1
|
Elbasha K, Kaur J, Abdelghani M, Landt M, Alotaibi S, Abdelaziz A, Abdel-Wahab M, Toelg R, Geist V, Richardt G, Allali A. Ten-year Durability, Hemodynamic Performance, and Clinical Outcomes after Transcatheter Aortic Valve Implantation Using a Self-expanding Device. Cardiol Ther 2024; 13:529-540. [PMID: 38734999 PMCID: PMC11333656 DOI: 10.1007/s40119-024-00369-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 04/16/2024] [Indexed: 05/13/2024] Open
Abstract
INTRODUCTION The expansion of transcatheter aortic valve implantation (TAVI) to low-risk and younger patients has increased the relevance of the long-term durability of transcatheter heart valves (THV). The present study aims to assess the 10-year durability, hemodynamic performance, and clinical outcomes after TAVI using the CoreValve system. METHODS An analysis from a prospective registry with predefined clinical and echocardiographic follow-up included 302 patients who underwent TAVI with the CoreValve system between 2007 and 2015. Bioprosthetic valve failure (BVF) was defined as any bioprosthetic valve dysfunction-related death, re-intervention, or severe hemodynamic valve deterioration. RESULTS At the time of TAVI, the mean age was 80.41 ± 7.01 years, and the Society of Thoracic Surgeons (STS) score was 6.13 ± 5.23%. At latest follow-up (median [IQR]: 5 [2-7] years), cumulative all-cause mortality rates at 3, 5, 7, and 10 years was 23.7%, 40%, 65.8%, and 89.8%, respectively. Mean aortic valve area and transvalvular gradient post-TAVI and at 5, 7, and 10 years were 1.94, 1.87, 1.69, and 1.98 cm2 (p = 0.236) and 8.3, 9.0, 8.2, and 10.1 mmHg (p = 0.796), respectively. Overall, 11 patients had BVF, of whom six had structural valve deterioration (SVD). The 10-year actual and actuarial freedom from BVF was 96.1% and 78.8%, and from SVD was 97.9% and 80.9%, respectively. Three patients developed significant non-SVD due to severe paravalvular leakage, and two patients were diagnosed with infective endocarditis. CONCLUSION Using an early-generation self-expanding bioprosthesis, we documented durable hemodynamic performance and low rates of BVF and SVD up to 10 years after TAVI.
Collapse
Affiliation(s)
- Karim Elbasha
- Cardiology Department, Heart Centre Segeberger Kliniken GmbH, Am Kurpak 1, 23795, Bad Segeberg, Germany.
- Cardiology Department, Zagazig University, Sharkia, Egypt.
| | - Jatinderjit Kaur
- Cardiology Department, Heart Centre Segeberger Kliniken GmbH, Am Kurpak 1, 23795, Bad Segeberg, Germany
| | - Mohammad Abdelghani
- Department of Cardiology, Al-Azhar University, Cairo, Egypt
- Cardiology Unit, Department of Internal Medicine, Sohar Hospital, Sohar, Oman
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Martin Landt
- Cardiology Department, Heart Centre Segeberger Kliniken GmbH, Am Kurpak 1, 23795, Bad Segeberg, Germany
| | - Sultan Alotaibi
- Cardiology Department, Heart Centre Segeberger Kliniken GmbH, Am Kurpak 1, 23795, Bad Segeberg, Germany
- Cardiac Centre, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | | | - Mohamed Abdel-Wahab
- Cardiology Department, Heart Centre Leipzig at the University of Leipzig, Leipzig, Germany
| | - Ralph Toelg
- Cardiology Department, Heart Centre Segeberger Kliniken GmbH, Am Kurpak 1, 23795, Bad Segeberg, Germany
| | - Volker Geist
- Cardiology Department, Heart Centre Segeberger Kliniken GmbH, Am Kurpak 1, 23795, Bad Segeberg, Germany
| | - Gert Richardt
- Cardiology Department, Heart Centre Segeberger Kliniken GmbH, Am Kurpak 1, 23795, Bad Segeberg, Germany
| | - Abdelhakim Allali
- Cardiology Department, Heart Centre Segeberger Kliniken GmbH, Am Kurpak 1, 23795, Bad Segeberg, Germany
- University Heart Centre Lübeck, Medical Clinic II, Lübeck, Germany
| |
Collapse
|
2
|
Al-Bayati A, Alrifai A, Darmoch F, Alkhaimy H, Fanari Z. Transcatheter aortic valve replacement outcomes in patients with high gradient versus low ejection fraction low gradient severe aortic stenosis: A meta-analysis of randomized controlled trials. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00606-7. [PMID: 39089911 DOI: 10.1016/j.carrev.2024.07.020] [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: 02/26/2024] [Revised: 06/23/2024] [Accepted: 07/25/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND The outcome of Low Flow-Low Gradient (LF-LG) severe aortic stenosis (AS) patients who underwent Transcatheter Aortic Valve Replacement (TAVR) procedure is not well defined. We conducted a systematic review of the literature to compare the outcomes of TAVR in LF-LG AS patients to the more traditional high gradient (HG) aortic stenosis. METHODS We comprehensively searched for controlled randomized and non-randomized studies from 4 online databases. We are presenting the data using risk ratios (95 % confidence intervals) and measuring heterogeneity using Higgins' I2 index. RESULTS Our analysis included 4380 patients with 3425 HG patients and 955 LF-LG patients from 6 cohort (5 retrospective and 1 prospective) studies. When compared to LFLG; TAVR was associated with significantly lower 30 days mortality in HG patients (5.1 % vs 7.4 %; relative risk [RR]: 0.55; 95 % confidence interval [CI]: 0.35 to 0.86; p < 0.01). Similar findings were also observed in 12-month cardiovascular (CV) mortality (5.5 % vs. 10.4 %; RR: 0.47; 95 % CI: 0.38 to 0.60; p < 0.01 and 12-month all-cause mortality (15.9 % vs 20.9 %; RR: 0.70; 95 % CI: 0.49 to 1.00; p < 0.05). There was no significant difference in myocardial infarction (MI) after TAVR between HG and LF-LG at 30 days (0.16 % vs. 0.95 %; p < 0.09) or 12 months (0.43 % vs. 0.95 %; p = 0.20). Similarly, there was no difference in stroke rates at 30 days (2.9 % vs. 2.86 %) or at 12 months (3.6 % vs. 3.06 %). CONCLUSIONS AND RELEVANCE Patients with LF-LG severe AS who underwent TAVR had worse 1-year all-cause mortality, 30-day all-cause, and 1-year CV mortality when compared to TAVR in HG severe AS. There was no difference in MI or stroke rates. Therefore, with heart team discussion and informed patient decision regarding the risk and benefit, TAVR would still offer better outcomes in LFLG AS compared to conservative medical management.
Collapse
Affiliation(s)
| | | | - Fahed Darmoch
- Northside Hospital Cardiovascular Institute, Cumming, GA, USA
| | - Haytham Alkhaimy
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Zaher Fanari
- University of California San Francisco, Fresno, CA, USA.
| |
Collapse
|
3
|
Fifer S, Keen B, Guilbert‐Wright P, Yamabe K, Murdoch DJ. Patient preferences for heart valve disease intervention. Health Expect 2024; 27:e13929. [PMID: 38050462 PMCID: PMC10726282 DOI: 10.1111/hex.13929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/15/2023] [Accepted: 11/21/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND This study aimed to determine how patients trade-off the benefits and risks of two different types of procedures used to treat heart valve disease (HVD). It also aimed to determine patients' preferences for HVD treatments (predicted uptake) and the relative importance of each treatment attribute. METHODS A discrete choice experiment (DCE) was conducted in Australia and Japan with patients who required a heart valve procedure. Patients were stratified into three categories: no prior procedure experience, minimally invasive procedure experience and invasive procedure experience. DCE attributes included risk of mortality; risk of stroke; needing dialysis; needing a new pacemaker; valve durability; independence 1 month after surgery; and out-of-pocket expenses. Participants chose between two hypothetical labelled approaches to therapy ('invasive procedure' and 'minimally invasive procedure'), with a separate opt-out included. A mixed multinomial logit model was used to analyse preferences. RESULTS The DCE was completed by 143 Australian and 206 Japanese patients. Both populations demonstrated an overall preference for the minimally invasive procedure over the invasive procedure. All attributes tested significantly predicted choice and were important to patient decision-making. However, patients' choices were most influenced by the durability of the valve and the likelihood of independence postprocedure, irrespective of their prior procedure experience. Differences in preference were observed between Australian and Japanese patients; valve durability was the most important attribute among Australian patients, while Japanese patients emphasised regaining independence postsurgery. Risk of mortality was less important relative to other key attributes in Japan; however, it remained significant to the model. CONCLUSIONS HVD patients prefer a minimally invasive procedure over an invasive procedure, irrespective of prior treatment experience. Key attributes contributing to treatment preferences are valve durability and faster recovery. These results can be used to help inform healthcare decision-makers about what features of heart valve procedures patients value most. PATIENT AND PUBLIC CONTRIBUTION People with lived experience of HVD were included in multiple stages of the design phase of this research. First, patients and doctors were consulted by taking part in qualitative interviews. The qualitative interviews helped inform which treatment attributes to include in the DCE based on what was important to those with lived experience and those who help make treatment decisions on behalf of patients. Qualitative interview participants also assisted with the framing of questions in the online survey to ensure the terminology was patient-friendly and relevant to those with lived experience. Following qualitative interviews, the DCE attribute list was agreed on in expert consultation with a steering committee, which included patient representatives and treating physicians (interventional cardiologists, cardiothoracic surgeons). The survey was also pilot tested with a small sample of patients and minor adjustments were made to the wording to ensure it was appropriate and meaningful to those with lived experience of HVD.
