1
|
Giamberti A, Ferrero P, Caldaroni F, Varrica A, Pasqualin G, D'Aiello F, Bergonzoni E, Ranucci M, Chessa M. The Appraisal of Adults with Congenital Heart Disease: Lesson from Comparison of Surgical Outcomes. Pediatr Cardiol 2024:10.1007/s00246-024-03517-6. [PMID: 38802599 DOI: 10.1007/s00246-024-03517-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 04/30/2024] [Indexed: 05/29/2024]
Abstract
The population of adults with congenital heart disease (ACHD) is constantly growing. There seems to be a consensus that these patients are difficult to manage especially if compared to patients with acquired heart disease. The aim of this study is to compare outcomes and results of cardiac surgery in ACHD patients with a reference population of adults with acquired cardiac disease. Retrospective study of 5053 consecutive patients older than 18 years hospitalized for cardiac surgery during a 5-years period in our Institution. Two groups of patients were identified. Group I: 419 patients operated for congenital heart disease; Group II: 4634 patients operated for acquired heart disease. In each Group were identified low, medium, and high-risk patients, according to validated scores. Right ventricular outflow tract surgery was the most frequent procedure in Group I, while coronary artery by-pass grafting was the most common in Group II. Patients with ACHD were younger (37.8 vs. 67.7 years), with higher number of previous operations (32.1% vs. 6.9%), had longer post-ICU hospital stay (11 vs. 8 days) but had lower ICU stay (1 vs. 2 days), shorter assisted mechanical ventilation (12 vs. 14 h) and lower surgical mortality (1 vs. 3.7%) (all p < 0.001). No differences were found in term of post-operative complications (12.4 vs. 15%). The surgical treatment of ACHD patients can be done with excellent results and if compared with acquired cardiac disease patients they have better results with shorter ICU stay and lower mortality.
Collapse
Affiliation(s)
- Alessandro Giamberti
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, University Hospital, Via Morandi 30, 20097, San Donato M.se, MI, Italy.
| | - Paolo Ferrero
- ACHD Unit - Pediatric and Adult Congenital Heart Centre, IRCCS Policlinico San Donato, San Donato M.se, MI, Italy
| | - Federica Caldaroni
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, University Hospital, Via Morandi 30, 20097, San Donato M.se, MI, Italy
| | - Alessandro Varrica
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, University Hospital, Via Morandi 30, 20097, San Donato M.se, MI, Italy
| | - Giulia Pasqualin
- ACHD Unit - Pediatric and Adult Congenital Heart Centre, IRCCS Policlinico San Donato, San Donato M.se, MI, Italy
| | - Fabio D'Aiello
- ACHD Unit - Pediatric and Adult Congenital Heart Centre, IRCCS Policlinico San Donato, San Donato M.se, MI, Italy
| | - Emma Bergonzoni
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, University Hospital, Via Morandi 30, 20097, San Donato M.se, MI, Italy
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Marco Ranucci
- Department of Cardiovascular Anesthesia, IRCCS Policlinico San Donato, San Donato M.se, MI, Italy
| | - Massimo Chessa
- ACHD Unit - Pediatric and Adult Congenital Heart Centre, IRCCS Policlinico San Donato, San Donato M.se, MI, Italy
- UniSR - Vita Salute San Raffaele University, Milan, Italy
| |
Collapse
|
2
|
Peters MC, Kruithof BPT, Bouten CVC, Voets IK, van den Bogaerdt A, Goumans MJ, van Wijk A. Preservation of human heart valves for replacement in children with heart valve disease: past, present and future. Cell Tissue Bank 2024; 25:67-85. [PMID: 36725733 PMCID: PMC10902036 DOI: 10.1007/s10561-023-10076-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 01/29/2023] [Indexed: 02/03/2023]
Abstract
Valvular heart disease affects 30% of the new-borns with congenital heart disease. Valve replacement of semilunar valves by mechanical, bioprosthetic or donor allograft valves is the main treatment approach. However, none of the replacements provides a viable valve that can grow and/or adapt with the growth of the child leading to re-operation throughout life. In this study, we review the impact of donor valve preservation on moving towards a more viable valve alternative for valve replacements in children or young adults.
Collapse
Affiliation(s)
- M C Peters
- Department of Pediatric Cardiothoracic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, 3584 EA, Utrecht, The Netherlands.
- Department of Cardiovascular Cell Biology, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands.
- Department of Biomedical Engineering, Eindhoven University of Technology, 5600 MB, Eindhoven, The Netherlands.
| | - B P T Kruithof
- Department of Cardiovascular Cell Biology, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands
- Department of Cardiology, Leiden University Medical Center, 2333 ZA, Leiden, The Netherlands
| | - C V C Bouten
- Department of Biomedical Engineering, Eindhoven University of Technology, 5600 MB, Eindhoven, The Netherlands
- Institute for Complex Molecular Systems, Eindhoven University of Technology, 5600 MB, Eindhoven, The Netherlands
| | - I K Voets
- Institute for Complex Molecular Systems, Eindhoven University of Technology, 5600 MB, Eindhoven, The Netherlands
- Department of Chemical Engineering and Chemistry, Eindhoven University of Technology, 5600 MB, Eindhoven, The Netherlands
| | - A van den Bogaerdt
- Heart Valve Department, ETB-BISLIFE Multi Tissue Center, 2333 BD, Beverwijk, The Netherlands
| | - M J Goumans
- Department of Cardiovascular Cell Biology, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands
| | - A van Wijk
- Department of Pediatric Cardiothoracic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, 3584 EA, Utrecht, The Netherlands
| |
Collapse
|
3
|
Sylvester CB, Ryan CT, Frankel WC, Asokan S, Zea-Vera R, Zhang Q, Wall MJ, Coselli JS, Rosengart TK, Chatterjee S, Ghanta RK. Readmission After Bioprosthetic vs Mechanical Mitral Valve Replacement in the United States. Ann Thorac Surg 2024; 117:113-118. [PMID: 35803331 DOI: 10.1016/j.athoracsur.2022.05.064] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/17/2022] [Accepted: 05/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Choosing between a bioprosthetic and a mechanical mitral valve is an important decision for both patients and surgeons. We compared patient outcomes and readmission rates after bioprosthetic mitral valve replacement (Bio-MVR) vs mechanical mitral valve replacement (Mech-MVR). METHODS The Nationwide Readmissions Database was queried to identify 31 474 patients who underwent isolated MVR (22 998 Bio-MVR, 8476 Mech-MVR) between January 1, 2016, and December 31, 2018. Propensity score matching by age, sex, elective status, and comorbidities was used to compare outcomes between matched cohorts by prosthesis type. Freedom from readmission within the first calendar year was estimated by Kaplan-Meier analysis and compared between matched cohorts. RESULTS Bio-MVR patients were older (median age, 69 vs 57 years; P < .001) and had more comorbidities (median Elixhauser score, 14 vs 11; P < .001) compared with Mech-MVR patients. After propensity score matching (n = 15 549), Bio-MVR patients had similar operative mortality (3.5% vs 3.4%; P = .97) and costs ($50 958 vs $49 782; P = .16) but shorter lengths of stay (8 vs 9 days; P < .001) and fewer 30-day (16.0% vs 18.1%; P = .04) and 90-day (23.8% vs 26.8%; P = .01) readmissions compared with Mech-MVR patients. The difference in readmissions persisted at 1 year (P = .045). Readmission for bleeding or coagulopathy complications was less common with Bio-MVR (5.7% vs 10.1%; P < .001). CONCLUSIONS Readmission was more common after Mech-MVR than after Bio-MVR. Identifying and closely observing patients at high risk for bleeding complications may bridge the readmissions gap between Bio-MVR and Mech-MVR.
Collapse
Affiliation(s)
- Christopher B Sylvester
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Medical Scientist Training Program, Baylor College of Medicine, Houston, Texas; Department of Bioengineering, Rice University, Houston, Texas
| | - Christopher T Ryan
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - William C Frankel
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Department of Thoracic and Cardiovascular Surgery, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sainath Asokan
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Rodrigo Zea-Vera
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Qianzi Zhang
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Matthew J Wall
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Todd K Rosengart
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Subhasis Chatterjee
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Ravi K Ghanta
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Division of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas.
| |
Collapse
|
4
|
Timmermans N, Lam KY, van Straten A, van 't Veer M, Soliman-Hamad M. Prosthetic Valve Endocarditis After Aortic Valve Replacement: Differences Between Biological and Mechanical Prostheses. Heart Lung Circ 2024; 33:130-137. [PMID: 38158265 DOI: 10.1016/j.hlc.2023.11.024] [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: 10/03/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 01/03/2024]
Abstract
AIMS Prosthetic valve endocarditis (PVE) is the most severe form of infective endocarditis associated with a high mortality rate. Whether PVE affects biological and mechanical aortic valves to the same extent remains controversial. This study aimed to compare the incidence of re-intervention because of PVE between bioprosthetic and mechanical valves. METHODS Patients undergoing isolated surgical aortic valve replacement (AVR) or combined AVR in a single cardiac surgery centre between January 1998 and December 2019 were analysed. All patients who underwent re-intervention because of PVE were identified. The primary endpoint was the rate of explants. Freedom from re-intervention and variables associated with re-intervention were analysed using Cox regression analysis including correction for competing risk. RESULTS During the study period, 5,983 aortic valve prostheses were implanted, including 3,620 biological (60.5%) and 2,363 mechanical (39.5%) prostheses. The overall mean follow-up period was 7.3±5.3 years (median, 6.5; IQR 2.9-11.2 years). The rate of re-intervention for PVE in the biological group was 1.5% (n=54) compared with 1.7% (n=40) in the mechanical group (p=0.541). Cox regression analysis revealed that younger age (HR 0.960, 95% CI 0.942-0.979; p<0.001), male sex (HR 2.362, 95% CI 1.384-4.033; p=0.002), higher creatinine (HR 1.002, 95% CI 0.999-1.004; p=0.057), and biological valve prosthesis (HR 2.073, 95% CI 1.258-3.414; p=0.004) were associated with re-intervention for PVE. After correction for competing risk of death, biological valve prosthesis was significantly associated with a higher rate of re-intervention for PVE (HR 2.011, 95% CI 1.177-3.437; p=0.011). CONCLUSIONS According to this single-centre, observational, retrospective cohort study, AVR using biological prosthesis is associated with re-intervention for PVE compared to mechanical prosthesis. Further investigations are needed to verify these findings.
Collapse
Affiliation(s)
- Naomi Timmermans
- Heart Center, Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Ka Yan Lam
- Heart Center, Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Albert van Straten
- Heart Center, Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Marcel van 't Veer
- Heart Center, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Mohamed Soliman-Hamad
- Heart Center, Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
| |
Collapse
|
5
|
Gunaydin S, McCusker K, Nicotra W. Redosing of long acting cardioplegic solutions in adult cardiac surgery: A comparative study. Perfusion 2023:2676591231216315. [PMID: 37965876 DOI: 10.1177/02676591231216315] [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: 11/16/2023]
Abstract
INTRODUCTION Despite promising results regarding using long-acting cardioplegia in the adult population, little data exists specifically for operations requiring prolonged aortic cross-clamp needing additional doses. In this pilot study, we evaluated the outcomes of patients undergoing surgery with prolonged cross-clamp time based on four different redosing compositions. METHODS During the period from January 2019 until June 2022, 288 patients undergoing cardiac surgery with an expected cross-clamp time over 60 min were prospectively randomized regarding the type of the cardioplegia used: Group 1 (N = 150)- single-dose del Nido antegrade cardioplegia and Group 2 (N = 138)- single-dose Histidine-Tryptophane-Ketoglutarate (HTK) antegrade cardioplegia. In patients with ischemic time over 60 min, needing a redosing were further analyzed separately in four subgroups: (A) Cold whole blood (CWB) (4:1) (N = 95); (A1: DN-CWB; A2: HTK-CWB) and (B) St Thomas Solution (N = 92) (B1: DN-St Thomas; B2: HTK-St Thomas. Control groups were C1 (DN redosed by DN) and C2 (HTK by HTK). RESULTS Troponin levels in A1 and B1 groups were significantly lower than in DN-control. Respiratory support time and incidence of atrial fibrillation were significantly lower in Group A1 versus DN-control. CONCLUSIONS Long-acting cardioplegic techniques are becoming widely utilized in the adult population, with minimal data on redosing methods/compositions for prolonged cases. Due to the small patient population, further investigation is needed to delineate optimal redosing methods, but this report brings to attention the initial success of multiple strategies.
