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Nichay NR, Dokuchaeva AA, Kulyabin YY, Boyarkin EV, Kuznetsova EV, Rusakova YL, Murashov IS, Vaver AA, Bogachev-Prokophiev AV, Zhuravleva IY. Epoxy- versus Glutaraldehyde-Treated Bovine Jugular Vein Conduit for Pulmonary Valve Replacement: A Comparison of Morphological Changes in a Pig Model. Biomedicines 2023; 11:3101. [PMID: 38002101 PMCID: PMC10669752 DOI: 10.3390/biomedicines11113101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023] Open
Abstract
Valved conduits are often required to replace pulmonary arteries (PA). A widely used Contegra device is made of bovine jugular vein (BJV), preserved with glutaraldehyde (GA) and iso-propanol. However, it has several drawbacks that may be attributed to its chemical treatment. We hypothesized that the use of an alternative preservation compound may significantly improve BJV conduit performance. This study aimed to compare the macroscopic and microscopic properties of the BJV treated with diepoxide (DE) and GA in a porcine model. Twelve DE-BJVs and four Contegra conduits were used for PA replacement in minipigs. To assess the isolated influence of GA, we included an additional control group-BJV treated with 0.625% GA (n = 4). The animals were withdrawn after 6 months of follow-up and the conduits were examined. Explanted DE-BJV had a soft elastic wall with no signs of thrombosis or calcification and good conduit integration, including myofibroblast germination, an ingrowth of soft connective tissue formations and remarkable neoangiogenesis. The inner surface of DE-BJVs was covered by a thin neointimal layer with a solid endothelium. Contegra grafts had a stiffer wall with thrombosis on the leaflets. Calcified foci, chondroid metaplasia, and hyalinosis were observed within the wall. The distal anastomotic sites had hyperplastic neointima, partially covered with the endothelium. The wall of GA-BJV was stiff and rigid with degenerative changes, a substantial amount of calcium deposits and dense fibrotic formations in adventitia. An irregular neointimal layer was presented in the anastomotic sites without endothelial cover in the GA BJV wall. These results demonstrate that DE treatment improves conduit integration and the endothelialization of the inner surface while preventing the mineralization of the BJV, which may reduce the risk of early conduit dysfunction.
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Affiliation(s)
- Nataliya R. Nichay
- E. Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, 15 Rechkunovskaya St., Novosibirsk 630055, Russia; (A.A.D.); (Y.Y.K.); (E.V.B.); (E.V.K.); (Y.L.R.); (I.S.M.); (A.A.V.); (A.V.B.-P.); (I.Y.Z.)
- Cardiovascular Department, Novosibirsk State Medical University, Ministry of Health of Russian Federation, 52 Krasny Prospect, Novosibirsk 630091, Russia
| | - Anna A. Dokuchaeva
- E. Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, 15 Rechkunovskaya St., Novosibirsk 630055, Russia; (A.A.D.); (Y.Y.K.); (E.V.B.); (E.V.K.); (Y.L.R.); (I.S.M.); (A.A.V.); (A.V.B.-P.); (I.Y.Z.)
| | - Yuriy Yu. Kulyabin
- E. Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, 15 Rechkunovskaya St., Novosibirsk 630055, Russia; (A.A.D.); (Y.Y.K.); (E.V.B.); (E.V.K.); (Y.L.R.); (I.S.M.); (A.A.V.); (A.V.B.-P.); (I.Y.Z.)
| | - Evgeniy V. Boyarkin
- E. Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, 15 Rechkunovskaya St., Novosibirsk 630055, Russia; (A.A.D.); (Y.Y.K.); (E.V.B.); (E.V.K.); (Y.L.R.); (I.S.M.); (A.A.V.); (A.V.B.-P.); (I.Y.Z.)
| | - Elena V. Kuznetsova
- E. Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, 15 Rechkunovskaya St., Novosibirsk 630055, Russia; (A.A.D.); (Y.Y.K.); (E.V.B.); (E.V.K.); (Y.L.R.); (I.S.M.); (A.A.V.); (A.V.B.-P.); (I.Y.Z.)
| | - Yanina L. Rusakova
- E. Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, 15 Rechkunovskaya St., Novosibirsk 630055, Russia; (A.A.D.); (Y.Y.K.); (E.V.B.); (E.V.K.); (Y.L.R.); (I.S.M.); (A.A.V.); (A.V.B.-P.); (I.Y.Z.)
| | - Ivan S. Murashov
- E. Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, 15 Rechkunovskaya St., Novosibirsk 630055, Russia; (A.A.D.); (Y.Y.K.); (E.V.B.); (E.V.K.); (Y.L.R.); (I.S.M.); (A.A.V.); (A.V.B.-P.); (I.Y.Z.)
| | - Andrey A. Vaver
- E. Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, 15 Rechkunovskaya St., Novosibirsk 630055, Russia; (A.A.D.); (Y.Y.K.); (E.V.B.); (E.V.K.); (Y.L.R.); (I.S.M.); (A.A.V.); (A.V.B.-P.); (I.Y.Z.)
| | - Alexander V. Bogachev-Prokophiev
- E. Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, 15 Rechkunovskaya St., Novosibirsk 630055, Russia; (A.A.D.); (Y.Y.K.); (E.V.B.); (E.V.K.); (Y.L.R.); (I.S.M.); (A.A.V.); (A.V.B.-P.); (I.Y.Z.)
| | - Irina Yu. Zhuravleva
- E. Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, 15 Rechkunovskaya St., Novosibirsk 630055, Russia; (A.A.D.); (Y.Y.K.); (E.V.B.); (E.V.K.); (Y.L.R.); (I.S.M.); (A.A.V.); (A.V.B.-P.); (I.Y.Z.)
