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D'Onofrio A, Cibin G, Tessari C, Lorenzoni G, Luzi G, Manzan E, Gregori D, Gerosa G. Multicenter, propensity-weighted comparison of stented, rapid-deployment and new-generation aortic valves. INTERNATIONAL JOURNAL OF CARDIOLOGY. HEART & VASCULATURE 2024; 54:101487. [PMID: 39263409 PMCID: PMC11387204 DOI: 10.1016/j.ijcha.2024.101487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 08/05/2024] [Accepted: 08/08/2024] [Indexed: 09/13/2024]
Abstract
Background Conventional stented, rapid deployment and new-generation stented valves are now available for surgical aortic valve replacement (SAVR). New-generation devices feature advanced tissue treatment for theoretical prolonged durability and a new stent design able to expand in case of future transcatheter Valve-in-Valve. Aim of this retrospective, multicenter, propensity-weighted study was to compare early clinical and hemodynamic outcomes of these three different bioprostheses. Methods We analyzed data of 2589 patients from two national multicenter registries and one Institutional database. Study devices were Magna Ease, Intuity/Intuity Elite and Inspiris Resilia (Edwards Lifesciences, Irvine, CA, USA) and were implanted in 296 (11.4 %), 1688 (65.2 %) and 605 (23.4 %) patients, respectively. A propensity score weighting approach was employed. Results In isolated SAVR, aortic cross clamp (ACC) time was shorter for Intuity (Magna Ease: 87, Intuity: 55, Inspiris: 70 min; Magna Ease vs. Intuity: p < 0.001; Inspiris vs. Intuity: p < 0.001). Overall mortality was 2 %, 1.7 % and 0.5 % in Magna Ease, Intuity and Inspiris groups, respectively (Magna Ease vs. Intuity: p = 0.476; Inspiris vs. Intuity: p = 0.395); permanent pace-maker implantation rate was lower for Inspiris (Magna Ease: 6 %, Intuity: 6 %, Inspiris: 2 %; Magna Ease vs. Intuity: p = 0.679; Inspiris vs. Intuity: p < 0.001). Median mean gradients were 13, 10 and 10 mmHg for Magna Ease, Intuity and Inspiris, respectively (Magna Ease vs. Intuity: p < 0.001; Inspiris vs. Intuity: p = 0.13). Conclusions All study devices provide excellent early clinical and hemodynamic outcomes. Inspiris shows low rates of permanent pace-maker implantation and its transaortic gradients are similar to rapid-deployment valves and lower than Magna Ease.
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Affiliation(s)
- Augusto D'Onofrio
- Division of Cardiac Surgery, University of Padova, Padova, Italy
- Division of Cardiac Surgery, University of Rome "Tor Vergata", Policlinico Tor Vergata, Viale Oxford 81, 00133, Roma, Italy
| | - Giorgia Cibin
- Division of Cardiac Surgery, University of Padova, Padova, Italy
| | - Chiara Tessari
- Division of Cardiac Surgery, University of Padova, Padova, Italy
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Giampaolo Luzi
- Division of Cardiac Surgery, San Carlo Hospital, Potenza, Italy
| | - Erica Manzan
- Division of Cardiac Surgery, San Carlo Hospital, Potenza, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Gino Gerosa
- Division of Cardiac Surgery, University of Padova, Padova, Italy
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Salenger R, Ad N, Grant MC, Bakaeen F, Balkhy HH, Mick SL, Sardari Nia P, Kempfert J, Bonaros N, Bapat V, Wyler von Ballmoos MC, Gerdisch M, Johnston DR, Engelman DT. Maximizing Minimally Invasive Cardiac Surgery With Enhanced Recovery (ERAS). INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2024:15569845241264565. [PMID: 39205530 DOI: 10.1177/15569845241264565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
We convened a group of cardiac surgeons, intensivists, and anesthesiologists with extensive experience in minimally invasive cardiac surgery (MICS) and perioperative care to identify the essential elements of a MICS program and the relationship with Enhanced Recovery After Surgery (ERAS). The MICS incision should minimize tissue invasion without compromising surgical goals. MICS also requires safe management of hemodynamics and preservation of cardiac function, which we have termed myocardial management. Finally, comprehensive perioperative care through an ERAS program should be provided to allow patients to achieve optimal recovery. Therefore, we propose that MICS requires 3 elements: (1) a less invasive surgical incision (non-full sternotomy), (2) optimized myocardial management, and (3) ERAS. We contend that the full benefit of MICS can be achieved only by also utilizing an ERAS platform.
