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Öner A, Hemmer C, Alozie A, Löser B, Dohmen PM. Introduction of the Rapid Deployment Aortic Valve System Use in Elderly Patients With Endocarditis. Front Cardiovasc Med 2022; 9:774189. [PMID: 35391848 PMCID: PMC8980357 DOI: 10.3389/fcvm.2022.774189] [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: 09/11/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction The rapid-deployment valve system (RDVS) was introduced to facility minimally invasive aortic valve replacement. In this study we evaluate the potential benefits of RDVS in elderly high-risk patients with endocarditis of the aortic valve. Materials and Methods Since the introduction of RDVS in our institution in December 2017 through October 2021, EDWARDS INTUITY rapid-deployment prosthesis (Model 8300A, Edwards Lifesciences, Irvine, CA, USA) has been implanted in a total of 115 patients for different indications by a single surgeon. Out of one-hundred and fifteen cases of RDVS implantation, seven patients with a median age of 77 yrs. (range 62-84yrs.), suffered from active infective endocarditis of the aortic valve. The median EuroSCORE II of these highly selected patient cohort was 77% (range 19-80%). Patient data were evaluated perioperatively including intra-operative data as well as in-hospital morbidity/mortality and follow-up after discharge from hospital. Results Three patients underwent previous cardiac surgery. Concomitant procedures were performed in six patients including, ascending aorta replacement (n = 3), mitral valve repair (n = 1), pulmonary valve replacement (n = 1), bypass surgery (n = 1), left atrial appendix resection (n = 1) and anterior mitral valve repair (n = 1). Median aortic cross-clamp and cardiopulmonary bypass time was 56 min (range 29-122 min) and 81 min (range 45-162 min.), respectively. Post-operative complications in these elderly high-risk patients were atrial fibrillation (n = 3) and re-exploration for pericardial effusion (n = 1). One pacemaker implantation was required on postoperative day 6 due to sick sinus syndrome. There was one in-hospital death (14%) and one during follow-up (14%). Conclusion Rapid-deployment aortic valve system seems to be a viable option with acceptable morbidity and mortality in elderly high-risk patients with active infective endocarditis of the aortic valve.
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Affiliation(s)
- Alper Öner
- Department of Cardiology, Heart Center Rostock, University of Rostock, Rostock, Germany
| | - Christoph Hemmer
- Department of Tropical Medicine and Infectious Diseases, University of Rostock, Rostock, Germany
| | - Anthony Alozie
- Department of Cardiac Surgery, Heart Center Rostock, University of Rostock, Rostock, Germany
| | - Benjamin Löser
- Department of Anesthesiology and Intensive Care Medicine, University of Rostock, Rostock, Germany
| | - Pascal M. Dohmen
- Department of Cardiac Surgery, Heart Center Rostock, University of Rostock, Rostock, Germany
- Department of Cardiothoracic Surgery, Faculty of Health Science, University of the Free State, Bloemfontein, South Africa
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Reemplazo valvular aórtico con bioprótesis sin sutura Perceval S: experiencia de un solo centro. CIRUGIA CARDIOVASCULAR 2019. [DOI: 10.1016/j.circv.2019.01.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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4
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Prótesis sin sutura Perceval S en la cirugía valvular aórtica de alto riesgo. Una herramienta fundamental para el cirujano. CIRUGIA CARDIOVASCULAR 2017. [DOI: 10.1016/j.circv.2017.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Weymann A, Konertz J, Laule M, Stangl K, Dohmen PM. Are Sutureless Aortic Valves Suitable for Severe High-Risk Patients Suffering from Active Infective Aortic Valve Endocarditis? Med Sci Monit 2017; 23:2782-2787. [PMID: 28592789 PMCID: PMC5472401 DOI: 10.12659/msm.902785] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Sutureless aortic valves were introduced to facilitate minimally invasive aortic valve surgery. Since sutureless aortic valves are a feasible procedure, we evaluated if any benefits could be identified in severe high-risk patients with active infective endocarditis of the aortic valve. Material/Methods Between April 2014 and April 2015, a total of 42 patients received a sutureless Perceval® aortic valve (Sorin Biomedica Cardio Srl, Saluggia, Italy) for different indications. Nine of these patients (median age 71 years, range 47–83 years) suffered from active infective endocarditis, including four patients with prosthetic aortic valve endocarditis. Five patients underwent prior cardiac surgery, including transcatheter aortic valve implantation (TAVI). The median EuroSCORE II was 29.5% (range 16.8–87.7%). Post-operatively, data regarding mortality, operative results, and early operative morbidity were collected. Results There were no cases of 30-day mortality. Four patients needed abscess closure with pericardium. Three patients underwent left atrial appendix closure: one left ventricular thrombectomy, one bypass grafting, and one arch replacement. Median aortic cross-clamp and cardiopulmonary bypass time was 35 minutes (range 26–88 minutes) and 52 minutes (range 40–133 minutes), respectively. The median intubation time was 14 hours (range 1–9 hours). In these high-risk patients, no postoperative morbidity was found except for one re-intubation due to extensive delirium and one re-exploration. No pacemaker implantation was needed. Echocardiographic evaluation showed no central or para-valvular regurgitation, and a median discharge mean gradient of 5.5 mm Hg (range 2.5–10.0 mm Hg). Conclusions Sutureless aortic valve replacement in very high-risk patients suffering from active infection endocarditis seems to be an option with limited morbidity and appropriate echocardiographic results, however, further studies are needed.