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Dib N, Iriart X, Belaroussi Y, Albadi W, Tafer N, Thambo JB, Khairy P, Roubertie F. The Ross Operation in Young Patients: A 15-Year Experience Focused on Right Ventricle to Pulmonary Artery Conduit Outcomes. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:86-92. [PMID: 37970525 PMCID: PMC10642144 DOI: 10.1016/j.cjcpc.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 12/20/2022] [Indexed: 11/17/2023]
Abstract
Background Data on long-term outcomes of the Ross operation in children and young adult patients are limited. The best pulmonary valve substitute for the right ventricular outflow tract reconstruction remains uncertain. This study aimed to assess the outcomes of right ventricular outflow tract reconstruction in the Ross operation in young patients using various pulmonary valve substitutes at a single institution. In addition, a comparison of reintervention rates between patients younger than 18 years and those older than 18 years was performed. Methods The study assessed all patients (N = 110) who underwent the Ross operation at the University Hospital of Bordeaux, France, between 2004 and 2020. Results The median follow-up time was 4.2 years, and the median age at operation was 15.9 years. There was no operative mortality and 1 late noncardiac death (0.8%). The overall survival rate at 10 years was 99.2%. The need for right ventricular outflow tract reoperation was lower with the pulmonary homograft compared with the Contegra conduit and Freestyle bioprosthesis: 94.3%, 93.8%, and 80% at 5 years, respectively, and 94.3%, 72.3%, and 34.3% at 10 years, respectively (P = 0.011). The probability of reintervention was not significantly different at 10 years among children vs adults (P = 0.22). Conclusions The Ross procedure in children and young adults was associated with a lower requirement for right ventricular outflow tract reoperation when pulmonary homografts were used instead of xenografts.
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Affiliation(s)
- Nabil Dib
- Department of Congenital Cardiac surgery, Bordeaux Heart University Hospital, University of Bordeaux II, Bordeaux, France
| | - Xavier Iriart
- Department of Congenital Cardiology, Bordeaux Heart University Hospital, University of Bordeaux II, Bordeaux, France
| | - Yaniss Belaroussi
- Department of Congenital Cardiac surgery, Bordeaux Heart University Hospital, University of Bordeaux II, Bordeaux, France
| | - Waleed Albadi
- Department of Congenital Cardiac surgery, Bordeaux Heart University Hospital, University of Bordeaux II, Bordeaux, France
| | - Nadir Tafer
- Department of Congenital Cardiac Anesthesiology, Bordeaux Heart University Hospital, University of Bordeaux II, Bordeaux, France
| | - Jean-Benoit Thambo
- Department of Congenital Cardiology, Bordeaux Heart University Hospital, University of Bordeaux II, Bordeaux, France
| | - Paul Khairy
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - François Roubertie
- Department of Congenital Cardiac surgery, Bordeaux Heart University Hospital, University of Bordeaux II, Bordeaux, France
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Kostyunin AE, Glushkova TV, Lobov AA, Ovcharenko EA, Zainullina BR, Bogdanov LA, Shishkova DK, Markova VE, Asanov MA, Mukhamadiyarov RA, Velikanova EA, Akentyeva TN, Rezvova MA, Stasev AN, Evtushenko A, Barbarash LS, Kutikhin AG. Proteolytic Degradation Is a Major Contributor to Bioprosthetic Heart Valve Failure. J Am Heart Assoc 2022; 12:e028215. [PMID: 36565196 PMCID: PMC9973599 DOI: 10.1161/jaha.122.028215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Whereas the risk factors for structural valve degeneration (SVD) of glutaraldehyde-treated bioprosthetic heart valves (BHVs) are well studied, those responsible for the failure of BHVs fixed with alternative next-generation chemicals remain largely unknown. This study aimed to investigate the reasons behind the development of SVD in ethylene glycol diglycidyl ether-treated BHVs. Methods and Results Ten ethylene glycol diglycidyl ether-treated BHVs excised because of SVD, and 5 calcified aortic valves (AVs) replaced with BHVs because of calcific AV disease were collected and their proteomic profile was deciphered. Then, BHVs and AVs were interrogated for immune cell infiltration, microbial contamination, distribution of matrix-degrading enzymes and their tissue inhibitors, lipid deposition, and calcification. In contrast with dysfunctional AVs, failing BHVs suffered from complement-driven neutrophil invasion, excessive proteolysis, unwanted coagulation, and lipid deposition. Neutrophil infiltration was triggered by an asymptomatic bacterial colonization of the prosthetic tissue. Neutrophil elastase, myeloblastin/proteinase 3, cathepsin G, and matrix metalloproteinases (MMPs; neutrophil-derived MMP-8 and plasma-derived MMP-9), were significantly overexpressed, while tissue inhibitors of metalloproteinases 1/2 were downregulated in the BHVs as compared with AVs, together indicative of unbalanced proteolysis in the failing BHVs. As opposed to other proteases, MMP-9 was mostly expressed in the disorganized prosthetic extracellular matrix, suggesting plasma-derived proteases as the primary culprit of SVD in ethylene glycol diglycidyl ether-treated BHVs. Hence, hemodynamic stress and progressive accumulation of proteases led to the extracellular matrix degeneration and dystrophic calcification, ultimately resulting in SVD. Conclusions Neutrophil- and plasma-derived proteases are responsible for the loss of BHV mechanical competence and need to be thwarted to prevent SVD.