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Affiliation(s)
- Rawn Salenger
- Division of Cardiac Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Niv Ad
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael C Grant
- Departments of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Faisal Bakaeen
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, OH, USA
| | - Husam H Balkhy
- Section of Cardiac Surgery, University of Chicago Medicine, IL, USA
| | - Stephanie L Mick
- Department of Cardiothoracic Surgery, New York Presbyterian Weill Cornell Medicine, NY, USA
| | - Peyman Sardari Nia
- Department of Cardiothoracic Surgery, Heart and Vascular Centre Maastricht University Medical Centre, The Netherlands
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Germany
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University of Innsbruck, Austria
| | - Vinayak Bapat
- Department of Cardiothoracic Surgery, Abbott Northwestern Hospital Allina Health, Minneapolis, MN, USA
| | - Moritz C Wyler von Ballmoos
- Department of Cardiovascular and Thoracic Surgery, Texas Health Harris Methodist Hospital, Fort Worth, TX, USA
| | - Marc Gerdisch
- Department of Cardiothoracic Surgery, Franciscan Health Indianapolis, IN, USA
| | - Douglas R Johnston
- Division of Cardiac Surgery, Department of Surgery, Northwestern University School of Medicine, Chicago, IL, USA
| | - Daniel T Engelman
- Heart and Vascular Program, Baystate Health, University of Massachusetts Medical School - Baystate, Springfield, MA, USA
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Lacquaniti A, Ceresa F, Campo S, Smeriglio A, Trombetta D, Patanè F, Monardo P. Surgical Aortic Valve Replacement and Renal Dysfunction: From Acute Kidney Injury to Chronic Disease. J Clin Med 2024; 13:2933. [PMID: 38792474 PMCID: PMC11122348 DOI: 10.3390/jcm13102933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/07/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
Background: Surgical aortic valve replacement (SAVR) is often complicated by acute kidney injury (AKI). Identifying patients at risk of AKI is important to start nephroprotective strategies or renal replacement therapy (RRT). This study investigated the incidence and risk factors of post-operative AKI in SAVR patients. Chronic kidney disease (CKD) developed in the post-cardiac-surgery follow-up period was also assessed. Methods: A total of 462 SAVR patients were retrospectively enrolled. The primary endpoint was the occurrence rate of AKI after surgery. Kidney recovery, during two planned outpatient clinic nephrological visits within 12 months after the surgery, was assessed. Results: A total of 76 patients experienced an AKI event. A Kaplan-Meier analysis revealed that subjects with CKD stage IV had a time to progression of 2.7 days, compared to patients with stages I-II, who were characterized by the slowest progression time, >11.2 days. A Cox regression indicated that CKD stages predicted a higher risk of AKI independently of other variables. During their ICU stay, 23 patients died, representing 5% of the population, most of them requiring RRT during their ICU stay. A severe CKD before the surgery was closely related to perioperative mortality. During the follow-up period, 21 patients with AKI worsened their CKD stage. Conclusions: AKI represents a common complication for SAVR patients in the early post-operative period, prolonging their ICU stay, with negative effects on survival, especially if RRT was required. Pre-operative CKD >3 stage is an independent risk factor for AKI in patients undergoing SAVR.