Collapse
Affiliation(s)
- Serdar Gunaydin
- Department of Cardiac Surgery, University of Health Sciences, Ankara, Turkey
| | - Kevin McCusker
- Department of Clinical Perfusion, Lawrence Technological University, Southfield, Michigan
| | - William Nicotra
- Department of Cardiac Surgery, St Clair Hospital, Pittsburgh, PA, USA
| |
Collapse
|
6
|
Miazza J, Vasiloi I, Koechlin L, Gahl B, Santer D, Berdajs D, Nestelberger T, Kaiser C, Eckstein F, Reuthebuch O. Combining Minimally Invasive Direct Coronary Artery Bypass Grafting with Transapical Aortic Valve Implantation-The Next Level Heart Team Approach. J Clin Med 2023; 12:6890. [PMID: 37959355 PMCID: PMC10647604 DOI: 10.3390/jcm12216890] [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: 09/25/2023] [Revised: 10/23/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
We present the results of a combined approach for transapical aortic valve replacement and minimally invasive coronary artery bypass grafting (taTAVI-MIDCAB) in patients with combined aortic stenosis and coronary artery disease. BACKGROUND For patients presenting with aortic stenosis and coronary artery disease, a simultaneous procedure addressing both diseases is recommended to reduce operative risk. In high-risk patients with hostile femoral or coronary axis, taTAVI-MIDCAB can be an alternative minimally invasive approach, offering the benefits of left interior mammary artery to left anterior descending coronary artery (LIMA-LAD) grafting. METHODS From 2014 to 2022, 10 patients underwent taTAVI-MIDCAB for combined coronary and severe aortic stenosis in the hybrid operation theater at our institution. We assessed perioperative outcomes and follow-up outcomes. RESULTS The median age was 83 years (81 to 86). The procedure was successfully performed in all patients without conversion to sternotomy. The median length of hospital and intensive care unit stay was 9 days (7 to 16) and 2.5 days (1 to 5), respectively. The median flow over the coronary artery bypass was 31 (22 to 44) mL/min, with a pulsatility index (PI) of 2.4 (2.1 to 3.2). Mild paravalvular leak occurred in 2 patients (10%). There were no neurological events nor acute kidney injury. Pacemaker implantation was required in 1 patient (10%). CONCLUSIONS Simultaneous surgical coronary revascularization and interventional valve implantation in the setting of a hostile femoral and coronary axis appears to be safe and beneficial.
Collapse
Affiliation(s)
- Jules Miazza
- Department of Cardiac Surgery, University Hospital Basel, 4031 Basel, Switzerland; (J.M.); (D.S.)
| | - Ion Vasiloi
- Department of Cardiac Surgery, University Hospital Basel, 4031 Basel, Switzerland; (J.M.); (D.S.)
| | - Luca Koechlin
- Department of Cardiac Surgery, University Hospital Basel, 4031 Basel, Switzerland; (J.M.); (D.S.)
| | - Brigitta Gahl
- Department of Cardiac Surgery, University Hospital Basel, 4031 Basel, Switzerland; (J.M.); (D.S.)
| | - David Santer
- Department of Cardiac Surgery, University Hospital Basel, 4031 Basel, Switzerland; (J.M.); (D.S.)
| | - Denis Berdajs
- Department of Cardiac Surgery, University Hospital Basel, 4031 Basel, Switzerland; (J.M.); (D.S.)
| | - Thomas Nestelberger
- Department of Cardiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
| | - Christoph Kaiser
- Department of Cardiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
| | - Friedrich Eckstein
- Department of Cardiac Surgery, University Hospital Basel, 4031 Basel, Switzerland; (J.M.); (D.S.)
| | - Oliver Reuthebuch
- Department of Cardiac Surgery, University Hospital Basel, 4031 Basel, Switzerland; (J.M.); (D.S.)
| |
Collapse
|
7
|
Maldonado-Cañón K, Buitrago G, Molina G, Rincón Tello FM, Maldonado-Escalante J. Teaching hospitals and their influence on survival after valve replacement procedures: A retrospective cohort study using inverse probability of treatment weighting (IPTW). PLoS One 2023; 18:e0290734. [PMID: 37624801 PMCID: PMC10456128 DOI: 10.1371/journal.pone.0290734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND The effect of teaching hospital status on cardiovascular surgery has been of common interest in recent decades, yet its magnitude on heart valve replacement is still a matter of debate. Given the ethical and practical unfeasibility of randomly assigning a patient to such an exposure, we use the inverse probability of treatment weighting (IPTW) to assess this marginal effect on the survival of Colombian patients who underwent a first heart valve replacement between 2016 and 2019. METHODS A retrospective cohort study was conducted based on administrative records. The time-to-death event and cumulative incidences of death, readmission, and reoperation are presented as outcomes. An artificial sample is configured through IPTW, adjusting for sociodemographic variables, comorbidities, technique, and intervention weight. RESULTS Of a sample of 3,517 patients, 1,051 (29.9%) were operated on in a teaching hospital. The median age was 65.0 (18.1-91.5), 38.5% of patients were ≤60, and 6.9% were ≥80. The cumulative incidences of death at 30, 90 days, and one year were 5.9%, 8%, and 10.9%, respectively. Furthermore, 23.5% of the patients were readmitted within 90 days and 3.6% underwent reintervention within one year. The odds of 30-day mortality are lower for patients operated in a teaching hospital (OR 0.51; 95% CI 0.29-0.92); however, no effect on survival was identified in terms of time-to-event of death (HR 1.07; 95%CI 0.78-1.46). CONCLUSIONS After IPTW, the odds of 30-day mortality are lower for patients operated in a teaching hospital. There was no effect on survival, 90-day or one-year mortality, 90-day readmission, or one-year reintervention. Together, we offer an opening for investigating an exposure that has yet to be explored in Latin America with potential value to understand teaching hospitals as the essential nature of reality of an academic-clinical synergy.
Collapse
Affiliation(s)
- Kevin Maldonado-Cañón
- Facultad de Medicina, Instituto de Investigaciones Clínicas, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Giancarlo Buitrago
- Facultad de Medicina, Instituto de Investigaciones Clínicas, Universidad Nacional de Colombia, Bogotá, Colombia
- Hospital Universitario Nacional de Colombia, Bogotá, Colombia
| | - Germán Molina
- Department of Cardiovascular Surgery, Clínica Universitaria Colombia, Bogota, Colombia
| | - Francisco Mauricio Rincón Tello
- Department of Cardiovascular Surgery, Hospital Universitario Fundación Santa Fe de Bogotá, Bogota, Colombia
- Department of Cardiovascular Surgery, Clínica Los Nogales, Bogota, Colombia
| | - Javier Maldonado-Escalante
- Department of Cardiovascular Surgery, Clínica Universitaria Colombia, Bogota, Colombia
- Department of Cardiovascular Surgery, Hospital Universitario Fundación Santa Fe de Bogotá, Bogota, Colombia
| |
Collapse
|
8
|
Mistiaen W. Referral of Patients for Surgical Aortic Valve Replacement before and after Introduction of the Transcatheter Aortic Valve Implantation-Changing Patterns of Preoperative Characteristics and Volume and Postoperative Outcome. J Cardiovasc Dev Dis 2023; 10:jcdd10050223. [PMID: 37233190 DOI: 10.3390/jcdd10050223] [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: 04/07/2023] [Revised: 05/15/2023] [Accepted: 05/20/2023] [Indexed: 05/27/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) was first presented in 2002 as a case report. Randomized controlled trials showed that TAVI could serve as an alternative for surgical aortic valve replacement (SAVR) in high-risk patients. While the indications for TAVI have expanded into low-risk groups, favorable results of SAVR in elderly showed an increase in application of surgical treatment in this age category. This review aims to explore the effect of the introduction of TAVI in the referral for SAVR with respect to volume, patient profile, early outcome, and use of mechanical heart valves. Results show that the volume of SAVR has increased in several cardiac centers. In a small minority of series, age and risk score of the referred patients also increased. In most of the series, early mortality rate reduced. These findings, however are not universal. Different management policies could be responsible for this observation. Moreover, some patients in whom aortic valve replacement in whatever form is indicated still do not receive adequate treatment. This can be due to several reasons. Heart teams consisting of interventional cardiologists and cardiac surgeons should become a universal approach in order to minimize the number of untreated patients.
Collapse
Affiliation(s)
- Wilhelm Mistiaen
- Faculty of Medicine & Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
- Department of Health and Sciences, Artesis-Plantijn University of Applied Sciences, 2000 Antwerp, Belgium
| |
Collapse
|
9
|
Nam SW, Song IA, Oh TK. Trends in Cardiovascular Surgery in South Korea: A Nationwide Cohort Study from 2010 to 2019. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00335-X. [PMID: 37296025 DOI: 10.1053/j.jvca.2023.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 04/14/2023] [Accepted: 05/17/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES We aimed to investigate mortality and its associated factors in cardiovascular surgery-associated intensive care unit (ICU) admissions in South Korea from 2010 to 2019. DESIGN Population-based cohort study. SETTING Data from the National Health Insurance Service database in South Korea were used in this study. PARTICIPANTS All adult patients admitted to the ICU associated with cardiovascular surgery in South Korea between January 1, 2010 and December 31, 2019 were analyzed. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 62,794 ICU admissions associated with cardiovascular surgery were included in the analysis (median value of age: 65 years; 58.0% men). This included patients who underwent coronary artery bypass grafting (CABG) only (n = 10,704), valve-only surgery (n = 35,812), CABG + valve surgery (n = 3,230), aortic procedures (n = 7,968), and others (n = 5,080). The number of cardiovascular surgeries associated with ICU admissions was 4,409 in 2010, which gradually increased to 10,366 in 2019. The aortic procedure group had the highest 1-year mortality rate after cardiovascular surgery (15.7%), followed by the CABG + valve (13.2%), others (11.5%), CABG-only (9.5%), and valve-only (8.7%) groups. Invasive life support procedures during the ICU stay and hospital admission through the emergency room were potential risk factors for 1-year mortality after cardiovascular surgery. CONCLUSIONS Cardiovascular surgery-associated intensive care admissions gradually increased from 2010 to 2019 in South Korea. Among these patients, the highest 1-year mortality rate was observed in the aortic procedures group, followed by the CABG + valve, others, CABG-only, and valve-only groups.
Collapse
Affiliation(s)
- Sun Woo Nam
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - In-Ae Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, South Korea
| | - Tak Kyu Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, South Korea.
| |
Collapse
|
10
|
Gwak SY, Ko KY, Cho I, Hong GR, Ha JW, Shim CY. Risk factors and outcomes with surgical bioprosthetic mitral valve dysfunction. Heart 2022; 109:63-69. [PMID: 36371666 DOI: 10.1136/heartjnl-2022-321307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/10/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND There are insufficient data regarding the risk factors associated with valve dysfunction of bioprosthetic valves in the mitral position This study aimed to investigate the factors associated with bioprosthetic mitral valve (MV) dysfunction (MVD). METHODS A total of 245 patients (age 67.2±11.2 years, 74.9% women) who were followed up for more than 5 years after surgical bioprosthetic MV replacement were analysed in the setting of retrospective study design. MVD was defined as an increased mean gradient of >5 mm Hg with limited leaflet motion and/or newly developed MV regurgitation of at least moderate severity on follow-up echocardiography. The clinical outcome was defined as a composite of cardiovascular mortality, redo MV surgery or intervention and heart failure-related hospitalisations. RESULTS During a median of 96.0 months (IQR 67.0-125.0 months), bioprosthetic MVD occurred in 66 (27.6%) patients. Factors associated with bioprosthetic MVD detected by multivariate regression analysis were age at surgery (HR 0.98, 95% CI 0.96 to 0.99, p<0.001), chronic kidney disease (HR 3.27, 95% CI 1.74 to 6.12, p<0.001), elevated mean diastolic pressure gradient >5.5 mm Hg across the bioprosthetic MV early after operation (HR 2.02, 95% CI 1.08 to 3.78, p=0.028) and average haemoglobin level after surgery (HR 0.80, 95% CI 0.67 to 0.96, p=0.015). Patients with bioprosthetic MVD showed significantly poorer clinical outcomes than those without bioprosthetic MVD (log-rank p<0.001). CONCLUSIONS Young age at operation, chronic kidney disease, elevated pressure gradient across the bioprosthetic MV early after surgery and postsurgical anaemia are associated with bioprosthetic MVD. Bioprosthetic MVD is associated with poor clinical outcomes.