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Affiliation(s)
- Alexander E. Kostyunin
- Department of Experimental MedicineResearch Institute for Complex Issues of Cardiovascular DiseasesKemerovoRussian Federation
| | - Tatiana V. Glushkova
- Department of Experimental MedicineResearch Institute for Complex Issues of Cardiovascular DiseasesKemerovoRussian Federation
| | - Arseniy A. Lobov
- Department of Regenerative BiomedicineResearch Institute of CytologySt. PetersburgRussian Federation
| | - Evgeny A. Ovcharenko
- Department of Experimental MedicineResearch Institute for Complex Issues of Cardiovascular DiseasesKemerovoRussian Federation
| | - Bozhana R. Zainullina
- Centre for Molecular and Cell TechnologiesSt. Petersburg State University Research ParkSt. Petersburg State University, Universitetskaya EmbankmentSt. PetersburgRussian Federation
| | - Leo A. Bogdanov
- Department of Experimental MedicineResearch Institute for Complex Issues of Cardiovascular DiseasesKemerovoRussian Federation
| | - Daria K. Shishkova
- Department of Experimental MedicineResearch Institute for Complex Issues of Cardiovascular DiseasesKemerovoRussian Federation
| | - Victoria E. Markova
- Department of Experimental MedicineResearch Institute for Complex Issues of Cardiovascular DiseasesKemerovoRussian Federation
| | - Maksim A. Asanov
- Department of Experimental MedicineResearch Institute for Complex Issues of Cardiovascular DiseasesKemerovoRussian Federation
| | - Rinat A. Mukhamadiyarov
- Department of Experimental MedicineResearch Institute for Complex Issues of Cardiovascular DiseasesKemerovoRussian Federation
| | - Elena A. Velikanova
- Department of Experimental MedicineResearch Institute for Complex Issues of Cardiovascular DiseasesKemerovoRussian Federation
| | - Tatiana N. Akentyeva
- Department of Experimental MedicineResearch Institute for Complex Issues of Cardiovascular DiseasesKemerovoRussian Federation
| | - Maria A. Rezvova
- Department of Experimental MedicineResearch Institute for Complex Issues of Cardiovascular DiseasesKemerovoRussian Federation
| | - Alexander N. Stasev
- Department of Experimental MedicineResearch Institute for Complex Issues of Cardiovascular DiseasesKemerovoRussian Federation
| | - Alexey V. Evtushenko
- Department of Experimental MedicineResearch Institute for Complex Issues of Cardiovascular DiseasesKemerovoRussian Federation
| | - Leonid S. Barbarash
- Department of Experimental MedicineResearch Institute for Complex Issues of Cardiovascular DiseasesKemerovoRussian Federation
| | - Anton G. Kutikhin
- Department of Experimental MedicineResearch Institute for Complex Issues of Cardiovascular DiseasesKemerovoRussian Federation
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Bouhout I, Kalfa D, Shah A, Goldstone AB, Harrington J, Bacha E. Surgical Management of Complex Aortic Valve Disease in Young Adults: Repair, Replacement, and Future Alternatives. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2022; 25:28-37. [PMID: 35835514 DOI: 10.1053/j.pcsu.2022.04.002] [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: 10/27/2021] [Revised: 03/17/2022] [Accepted: 04/29/2022] [Indexed: 11/11/2022]
Abstract
The ideal aortic valve substitute in young adults remains unknown. Prosthetic valves are associated with a suboptimal survival and carry a significant risk of valve-related complications in young patients, mainly reinterventions with tissue valves and, thromboembolic events and major bleeding with mechanical prostheses. The Ross procedure is the only substitute that restores a survival curve similar to that of a matched general population, and permits a normal life without functional limitations. Though the risk of reintervention is the Achilles' heel of this procedure, it is very low in patients with aortic stenosis and can be mitigated in patients with aortic regurgitation by tailored surgical techniques. Finally, the Ozaki procedure and the transcatheter aortic valve implantation are seen by many as future alternatives but lack evidence and long-term follow-up in this specific patient population.
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Affiliation(s)
- Ismail Bouhout
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University, New York, New York
| | - David Kalfa
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University, New York, New York
| | - Amee Shah
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University, New York, New York
| | - Andrew B Goldstone
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University, New York, New York
| | - Jamie Harrington
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University, New York, New York
| | - Emile Bacha
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University, New York, New York.
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Tsaroev B, Chernov I, Enginoev S, Mustaev M. Survival and freedom from reoperation after the Ross procedure in a Russian adult population: A single-center experience. JTCVS OPEN 2022; 10:140-147. [PMID: 36004253 PMCID: PMC9390578 DOI: 10.1016/j.xjon.2022.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 04/12/2022] [Indexed: 11/30/2022]
Abstract
Objectives To evaluate our 12-year experience with the Ross procedure in adults. Methods A retrospective analysis of 215 cases of the Ross procedure was performed. The mean age of the patients was 36 ± 11.1 years, and the male to female ratio was 75% to 25%, respectively. The pulmonary autograft was placed into the aortic position using the full-root replacement technique and its modified versions. The right ventricular outflow tract was reconstructed using a pulmonary homograft in all cases. Results The 30-day mortality after the operation was 0.9% (2 patients). The median duration of follow-up was 6.1 years (interquartile range, 6.5 years) and was complete in 86% of cases. The survival at 12 years was 94.7% and was comparable with the survival rate of the general population matched for age and sex. At the end of the follow-up, freedom from reoperation due to pulmonary autograft and homograft dysfunction was 89.1% and 99%, respectively. Conclusions In our series, the Ross procedure resulted in low early mortality and excellent survival in adults. The long-term survival was not statistically different from the survival of the general population. The pulmonary homograft offered an excellent durability and freedom from reoperation.
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Affiliation(s)
- Bashir Tsaroev
- Federal State Budgetary Institution “Federal Center for Cardiovascular Surgery” of the Ministry of Health of the Russian Federation, Astrakhan, Astrakhan Region, Russia
- Department of Vascular Surgery, Alexandro-Mariinsky Regional Clinical Hospital, Astrakhan, Astrakhan Region, Russia
| | - Igor Chernov
- Federal State Budgetary Institution “Federal Center for Cardiovascular Surgery” of the Ministry of Health of the Russian Federation, Astrakhan, Astrakhan Region, Russia
| | - Soslan Enginoev
- Federal State Budgetary Institution “Federal Center for Cardiovascular Surgery” of the Ministry of Health of the Russian Federation, Astrakhan, Astrakhan Region, Russia
- Department of Cardiovascular Surgery, Astrakhan State Medical University, Astrakhan, Astrakhan Region, Russia
| | - Muslim Mustaev
- Department of Adult Cardiac Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Huyan Y, Chang Y, Song J. Application of Homograft Valved Conduit in Cardiac Surgery. Front Cardiovasc Med 2021; 8:740871. [PMID: 34712711 PMCID: PMC8545902 DOI: 10.3389/fcvm.2021.740871] [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: 07/13/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
Valved conduits often correct the blood flow of congenital heart disease by connecting the right ventricle to the pulmonary artery (RV-PA). The homograft valved conduit was invented in the 1960s, but its wide application is limited due to the lack of effective sterilization and preservation methods. Modern cryopreservation prolongs the preservation time of homograft valved conduit, which makes it become the most important treatment at present, and is widely used in Ross and other operations. However, homograft valved conduit has limited biocompatibility and durability and lacks any additional growth capacity. Therefore, decellularized valved conduit has been proposed as an effective improved method, which can reduce immune response and calcification, and has potential growth ability. In addition, as a possible substitute, commercial xenograft valved conduit has certain advantages in clinical application, and tissue engineering artificial valved conduit needs to be further studied.