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Affiliation(s)
- Antonio Lacquaniti
- Nephrology and Dialysis Unit, Department of Internal Medicine, Papardo Hospital, 98158 Messina, Italy
| | - Fabrizio Ceresa
- Cardiac Surgery Unit, Papardo Hospital, 98158 Messina, Italy
| | - Susanna Campo
- Nephrology and Dialysis Unit, Department of Internal Medicine, Papardo Hospital, 98158 Messina, Italy
| | - Antonella Smeriglio
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98122 Messina, Italy
| | - Domenico Trombetta
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98122 Messina, Italy
| | | | - Paolo Monardo
- Nephrology and Dialysis Unit, Department of Internal Medicine, Papardo Hospital, 98158 Messina, Italy
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Yanagino Y, Kawamoto N, Kainuma S, Tadokoro N, Kakuta T, Ikuta A, Tonai K, Fujita T, Fukushima S. Successful Implantation of Rapid Deployment Aortic Valve after TAVR Explantation. J Cardiothorac Surg 2024; 19:211. [PMID: 38616249 PMCID: PMC11017536 DOI: 10.1186/s13019-024-02728-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 03/29/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has become widely used in recent years, However, there is also an increasing need for removal of TAVR valves due to prosthetic valve dysfunction (PVD) and the development of infective endocarditis. Surgical aortic valve replacement (AVR) for these patients is risky due to the original patient background and anatomic conditions. Intuity rapid deployment aortic valve (Edwards Lifesciences, Irvine, CA) replacement would be useful for such high risk patients to prevent longer cardiac arrest time and obtain good hemodynamic results. However, there are few reports which present Intuity valve replacement after TAVR explantation. Herein, We report two cases in which we have achieved good hemodynamics with shorter cardiac arrest times by using a rapid deployment valve after TAVR explantation. CASE PRESENTATION We present 2 cases of successful implantation of the Intuity rapid deployment valve after TAVR explantation. The 84- and 88-year-old female patients had previously received TAVR for severe aortic stenosis with SAPIEN XT (Edwards Lifesciences, Irvine, CA) and developed PVD during follow-up. The TAVR valve was removed carefully, then an Intuity valve was implanted with cardiac arrest times of 69 and 41 min. Both patients had good echocardiographic results with effective orifice area of 2.0 cm2 and 1.2 cm2 and mean trans-aortic plessure gradient of 9 mmHg and 15 mmHg respectively without aortic regurgitation. They were discharged without major complications. CONCLUSIONS Surgical AVR using a rapid deployment valve is a useful alternative to sutured AVR after TAVR valve explantation. It allows for shorter cardiac arrest times and better postoperative hemodynamics without major complication.
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Affiliation(s)
- Yusuke Yanagino
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 kishibe- shimmachi, Suita, 564-8565, Osaka, Japan
| | - Naonori Kawamoto
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 kishibe- shimmachi, Suita, 564-8565, Osaka, Japan.
| | - Satoshi Kainuma
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 kishibe- shimmachi, Suita, 564-8565, Osaka, Japan
| | - Naoki Tadokoro
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 kishibe- shimmachi, Suita, 564-8565, Osaka, Japan
| | - Takashi Kakuta
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 kishibe- shimmachi, Suita, 564-8565, Osaka, Japan
| | - Ayumi Ikuta
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 kishibe- shimmachi, Suita, 564-8565, Osaka, Japan
| | - Kohei Tonai
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 kishibe- shimmachi, Suita, 564-8565, Osaka, Japan
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 kishibe- shimmachi, Suita, 564-8565, Osaka, Japan
| | - Satsuki Fukushima
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 kishibe- shimmachi, Suita, 564-8565, Osaka, Japan
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Xu M, Zhen Y, Zhang Z, Zheng X, Liu X, Liu J, Yang L, Ye Z, Wen J, Liu P. Risk factor and correlation between postoperative serum myoglobin and acute kidney injury after pulmonary endarterectomy. J Thorac Dis 2024; 16:1074-1086. [PMID: 38505040 PMCID: PMC10944744 DOI: 10.21037/jtd-23-1510] [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: 09/26/2023] [Accepted: 12/29/2023] [Indexed: 03/21/2024]
Abstract
Background Acute kidney injury (AKI) is a common and life-threatening complication following pulmonary endarterectomy (PEA). Our study aimed to investigate the risk factors associated with AKI and evaluate the correlation between serum myoglobin (sMb) levels and postoperative AKI. Methods We conducted a retrospective study involving 134 patients who underwent PEA at China-Japan Friendship Hospital. AKI was defined and staged according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Results During the study period, the incidence of postoperative AKI was 57.5%, and the associated mortality rate was 6.0%. Severe AKI was found to be significantly associated with worse short-term outcomes (P<0.05). Logarithmically transformed postoperative day (POD) 0 sMb levels were significantly associated with AKI [odds ratio (OR) =5.174; 95% confidence interval (CI), 2.307-11.603; P<0.001] and severe AKI (OR =4.605; 95% CI, 1.510-14.048; P=0.007), also had independent predictive value [area under the curve (AUC) =0.776 in AKI and AUC =0.737 in severe AKI]. The optimal cut-off values were 370.544 ng/mL for AKI and 419.473 ng/mL for severe AKI. Furthermore, albumin concentration was found to play a protective role in the development of severe AKI (OR =0.838; 95% CI, 0.716-0.980; P=0.027) when higher than 40.350 g/L. Conclusions Our findings suggest that a high concentration of POD0 sMb may increase the risk of developing AKI following PEA surgery. Increasing albumin concentration could serve as an effective preventive measure against AKI.