Collapse
Affiliation(s)
- Seo-Yeon Gwak
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyu-Yong Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Iksung Cho
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Geu-Ru Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jong-Won Ha
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Chi Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea
| |
Collapse
|
11
|
Demal TJ, Reichenspurner H, Conradi L. Prognoserelevanz des „Heart Teams“ bei Mitralklappenerkrankungen. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2022. [DOI: 10.1007/s00398-022-00492-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
12
|
D'Angelo AM, Nemeth S, Wang C, Kossar AP, Takeda K, Takayama H, Bapat V, Naka Y, Argenziano M, Smith CR, Beck J, Spellman J, Kurlansky P, George I. Re-dosing of del Nido cardioplegia in adult cardiac surgery requiring prolonged aortic cross-clamp. Interact Cardiovasc Thorac Surg 2021; 34:556-563. [PMID: 34788429 PMCID: PMC8972223 DOI: 10.1093/icvts/ivab310] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/24/2021] [Accepted: 09/20/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
- Alex M D'Angelo
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Samantha Nemeth
- Center for Innovation and Outcomes Research, Columbia University, New York, NY, USA
| | - Catherine Wang
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Alexander P Kossar
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Koji Takeda
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Hiroo Takayama
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Vinayak Bapat
- Department of Cardiothoracic Surgery, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Yoshifumi Naka
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Michael Argenziano
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Craig R Smith
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - James Beck
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Jessica Spellman
- Department of Anesthesiology, Columbia University Medical Center, New York, NY, USA
| | - Paul Kurlansky
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
| | - Isaac George
- Department of Surgery, Columbia University Medical Center, New York, NY, USA
| |
Collapse
|
13
|
Woo HS, Hwang HY, Kim HJ, Kim JB, Lee S, Lim C, Chang BC, Lee NR, Suh Y, Choi JW. Changes in the Prosthesis Types Used for Aortic Valve Replacement after the Introduction of Sutureless and Rapid Deployment Valves in Korea: A Nationwide Population-Based Cohort Study. J Chest Surg 2021; 54:369-376. [PMID: 34493693 PMCID: PMC8548199 DOI: 10.5090/jcs.21.033] [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: 04/23/2021] [Revised: 06/26/2021] [Accepted: 07/14/2021] [Indexed: 11/16/2022] Open
Abstract
Background Sutureless and rapid deployment valves for aortic valve replacement (AVR) were introduced in Korea in December 2016. This study evaluated changing trends in the prosthetic valves used for AVR in Korea after the introduction of sutureless and rapid deployment valves. Methods From December 2016 to December 2018, 4,899 patients underwent AVR in Korea. After applying the exclusion criteria, 4,872 patients were analyzed to determine changes in the type of prosthetic valve used for AVR. The study period was divided into 5 groups corresponding to 5-month intervals. Results The total number of AVR cases was 194.88±28.78 per month during the study period. Mechanical valves were used in approximately 27% to 33% of cases, and the proportion of mechanical valve use showed a tendency to decrease, with marginal significance overall (p=0.078) and significant decreases in patients less than 60 years of age and in men (p=0.013 and p=0.023, respectively). The use of sutureless valves increased from 13.4% to 25.8% of cases (p<0.001), especially in elderly patients (>70 years) and those requiring concomitant surgery. In a comparison between sutureless and rapid deployment valves, the use of Perceval S valves (a type of sutureless valve), gradually increased (p<0.001). Conclusion After the introduction of sutureless and rapid deployment valves in Korea, the rate of use of these new valves remarkably increased, especially in elderly patients and those requiring concomitant surgery. Further studies should investigate the clinical outcomes of these new prostheses.
Collapse
Affiliation(s)
- Hyeok Sang Woo
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| | - Ho Jin Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sak Lee
- Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Seoul, Korea
| | - Cheong Lim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Byung-Cheul Chang
- Department of Thoracic and Cardiovascular Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Na Rae Lee
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Youshin Suh
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Jae Woong Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Korea
| |
Collapse
|
14
|
Grant SW, Kendall S, Goodwin AT, Cooper G, Trivedi U, Page R, Jenkins DP. Trends and outcomes for cardiac surgery in the United Kingdom from 2002 to 2016. JTCVS OPEN 2021; 7:259-269. [PMID: 36003724 PMCID: PMC9390523 DOI: 10.1016/j.xjon.2021.02.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/02/2021] [Indexed: 12/13/2022]
Abstract
Objectives Cardiac surgery has evolved significantly since the turn of the century. The objective of this study was to investigate trends in cardiac surgery activity and outcomes in the United Kingdom utilizing a mandatory national cardiac surgical clinical database in the context of a comprehensive public health care system (ie, the UK National Health Service). Methods Data for all cardiac surgery procedures performed between 2002 and 2016 were extracted from the UK National Adult Cardiac Surgery Audit database. Data are validated and cleaned using reproducible algorithms. Trends in activity and outcomes were analyzed by fiscal year using linear regression. Results A total of 534,067 procedures were performed during the study period with the number of cases per year peaking in 2008/2009 at 41,426. Despite an increase in patient age and mean logistic European System for Cardiac Operative Risk Evaluation score, the in-hospital mortality rate for all cardiac surgery has fallen from 4.0% to 2.8% (P < .001). The number of isolated coronary artery bypass graft procedures has steadily declined but the total number of valve procedures has steadily increased (both P values < .001). The number of thoracic aortic procedures performed each year has doubled (P < .001), but the incidence of redo procedures has steadily declined. The proportion of emergency and salvage procedures has remained stable. Conclusions This study, which covers all cardiac surgery procedures performed in the United Kingdom for fiscal years between 2002 and 2016, demonstrates that despite an increase in patient risk profile, there has been a consistent reduction in in-hospital mortality. A number of other markers associated with quality have also improved.
Collapse
Affiliation(s)
- Stuart W Grant
- Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom
| | - Simon Kendall
- James Cook University Hospital, Middlesbrough, United Kingdom
| | | | - Graham Cooper
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Uday Trivedi
- Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Richard Page
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - David P Jenkins
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| |
Collapse
|
15
|
Variablity of Mechanical or Tissue Valve Implantation in Patients Undergoing Surgical Aortic Valve Replacement in Spain: National Retrospective Analysis from 2007 to 2018. J Clin Med 2021; 10:jcm10153209. [PMID: 34361993 PMCID: PMC8347167 DOI: 10.3390/jcm10153209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/07/2021] [Accepted: 07/20/2021] [Indexed: 11/17/2022] Open
Abstract
Background: There is no robust evidence regarding the types of valves implanted among patients undergoing surgical aortic valve replacement (SAVR) in Spain. Methods: All cases of patients undergoing SAVR ± coronary artery bypass grafting from January 2007 to December 2018 in the public Spanish National Health System were included. We analyzed the trends of SAVR volume, risk profile and type of implanted valve across time and place. Using multivariable logistic regression, we identified factors associated with biological SAVR. Results: In total, 62,870 episodes of SAVR in 15 Spanish territories were included. In 35,693 (56.8%), a tissue valve was implanted. The annual volume of procedures increased from 107.3/million (2007) to 128.6 (2017). In 2018, it fell to 108.5. Age increased and Charlson’s comorbity index worsened throughout the study period. Tissue valve implantation increased in most regions. After adjusting for other covariates, we observed a high variability in aortic valve implantation across different regions, with differences of as much as 20-fold in the use of tissue valves. Conclusions: Between 2007 and 2018, we detected a significant increase in the use of bioprostheses in patients undergoing SAVR in Spain, and a great variability in the types of valve between the Spanish territories, which was not explained by the different risk profiles of patients.
Collapse
|
16
|
Kontogeorgos S, Thunström E, Pivodic A, Dahlström U, Fu M. Prognosis and outcome determinants after heart failure diagnosis in patients who underwent aortic valvular intervention. ESC Heart Fail 2021; 8:3237-3247. [PMID: 34057321 PMCID: PMC8318512 DOI: 10.1002/ehf2.13451] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/26/2021] [Accepted: 05/19/2021] [Indexed: 12/17/2022] Open
Abstract
AIMS To study clinical phenotype, prognosis for all-cause and cardiovascular (CV) mortality and predictive factors in patients with incident heart failure (HF) after aortic valvular intervention (AVI) for aortic stenosis (AS). METHODS AND RESULTS In this retrospective, observational study we included patients from the Swedish Heart Failure Registry (SwedeHF) recorded 2003-2016, with AS diagnosis and AVI before HF diagnosis. The AS diagnosis was established according to International Classification of Diseases 10th revision (ICD-10) codes, thus without information concerning clinical or echocardiographical data on the aortic valve disease. The patients were divided into two subgroups: left ventricular ejection fraction (LVEF) ≥ 50% (AS-HFpEF) and <50% (AS-HFrEF). We individually matched three controls with HF from the SwedeHF without AS (control group) for each patient. Baseline characteristics, co-morbidities, survival status and outcomes were obtained by linking the SwedeHF with two other Swedish registries. We used Kaplan-Meier curves to present time to all-cause mortality, cumulative incidence function for time to CV mortality and Cox proportional hazards model to evaluate the relative difference between AS-HFrEF and AS-HFpEF and AS-HF and controls. The crude all-cause mortality was 49.0%, CV mortality 27.9% in AS-HF patients, respectively 44.7% and 26.6% in matched controls. The adjusted risk for all-cause mortality and CV mortality was similar in HF, regardless of LVEF vs. controls. No significant difference in factors predicting higher all-cause mortality was observed in AS-HFrEF vs. AS-HFpEF, except for diabetes (only in AS-HFrEF), with statistically significant interaction predicting death between the two groups. CONCLUSIONS In this nationwide SwedeHF study, we characterized incident HF population after AVI. We found no significant differences in all-cause and CV mortality compared with general HF population. They had virtually the same predictors for mortality, regardless of LVEF.
Collapse
Affiliation(s)
- Silvana Kontogeorgos
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Erik Thunström
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Aldina Pivodic
- Statistiska Konsultgruppen, Gothenburg, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ulf Dahlström
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Michael Fu
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
17
|
Sardari Nia P, Olsthoorn JR, Heuts S, van Kuijk SMJ, Vainer J, Streukens S, Schalla S, Segers P, Barenbrug P, Crijns HJGM, Maessen JG. Effect of a dedicated mitral heart team compared to a general heart team on survival: a retrospective, comparative, non-randomized interventional cohort study based on prospectively registered data. Eur J Cardiothorac Surg 2021; 60:263-273. [PMID: 33783480 DOI: 10.1093/ejcts/ezab065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/21/2020] [Accepted: 01/13/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Although in both the US and European guidelines the 'heart team approach' is a class I recommendation, supporting evidence is still lacking. Therefore, we sought to provide comparative survival data of patients with mitral valve disease referred to the general and the dedicated heart team. METHODS In this retrospective cohort, patients evaluated for mitral valve disease by a general heart team (2009-2014) and a dedicated mitral valve heart team (2014-2018) were included. Decision-making was recorded prospectively in heart team electronic forms. The end point was overall survival from decision of the heart team. RESULTS In total, 1145 patients were included of whom 641 (56%) were discussed by dedicated heart team and 504 (44%) by general heart team. At 5 years, survival probability was 0.74 [95% confidence interval (CI) 0.68-0.79] for the dedicated heart team group compared to 0.70 (95% CI 0.66-0.74, P = 0.040) for the general heart team. Relative risk of mortality adjusted for EuroSCORE II, treatment groups (surgical, transcatheter and non-intervention), mitral valve pathology (degenerative, functional, rheumatic and others) and 13 other baseline characteristics for patients in the dedicated heart team was 29% lower [hazard ratio (HR) 0.71, 95% CI 0.54-0.95; P = 0.019] than for the general heart team. The adjusted relative risk of mortality was 61% lower for patients following the advice of the heart team (HR 0.39, 95% CI 0.25-0.62; P < 0.001) and 43% lower for patients following the advice of the general heart team (HR 0.57, 95% CI 0.37-0.87; P = 0.010) compared to those who did not follow the advice of the heart team. CONCLUSIONS In this retrospective cohort, patients treated for mitral valve disease based on a dedicated heart team decision have significantly higher survival independent of the allocated treatment, mitral valve pathology and baseline characteristics.
