1
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Pompeu Sá M, Van den Eynde J, Amabile A, Malin JH, Jacquemyn X, Tasoudis P, Sicouri S, Schena S, Torregrossa G, Ramlawi B. Late Outcomes Following Aortic Root Enlargement during Aortic Valve Replacement: Meta-Analysis with Reconstructed Time-to-Event Data. J Cardiothorac Vasc Anesth 2022; 36:3065-3073. [DOI: 10.1053/j.jvca.2022.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/15/2022] [Accepted: 04/08/2022] [Indexed: 11/11/2022]
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2
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Aortic root widening: “pro et contra”. Indian J Thorac Cardiovasc Surg 2021; 38:91-100. [PMID: 35463701 PMCID: PMC8980977 DOI: 10.1007/s12055-020-01125-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/12/2020] [Accepted: 12/16/2020] [Indexed: 10/22/2022] Open
Abstract
In patients with a small aortic annulus, the clinical benefits of aortic valve replacement depend on avoidance of patient-prosthesis mismatch as it is associated with reduced overall survival. Aortic root widening or enlargement is a useful technique to implant larger valve prosthesis to prevent patient-prosthesis mismatch. Posterior annular enlargement is the commonest technique used for aortic root enlargement. Consistent enlargement of the aortic root requires more extensive procedures like Manouguian or Konno-Rastan techniques. The patients commonly selected are younger patients with good life expectancy. However, caution is advised in applying this procedure in elderly patients, patients with heavily calcified annulus and when performing concomitant procedures. There is no definitive conclusion on the best material to use for the reconstruction of aortic annulus and aorta in aortic root enlargement procedures.
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3
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Vriesendorp MD, de Lind van Wijngaarden RAF, Klautz RJM. Concomitant aortic root enlargement is perhaps safe, but is it also effective? Eur J Cardiothorac Surg 2020; 57:815. [PMID: 31828340 PMCID: PMC7078851 DOI: 10.1093/ejcts/ezz345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/22/2019] [Indexed: 11/21/2022] Open
Affiliation(s)
- Michiel D Vriesendorp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | | | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
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4
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Lau C, Gaudino M. Commentary: Aortic root enlargement: Just because we can, does that mean we should? JTCVS Tech 2020; 4:97-98. [PMID: 34317975 PMCID: PMC8306849 DOI: 10.1016/j.xjtc.2020.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 08/30/2020] [Accepted: 09/05/2020] [Indexed: 12/04/2022] Open
Affiliation(s)
- Christopher Lau
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
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5
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Commentary: Aortic root enlargement-when and how? JTCVS Tech 2020; 4:99-100. [PMID: 34317976 PMCID: PMC8303079 DOI: 10.1016/j.xjtc.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 08/01/2020] [Accepted: 08/04/2020] [Indexed: 11/23/2022] Open
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6
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Antunes MJ. Enlargement of the narrow aortic root: Fear of what? J Card Surg 2020; 35:2165-2167. [PMID: 32652619 DOI: 10.1111/jocs.14725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 11/27/2022]
Abstract
Prosthesis-patient mismatch (PPM) associated with aortic valve replacement, especially of aortic stenosis, is a common problem. Severe PPM is known to increase perioperative morbidity and mortality and to negatively affect late survival. Surgical enlargement of the narrow aortic root enlargement (ARE) is now increasingly accepted as a method of facilitating implantation of a larger valve prosthesis, hence decreasing the risk of PPM. There are diagnostic methods and tables that help to predict the risk of this complication and assist in the planning of the surgery. Still, many surgeons are afraid or reluctant to perform ARE because of potential technical complications of a procedure perceived to increase the complexity of the surgery. However, these procedures have been proven safe and effective, and are at the reach of almost any cardiac surgeon, including less experienced ones. In addition, there are modifications to the techniques that make them even simpler and more reproducible.