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Affiliation(s)
- Alexander Weymann
- Department of Cardiac Surgery, University Hospital Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Johanna Konertz
- Department of Cardiac Surgery, University Hospital Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Michael Laule
- Department of Cardiology and Angiology, Charite Hospital, Medical University Berlin, Berlin, Germany
| | - Karl Stangl
- Department of Cardiology and Angiology, Charite Hospital, Medical University Berlin, Berlin, Germany
| | - Pascal M Dohmen
- Department of Cardiac Surgery, University Hospital Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.,Department of Cardiothoracic Surgery, Faculty of Health Science, Free State University, Bloemfontein, South Africa
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Stamp N, Granger E, Larbalestier R. Modern cardiac surgery: the future of cardiac surgery in Australia. ANZ J Surg 2017; 87:661-664. [DOI: 10.1111/ans.14031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 03/12/2017] [Indexed: 01/05/2023]
Affiliation(s)
- Nikki Stamp
- Cardiothoracic Surgery; Fiona Stanley Hospital; Perth Western Australia Australia
| | - Emily Granger
- Cardiothoracic Surgery; St Vincent's Hospital; Sydney New South Wales Australia
| | - Robert Larbalestier
- Cardiothoracic Surgery; Fiona Stanley Hospital; Perth Western Australia Australia
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First-in-Man Transcervical Surgical Aortic Valve Replacement Using the CoreVista System. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 11:84-93. [PMID: 26889881 DOI: 10.1097/imi.0000000000000228] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to evaluate a novel device system for surgical aortic valve replacement (SAVR) using a unique new less invasive access approach. The hypothesis is that SAVR can be performed through a short transverse incision in the neck, similar to that used for transcervical thymectomy avoiding chest disruption. METHODS A new device system was developed to provide retraction, step-by-step illumination, and on-screen visualization for the new approach. Preliminary feasibility studies were performed in cadavers. Comprehensive risk analysis was performed, and training was implemented in Thiel preserved cadavers. For the first-in-man clinical case, a 63-year-old woman with symptomatic critical aortic stenosis (The Society of Thoracic Surgeons risk, 11%) and heavily calcified aortic valve was selected. A short transverse incision was made in the neck; the device was introduced, and the sternum was elevated; femorofemoral cardiopulmonary bypass was established; substernal dissection was guided by the sequenced illumination, and high-definition visualization was provided by the device, allowing for optimal exposition of the aorta and aortic valve; and a 23-mm Medtronic ENABLE sutureless valve prosthesis was implanted. Procedure success was evaluated according to the standardized composite end point definition of "device success" proposed by the Valve Academic Research Consortium. RESULTS Access, delivery, and deployment of the valve prosthesis were successful. The correct position and intended performance of the valve were demonstrated (mean gradient, 6 mm Hg; aortic valve area, 2.5 cm) with the absence of moderate or severe prosthetic aortic regurgitation. Only one valve prosthesis was used. CONCLUSIONS Transcervical SAVR with sutureless valve is feasible using this novel access system. The new approach has potential to offer patients substantially shorter stay and fewer, less serious complications, as has been observed in transcervical thymectomy. Further studies are merited.