Collapse
Affiliation(s)
- Peyman Sardari Nia
- Department of Cardiothoracic Surgery, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands.,Cardiovascular Research Institute (CARIM), Maastricht University, Maastricht, Netherlands
| | - Jules R Olsthoorn
- Department of Cardiothoracic Surgery, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | - Samuel Heuts
- Department of Cardiothoracic Surgery, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | - Jindrich Vainer
- Department of Cardiology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Sebastian Streukens
- Department of Cardiology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Simon Schalla
- Cardiovascular Research Institute (CARIM), Maastricht University, Maastricht, Netherlands.,Department of Cardiology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Patrique Segers
- Department of Cardiothoracic Surgery, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | - Paul Barenbrug
- Department of Cardiothoracic Surgery, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | - Harry J G M Crijns
- Cardiovascular Research Institute (CARIM), Maastricht University, Maastricht, Netherlands.,Department of Cardiology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands.,Cardiovascular Research Institute (CARIM), Maastricht University, Maastricht, Netherlands
| |
Collapse
|
18
|
Vanneman MW, Dalia AA. Perioperative and Echocardiographic Considerations for the Inspiris Resilia Aortic Valve--Current and Future. J Cardiothorac Vasc Anesth 2020; 34:2807-2812. [DOI: 10.1053/j.jvca.2020.03.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 03/31/2020] [Indexed: 11/11/2022]
|
19
|
Zeng BQ, Yu SQ, Chen Y, Zhai W, Liu B, Zhan SY, Sun F. [Safety of biological valves for aortic valve replacement: A systematic review and meta-analysis]. JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2020; 52:547-556. [PMID: 32541991 DOI: 10.19723/j.issn.1671-167x.2020.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To provide a comprehensive and contemporary overview of the long-term safety outcomes after aortic valve replacements (AVR) with conventional biological heart valve (stented or stentless). METHODS English databases (Medline, Embase, Web of Science, CENTRAL, and ClinicalTrial.gov) and Chinese databases (CNKI, VIP, WanFang, and SinoMed) were searched systemically from January 1, 2000 to January 26, 2019. Eligible randomized controlled trials, non-randomized clinical trials, cohort studies (retrospective or prospective), and unselected case series were included. Strict screening of the obtained literature was conducted to extract relevant data by two reviewers. Other inclusion criteria were studied reporting on outcomes of AVR with biological valves (stented or stentless), with or without coronary artery bypass grafting (CABG) or valve repair procedure, with mean follow-up length equal to or longer than 5 years. We excluded studies that reported only a specific patient group (e.g., patients with renal failure, or pregnancy), without the report of biological valve type, or with study population size less than 100. The meta-analysis was performed using Stata 14.0 software. RESULTS In this study, 53 papers (in total 57 study groups) involving 47 803 patients were included. (1) The all-cause mortality was 6.33/100 patient-years (95%CI: 5.85-6.84). Subgroup analysis showed that the mortality rates of porcine and bovine valve prostheses were 5.69/100 patient-years (95%CI: 5.05-6.41) and 7.29/100 patient-years (95%CI: 6.53-8.13), respectively. The all-cause mortality rates for stented and stentless valve were 6.69/100 patient-years (95%CI: 6.12-7.30) and 5.21/100 patient-years (95%CI: 4.43-6.14), respectively. (2) The incidence rate of thromboembolism was 1.16/100 patient-years (95%CI: 0.96-1.40), the incidence rate of permanent pacemaker (PPM) implantation was 1.08/100 patient-years (95%CI: 0.75-1.54), the incidence rate of stroke was 0.74/100 patient-years (95%CI: 0.51-1.06), the incidence rate of structural valve dysfunction (SVD) was 0.73/100 patient-years (95%CI: 0.59-0.91), the incidence rate of major bleeding was 0.52/100 patient-years (95%CI: 0.41-0.65), the incidence rate of endocarditis was 0.38/100 patient-years (95%CI: 0.33-0.44), and the incidence rate of non-structural valve dysfunction (NSVD) was 0.20/100 patient-years (95%CI: 0.13-0.31). The total reoperation rate for biological aortic valve was 0.77/100 patient-years (95%CI: 0.65-0.91), and the SVD related reoperation rate was 0.46/100 patient-years (95%CI: 0.36-0.58). CONCLUSION The all-cause mortality for conventional biological AVR was 6.33/100 patient-years. Thromboembolism, PPM implantation, reoperation, stroke, and SVD were major long term complications.
Collapse
Affiliation(s)
- B Q Zeng
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - S Q Yu
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - Y Chen
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - W Zhai
- Beijing Center for ADR Monitoring, Beijing 100024, China
| | - B Liu
- Beijing Center for ADR Monitoring, Beijing 100024, China
| | - S Y Zhan
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - F Sun
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| |
Collapse
|
20
|
Anantha-Narayanan M, Reddy YNV, Sundaram V, Murad MH, Erwin PJ, Baddour LM, Schaff HV, Nishimura RA. Endocarditis risk with bioprosthetic and mechanical valves: systematic review and meta-analysis. Heart 2020; 106:1413-1419. [PMID: 32471905 DOI: 10.1136/heartjnl-2020-316718] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 04/18/2020] [Accepted: 04/26/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Bioprosthetic valves are being used with increased frequency for valve replacement, with controversy regarding risk:benefit ratio compared with mechanical valves in younger patients. However, prior studies have been too small to provide comparative estimates of less common but serious adverse events such as infective endocarditis. We aimed to compare the incidence of infective endocarditis between bioprosthetic valves and mechanical valves. METHODS We searched PubMed, Cochrane, EMBASE, Scopus and Web of Science from inception to April 2018 for studies comparing left-sided aortic and mitral bioprosthetic to mechanical valves for randomised trials or observational studies with propensity matching. We used random-effects model for our meta-analysis. Our primary outcome of interest was the rate of infective endocarditis at follow-up. RESULTS 13 comparison groups with 43 941 patients were included. Mean age was 59±7 years with a mean follow-up of 10.4±5.0 years. Patients with bioprosthetic valves had a higher risk of infective endocarditis compared with patients receiving mechanical valves (OR 1.59, 95% CI 1.35 to 1.88, p<0.001) with an absolute risk reduction of 9 per 1000 (95% CI 6 to 14). Heterogeneity within the included studies was low (I2=0%). Exclusion of the study with maximum weight did not change the results of the analysis (OR 1.57, 95% CI 1.14 to 2.17, p=0.006). A meta-regression of follow-up time on incidence of infective endocarditis was not statistically significant (p=0.788) indicating difference in follow-up times did not alter the pooled risk of infective endocarditis. CONCLUSIONS Bioprosthetic valves may be associated with a higher risk of infective endocarditis. These data should help guide the discussion when deciding between bioprosthetic and mechanical valves in individual patients.
Collapse
Affiliation(s)
| | - Yogesh N V Reddy
- Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Varun Sundaram
- Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, Ohio, USA.,Division of Population Science, National Heart and Lung Institute, London, UK
| | | | - Patricia J Erwin
- Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Larry M Baddour
- Division of Infectious Diseases, Mayo Clinic Department of Health Sciences Research, Rochester, Minnesota, USA
| | - Hartzell V Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Rick A Nishimura
- Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| |
Collapse
|
21
|
den Os MM, van den Brom CE, van Leeuwen ALI, Dekker NAM. Microcirculatory perfusion disturbances following cardiopulmonary bypass: a systematic review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:218. [PMID: 32404120 PMCID: PMC7222340 DOI: 10.1186/s13054-020-02948-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 05/05/2020] [Indexed: 12/11/2022]
Abstract
Background Microcirculatory perfusion disturbances are associated with increased morbidity and mortality in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Technological advancements made it possible to monitor sublingual microcirculatory perfusion over time. The goal of this review is to provide an overview of the course of alterations in sublingual microcirculatory perfusion following CPB. The secondary goal is to identify which parameter of sublingual microcirculatory perfusion is most profoundly affected by CPB. Methods PubMed and Embase databases were systematically searched according to PRISMA guidelines and as registered in PROSPERO. Studies that reported sublingual microcirculatory perfusion measurements before and after onset of CPB in adult patients undergoing cardiac surgery were included. The primary outcome was sublingual microcirculatory perfusion, represented by functional capillary density (FCD), perfused vessel density (PVD), total vessel density (TVD), proportion of perfused vessels (PPV), and microvascular flow index (MFI). Results The search identified 277 studies, of which 19 fulfilled all eligibility criteria. Initiation of CPB had a profound effect on FCD, PVD, or PPV. Seventeen studies (89%) reported one or more of these parameters, and in 11 of those studies (65%), there was a significant decrease in these parameters during cardiac surgery; the other 6 studies (35%) reported no effect. In 29% of the studies, FCD, PVD, or PPV normalized by the end of cardiac surgery, and in 24% percent of the studies, this effect lasted at least 24 h. There was no clear effect of CPB on TVD and a mixed effect on MFI. Conclusion CPB during cardiac surgery impaired sublingual microcirculatory perfusion as reflected by reduced FCD, PVD, and PPV. Four studies reported this effect at least 24 h after surgery. Further research is warranted to conclude on the duration of CPB-induced microcirculatory perfusion disturbances and the relationship with clinical outcome. Trial registration PROSPERO, CRD42019127798
Collapse
Affiliation(s)
- Matthijs M den Os
- Department of Anesthesiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Charissa E van den Brom
- Department of Anesthesiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Department of Physiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Anoek L I van Leeuwen
- Department of Anesthesiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Department of Physiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.,Department of Cardiothoracic surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Nicole A M Dekker
- Department of Anesthesiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. .,Department of Physiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
| |
Collapse
|
22
|
Weiss MG, Møller JE, Dahl JS, Riber L, Sibilitz KL, Lykking EK, Borregaard B. Causes and characteristics associated with early and late readmission after open-heart valve surgery. J Card Surg 2020; 35:747-754. [PMID: 32048362 DOI: 10.1111/jocs.14460] [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: 01/10/2023]
Abstract
OBJECTIVES The objectives of the study were to describe the causes of readmission from discharge to 30 days and from day 31 to 180 after discharge and to investigate the characteristics associated with overall and cause-specific readmissions after open-heart valve surgery. METHODS A single-center, retrospective cohort of 980 patients undergoing open-heart valve surgery from 2013 to 2016. Time to the first readmission was analyzed using univariable and multivariable Cox proportional hazard models. Results are reported as hazard ratios (HR) with 95% confidence intervals (CI). RESULTS In total, 366 patients (37%) experienced unplanned cardiac readmission within 180 days after discharge. Within 30 days after discharge, the most frequent causes of readmission were pericardial/pleural effusions (n = 87), infections (n = 50), and atrial fibrillation/flutter (n = 45). Accordingly, infections (n = 32) were the most common cause from day 31 to 180. No powerful predictors of overall cardiac readmission were identified, but several characteristics were associated with cause-specific readmissions: age ≤65 years (HR: 1.85; CI: 1.18-2.88), male gender (HR: 1.85; CI: 1.11-3.09), high alcohol intake (HR: 1.99; CI: 1.22-3.24) and mitral valve procedures (HR: 1.86; CI: 1.11-3.10) were associated with readmissions due to effusions. Ischemic heart disease with a prior percutaneous coronary intervention (HR: 2.94; CI: 1.53-5.63), mitral valve procedures (HR: 2.10; CI: 1.23-3.59), and postoperative atrial fibrillation/flutter (HR: 1.71; CI: 1.03-2.85) were associated with atrial fibrillation/flutter readmissions. CONCLUSION Predicting overall readmissions after open-heart valve surgery is difficult as causes of readmissions vary and different causes are associated with different characteristics. Future studies should target reducing cause-specific readmissions.
Collapse
Affiliation(s)
- Marc G Weiss
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - Jacob E Møller
- Department of Cardiology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark.,Department of Cardiology, Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Jordi S Dahl
- Department of Cardiology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Lars Riber
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Kirstine L Sibilitz
- Department of Cardiology, Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Emilie K Lykking
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
23
|
Jiménez-García R, Perez-Farinos N, Miguel-Díez JD, Hernández-Barrera V, Méndez-Bailón M, Jimenez-Trujillo I, Miguel-Yanes JMD, López-de-Andrés A. National Trends in Utilization and In-Hospital Outcomes of Surgical Aortic Valve Replacements in Spain, 2001-2015. Braz J Cardiovasc Surg 2020; 35:65-74. [PMID: 32270962 PMCID: PMC7089743 DOI: 10.21470/1678-9741-2019-0181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The aims of this study were to examine the incidence and in-hospital outcomes of surgical aortic valve replacement (SAVR) and to identify factors associated with in-hospital mortality (IHM) among patients according to the type of implanted valve used in SAVR. METHODS We performed a retrospective study using the Spanish National Hospital Discharge Database, 2001-2015. We included patients who had SAVR listed as a procedure in their discharge report. RESULTS We identified 86,578 patients who underwent SAVR (52.78% mechanical and 47.22% bioprosthetic). Incidence of SAVR coding increased significantly from 11.95 cases per 100,000 inhabitants in 2001 to 17.92 in 2015 (P<0.001). Age and comorbidities increased over time (P<0.001). There was a significant increase in the frequency of concomitant coronary artery bypass grafting (CABG) and in the use of pacemaker implantation. The use of mechanical SAVR decreased and the use of bioprosthetic valves increased over time. IHM decreased over time (from 8.13% in 2001-05 to 5.39% in 2011-15). Patients who underwent mechanical SAVR had higher IHM than those who underwent bioprosthetic SAVR (7.44% vs. 6%; P<0.05). Higher IHM rates were associated with advanced age, female sex, comorbidities, concomitant CABG, and the use of mechanical SAVR (OR 1.67; 95% CI 1.57-1.77). CONCLUSION The number of SAVRs performed in Spain has increased since 2001. The use of mechanical SAVR has decreased and the use of bioprosthetic valves has increased over time. IHM has decreased over time for both types of valves and despite a concomitant increase in age and comorbidities of patients during the same period.