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Affiliation(s)
- Manuel J Antunes
- Clinic of Cardiothoracic Surgery, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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7
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Sá MPBO, Zhigalov K, Cavalcanti LRP, Escorel Neto AC, Rayol SC, Weymann A, Ruhparwar A, Lima RC. Impact of Aortic Annulus Enlargement on the Outcomes of Aortic Valve Replacement: A Meta-analysis. Semin Thorac Cardiovasc Surg 2020; 33:316-325. [PMID: 32621964 DOI: 10.1053/j.semtcvs.2020.06.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 06/28/2020] [Indexed: 11/11/2022]
Abstract
We sought to evaluate the impact of surgical aortic annulus enlargement (ARE) on the perioperative outcomes of surgical aortic valve replacement. Databases were searched for articles published by October 2019 in order to carry out a systematic review followed by meta-analysis. Thirteen studies with 40,447 patients (aortic valve replacement [AVR] with aortic annulus enlargement [AAE]: 4686 patients; AVR without AAE: 35,761 patients) were included. The total rate of AAE was 11.6%, ranging from 4.1%-28.1%. The overall unadjusted odds ratio (OR) (95% confidence interval [CI]) for operative mortality showed a statistically significant difference between the groups, with higher risk in the "AVR with AAE" group (OR 1.388; 95% CI 1.049-1.836, P < 0.001), but not for isolated AVR+AAE (OR 1.341; 95% CI 0.920-1.956, P = 0.127) and also not in matched populations (OR 1.003; 95% CI 0.773-1.300, P = 0.984). The "AVR with AAE" group showed an overall lower risk of significant patient-prosthesis mismatch (PPM) (OR 0.567; 95% CI 0.376-0.854, P = 0.007) and a higher overall difference in means of indexed effective orifice area (iEOA) (random effect model: 0.058 cm2/m2; 95% CI 0.024-0.092, P < 0.001). The overall ORs for myocardial infarction, stroke, complete heart block/permanent pacemaker implantation and reoperation for bleeding showed no statistically significant difference between the groups. AAE is a useful adjunct to AVR, but the benefit of reduced PPM must be balanced against a possibly higher risk of perioperative mortality.
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Affiliation(s)
- Michel Pompeu B O Sá
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Brazil; University of Pernambuco - UPE, Recife, Brazil; Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Instituite - FCM/ICB, Recife, Brazil.
| | - Konstantin Zhigalov
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Luiz Rafael P Cavalcanti
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Brazil; University of Pernambuco - UPE, Recife, Brazil
| | - Antonio C Escorel Neto
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Brazil; University of Pernambuco - UPE, Recife, Brazil
| | - Sérgio C Rayol
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Brazil; University of Pernambuco - UPE, Recife, Brazil
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Ricardo C Lima
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Brazil; University of Pernambuco - UPE, Recife, Brazil; Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Instituite - FCM/ICB, Recife, Brazil
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8
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Hawkins RB, Beller JP, Mehaffey JH, Charles EJ, Quader MA, Rich JB, Kiser AC, Joseph M, Speir AM, Kern JA, Ailawadi G. Incremental Risk of Annular Enlargement: A Multi-Institutional Cohort Study. Ann Thorac Surg 2019; 108:1752-1759. [DOI: 10.1016/j.athoracsur.2019.04.118] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 03/25/2019] [Accepted: 04/29/2019] [Indexed: 11/27/2022]
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9
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Commentary: Aortic root enlargement, a useful and reproducible way to a larger prosthesis. J Thorac Cardiovasc Surg 2019; 160:924-925. [PMID: 31668547 DOI: 10.1016/j.jtcvs.2019.09.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 09/14/2019] [Accepted: 09/16/2019] [Indexed: 11/20/2022]
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10
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Yu W, Tam DY, Rocha RV, Makhdoum A, Ouzounian M, Fremes SE. Aortic Root Enlargement Is Safe and Reduces the Incidence of Patient-Prosthesis Mismatch: A Meta-analysis of Early and Late Outcomes. Can J Cardiol 2019; 35:782-790. [DOI: 10.1016/j.cjca.2019.02.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/07/2019] [Accepted: 02/08/2019] [Indexed: 12/29/2022] Open
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11
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Rayol SDC, Sá MPBO, Cavalcanti LRP, Saragiotto FAS, Diniz RGS, Sá FBCDAE, Menezes AM, Silva FPV, Lima RC. Prosthesis-Patient Mismatch after Surgical Aortic Valve Replacement: Neither Uncommon nor Harmless. Braz J Cardiovasc Surg 2019; 34:361-365. [PMID: 31310476 PMCID: PMC6629220 DOI: 10.21470/1678-9741-2019-0008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Prosthesis-patient mismatch (PPM) after surgical aortic valve replacement (SAVR)
is an issue that has been overlooked (not to say neglected). Cardiac surgeons
must bear in mind that this is a real problem that we must tackle. The purpose
of this paper is to be a wake-up call to the surgical community by giving a
brief overview of what PPM is, its incidence and impact on the outcomes. We also
discuss the increasing role played by imaging for predicting and assessing PPM
after SAVR (with which surgeons must become more acquainted) and, finally, we
present some options to avoid PPM after the surgical procedure.