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Affiliation(s)
- Yige Huyan
- The Cardiomyopathy Research Group at Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Chang
- The Cardiomyopathy Research Group at Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiangping Song
- The Cardiomyopathy Research Group at Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Romeo JLR, Papageorgiou G, da Costa FFD, Sievers HH, Bogers AJJC, El-Hamamsy I, Skillington PD, Wynne R, Mastrobuoni S, El Khoury G, Takkenberg JJM, Mokhles MM. Long-term Clinical and Echocardiographic Outcomes in Young and Middle-aged Adults Undergoing the Ross Procedure. JAMA Cardiol 2021; 6:539-548. [PMID: 33656518 DOI: 10.1001/jamacardio.2020.7434] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance There is no ideal valve substitute for young adults requiring aortic valve replacement. Multicenter data supporting use of the Ross procedure with respect to long-term postoperative valve-related mortality and reintervention, as well as function of the autograft and pulmonary homograft, are needed. Objective To determine the long-term clinical and echocardiographic outcomes in young and middle-aged patients undergoing the Ross procedure. Design, Setting, and Participants A retrospective multicenter international cohort study with a median follow-up period of 9.2 years was conducted in 5 experienced centers regularly performing the Ross procedure. Consecutive patients aged 18 to 65 years were included by each center between 1991 and 2018. Main Outcomes and Measures Survival and autograft-related and homograft-related reintervention. Serial echocardiographic measurements of valve function were analyzed using mixed-effects modeling. Results During the study period, 1431 patients (74.3% men; n = 1063) were operated on at a median age of 48.5 years (mean [SD], 47.7 [9.5]; range, 18.1-65; interquartile range, 42.7-54.0). Implantation techniques were root inclusion in 355 (24.9%), root replacement in 485 (34.0%), and subcoronary implantation in 587 (41.1%). Right ventricular outflow tract reconstruction was performed with homografts in 98.6% (n = 1189) and bioprostheses in 1.4% (n = 17). Ten patients (0.7%) died before discharge. Median follow-up was 9.2 years (13 015 total patient-years). Survival after 10 and 15 years was 95.1% (95% CI, 93.8%-96.5%) and 88.5% (95% CI, 85.9%-91.1%), respectively. Freedom from autograft and homograft reintervention after 15 years was 92.0% and 97.2%, respectively. Late events were autograft endocarditis in 14 patients (0.11% per patient-year), homograft endocarditis in 11 patients (0.08% per patient-year), and stroke in 37 patients (0.3% per patient-year). Conclusions and Relevance Given its excellent short-term and long-term outcome in young and middle-aged adults in this study, the Ross procedure should be considered in young and middle-aged adults who require aortic valve replacement. Patients should be referred to an experienced center with a program dedicated to the Ross procedure.
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Affiliation(s)
- Jamie L R Romeo
- Department of Cardio-Thoracic Surgery Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Grigorios Papageorgiou
- Department of Cardio-Thoracic Surgery Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Francisco F D da Costa
- Department of Cardiac Surgery, Santa Casa de Curitiba, Pontifícia Universidade Católica do Paraná, Curitiba, Paraná, Brazil
| | - Hans H Sievers
- Department of Cardiac and Thoracic Vascular Surgery, University of Lübeck, Lübeck, Germany
| | - Ad J J C Bogers
- Department of Cardio-Thoracic Surgery Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Ismail El-Hamamsy
- Department of Cardiovascular Surgery, CHU Sainte Justine, Montreal, Canada, Montreal, Quebec, Canada
| | - Peter D Skillington
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Rochelle Wynne
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Western Sydney Local Health District, Blacktown Clinical School, Western Sydney University, Penrith, New South Wales, Australia
| | - Stefano Mastrobuoni
- Department of Cardiovascular and Thoracic Surgery, St Luc University Clinic, Brussels, Belgium
| | - Gebrine El Khoury
- Department of Cardiovascular and Thoracic Surgery, St Luc University Clinic, Brussels, Belgium
| | - Johanna J M Takkenberg
- Department of Cardio-Thoracic Surgery Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Mostafa M Mokhles
- Department of Cardio-Thoracic Surgery Erasmus Medical Centre, Rotterdam, the Netherlands.,Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
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8
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Sharifulin R, Bogachev-Prokophiev A, Demin I, Afanasyev A, Ovcharov M, Pivkin A, Sapegin A, Zhuravleva I, Karaskov A. Allografts and xenografts for right ventricular outflow tract reconstruction in Ross patients. Eur J Cardiothorac Surg 2021; 59:162-169. [PMID: 32864698 DOI: 10.1093/ejcts/ezaa244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 05/30/2020] [Accepted: 06/04/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Pulmonary allografts (AG) are the gold standard for right ventricular outflow tract (RVOT) reconstruction during the Ross procedure. However, there is limited availability of AG in some countries, and the use of alternative grafts for RVOT reconstruction remains controversial. This study aimed to compare the rates of freedom from RVOT graft dysfunction for AG and diepoxide-treated pericardial xenografts (DPXG). METHODS Between 1998 and 2015, 793 adult patients underwent the Ross procedure in our centre. Using propensity score matching, the clinical outcomes and echocardiographic results of AG and DPXG were compared. RESULTS Propensity score matching resulted in 2 groups (AG and DPXG) of 122 patients each. No difference was found in early mortality (2.5%) in both groups. The freedom from RVOT graft dysfunction curves were comparable between the AG and DPXG groups (P = 0.186) and the 8-year rates of freedom from graft dysfunction were 91.8% and 82.2%, respectively. The survival rates at 8 years were 90.5% and 90.1%, and the rates of freedom from RVOT reintervention at 8 years were 100% and 96.8% for the AG and DPXG groups, respectively. At discharge and follow-up, transprosthetic gradients were significantly higher in the DPXG group. The rate of the RVOT gradient progression was also higher in the DPXG group than in the AG group (1.80 ± 0.06 vs 1.39 ± 0.04 mmHg/year, P < 0.001). CONCLUSIONS There was no difference in freedom from RVOT graft dysfunction by 8 years when using AG and DPXG in adult Ross patients, nor in survival and freedom from RVOT conduit reintervention. Long-term results need further evaluation.