Collapse
Affiliation(s)
- Rodrigo Jiménez-García
- Rey Juan Carlos University Health Sciences Faculty Preventive Medicine and Public Health Teaching and Research Unit Madrid Spain Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain
| | - Napoleón Perez-Farinos
- Universidad de Málaga Faculty of Medicine Department of Public Health and Psychiatry Andalucía Spain Department of Public Health and Psychiatry, Faculty of Medicine, Universidad de Málaga, Andalucía, Spain
| | - Javier de Miguel-Díez
- Universidad Complutense de Madrid Hospital General Universitario Gregorio Marañón Respiratory Department Madrid Spain Respiratory Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Valentín Hernández-Barrera
- Rey Juan Carlos University Health Sciences Faculty Preventive Medicine and Public Health Teaching and Research Unit Madrid Spain Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain
| | - Manuel Méndez-Bailón
- Universidad Complutense de Madrid Hospital Universitario Clínico San Carlos Internal Medicine Department Madrid Spain Internal Medicine Department, Hospital Universitario Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Isabel Jimenez-Trujillo
- Rey Juan Carlos University Health Sciences Faculty Preventive Medicine and Public Health Teaching and Research Unit Madrid Spain Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain
| | - José M de Miguel-Yanes
- Hospital General Gregorio Marañon Internal Medicine Department Madrid Spain Internal Medicine Department, Hospital General Gregorio Marañon, Madrid, Spain
| | - Ana López-de-Andrés
- Rey Juan Carlos University Health Sciences Faculty Preventive Medicine and Public Health Teaching and Research Unit Madrid Spain Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain
| |
Collapse
|
24
|
Kurlansky P. Commentary: The future of heart valve surgery: Transcutaneous aortic valve replacement and beyond. J Thorac Cardiovasc Surg 2019; 159:428-429. [PMID: 31630838 DOI: 10.1016/j.jtcvs.2019.06.129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Paul Kurlansky
- Division of Cardiac Surgery, Columbia University, New York, NY.
| |
Collapse
|
25
|
Alkhouli M, Alqahtani F, Cook CC. Association between surgical volume and clinical outcomes following coronary artery bypass grafting in contemporary practice. J Card Surg 2019; 34:1049-1054. [PMID: 31389634 DOI: 10.1111/jocs.14205] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Mohamad Alkhouli
- Division of Cardiology, Department of MedicineWest Virginia University Morgantown West Virginia
- Department of Cardiovascular DiseasesMayo Clinic College of Medicine and Science Rochester Minnesota
| | - Fahad Alqahtani
- Division of Cardiology, Department of MedicineWest Virginia University Morgantown West Virginia
| | - Chris C. Cook
- Department of Cardiovascular SurgeryWest Virginia University Morgantown West Virginia
| |
Collapse
|
26
|
Gaudino M, Chikwe J. Commentary: Who needs evidence when patient preference is a Class I indication? J Thorac Cardiovasc Surg 2019; 159:430-431. [PMID: 31227179 DOI: 10.1016/j.jtcvs.2019.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 05/21/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY.
| | - Joanna Chikwe
- Department of Surgery, The State University of New York, Stony Brook, NY; Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York, NY
| |
Collapse
|
27
|
López-de-Andrés A, de Miguel-Díez J, Muñoz-Rivas N, Hernández-Barrera V, Méndez-Bailón M, de Miguel-Yanes JM, Jiménez-García R. Impact of type 2 diabetes mellitus in the utilization and in-hospital outcomes of surgical mitral valve replacement in Spain (2001-2015). Cardiovasc Diabetol 2019; 18:60. [PMID: 31077189 PMCID: PMC6511144 DOI: 10.1186/s12933-019-0866-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 05/02/2019] [Indexed: 01/03/2023] Open
Abstract
Background The main aims of this study were to examine the incidence and in-hospital outcomes of mechanical and bioprosthetic surgical mitral valve replacement (SMVR) among patients with and without T2DM. Methods We performed a retrospective study using the Spanish National Hospital Discharge Database from 2001 to 2015. We included patients with SMVR codified in their discharge report. We grouped admissions by diabetes status. Propensity score matching (PSM) was used to compare outcomes of isolated SMVR. Results We identified 42,937 patients (16.41% with T2DM). Incidence rates of mechanical and bioprosthetic SMVR were higher among T2DM patients than among non-T2DM patients. In both groups of patients, the use of bioprosthetic SMVR increased over time. The use of mechanical valves remained stable among T2DM patients. In T2DM and non-T2DM patients with mechanical SMVR, in hospital mortality (IHM) and MACCE decreased significantly (p < 0.001) from 2001 to 2015. T2DM patients had an overall 11.37% IHM, compared with 10.76% among non-T2DM patients (p = 0.176). Regarding MACCE figures were 14.72% vs. 14.22% (p = 0.320) after mechanical SMVR. Total crude IHM were 14.29% for T2DM patients and 15.13% for those without T2DM with bioprosthetic SMVR (p = 0.165) and 18.22 vs. 19.64%, for a MACCE (p = 0.185). Using PSM we found that the IHM and the MACCE of isolated SMVR did not differ significantly between patients with or without T2DM beside the type of valve replacement. Among T2DM patients, those who received bioprosthetic valves had higher IHM (14.29% vs. 11.37%; p = 0.003) and a higher rate of MACCE (18.22% vs. 14.72%; p = 0.001) than T2DM patients with mechanical SMVR. Conclusions In Spain from 2001 to 2015, the incidence rates of hospitalization to undergo mechanical or bioprosthetic SMVR were higher among the population suffering T2DM than among the non-T2DM population. In both groups of patients the use of bioprosthetic SMVR increased over time and the use of mechanical valves remained stable in T2DM. T2DM patients have IHM and MACCE after mechanical and bioprosthetic SMVR which are not significantly different to those found among non-diabetic patients. Among T2DM patients, the crude IHM was significantly higher in those who received a bioprosthetic SMVR than those with mechanical SMVR. Electronic supplementary material The online version of this article (10.1186/s12933-019-0866-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Ana López-de-Andrés
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Avda. de Atenas s/n, 28922, Alcorcón, Madrid, Spain
| | | | - Nuria Muñoz-Rivas
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Avda. de Atenas s/n, 28922, Alcorcón, Madrid, Spain
| | - Manuel Méndez-Bailón
- Internal Medicine Department, Hospital Universitario Clínico San Carlos, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - José M de Miguel-Yanes
- Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Rodrigo Jiménez-García
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Avda. de Atenas s/n, 28922, Alcorcón, Madrid, Spain.
| |
Collapse
|
28
|
De Miguel-Díez J, López-De-Andrés A, Hernández-Barrera V, De Miguel-Yanes JM, Méndez-Bailón M, Muñoz-Rivas N, Jiménez-García R. Chronic obstructive pulmonary disease is not associated with worse in-hospital outcomes after surgical aortic valve replacement in Spain (2001-2015). THE JOURNAL OF CARDIOVASCULAR SURGERY 2019; 60:413-421. [DOI: 10.23736/s0021-9509.19.10747-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
29
|
Gökalp AL, de Heer F, Etnel JRG, Kluin J, Takkenberg JJM. Clinical and quality of life outcomes after aortic valve replacement and aortic root surgery in adult patients <65 years old. Ann Cardiothorac Surg 2019; 8:372-382. [PMID: 31240181 DOI: 10.21037/acs.2019.04.07] [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
Selecting the optimal surgical treatment strategy in patients below the age of 65 years (i.e., non-elderly patients) with aortic valve or aortic root disease remains challenging. The objective of the current study is to summarize contemporary research on clinical and quality of life outcomes after aortic valve replacement (AVR) and aortic root surgery in non-elderly patients. Recent systematic reviews on clinical outcome after biological and mechanical AVR, the Ross procedure and aortic root surgery show that event occurrence is considerable after any type of AVR or aortic root surgery and-with the exception of the Ross procedure-survival is suboptimal. Although thromboembolism and bleeding events are more common after mechanical AVR and root surgery, these events are also considerably present after biological AVR, the Ross procedure and valve-sparing aortic root surgery (VSRR). Similarly, reoperation is more common after biological AVR, the Ross procedure and VSRR, but also occurs frequently after mechanical AVR and root replacement. Published evidence in AVR patients points to the direction of better health-related quality of life (HRQoL) outcomes with a biological solutions, while the HRQoL after aortic root surgery is limited and contradictory. This review illustrates that treatment for non-elderly aortic valve and aortic root disease patients needs to be tailored to the individual patient, considering both clinical and HRQoL outcomes as crucial factors to reach a treatment decision that best reflects the patient's values and goals in life.
Collapse
Affiliation(s)
- Arjen L Gökalp
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Jonathan R G Etnel
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jolanda Kluin
- Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Johanna J M Takkenberg
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
30
|
Lotz-Esquivel S, Matarrita-Quesada B, Monge-Bonilla C, Kuhn-Delgadillo K. Cirugía cardiaca en Costa Rica: caracterización de los pacientes en el Hospital San Juan de Dios del 2010 al 2015. CIRUGIA CARDIOVASCULAR 2019. [DOI: 10.1016/j.circv.2018.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
31
|
López-de-Andrés A, Méndez-Bailón M, Perez-Farinos N, Hernández-Barrera V, de Miguel-Díez J, Muñoz-Rivas N, Jiménez-García R. Gender differences in incidence and in-hospital outcomes of surgical aortic valve replacement in Spain, 2001–15. Eur J Public Health 2019; 29:674-680. [DOI: 10.1093/eurpub/ckz019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
we aim to examine trends in the incidence of surgical aortic valve replacement (SAVR) among women and men in Spain from 2001 to 2015; compare in-hospital outcomes for mechanical and bioprosthetic SAVR by gender and; to identify factors associated with in-hospital mortality (IHM) after SAVR.
Methods
We performed a retrospective study using the Spanish National Hospital Discharge Database, 2001–15. We included patients that had SAVR as procedure in their discharge report. Propensity score matching (PSM) was performed to assess the impact of gender on the outcomes of mechanical and bioprosthetic SAVR.
Results
We identified 86 578 patients who underwent SAVR (40% women). Incidence of SVAR was higher in men (incidence rate ratio 1.57; 95%CI 1.55–1.59). In 2001, 73.36% of the men and 71.57% of women received a mechanical prosthesis; these proportions decreased to 43.04% in men and 35.89% in women in 2015, whereas bioprosthetic SAVR increased to 56.96% and 64.11%. After PSM we found that IHM was higher in women than in matched men for mechanical (8.94% vs. 6.79%; P < 0.001) and bioprosthetic (6.51 vs. 5.42%; P = 0.001) SAVR. The mean length of hospital stay was longer (19.54 vs. 18.74 days; P < 0.001) among females than males undergoing mechanical SAVR. Higher IHM after SAVR was associated with older age, comorbidities (except diabetes and atrial fibrillation), concomitant coronary artery bypass graft and emergency room admission.
Conclusions
This nation-wide analysis over 15 years of gender-specific outcomes after SAVR showed that, after PSM women have significantly higher IHM after mechanical and bioprosthetic SAVR than men.
Collapse
Affiliation(s)
- Ana López-de-Andrés
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Manuel Méndez-Bailón
- Internal Medicine Department, Hospital Universitario Clínico San Carlos, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain
| | - Napoleon Perez-Farinos
- Department of Public Health and Psychiatry, Faculty of Medicine, Universidad de Malaga, Malaga, Spain
| | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Javier de Miguel-Díez
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Nuria Muñoz-Rivas
- Medicine Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Rodrigo Jiménez-García
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| |
Collapse
|
32
|
Osman M, Kheiri B, Osman K, Barbarawi M, Alhamoud H, Alqahtani F, Alkhouli M. Alcohol septal ablation vs myectomy for symptomatic hypertrophic obstructive cardiomyopathy: Systematic review and meta-analysis. Clin Cardiol 2018; 42:190-197. [PMID: 30421437 DOI: 10.1002/clc.23113] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/25/2018] [Accepted: 11/08/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Surgical myectomy (SM) and Alcohol septal ablation (ASA) are effective therapies for patients with hypertrophic cardiomyopathy who remain symptomatic despite medical therapy. A plethora of data has recently emerged on the long-term outcomes of these procedures. We hence sought to perform an updated meta-analysis comparing both procedures. METHODS Studies reporting long-term (>3-years) outcomes of SM and/or ASA were included. The primary endpoint was all-cause mortality. Secondary endpoints included cardiovascular mortality, sudden cardiac death (SCD), reintervention, and complications including death, pacemaker implantation, and stroke. RESULTS Twenty-two ASA cohorts (n = 4213; follow-up = 6.6-years) and 23 SM cohorts (n = 4240; follow-up = 6.8-years) were included. Septal myectomy was associated with higher periprocedural mortality and stroke (2% vs 1.2%, P = 0.009 and 1.5% vs 0.8% P = 0.013, respectively), but ASA was associated with more need of pacemaker (10% vs 5%, P < 0.001). During long-term follow-up, all-cause mortality, cardiovascular mortality, and sudden cardiac death rates were 1.5%, 0.4%, and 0.3% per person-year in the ASA group and 1.1%, 0.5%, and 0.3% per person-year in the SM group (P = 0.21, P = 0.53, P = 0.43), respectively. Repeat septal reduction intervention(s) were more common after ASA (11% vs 1.5%, P < 0.001). CONCLUSION Compared with SM, ASA is associated with lower periprocedural mortality and stroke but higher rates of pacemaker implantations and reintervention. However, there was no difference between ASA and SM with regards to long-term all-cause mortality, cardiovascular mortality, or SCD.