Collapse
Affiliation(s)
- Simon Fifer
- Community and Patient Preference Research (CaPPRe)SydneyNew South WalesAustralia
| | - Brittany Keen
- Community and Patient Preference Research (CaPPRe)SydneyNew South WalesAustralia
| | | | - Kaoru Yamabe
- Graduate School of Public PolicyThe University of TokyoTokyoJapan
| | - Dale J. Murdoch
- The Prince Charles HospitalBrisbaneQueenslandAustralia
- Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
| |
Collapse
|
4
|
Taniguchi T, Morimoto T, Yamaji K, Shirai S, Ando K, Shiomi H, Takeji Y, Ohno N, Kanamori N, Yamazaki F, Koyama T, Kim K, Ehara N, Furukawa Y, Komiya T, Iwakura A, Shirotani M, Esaki J, Sakaguchi G, Fujii K, Nakayama S, Mabuchi H, Tsuneyoshi H, Eizawa H, Shiraga K, Hanyu M, Nakano A, Ishii K, Tamura N, Higashitani N, Kouchi I, Yamada T, Nishizawa J, Jinnai T, Morikami Y, Minatoya K, Kimura T. Life Expectancy of Patients With Severe Aortic Stenosis in Relation to Age and Surgical Risk Score. Ann Thorac Surg 2023; 116:1195-1203. [PMID: 36739072 DOI: 10.1016/j.athoracsur.2023.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 12/28/2022] [Accepted: 01/14/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND There is a paucity of data regarding shorter life expectancy after aortic valve replacement (AVR) in patients with severe aortic stenosis (AS). METHODS Among 3815 patients with severe AS enrolled in the CURRENT AS (Contemporary outcomes after sURgery and medical tREatmeNT in patients with severe Aortic Stenosis) registry, there were 1469 patients (initial AVR: n = 647; conservative strategy: n = 822) with low surgical risk, 1642 patients (initial AVR: n = 433; conservative strategy: n = 1209) with intermediate surgical risk, and 704 patients (initial AVR: n = 117; conservative strategy: n = 587) with high surgical risk. Among 1163 patients who actually underwent surgical AVR as the initial strategy, patients were divided into 4 groups according to age <65 years (n = 185), 65 to 74 (n = 394), 75 to 80 (n = 345), and >80 (n = 239). The expected survival of the general Japanese population was obtained from the Statistics Bureau of Japan. The surgical risk was estimated using The Society of Thoracic Surgery (STS) score. RESULTS The median follow-up was 3.7 years. The cumulative incidences of all-cause death were significantly lower in the initial AVR strategy than in the initial conservative strategy across the 3 STS groups. Shorter life expectancy after surgical AVR was seen especially in younger patients. The observed mortality in low-risk patients was comparable to the expected mortality across all the age-groups, while intermediate-risk patients aged <75 years, and high-risk patients across all age-groups had higher mortality compared with the expected mortality. CONCLUSIONS The risk stratification according to age and STS score might be useful to estimate shorter life expectancy after AVR, and these findings have implications for decision making in the choice of surgical or transcatheter AVR.
Collapse
Affiliation(s)
- Tomohiko Taniguchi
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan
| | - Kyohei Yamaji
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shinichi Shirai
- Department of Cardiovascular Medicine, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kenji Ando
- Department of Cardiovascular Medicine, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasuaki Takeji
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Nobuhisa Ohno
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Norio Kanamori
- Department of Cardiovascular Medicine, Shimada General Medical Center, Shimada, Japan
| | - Fumio Yamazaki
- Department of Cardiovascular Surgery, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Tadaaki Koyama
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kitae Kim
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Natsuhiko Ehara
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Atsushi Iwakura
- Department of Cardiovascular Surgery, Tenri Hospital, Tenri City, Japan
| | - Manabu Shirotani
- Department of Cardiovascular Medicine, Kindai University Nara Hospital, Nara, Japan
| | - Jiro Esaki
- Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital, West Kyoto, Japan
| | - Genichi Sakaguchi
- Department of Cardiovascular Surgery, Kindai University Hospital, Osaka Sayama City, Japan
| | - Kosuke Fujii
- Department of Cardiovascular Surgery, Kishiwada City Hospital, Kishiwada, Japan
| | - Shogo Nakayama
- Department of Cardiovascular Surgery, Osaka Red Cross Hospital, Osaka, Japan
| | - Hiroshi Mabuchi
- Department of Cardiovascular Medicine, Koto Memorial Hospital, Higashiomi, Japan
| | - Hiroshi Tsuneyoshi
- Department of Cardiovascular Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Hiroshi Eizawa
- Department of Cardiovascular Medicine, Kobe City Nishi-Kobe Medical Center, Kobe, Japan
| | - Kotaro Shiraga
- Department of Cardiovascular Surgery, Kyoto Medical Center, Kyoto Japan
| | - Michiya Hanyu
- Department of Cardiovascular Surgery, Kitano Hospital, Osaka, Japan
| | - Akira Nakano
- Department of Cardiovascular Medicine, Hikone Municipal Hospital, Hikone, Japan
| | - Katsuhisa Ishii
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital, Fukushima, Japan
| | - Nobushige Tamura
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Nobuya Higashitani
- Department of Cardiovascular Medicine, Otsu Red Cross Hospital, Otsu, Japan
| | - Ichiro Kouchi
- Department of Cardiovascular Medicine, Saiseikai Noe Hospital, Osaka, Japan
| | - Tomoyuki Yamada
- Department of Cardiovascular Surgery, Shiga General Hospital, Shiga, Japan
| | - Junichiro Nishizawa
- Department of Cardiovascular Surgery, Hamamatsu Rosai Hospital, Hamamatsu City, Japan
| | - Toshikazu Jinnai
- Department of Cardiovascular Medicine, Otsu Red Cross Hospital, Otsu, Japan
| | - Yuko Morikami
- Department of Cardiovascular Medicine, Hirakata Kohsai Hospital, Hirakata, Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| |
Collapse
|
5
|
Yu Q, Tian M, Pi G, Jia Y, Jin X. Geriatric nutritional risk index as a predictor of prognosis in hematologic malignancies: a systematic review and meta-analysis. Front Nutr 2023; 10:1274592. [PMID: 37941772 PMCID: PMC10627839 DOI: 10.3389/fnut.2023.1274592] [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: 08/08/2023] [Accepted: 09/29/2023] [Indexed: 11/10/2023] Open
Abstract
Objective Recent studies have reported inconsistent results regarding the association between geriatric nutritional risk index (GNRI) and clinical outcomes in patients with hematologic malignancies (HMs). We performed a meta-analysis to evaluate the effect of low GNRI on the overall survival (OS) and progression-free survival (PFS) in patients with HMs. Research Methods and Procedures We conducted the research via PubMed, Embase, and Cochrane Library databases to identify trials. Exploring the association between GNRI and prognosis in patients with HMs. A meta-analysis of OS and PFS was performed. Quality In Prognostic Studies instrument and Newcastle-Ottawa quality assessment Scale were used to assess the quality of included trials. Results Fourteen studies enrolling 3,524 patients with HMs were included. Low GNRI was associated with shorter OS (Hazard ratio (HR) = 1.77; 95% CI = 1.44-2.18, p < 0.01) and PFS (HR = 1.63; 95% CI = 1.17-2.27, p < 0.01) in patients with HMs. In the subgroup analysis, GNRI was not significantly associated with prognosis in Chinese patients with HMs (OS, HR =1.33; 95% CI = 0.89-1.98, p = 0.16; PFS, HR = 1.70; 95% CI = 0.72-4.01, p = 0.23). For the subgroup with a GNRI cutoff value less than 98, there was no significant difference in PFS (HR = 1.34; 95% CI = 0.98-1.83, p = 0.06). Conclusion Low GNRI negatively impacted on the prognosis in patients with HMs. Prospective studies to identify the best cut-off value for GNRI are required.
Collapse
Affiliation(s)
- Qiong Yu
- Department of Digestive Medicine, Wuhan Sixth Hospital and Affiliated Hospital of Jianghan University, Wuhan, China
| | - Mengxing Tian
- Department of Clinical Nutrition, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guoliang Pi
- Department of Thoracic Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yegui Jia
- Department of Digestive Medicine, Wuhan Sixth Hospital and Affiliated Hospital of Jianghan University, Wuhan, China
| | - Xin Jin
- Department of Clinical Nutrition, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
6
|
Nappi F, Schoell T, Spadaccio C, Acar C, da Costa FDA. A Literature Review on the Use of Aortic Allografts in Modern Cardiac Surgery for the Treatment of Infective Endocarditis: Is There Clear Evidence or Is It Merely a Perception? Life (Basel) 2023; 13:1980. [PMID: 37895362 PMCID: PMC10608498 DOI: 10.3390/life13101980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023] Open
Abstract
Infective valve endocarditis is caused by different pathogens and 60% of those involve the aortic valve with valve failure. Although S. aureus is recognized as the most frequently isolated causative bacterium associated with IE in high-income countries, Gram-positive cocci nevertheless play a crucial role in promoting infection in relation to their adhesive matrix molecules. The presence of pili on the surface of Gram-positive bacteria such as in different strains of Enterococcus faecalis and Streptococcus spp., grants these causative pathogens a great offensive capacity due to the formation of biofilms and resistance to antibiotics. The indications and timing of surgery in endocarditis are debated as well as the choice of the ideal valve substitute to replace the diseased valve(s) when repair is not possible. We reviewed the literature and elaborated a systematic approach to endocarditis management based on clinical, microbiological, and anatomopathological variables known to affect postoperative outcomes with the aim to stratify the patients and orient decision making. From this review emerges significant findings on the risk of infection in the allograft used in patients with endocarditis and no endocarditis etiology suggesting that the use of allografts has proved safety and effectiveness in patients with both pathologies.
Collapse
Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord, 93200 Saint-Denis, France;
| | - Thibaut Schoell
- Department of Cardiac Surgery, Centre Cardiologique du Nord, 93200 Saint-Denis, France;
| | - Cristiano Spadaccio
- Cardiothoracic Surgery, Lancashire Cardiac Center, Blackpool Victoria Hospital, Blackpool FY3 8NP, UK;
| | - Christophe Acar
- Department of Cardiothoracic Surgery, Hôpital Pitié-Salpêtrière, Boulevard de Hôpital 47-83, 75013 Paris, France;
| | - Francisco Diniz Affonso da Costa
- Department of Cardiovascular Surgery, Instituto de Neurologia e Cardiologia de Curitiba—INC Cardio, Curitiba 81210-310, Parana, Brazil;
| |
Collapse
|
7
|
Ehrlich T, Abeln KB, Froede L, Burgard C, Giebels C, Schäfers HJ. Valve-sparing aortic root replacement-for all patients? J Thorac Cardiovasc Surg 2023:S0022-5223(23)00781-X. [PMID: 37696427 DOI: 10.1016/j.jtcvs.2023.08.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/22/2023] [Accepted: 08/26/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Valve-sparing root replacement (VSRR) has been associated with good survival and low rates of valve-related complications (VRCs). Whether these advantages are present irrespective of patient comorbidity or age is unclear. The aim of this study was to analyze survival and frequency of VRCs in relation to patient comorbidity and age. METHODS Between October 1995 and December 2021, 1156 patients with a bicuspid or tricuspid aortic valve were treated by root remodeling. The mean patient age was 53.3 ± 14 years, and 973 (84%) were male. The mean duration of follow-up was 6.7 ± 5.5 years (median, 5.9 years), and follow-up was 95% complete (7746 patient-years). We analyzed the population according to comorbidity and age at surgery. A discriminating cutoff for the effect of age was determined using receiver operating characteristic curve (ROC) analysis. RESULTS Mean survival at 15 years was 74.7 ± 2.5%. Deceased patients were older (mean, 65.3 ± 12 years vs 51.6 ± 14.1 years; P < .001) at the time of surgery and had more comorbidities (coronary artery disease [CAD], 28.4% vs 9.8%; P < .001). The sole significant adjusted predictor was age (P < .001). By ROC analysis (area under the curve, 0.780), the optimal cutoff for age was 61 years. Survival was 87.1 ± 2.8% at 15 years in patients age <61 years, compared to 55.3 ± 4.3% in patients age >61 years (P < .0001). Using competing risk analysis, VRC-free survival at 15 years was 66.8% at 15 years, including 76.7% in patients age <61 years and 52.4% in those age >61 years (P < .0001). CONCLUSIONS VSRR is associated with a low incidence of VRC and excellent durability. Survival is decreased in the presence of comorbidities, mainly CAD, and patient age >61 years. Despite lower survival, freedom from VRC is good.
