1
|
AlBadri A, Joseph J, Patel V, Patel D, Koren O, Cheng W, Jilaihawi H, Makkar R. Hemodynamic and Mid-Term Outcomes for Transcatheter Aortic Valve Replacement in Degenerated Internally Stented Valves. JACC Cardiovasc Interv 2023; 16:542-554. [PMID: 36922040 DOI: 10.1016/j.jcin.2023.01.381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 01/03/2023] [Accepted: 01/30/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Valve-in-valve (ViV) transcatheter aortic valve replacement is indicated in patients undergoing repeat intervention for degenerative aortic valve bioprostheses. Patients with internally stented valves (ie, Mitroflow and Trifecta) are at high risk for coronary artery obstruction during ViV procedures because of valve design, as the leaflets are mounted outside the valve stent. OBJECTIVES The aim of this study was to compare the hemodynamic and clinical outcomes of transcatheter aortic valve replacement within internally stented valves (ViV-IS) vs other surgical valves (ViV-OS). METHODS Baseline characteristics, hemodynamic parameters, and clinical outcomes of patients who underwent ViV-IS were retrospectively collected and compared with those of patients who underwent ViV-OS. RESULTS A total of 250 patients (65% men, median Society of Thoracic Surgeons score 4.4% [IQR: 2.2%-8.4%]) were included. Seventy-one patients (28%) underwent ViV-IS, and 179 (72%) patients underwent ViV-OS. Patients who underwent ViV-OS had better periprocedural hemodynamic status compared with those who underwent ViV-IS (median mean gradient 6 [IQR: 2-13] vs 12 [IQR: 6-16]; P < 0.001). This was not significantly different when both groups were matched on the basis of age, sex, and valve internal diameter size (median mean gradient: 18 [IQR: 13-25] for ViV-OS vs 18 [IQR: 11-24] for ViV-IS; P = 0.36). Coronary protection for potential occlusion was performed more in ViV-IS vs ViV-OS pr (79% vs 6%, respectively; P < 0.001). Patients who underwent ViV-IS had a higher risk for coronary occlusion, requiring stent deployment, compared with those who underwent ViV-OS (54% vs 3%, respectively; P < 0.001. There was no difference in mortality at 3 years between the 2 groups (P = 0.59). CONCLUSIONS Patients who underwent ViV-IS had a very high incidence of coronary compromise that can be safely and effectively treated. In the setting of a systematic coronary protection strategy, ViV-OS and ViV-IS provide similar mid-term outcome, and periprocedural hemodynamic status (following adjustment for age, sex, and true internal diameter).
Collapse
Affiliation(s)
- Ahmed AlBadri
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jubin Joseph
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Vivek Patel
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Dhairya Patel
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ofir Koren
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Wen Cheng
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Hasan Jilaihawi
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Raj Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
| |
Collapse
|
2
|
Yount KW, Hawkins RB, Mehaffey JH, Teman NR, Yarboro LT, Kern JA, Ailawadi G. Aortic valve biologic protheses: A cohort comparison of premature valve failure. J Card Surg 2022; 37:1224-1229. [PMID: 35245397 DOI: 10.1111/jocs.16328] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/18/2021] [Accepted: 11/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Recent reports suggest an increased rate of early structural valve degeneration (SVD) in the Trifecta bioprosthesis (Abbott Cardiovascular). We sought to compare the intermediate-term outcomes of the Magna (Edwards Life Sciences) and Trifecta valves. METHODS All surgical aortic valve replacements (SAVRs) with Trifecta or Magna/Magna Ease bioprostheses at an academic medical center were extracted from an institutional database. Patients who survived until after discharge (2011-2019) were included. The primary outcome was valve failure for any reason requiring reintervention or contributing to death, identified by reintervention or review of cause of death. Time to failure was estimated with Kaplan-Meier analysis and Cox Proportional Hazards Modeling. RESULTS Out of 1444 patients, 521 (36%) underwent Trifecta and 923 (64%) underwent Magna implantation with a median follow-up of 27.6 months. Trifecta patients had larger median valve size (25 vs. 23 mm, p < .001) and lower median gradient (8.0 vs. 10.9 mmHg, p < .001). Trifecta patients had higher 48-month estimated failure rates (20.2 ± 7.6% vs. 2.6 ± 0.7%, p < .0001), with failure rates of 21.4 versus 9.2 failures per 1000 person-years (p < .001). After risk-adjustment, Trifecta patients had a 5.3 times hazard of failure (95% confidence interval: 2.78-12.34, p < .001) compared to Magna patients. Only Trifecta valves failed due to sudden aortic regurgitation, 8 out of 521 (1.5%). CONCLUSION Despite lower postoperative mean gradients, the Trifecta bioprosthesis may have an increased risk of intermediate-term SVD. Further research is warranted to confirm the potential for sudden valve failure.