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Marzouk M, Shanmugam G, Kalavrouziotis D, Mohammadi S. Ascending Aortic Replacement and Sutureless Valve in a Failed Stentless Aortic Prosthesis: A Bailout Option. Ann Thorac Surg 2017; 102:e507-e509. [PMID: 27847067 DOI: 10.1016/j.athoracsur.2016.05.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 03/08/2016] [Accepted: 05/03/2016] [Indexed: 11/19/2022]
Abstract
Aortic valve replacement with a Perceval sutureless bioprosthesis is a viable rescue option for a failed aortic stentless prosthesis. However, a dilated sinotubular junction and ascending aorta are reported as a contraindication for this technique. We describe an aortic sutureless valve implantation in a patient with a dilated ascending aorta and small aortic root after Dacron graft replacement of the ascending aorta in a failed aortic stentless bioprosthesis.
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Affiliation(s)
- Mohamed Marzouk
- Division of Cardiac Surgery, Quebec Heart and Lung University Institute, Laval University, Quebec City, Quebec, Canada
| | - Ganesh Shanmugam
- Division of Cardiac Surgery, Quebec Heart and Lung University Institute, Laval University, Quebec City, Quebec, Canada
| | - Dimitri Kalavrouziotis
- Division of Cardiac Surgery, Quebec Heart and Lung University Institute, Laval University, Quebec City, Quebec, Canada
| | - Siamak Mohammadi
- Division of Cardiac Surgery, Quebec Heart and Lung University Institute, Laval University, Quebec City, Quebec, Canada.
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Minimally Invasive Versus Conventional Aortic Valve Replacement: A Propensity-Matched Study From the UK National Data. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 11:15-23; discussion 23. [PMID: 26926521 PMCID: PMC4791314 DOI: 10.1097/imi.0000000000000236] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Minimally invasive aortic valve replacement (MIAVR) has been demonstrated as a safe and effective option but remains underused. We aimed to evaluate outcomes of isolated MIAVR compared with conventional aortic valve replacement (CAVR).
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Vola M, Guichard JB, Campisi S, Fuzellier JF, Gerbay A, Doguet F, Isaaz K, Azarnoush K, Anselmi A, Ruggieri VG. Sutureless aortic bioprosthesis valve implantation and bicuspid valve anatomy: an unsolved dilemma? Heart Vessels 2016; 31:1783-1789. [PMID: 26758734 DOI: 10.1007/s00380-015-0790-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 12/25/2015] [Indexed: 11/24/2022]
Abstract
Interest is growing in the clinical use of sutureless (SU) valves. However, indications in some anatomical sub-settings, like bicuspid aortic valves (BAV), have been so far limited. We discuss herein our initial experience with the implantation of the 3f Enable SU bioprosthesis in patients with a BAV. Patients with a BAV were selected in our unit between March 2011 and September 2014 for a SU 3f Enable valve implantation. Twenty of the 198 patients who underwent a 3f Enable valve implantation in our unit had a BAV. Procedural success was 100 %, but reclamping was necessary in one (5 %) case. Median size of implanted bioprosthesis was 23 mm. After a mean follow-up of 13.8 ± 10.7 months, survival was 100 %. Two patients (10 %) showed an immediate grade 1 paravalvular leak (PVL) that progressed to grade 2 and 3+ (moderate/severe), respectively, during follow-up. Type of bicuspidy (Sievers classification) in these two patients was 0 and intraoperatively aortic annuli admitted the 25 mm calibrator. Among the 18 patients without PVL, no one had a type 0 large BAV. At 1 year, implantation of the 3f Enable SU bioprosthesis appears to be safe in patients with BAV type I and II, while in type 0 use of the SU valve seems to be safe only if the annular diameter is <25 mm. Larger studies are necessary to confirm our findings in order to clarify the indications for SU technology in the subset of bicuspid patients.
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Affiliation(s)
- Marco Vola
- Cardiac Surgery Unit, Cardiovascular Department, University Hospital, St. Etienne, France. .,Service de Chirurgie Cardiovasculaire, Pôle Cardiovasculaire, Hôpital Nord, Centre Hospitalier Universitaire de Saint-Etienne, 42055, Saint-Etienne Cedex, France.