Collapse
Affiliation(s)
- Tristan Ehrlich
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Karen B Abeln
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Lennart Froede
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Christian Burgard
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Christian Giebels
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany.
| |
Collapse
|
8
|
Newell P, Javadikasgari H, Rojas-Alexandre M, Hirji S, Harloff M, Cherkasky O, McGurk S, Malarczyk A, Shah P, Sabe A, Kaneko T. All-cause procedural readmissions following transcatheter aortic valve replacement. JTCVS OPEN 2023; 15:83-93. [PMID: 37808066 PMCID: PMC10556937 DOI: 10.1016/j.xjon.2023.05.017] [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: 06/29/2022] [Revised: 04/12/2023] [Accepted: 05/01/2023] [Indexed: 10/10/2023]
Abstract
Objective With expanding eligibility criteria, transcatheter aortic valve replacement is being performed on patients with longer life expectancy, and subsequent procedures after index transcatheter aortic valve replacement are inevitable. This study examines the incidence and outcomes of patients undergoing subsequent procedural readmissions after transcatheter aortic valve replacement. Methods All patients who underwent index transcatheter aortic valve replacement and were discharged alive from January 2012 to December 2019 at a single institution were evaluated. Study end points were mortality and readmission for procedure with more than 1-day hospital stay. Effect on survival was evaluated by treating procedural readmission as a time-dependent variable by Cox proportional hazard model and competing risk analysis. Results A total of 1092 patients met inclusion criteria with a median follow-up time of 34 months. A total of 218 patients (20.0%) had 244 subsequent procedural readmissions. During the 244 procedural readmissions, there were 260 procedures; 96 (36.9%) were cardiac (most commonly pacemaker implantation, percutaneous coronary interventions, and surgical aortic valve replacements), and 164 (63.1%) were noncardiac (most commonly orthopedic and gastrointestinal procedures). The overall procedural readmission rates were 32%, 39%, and 42%, and all-cause mortality was 27%, 44%, and 54% at 20, 40, and 60 months, respectively. Procedural readmissions were not associated with a survival penalty in any surgical risk group or on Cox regression (hazard ratio, 1.25; 0.91-1.64, P = .17). Conclusions After transcatheter aortic valve replacement, procedural interventions are seen frequently, with most procedures occurring within the first year after transcatheter aortic valve replacement. However, subsequent procedural readmissions do not appear to have a survival penalty for patients after transcatheter aortic valve replacement. After transcatheter aortic valve replacement with resolution of aortic stenosis, subsequent procedures can and should be pursued if they are needed.
Collapse
Affiliation(s)
- Paige Newell
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Hoda Javadikasgari
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Mehida Rojas-Alexandre
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Sameer Hirji
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Morgan Harloff
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Olena Cherkasky
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Siobhan McGurk
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Alexandra Malarczyk
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Pinak Shah
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Ashraf Sabe
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Washington University School of Medicine, St Louis, Mo
| |
Collapse
|
9
|
Galper BZ, Chinnakondepalli KM, Wang K, Magnuson EA, Lu M, Thourani VH, Kodali S, Makkar R, Herrmann HC, Kapadia S, Williams M, Webb J, Smith CR, Mack MJ, Leon MB, Cohen DJ. Economic Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement in Patients with Severe Aortic Stenosis and Low Surgical Risk: Results from the PARTNER 3 Trial. Circulation 2023; 147:1594-1605. [PMID: 37154049 DOI: 10.1161/circulationaha.122.062481] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 03/08/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND In patients with severe symptomatic aortic stenosis at low surgical risk, transfemoral transcatheter aortic valve replacement (TAVR) with the SAPIEN 3 valve has been shown to reduce the composite of death, stroke, or rehospitalization at 2-year follow-up compared with surgical aortic valve replacement (SAVR). Whether TAVR is cost-effective compared with SAVR for low-risk patients remains uncertain. METHODS Between 2016 and 2017, 1000 low-risk patients with aortic stenosis were randomly assigned to TAVR with the SAPIEN 3 valve or SAVR in the PARTNER 3 trial (Placement of Aortic Transcatheter Valves). Of these patients, 929 underwent valve replacement, were enrolled in the United States, and were included in the economic substudy. Procedural costs were estimated using measured resource use. Other costs were determined by linkage with Medicare claims or by regression models when linkage was not feasible. Health utilities were estimated using the EuroQOL 5-item questionnaire. With the use of a Markov model informed by in-trial data, lifetime cost-effectiveness from the perspective of the US health care system was estimated in terms of cost per quality-adjusted life-year gained. RESULTS Although procedural costs were nearly $19 000 higher with TAVR, total index hospitalization costs were only $591 more with TAVR compared with SAVR. Follow-up costs were lower with TAVR such that TAVR led to 2-year cost savings of $2030/patient compared with SAVR (95% CI, -$6222 to $1816) and a gain of 0.05 quality-adjusted life-years (95% CI, -0.003 to 0.102). In our base-case analysis, TAVR was projected to be an economically dominant strategy with a 95% probability that the incremental cost-effectiveness ratio for TAVR would be <$50 000/quality-adjusted life-year gained (consistent with high economic value from a US health care perspective). These findings were sensitive to differences in long-term survival, however, such that a modest long-term survival advantage with SAVR would render SAVR cost-effective (although not cost saving) compared with TAVR. CONCLUSIONS For patients with severe aortic stenosis and low surgical risk similar to those enrolled in the PARTNER 3 trial, transfemoral TAVR with the SAPIEN 3 valve is cost saving compared with SAVR at 2 years and is projected to be economically attractive in the long run as long as there are no substantial differences in late death between the 2 strategies. Long-term follow-up will be critical to ultimately determine the preferred treatment strategy for low-risk patients from both a clinical and economic perspective.
Collapse
Affiliation(s)
| | | | - Kaijun Wang
- Saint-Luke's Mid America Heart Institute, Kansas City, MO (K.M.C., K.W., E.A.M.)
| | - Elizabeth A Magnuson
- Saint-Luke's Mid America Heart Institute, Kansas City, MO (K.M.C., K.W., E.A.M.)
| | | | | | - Susheel Kodali
- New York-Presbyterian/Columbia University Irving Medical Center, New York (S. Kodali, C.R.S., M.B.L.)
| | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, CA (R.M.)
| | | | | | | | - John Webb
- St. Paul's Hospital, Vancouver, BC, Canada (J.W.)
| | - Craig R Smith
- New York-Presbyterian/Columbia University Irving Medical Center, New York (S. Kodali, C.R.S., M.B.L.)
| | | | - Martin B Leon
- New York-Presbyterian/Columbia University Irving Medical Center, New York (S. Kodali, C.R.S., M.B.L.)
- Cardiovascular Research Foundation, New York, NY (M.B.L., D.J.C.)
| | - David J Cohen
- Cardiovascular Research Foundation, New York, NY (M.B.L., D.J.C.)
- St. Francis Hospital, Roslyn, NY (D.J.C.)
| |
Collapse
|
10
|
UMETSU AKIKO, MATSUSHITA SATOSHI, KINOSHITA TAKESHI, TABATA MINORU. Concomitant Septal Myectomy with Aortic Valve Replacement for Severe Aortic Stenosis with Left Ventricular Outflow Tract Obstruction. JUNTENDO IJI ZASSHI = JUNTENDO MEDICAL JOURNAL 2023; 69:203-215. [PMID: 38855434 PMCID: PMC11153074 DOI: 10.14789/jmj.jmj22-0036-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/06/2023] [Indexed: 06/11/2024]
Abstract
Objectives Septal myectomy confers survival benefits on patients with hypertrophic cardiomyopathy. However, its role in the treatment of severe aortic stenosis (sAS) with left ventricular outflow tract obstruction (LVOTO) remains under investigation. Another challenging question in the era of transcatheter aortic valve replacement is who would benefit more from traditional surgical aortic valve replacement (SAVR) with myectomy. Therefore, this study aimed to investigate myectomy cases at our hospital in Japan. Methods A total of 740 patients who underwent SAVR for sAS between 2012 and 2019 were identified. The demographics and baseline echocardiographic findings were retrospectively compared between patients who underwent concomitant myectomy and those who did not. The myectomy group was further assessed for factors predisposing to LVOTO, operative details, echocardiographic changes, and prognosis. The resected septa were histopathologically analyzed. Results The myectomy group mostly comprised elderly females with a small hypercontractile heart. Myectomy with SAVR led to statistically significant improvements in concentric left ventricular hypertrophy and LVOTO parameters. Survival was comparable with that reported in previous reports, even in the elderly subset (≥ 75 years). The septa showed mild fibrosis. Conclusions Myectomy can be safely performed with SAVR for sAS with LVOTO, even in the elderly, and it effectively improves LVOTO. Special attention should be paid to elderly females with relatively more severe AS and a small yet extra-hypertrophic and extra-hypercontractile heart. Such patients warrant comprehensive assessment of LVOTO, and despite its invasiveness, SAVR may be potentially more beneficial by allowing direct observation of LVOTO and ancillary myectomy.
Collapse
Affiliation(s)
| | - SATOSHI MATSUSHITA
- Corresponding author: Satoshi Matsushita, Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan, TEL: +81-3-3813-3111 E-mail:
| | | | | |
Collapse
|
11
|
Yang YW, Zhou YW, Xia X, Jia SL, Zhao YL, Zhou LX, Cao Y, Ge ML. Prognostic value of temporal muscle thickness, a novel radiographic marker of sarcopenia, in patients with brain tumor: A systematic review and meta-analysis. Nutrition 2023; 112:112077. [PMID: 37236042 DOI: 10.1016/j.nut.2023.112077] [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: 02/14/2023] [Revised: 04/24/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023]
Abstract
Sarcopenia has been identified as a prognostic factor among certain types of cancer. However, it is unclear whether there is prognostic value of temporalis muscle thickness (TMT), a potential surrogate for sarcopenia, in adults patients with brain tumors. Therefore, we searched the Medline, Embase, and PubMed to systematically review and meta-analyze the relationship between TMT and overall survival, progression-free survival, and complications in patients with brain tumors and the hazard ratio (HR) or odds ratios (OR), and 95% confidence interval (CI) were evaluated. The quality in prognostic studies (QUIPS) instrument was employed to evaluate study quality. Nineteen studies involving 4570 patients with brain tumors were included for qualitative and quantitative analysis. Meta-analysis revealed thinner TMT was associated with poor overall survival (HR, 1.72; 95% CI, 1.45-2.04; P < 0.01) in patients with brain tumors. Sub-analyses showed that the association existed for both primary brain tumors (HR, 2.02; 95% CI, 1.55-2.63) and brain metastases (HR, 1.39; 95% CI, 1.30-1.49). Moreover, thinner TMT also was the independent predictor of progression-free survival in patients with primary brain tumors (HR, 2.88; 95% CI, 1.85-4.46; P < 0.01). Therefore, to improve clinical decision making it is important to integrate TMT assessment into routine clinical settings in patients with brain tumors.