Collapse
Affiliation(s)
- Kenan W Yount
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Robert B Hawkins
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - J Hunter Mehaffey
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Nicholas R Teman
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Leora T Yarboro
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - John A Kern
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
3
|
Attia RQ, Raja SG. Surgical pericardial heart valves: 50 Years of evolution. Int J Surg 2021; 94:106121. [PMID: 34543742 DOI: 10.1016/j.ijsu.2021.106121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 08/10/2021] [Accepted: 09/15/2021] [Indexed: 11/25/2022]
Abstract
Valve disease carries a huge burden globally and the number of heart valve procedures are projected to increase from the current 300 000 to 800 000 annually by 2050. Since its genesis 50 years ago, pericardial heart valve has moved leaps and bounds to ever more ingenious designs and manufacturing methods with parallel developments in cardiology and cardiovascular surgical treatments. This feat has only been possible through close collaboration of many scientific disciplines in the fields of engineering, material sciences, basic tissue biology, medicine and surgery. As the pace of change continues to accelerate, we ask the readers to go back with us in time to understand developments in design and function of pericardial heart valves. This descriptive review seeks to focus on the qualities of pericardial heart valves, the advantages, successes and failures encapsulating the evolution of surgically implanted pericardial heart valves over the past five decades. We present the data on comparison of the pericardial heart valves to porcine valves, discuss structural valve deterioration and the future of heart valve treatments.
Collapse
Affiliation(s)
- Rizwan Q Attia
- Department of Cardiac Surgery, Harefield Hospital, Hill End Road, Harefield, Uxbridge, London, UB9 6JH, United Kingdom
| | | |
Collapse
|
4
|
Della Barbera M, Valente M, Basso C, Pettenazzo E, Thiene G. The pathology of early failure in Mitroflow pericardial valve bioprosthesis (12A/LX). Cardiovasc Pathol 2021; 55:107373. [PMID: 34333132 DOI: 10.1016/j.carpath.2021.107373] [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: 06/17/2021] [Revised: 07/21/2021] [Accepted: 07/24/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Limited mid-term durability of 12A/LX Mitroflow bioprosthesis has been reported. Aim of the study was to ascertain the pathologic substrates and possible mechanisms of structural valve deterioration in explants from animals and humans. METHODS Nine aortic 12A/LX Mitroflow bioprostheses preserved in hypotonic solution and three aortic 12A/LX bioprostheses, preserved in isotonic solution, were explanted from juvenile sheep, mean time from implant 95.66 ± 36.04 days and 132.33 ± 28.88 days from implant respectively. One stented unimplanted 12A/LX Mitroflow preserved in isotonic colution before glutaraldeyde fixation served as control. Ten aortic 12A/LX Mitroflow bioprostheses were explanted from humans because of severe dysfunction: five children, (3 females and 2 males, mean age 14.19 ± 4.77 years, range 11-21), 26 ± 8.24 months from implant and 5 adults (4 females and 1 male, mean age 57.4 ± 19.85 years, range 31-72), 64.4 ± 26.94 months from implant. X-ray, histology, and transmission electron microscopy were carried out as well as spectroscopy for calcium (Ca++) and phosphorus (P) content in human explants. RESULTS Explants, from both animals and humans, showed cusp folding and stiffness, with coarse calcific deposits at gross examination and X-ray. Severe collagen denaturation, plasma insudation and massive calcification, involving both collagen and cell debris, were observed microscopically. Mean Ca++ content of 183.27 ± 62.48 and P content of 94.35 ±33.76 mg/g dry weight was found in children and Ca++ content of 205.49 ± 2.23 and P content of 99.75 ± 0.11 mg/g dry weight in adults. Obstructive fibrous tissue overgrowth was detected in 6 human cases. CONCLUSIONS Collagen denaturation was observed in pericardial Mitroflow 12A/LX bioprosthesis with premature structural valve deterioration. Optimal collagen fixation and preservation as well as phospholipids reduction by removing cell debris, as employed in the novel CROWN PRT Mitroflow bioprosthesis, are expected to solve the flaw and achieve long-term durability.
Collapse
Affiliation(s)
- Mila Della Barbera
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiovascular Pathology, University of Padua Medical School, Padua, Italy
| | - Marialuisa Valente
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiovascular Pathology, University of Padua Medical School, Padua, Italy
| | - Cristina Basso
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiovascular Pathology, University of Padua Medical School, Padua, Italy
| | - Elena Pettenazzo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiovascular Pathology, University of Padua Medical School, Padua, Italy
| | - Gaetano Thiene
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiovascular Pathology, University of Padua Medical School, Padua, Italy.