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Affiliation(s)
- Sérgio da Costa Rayol
- Pronto-Socorro Cardiológico de Pernambuco Department of Cardiovascular Surgery Recife PE Brazil Department of Cardiovascular Surgery at Pronto-Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE, Brazil.,Universidade de Pernambuco Recife PE Brazil Universidade de Pernambuco (UPE), Recife, PE, Brazil
| | - Michel Pompeu Barros Oliveira Sá
- Pronto-Socorro Cardiológico de Pernambuco Department of Cardiovascular Surgery Recife PE Brazil Department of Cardiovascular Surgery at Pronto-Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE, Brazil.,Universidade de Pernambuco Recife PE Brazil Universidade de Pernambuco (UPE), Recife, PE, Brazil.,Faculdade de Ciências Médicas and Instituto de Ciências Biológicas Postgraduate Studies and Research in Health Sciences Recife PE Brazil Nucleus of Postgraduate Studies and Research in Health Sciences at Faculdade de Ciências Médicas and Instituto de Ciências Biológicas (FCM/ICB), Recife, PE, Brazil
| | - Luiz Rafael Pereira Cavalcanti
- Pronto-Socorro Cardiológico de Pernambuco Department of Cardiovascular Surgery Recife PE Brazil Department of Cardiovascular Surgery at Pronto-Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE, Brazil.,Universidade de Pernambuco Recife PE Brazil Universidade de Pernambuco (UPE), Recife, PE, Brazil
| | - Felipe Augusto Santos Saragiotto
- Pronto-Socorro Cardiológico de Pernambuco Department of Cardiovascular Surgery Recife PE Brazil Department of Cardiovascular Surgery at Pronto-Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE, Brazil.,Universidade de Pernambuco Recife PE Brazil Universidade de Pernambuco (UPE), Recife, PE, Brazil
| | - Roberto Gouvea Silva Diniz
- Pronto-Socorro Cardiológico de Pernambuco Department of Cardiovascular Surgery Recife PE Brazil Department of Cardiovascular Surgery at Pronto-Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE, Brazil.,Universidade de Pernambuco Recife PE Brazil Universidade de Pernambuco (UPE), Recife, PE, Brazil
| | - Frederico Browne Correia de Araujo E Sá
- Pronto-Socorro Cardiológico de Pernambuco Department of Cardiovascular Surgery Recife PE Brazil Department of Cardiovascular Surgery at Pronto-Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE, Brazil.,Universidade de Pernambuco Recife PE Brazil Universidade de Pernambuco (UPE), Recife, PE, Brazil
| | - Alexandre Motta Menezes
- Pronto-Socorro Cardiológico de Pernambuco Department of Cardiovascular Surgery Recife PE Brazil Department of Cardiovascular Surgery at Pronto-Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE, Brazil.,Universidade de Pernambuco Recife PE Brazil Universidade de Pernambuco (UPE), Recife, PE, Brazil
| | - Frederico Pires Vasconcelos Silva
- Pronto-Socorro Cardiológico de Pernambuco Department of Cardiovascular Surgery Recife PE Brazil Department of Cardiovascular Surgery at Pronto-Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE, Brazil.,Universidade de Pernambuco Recife PE Brazil Universidade de Pernambuco (UPE), Recife, PE, Brazil
| | - Ricardo Carvalho Lima
- Pronto-Socorro Cardiológico de Pernambuco Department of Cardiovascular Surgery Recife PE Brazil Department of Cardiovascular Surgery at Pronto-Socorro Cardiológico de Pernambuco (PROCAPE), Recife, PE, Brazil.,Universidade de Pernambuco Recife PE Brazil Universidade de Pernambuco (UPE), Recife, PE, Brazil.,Faculdade de Ciências Médicas and Instituto de Ciências Biológicas Postgraduate Studies and Research in Health Sciences Recife PE Brazil Nucleus of Postgraduate Studies and Research in Health Sciences at Faculdade de Ciências Médicas and Instituto de Ciências Biológicas (FCM/ICB), Recife, PE, Brazil
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12