Collapse
Affiliation(s)
- Yan-Wu Yang
- Emergency Department, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yi-Wu Zhou
- Emergency Department, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xin Xia
- Center of Gerontology and Geriatrics (National Clinical Research Center for Geriatrics), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shu-Li Jia
- Center of Gerontology and Geriatrics (National Clinical Research Center for Geriatrics), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yun-Li Zhao
- Center of Gerontology and Geriatrics (National Clinical Research Center for Geriatrics), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li-Xing Zhou
- Center of Gerontology and Geriatrics (National Clinical Research Center for Geriatrics), West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yu Cao
- Emergency Department, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Mei-Ling Ge
- Center of Gerontology and Geriatrics (National Clinical Research Center for Geriatrics), West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| |
Collapse
|
12
|
Hernández-Vaquero D, Rodríguez-Caulo E, Vigil-Escalera C, Blanco-Herrera Ó, Berastegui E, Arias-Dachary J, Souaf S, Parody G, Laguna G, Adsuar A, Castellá M, Valderrama JF, Pulitani I, Cánovas S, Ferreiro A, García-Valentín A, Carnero M, Pareja P, Corrales JA, Blázquez JA, Macías D, Fletcher-Sanfeliu D, Martínez D, Martín E, Martín M, Margarit J, Hernández-Estefanía R, Monguió E, Otero J, Silva J. Life expectancy after surgical aortic valve replacement for low-gradient aortic stenosis with preserved ejection fraction. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:32-39. [PMID: 35732565 DOI: 10.1016/j.rec.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/29/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION AND OBJECTIVES Surgical aortic valve replacement (SAVR) can modify the natural history of severe aortic stenosis (SAS). However, compared with the general population, these patients have a loss of life expectancy. The life expectancy of patients who undergo SAVR due to low-gradient SAS with preserved left ventricular ejection fraction (LVEF) is unknown. METHODS We included all patients between 50 and 65 years who underwent isolated SAVR in 27 Spanish centers during an 18-year period. We analyzed observed and expected survival at 18 years in patients with low-gradient SAS with preserved LVEF and all other types of SAS. We used propensity score matching to compare the life expectancy of patients with low-gradient SAS with preserved LVEF vs those with high-gradient SAS with preserved LVEF. RESULTS We analyzed 5084 patients, of whom 413 had low-gradient SAS with preserved LVEF. For these patients, observed survival at 10, 15 and 18 years was 86.6% (95%CI, 85.3-87.8), 75% (95%CI, 72.7-77.2), and 63.5% (95%CI, 58.8-67.8). Expected survival at 10, 15 and 18 years was 90.2%, 82.1%, and 75.7%. In the matched sample, survival of patients with low-gradient SAS with preserved LVEF was similar to that of patients with high-gradient with preserved LVEF, log-rank test, P=.95; HR=1 (95%CI, 0.7-1.4; P=.95). CONCLUSIONS There is a loss of life expectancy in patients with all types of SAS undergoing SAVR. This loss is higher in patients with left ventricular dysfunction and lower in patients with low-gradient or high-gradient aortic stenosis with preserved LVEF. The benefit of surgery is similar between these last 2 groups.
Collapse
Affiliation(s)
- Daniel Hernández-Vaquero
- Departamento de Cirugía Cardiaca, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.
| | | | - Carlota Vigil-Escalera
- Departamento de Cirugía Cardiaca, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | | | - Elisabet Berastegui
- Departamento de Cirugía Cardiaca, Hospital Germans Trias I Pujol, Badalona, Barcelona, Spain
| | - Javier Arias-Dachary
- Departamento de Cirugía Cardiaca, Hospital Universitario Reina Sofía, Cordoba, Spain
| | - Souhayla Souaf
- Departamento de Cirugía Cardiaca, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - Gertrudis Parody
- Departamento de Cirugía Cardiaca, Hospital Universitario Virgen de la Macarena, Seville, Spain
| | - Gregorio Laguna
- Departamento de Cirugía Cardiaca, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Alejandro Adsuar
- Departamento de Cirugía Cardiaca, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Manel Castellá
- Departamento de Cirugía Cardiaca, Hospital Clinic de Barcelona, Barcelona, Spain
| | - José F Valderrama
- Departamento de Cirugía Cardiaca, Hospital Universitario Regional de Málaga, Malaga, Spain
| | - Ivana Pulitani
- Departamento de Cirugía Cardiaca, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Sergio Cánovas
- Departamento de Cirugía Cardiaca, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Andrea Ferreiro
- Departamento de Cirugía Cardiaca, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Antonio García-Valentín
- Departamento de Cirugía Cardiaca, Hospital General Universitario de Alicante, Alicante, Spain
| | - Manuel Carnero
- Departamento de Cirugía Cardiaca, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Pilar Pareja
- Departamento de Cirugía Cardiaca, Hospital Universitario Virgen de la Salud, Toledo, Spain
| | - José A Corrales
- Departamento de Cirugía Cardiaca, Hospital Universitario de Badajoz, Badajoz, Spain
| | - José A Blázquez
- Departamento de Cirugía Cardiaca, Hospital Universitario La Paz, Madrid, Spain
| | - Diego Macías
- Departamento de Cirugía Cardiaca, Hospital Universitario Puerta del Mar, Cadiz, Spain
| | - Delfina Fletcher-Sanfeliu
- Departamento de Cirugía Cardiaca, Hospital Universitario Son Espases, Palma de Mallorca, Balearic Islands, Spain
| | - Daniel Martínez
- Departamento de Cirugía Cardiaca, Hospital Universitario Puerta del Hierro, Majadahonda, Madrid, Spain
| | - Elio Martín
- Departamento de Cirugía Cardiaca, Hospital Universitario de León, Leon, Spain
| | - Miren Martín
- Departamento de Cirugía Cardiaca, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Juan Margarit
- Departamento de Cirugía Cardiaca, Hospital Universitario De la Ribera, Alzira, Valencia, Spain
| | | | - Emilio Monguió
- Departamento de Cirugía Cardiaca, Hospital Universitario de La Princesa, Madrid, Spain
| | - Juan Otero
- Departamento de Cirugía Cardiaca, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - Jacobo Silva
- Departamento de Cirugía Cardiaca, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| |
Collapse
|
13
|
Telyuk P, Hancock H, Maier R, Batty JA, Goodwin A, Owens WA, Ogundimu E, Akowuah E. Long-term outcomes of mini-sternotomy versus conventional sternotomy for aortic valve replacement: a randomized controlled trial. EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY : OFFICIAL JOURNAL OF THE EUROPEAN ASSOCIATION FOR CARDIO-THORACIC SURGERY 2022; 63:6832043. [PMID: 36394261 DOI: 10.1093/ejcts/ezac540] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/06/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Aortic valve replacement (AVR) for severe symptomatic aortic stenosis is one of the most common cardiac surgical procedures with excellent long-term outcomes. Multiple previous studies have compared short-term outcomes of AVR with mini-sternotomy versus AVR with conventional sternotomy. We have previously reported the results of the randomized MAVRIC trial, which aimed to evaluate early postoperative morbidity among patients undergoing mini-sternotomy and conventional sternotomy AVR. We now report the long-term all-cause mortality, reoperation, MACE outcomes and echocardiographic data from this trial. METHODS The prospective, randomized, single-centre, single-blind MAVRIC (manubrium-limited mini-sternotomy versus conventional sternotomy for aortic valve replacement) trial compared manubrium-limited mini-sternotomy and conventional median sternotomy for the treatment of patients with severe aortic stenosis. The previously reported primary outcome was the proportion of patients receiving red cell transfusion postoperatively and within 7 days of the index procedure. Currently reported exploratory analyses of a combined long-term all-cause mortality and reoperation were compared between groups via the log-rank test. Sensitivity analyses reviewed individual components of the combined end point. The primary analysis and long-term exploratory analyses were based on an intention-to-treat principle. RESULTS Between March 2014 and June 2016, 270 patients were enrolled and randomized in a 1:1 fashion to undergo mini-sternotomy AVR (n = 135) or conventional median sternotomy AVR (n = 135). At the median follow-up of 6.1 years, the composite outcome of all-cause mortality and reoperation occurred in 18.5% (25/135) of patients in the conventional sternotomy group and in 17% (23/135) of patients in the mini-sternotomy group. The incidence of chronic kidney disease, cerebrovascular accident and myocardial infarction was not significantly different between 2 groups. Follow-up echocardiographic data suggested no difference in peak and mean gradients or incidence of aortic regurgitation between 2 approaches. CONCLUSIONS This exploratory long-term analysis demonstrated that, in patients with severe aortic stenosis undergoing isolated AVR, there was no significant difference between manubrium-limited mini-sternotomy and conventional sternotomy with respect to all-cause mortality, rate of reoperation, MACE events and echocardiographic data at the median of 6.1-year follow-up.
Collapse
Affiliation(s)
- Pyotr Telyuk
- Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK
| | - Helen Hancock
- Newcastle Clinical Trials Unit, Newcastle upon Tyne, UK
| | - Rebecca Maier
- Newcastle Clinical Trials Unit, Newcastle upon Tyne, UK
| | - Jonathan A Batty
- Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK
| | - Andrew Goodwin
- Department of Cardiovascular Surgery, The James Cook University Hospital, Middlesbrough, UK
| | - W Andrew Owens
- Department of Cardiovascular Surgery, The James Cook University Hospital, Middlesbrough, UK
| | | | - Enoch Akowuah
- Department of Cardiovascular Surgery, The James Cook University Hospital, Middlesbrough, UK
| |
Collapse
|
14
|
Ito S, Oh JK. Aortic Stenosis: New Insights in Diagnosis, Treatment, and Prevention. Korean Circ J 2022; 52:721-736. [PMID: 36217595 PMCID: PMC9551229 DOI: 10.4070/kcj.2022.0234] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 09/07/2022] [Indexed: 12/02/2022] Open
Abstract
Aortic stenosis (AS) is one of the most common valvular heart diseases and the number of patients with AS is expected to increase globally as the older population is growing fast. Since the majority of patients are elderly, AS is no longer a simple valvular heart disease of left ventricular outflow obstruction but is accompanied by other cardiac and comorbid conditions. Because of the significant variations of the disease, identifying patients at high risk and even earlier detection of patients with AS before developing symptomatic severe AS is becoming increasingly important. With the proven of efficacy and safety of transcatheter aortic valve replacement (TAVR) in the severe AS population, there is a growing interest in applying TAVR in those with less than severe AS. A medical therapy to reduce or prevent the progression in AS is actively investigated by several randomized control trials. In this review, we will summarize the most recent findings in AS and discuss potential future management strategies of patients with AS.