| | | | - Salvatore Campisi
- Cardiac Surgery Unit, Cardiovascular Department, University Hospital, St. Etienne, France
| | | | - Antoine Gerbay
- Cardiology Unit, Cardiovascular Department, University Hospital, St. Etienne, France
| | - Fabien Doguet
- Cardiac Surgery Unit, Cardiovascular Department, University Hospital, St. Etienne, France
| | - Karl Isaaz
- Cardiology Unit, Cardiovascular Department, University Hospital, St. Etienne, France
| | - Kasra Azarnoush
- Cardiac Surgery Unit, Cardiovascular Department, University Hospital, St. Etienne, France
| | - Amedeo Anselmi
- Cardiac Surgery Unit, Cardiovascular Department, University Hospital, St. Etienne, France
| | - Vito Giovani Ruggieri
- Cardiac Surgery Unit, Cardiovascular Department, University Hospital, St. Etienne, France
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11
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Bouhout I, Noly PE, Parisi A, Bouchard D. First case of Perceval S prosthesis early structural valve deterioration: Not an easy reoperation. J Thorac Cardiovasc Surg 2016; 152:e71-3. [DOI: 10.1016/j.jtcvs.2016.05.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 03/31/2016] [Accepted: 05/04/2016] [Indexed: 11/28/2022]
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Ramakrishna H, Patel PA, Gutsche JT, Vallabhajosyula P, Szeto WY, MacKay E, Feinman JW, Shah R, Zhou E, Weiss SJ, Augoustides JG. Surgical Aortic Valve Replacement-Clinical Update on Recent Advances in the Contemporary Era. J Cardiothorac Vasc Anesth 2016; 30:1733-1741. [PMID: 27542900 DOI: 10.1053/j.jvca.2016.04.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic, Phoenix, AZ
| | | | | | - Prashanth Vallabhajosyula
- Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Wilson Y Szeto
- Division of Cardiovascular Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | | | - Ronak Shah
- Department of Anesthesiology and Critical Care
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Borger MA, Dohmen PM, Knosalla C, Hammerschmidt R, Merk DR, Richter M, Doenst T, Conradi L, Treede H, Moustafine V, Holzhey DM, Duhay F, Strauch J. Haemodynamic benefits of rapid deployment aortic valve replacement via a minimally invasive approach: 1-year results of a prospective multicentre randomized controlled trial. Eur J Cardiothorac Surg 2016; 50:713-720. [DOI: 10.1093/ejcts/ezw042] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 01/26/2016] [Accepted: 02/03/2016] [Indexed: 01/22/2023] Open
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Dapunt OE, Luha O, Ebner A, Sonecki P, Spadaccio C, Sutherland FWH. First-in-Man Transcervical Surgical Aortic Valve Replacement Using the CoreVista System. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016. [DOI: 10.1177/155698451601100202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Olev Luha
- Medical University of Graz, Graz, Austria
| | - Adrian Ebner
- Universidad Nacional de Asuncion Medicina, Paraguay, San Lorenzo, Paraguay
| | - Piotr Sonecki
- Golden Jubilee National Hospital, Glasgow, United Kingdom
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Attia RQ, Hickey GL, Grant SW, Bridgewater B, Roxburgh JC, Kumar P, Ridley P, Bhabra M, Millner RWJ, Athanasiou T, Casula R, Chukwuemka A, Pillay T, Young CP. Minimally Invasive versus Conventional Aortic Valve Replacement: A Propensity-Matched Study from the UK National Data. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016. [DOI: 10.1177/155698451601100104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Rizwan Q. Attia
- Department of Cardiothoracic Surgery, Guy's and St Thomas’ Hospital, London, UK
| | - Graeme L. Hickey
- Centre for Health Informatics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- National Institute for Cardiovascular Outcomes Research, Institute of Cardiovascular Science, University College London, London, UK
| | - Stuart W. Grant
- Centre for Health Informatics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Department of Cardiothoracic Surgery, Manchester Academic Health Science Centre, University Hospital of South Manchester, Wythenshawe, UK
| | - Ben Bridgewater
- Centre for Health Informatics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- National Institute for Cardiovascular Outcomes Research, Institute of Cardiovascular Science, University College London, London, UK
- Department of Cardiothoracic Surgery, Manchester Academic Health Science Centre, University Hospital of South Manchester, Wythenshawe, UK
| | - James C. Roxburgh
- Department of Cardiothoracic Surgery, Guy's and St Thomas’ Hospital, London, UK
| | - Pankaj Kumar
- Department of Cardiothoracic Surgery, Morriston Hospital, Morriston, Swansea, UK
| | - Paul Ridley
- Department of Cardiothoracic Surgery North Staffordshire Royal Infirmary, University Hospital of North Staffordshire NHS Trust, Stoke-on-Trent, UK
| | - Moninder Bhabra
- Department of Cardiothoracic Surgery, Heart and Lung Centre, New Cross Hospital, Wolverhampton, UK