| |
Collapse
|
5
|
Pernigo M, Triggiani M, Adamo M, Pasini GF. Severe Aortic Regurgitation of Early Degenerated Mitroflow Bioprosthesis: From Echocardiographic Diagnosis to Treatment with Valve-in-Valve Transcatheter Aortic Valve Implantation. J Cardiovasc Echogr 2021; 31:51-54. [PMID: 34221889 PMCID: PMC8230156 DOI: 10.4103/jcecho.jcecho_129_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 12/27/2020] [Indexed: 12/02/2022] Open
Abstract
Valve-in-Valve transcatheter aortic valve implantation (ViV TAVI) is emerging as an effective therapeutic option for bioprosthetic valve failure. Recently, concern has been raised for early valve deterioration of Mitroflow (Sorin) aortic bioprosthesis, with the development of prevalent stenosis. We report cases of pure severe aortic regurgitation (AR) due to early and mid-term prosthesis degeneration. From June 2018 to October 2019, three patients were treated in our division for the new appearance of severe intraprosthetic regurgitation. Patient 1 (man, 85-year-old) and patient 3 (woman, 83-year-old) had a Mitroflow n. 25 and n. 21 implanted, respectively, in 2012 and 2013 for severe aortic stenosis. Patient 2, a 67-year-old woman with Marfan syndrome underwent a Mitroflow n. 25 implant in 2008 for severe AR and presented chronic type-B aortic dissection. Patient 1 was diagnosed with severe AR in the ambulatory setting, while the other patients presented acute heart failure, requiring inotrope support and high doses intravenous diuretics, and in case 3, temporary extracorporeal ultrafiltration. All patients appeared at high surgical risk and were successfully treated with ViV TAVI, through the right axillary artery in patient 2, and through the femoral artery in patients 1 and 3. Results were good at short- and mid-term follow-up. In conclusion, early and midterm bioprosthesis degeneration with the development of severe AR is a possible complication of the Mitroflow aortic valve. ViV TAVI has been confirmed as a safe and effective therapeutic option in our cases.
Collapse
Affiliation(s)
- Matteo Pernigo
- Department of Cardiology, 'La Memoria' Hospital, ASST Garda, Gavardo (Brescia) - Italy, Italy
| | - Marco Triggiani
- Department of Cardiology, 'La Memoria' Hospital, ASST Garda, Gavardo (Brescia) - Italy, Italy
| | - Marianna Adamo
- Department of Cardiology, Cath-Lab Unit, 'Spedali Civili' Hospital, Brescia, Italy
| | - Gian Franco Pasini
- Department of Cardiology, 'La Memoria' Hospital, ASST Garda, Gavardo (Brescia) - Italy, Italy
| |
Collapse
|
6
|
Mosquera VX, Bouzas-Mosquera A, Vilela-González Y, Velasco C, Salgado-Fernández J, Calviño-Santos R, Vázquez-González N, Vázquez-Rodríguez JM, Herrera-Noreña JM. Balloon-expanding transcatheter aortic valve implantation for degenerated Mitroflow bioprostheses: clinical and echocardiographic long-term outcomes. Interact Cardiovasc Thorac Surg 2021; 33:173-180. [PMID: 33782703 DOI: 10.1093/icvts/ivab065] [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: 12/03/2020] [Revised: 01/14/2021] [Accepted: 02/05/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study aims to analyse the risks associated with valve-in-valve procedures for treating structural valve deterioration in Mitroflow bioprostheses, as well as to determine the impact of the original Mitroflow size on the patients' long-term outcomes. METHODS Between January 2012 and September 2019, 21 patients (61.9% males; mean age 82.4 ± 5.4 years) were treated for Mitroflow deterioration with valve-in-valve procedures (12 transapical and 9 transfemoral). RESULTS Mean EuroSCORE I and EuroSCORE II were 28.2% ± 13.6% and 10.5% ± 6.1%, respectively. Six patients presented an indexed aortic root diameter <14 mm/m2 and 7 patients a diameter of sinus of Valsalva <30 mm. Implanted transcatheter valve sizes were 20 mm in 6 cases, 23 mm in 14 cases and 26 mm in 1 patient. A Valve Academic Research Consortium-2 complication occurred in 23.8% of cases, including 3 coronary occlusions. In-hospital mortality was 9.5%. The 20 mm transcatheter valves presented significantly higher postoperative peak and mean aortic gradients than other sizes (54.1 ± 11.3 mmHg vs 29.9 ± 9.6 mmHg, P = 0.003; and 29.3 ± 7.7 mmHg vs 17.4 ± 5.9 mmHg, P = 0.015, respectively). There were 12 cases of patient-prosthesis mismatch (57.1%) and 3 cases (14.3%) of severe patient-prosthesis mismatch. Cumulative survival was 85.7% ± 7.6% at 1 year, 74.3% ± 10% at 2 years and 37.1% ± 14.1% at 5 years. CONCLUSIONS Valve-in-valve procedures with balloon-expandable transcatheter valves associate a high risk of coronary occlusion in patients with indexed aortic root diameter <14 mm/m2 and low coronary ostia <12 mm. Valve-in valve procedures with 20 mm balloon-expandable transcatheter valves in ≤21 mm Mitroflow bioprosthesis leave significant residual transvalvular gradients that might obscure patients' long-term outcomes.