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Affiliation(s)
- Ravil Sharifulin
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | | | - Igor Demin
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Alexander Afanasyev
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Mikhail Ovcharov
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Alexey Pivkin
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Andrey Sapegin
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Irina Zhuravleva
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia
| | - Alexander Karaskov
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Centre, Novosibirsk, Russia
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Zhuravleva IY, Karpova EV, Oparina LA, Poveschenko OV, Surovtseva MA, Titov AT, Ksenofontov AL, Vasilieva MB, Kuznetsova EV, Bogachev-Prokophiev AV, Trofimov BA. Cross-linking method using pentaepoxide for improving bovine and porcine bioprosthetic pericardia: A multiparametric assessment study. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 118:111473. [PMID: 33255052 DOI: 10.1016/j.msec.2020.111473] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/14/2020] [Accepted: 08/31/2020] [Indexed: 12/16/2022]
Abstract
Bioprosthetic heart valves made from bovine pericardium (BP) and porcine pericardium (PP) preserved with glutaraldehyde (GA) are commonly used in valve surgeries but prone to calcification in many patients. In this study, we compared BP and PP preserved with GA, ethylene glycol diglycidyl ether (DE), and 1,2,3,4,6-penta-O-{1-[2-(glycidyloxy)ethoxy]ethyl}-d-glucopyranose (PE). We studied the stabilities of DE and PE in preservation media along with the amino acid (AA) compositions, Fourier-transform infrared spectra, mechanical properties, surface morphologies, thermal stability, calcification, and the cytocompatibility of BP and PP treated with 0.625% GA, 5% DE, 2% PE, and alternating 5% DE and 2% PE for 3 + 11 d and 10 + 10 d, respectively. Both epoxides were stable in the water-buffer solutions (pH 7.4). DE provided high linkage densities in BP and PP owing to reactions with Hyl, Lys, His, Arg, Ser, and Tyr. PE reacted weakly with these AAs but strongly with Met. High cross-linking density obtained using the 10 d + 10 d method provided satisfactory thermal stability of biomaterials. The epoxy preservations improved cytocompatibility and resistance to calcification. PE enhanced the stress/strain properties of the xenogeneic pericardia, perhaps by forming nanostructures that were clearly visualised in BP using scanning electron microscopy. The DE + PE combination, in an alternating cross-linking manner, thus constitutes a promising option for developing bioprosthetic pericardia.
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Affiliation(s)
- Irina Yu Zhuravleva
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, 15 Rechkunovskaya St., Novosibirsk 630055, Russia.
| | - Elena V Karpova
- N. Vorozhtsov Institute of Organic Chemistry of SB RAS, 9 Lavrentyev Avenue, Novosibirsk 630090, Russia
| | - Ludmila A Oparina
- A. Favorsky Institute of Chemistry SB RAS, 1 Favorsky St., Irkutsk 664033, Russia
| | - Olga V Poveschenko
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, 15 Rechkunovskaya St., Novosibirsk 630055, Russia
| | - Maria A Surovtseva
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, 15 Rechkunovskaya St., Novosibirsk 630055, Russia
| | - Anatoly T Titov
- V. Sobolev Institute of Geology and Mineralogy SB RAS, 3 Academician Koptyug Avenue, Novosibirsk 630090, Russia
| | - Alexander L Ksenofontov
- A. Belozersky Research Institute of Physico-Chemical Biology MSU, House 1, Building 40 Leninskye gory, Moscow 119992, Russia
| | - Maria B Vasilieva
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, 15 Rechkunovskaya St., Novosibirsk 630055, Russia
| | - Elena V Kuznetsova
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, 15 Rechkunovskaya St., Novosibirsk 630055, Russia
| | - Alexander V Bogachev-Prokophiev
- E. Meshalkin National Medical Research Center of the RF Ministry of Health, 15 Rechkunovskaya St., Novosibirsk 630055, Russia
| | - Boris A Trofimov
- A. Favorsky Institute of Chemistry SB RAS, 1 Favorsky St., Irkutsk 664033, Russia
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Iyer KS. Valved conduits in the right ventricular outflow-the Achilles heel of congenital heart surgery! Indian J Thorac Cardiovasc Surg 2020; 37:127-128. [PMID: 33642709 DOI: 10.1007/s12055-020-01050-8] [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: 08/16/2020] [Revised: 08/28/2020] [Accepted: 09/05/2020] [Indexed: 11/28/2022] Open
Abstract
Valved conduits play an important role in the reconstruction of the right ventricular outflow tract, but their limited longevity remains an unsolved problem for the congenital heart surgeon.
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Affiliation(s)
- Krishna Subramony Iyer
- Pediatric & Congenital Heart Surgery, Fortis Escorts Heart Institute, New Delhi, 110029 India
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11
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Zhuravleva IY, Polienko YF, Karpova EV, Timchenko TP, Vasilieva MB, Baratova LA, Shatskaya SS, Kuznetsova EV, Nichay NR, Beshchasna N, Bogachev‐Prokophiev AV. Treatment with bisphosphonates to mitigate calcification of elastin‐containing bioprosthetic materials. J Biomed Mater Res A 2020; 108:1579-1588. [DOI: 10.1002/jbm.a.36927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 03/04/2020] [Accepted: 03/09/2020] [Indexed: 01/23/2023]
Affiliation(s)
- Irina Y. Zhuravleva
- Center for Innovative Surgical TechnologiesE. Meshalkin National Medical Research Center of the RF Ministry of Health Novosibirsk Russian Federation
| | - Yuliya F. Polienko
- Laboratory of Nitrogen Compounds (Y.F. Polienko) and Center of Spectral Research (E.V.Karpova)N. Vorozhtsov Novosibirsk Institute of Organic Chemistry SB RAS Novosibirsk Russian Federation
| | - Elena V. Karpova
- Laboratory of Nitrogen Compounds (Y.F. Polienko) and Center of Spectral Research (E.V.Karpova)N. Vorozhtsov Novosibirsk Institute of Organic Chemistry SB RAS Novosibirsk Russian Federation
| | - Tatyana P. Timchenko
- Center for Innovative Surgical TechnologiesE. Meshalkin National Medical Research Center of the RF Ministry of Health Novosibirsk Russian Federation
| | - Maria B. Vasilieva
- Center for Innovative Surgical TechnologiesE. Meshalkin National Medical Research Center of the RF Ministry of Health Novosibirsk Russian Federation
| | - Ludmila A. Baratova
- Department of chromatographical analysisA. Belozersky Research Institute of Physico‐Chemical Biology MSU Moscow Russian Federation
| | - Svetlana S. Shatskaya
- Laboratory of Intercalation and Mechanochemical ReactionsInstitute of Solid State Chemistry and Mechanochemistry SB RAS Novosibirsk Russian Federation