| | - Russell W. J. Millner
- Department of Cardiothoracic Surgery, Lancashire Cardiac Centre, Victoria Hospital NHS Trust, Blackpool, UK
| | - Thanos Athanasiou
- Department of Cardiothoracic Surgery, Hammersmith Hospital, London, UK
| | - Roberto Casula
- Department of Cardiothoracic Surgery, Hammersmith Hospital, London, UK
| | - Andrew Chukwuemka
- Department of Cardiothoracic Surgery, Hammersmith Hospital, London, UK
| | - Thasee Pillay
- Department of Cardiothoracic Surgery, The Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK
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Gersak B, Fischlein T, Folliguet TA, Meuris B, Teoh KH, Moten SC, Solinas M, Miceli A, Oberwalder PJ, Rambaldini M, Bhatnagar G, Borger MA, Bouchard D, Bouchot O, Clark SC, Dapunt OE, Ferrarini M, Laufer G, Mignosa C, Millner R, Noirhomme P, Pfeiffer S, Ruyra-Baliarda X, Shrestha M, Suri RM, Troise G, Diegeler A, Laborde F, Laskar M, Najm HK, Glauber M. Sutureless, rapid deployment valves and stented bioprosthesis in aortic valve replacement: recommendations of an International Expert Consensus Panel. Eur J Cardiothorac Surg 2015; 49:709-18. [DOI: 10.1093/ejcts/ezv369] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 09/22/2015] [Indexed: 01/28/2023] Open
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Abstract
With the advent of transcatheter aortic valve replacement and the emergence of rapid deployment aortic valves, there is a resurgent interest in minimizing the trauma of surgical aortic valve replacement (AVR). The present review summarizes the history of minimal access AVR and attempts to collate the existing evidence regarding minimal access AVR.
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Affiliation(s)
- Rawn Salenger
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - James S Gammie
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Julia A Collins
- Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, MD
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Abstract
For the year 2014, more than 17,000 published references can be found in Pubmed when entering the search term "cardiac surgery". The last year has been characterized by a vivid discussion in the fields where classic cardiac surgery and modern interventional techniques overlap. Specifically, there have been important contributions in the field of coronary revascularization with either percutaneous coronary intervention or bypass surgery as well as in the fields of interventional valve therapy. Here, the US core valve trial with the first demonstration of a survival advantage at 1 year with transcatheter valves compared to surgical aortic valve replacement or the 5-year outcome of the SYNTAX trial with significant advantages for bypass surgery has been the landmark. However, in addition to these most visible publications, there have been several highly relevant and interesting contributions. This review article will summarize the most pertinent publications in the fields of coronary revascularization, surgical treatment of valve disease, heart failure (i.e., transplantation and ventricular assist devices) and aortic surgery. This condensed summary will provide the reader with "solid ground" for up-to-date decision-making in cardiac surgery.
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Emergency Transcatheter Aortic Valve Implantation for Acute and Early Failure of Sutureless Perceval Aortic Valve. Can J Cardiol 2015; 31:1204.e13-5. [DOI: 10.1016/j.cjca.2015.02.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 02/03/2015] [Accepted: 02/08/2015] [Indexed: 11/19/2022] Open
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Chandola R, Teoh K, Elhenawy A, Christakis G. Perceval Sutureless Valve - are Sutureless Valves Here? Curr Cardiol Rev 2015; 11:220-8. [PMID: 25394851 PMCID: PMC4558353 DOI: 10.2174/1573403x11666141113155744] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Revised: 10/28/2014] [Accepted: 11/03/2014] [Indexed: 12/03/2022] Open
Abstract
With the advent of transcatheter aortic valve implantation (TAVI) techniques, a renewed interest has developed in sutureless aortic valve concepts in the last decade. The main feature of sutureless aortic valve implantation is the speed of insertion, thus making implantation easier for the surgeon. As a result, cross clamp times and myocardial ischemia may be reduced. The combined procedures (CABG with AVR in particular) can be done with a short cross clamp time. Perceval valve also provides an increased effective orifice area as compared with a stented bioprosthesis. Sutureless implantation of the Perceval valve is not only associated with shorter cross-clamp and cardiopulmonary bypass times but improved clinical outcomes too. This review covers the sutureless aortic valves and their evolution, with elaborate details on Perceval S valve in particular (which is the most widely used sutureless valve around the globe).