Collapse
Affiliation(s)
- Victor X Mosquera
- Department of Cardiac Surgery, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | | | - Yago Vilela-González
- Department of Cardiac Surgery, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Carlos Velasco
- Department of Cardiac Surgery, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | | | - Ramón Calviño-Santos
- Department of Cardiology, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | | | | | - José M Herrera-Noreña
- Department of Cardiac Surgery, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| |
Collapse
|
7
|
Porterie J, Kalavrouziotis D, Mohammadi S. Commentary: Early failure of the Trifecta GT bioprosthesis: Innovation is not always progress. JTCVS Tech 2020; 4:109-110. [PMID: 34317980 PMCID: PMC8307754 DOI: 10.1016/j.xjtc.2020.09.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 09/05/2020] [Accepted: 09/24/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Jean Porterie
- Division of Cardiac Surgery, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Dimitri Kalavrouziotis
- Division of Cardiac Surgery, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Siamak Mohammadi
- Division of Cardiac Surgery, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| |
Collapse
|
8
|
Rosati CM, Shiomi S, Fukuhara S. Reply. Ann Thorac Surg 2020; 110:343-344. [DOI: 10.1016/j.athoracsur.2019.10.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 10/25/2019] [Indexed: 11/17/2022]
|
9
|
Jawad K, Lehmann S, Koziarz A, Dieterlen M, Feder S, Misfeld M, Garbade J, Rao V, Borger M. Midterm results after St Jude Medical Epic porcine xenograft for aortic, mitral, and double valve replacement. J Card Surg 2020; 35:1769-1777. [PMID: 32598528 DOI: 10.1111/jocs.14554] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the results after stented porcine xenograft implantation (Epic, SJM, St Paul, MN) with Linx anticalcification treatment in elderly patients at our high-volume tertiary care center. METHODS A total of 3825 patients undergoing aortic (AVR = 2441), mitral (MVR = 892), or double valve (DVR = 492) replacement between 11/2001 and 12/2017 with Epic xenografts were evaluated. Outcomes were assessed by reviewing the prospectively acquired hospital database results, and regular annual follow-up information was acquired from questionnaires or telephone interviews. RESULTS For patients undergoing AVR, MVR, DVR, age at surgery were 76.4 ± 6, 71.2 ± 9, 72.9 ± 8 years; active endocarditis was an indication for valve surgery in 4.5%, 20.7%, 19.7%; and the predicted median (interquartile range [IQR]) mortality risk (EuroSCORE II) was 5.2% (3.1%-9.4%), 7.5% (3.9%-16.2%), 9.9% (6.0%-19.6%), respectively. Median follow-up was 3.04 (IQR: 0.18-5.21). Thirty-day survival was 91.2% ± 0.6%, 87.6% ± 0.1.1%, 84.7% ± 1.6%; and 10-year survival was 56.7% ± 1.0%, 59.4% ± 2.5%, 50.45% ± 3.1%, respectively. Patients who underwent MVR versus AVR were at significant increased risk for reoperation for endocarditis (adjusted odds ratio; 2.2, 95% confidence interval; 1.29-3.7; P = .003). There was no significant difference in all-cause mortality at midterm in AVR vs MVR in the matched cohort (P = .85). CONCLUSIONS Implantation of the Epic stented porcine xenograft is associated with acceptable survival and freedom from valve-related complications or reoperation due to structural valve disease at midterm follow-up.
Collapse
Affiliation(s)
- Khalil Jawad
- Department of Cardiac Surgery, Heart Center, Leipzig University, Leipzig, Germany.,Department of Cardiac Surgery, Peter Munk Cardiac Center, Toronto, Canada
| | - Sven Lehmann
- Department of Cardiac Surgery, Heart Center, Leipzig University, Leipzig, Germany
| | | | - Maja Dieterlen
- Department of Cardiac Surgery, Heart Center, Leipzig University, Leipzig, Germany
| | - Stefan Feder
- Department of Cardiac Surgery, Heart Center, Leipzig University, Leipzig, Germany
| | - Martin Misfeld
- Department of Cardiac Surgery, Heart Center, Leipzig University, Leipzig, Germany
| | - Jens Garbade
- Department of Cardiac Surgery, Heart Center, Leipzig University, Leipzig, Germany
| | - Vivek Rao
- Department of Cardiac Surgery, Peter Munk Cardiac Center, Toronto, Canada
| | - Michael Borger
- Department of Cardiac Surgery, Heart Center, Leipzig University, Leipzig, Germany
| |
Collapse
|
10
|
Transcatheter aortic valve replacement valve durability: Good enough for young, low-risk patients? J Thorac Cardiovasc Surg 2020; 159:1249-1255. [DOI: 10.1016/j.jtcvs.2019.05.089] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/02/2019] [Accepted: 05/04/2019] [Indexed: 11/13/2022]
|
11
|
Testa L, Latib A, Brambilla N, De Marco F, Fiorina C, Adamo M, Giannini C, Angelillis M, Barbanti M, Sgroi C, Poli A, Ferrara E, Bruschi G, Russo CF, Matteo M, De Felice F, Musto C, Curello S, Colombo A, Tamburino C, Petronio AS, Bedogni F. Long-term clinical outcome and performance of transcatheter aortic valve replacement with a self-expandable bioprosthesis. Eur Heart J 2020; 41:1876-1886. [DOI: 10.1093/eurheartj/ehz925] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/28/2019] [Accepted: 12/06/2019] [Indexed: 01/03/2023] Open
Abstract
Abstract
Aims
In the last decade, transcatheter aortic valve (TAV) replacement determined a paradigm shift in the treatment of patients with severe symptomatic aortic stenosis. Data on long-term TAV performance are still limited. We sought to evaluate the clinical and haemodynamic outcomes of the CoreValve self-expandable valve up to 8-year follow-up (FU).