Collapse
Affiliation(s)
- Mohammed Osman
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Babikir Kheiri
- Hurley Medical Center, Michigan State University, Flint, Michigan
| | | | | | - Hani Alhamoud
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Fahad Alqahtani
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Mohamad Alkhouli
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia
| |
Collapse
|
33
|
Impact of type 2 diabetes mellitus in the utilization and in-hospital outcomes of surgical aortic valve replacement in Spain (2001-2015). Cardiovasc Diabetol 2018; 17:135. [PMID: 30326902 PMCID: PMC6190659 DOI: 10.1186/s12933-018-0780-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/12/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The aims of this study were to examine trends in the incidence and in-hospital outcomes of SAVR among T2DM patients from 2001 to 2015, to compare clinical variables among T2DM patients and matched non-T2DM patients hospitalized for SAVR and to identify factors associated with in-hospital mortality (IHM) among T2DM patients. METHODS We performed a retrospective study using the Spanish National Hospital Discharge Database, 2001-2015. We included patients who had SAVR as the procedure in their discharge report. For each T2DM patient, we selected a sex-, age-, implanted valve type- and year-matched nondiabetic patient. RESULTS We identified 78,223 patients who underwent SAVR (23.49% with T2DM). The prevalence of T2DM increased significantly (p < 0.001) from 16.7% in 2001-2003 to 23.5% in 2012-2015. The incidence of SAVR increased significantly from 28.99 cases in 2001 to 65.79 cases in 2015 per 100,000 individuals in the T2DM population. Using Poisson regression models, we found that the incidence of SAVR was 2.60 times higher among patients with T2DM than among those without diabetes (IRR 2.60; 95% CI 2.56-2.65). The incidence of mechanical SAVR among T2DM patients remained stable from 2001 to 2015, and bioprosthetic SAVR rose from 8.29 to 41.74 cases per 100,000 individuals in the T2DM patient population (p < 0.001). We matched 8835 and 9543 patients who underwent mechanical and bioprosthetic SAVR, respectively. IHM decreased over time in T2DM patients and non-T2DM patients (from 8.89% and 7.81% to 3.88% and 5.07%, respectively). IHM was significantly lower in T2DM patients than in nondiabetic subjects who underwent bioprosthetic SAVR (4.77% vs. 6.04%, p < 0.001), with similar results obtained for mechanical valves (7.11% and 7.77%). CONCLUSIONS The incidence of SAVR was higher in T2DM patients, and the incidence of bioprosthetic SAVR increased significantly among T2DM subjects. IHM decreased over time, regardless of the existence or absence of T2DM and the valve type. IHM was significantly lower in T2DM patients than in nondiabetic patients who underwent bioprosthetic SAVR.
Collapse
|
34
|
Danielsen SO, Moons P, Sandven I, Leegaard M, Solheim S, Tønnessen T, Lie I. Thirty-day readmissions in surgical and transcatheter aortic valve replacement: A systematic review and meta-analysis. Int J Cardiol 2018; 268:85-91. [DOI: 10.1016/j.ijcard.2018.05.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 05/09/2018] [Indexed: 11/24/2022]
|
35
|
Poli D, Antonucci E, Pengo V, Grifoni E, Maggini N, Testa S, Lodigiani C, Insana A, Marongiu F, Barcellona D, Paparo C, Bucherini E, Pignatelli P, Palareti G. Risk of reoperation in bioprosthetic valve patients with indication for long-term anticoagulation. Results from the observational retrospective multicentre PLECTRUM study. Open Heart 2018; 5:e000837. [PMID: 30228907 PMCID: PMC6135414 DOI: 10.1136/openhrt-2018-000837] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/19/2018] [Accepted: 07/24/2018] [Indexed: 01/15/2023] Open
Abstract
Objective Several factors should be considered when a prosthetic heart valve, bioprosthetic valve (BV) or mechanical valve is to be implanted: thrombogenicity, life expectancy and the risk of reoperation. Methods We conducted an observational retrospective multicentre study among Italian Thrombosis Centers on patients with BV on long-term vitamin K antagonist (VKA) treatment to evaluate the risk of reoperation and the rate of bleeding and thrombotic events. Results We analysed 612 patients (median age 71.8 years) with BV on long-term VKA treatment for the presence of atrial fibrillation (AF) (78.4%) or other indications (21.6%). Thirty-four major bleeding events (rate 1.1×100 patient-years) and 29 thromboembolic events (rate 0.9×100 patient-years) were recorded, and 46 patients (rate 1.5×100 patient-years) underwent reoperation. The rate of reoperation was higher among younger patients: 32.9% in patients <60 years and 3.9% in patients ≥60 years (relative risk (RR) 3.8, 95% CI 2.1 to 7.2; p=0.0001). When patients were analysed according to age <65 or ≥65 years and <75 or ≥70 years, younger patients still were at higher risk for reoperation (RR 3.1, 95% CI 1.7 to 6.0 and 3.7, 95% CI 1.7 to 8.6, respectively). Conclusions Our findings suggest that the threshold of 65 years for implanting a BV should be carefully evaluated, considering the high risk for reoperation and the high risk of AF occurrence with persisting need for long-term anticoagulation. The high risk for reoperation of young patients implanted with BV and the availability of a safer and easier way to conduct VKA treatment, such as the use of point-of-care devices, should be considered when the type of valve must be chosen.
Collapse
Affiliation(s)
- Daniela Poli
- Thrombosis Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | | | - Vittorio Pengo
- Department of Cardiac Thoracic and Vascular Sciences, Thrombosis Centre, University of Padova, Padova, Italy
| | - Elisa Grifoni
- Thrombosis Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Niccolò Maggini
- Thrombosis Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Sophie Testa
- Haemostasis and Thrombosis Centre, Hospital of Cremona, Cremona, Italy
| | | | - Antonio Insana
- Servizio Di Patologia Clinica Ospedale S. Croce Moncalieri, Moncalieri, Italy
| | - Francesco Marongiu
- Centro Emostasi, Azienda Ospedaliero Universitaria di Monserrato, Cagliari, Italy
| | - Doris Barcellona
- Centro Emostasi, Azienda Ospedaliero Universitaria di Monserrato, Cagliari, Italy
| | | | | | | | | |
Collapse
|
36
|
Di Eusanio M, Vessella W, Carozza R, Capestro F, D’Alfonso A, Zingaro C, Munch C, Berretta P. Ultra fast-track minimally invasive aortic valve replacement: going beyond reduced incisions. Eur J Cardiothorac Surg 2018; 53:ii14-ii18. [DOI: 10.1093/ejcts/ezx508] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 12/21/2017] [Indexed: 12/22/2022] Open
Affiliation(s)
- Marco Di Eusanio
- Cardiovascular Department, Cardiac Surgery Unit, Opsedali Riuniti, Marche Polytechnic University, Ancona, Italy
| | - Walter Vessella
- Cardiovascular Department, Cardiac Anaesthesia and Intensive Care Unit, Ospedali Riuniti, Ancona, Italy
| | - Roberto Carozza
- Cardiovascular Department, Perfusion Unit, Ospedali Riuniti, Ancona, Italy
| | - Filippo Capestro
- Cardiovascular Department, Cardiac Surgery Unit, Opsedali Riuniti, Marche Polytechnic University, Ancona, Italy
| | - Alessandro D’Alfonso
- Cardiovascular Department, Cardiac Surgery Unit, Opsedali Riuniti, Marche Polytechnic University, Ancona, Italy
| | - Carlo Zingaro
- Cardiovascular Department, Cardiac Surgery Unit, Opsedali Riuniti, Marche Polytechnic University, Ancona, Italy
| | - Christopher Munch
- Cardiovascular Department, Cardiac Anaesthesia and Intensive Care Unit, Ospedali Riuniti, Ancona, Italy
| | - Paolo Berretta
- Cardiovascular Department, Cardiac Surgery Unit, Opsedali Riuniti, Marche Polytechnic University, Ancona, Italy
| |
Collapse
|
37
|
Di Eusanio M, Phan K, Berretta P, Carrel TP, Andreas M, Santarpino G, Di Bartolomeo R, Folliguet T, Meuris B, Mignosa C, Martinelli G, Misfeld M, Glauber M, Kappert U, Shrestha M, Albertini A, Teoh K, Villa E, Yan T, Solinas M. Sutureless and Rapid-Deployment Aortic Valve Replacement International Registry (SURD-IR): early results from 3343 patients†. Eur J Cardiothorac Surg 2018; 54:768-773. [DOI: 10.1093/ejcts/ezy132] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 03/08/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Marco Di Eusanio
- Cardiovascular Department, Cardiac Surgery Unit, Ospedali Riuniti, Polytechnic University of Marche, Ancona, Italy
- The Collaborative Research (CORE) Group, Sydney, Australia
| | - Kevin Phan
- The Collaborative Research (CORE) Group, Sydney, Australia
| | - Paolo Berretta
- Cardiovascular Department, Cardiac Surgery Unit, Ospedali Riuniti, Polytechnic University of Marche, Ancona, Italy
| | | | | | - Giuseppe Santarpino
- Città di Lecce Hospital, GVM Care & Research, Lecce, Italy
- Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany
| | - Roberto Di Bartolomeo
- Department of Cardiac Surgery, Sant’Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Thierry Folliguet
- Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Nancy, France
| | - Bart Meuris
- Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium
| | - Carmelo Mignosa
- Cardiac Surgery Unit, Centro Clinico-Diagnostico ‘G.B. Morgagni’, Heart Center, Pedara, Italy
| | | | | | - Mattia Glauber
- Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals IRCCS Gruppo San Donato, Milan, Italy
| | - Utz Kappert
- Dresden Heart Center, Department of Cardiac Surgery, Dresden University Hospital, Dresden, Germany
| | | | | | - Kevin Teoh
- Southlake Regional Health Centre, Newmarket, ON, Canada
| | | | - Tristan Yan
- The Collaborative Research (CORE) Group, Sydney, Australia
- Macquarie University, Sydney, Australia
| | | |
Collapse
|
38
|
Fujita B, Ensminger S, Bauer T, Möllmann H, Beckmann A, Bekeredjian R, Bleiziffer S, Schäfer E, Hamm CW, Mohr FW, Katus HA, Harringer W, Walther T, Frerker C. Trends in practice and outcomes from 2011 to 2015 for surgical aortic valve replacement: an update from the German Aortic Valve Registry on 42 776 patients. Eur J Cardiothorac Surg 2017; 53:552-559. [DOI: 10.1093/ejcts/ezx408] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/28/2017] [Indexed: 02/03/2023] Open
Affiliation(s)
- Buntaro Fujita
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Stephan Ensminger
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Timm Bauer
- Department of Cardiology, University of Giessen, Giessen, Germany
| | - Helge Möllmann
- Department of Internal Medicine, St.-Johannes-Hospital, Dortmund, Germany
| | - Andreas Beckmann
- German Society of Thoracic, Cardiac and Vascular Surgery, Berlin, Germany
| | - Raffi Bekeredjian
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Sabine Bleiziffer
- Clinic for Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
| | - Elke Schäfer
- BQS Institute for Quality and Patient Safety, Düsseldorf, Germany
| | - Christian W Hamm
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Friedrich W Mohr
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Hugo A Katus
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Wolfgang Harringer
- Department of Thoracic and Cardiovascular Surgery, Klinikum Braunschweig, Braunschweig, Germany
| | - Thomas Walther
- Department of Cardiac Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Christian Frerker
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | | |
Collapse
|
39
|