| | - Elena V. Kuznetsova
- Center for Innovative Surgical TechnologiesE. Meshalkin National Medical Research Center of the RF Ministry of Health Novosibirsk Russian Federation
| | - Nataliya R. Nichay
- Center for Innovative Surgical TechnologiesE. Meshalkin National Medical Research Center of the RF Ministry of Health Novosibirsk Russian Federation
| | - Natalia Beshchasna
- Bio‐ and Nanotechnology DepartmentFraunhofer Institute for Ceramic Technologies and Systems Dresden Germany
| | - Alexander V. Bogachev‐Prokophiev
- Center for Innovative Surgical TechnologiesE. Meshalkin National Medical Research Center of the RF Ministry of Health Novosibirsk Russian Federation
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13
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Nichay NR, Zhuravleva IY, Kulyabin YY, Zubritskiy AV, Voitov AV, Soynov IA, Gorbatykh AV, Bogachev-Prokophiev AV, Karaskov AM. Diepoxy- Versus Glutaraldehyde-Treated Xenografts: Outcomes of Right Ventricular Outflow Tract Reconstruction in Children. World J Pediatr Congenit Heart Surg 2019; 11:56-64. [PMID: 31835985 DOI: 10.1177/2150135119885900] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Xenografts used for right ventricular outflow tract (RVOT) reconstruction are typically treated with glutaraldehyde. However, potential benefit of epoxy treatment was demonstrated in experimental studies. We aimed to compare diepoxy-treated bovine pericardial valved conduits (DE-PVCs) and glutaraldehyde-treated bovine pericardial valved conduits (GA-PVCs) for RVOT reconstruction in pediatric patients. METHODS Between 2002 and 2017, 117 patients underwent RVOT reconstruction with PVC in single center: DE-PVC group, n = 39; and GA-PVC group, n = 78. After performing propensity score analysis (1:1) for the entire sample, 29 patients from the DE-PVC group were matched with 29 patients from the GA-PVC group. RESULTS There were no conduit-related deaths. In the DE-PVC group, the freedom from conduit failure was 90.9% at four years and 54.3% at eight years postoperatively. In the GA-PVC group, it was 46.3% and 33.1%, respectively. The difference was significant (P = .037). Conduit failure was typically caused by stenosis in both groups. In the DE-PVC group, the main cause of stenosis was xenograft calcification (27.6%); while in the GA-PVC group, it was mostly due to neointimal proliferation (25.0%) and, less often, calcification (14.3%). Conduit thrombosis was the cause of replacement in 6.9% of patients from the GA-PVC group. CONCLUSIONS Diepoxy-treated bovine pericardial valved conduit is a suitable alternative to GA-PVC for RVOT reconstruction in pediatric patients. Diepoxy-treated bovine pericardial valved conduits may be less prone to conduit failure and more resistant to neointimal proliferation and conduit thrombosis than GA-PVCs.
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Affiliation(s)
- Nataliya R Nichay
- Department of Congenital Heart Disease, E. Meshalkin National Medical Research Center, Ministry of Health Russian Federation, Novosibirsk, Russia
| | - Irina Y Zhuravleva
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Center, Ministry of Health Russian Federation, Novosibirsk, Russia
| | - Yuriy Y Kulyabin
- Department of Congenital Heart Disease, E. Meshalkin National Medical Research Center, Ministry of Health Russian Federation, Novosibirsk, Russia
| | - Alexey V Zubritskiy
- Department of Congenital Heart Disease, E. Meshalkin National Medical Research Center, Ministry of Health Russian Federation, Novosibirsk, Russia
| | - Alexey V Voitov
- Department of Congenital Heart Disease, E. Meshalkin National Medical Research Center, Ministry of Health Russian Federation, Novosibirsk, Russia
| | - Ilia A Soynov
- Department of Congenital Heart Disease, E. Meshalkin National Medical Research Center, Ministry of Health Russian Federation, Novosibirsk, Russia
| | - Artem V Gorbatykh
- Department of Congenital Heart Disease, E. Meshalkin National Medical Research Center, Ministry of Health Russian Federation, Novosibirsk, Russia
| | - Alexander V Bogachev-Prokophiev
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Center, Ministry of Health Russian Federation, Novosibirsk, Russia
| | - Alexander M Karaskov
- Heart Valve Surgery Department, E. Meshalkin National Medical Research Center, Ministry of Health Russian Federation, Novosibirsk, Russia
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Poh CL, Buratto E, Larobina M, Wynne R, O'Keefe M, Goldblatt J, Tatoulis J, Skillington PD. The Ross procedure in adults presenting with bicuspid aortic valve and pure aortic regurgitation: 85% freedom from reoperation at 20 years. Eur J Cardiothorac Surg 2019; 54:420-426. [PMID: 29546380 DOI: 10.1093/ejcts/ezy073] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 02/01/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The Ross procedure has demonstrated excellent results when performed in patients with aortic stenosis or mixed aortic valve disease [aortic stenosis and aortic regurgitation (AR)]. However, due to its reported risk of late reoperation, it is not recommended under current guidelines for patients presenting with bicuspid aortic valve and pure AR. We have analysed our own results in light of this recommendation. METHODS Between 1993 and 2016, 129 consecutive patients with a mean age of 34.7 ± 10.6 years (range 16-64 years) presented with bicuspid aortic valve and pure AR and underwent the Ross procedure. Patients were reviewed annually and had 2nd yearly transthoracic echocardiograms during follow-up. The unit had a liberal reoperation policy where reoperation was performed if patients developed recurrent moderate or greater AR during follow-up. RESULTS There was 1 inpatient death, and 3 late deaths over a mean follow-up duration of 9.6 ± 6.8 years. Late survival at 10 and 20 years post-surgery were 99% [95% confidence interval (CI) 94-100] and 95% (95% CI 85-99), respectively. Eleven patients underwent redo aortic valve replacement (AVR) and 4 patients had redo pulmonary valve replacement. Freedom from reoperation for AVR and more-than-mild AR at 10 and 20 years post-surgery were 89% (95% CI 81-94) and 85% (95% CI 74-92), respectively. Having longer aortic cross-clamp (hazard ratio 1.03, 95% CI 1.00-1.06; P = 0.05) and cardiopulmonary bypass times (hazard ratio 1.02, 95% CI 1.00-1.05; P = 0.05), and having a larger preoperative sinotubular junction diameter (hazard ratio 1.15, 95% CI 1.03-1.30; P = 0.02) were significant predictors of having redo AVR or significant AR at follow-up. CONCLUSIONS With a 20-year freedom from redo AVR and greater-than-mild residual AR of 85%, the utilization of the Ross procedure in bicuspid aortic valve patients with pure AR should be considered.