Methods and results
Nine hundred and ninety inoperable or high-risk patients were treated with the CoreValve TAV in eight Italian Centres from June 2007 to December 2011. The median FU was 4.4 years (interquartile range 1.4–6.7 years). Longest FU reached 11 years. A total of 728 died within 8-year FU (78.3% mortality from Kaplan–Meier curve analysis). A significant functional improvement was observed in the majority of patients and maintained over time, with 79.3% of surviving patients still classified New York Heart Association class ≤ II at 8 years. Echocardiographic data showed that the mean transprosthetic aortic gradient remained substantially unchanged (9 ± 4 mmHg at discharge, 9 ± 5 mmHg at 8 years, P = 0.495). The rate of Grade 0/1 paravalvular leak was consistent during FU with no significant change from post-procedure to FU ≥5 years in paired analysis (P = 0.164). Structural valve deterioration (SVD) and late bioprosthetic valve failure (BVF) were defined according to a modification of the 2017 EAPCI/ESC/EACTS criteria. In cumulative incidence functions at 8 years, moderate and severe SVD were 3.0% [95% confidence interval (CI) 2.1–4.3%] and 1.6% (95% CI 0.6–3.9%), respectively, while late BVF was 2.5% (95% CI 1.2–5%).
Conclusion
While TAVs are questioned about long-term performance and durability, the results of the present research provide reassuring 8-year evidence on the CoreValve first-generation self-expandable bioprosthesis.
Collapse
Affiliation(s)
- Luca Testa
- Department of Cardiology, IRCCS Policlinico S. Donato, San Donato Milanese, 20149 Milan, Italy
| | - Azeem Latib
- Department of Cardiology, Interventional Cardiology Unit, San Raffaele Scientific Institute, Via Olgettina Milano, 58, 20132 Milano MI, Italy
| | - Nedy Brambilla
- Department of Cardiology, IRCCS Policlinico S. Donato, San Donato Milanese, 20149 Milan, Italy
| | - Federico De Marco
- Department of Cardiology, IRCCS Policlinico S. Donato, San Donato Milanese, 20149 Milan, Italy
| | - Claudia Fiorina
- Cardiothoracic Department, Spedali Civili Brescia, Piazzale Spedali Civili, 1, Brescia, Italy
| | - Marianna Adamo
- Cardiothoracic Department, Spedali Civili Brescia, Piazzale Spedali Civili, 1, Brescia, Italy
| | - Cristina Giannini
- Catheterisation Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Via Piero Trivella, 56124 Pisa, Italy
| | - Marco Angelillis
- Catheterisation Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Via Piero Trivella, 56124 Pisa, Italy
| | - Marco Barbanti
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Via S. Sofia, Catania, Italy
| | - Carmelo Sgroi
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Via S. Sofia, Catania, Italy
| | - Arnaldo Poli
- Department of Cardiology, Interventional Cardiology Unit, ASST Ovest Milanese, Legnano Hospital, Via Papa Giovanni Paolo II, 20025 Legnano, Italy
| | - Erica Ferrara
- Department of Cardiology, Interventional Cardiology Unit, ASST Ovest Milanese, Legnano Hospital, Via Papa Giovanni Paolo II, 20025 Legnano, Italy
| | - Giuseppe Bruschi
- Department of Cardiology, “De Gasperis” Cardio Center, ASST Niguarda Metropolitan Hospital, Piazza Ospedale Maggiore, 3 Milano, Italy
| | - Claudio Francesco Russo
- Department of Cardiology, “De Gasperis” Cardio Center, ASST Niguarda Metropolitan Hospital, Piazza Ospedale Maggiore, 3 Milano, Italy
| | - Montorfano Matteo
- Department of Cardiology, Interventional Cardiology Unit, San Raffaele Scientific Institute, Via Olgettina Milano, 58, 20132 Milano MI, Italy
| | - Francesco De Felice
- Department of Cardiology, Interventional Cardiology Unit, S. Camillo Forlanini Hospital, Circonvallazione Gianicolense, 87, 00152 Roma, Italy
| | - Carmine Musto
- Department of Cardiology, Interventional Cardiology Unit, S. Camillo Forlanini Hospital, Circonvallazione Gianicolense, 87, 00152 Roma, Italy
| | - Salvatore Curello
- Cardiothoracic Department, Spedali Civili Brescia, Piazzale Spedali Civili, 1, Brescia, Italy
| | - Antonio Colombo
- Department of Cardiology, Interventional Cardiology Unit, San Raffaele Scientific Institute, Via Olgettina Milano, 58, 20132 Milano MI, Italy
| | - Corrado Tamburino
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Via S. Sofia, Catania, Italy
| | - Anna Sonia Petronio
- Catheterisation Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Via Piero Trivella, 56124 Pisa, Italy
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico S. Donato, San Donato Milanese, 20149 Milan, Italy
| |
Collapse
|
12
|