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Affiliation(s)
- Mingyuan Xu
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Yanan Zhen
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Zhaohua Zhang
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Xia Zheng
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Xiaopeng Liu
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Jingwen Liu
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Liang Yang
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
- China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhidong Ye
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Jianyan Wen
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Peng Liu
- Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
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Atroshchenko GV, Navarra E, Valdis M, Sandoval E, Hashemi N, Cerny S, Pereda D, Palmen M, Bjerrum F, Bruun NH, Tolsgaard MG. Simulation-based assessment of robotic cardiac surgery skills: An international multicenter, cross-specialty trial. JTCVS OPEN 2023; 16:619-627. [PMID: 38204726 PMCID: PMC10775167 DOI: 10.1016/j.xjon.2023.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/02/2023] [Accepted: 10/10/2023] [Indexed: 01/12/2024]
Abstract
Objective This study aimed to investigate the validity of simulation-based assessment of robotic-assisted cardiac surgery skills using a wet lab model, focusing on the use of a time-based score (TBS) and modified Global Evaluative Assessment of Robotic Skills (mGEARS) score. Methods We tested 3 wet lab tasks (atrial closure, mitral annular stitches, and internal thoracic artery [ITA] dissection) with both experienced robotic cardiac surgeons and novices from multiple European centers. The tasks were assessed using 2 tools: TBS and mGEARS score. Reliability, internal consistency, and the ability to discriminate between different levels of competence were evaluated. Results The results demonstrated a high internal consistency for all 3 tasks using mGEARS assessment tool. The mGEARS score and TBS could reliably discriminate between different levels of competence for the atrial closure and mitral stitches tasks but not for the ITA harvesting task. A generalizability study also revealed that it was feasible to assess competency of the atrial closure and mitral stitches tasks using mGEARS but not the ITA dissection task. Pass/fail scores were established for each task using both TBS and mGEARS assessment tools. Conclusions The study provides sufficient evidence for using TBS and mGEARS scores in evaluating robotic-assisted cardiac surgery skills in wet lab settings for intracardiac tasks. Combining both assessment tools enhances the evaluation of proficiency in robotic cardiac surgery, paving the way for standardized, evidence-based preclinical training and credentialing. Clinical trial registry number NCT05043064.
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Affiliation(s)
- Gennady V. Atroshchenko
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark
- ROCnord Robotic Centre Aalborg, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Emiliano Navarra
- Department of Cardiac Surgery, Ospedale Sant'Andrea, “Sapienza” University of Rome, Rome, Italy
| | - Matthew Valdis
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Center, London, Ontario, Canada
| | - Elena Sandoval
- Department of Cardiovascular Surgery, Hospital Clínic, Barcelona, Spain
| | - Nasseh Hashemi
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Nordsim, Aalborg University Hospital, Aalborg, Denmark
| | - Stepan Cerny
- Department of Cardiac Surgery, Na Homolce Hospital, Prague, Czech Republic
| | - Daniel Pereda
- Department of Cardiovascular Surgery, Hospital Clínic, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Meindert Palmen
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Flemming Bjerrum
- Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital–Herlev and Gentofte, Herlev, Denmark
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Denmark
| | - Niels Henrik Bruun
- Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Martin G. Tolsgaard
- Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Denmark
- Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Denmark
- Department of Medicine, University of Copenhagen, Denmark
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Non-Inferiority of Sutureless Aortic Valve Replacement in the TAVR Era: David versus Goliath. LIFE (BASEL, SWITZERLAND) 2022; 12:life12070979. [PMID: 35888069 PMCID: PMC9316623 DOI: 10.3390/life12070979] [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: 05/04/2022] [Revised: 06/20/2022] [Accepted: 06/27/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The rapid development of transcatheter treatment methods has made transcatheter aortic valve replacement (TAVR) a feasible alternative to conventional surgical aortic valve replacement (SAVR). Recently, indications for TAVR have been expanded to intermediate- and low-risk patients, although there still remains a portion of ineligible patients. We sought to evaluate and compare our experience with sutureless SAVR and transapical TAVR in the "grey-area" of patients unsuitable for transfemoral access. METHODS Between April 2018 and June 2021, 248 consecutive patients underwent a sutureless SAVR (SU-SAVR) or TA-TAVR at our institution. We performed a pair-matched analysis and identified 56 patient pairs based on the EuroSCORE II. All transcatheter procedures were performed using SAPIEN XT/3™ prostheses, while all surgical procedures deployed the Perceval (LivaNova) aortic valve. RESULTS All patients presented with multiple comorbidities as reflected by the median EuroSCORE-II of 3.1% (IQR 1.9-5.3). Thirty-four patients from the surgical group (60.7%) underwent a concomitant myocardial revascularization. There was no significant difference in major adverse events, pacemaker implantation or postoperative mortality during follow-up. Both interventions demonstrated technical success with similar mean postoperative pressure gradients at follow-up and no cases of paravalvular leakage. CONCLUSIONS Sutureless aortic valve replacement constitutes a feasible treatment alternative for patients with aortic valve disease who are ineligible for transfemoral access route and/or require concomitant coronary revascularization. With its excellent hemodynamic performance, similar survival compared to TA-TAVR, and high cost-efficiency without compromising the postoperative outcomes and in-hospital length of stay SU-AVR might be considered for patients in the "grey-area" between TAVR and SAVR.