Benstoem C, Stoppe C, Liakopoulos OJ, Ney J, Hasenclever D, Meybohm P, Goetzenich A. Remote ischaemic preconditioning for coronary artery bypass grafting (with or without valve surgery). Cochrane Database Syst Rev 2017; 5:CD011719. [PMID: 28475274 PMCID: PMC6481544 DOI: 10.1002/14651858.cd011719.pub3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Despite substantial improvements in myocardial preservation strategies, coronary artery bypass grafting (CABG) is still associated with severe complications. It has been reported that remote ischaemic preconditioning (RIPC) reduces reperfusion injury in people undergoing cardiac surgery and improves clinical outcome. However, there is a lack of synthesised information and a need to review the current evidence from randomised controlled trials (RCTs). OBJECTIVES To assess the benefits and harms of remote ischaemic preconditioning in people undergoing coronary artery bypass grafting, with or without valve surgery. SEARCH METHODS In May 2016 we searched CENTRAL, MEDLINE, Embase and Web of Science. We also conducted a search of ClinicalTrials.gov and the International Clinical Trials Registry Platform (ICTRP). We also checked reference lists of included studies. We did not apply any language restrictions. SELECTION CRITERIA We included RCTs in which people scheduled for CABG (with or without valve surgery) were randomly assigned to receive RIPC or sham intervention before surgery. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion, extracted data and checked them for accuracy. We calculated mean differences (MDs), standardised mean differences (SMDs) and risk ratios (RR) using a random-effects model. We assessed quality of the trial evidence for all primary outcomes using the GRADE methodology. We completed a 'Risk of bias' assessment for all studies and performed sensitivity analysis by excluding studies judged at high or unclear risk of bias for sequence generation, allocation concealment and incomplete outcome data. We contacted authors for missing data. Our primary endpoints were 1) composite endpoint (including all-cause mortality, non-fatal myocardial infarction or any new stroke, or both) assessed at 30 days after surgery, 2) cardiac troponin T (cTnT, ng/L) at 48 hours and 72 hours, and as area under the curve (AUC) 72 hours (µg/L) after surgery, and 3) cardiac troponin I (cTnI, ng/L) at 48 hours, 72 hours, and as area under the curve (AUC) 72 hours (µg/L) after surgery. MAIN RESULTS We included 29 studies involving 5392 participants (mean age = 64 years, age range 23 to 86 years, 82% male). However, few studies contributed data to meta-analyses due to inconsistency in outcome definition and reporting. In general, risk of bias varied from low to high risk of bias across included studies, and insufficient detail was provided to inform judgement in several cases. The quality of the evidence of key outcomes ranged from moderate to low quality due to the presence of moderate or high statistical heterogeneity, imprecision of results or due to limitations in the design of individual studies.Compared with no RIPC, we found that RIPC has no treatment effect on the rate of the composite endpoint with RR 0.99 (95% confidence interval (CI) 0.78 to 1.25); 2 studies; 2463 participants; moderate-quality evidence. Participants randomised to RIPC showed an equivalent or better effect regarding the amount of cTnT release measured at 72 hours after surgery with SMD -0.32 (95% CI -0.65 to 0.00); 3 studies; 1120 participants; moderate-quality evidence; and expressed as AUC 72 hours with SMD -0.49 (95% CI -0.96 to -0.02); 3 studies; 830 participants; moderate-quality evidence. We found the same result in favour of RIPC for the cTnI release measured at 48 hours with SMD -0.21 (95% CI -0.40 to -0.02); 5 studies; 745 participants; moderate-quality evidence; and measured at 72 hours after surgery with SMD -0.37 (95% CI -0.59 to -0.15); 2 studies; 459 participants; moderate-quality evidence. All other primary outcomes showed no differences between groups (cTnT release measured at 48 hours with SMD -0.14, 95% CI -0.33 to 0.06; 4 studies; 1792 participants; low-quality evidence and cTnI release measured as AUC 72 hours with SMD -0.17, 95% CI -0.48 to 0.14; 2 studies; 159 participants; moderate-quality evidence).We also found no differences between groups for all-cause mortality after 30 days, non-fatal myocardial infarction after 30 days, any new stroke after 30 days, acute renal failure after 30 days, length of stay on the intensive care unit (days), any complications and adverse effects related to ischaemic preconditioning. We did not assess many patient-centred/salutogenic-focused outcomes. AUTHORS' CONCLUSIONS We found no evidence that RIPC has a treatment effect on clinical outcomes (measured as a composite endpoint including all-cause mortality, non-fatal myocardial infarction or any new stroke, or both, assessed at 30 days after surgery). There is moderate-quality evidence that RIPC has no treatment effect on the rate of the composite endpoint including all-cause mortality, non-fatal myocardial infarction or any new stroke assessed at 30 days after surgery, or both. We found moderate-quality evidence that RIPC reduces the cTnT release measured at 72 hours after surgery and expressed as AUC (72 hours). There is moderate-quality evidence that RIPC reduces the amount of cTnI release measured at 48 hours, and measured 72 hours after surgery. Adequately-designed studies, especially focusing on influencing factors, e.g. with regard to anaesthetic management, are encouraged and should systematically analyse the commonly used medications of people with cardiovascular diseases.
Collapse
Affiliation(s)
- Carina Benstoem
- University Hospital AachenDepartment of Cardiothoracic SurgeryPauwelsstrasse 30AachenNorth Rhine WestphaliaGermany52074
| | - Christian Stoppe
- RWTH Aachen UniversityDepartment of Intensive Care MedicinePauwelsstrasse 30AachenNorth Rhine WestphaliaGermany52074
| | - Oliver J Liakopoulos
- Heart Center, University of CologneDepartment of Cardiothoracic SurgeryKerpener Str. 62CologneGermany50937
| | - Julia Ney
- University Hospital RWTH AachenDepartment of AnaesthesiologyPauwelsstrasse 30AachenGermany
| | - Dirk Hasenclever
- University of LeipzigInstitute for Medical Informatics, Statistics & Epidemiology (IMISE)Haertelstrasse 16‐18LeipzigGermany
| | - Patrick Meybohm
- University Hospital FrankfurtDepartment of Anaesthesiology, Intensive Care and Pain TherapyTheodor‐Stern‐Kai 7Frankfurt am MainGermany60590
| | - Andreas Goetzenich
- University Hospital AachenDepartment of Cardiothoracic SurgeryPauwelsstrasse 30AachenNorth Rhine WestphaliaGermany52074
| | | |
Collapse
|
40
|
Head SJ, Çelik M, Kappetein AP. Mechanical versus bioprosthetic aortic valve replacement. Eur Heart J 2017; 38:2183-2191. [DOI: 10.1093/eurheartj/ehx141] [Citation(s) in RCA: 159] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 03/03/2017] [Indexed: 02/06/2023] Open
|
41
|
Aortic valve replacement with sutureless and rapid deployment aortic valve prostheses. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2016; 13:504-10. [PMID: 27582765 PMCID: PMC4987419 DOI: 10.11909/j.issn.1671-5411.2016.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Aortic valve stenosis is the most common valve disease in the western world. Over the past few years the number of aortic valve replacement (AVR) interventions has increased with outcomes that have been improved despite increasing age of patients and increasing burden of comorbidities. However, despite such excellent results and its well-established position, conventional AVR has undergone great development over the previous two decades. Such progress, by way of less invasive incisions and use of new technologies, including transcatheter aortic valve implantation and sutureless valve prostheses, is intended to reduce the traumatic impact of the surgical procedure, thus fulfilling lower risk patients' expectations on the one hand, and extending the operability toward increasingly high-risk patients on the other. Sutureless and rapid deployment aortic valves are biological, pericardial prostheses that anchor within the aortic annulus with no more than three sutures. The sutureless prostheses, by avoiding the passage and the tying of the sutures, significantly reduce operative times and may improve outcomes. However, there is still a paucity of robust, evidence-based data on the role and performance of sutureless AVR. Therefore, strongest long-term data, randomized studies and registry data are required to adequately assess the durability and long-term outcomes of sutureless aortic valve replacement.
Collapse
|
42
|
Bell RM, Bøtker HE, Carr RD, Davidson SM, Downey JM, Dutka DP, Heusch G, Ibanez B, Macallister R, Stoppe C, Ovize M, Redington A, Walker JM, Yellon DM. 9th Hatter Biannual Meeting: position document on ischaemia/reperfusion injury, conditioning and the ten commandments of cardioprotection. Basic Res Cardiol 2016; 111:41. [PMID: 27164905 PMCID: PMC4863033 DOI: 10.1007/s00395-016-0558-1] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 05/03/2016] [Indexed: 12/21/2022]
Abstract
In the 30 years since the original description of ischaemic preconditioning, understanding of the pathophysiology of ischaemia/reperfusion injury and concepts of cardioprotection have been revolutionised. In the same period of time, management of patients with coronary artery disease has also been transformed: coronary artery and valve surgery are now deemed routine with generally excellent outcomes, and the management of acute coronary syndromes has seen decade on decade reductions in cardiovascular mortality. Nonetheless, despite these improvements, cardiovascular disease and ischaemic heart disease in particular, remain the leading cause of death and a significant cause of long-term morbidity (with a concomitant increase in the incidence of heart failure) worldwide. The need for effective cardioprotective strategies has never been so pressing. However, despite unequivocal evidence of the existence of ischaemia/reperfusion in animal models providing a robust rationale for study in man, recent phase 3 clinical trials studying a variety of cardioprotective strategies in cardiac surgery and acute ST-elevation myocardial infarction have provided mixed results. The investigators meeting at the Hatter Cardiovascular Institute workshop describe the challenge of translating strong pre-clinical data into effective clinical intervention strategies in patients in whom effective medical therapy is already altering the pathophysiology of ischaemia/reperfusion injury-and lay out a clearly defined framework for future basic and clinical research to improve the chances of successful translation of strong pre-clinical interventions in man.
Collapse
Affiliation(s)
- R M Bell
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
| | - H E Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - R D Carr
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
- MSD A/S, Copenhagen V, Denmark
| | - S M Davidson
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
| | - J M Downey
- Department of Physiology, University of South Alabama College of Medicine, Mobile, AL, USA
| | - D P Dutka
- Department of Cardiovascular Medicine, Addenbrooke's Hospital, Cambridge, UK
| | - G Heusch
- Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, Essen, Germany
| | - B Ibanez
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | - R Macallister
- Centre for Clinical Pharmacology, University College London, London, UK
| | - C Stoppe
- Department of Anesthesiology, University Hospital Aachen, Aachen, Germany
| | - M Ovize
- Centre de recherche en Cancérologie de Lyon, Université Lyon, Lyon, France
| | - A Redington
- Department of Pediatric Cardiology, the Heart Institute at Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - J M Walker
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, 67 Chenies Mews, London, WC1E 6HX, UK
| | - D M Yellon
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, 67 Chenies Mews, London, WC1E 6HX, UK.
| |
Collapse
|
43
|
Kim LK, Looser P, Swaminathan RV, Minutello RM, Wong SC, Girardi L, Feldman DN. Outcomes in patients undergoing coronary artery bypass graft surgery in the United States based on hospital volume, 2007 to 2011. J Thorac Cardiovasc Surg 2016; 151:1686-92. [DOI: 10.1016/j.jtcvs.2016.01.050] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 01/11/2016] [Accepted: 01/26/2016] [Indexed: 11/25/2022]
|
44
|
Siregar S, Nieboer D, Vergouwe Y, Versteegh MIM, Noyez L, Vonk ABA, Steyerberg EW, Takkenberg JJM. Improved Prediction by Dynamic Modeling: An Exploratory Study in the Adult Cardiac Surgery Database of the Netherlands Association for Cardio-Thoracic Surgery. Circ Cardiovasc Qual Outcomes 2016; 9:171-81. [PMID: 26933048 DOI: 10.1161/circoutcomes.114.001645] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 01/22/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The predictive performance of static risk prediction models such as EuroSCORE deteriorates over time. We aimed to explore different methods for continuous updating of EuroSCORE (dynamic modeling) to improve risk prediction. METHODS AND RESULTS Data on adult cardiac surgery from 2007 to 2012 (n=95 240) were extracted from the Netherlands Association for Cardio-Thoracic Surgery database. The logistic EuroSCORE predicting in-hospital death was updated using 6 methods: recalibrating the intercept of the logistic regression model; recalibrating the intercept and joint effects of the prognostic factors; re-estimating all prognostic factor effects, re-estimating all prognostic factor effects, and applying shrinkage of the estimates; applying a test procedure to select either of these; and a Bayesian learning strategy. Models were updated with 1 or 3 years of data, in all cardiac surgery or within operation subgroups. Performance was tested in the subsequent year according to discrimination (area under the receiver operating curve, area under the curve) and calibration (calibration slope and calibration-in-the-large). Compared with the original EuroSCORE, all updating methods resulted in improved calibration-in-the-large (range -0.17 to 0.04 versus -1.13 to -0.97, ideally 0.0). Calibration slope (range 0.92-1.15) and discrimination (area under the curve range 0.83-0.87) were similar across methods. In small subgroups, such as aortic valve replacement and aortic valve replacement+coronary artery bypass grafting, extensive updating using 1 year of data led to poorer performance than using the original EuroSCORE. The choice of updating method had little effect on benchmarking results of all cardiac surgery. CONCLUSIONS Several methods for dynamic modeling may result in good discrimination and superior calibration compared with the original EuroSCORE. For large populations, all methods are appropriate. For smaller subgroups, it is recommended to use data from multiple years or a Bayesian approach.