Collapse
Affiliation(s)
- Saki Ito
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
15
|
Chen C, Patterson B, Simpson R, Li Y, Chen Z, Lv Q, Guo D, Li X, Fu W, Guo B. Do fluoroquinolones increase aortic aneurysm or dissection incidence and mortality? A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9:949538. [PMID: 36017083 PMCID: PMC9396038 DOI: 10.3389/fcvm.2022.949538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 07/13/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The aim of this study was to determine the association between fluoroquinolones (FQs) use, the risk of de novo aortic aneurysm or dissection (AAD), and the prognosis of patients with pre-existing AAD. Materials and methods We searched PubMed, EMBASE, CENTRAL, Scopus, and Web of Science on 31 March 2022. Observational studies that evaluated the association of FQs with AAD risk in the general population or FQs with the prognosis of patients with preexisting AAD and presented adjusted effect estimates were included. Two reviewers assessed study eligibility, extracted data, and assessed the risk of bias and certainty of evidence using GRADE. Results Of the 13 included studies, 11 focused on the association of FQs with de novo AAD incidence, and only one study investigated the association of FQs with the patient with AAD prognosis. FQ use was associated with an increased risk of de novo AAD within 30 days (RR: 1.42; 95% CI: 1.11-1.81; very low certainty) and 60 days (RR: 1.44; 95% CI: 1.26-1.64; low certainty). Specifically, the association was significant when compared with amoxicillin, azithromycin, doxycycline, or no antibiotic use. Furthermore, patients with preexisting AAD exposure to FQ had an increased risk of all-cause mortality (RR: 1.61; 95% CI: 1.50-1.73; moderate certainty) and aortic-specific mortality (RR: 1.80; 95% CI: 1.50-2.15; moderate certainty), compared to the non-exposed FQ group within a 60-day risk period. Conclusion FQs were associated with an increased incidence of AAD in the general population and a higher risk of adverse outcomes in patients with preexisting AAD. Nevertheless, the results may be affected by unmeasured confounding factors. This should be considered by physicians contemplating using FQs in patients with aortic dilation and those at high risk of AAD. Systematic Review Registration [https://www.crd.york.ac.uk/prospero/], identifier [CRD42021230171].
Collapse
Affiliation(s)
- Can Chen
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Benjamin Patterson
- Department of Vascular Surgery, University Hospital Southampton, Southampton, United Kingdom
| | - Ruan Simpson
- Department of Pathology, Portsmouth Hospitals NHS Trust, United Kingdom
| | - Yanli Li
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhangzhang Chen
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qianzhou Lv
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Daqiao Guo
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Xiaoyu Li
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Weiguo Fu
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Baolei Guo
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
- Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
16
|
Esperanza de vida después del recambio valvular debido a estenosis aórtica de bajo gradiente con función ventricular conservada. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
17
|
Nappi F, Avtaar Singh SS, Nappi P, Fiore A. Biomechanics of Transcatheter Aortic Valve Implant. Bioengineering (Basel) 2022; 9:bioengineering9070299. [PMID: 35877350 PMCID: PMC9312295 DOI: 10.3390/bioengineering9070299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 11/16/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has grown exponentially within the cardiology and cardiac surgical spheres. It has now become a routine approach for treating aortic stenosis. Several concerns have been raised about TAVI in comparison to conventional surgical aortic valve replacement (SAVR). The primary concerns regard the longevity of the valves. Several factors have been identified which may predict poor outcomes following TAVI. To this end, the lesser-used finite element analysis (FEA) was used to quantify the properties of calcifications which affect TAVI valves. This method can also be used in conjunction with other integrated software to ascertain the functionality of these valves. Other imaging modalities such as multi-detector row computed tomography (MDCT) are now widely available, which can accurately size aortic valve annuli. This may help reduce the incidence of paravalvular leaks and regurgitation which may necessitate further intervention. Structural valve degeneration (SVD) remains a key factor, with varying results from current studies. The true incidence of SVD in TAVI compared to SAVR remains unclear due to the lack of long-term data. It is now widely accepted that both are part of the armamentarium and are not mutually exclusive. Decision making in terms of appropriate interventions should be undertaken via shared decision making involving heart teams.
Collapse
Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord, 93200 Saint-Denis, France
- Correspondence: ; Tel.: +33-149334104; Fax: +33-149334119
| | | | - Pierluigi Nappi
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy;
| | - Antonio Fiore
- Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, 94000 Creteil, France;
| |
Collapse
|
18
|
De Donno L, Galligani A, Maestri F, Gripshi F, Pattuzzi C, Scarpanti M, Gabor EA, Manca A, Nicolini F. What if Valve-in-Valve TAVR fails? Is surgical re-replacement still an option in high-risk patients? A case report. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022115. [PMID: 35674476 PMCID: PMC10510991 DOI: 10.23750/abm.v93is1.11705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 06/15/2023]
Abstract
Redo surgical aortic valve replacement has been the gold standard for the treatment of degenerated bioprostheses; however it carries an inherent risk associated with a reoperative open heart surgery. Valve-in-Valve transcatheter aortic valve implantation (ViV-TAVI) has emerged as an alternative approach. Few articles in literature review transcatheter aortic valve replacement's failure rates, complications (i.e., valve dislocation, paravalvular leaks) and their surgical management. The rate of reoperations after a percutaneous approach is expected to increase, with the currently rising number of transcatheter procedures worldwide even in patients with a longer life expectancy. Valve dislocation is a rare but serious complication that can severely impact on the outcome of patients. Paravalvular leaks and structural valve degeneration are the most common causes of surgical re-intervention. We present the case of a complex patient with previous surgical aortic valve and ascending aorta replacement who underwent a transfemoral valve-in-valve TAVI for bioprosthesis degeneration, complicated by valve dislocation requiring surgical reoperation.
Collapse
Affiliation(s)
- Luca De Donno
- a:1:{s:5:"en_US";s:55:"Departement of Cardiac Suurgery, Parma General Hospital";}.
| | - Alan Galligani
- Department of Cardio-Thoracic and Vascular Surgery, Cardiac Surgery Unit, University Hospital "Azienda Ospedaliera-Universiteria" of Parma, Parma, Italy..
| | - Francesco Maestri
- Department of Cardio-Thoracic and Vascular Surgery, Cardiac Surgery Unit, University Hospital "Azienda Ospedaliera-Universiteria" of Parma, Parma, Italy..
| | - Florida Gripshi
- Department of Cardio-Thoracic and Vascular Surgery, Cardiac Surgery Unit, University Hospital "Azienda Ospedaliera-Universiteria" of Parma, University of Parma, Parma, Italy.
| | - Claudia Pattuzzi
- Department of Cardio-Thoracic and Vascular Surgery, Cardiac Surgery Unit, University Hospital "Azienda Ospedaliera-Universiteria" of Parma, University of Parma, Parma, Italy.
| | - Matteo Scarpanti
- Department of Cardio-Thoracic and Vascular Surgery, Cardiac Surgery Unit, University Hospital "Azienda Ospedaliera-Universiteria" of Parma, University of Parma, Parma, Italy.
| | - Elena Adelina Gabor
- Department of Cardio-Thoracic and Vascular Surgery, Cardiac Surgery Unit, University Hospital "Azienda Ospedaliera-Universiteria" of Parma, University of Parma, Parma, Italy.
| | - Arianna Manca
- Department of Cardio-Thoracic and Vascular Surgery, Cardiac Surgery Unit, University Hospital "Azienda Ospedaliera-Universiteria" of Parma, University of Parma, Parma, Italy.
| | - Francesco Nicolini
- Department of Cardio-Thoracic and Vascular Surgery, Cardiac Surgery Unit, University Hospital "Azienda Ospedaliera-Universiteria" of Parma, University of Parma, Parma, Italy.
| |
Collapse
|
19
|
Otto CM, Song JK. Treatment of Aortic Stenosis With Transcatheter Aortic Valve Implantation. JAMA 2022; 327:1870-1871. [PMID: 35579656 DOI: 10.1001/jama.2022.5424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Catherine M Otto
- Division of Cardiology, University of Washington School of Medicine, Seattle
| | - Jae-Kwan Song
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| |
Collapse
|
20
|
Hernández-Vaquero D, Rodríguez-Caulo E, Vigil-Escalera C, Blanco-Herrera Ó, Berastegui E, Arias-Dachary J, Souaf S, Parody G, Laguna G, Adsuar A, Castellá M, Valderrama JF, Pulitani I, Cánovas S, Ferreiro A, García-Valentín A, Carnero M, Pareja P, Corrales JA, Blázquez JA, Macías D, Fletcher-Sanfeliu D, Martínez D, Martín E, Martín M, Margarit J, Hernández-Estefanía R, Monguió E, Otero J, Silva J. Life expectancy after aortic valve replacement in young patients. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:294-299. [PMID: 34103259 DOI: 10.1016/j.rec.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/21/2021] [Indexed: 06/12/2023]
Abstract
INTRODUCTION AND OBJECTIVES In young patients with severe aortic stenosis, it is unknown whether their life expectancy restored after aortic valve replacement (AVR) is unknown. METHODS We analyzed all patients aged between 50 and 65 years who underwent isolated AVR in 27 Spanish centers during an 18-year period. We compared observed and expected survival at 15 years of follow-up. We repeated all analyses for patients without complications in the postoperative period. RESULTS A total of 5084 patients were analyzed. For the overall sample, observed survival at 10 and 15 years was 85.3% (95%CI, 84.1%-86.4%) and 73.7% (95%CI, 71.6%-75.6%), respectively. Expected survival was 90.1% and 82.1%. Cumulative relative survival for 1, 5, 10 and 15 years of follow-up was 97.4% (95%CI, 96.9%-97.9%), 96.5% (95%CI, 95.7%-97.3%), 94.7% (95%CI, 93.3%-95.9%), and 89.8% (95%CI, 87.3%-92.1%). For patients without complications, cumulative relative survival for 1, 5, 10 and 15 years was 100.3% (95%CI, 99.8%-100.5%), 98.9% (95%CI 97.6% -99.9%), 97.3% (95%CI, 94.9%-99.4%), and 91.9% (95%CI, 86.5%-96.8%). CONCLUSIONS Life expectancy in young patients who have severe aortic stenosis and undergo AVR is lower than that of the general population. Life expectancy of individuals without complications during the postoperative period is also reduced. Therefore, baseline characteristics are likely the main factors that explain the reduction in life expectancy.