Lam KY, Koene B, Timmermans N, Soliman-Hamad M, van Straten A. Reintervention After Aortic Valve Replacement: Comparison of 3 Aortic Bioprostheses. Ann Thorac Surg 2019; 110:615-621. [PMID: 31846642 DOI: 10.1016/j.athoracsur.2019.10.060] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/17/2019] [Accepted: 10/18/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND The decision to implant a biological valve prosthesis is influenced by the issue of durability. We investigated the rate and the cause of reintervention in 3 different aortic valve bioprostheses. METHODS The study included all patients who underwent aortic valve replacement with a biological valve prosthesis between October 2009 and December 2018. Three different bioprostheses were compared: Carpentier-Edwards (CE) Magna Ease (Edwards Lifesciences, Irvine, CA), Trifecta (St. Jude Medical, St Paul, MN), and Mitroflow (LivaNova, London, United Kingdom). The primary end point was the rate of explantation. The degree of event-free survival and possible predictors for reintervention were also analyzed using Cox regression analysis. RESULTS In total, 2004 biological aortic valves were implanted, including 923 CE, 719 Trifecta, and 362 Mitroflow bioprostheses. The CE group had a significantly higher degree of event-free survival (917 [99.3%]) compared with the Trifecta (685 [95.3%]) and Mitroflow (340 [93.9%]) groups (P < .0001). The only cause of reintervention in the CE group was prosthetic valve endocarditis (6 [100%]), whereas structural valve deterioration was the most common cause of reintervention in the Trifecta (14 [41.2%]) and Mitroflow (14 [63.6%]) groups. Cox regression analysis revealed that age (hazard ratio [HR] 0.9; 95% confidence interval [CI], 0.9-0.9; P < .0001) and type of prosthesis (Trifecta: HR, 6.3; 95% CI, 2.6-15.2; P < .0001; Mitroflow: HR, 6.0, 95% CI, 2.4-15.1; P < .0001) were associated with lower event-free survival. CONCLUSIONS The freedom from reintervention after implantation of the CE bioprosthesis is significantly greater than that of the Trifecta and Mitroflow bioprostheses. Further investigations with larger patient populations and long-term follow-up are required to establish their durability and long-term efficacy.
Collapse
Affiliation(s)
- Ka Yan Lam
- Heart Center, Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, the Netherlands.
| | - Bart Koene
- Heart Center, Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, the Netherlands
| | - Naomi Timmermans
- Heart Center, Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, the Netherlands
| | - Mohamed Soliman-Hamad
- Heart Center, Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, the Netherlands
| | - Albert van Straten
- Heart Center, Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, the Netherlands
| |
Collapse
|
13
|
Ius F, Moscalenco D, Boethig D, Tudorache I, Haverich A, Warnecke G, Cebotari S. Cardiac valve operations after solid organ transplantation: A single-center experience. J Thorac Cardiovasc Surg 2019; 161:595-606.e4. [PMID: 31761345 DOI: 10.1016/j.jtcvs.2019.10.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 10/10/2019] [Accepted: 10/11/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Cardiac valve operations in patients who have undergone solid organ transplantation (ie, kidney, liver, pancreas, heart, and lung) pose unique challenges due to patient comorbidities and to the need for immunosuppressive therapy. The aim of this retrospective study was to present our experience with patients with solid-organ transplant who had cardiac valve operation at the time or after transplantation. METHODS Records of patients who had undergone cardiac valve operations after solid organ transplantation between January 1998 and January 2019 were retrospectively reviewed. Follow-up amounted to a median of 51 months (interquartile range, 5-88 months). RESULTS Among the 14,465 patients who underwent treatment for a cardiac valvular pathology during the study period, 127 patients (0.9%) had undergone a solid organ transplantation (kidney: n = 9 [76%]; liver: n = 12 [9%]; pancreas: n = 4 [3%]; heart: n = 16 [13%]; lung: n = 9 [7%]). Postoperatively, 14 patients (11%) underwent rethoracotomy for bleeding and 24 patients (19%) required new dialysis treatment. Twenty-five patients (20%) died in-hospital. Postoperative course was worse in patients operated for endocarditis or undergoing concomitant transplantation and valve surgery. Overall survival was 59%, 47%, and 40%, but survival conditioned to hospital discharge was 73%, 58%, and 50% at 5-, 10-, and 15-year follow-up, respectively. Freedom from major valve-related events amounted to 77%, 56%, and 46%, respectively. CONCLUSIONS Although the high prevalence of postoperative complications, especially in patients with endocarditis or concomitant transplantation and valve surgery, survival conditioned to hospital discharge was satisfactory in patients undergoing valve surgery after solid organ transplantation.