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Affiliation(s)
- Rahul Chandola
- Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room H4 06, Toronto, ON, M4N 3M5, Canada.
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Miceli A, Gilmanov D, Murzi M, Marchi F, Ferrarini M, Cerillo AG, Quaini E, Solinas M, Berti S, Glauber M. Minimally invasive aortic valve replacement with a sutureless valve through a right anterior mini-thoracotomy versus transcatheter aortic valve implantation in high-risk patients. Eur J Cardiothorac Surg 2015; 49:960-5. [DOI: 10.1093/ejcts/ezv210] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 04/24/2015] [Indexed: 11/13/2022] Open
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Grossi EA, Moore M, Mallow PJ, Rizzo JA. The Cost of an Operating Room Minute for Heart Valve Procedures. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2015; 2:170-180. [PMID: 34430664 PMCID: PMC8341883 DOI: 10.36469/9898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Background: Heart valve disease is very common, with approximately 5 million people diagnosed with this disease annually in the United States. There has been substantial innovation in the technologies and techniques of surgical repair and replacement over the past decade. However, there is little information that allows the potential time savings associated with these technologies and techniques to be quantified from the hospital perspective. Objectives: The study objective was to estimate the variable cost per operating room (OR) minute in valvular procedures - aortic valve replacement (AVR), mitral valve replacement (MVR) and mitral valve repair (MVRepair) - and determine if there is a difference in OR cost per minute between traditional sternal versus less invasive right thoracotomy surgical techniques. Methods: The Premier database was queried from 2007 to 2011 for patients undergoing AVR, MVR, or MVRepair. Patients were identified using the International Classification of Diseases, 9th Revision (ICD-9) procedure codes. Propensity score matching created cohorts adjusted for patient differences and surgical approach -any sternal incision (Sternal) or right thoracotomy (RT). Regression analysis was performed to estimate the OR cost per minute based on heart valve procedure. Results: There were 2,656 heart valve procedures - 1,604 AVR, 434 MVR and 618 MVRepair - that met the inclusion criteria. The mean OR cost per minute for AVR procedures was $26.49 and $25.16 (p <0.01) for Sternal and RT, respectively. MVR procedures by surgical approach had a mean OR cost per minute of $25.66 and $25.00 and (p NS) for Sternal and RT, respectively. MVRepair procedures by surgical approach had a mean OR cost per minute of $25.17 and $24.40 and (p NS) for Sternal and RT, respectively. The overall estimate of the OR cost per minute for valvular procedures was $25.99. Conclusions: Quantifying the variable cost of an OR minute from a multi-institution database provides researchers with an important benchmark to use in economic evaluations of valvular procedures.
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Affiliation(s)
| | - Matthew Moore
- Global Health Economic Strategy, Edwards Lifesciences Inc., Irvine, CA USA
| | - Peter J Mallow
- CTI Clinical Trial and Consulting Services, Cincinnati, OH USA
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A Randomized Multicenter Trial of Minimally Invasive Rapid Deployment Versus Conventional Full Sternotomy Aortic Valve Replacement. Ann Thorac Surg 2015; 99:17-25. [DOI: 10.1016/j.athoracsur.2014.09.022] [Citation(s) in RCA: 153] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 09/07/2014] [Accepted: 09/09/2014] [Indexed: 11/18/2022]
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Englberger L, Carrel TP, Doss M, Sadowski J, Bartus K, Eckstein FF, Asch FM, Martens S. Clinical performance of a sutureless aortic bioprosthesis: Five-year results of the 3f Enable long-term follow-up study. J Thorac Cardiovasc Surg 2014; 148:1681-7. [DOI: 10.1016/j.jtcvs.2014.03.054] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 03/24/2014] [Accepted: 03/28/2014] [Indexed: 10/25/2022]
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Chalmers J, Pullan M, Mediratta N, Poullis M. A need for speed? Bypass time and outcomes after isolated aortic valve replacement surgery. Interact Cardiovasc Thorac Surg 2014; 19:21-6. [DOI: 10.1093/icvts/ivu102] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kumar R, Latib A, Colombo A, Ruiz CE. Self-expanding prostheses for transcatheter aortic valve replacement. Prog Cardiovasc Dis 2014; 56:596-609. [PMID: 24838135 DOI: 10.1016/j.pcad.2014.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) has emerged as an alternative to surgical aortic valve replacement in patients who are considered high surgical risk or inoperable due to advanced age and comorbidities. Randomized trial and registry data have demonstrated the safety and efficacy of TAVR in such patients. Currently available transcatheter heart valves (THVs) employ either balloon-expandable or self-expanding designs, and several new designs have shown promising early results. Differences in valve design may offer specific advantages for accurate deployment and minimizing complications. This article reviews several designs of self-expanding THVs that are currently available or have undergone successful implantation in humans. Additional studies are required to compare the relative performance of these devices.