Collapse
Affiliation(s)
- Sabrina Siregar
- From the Department of Cardio-Thoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands (S.S., M.I.M.V.); Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands (D.N., Y.V., E.W.S.); Department of Cardio-Thoracic Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (L.N.); Department of Cardio-Thoracic Surgery, VU Medical Center, Amsterdam, The Netherlands (A.B.A.V.); and Department of Cardio-Thoracic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands (J.J.M.T.).
| | - Daan Nieboer
- From the Department of Cardio-Thoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands (S.S., M.I.M.V.); Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands (D.N., Y.V., E.W.S.); Department of Cardio-Thoracic Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (L.N.); Department of Cardio-Thoracic Surgery, VU Medical Center, Amsterdam, The Netherlands (A.B.A.V.); and Department of Cardio-Thoracic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands (J.J.M.T.)
| | - Yvonne Vergouwe
- From the Department of Cardio-Thoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands (S.S., M.I.M.V.); Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands (D.N., Y.V., E.W.S.); Department of Cardio-Thoracic Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (L.N.); Department of Cardio-Thoracic Surgery, VU Medical Center, Amsterdam, The Netherlands (A.B.A.V.); and Department of Cardio-Thoracic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands (J.J.M.T.)
| | - Michel I M Versteegh
- From the Department of Cardio-Thoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands (S.S., M.I.M.V.); Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands (D.N., Y.V., E.W.S.); Department of Cardio-Thoracic Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (L.N.); Department of Cardio-Thoracic Surgery, VU Medical Center, Amsterdam, The Netherlands (A.B.A.V.); and Department of Cardio-Thoracic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands (J.J.M.T.)
| | - Luc Noyez
- From the Department of Cardio-Thoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands (S.S., M.I.M.V.); Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands (D.N., Y.V., E.W.S.); Department of Cardio-Thoracic Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (L.N.); Department of Cardio-Thoracic Surgery, VU Medical Center, Amsterdam, The Netherlands (A.B.A.V.); and Department of Cardio-Thoracic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands (J.J.M.T.)
| | - Alexander B A Vonk
- From the Department of Cardio-Thoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands (S.S., M.I.M.V.); Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands (D.N., Y.V., E.W.S.); Department of Cardio-Thoracic Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (L.N.); Department of Cardio-Thoracic Surgery, VU Medical Center, Amsterdam, The Netherlands (A.B.A.V.); and Department of Cardio-Thoracic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands (J.J.M.T.)
| | - Ewout W Steyerberg
- From the Department of Cardio-Thoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands (S.S., M.I.M.V.); Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands (D.N., Y.V., E.W.S.); Department of Cardio-Thoracic Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (L.N.); Department of Cardio-Thoracic Surgery, VU Medical Center, Amsterdam, The Netherlands (A.B.A.V.); and Department of Cardio-Thoracic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands (J.J.M.T.)
| | - Johanna J M Takkenberg
- From the Department of Cardio-Thoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands (S.S., M.I.M.V.); Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands (D.N., Y.V., E.W.S.); Department of Cardio-Thoracic Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands (L.N.); Department of Cardio-Thoracic Surgery, VU Medical Center, Amsterdam, The Netherlands (A.B.A.V.); and Department of Cardio-Thoracic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands (J.J.M.T.)
| |
Collapse
|
45
|
Tudorache I, Horke A, Cebotari S, Sarikouch S, Boethig D, Breymann T, Beerbaum P, Bertram H, Westhoff-Bleck M, Theodoridis K, Bobylev D, Cheptanaru E, Ciubotaru A, Haverich A. Decellularized aortic homografts for aortic valve and aorta ascendens replacement. Eur J Cardiothorac Surg 2016; 50:89-97. [PMID: 26896320 PMCID: PMC4913875 DOI: 10.1093/ejcts/ezw013] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 12/11/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The choice of valve prosthesis for aortic valve replacement (AVR) in young patients is challenging. Decellularized pulmonary homografts (DPHs) have shown excellent results in pulmonary position. Here, we report our early clinical results using decellularized aortic valve homografts (DAHs) for AVR in children and mainly young adults. METHODS This prospective observational study included all 69 patients (44 males) operated from February 2008 to September 2015, with a mean age of 19.7 ± 14.6 years (range 0.2–65.3 years). In 18 patients, a long DAH was used for simultaneous replacement of a dilated ascending aorta as an extended aortic root replacement (EARR). Four patients received simultaneous pulmonary valve replacement with DPH. RESULTS Thirty-nine patients (57%) had a total of 62 previous operations. The mean aortic cross-clamp time in isolated cases was 129 ± 41 min. There was 1 conduit-unrelated death. The mean DAH diameter was 22.4 ± 3.7 mm (range, 10–29 mm), the average peak gradient was 14 ± 15 mmHg and the mean aortic regurgitation grade (0.5 = trace, 1 = mild) was 0.6 ± 0.5. The mean effective orifice area (EOA) of 25 mm diameter DAH was 3.07 ± 0.7 cm2. DAH annulus z-values were 1.1 ± 1.1 at implantation and 0.7 ± 1.3 at the last follow-up. The last mean left ventricle ejection fraction and left ventricle end diastolic volume index was 63 ± 7% and 78 ± 16 ml/m2 body surface area, respectively. To date, no dilatation has been observed at any level of the graft during follow-up; however, the observational time is short (140.4 years in total, mean 2.0 ± 1.8 years, maximum 7.6 years). One small DAH (10 mm at implantation) had to be explanted due to subvalvular stenosis and developing regurgitation after 4.5 years and was replaced with a 17 mm DAH without complication. No calcification of the explanted graft was noticed intraoperatively and after histological analysis, which revealed extensive recellularization without inflammation. CONCLUSIONS DAHs withstand systemic circulation, provide outstanding EOA and appear as an alternative to conventional grafts for AVR in young patients. EARR using DAH is a further option in aortic valve disease associated with aorta ascendens dilatation as it avoids the use of any prosthetic material.
Collapse
Affiliation(s)
- Igor Tudorache
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Alexander Horke
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Serghei Cebotari
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Samir Sarikouch
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dietmar Boethig
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Thomas Breymann
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Philipp Beerbaum
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Harald Bertram
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Mechthild Westhoff-Bleck
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Karolina Theodoridis
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dmitry Bobylev
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Eduard Cheptanaru
- State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
| | - Anatol Ciubotaru
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
| | - Axel Haverich
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| |
Collapse
|
46
|
Torre M, Hwang DH, Padera RF, Mitchell RN, VanderLaan PA. Osseous and chondromatous metaplasia in calcific aortic valve stenosis. Cardiovasc Pathol 2016; 25:18-24. [DOI: 10.1016/j.carpath.2015.08.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 08/14/2015] [Accepted: 08/20/2015] [Indexed: 12/22/2022] Open
|
47
|
Kim LK, Minutello RM, Feldman DN, Swaminathan RV, Bergman G, Singh H, Kaple RK, Wong SC. Association Between Transcatheter Aortic Valve Implantation Volume and Outcomes in the United States. Am J Cardiol 2015; 116:1910-5. [PMID: 26508710 DOI: 10.1016/j.amjcard.2015.09.040] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 09/19/2015] [Accepted: 09/19/2015] [Indexed: 10/22/2022]
Abstract
With the rapid advance of transcatheter aortic valve implantation (TAVI), it is important to evaluate the relationship between TAVI volumes and outcomes. The aim of this study was to analyze in-hospital outcomes after TAVI stratified according to hospital volumes. Using the National Inpatient Sample files from 2012, hospitals performing transfemoral (TF)-TAVI and transapical (TA)-TAVI were divided into high-volume and low-volume centers. A total of 7,660 patients underwent TAVI in 256 hospitals in 2012. In the TF-TAVI cohort, multivariate logistic regression analyses demonstrated that low TF-TAVI volume status was an independent predictor of death and bleeding. In the TA-TAVI cohort, low volume status was a predictor of death, myocardial infarction, and need for permanent pacemaker. In addition, hospitals that performed low TA-TAVI volume were associated with significantly higher rate of death after surgical aortic valve replacement in comparison with the hospitals that perform high TA-TAVI volume (3.6% vs 2.3%, p <0.001). In conclusion, centers with lower volume of TAVI had more frequent adverse events compared with higher volume centers.
Collapse
|
48
|
Transcatheter Valve Implantation in Failed Surgically Inserted Bioprosthesis. JACC Cardiovasc Imaging 2015; 8:960-79. [DOI: 10.1016/j.jcmg.2015.01.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 01/29/2015] [Accepted: 01/29/2015] [Indexed: 12/15/2022]
|
49
|
D'ascenzo F, Moretti C, Marra WG, Montefusco A, Omede P, Taha S, Castagno D, Gaemperli O, Taramasso M, Frea S, Pidello S, Rudolph V, Franzen O, Braun D, Giannini C, Ince H, Perl L, Zoccai G, Marra S, D'Amico M, Maisano F, Rinaldi M, Gaita F. Meta-analysis of the usefulness of Mitraclip in patients with functional mitral regurgitation. Am J Cardiol 2015; 116:325-31. [PMID: 25975726 DOI: 10.1016/j.amjcard.2015.04.025] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 04/07/2015] [Accepted: 04/07/2015] [Indexed: 02/08/2023]
Abstract
Midterm outcomes for patients presenting with heart failure and functional mitral regurgitation (MR) treated with Mitraclip remain unclear. Pubmed, Medline, and Google Scholar were systematically searched for studies enrolling patients with severe-moderate MR who underwent Mitraclip implantation. All events after at least 6 months were the primary safety end point (including death, rehospitalization for heart failure, and reinterventions), whereas change in the ejection fraction, left ventricular volumes, arterial pulmonary pressure, and left atrial diameters were considered as secondary end points. Meta-regression analysis was performed to evaluate the effect of baseline clinical and echocardiographic parameters on efficacy outcomes: 875 patients were included in 9 studies; 1.48 clips (1.3 to 1.7) for patients were implanted, and after a median follow-up of 9 months (6 to 12), 409 patients (78% [75% to 83%]) were in class New York Heart Association I/II and 57 (11% [8% to 14%]) still had moderate-to-severe MR. Overall adverse events occurred in 137 (26% [20% to 31%]) of the patients and 78 (15% [1% to 17%]) of them died; 6-minute walk test improved by 100 m (83 to 111), whereas a significant reduction in left ventricular volumes and systolic pulmonary pressure was reported. At meta-regression analysis, an increase in left ventricle systolic volumes positively affected reduction of volumes after Mitraclip, whereas atrial fibrillation reduced the positive effect of the valve implantation on ejection fraction on end-diastolic and -systolic volumes. In conclusion, Mitraclip represents an efficacious strategy for patients with heart failure and severe MR. It offers a significant improvement in functional class and in cardiac remodeling, in patients with severely dilated hearts as well, although its efficacy remains limited in the presence of atrial fibrillation.
Collapse
|
50
|
van Laar C, Kievit PC, Noyez L. Surgical aortic valve replacement in patients older than 75 years: is there really a quality of life benefit? Neth Heart J 2015; 23:174-9. [PMID: 25884084 PMCID: PMC4352151 DOI: 10.1007/s12471-015-0660-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background To evaluate the results of elective isolated surgical aortic valve replacement (SAVR) on quality of life (QoL) in patients > 75 years. Methods 138 patients operated between January 2008 and December 2011 were included. The EuroQOL questionnaire (EQ-5D, EQ-VAS) was completed preoperatively, and 1- and 2-years postoperatively. The logistic EuroSCORE was used for risk stratification, the Corpus Christi Heart project criteria to assess physical activity. Results Mean age was 79.5 ± 2.8 years, mean risk 9.7 ± 5.4, hospital mortality 2.8 %. For 115 patients (83.3 %) the preoperative QoL information was complete. Fifty patients were classified as sedentary. In the first postoperative year 13 patients died, mostly sedentary patients (p = 0.046) with a low EQ-5D (p = 0.017). There was no QoL information on 32 survivors, mostly sedentary patients (p = 0.001). The 70 patients with QoL information showed an increased QoL (NS). Two years postoperatively, 16 patients died, significantly more sedentary patients (p = 0.015) with a low EQ-5D (p = 0.006). For 42 survivors, there was no QoL information; these were mostly sedentary patients (p = 0.021). The 57 patients with 2-year QoL information had an increased EQ-5D (NS) and EQ-VAS (p = 0.024). Conclusions QoL increases after SAVR. However, the patients lost to follow-up were mostly sedentary or had a low preoperative QoL, which can lead to biased results.
Collapse
Affiliation(s)
- Charlotte van Laar
- Department of Cardio-Thoracic Surgery-615, Heart Center, Radboud University Nijmegen Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | | | | |
Collapse
|