Collapse
Affiliation(s)
- Daniel Hernández-Vaquero
- Servicio de Cirugía Cardiaca, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.
| | | | - Carlota Vigil-Escalera
- Servicio de Cirugía Cardiaca, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | | | - Elisabet Berastegui
- Servicio de Cirugía Cardiaca, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Javier Arias-Dachary
- Servicio de Cirugía Cardiaca, Hospital Universitario Reina Sofía, Cordoba, Spain
| | - Souhayla Souaf
- Servicio de Cirugía Cardiaca, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain
| | - Gertrudis Parody
- Servicio de Cirugía Cardiaca, Hospital Universitario Virgen de la Macarena, Seville, Spain
| | - Gregorio Laguna
- Servicio de Cirugía Cardiaca, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Alejandro Adsuar
- Servicio de Cirugía Cardiaca, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Manel Castellá
- Servicio de Cirugía Cardiaca, Hospital Clínico Universitario de Barcelona, Barcelona, Spain
| | - José F Valderrama
- Servicio de Cirugía Cardiaca, Hospital Universitario Regional de Málaga, Malaga, Spain
| | - Ivana Pulitani
- Servicio de Cirugía Cardiaca, Hospital Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Sergio Cánovas
- Servicio de Cirugía Cardiaca, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Andrea Ferreiro
- Servicio de Cirugía Cardiaca, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | - Manuel Carnero
- Servicio de Cirugía Cardiaca, Hospital Clínico San Carlos, Madrid, Spain
| | - Pilar Pareja
- Servicio de Cirugía Cardiaca, Hospital Universitario Virgen de la Salud, Toledo, Spain
| | - José A Corrales
- Servicio de Cirugía Cardiaca, Hospital Universitario de Badajoz, Badajoz, Spain
| | - José A Blázquez
- Servicio de Cirugía Cardiaca, Hospital Universitario La Paz, Madrid, Spain
| | - Diego Macías
- Servicio de Cirugía Cardiaca, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | | | - Daniel Martínez
- Servicio de Cirugía Cardiaca, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Elio Martín
- Servicio de Cirugía Cardiaca, Hospital Universitario de León, Leon, Spain
| | - Miren Martín
- Servicio de Cirugía Cardiaca, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Juan Margarit
- Servicio de Cirugía Cardiaca, Hospital Universitario Público de la Ribera, Alzira, Valencia, Spain
| | | | - Emilio Monguió
- Servicio de Cirugía Cardiaca, Hospital Universitario La Princesa, Madrid, Spain
| | - Juan Otero
- Servicio de Cirugía Cardiaca, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - Jacobo Silva
- Servicio de Cirugía Cardiaca, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| |
Collapse
|
21
|
Xu XT, He DL, Tian MX, Wu HJ, Jin X. Prognostic Value of Sarcopenia in Patients With Diffuse Large B-Cell Lymphoma Treated With R-CHOP: A Systematic Review and Meta-Analysis. Front Nutr 2022; 9:816883. [PMID: 35284466 PMCID: PMC8914205 DOI: 10.3389/fnut.2022.816883] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/01/2022] [Indexed: 01/04/2023] Open
Abstract
ObjectiveSeveral studies have reported conflicting results regarding the association between sarcopenia and outcomes in patients with diffuse large B-cell lymphoma (DLBCL). This meta-analysis aimed to evaluate the prognostic value of sarcopenia in patients with DLBCL.MethodsPubMed, Embase, and Cochrane Library databases were searched to identify trials exploring the association between sarcopenia and prognosis in patients with DLBCL treated with chemotherapy. A meta-analysis of overall survival (OS), progression-free survival (PFS), treatment completion, and rate of complete response (CR) was performed.ResultsTwelve studies that involved 2,324 patients with DLBCL were included. Sarcopenia was associated with poor OS and PFS in patients with DLBCL, even after adjusting for confounders. Patients with sarcopenia had lower rates of CR and treatment completion than patients without sarcopenia.ConclusionsSarcopenia is a negative predictor of prognosis in patients with DLBCL. Additional and prospective studies investigating the diagnostic criteria for sarcopenia are warranted.
Collapse
Affiliation(s)
- Xin-Tian Xu
- Department of Pharmacy, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dong-Liang He
- Department of Nutrition, Hengyang Central Hospital, Hengyang, China
| | - Meng-Xing Tian
- Department of Clinical Nutrition, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hui-Jing Wu
- Department of Lymphoma Medicine (Breast Cancer and Soft Tissue Tumor Medicine), Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xin Jin
- Department of Clinical Nutrition, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Xin Jin
| |
Collapse
|
22
|
Chan J, Dimagli A, Fudulu DP, Sinha S, Narayan P, Dong T, Angelini GD. Trend and early outcomes in isolated surgical aortic valve replacement in the United Kingdom. Front Cardiovasc Med 2022; 9:1077279. [PMID: 36698929 PMCID: PMC9868612 DOI: 10.3389/fcvm.2022.1077279] [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: 10/22/2022] [Accepted: 12/12/2022] [Indexed: 01/11/2023] Open
Abstract
Objective Surgical aortic valve replacement (SAVR) is traditionally the gold-standard treatment in patients with aortic valve disease. The advancement of transcatheter aortic valve replacement (TAVR) provides an alternative treatment to patients with high surgical risks and those who had previous cardiac surgery. We aim to evaluate the trend, early clinical outcomes, and the choice of prosthesis use in isolated SAVR in the United Kingdom. Methods All patients (n = 79,173) who underwent elective or urgent isolated surgical aortic valve replacement (SAVR) from 1996 to 2018 were extracted from the National Adult Cardiac Surgery Audit database. Patients who underwent additional procedures and emergency or salvage SAVR were excluded from the study. Trend and clinical outcomes were investigated in the whole cohort. Patients who had previous cardiac surgery, high-risk groups (EuroSCORE II >4%), and predicted/observed mortality were evaluated. Furthermore, the use of biological prostheses in five different age groups, that are <50, 50-59, 60-69, 70-79, and >80, was investigated. Clinical outcomes between the use of mechanical and biological aortic valve prostheses in patients <65 years old were analyzed. Results The number of isolated SAVR increased across the study period with an average of 4,661 cases performed annually after 2010. The in-hospital/30-day mortality rate decreased from 5.28% (1996) to 1.06% (2018), despite an increasing trend in EuroSCORE II. The number of isolated SAVR performed in octogenarians increased from 596 to 2007 (the first year when TAVR was introduced in the UK) to 872 in 2015 and then progressively decreased to 681 in 2018. Biological prosthesis usage increased across all age groups, particularly in the 60-69 group, from 24.59% (1996) to 81.87% (2018). There were no differences in short-term outcomes in patients <65 years old who received biological or mechanical prostheses. Conclusion Surgical aortic valve replacement remains an effective treatment for patients with isolated aortic valve disease with a low in-hospital/30-day mortality rate. The number of patients with high-risk and octogenarians who underwent isolated SAVR and those requiring redo surgery has reduced since 2016, likely due to the advancement in TAVR. The use of biological aortic prostheses has increased significantly in recent years in all age groups.
Collapse
Affiliation(s)
- Jeremy Chan
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Arnaldo Dimagli
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Daniel P Fudulu
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Shubhra Sinha
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Pradeep Narayan
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom.,NH Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | - Tim Dong
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Gianni D Angelini
- Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| |
Collapse
|
23
|
Kostyunin AE, Glushkova TV, Shishkova DK, Markova VE, Ovcharenko EA. [Screening analysis of proteolytic enzymes and their inhibitors in the leaflets of epoxy-treated bioprosthetic heart valves explanted due to dysfunction]. BIOMEDITSINSKAIA KHIMIIA 2022; 68:68-75. [PMID: 35221298 DOI: 10.18097/pbmc20226801068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Bioprosthetic heart valves (BHVs) are known for their lower thrombogenicity rates and excellent hemodynamic parameters similar to native valves. However, the lifespan of these medical devices is limited to 15 years due to the structural valve degeneration. One of the mechanisms underlying functional impairment and calcification of BHVs includes proteolytic degradation of biomaterials. However, proteases found in xenogeneic BHVs tissue remain poorly studied. In this study using the dot blot assay, we have performed a screening analysis of proteolytic enzymes and their inhibitors in the leaflets of five BHVs explanted due to their dysfunction. Five aortic valves (AVs) explanted due to calcific aortic valve disease were studied as a comparison group. The results of the study have demonstrated that at least 17 proteases and 19 of their inhibitors can be found in BHVs. In the AVs 20 proteases and 21 their inhibitors were identified. Small quantitative differences were noted between proteomic profiles of the BHVs and AVs. Matrix metalloproteinases (MMPs) were expressed in BHVs and AVs at comparable levels, but the level of tissue inhibitors of metalloproteinases-1/-2 and RECK protein in implant tissues was lower than in natural valves. Probably, excessive activity of MMPs cannot be counterbalanced by their inhibitors in BHVs and therefore MMPs can degrade prosthetic biomaterial. Moreover, the detection of a wide range of proteolytic enzymes and their inhibitors in the degenerated BHVs suggests the existence of several pathophysiological pathways that can lead to structural valve degeneration.
Collapse
Affiliation(s)
- A E Kostyunin
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - T V Glushkova
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - D K Shishkova
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - V E Markova
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - E A Ovcharenko
- Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| |
Collapse
|
24
|
Piperata A, Fiocco A, Cavicchiolo A, Ponzoni M, Pesce R, Gemelli M, Evangelista G, Gastino E, Michelotti S, Mazzaro E, Garufi L, DePaulis R, Zanella L, Nadali M, Mangino D, Lorenzoni G, Gregori D, Jorgji V, Gerosa G, Bottio T. Carpentier-Edwards Magna Ease bioprosthesis: a multicentre clinical experience and 12-year durability. Eur J Cardiothorac Surg 2021; 61:888-896. [PMID: 34962258 DOI: 10.1093/ejcts/ezab552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 10/19/2021] [Accepted: 11/01/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The goal of this multicentre retrospective study was to compare long-term clinical and haemodynamic outcomes of the Carpentier-Edwards Magna Ease (CEME) bioprosthesis by patient age. METHODS We included consecutive patients who underwent isolated and combined surgical aortic valve replacement (AVR) with CEME valve between January 2008 and March 2020 at 4 cardiac surgery centres in Italy. Survival distribution was evaluated at follow-up according to age and surgery type (combined or isolated AVR), together with freedom from structural valve deterioration (SVD), reoperation and combined events, i.e. SVD, reoperation, endocarditis and thromboembolic events. RESULTS A total of 1027 isolated and 1121 combined AVR were included; 776 patients were younger than 65 years whereas 1372 were 65 years or older. The 30-day Valve-Academic-Research-Consortium mortality was 2% (<65 years) and 6% (≥ 65 years) (P < 0.001), whereas it was 3% for isolated AVR and 7% for combined AVR (P < 0.001). The 12-year survival was 81% for those younger than 65 years vs 45% for those equal to or older than 65 years (P < 0.001), whereas they were 61% vs 49% for isolated and combined AVR (P = 0.10). The 12-year freedom from combined events, excluding death, was 79% for those younger than 65 years vs 87% for those equal to or older than (P = 0.51), whereas they were 83% for isolated and 86% for combined AVR (P = 0.10). The 12-year freedom from SVD was 93% and 93% in patients younger than 65 and those equal to or older than 65 years (P = 0.63), and the results were comparable even in cases with isolated and combined AVR (92% vs 94%, P = 0.21). A multivariable Cox analysis including gender, presence of patient-prosthesis mismatch, isolated AVR and age showed that only the age was an independent risk factor for the incidence of SVD (P = 0.029). CONCLUSIONS Outcomes from this large multicentre analysis demonstrated that a CEME bioprosthesis provides good clinical results and long-term durability even in patients younger than 65 years. Furthermore, the hazard for SVD has been shown to be lower for older age. CLINICAL TRIAL REGISTRATION NUMBER 105n/AO/21.