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Haunschild J, Scharnowski S, Mende M, von Aspern K, Misfeld M, Mohr FW, Borger MA, Etz CD. Aortic root enlargement to mitigate patient-prosthesis mismatch: do early adverse events justify reluctance?†. Eur J Cardiothorac Surg 2019; 56:ezz016. [PMID: 30789225 DOI: 10.1093/ejcts/ezz016] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 01/09/2019] [Accepted: 01/09/2019] [Indexed: 02/28/2024] Open
Abstract
OBJECTIVES: Concomitant aortic root enlargement (ARE) at the time of surgical aortic valve replacement can be performed to avoid patient-prosthesis mismatch, an important predictor of adverse long-term outcome. METHODS: We performed a single-centre, retrospective analysis of 4120 patients receiving isolated aortic valve replacement, of whom 171 (4%) had concomitant ARE between January 2005 and December 2015. The analysis of postoperative outcome and early mortality was performed. Owing to inequality of the groups, patients were matched 1:1. RESULTS: The mean age of all 4120 patients was 68.8 ± 10.5 years, and comorbidities were equally balanced after matching. The mean aortic cross-clamp time, cardiopulmonary bypass time and total operative time were prolonged by 19, 20 and 27 min in the ARE group, respectively. Early mortality was not statistically significantly different with 1.4% in the surgical aortic valve replacement and 1.8% in the ARE group. Postoperative complications were <5% in all matched 338 patients: bleeding (3% vs 3%), pericardial effusion (3.0% vs 4.2%), sternal instability (1.8% vs 0%) and sternal wound infection (3.0% vs 1.2%). A significant higher number of patients had respiratory failure after ARE (unmatched: 17.1% vs 9.9%, P < 0.001; matched: 18.3% vs 9.5%, P = 0.028). Factors independently associated with overall mortality were age [hazard ratio (HR) 1.71], chronic obstructive pulmonary disease (HR 1.47), diabetes (HR 1.82), atrial fibrillation (HR 2.14) and postoperative respiratory failure (HR 2.84). CONCLUSIONS: ARE can be performed safely in experienced centres with no significant increase in the risk of early postoperative surgical complications and early mortality. However, the surgeon and the intensive care unit team should be aware of an increased risk for postoperative respiratory failure in ARE patients.
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Affiliation(s)
- Josephina Haunschild
- Department of Cardiac Surgery, Heart Center Leipzig, University Leipzig, Leipzig, Germany
| | - Sven Scharnowski
- Department of Cardiac Surgery, Heart Center Leipzig, University Leipzig, Leipzig, Germany
| | - Meinhard Mende
- Centre for Clinical Trials, University of Leipzig, Leipzig, Germany
| | - Konstantin von Aspern
- Department of Cardiac Surgery, Heart Center Leipzig, University Leipzig, Leipzig, Germany
| | - Martin Misfeld
- Department of Cardiac Surgery, Heart Center Leipzig, University Leipzig, Leipzig, Germany
| | - Friedrich-Wilhelm Mohr
- Department of Cardiac Surgery, Heart Center Leipzig, University Leipzig, Leipzig, Germany
| | - Michael A Borger
- Department of Cardiac Surgery, Heart Center Leipzig, University Leipzig, Leipzig, Germany
| | - Christian D Etz
- Department of Cardiac Surgery, Heart Center Leipzig, University Leipzig, Leipzig, Germany
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13
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Sá MPBO, Carvalho MMB, Sobral Filho DC, Cavalcanti LRP, Diniz RGS, Rayol SC, Soares AMMN, Sá FBCDA, Menezes AM, Clavel MA, Pibarot P, Lima RC. Impact of surgical aortic root enlargement on the outcomes of aortic valve replacement: a meta-analysis of 13 174 patients. Interact Cardiovasc Thorac Surg 2019; 29:74-82. [DOI: 10.1093/icvts/ivy364] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/19/2018] [Accepted: 11/11/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Michel Pompeu Barros Oliveira Sá
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco – PROCAPE, Recife, Brazil