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Affiliation(s)
- Robert Kumar
- Division of Cardiology, Sharp Rees-Stealy Medical Group, San Diego, CA
| | - Azeem Latib
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Carlos E Ruiz
- Department of Structural and Congenital Heart Disease, Lenox Hill Heart and Vascular Institute, North Shore/LIJ Health System, New York, NY.
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Ramakrishna H, Kohl BA, Jassar AS, Augoustides JGT. Incidental moderate mitral regurgitation in patients undergoing aortic valve replacement for aortic stenosis: review of guidelines and current evidence. J Cardiothorac Vasc Anesth 2014; 28:417-22. [PMID: 24508019 DOI: 10.1053/j.jvca.2013.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Indexed: 11/11/2022]
Abstract
Recent evidence has shown that moderate mitral regurgitation is common and clinically relevant in patients presenting for surgical and transcatheter aortic valve replacement for aortic stenosis. Prospective multicenter clinical trials are now indicated to resolve the clinical equipoise about whether or not mitral valve intervention also is indicated at the time of aortic valve intervention. Advances in three-dimensional transesophageal echocardiography, transcatheter mitral interventions, and surgical aortic valve replacement, including the advent of sutureless valves, likely will expand the therapeutic possibilities for moderate mitral regurgitation in the setting of aortic valve interventions for severe aortic stenosis.
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Affiliation(s)
| | - Benjamin A Kohl
- Department of Anesthesiology and Critical Care, Cardiovascular and Thoracic Section, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Arminder S Jassar
- Department of Surgery, Division of Cardiovascular Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John G T Augoustides
- Department of Anesthesiology and Critical Care, Cardiovascular and Thoracic Section, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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Bridgewater B. Almanac 2012: Adult cardiac surgery. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2013; 83:64-71. [PMID: 23453923 DOI: 10.1016/j.acmx.2013.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 01/15/2013] [Indexed: 11/19/2022] Open
Affiliation(s)
- Ben Bridgewater
- University Hospital of South Manchester, Manchester, United Kingdom.
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Bridgewater B. Almanac 2012 adult cardiac surgery: The national society journals present selected research that has driven recent advances in clinical cardiology. Egypt Heart J 2013. [DOI: 10.1016/j.ehj.2012.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Bridgewater B. Almanac 2012: adult cardiac surgery: the national society journals present selected research that has driven recent advances in clinical cardiology. Rev Port Cardiol 2013; 32:173-80. [PMID: 23369506 DOI: 10.1016/j.repc.2012.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 11/15/2012] [Indexed: 11/17/2022] Open
Abstract
This review covers the important publications in adult cardiac surgery in the last few years, including the current evidence base for surgical revascularisation and the use of off-pump surgery, bilateral internal mammary arteries and endoscopic vein harvesting. The changes in conventional aortic valve surgery are described alongside the outcomes of clinical trials and registries for transcatheter aortic valve implantation, and the introduction of less invasive and novel approaches of conventional aortic valve replacement surgery. Surgery for mitral valve disease is also considered, with particular reference to surgery for asymptomatic degenerative mitral regurgitation.
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Bridgewater B. Almanac 2012: Adult cardiac surgery: The national society journals present selected research that has driven recent advances in clinical cardiology. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.repce.2013.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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One-year outcomes of the Surgical Treatment of Aortic Stenosis With a Next Generation Surgical Aortic Valve (TRITON) trial: A prospective multicenter study of rapid-deployment aortic valve replacement with the EDWARDS INTUITY Valve System. J Thorac Cardiovasc Surg 2013; 145:110-5; discussion 115-6. [DOI: 10.1016/j.jtcvs.2012.07.108] [Citation(s) in RCA: 177] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Revised: 06/22/2012] [Accepted: 07/26/2012] [Indexed: 11/22/2022]
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