Collapse
Affiliation(s)
- Antonio Piperata
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Alessandro Fiocco
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Andrea Cavicchiolo
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Matteo Ponzoni
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Rita Pesce
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Marco Gemelli
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Giuseppe Evangelista
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Elisa Gastino
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Sara Michelotti
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Enzo Mazzaro
- Cardiac Surgery Unit, Azienda Integrata Isontina, Trieste Hospital, Trieste, Italy
| | - Luigi Garufi
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Ruggero DePaulis
- Cardiac Surgery Unit, European Hospital, Unicamillus, International Medical University, Rome, Italy
| | - Luca Zanella
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Matteo Nadali
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | | | - Giulia Lorenzoni
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Dario Gregori
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Vjola Jorgji
- Hacohen Lab, Massachusetts General Hospital, Boston, MA, USA
| | - Gino Gerosa
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Tomaso Bottio
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padova, Italy
| |
Collapse
|
25
|
Martinsson A, Nielsen SJ, Milojevic M, Redfors B, Omerovic E, Tønnessen T, Gudbjartsson T, Dellgren G, Jeppsson A. Life Expectancy After Surgical Aortic Valve Replacement. J Am Coll Cardiol 2021; 78:2147-2157. [PMID: 34823657 DOI: 10.1016/j.jacc.2021.09.861] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/12/2021] [Accepted: 09/06/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Surgical risk, age, perceived life expectancy, and valve durability influence the choice between surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation. The contemporaneous life expectancy after SAVR, in relation to surgical risk and age, is unknown. OBJECTIVES The purpose of this study was to determine median survival time in relation to surgical risk and chronological age in SAVR patients. METHODS Patients ≥60 years with aortic stenosis who underwent isolated SAVR with a bioprosthesis (n = 8,353) were risk-stratified before surgery into low, intermediate, or high surgical risk using the logistic EuroSCORE (2001-2011) or EuroSCORE II (2012-2017) and divided into age groups. Median survival time and cumulative 5-year mortality were estimated with Kaplan-Meier curves. Cox regression analysis was used to further determine the importance of age. RESULTS There were 7,123 (85.1%) low-risk patients, 942 (11.3%) intermediate-risk patients, and 288 (3.5%) high-risk patients. Median survival time was 10.9 years (95% confidence interval: 10.6-11.2 years) in low-risk, 7.3 years (7.0-7.9 years) in intermediate-risk, and 5.8 years (5.4-6.5 years) in high-risk patients. The 5-year cumulative mortality was 16.5% (15.5%-17.4%), 30.7% (27.5%-33.7%), and 43.0% (36.8%-48.7%), respectively. In low-risk patients, median survival time ranged from 16.2 years in patients aged 60 to 64 years to 6.1 years in patients aged ≥85 years. Age was associated with 5-year mortality only in low-risk patients (interaction P < 0.001). CONCLUSIONS Eighty-five percent of SAVR patients receiving bioprostheses have low surgical risk. Estimated survival is substantial following SAVR, especially in younger, low-risk patients, which should be considered in Heart Team discussions.
Collapse
Affiliation(s)
- Andreas Martinsson
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
| | - Susanne J Nielsen
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Milan Milojevic
- Department of Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia; Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Björn Redfors
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Theis Tønnessen
- Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway; University of Oslo, Oslo, Norway
| | - Tomas Gudbjartsson
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Göran Dellgren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anders Jeppsson
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden; Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
26
|
Can TAVR Match the Excellent Survival After SAVR in Younger, Low-Risk Patients? J Am Coll Cardiol 2021; 78:2158-2160. [PMID: 34823658 DOI: 10.1016/j.jacc.2021.09.860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 11/23/2022]
|
27
|
Jin X, Xu XT, Tian MX. Letter to the Editor: A comment to "Is sarcopenia a predictor of prognosis for patients undergoing radiotherapy for head and neck cancer? A meta-analysis". Clin Nutr 2021; 41:575-576. [PMID: 34876301 DOI: 10.1016/j.clnu.2021.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/18/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Xin Jin
- Department of Clinical Nutrition, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Xin-Tian Xu
- Department of Pharmacy, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Meng-Xing Tian
- Department of Clinical Nutrition, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| |
Collapse
|
28
|
Sitges M, Borregaard B, De Paulis R, Nolan P, Woan W, Pearce K, Näumann J, Johnson N, Wait S. Creating a better journey of care for patients with heart valve disease. EUROPEAN HEART JOURNAL OPEN 2021; 1:oeab034. [PMID: 35005718 PMCID: PMC8689964 DOI: 10.1093/ehjopen/oeab034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/14/2021] [Accepted: 11/03/2021] [Indexed: 12/26/2022]
Abstract
Heart valve disease has been described as 'the next cardiac epidemic', with prevalence expected to double by 2040 and triple by 2060 due to the ageing of the population. Yet until now, it has been characterized by scarce data, limited research, and low general awareness compared with other cardiovascular diseases. Effective treatment options exist for heart valve disease, and early detection and treatment can dramatically change disease progression, improve quality of life, and reduce mortality. Unfortunately, in too many patients, heart valve disease is undetected, undiagnosed, untreated, or treated too late, leading to avoidable deaths and costs, and significant compromises to people's quality of life. These gaps in the patient pathway can be remedied through appropriate policy action, with a focus on: early detection and diagnosis; timely intervention; patient-centred follow-up care; patient engagement and empowerment; psychological support; and better data to guide practice. Ensuring all patients have access to appropriate diagnosis and care without delays is imperative as we look towards rebuilding stronger and more resilient health systems, and 'build back better' after the coronavirus disease-19 pandemic.
Collapse
Affiliation(s)
- Marta Sitges
- Cardiovascular Institute, Hospital Clinic of Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Ruggero De Paulis
- Cardiac Surgery Department, European Hospital, Unicamillus University, Rome, Italy
| | - Paul Nolan
- Department of cardiology, Galway University Hospital, Saolta University Healthcare Group, Galway, Ireland
| | - Wil Woan
- Heart Valve Voice, Global Heart Hub Heart Valve Disease Patient Council, Manchester, UK
| | - Keith Pearce
- Department of cardiology, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Neil Johnson
- Croí West of Ireland Cardiac and Stroke Foundation and National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - Suzanne Wait
- The Health Policy Partnership, 68-69 St Martins’ Lane, London WC2N 4JS, UK
| |
Collapse
|
29
|
Jahangiri M, Bilkhu R, Embleton-Thirsk A, Dehbi HM, Mani K, Anderson J, Avlonitis V, Baghai M, Birdi I, Booth K, Bose A, Briffa N, Buchan K, Bhudia S, Cale A, Deglurkar I, Farid S, Hadjinikolaou L, Jarvis M, Javadpour SH, Jeganathan R, Kuduvalli M, Lall K, Mascaro J, Mehta D, Ohri S, Punjabi P, Venkateswaran R, Ridley P, Satur C, Stoica S, Trivedi U, Zaidi A, Yiu P, Moorjani N, Kendall S, Freemantle N. Surgical aortic valve replacement in the era of transcatheter aortic valve implantation: a review of the UK national database. BMJ Open 2021; 11:e046491. [PMID: 34711589 PMCID: PMC8557283 DOI: 10.1136/bmjopen-2020-046491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 09/21/2021] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To date the reported outcomes of surgical aortic valve replacement (SAVR) are mainly in the settings of trials comparing it with evolving transcatheter aortic valve implantation. We set out to examine characteristics and outcomes in people who underwent SAVR reflecting a national cohort and therefore 'real-world' practice. DESIGN Retrospective analysis of prospectively collected data of consecutive people who underwent SAVR with or without coronary artery bypass graft (CABG) surgery between April 2013 and March 2018 in the UK. This included elective, urgent and emergency operations. Participants' demographics, preoperative risk factors, operative data, in-hospital mortality, postoperative complications and effect of the addition of CABG to SAVR were analysed. SETTING 27 (90%) tertiary cardiac surgical centres in the UK submitted their data for analysis. PARTICIPANTS 31 277 people with AVR were identified. 19 670 (62.9%) had only SAVR and 11 607 (37.1%) had AVR+CABG. RESULTS In-hospital mortality for isolated SAVR was 1.9% (95% CI 1.6% to 2.1%) and was 2.4% for AVR+CABG. Mortality by age category for SAVR only were: <60 years=2.0%, 60-75 years=1.5%, >75 years=2.2%. For SAVR+CABG these were; 2.2%, 1.8% and 3.1%. For different categories of EuroSCORE, mortality for SAVR in low risk people was 1.3%, in intermediate risk 1% and for high risk 3.9%. 74.3% of the operations were elective, 24% urgent and 1.7% emergency/salvage. The incidences of resternotomy for bleeding and stroke were 3.9% and 1.1%, respectively. Multivariable analyses provided no evidence that concomitant CABG influenced outcome. However, urgency of the operation, poor ventricular function, higher EuroSCORE and longer cross clamp and cardiopulmonary bypass times adversely affected outcomes. CONCLUSIONS Surgical SAVR±CABG has low mortality risk and a low level of complications in the UK in people of all ages and risk factors. These results should inform consideration of treatment options in people with aortic valve disease.