- University of Pernambuco – UPE, Recife, Brazil
- Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Instituite – FCM/ICB, Recife, Brazil
| | - Martinha Milliany Barros Carvalho
- University of Pernambuco – UPE, Recife, Brazil
- Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Instituite – FCM/ICB, Recife, Brazil
| | - Dário Celestino Sobral Filho
- University of Pernambuco – UPE, Recife, Brazil
- Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Instituite – FCM/ICB, Recife, Brazil
| | - Luiz Rafael Pereira Cavalcanti
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco – PROCAPE, Recife, Brazil
- University of Pernambuco – UPE, Recife, Brazil
| | - Roberto Gouvea Silva Diniz
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco – PROCAPE, Recife, Brazil
- University of Pernambuco – UPE, Recife, Brazil
| | - Sérgio Costa Rayol
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco – PROCAPE, Recife, Brazil
- University of Pernambuco – UPE, Recife, Brazil
| | - Alexandre Magno Macário Nunes Soares
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco – PROCAPE, Recife, Brazil
- University of Pernambuco – UPE, Recife, Brazil
| | | | - Alexandre Motta Menezes
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco – PROCAPE, Recife, Brazil
- University of Pernambuco – UPE, Recife, Brazil
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie e de Pneumologie du Québec, Quebec City, QC, Canada
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie e de Pneumologie du Québec, Quebec City, QC, Canada
| | - Ricardo Carvalho Lima
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco – PROCAPE, Recife, Brazil
- University of Pernambuco – UPE, Recife, Brazil
- Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Instituite – FCM/ICB, Recife, Brazil
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14
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Sá MPBDO, de Carvalho MMB, Sobral Filho DC, Cavalcanti LRP, Rayol SDC, Diniz RGS, Menezes AM, Clavel MA, Pibarot P, Lima RC. Surgical aortic valve replacement and patient–prosthesis mismatch: a meta-analysis of 108 182 patients. Eur J Cardiothorac Surg 2019; 56:44-54. [DOI: 10.1093/ejcts/ezy466] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 12/10/2018] [Accepted: 12/13/2018] [Indexed: 11/14/2022] Open
Abstract
Abstract
OBJECTIVES
This study sought to evaluate the impact of patient–prosthesis mismatch (PPM) on the risk of perioperative, early-, mid- and long-term mortality rates after surgical aortic valve replacement.
METHODS
Databases were searched for studies published until March 2018. The main outcomes of interest were perioperative mortality, 1-year mortality, 5-year mortality and 10-year mortality.
RESULTS
The search yielded 3761 studies for inclusion. Of these, 70 articles were analysed, and their data were extracted. The total number of patients included was 108 182 who underwent surgical aortic valve replacement. The incidence of PPM after surgical aortic valve replacement was 53.7% (58 116 with PPM and 50 066 without PPM). Perioperative mortality [odds ratio (OR) 1.491, 95% confidence interval (CI) 1.302–1.707; P < 0.001], 1-year mortality (OR 1.465, 95% CI 1.277–1.681; P < 0.001), 5-year mortality (OR 1.358, 95% CI 1.218–1.515; P < 0.001) and 10-year mortality (OR 1.534, 95% CI 1.290–1.825; P < 0.001) were increased in patients with PPM. Both severe PPM and moderate PPM were associated with increased risk of perioperative mortality, 1-year mortality, 5-year mortality and 10-year mortality when analysed together and separately, although we observed a higher risk in the group with severe PPM.
CONCLUSIONS
Moderate/severe PPM increases perioperative, early-, mid- and long-term mortality rates proportionally to its severity. The findings of this study support the implementation of surgical strategies to prevent PPM in order to decrease mortality rates.