Collapse
Affiliation(s)
- Fabio Ius
- Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany.
| | - Daniel Moscalenco
- Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Dietmar Boethig
- Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Igor Tudorache
- Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Gregor Warnecke
- Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Serghei Cebotari
- Department of Cardiothoracic, Transplant, and Vascular Surgery, Hannover Medical School, Hannover, Germany
| |
Collapse
|
14
|
Panico RA, Giannini C, De Carlo M, Angelillis M, Spontoni P, Pieroni A, Costa G, Bertini P, Guarracino F, Petronio AS. Long-term results and durability of the CoreValve transcatheter aortic bioprosthesis: outcomes beyond five years. EUROINTERVENTION 2019; 14:1639-1647. [PMID: 30561369 DOI: 10.4244/eij-d-18-00779] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to determine the long-term outcomes of high-risk patients who underwent transcatheter aortic valve implantation (TAVI) with the third-generation CoreValve device, according to the 2017 EAPCI/ESC/EACTS definition of valve durability. METHODS AND RESULTS Between 2007 and 2013, 278 consecutive patients were enrolled in our prospective single-centre CoreValve registry (mean age 82±6 years, mean STS score 6.4±5.0%). The median follow-up of survivors was 6.8 years. The Cox proportional hazards model was used to identify independent predictors of HF rehospitalisation and all-cause mortality. Predictors of HF rehospitalisation were LVEF, MR and PVL at the last echocardiographic follow-up. The majority of patients were in NYHA Class I or II and showed mild/trivial paravalvular leak throughout follow-up. Mean pressure gradients remained stable over time. The overall crude cumulative incidences of structural valve deterioration and bioprosthetic valve failure were 3.6% and 2.5%, respectively. CONCLUSIONS Although overall mortality was high in this elderly patient cohort, the CoreValve bioprosthesis showed good durability at seven-year follow-up.
Collapse
|
15
|
Edelman JJ, Khan JM, Rogers T, Shults C, Satler LF, Ben-Dor II, Waksman R, Thourani VH. Valve-in-Valve TAVR: State-of-the-Art Review. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 14:299-310. [DOI: 10.1177/1556984519858020] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
An increasing number of surgically implanted bioprostheses will require re-intervention for structural valve deterioration. Valve-in-valve transcatheter aortic valve replacement (ViV TAVR) has become an alternative to reoperative surgery, currently approved for high-risk and inoperable patients. Challenges to the technique include higher rates of prosthesis–patient mismatch and coronary obstruction, compared to native valve TAVR. Herein, we review results of ViV TAVR and novel techniques to overcome the aforementioned challenges.
Collapse
Affiliation(s)
- J. James Edelman
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University School of Medicine, Washington, DC, USA
| | - Jaffar M. Khan
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Christian Shults
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University School of Medicine, Washington, DC, USA
| | - Lowell F. Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - I. Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Vinod H. Thourani
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University School of Medicine, Washington, DC, USA
| |
Collapse
|
16
|
Kilic A, Sultan I, Navid F, Aranda-Michel E, Chu D, Thoma F, Gleason TG. Trifecta Aortic Bioprosthesis: Midterm Results in 1,953 Patients From a Single Center. Ann Thorac Surg 2019; 107:1356-1362. [DOI: 10.1016/j.athoracsur.2018.10.063] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/04/2018] [Accepted: 10/22/2018] [Indexed: 11/30/2022]
|
17
|
Waziri F, Karunanithi Z, Løgstrup BB, Hjortdal V, Nielsen PH, Poulsen SH. Influence of Mitroflow bioprosthesis structural valve deterioration on cardiac morbidity. J Cardiothorac Surg 2019; 14:62. [PMID: 30885227 PMCID: PMC6423753 DOI: 10.1186/s13019-019-0875-1] [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: 07/30/2018] [Accepted: 03/04/2019] [Indexed: 11/23/2022] Open
Abstract
Background This study investigated the extent and nature of cardiac morbidity and cause of mortality in patients with Mitroflow structural valve deterioration (SVD). Methods A retrospective study was performed examining the medical records of patients who had received Mitroflow bioprosthesis between February 2001 and April 2014 and died during this period. A total of 211 patients were identified and included in the analyses. To determine the cause of mortality, cases were divided into three predefined groups: cardiovascular death due to SVD (group 1), cardiovascular death with no SVD (group 2) and non-cardiovascular death without SVD (group 3). Results Overall mortality in this study was 7.6% at 1 year, 46.4% at 5 years and 97.2% at 10 years. In group 1, 53 patients (25%) died; in group 2, 59 patients (28%) died; and in group 3, 99 patients (47%) died. Hospitalisation for congestive heart failure was observed in 49.1% in the SVD group vs. 10.2 and 13.1% in the two other groups, p < 0.001. Hospitalisation for endocarditis was also significantly higher in the SVD group (11.3%) than in the two other groups (6.8 and 0%), p < 0.05. Hospitalisation due to myocardial infarction, cerebral stroke, arrhythmia or other cardiac-related diseases was not significantly different between groups. Conclusion Structural valve deterioration in Mitroflow bioprosthesis was associated with a high prevalence of hospital admissions due to congestive heart failure and endocarditis. Patients with Mitroflow bioprosthesis should be systematically and routinely followed with echocardiography, and reoperation should be considered if SVD has developed.