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Affiliation(s)
- Chin L Poh
- Department of Cardiothoracic Surgery, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Edward Buratto
- Department of Surgery, The University of Melbourne, Melbourne, VIC, Australia
| | - Marco Larobina
- Department of Cardiothoracic Surgery, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Rochelle Wynne
- Department of Cardiothoracic Surgery, The Royal Melbourne Hospital, Melbourne, VIC, Australia.,School of Nursing & Midwifery, Deakin University, Geelong, VIC, Australia
| | - Michael O'Keefe
- Department of Cardiothoracic Surgery, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - John Goldblatt
- Department of Cardiothoracic Surgery, The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - James Tatoulis
- Department of Cardiothoracic Surgery, The Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Surgery, The University of Melbourne, Melbourne, VIC, Australia
| | - Peter D Skillington
- Department of Cardiothoracic Surgery, The Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Surgery, The University of Melbourne, Melbourne, VIC, Australia
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15
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Long-term assessment of the Ross procedure in adults: Clinical and echocardiographic follow-up at 20 years. Rev Port Cardiol 2019; 38:315-321. [DOI: 10.1016/j.repc.2018.06.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 04/18/2018] [Accepted: 06/13/2018] [Indexed: 11/23/2022] Open
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16
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Guerreiro S, Madeira M, Ribeiras R, Queiroz e Melo J, Canada M, Horta E, Reis C, Neves JP, Mendes M. Long-term assessment of the Ross procedure in adults: Clinical and echocardiographic follow-up at 20 years. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2019.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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17
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d'Udekem Y, Tweddell JS, Karl TR. The great debate series: surgical treatment of aortic valve abnormalities in children. Eur J Cardiothorac Surg 2019; 53:919-931. [PMID: 29668975 DOI: 10.1093/ejcts/ezy069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 01/22/2018] [Indexed: 11/13/2022] Open
Abstract
This article is the latest in an EJCTS series entitled 'The Great Debates'. We have chosen the topic of aortic valve (AoV) surgery in children, with a focus on infants and neonates. The topic was selected due to the significant challenges that AoV problems in the young may present to the surgical team. There are many areas of active controversy, despite the vast accumulated world experience. We have tried to incorporate many of these issues in the questions posed, not claiming to be all-inclusive. The individuals invited to this debate are experts in paediatric valve surgery, with broad and successful clinical experiences on multiple continents. We hope that the facts and opinions presented in this debate will generate interest and discussion and perhaps prove useful in decision-making for future complex valve cases.
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Affiliation(s)
- Yves d'Udekem
- Cardiac Surgical Unit, Royal Children's Hospital, Melbourne, VIC, Australia
| | - James S Tweddell
- Department of Cardiothoracic Surgery, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Tom R Karl
- Johns Hopkins All Children's Heart Institute, St. Petersburg, FL, USA.,European Journal of Cardio-Thoracic Surgery
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18
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Ibrahim M, Spelde AE, Carter TI, Patel PA, Desai N. The Ross Operation in the Adult: What, Why, and When? J Cardiothorac Vasc Anesth 2018. [DOI: 10.1053/j.jvca.2017.12.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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19
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Lee H, Sung K, Kim WS, Jeong DS, Ahn JH, Carriere KC, Park PW. Late clinical outcomes after mechanical aortic valve replacement for aortic stenosis: old versus new prostheses. J Thorac Dis 2018; 10:3361-3371. [PMID: 30069331 DOI: 10.21037/jtd.2018.06.03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background The study aimed to evaluate the late clinical outcomes of new-generation mechanical valves for severe aortic stenosis (AS) compared with old mechanical valves. Methods We retrospectively reviewed data from 254 patients with severe AS, who underwent primary mechanical aortic valve replacement from 1995 to 2013. Patients were classified into two groups: old-valve group (n=65: 33 ATS standard, 32 Medtronic-Hall) and new-valve group (n=189: 113 St. Jude Regent, 46 On-X, 30 Sorin Overline). Median patient age was 58 years (Q1-Q3: 52-61). With propensity score matching based on demographic information, 56 patients in the old-valve group were matched with 177 patients in the new-valve group. The median follow-up duration was 91 months (Q1-Q3: 48-138). Results Cardiac-related mortality and hemorrhagic events were significantly lower in the new-valve group (P=0.047 and P=0.032, respectively). The median international normalized ratio (INR) at follow-up was significantly higher in the old-valve group [2.23, Q1-Q3: 2.14-2.35 (old-valve group); 2.08, Q1-Q3: 1.92-2.23 (new-valve group), P<0.001]. The incidence of prosthesis-patient mismatch (PPM) was significantly higher in the old-valve group (P<0.001). Multivariate analysis of the total population revealed that PPM was a significant risk factor for cardiac-related events [hazard ratio (HR) =5.279, 95% CI, 1.886-14.561, P=0.002] and showed higher trend of increasing mortality (HR =3.082, P=0.076). Conclusions New mechanical prostheses showed a better hemodynamic performance and lower incidence of PPM. Anticoagulation strategy to lower the target INR in patients with new mechanical valves may improve late outcomes by reducing hemorrhagic events.
