , Cincinnati , OH , USA
| | - Swetha R Palli
- e CTI Clinical Trial and Consulting Services, Inc. , Cincinnati , OH , USA
| | - Eugene A Grossi
- f New York University School of Medicine , New York , NY , USA
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Shehada SE, Öztürk Ö, Wottke M, Lange R. Propensity score analysis of outcomes following minimal access versus conventional aortic valve replacement. Eur J Cardiothorac Surg 2016; 49:464-470. [DOI: 10.1093/ejcts/ezv061] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Pfeiffer S, Santarpino G. Sutureless valves in the era of transcatheter aortic valve implantation. Eur J Cardiothorac Surg 2016; 49:1028-30. [PMID: 26719410 DOI: 10.1093/ejcts/ezv458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Steffen Pfeiffer
- Department of Cardiac Surgery-Cardiovascular Center, Paracelsus Medical University Nuremberg, Klinikum Nürnberg, Nuremberg, Germany
| | - Giuseppe Santarpino
- Department of Cardiac Surgery-Cardiovascular Center, Paracelsus Medical University Nuremberg, Klinikum Nürnberg, Nuremberg, Germany
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Gleason TG. The sutureless valve redux: Innovation or hype? J Thorac Cardiovasc Surg 2015; 151:743-744. [PMID: 26602254 DOI: 10.1016/j.jtcvs.2015.10.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 10/19/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Thomas G Gleason
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pa.
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50
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A Meta-Analysis Examining Differences in Short-Term Outcomes between Sutureless and Conventional Aortic Valve Prostheses. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2015; 10:375-82. [DOI: 10.1097/imi.0000000000000221] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective Sutureless aortic valve prostheses are anchored by radial force in a mechanism similar to that of transcatheter aortic valve implantation. Transcatheter aortic valve implantation is associated with an increased permanent pacemaker (PPM) requirement in a significant proportion of patients. We undertook a meta-analysis to examine the incidence of PPM insertion associated with sutureless compared with conventional surgical aortic valve replacement. Methods A systematic review was conducted in accordance with the Prisma guidelines.1 All searches were performed on August 10, 2014. Studies between 2007 and 2014 were included in the search. Results A total of 832 patients were included in the sutureless group and 3,740 in the conventional group. Aortic cross-clamp (39.8 vs 62.4 minutes; P < 0.001) and cardiopulmonary bypass (64.9 vs 86.7 minutes; P = 0.002) times were shorter in the sutureless group. Permanent pacemaker implantation rate was higher in the sutureless cohort (9.1% vs 2.4%; P = 0.025). Conclusions Sutureless aortic valve prostheses are associated with significantly shorter cardiopulmonary bypass and aortic cross-clamp times and a higher incidence of PPM insertion than conventional. Further investigation of the prognostic significance is required.
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