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Santarpino G, Vogt F, Mastroroberto P. Minimally invasive sutureless aortic valve replacement in the Redo setting: the new surgical frontier in the valve-in-valve era. Ann Cardiothorac Surg 2020; 9:325-327. [PMID: 32832415 DOI: 10.21037/acs.2019.11.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Giuseppe Santarpino
- Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany.,Department of Cardiac Surgery, Citta di Lecce Hospital, GVM Care & Research, Lecce, Italy.,Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - Ferdinand Vogt
- Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany
| | - Pasquale Mastroroberto
- Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
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Tsubota H, Sakaguchi G, Marui A. Incidence and influence of prosthesis-patient mismatch after reoperative aortic valve replacement: a retrospective single-center study. J Cardiothorac Surg 2020; 15:53. [PMID: 32228628 PMCID: PMC7104489 DOI: 10.1186/s13019-020-01094-2] [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: 11/13/2019] [Accepted: 03/23/2020] [Indexed: 11/10/2022] Open
Abstract
Background Reoperative aortic valve replacement (AVR) is associated with increased mortality compared with initial surgery, and a smaller valve might be implanted during repeat AVR (re-AVR; AVR after prior AVR). We describe the clinical outcomes and incidence of prosthesis-patient mismatches (PPM) after reoperative AVR. Methods Among 113 patients who underwent reoperative AVR between 2007 and 2018, 44 underwent re-AVR and 69 underwent a first replacement of a diseased natural valve after any cardiac surgery except AVR (primary AVR). We then compared early and late outcomes, the impact of re-AVR on the effective orifice areas (EOA), and the incidence and influence of PPM on reoperative AVR. Results Hospital mortality was 2.7%, and the overall 1-, 3-, and 5-year survival rates were 95, 91 and 86%, respectively. The reference EOA of the newly implanted valve was smaller than that of the previous valve (1.4 ± 0.3 vs. 1.6 ± 0.3 cm2, p < 0.01). The mean pressure gradient was greater (15.2 ± 6.4 vs. 12.7 ± 6.2 mmHg, p = 0.04) and indexed EOA was smaller (0.92 ± 0.26 vs. 1.06 ± 0.36 cm2/m2, p = 0.04) during re-AVR than primary AVR, whereas the incidence of PPM was similar (38.7% vs. 34.8%, p = 0.87) between the groups. Conclusions The clinical outcomes of reoperative AVR were acceptable. Although the reference EOA of new implanted valves was smaller than that of previous valves, re-AVR did not increase the incidence of PPM. These findings might serve as a guide for future decisions regarding the surgical approach to treating degenerated prosthetic valves.
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Affiliation(s)
- Hideki Tsubota
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Asano 3-2-1, Kokura Kita-ku, Kitakyushu, Fukuoka, 802-8555, Japan.
| | - Genichi Sakaguchi
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Asano 3-2-1, Kokura Kita-ku, Kitakyushu, Fukuoka, 802-8555, Japan
| | - Akira Marui
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Asano 3-2-1, Kokura Kita-ku, Kitakyushu, Fukuoka, 802-8555, Japan
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Santarpino G, Berretta P, Kappert U, Teoh K, Mignosa C, Meuris B, Villa E, Albertini A, Carrel TP, Misfeld M, Martinelli G, Phan K, Miceli A, Folliguet T, Shrestha M, Solinas M, Andreas M, Savini C, Yan T, Fischlein T, Di Eusanio M. Minimally Invasive Redo Aortic Valve Replacement: Results From a Multicentric Registry (SURD-IR). Ann Thorac Surg 2020; 110:553-557. [PMID: 31954690 DOI: 10.1016/j.athoracsur.2019.11.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 10/29/2019] [Accepted: 11/06/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Reoperation for aortic valve replacement can be challenging and is usually associated with an increased risk for complications and mortality. The study aim was to report the results of a multicenter cohort of patients who underwent minimally invasive reoperative aortic valve replacement with a sutureless or rapid-deployment prosthesis. METHODS From 2007 to 2018 data from 3651 patients were retrospectively collected from the Sutureless and Rapid-Deployment Aortic Valve Replacement International Registry. Of them, 63 patients who had previously undergone cardiac surgery represented the study population. In-hospital clinical and echocardiographic outcomes were recorded. RESULTS Mean age of the selected 63 patients was 75.3 ± 7.8 years and logistic EuroSCORE 10.1. Surgery was performed by ministernotomy in 43 patients (68.3%) and by anterior right thoracotomy in 20 (31.7%); 31 patients (49.2%) received the Perceval valve (Livanova PLC, London, UK) and 32 (50.8%) the Intuity valve (Edwards Lifesciences, Irvine, CA). Mean cross-clamp time was 57.8 ± 23.2 minutes and cardiopulmonary bypass time 95.0 ± 34.3 minutes. Neither conversion to full sternotomy nor in-hospital deaths occurred. Postoperative events were ischemic cerebral events in 3 patients (4.8%), need for pacemaker implantation in 2 (3.6%), bleeding requiring reoperation in 5 (8.9%), and dialysis in 1 (1.6%). Median intensive care unit stay was 1 day, and median length of hospital stay was 10 days. On echocardiographic evaluation 1 patient showed a significant postoperative aortic regurgitation. CONCLUSIONS Minimally invasive reoperative aortic valve replacement with a sutureless or rapid-deployment prosthesis is a safe and feasible treatment strategy, resulting in fast recovery and improved postoperative outcome with no mortality and an acceptable complication rate.
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Affiliation(s)
- Giuseppe Santarpino
- Città di Lecce Hospital, GVM Care & Research, Lecce, Italy; Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany; Cardiac Surgery Unit, Department of Experimental and Clinical Medicine-University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Paolo Berretta
- Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ospedali Riuniti, Ancona, Italy.
| | - Utz Kappert
- Department of Cardiac Surgery, University Heart Centre Dresden, Dresden, Germany
| | - Kevin Teoh
- Southlake Regional Health Centre, Ontario, Canada
| | - Carmelo Mignosa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
| | - Bart Meuris
- Gasthuisberg, Cardiale Heelkunde, Leuven, Belgium
| | | | - Alberto Albertini
- Cardiovascular Surgery Unit, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Thierry P Carrel
- Department of Cardiovascular Surgery, University of Bern, Bern, Switzerland
| | - Martin Misfeld
- University Clinic for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | | | | | - Antonio Miceli
- Istituto Clinico Sant'Ambrogio, Clinical & Research Hospitals, IRCCS Gruppo San Donato, Milan, Italy
| | | | | | - Marco Solinas
- Pasquinucci Heart Hospital, G. Monasterio Foundation, Massa, Italy
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Carlo Savini
- Cardiac Surgery Department, Sant'Orsola Malpighi Hospital, University of Bologna, Italy
| | - Tristan Yan
- The Collaborative Research (CORE) Group; Macquarie University, Sydney, Australia
| | - Theodor Fischlein
- Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany
| | - Marco Di Eusanio
- Cardiac Surgery Unit, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ospedali Riuniti, Ancona, Italy; The Collaborative Research (CORE) Group
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