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Affiliation(s)
- Heemoon Lee
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kiick Sung
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wook Sung Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Seop Jeong
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joong Hyun Ahn
- Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keumhee Chough Carriere
- Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Pyo Won Park
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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20
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Sharifulin R, Bogachev-Prokophiev A, Demin I, Zheleznev S, Pivkin A, Afanasyev A, Karaskov A. Right ventricular outflow tract reconstruction using a polytetrafluoroethylene conduit in Ross patients†. Eur J Cardiothorac Surg 2018; 54:427-433. [DOI: 10.1093/ejcts/ezy128] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 01/30/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ravil Sharifulin
- Department of Heart Valve Surgery, E. Meshalkin National Medical Research Centre, Novosibirsk, Russian Federation
| | | | - Igor Demin
- Department of Heart Valve Surgery, E. Meshalkin National Medical Research Centre, Novosibirsk, Russian Federation
| | - Sergey Zheleznev
- Department of Heart Valve Surgery, E. Meshalkin National Medical Research Centre, Novosibirsk, Russian Federation
| | - Alexey Pivkin
- Department of Heart Valve Surgery, E. Meshalkin National Medical Research Centre, Novosibirsk, Russian Federation
| | - Alexander Afanasyev
- Department of Heart Valve Surgery, E. Meshalkin National Medical Research Centre, Novosibirsk, Russian Federation
| | - Alexander Karaskov
- Department of Heart Valve Surgery, E. Meshalkin National Medical Research Centre, Novosibirsk, Russian Federation
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21
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Valve performance classification in 630 subcoronary Ross patients over 22 years. J Thorac Cardiovasc Surg 2018; 156:79-86.e2. [PMID: 29606322 DOI: 10.1016/j.jtcvs.2018.03.015] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/30/2018] [Accepted: 03/05/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To define the function of the "Ross valves" and its clinical meaning in a practical valve performance classification as part of the outcome analysis. METHODS From 1994 to 2017, 630 consecutive patients underwent the subcoronary Ross procedure at our institution. The valve performance classification combines hemodynamics, symptoms, and management criteria. Median follow-up was 12.5 years (maximum 22.3 years, 7404 patient-years, 99.4% completeness). RESULTS The mean age of the patients was 44.7 ± 11.9 years. Hospital deaths was 0.3% (n = 2). Twenty years after the operation survival was 73.1% (95% confidence interval [CI], 65.4%-81.6%) and statistically not different from the age- and gender-matched general population; freedom from reoperation was 85.9% (95% CI, 80.2%-92.0%; 0.6% per patient-year), 89.8% (95% CI, 84.3%-95.7%) for autograft, and 91.0% (95% CI, 86.3%-96.0%) for homograft. Preoperative annulus diameter, aortic regurgitation, annulus reinforcement, sinotubular junction reinforcement, and bicuspid aortic valve type were no significant risk factors for reoperation. At 20 years the probability of a patient being in valve performance class I to IV was 5%, 74%, 19%, and 1%, respectively. Time to reoperation was not different in bicuspid and tricuspid aortic valves; preoperative aortic stenosis tended to have better outcome of autograft function. CONCLUSIONS These up to 22 years data show that the subcoronary Ross procedure continues to provide an excellent tissue aortic valve replacement. The suggested valve performance classification emerged as a practical concept for outcome analysis with the probability of 79% being in the favorable class I or II at 20 years.
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22
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Nichay NR, Zhuravleva IY, Kulyabin YY, Timchenko TP, Voitov AV, Kuznetsova EV, Soynov IA, Zubritskiy AV, Bogachev-Prokophiev AV, Karaskov AM. In search of the best xenogeneic material for a paediatric conduit: an analysis of clinical data†. Interact Cardiovasc Thorac Surg 2018; 27:34-41. [DOI: 10.1093/icvts/ivy029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 01/16/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Nataliya R Nichay
- Department of Congenital Heart Disease, E.Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Irina Y Zhuravleva
- Laboratory of Biological Prosthetics, E.Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Yuriy Y Kulyabin
- Department of Congenital Heart Disease, E.Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Tatyana P Timchenko
- Laboratory of Biological Prosthetics, E.Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Alexey V Voitov
- Department of Congenital Heart Disease, E.Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Elena V Kuznetsova
- Laboratory of Biological Prosthetics, E.Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Ilia A Soynov
- Department of Congenital Heart Disease, E.Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | - Alexey V Zubritskiy
- Department of Congenital Heart Disease, E.Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
| | | | - Alexander M Karaskov
- Department of Heart Valve Surgery, E.Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
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23
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In search of the best xenogeneic material for a paediatric conduit: an experimental study†. Interact Cardiovasc Thorac Surg 2018; 26:738-744. [DOI: 10.1093/icvts/ivx445] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 12/22/2017] [Indexed: 11/14/2022] Open
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25
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Holst KA, Said SM, Nelson TJ, Cannon BC, Dearani JA. Current Interventional and Surgical Management of Congenital Heart Disease: Specific Focus on Valvular Disease and Cardiac Arrhythmias. Circ Res 2017; 120:1027-1044. [PMID: 28302746 DOI: 10.1161/circresaha.117.309186] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 02/20/2017] [Accepted: 02/20/2017] [Indexed: 01/15/2023]
Abstract
Successful outcome in the care of patients with congenital heart disease depends on a comprehensive multidisciplinary team. Surgery is offered for almost every heart defect, despite complexity. Early mortality for cardiac surgery in the neonatal period is ≈10% and beyond infancy is <5%, with 90% to 95% of patients surviving with a good quality of life into the adult years. Advances in imaging have facilitated accurate diagnosis and planning of interventions and surgical procedures. Similarly, advances in the perioperative medical management of patients, particularly with intensive care, has also contributed to improving outcomes. Arrhythmias and heart failure are the most common late complications for the majority of defects, and reoperation for valvar problems is common. Lifelong surveillance for monitoring of recurrent or residual structural heart defects, as well as periodic assessment of cardiac function and arrhythmia monitoring, is essential for all patients. The field of congenital heart surgery is poised to incorporate new innovations such as bioengineered cells and scaffolds that will iteratively move toward bioengineered patches, conduits, valves, and even whole organs.
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Affiliation(s)
- Kimberly A Holst
- From the Department of Cardiovascular Surgery (K.A.H., S.M.S., J.A.D.), Departments of Pediatric and Adolescent Medicine, and Molecular Pharmacology and Experimental Therapeutics (T.J.N., B.C.C.), and Division of Pediatric Cardiology (T.J.N., B.C.C.), Mayo Clinic, Rochester, MN
| | - Sameh M Said
- From the Department of Cardiovascular Surgery (K.A.H., S.M.S., J.A.D.), Departments of Pediatric and Adolescent Medicine, and Molecular Pharmacology and Experimental Therapeutics (T.J.N., B.C.C.), and Division of Pediatric Cardiology (T.J.N., B.C.C.), Mayo Clinic, Rochester, MN
| | - Timothy J Nelson
- From the Department of Cardiovascular Surgery (K.A.H., S.M.S., J.A.D.), Departments of Pediatric and Adolescent Medicine, and Molecular Pharmacology and Experimental Therapeutics (T.J.N., B.C.C.), and Division of Pediatric Cardiology (T.J.N., B.C.C.), Mayo Clinic, Rochester, MN
| | - Bryan C Cannon
- From the Department of Cardiovascular Surgery (K.A.H., S.M.S., J.A.D.), Departments of Pediatric and Adolescent Medicine, and Molecular Pharmacology and Experimental Therapeutics (T.J.N., B.C.C.), and Division of Pediatric Cardiology (T.J.N., B.C.C.), Mayo Clinic, Rochester, MN
| | - Joseph A Dearani
- From the Department of Cardiovascular Surgery (K.A.H., S.M.S., J.A.D.), Departments of Pediatric and Adolescent Medicine, and Molecular Pharmacology and Experimental Therapeutics (T.J.N., B.C.C.), and Division of Pediatric Cardiology (T.J.N., B.C.C.), Mayo Clinic, Rochester, MN.
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