Collapse
Affiliation(s)
- Farhad Waziri
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200, Aarhus N, Denmark. .,Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200, Aarhus N, Denmark. .,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 99, 8200, Aarhus N, Denmark.
| | - Zarmiga Karunanithi
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 99, 8200, Aarhus N, Denmark
| | - Brian Bridal Løgstrup
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 99, 8200, Aarhus N, Denmark
| | - Vibeke Hjortdal
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 99, 8200, Aarhus N, Denmark
| | - Per Hostrup Nielsen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 99, 8200, Aarhus N, Denmark
| | - Steen Hvitfeldt Poulsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 99, 8200, Aarhus N, Denmark
| |
Collapse
|
18
|
Michel E, Malaisrie SC. Not All Bioprosthetic Valves Are Created Equal. Semin Thorac Cardiovasc Surg 2019; 31:359-360. [PMID: 30735712 DOI: 10.1053/j.semtcvs.2019.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 02/01/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Eriberto Michel
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - S Christopher Malaisrie
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| |
Collapse
|
19
|
Aasbjerg K, Mortensen PE, Nørgaard MA, Rytgaard HC, Gerds TA, Søgaard P, Torp-Pedersen C, Mortensen RN, Bagge BJ, Køber L, Nielsen PH. Comparison of Survival After Aortic Valve Replacement With Mitroflow or Perimount Prostheses. Semin Thorac Cardiovasc Surg 2019; 31:350-358. [DOI: 10.1053/j.semtcvs.2018.11.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 11/30/2018] [Indexed: 11/11/2022]
|
20
|
Zannis K, Diplaris K, Monin JL, Khelil N, Debauchez M, Dervanian P, Lansac E, Czirom D, Noghin M, Mankoubi L, Amabile N. Mitroflow LXA structural deterioration following aortic valve replacement: a single-center experience. THE JOURNAL OF CARDIOVASCULAR SURGERY 2018; 59:746-752. [PMID: 29786406 DOI: 10.23736/s0021-9509.18.10204-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Concerns have been previously raised regarding the potential early degeneration of the Mitroflow (Sorin Group Italia, Saluggia, Vercelli, Italy) bioprostheses. We aimed to evaluate our clinical experience with the Mitroflow LXA prosthesis for aortic valve replacement. METHODS We prospectively analyzed data from 227 consecutive patients (133 males, mean age 73.9±9.2 years) implanted with the Mitroflow LXA between February 2007 and October 2011. Follow-up data were obtained by contacting the referring cardiologists. Kaplan-Meier curves were constructed for all-cause mortality, valve related mortality and structural valve degeneration (SVD). Multivariable analysis was conducted to identify SVD predictors. RESULTS Median follow-up time was 54.2±37.9 months and completeness of follow-up was 95%. Overall mortality in the entire series was at 31% (N.=71) and mortality from cardiac or unknown causes at 20% (N.=46). SVD occurred in 24 patients (10%) (median delay between implantation and diagnosis: 62.6 (36.5) months). Reintervention was required in 20 cases (13 redo surgery, 7 percutaneous transcatheter valve intervention). The 8 years actuarial global survival was 54.7±4.9%, freedom from valve related mortality 67.5±4.9% and freedom from SVD 72±8%. The estimated freedom from SVD was significantly (P=0.007) longer in larger prosthesis (diameter >21 mm, 77±11%) compared to the smaller devices (≤21 mm, 59±13%.). Multivariate analysis identified smaller prostheses and age at implantation as independent predictors of SVD. CONCLUSIONS The Mitroflow LXA showed evidence of early SVD in this cohort. A close follow-up of these patients is strongly advised.
Collapse
|
21
|
Ius F, Haverich A, Cebotari S. Reply to Hernández-Vaquero et al. Eur J Cardiothorac Surg 2018; 53:892-893. [PMID: 29161411 DOI: 10.1093/ejcts/ezx404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 10/28/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Fabio Ius
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Serghei Cebotari
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| |
Collapse
|
22
|
Rodriguez-Gabella T, Voisine P, Dagenais F, Mohammadi S, Perron J, Dumont E, Puri R, Asmarats L, Côté M, Bergeron S, Pibarot P, Rodés-Cabau J. Long-Term Outcomes Following Surgical Aortic Bioprosthesis Implantation. J Am Coll Cardiol 2018; 71:1401-1412. [DOI: 10.1016/j.jacc.2018.01.059] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 01/20/2018] [Accepted: 01/22/2018] [Indexed: 10/17/2022]
|
23
|
Hernández-Vaquero D, Díaz R, Pascual I, Silva J. Studying the degeneration of bioprostheses requires specific statistical analysis. Eur J Cardiothorac Surg 2017; 53:892. [DOI: 10.1093/ejcts/ezx405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 10/28/2017] [Indexed: 01/05/2023] Open
Affiliation(s)
| | - Rocío Díaz
- Department of Cardiac Surgery, Central University Hospital of Asturias, Oviedo, Spain
| | - Isaac Pascual
- Department of Cardiac Surgery, Central University Hospital of Asturias, Oviedo, Spain
| | - Jacobo Silva
- Department of Cardiac Surgery, Central University Hospital of Asturias, Oviedo, Spain
| |
Collapse
|