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Wang X, Guo N, Chen Y, Dai H. A new model to predict acute kidney injury after cardiac surgery in patients with renal insufficiency. Ren Fail 2022; 44:767-776. [PMID: 35505569 PMCID: PMC9090423 DOI: 10.1080/0886022x.2022.2071297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objective To establish a simple model for predicting postoperative acute kidney injury (AKI) requiring renal replacement therapy (RRT) in patients with renal insufficiency (CKD stages 3–4) who underwent cardiac surgery. Methods A total of 330 patients were enrolled. Among them, 226 were randomly selected for the development group and the remaining 104 for the validation group. The primary outcome was AKI requiring RRT. A nomogram was constructed based on the multivariate analysis with variables selected by the application of the least absolute shrinkage and selection operator. Meanwhile, the discrimination, calibration, and clinical power of the new model were assessed and compared with those of the Cleveland Clinic score and Simplified Renal Index (SRI) score in the validation group. Results: The rate of RRT in the development group was 10.6% (n = 24), while the rate in the validation group was 14.4% (n = 15). The new model included four variables such as postoperative creatinine, aortic cross‐clamping time, emergency, and preoperative cystatin C, with a C-index of 0.851 (95% CI, 0.779–0.924). In the validation group, the areas under the receiver operating characteristic curves for the new model, SRI score, and Cleveland Clinic score were 0.813, 0.791, and 0.786, respectively. Furthermore, the new model demonstrated greater clinical net benefits compared with the Cleveland Clinic score or SRI score. Conclusions We developed and validated a powerful predictive model for predicting severe AKI after cardiac surgery in patients with renal insufficiency, which would be helpful to assess the risk for severe AKI requiring RRT.
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Affiliation(s)
- Xijian Wang
- Department of Nephrology, Affiliated Hospital of Nantong University, Nantong Jiangsu, China
| | - Naifeng Guo
- Department of Nephrology, Affiliated Hospital of Nantong University, Nantong Jiangsu, China
| | - Ying Chen
- Department of Epidemiology and Medical Statistics, Nantong University School of Public Health, Nantong Jiangsu, China
| | - Houyong Dai
- Department of Nephrology, Affiliated Hospital of Nantong University, Nantong Jiangsu, China
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What Can We Learn from the Past by Means of Very Long-Term Follow-Up after Aortic Valve Replacement? J Clin Med 2021; 10:jcm10173925. [PMID: 34501375 PMCID: PMC8432120 DOI: 10.3390/jcm10173925] [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: 07/28/2021] [Revised: 08/23/2021] [Accepted: 08/29/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Studies on very long-term outcomes after aortic valve replacement are sparse. Methods: In this retrospective cohort study, long-term outcomes during 25.1 ± 2.8 years of follow-up were determined in 673 patients who underwent aortic valve replacement with or without concomitant coronary artery bypass surgery for severe aortic stenosis and/or regurgitation. Independent predictors of decreased long-term survival were determined. Cumulative incidence rates of major adverse events in patients with a mechanical versus those with a biologic prosthesis were assessed, as well as of major bleeding events in patients with a mechanical prosthesis under the age of 60 versus those above the age of 60. Results: Impaired left ventricular function, severe prosthesis–patient mismatch, and increased aortic cross-clamp time were independent predictors of decreased long-term survival. Left ventricular hypertrophy, a mechanical or biologic prosthesis, increased cardiopulmonary bypass time, new-onset postoperative atrial fibrillation, and the presence of symptoms did not independently predict decreased long-term survival. The risk of major bleeding events was higher in patients with a mechanical in comparison with those with a biologic prosthesis. Younger age (under 60 years) did not protect patients with a mechanical prosthesis against major bleeding events. Conclusions: Very long-term outcome data are invaluable for careful decision-making on aortic valve replacement.
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