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Affiliation(s)
- Michel Pompeu Barros de Oliveira Sá
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco—PROCAPE, Recife, Brazil
- University of Pernambuco—UPE, Recife, Brazil
- Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Institute—FCM/ICB, Recife, Brazil
| | - Martinha Millianny Barros de Carvalho
- University of Pernambuco—UPE, Recife, Brazil
- Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Institute—FCM/ICB, Recife, Brazil
| | - Dário Celestino Sobral Filho
- University of Pernambuco—UPE, Recife, Brazil
- Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Institute—FCM/ICB, Recife, Brazil
| | - Luiz Rafael Pereira Cavalcanti
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco—PROCAPE, Recife, Brazil
- University of Pernambuco—UPE, Recife, Brazil
| | - Sérgio da Costa Rayol
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco—PROCAPE, Recife, Brazil
- University of Pernambuco—UPE, Recife, Brazil
| | - Roberto Gouvea Silva Diniz
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco—PROCAPE, Recife, Brazil
- University of Pernambuco—UPE, Recife, Brazil
| | - Alexandre Motta Menezes
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco—PROCAPE, Recife, Brazil
- University of Pernambuco—UPE, Recife, Brazil
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Canada
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Canada
| | - Ricardo Carvalho Lima
- Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco—PROCAPE, Recife, Brazil
- University of Pernambuco—UPE, Recife, Brazil
- Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Institute—FCM/ICB, Recife, Brazil
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15
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Correia PM. The place of a stentless aortic bioprosthetic valve. Rev Port Cardiol 2018; 37:819-820. [PMID: 30318189 DOI: 10.1016/j.repc.2018.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Pedro M Correia
- Centro de Cirurgia Cardiotorácica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
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16
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The place of a stentless aortic bioprosthetic valve. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2018.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Surgical Enlargement of the Aortic Root Does Not Increase the Operative Risk of Aortic Valve Replacement. Circulation 2018; 137:1585-1594. [DOI: 10.1161/circulationaha.117.030525] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 11/03/2017] [Indexed: 11/16/2022]
Abstract
Background:
Surgical aortic root enlargement (ARE) during aortic valve replacement (AVR) allows for larger prosthesis implantation and may be an important adjunct to surgical AVR in the transcatheter valve-in-valve era. The incremental operative risk of adding ARE to AVR has not been established. We aimed to evaluate the early outcomes of patients undergoing AVR with or without ARE.
Methods:
From January 1990 to August 2014, 7039 patients underwent AVR (AVR+ARE, n=1854; AVR, n=5185) at a single institution. Patients with aortic dissection and active endocarditis were excluded. Mean age was 65±14 years and 63% were male. Logistic regression and propensity score matching were used to adjust for unbalanced variables in group comparisons.
Results:
Patients undergoing AVR+ARE were more likely to be female (46% versus 34%,
P
<0.001) and had higher rates of previous cardiac surgery (18% versus 12%,
P
<0.001), chronic obstructive pulmonary disease (5% versus 3%,
P
=0.004), urgent/emergent status (6% versus 4%,
P
=0.01), and worse New York Heart Association status (
P
<0.001). Most patients received bioprosthetic valves (AVR+ARE: 73.4% versus AVR: 73.3%,
P
=0.98) and also underwent concomitant cardiac procedures (AVR+ARE: 68% versus AVR: 67%,
P
=0.31). Mean prosthesis size implanted was slightly smaller in patients requiring AVR+ARE versus AVR (23.4±2.1 versus 24.1±2.3,
P
<0.001). In-hospital mortality was higher after AVR+ARE (4.3% versus 3.0%,
P
=0.008), although when the cohort was restricted to patients undergoing isolated aortic valve replacement with or without root enlargement, mortality was not statistically different (AVR+ARE: 1.7% versus AVR: 1.1%,
P
=0.29). After adjustment for baseline characteristics, AVR+ARE was not associated with an increased risk of in-hospital mortality when compared with AVR (odds ratio, 1.03; 95% confidence interval, 0.75–1.41;
P
=0.85). Furthermore, AVR+ARE was not associated with an increased risk of postoperative adverse events. Results were similar if propensity matching was used instead of multivariable adjustments for baseline characteristics.
Conclusions:
In the largest analysis to date, ARE was not associated with increased risk of mortality or adverse events. Surgical ARE is a safe adjunct to AVR in the modern era.
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