Collapse
Affiliation(s)
| | - Rajdeep Bilkhu
- Department of Cardiac Surgery, St Thomas' Hospital, London, UK
| | | | - Hakim-Moulay Dehbi
- University College London Institute of Clinical Trials and Methodology, London, UK
| | - Krishna Mani
- Department of Cardiac Surgery, St George's Hospital, London, UK
| | - Jon Anderson
- Department of Cardiac Surgery, Hammersmith Hospital, London, UK
| | | | - Max Baghai
- Department of Cardiac Surgery, King's College Hospital, London, UK
| | - Inderpaul Birdi
- Department of Cardiac Surgery, Essex Cardiothoracic Centre, Basildon, UK
| | - Karen Booth
- Department of Cardiac Surgery, Freeman Hospital Cardiothoracic Centre, Newcastle upon Tyne, UK
| | - Amal Bose
- Department of Cardiac Surgery, Lancashire Cardiac Centre, Blackpool, UK
| | - Norman Briffa
- Sheffield Teaching Hospitals NHS Foundation Trust Cardiothoracic Centre, Sheffield, UK
| | - Keith Buchan
- Department of Cardiac Surgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | | | - Alex Cale
- Department of Cardiac Surgery, Castle Hill Hospital, Cottingham, UK
| | - Indu Deglurkar
- Department of Cardiac Surgery, University Hospital of Wales Healthcare NHS Trust, Cardiff, UK
| | - Shakil Farid
- Department of Cardiac Surgery, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Leonidas Hadjinikolaou
- Department of Cardiac Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Martin Jarvis
- Department of Cardiac Surgery, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | | | | | - Manoj Kuduvalli
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Kulvinder Lall
- Saint Bartholomew's Hospital Barts Heart Centre, London, UK
| | - Jorge Mascaro
- Department of Cardiac Surgery, Queen Elizabeth Medical Centre, Birmingham, UK
| | - Dheeraj Mehta
- Department of Cardiac Surgery, University Hospital of Wales Healthcare NHS Trust, Cardiff, UK
| | - Sunil Ohri
- Department of Cardiac Surgery, Southampton University Hospitals NHS Trust, Southampton, UK
| | - Prakash Punjabi
- Department of Cardiac Surgery, Hammersmith Hospital, London, UK
| | | | - Paul Ridley
- Department of Cardiac Surgery, University Hospital of North Staffordshire NHS Trust, Stoke-on-Trent, UK
| | - Christopher Satur
- Department of Cardiac Surgery, University Hospital of North Staffordshire NHS Trust, Stoke-on-Trent, UK
| | - Serban Stoica
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK
| | - Uday Trivedi
- Royal Sussex County Hospital Sussex Cardiac Centre, Brighton, UK
| | - Afzal Zaidi
- Department of Cardiac Surgery, Morriston Hospital, Swansea, UK
| | - Patrick Yiu
- Department of Cardiac Surgery, New Cross Hospital, Wolverhampton, UK
| | - Narain Moorjani
- Department of Cardiac Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Simon Kendall
- Department of Cardiac Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Nick Freemantle
- Comprehensive Clinical Trials Unit, University College London Institute of Clinical Trials and Methodology, London, UK
| |
Collapse
|
30
|
Baolei G, Can C, Peng L, Yan S, Cheng Y, Hui T, Minzhi L, Daqiao G, Weiguo F. Molecular Imaging of Abdominal Aortic Aneurysms with Positron Emission Tomography: A Systematic Review. Eur J Vasc Endovasc Surg 2021; 62:969-980. [PMID: 34696984 DOI: 10.1016/j.ejvs.2021.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 07/29/2021] [Accepted: 08/14/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Previous studies on the relationship between positron emission tomography (PET) images and abdominal aortic aneurysm (AAA) progression have shown contradictory results, and the objective of this study was to systematically review the role of PET in predicting AAA prognosis. DATA SOURCES PubMed, Embase, and Web of Science were searched for studies evaluating the correlation between PET imaging results and AAA growth, repair, or rupture. REVIEW METHODS Two authors independently performed the study search, data extraction, and quality assessment following a standard method. RESULTS Of the 11 studies included in this review, nine used 18F-fluorodeoxyglucose (18F-FDG) PET and computed tomography (CT) imaging, whereas the remaining two used 18F-sodium fluoride (18F-NaF) PET/CT and 18F-FDG PET/magnetic resonance imaging (MRI). Findings from the 18F-FDG PET/CT studies were contradictory. Six studies found no significant association or correlation, and two studies found a significant negative correlation between 18F-FDG uptake and AAA expansion. Additionally, one study found that the 18F-FDG uptake was statistically positively related to the expansion rate in a specific AAA subgroup whose AAAs expanded significantly. Two studies suggested that increased 18F-FDG uptake was significantly associated with AAA repair, while the other studies either found no association between 18F-FDG uptake and AAA rupture or repair or failed to report the occurrence of clinical events. One PET/CT study that used 18F-NaF as a tracer showed that an increased tracer uptake was significantly associated with AAA growth and clinical events. Finally, the 18F-FDG PET/MRI study indicated that 18F-FDG uptake was not significantly correlated with AAA expansion. CONCLUSION A definitive role for 18F-FDG PET imaging for AAA prognosis awaits further investigation, and new PET tracers such as 18F-NaF have the potential to be a promising method for predicting AAA clinical outcomes.
Collapse
Affiliation(s)
- Guo Baolei
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China.
| | - Chen Can
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lv Peng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shan Yan
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yan Cheng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tan Hui
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lv Minzhi
- Department of Medical Statistics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guo Daqiao
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Fu Weiguo
- Department of Vascular Surgery, Zhongshan Hospital, Institute of Vascular Surgery, Fudan University, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China.
| |
Collapse
|
31
|
Hernández-Vaquero D, Rodríguez-Caulo E, Vigil-Escalera C, Blanco-Herrera Ó, Berastegui E, Arias-Dachary J, Souaf S, Parody G, Laguna G, Adsuar A, Castellá M, Valderrama JF, Pulitani I, Cánovas S, Ferreiro A, García-Valentín A, Carnero M, Pareja P, Corrales JA, Blázquez JA, Macías D, Fletcher-Sanfeliu D, Martínez D, Martín E, Martín M, Margarit J, Hernández-Estefanía R, Monguió E, Otero J, Silva J. Esperanza de vida tras el reemplazo de válvula aórtica en pacientes jóvenes. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2021.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
32
|
Gallo M, Sá MPBO, Doulamis IP, Hussein N, Laforgia PL, Kampaktsis PN, Tagliari AP, Ferrari E. Transcatheter valve-in-valve implantation for degenerated bioprosthetic aortic and mitral valves - an update on indications, techniques, and clinical results. Expert Rev Med Devices 2021; 18:597-608. [PMID: 34080501 DOI: 10.1080/17434440.2021.1939009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: Aortic and mitral bioprosthesis are the gold standard treatment to replace a pathological native valve. However, bioprostheses are prone to structural valve degeneration, resulting in limited long-term durability. During the past decade, the implantation of transcatheter stent-valves within degenerated aortic and mitral bioprostheses, (the so-called 'valve-in-valve' procedure), represents a valid alternative to redo surgery in patients with high-risk surgical profiles.Areas covered: We reviewed the clinical outcomes and the procedural details of transcatheter aortic and mitral valve-in-valve series according to current published literature and include a practical guide for valve sizing and stent-valve positioning and strategies to prevent complications.Expert opinion: In both aortic and mitral positions meticulous planning is fundamental in these procedures to avoid serious complications including patient prosthesis mismatch, coronary obstruction and left ventricular outflow tract obstruction.
Collapse
Affiliation(s)
- Michele Gallo
- Cardiovascular Surgery, Cardiocentro Ticino Institute, Lugano, Switzerland
| | - Michel Pompeu B O Sá
- Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco PROCAPE, University of Pernambuco-UPE, Recife, Brazil
| | - Ilias P Doulamis
- Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nabil Hussein
- Department of Congenital Cardiac Surgery, Yorkshire Heart Centre, Leeds General Infirmary, England, UK
| | - Pietro L Laforgia
- Department of Cardiology, Institut Cardiovasculaire Paris Sud, Massy, France
| | | | - Ana Paula Tagliari
- Postgraduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Enrico Ferrari
- Cardiovascular Surgery, Cardiocentro Ticino Institute, Lugano, Switzerland
| |
Collapse
|
33
|
Kontogeorgos S, Thunström E, Pivodic A, Dahlström U, Fu M. Prognosis and outcome determinants after heart failure diagnosis in patients who underwent aortic valvular intervention. ESC Heart Fail 2021; 8:3237-3247. [PMID: 34057321 PMCID: PMC8318512 DOI: 10.1002/ehf2.13451] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/26/2021] [Accepted: 05/19/2021] [Indexed: 12/17/2022] Open
Abstract
AIMS To study clinical phenotype, prognosis for all-cause and cardiovascular (CV) mortality and predictive factors in patients with incident heart failure (HF) after aortic valvular intervention (AVI) for aortic stenosis (AS). METHODS AND RESULTS In this retrospective, observational study we included patients from the Swedish Heart Failure Registry (SwedeHF) recorded 2003-2016, with AS diagnosis and AVI before HF diagnosis. The AS diagnosis was established according to International Classification of Diseases 10th revision (ICD-10) codes, thus without information concerning clinical or echocardiographical data on the aortic valve disease. The patients were divided into two subgroups: left ventricular ejection fraction (LVEF) ≥ 50% (AS-HFpEF) and <50% (AS-HFrEF). We individually matched three controls with HF from the SwedeHF without AS (control group) for each patient. Baseline characteristics, co-morbidities, survival status and outcomes were obtained by linking the SwedeHF with two other Swedish registries. We used Kaplan-Meier curves to present time to all-cause mortality, cumulative incidence function for time to CV mortality and Cox proportional hazards model to evaluate the relative difference between AS-HFrEF and AS-HFpEF and AS-HF and controls. The crude all-cause mortality was 49.0%, CV mortality 27.9% in AS-HF patients, respectively 44.7% and 26.6% in matched controls. The adjusted risk for all-cause mortality and CV mortality was similar in HF, regardless of LVEF vs. controls. No significant difference in factors predicting higher all-cause mortality was observed in AS-HFrEF vs. AS-HFpEF, except for diabetes (only in AS-HFrEF), with statistically significant interaction predicting death between the two groups. CONCLUSIONS In this nationwide SwedeHF study, we characterized incident HF population after AVI. We found no significant differences in all-cause and CV mortality compared with general HF population. They had virtually the same predictors for mortality, regardless of LVEF.
Collapse
Affiliation(s)
- Silvana Kontogeorgos
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Erik Thunström
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Aldina Pivodic
- Statistiska Konsultgruppen, Gothenburg, Sweden.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ulf Dahlström
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | - Michael Fu
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
34
|
Percutaneous versus Surgical Intervention for Severe Aortic Valve Stenosis: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2021; 2021:3973924. [PMID: 34136565 PMCID: PMC8175165 DOI: 10.1155/2021/3973924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/04/2021] [Accepted: 05/14/2021] [Indexed: 11/18/2022]
Abstract
Aortic stenosis is a disease that is increasing in prevalence and manifests as decreased cardiac output, which if left untreated can result in heart failure and ultimately death. It is primarily a disease of the elderly who often have multiple comorbidities. The advent of transcatheter aortic valve therapies has changed the way we treat these conditions. However, long-term results of these therapies remain uncertain. Recently, there has been an increasing number of studies examining the role of both surgical aortic valve replacement and transcatheter aortic valve replacement. We therefore performed a systematic review using Ovid MEDLINE, Ovid Embase, and the Cochrane Library. Two investigators searched papers published between January 1, 2007, and to date using the following terms: "aortic valve stenosis," "aortic valve operation," and "transcatheter aortic valve therapy." Both strategies in aortic stenosis treatment highlighted specific indications alongside the pitfalls such as structural valve degeneration and valve thrombosis which have a bearing on clinical outcomes. We propose some recommendations to help clinicians in the decision-making process as technological improvements make both surgical and transcatheter therapies viable options for patients with aortic stenosis. Finally, we assess the role of finite element analysis in patient selection for aortic valve replacement. THVT and AVR-S are both useful tools in the armamentarium against aortic stenosis. The decision between the two treatment strategies should be best guided by a strong robust evidence base, ideally with a long-term follow-up. This is best performed by the heart team with the patient as the center of the discussion.
Collapse
|
35
|
2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg 2021; 162:e183-e353. [PMID: 33972115 DOI: 10.1016/j.jtcvs.2021.04.002] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
36
|
Abstract
PURPOSE OF REVIEW The PARTNER 3 trial was conducted to compare outcomes after transcatheter aortic valve replacement (TAVR) with a balloon-expandable valve and surgical aortic valve replacement (SAVR) in individuals at low surgical risk with aortic stenosis. Recently reported rates of death, stoke and valve thrombosis in the TAVR arm have raised concerns about the longevity of this intervention in low-risk individuals. It is incumbent on all members of the Heart Team to understand the potential consequences of these findings. RECENT FINDINGS TAVR was initially superior to SAVR at 1 year for a primary composite endpoint of death, stroke and rehospitalization. Results at 2 years now indicate noninferiority. Potential causative factors, comparisons with other transcatheter valves and implications for patients, providers and trainees are explored. Recommendations are additionally provided regarding TAVR and SAVR in individuals with aortic stenosis. SUMMARY Concerns regarding the longevity of TAVR in low-risk individuals notwithstanding, results from PARTNER 3 indicate that TAVR is at least noninferior to SAVR out to 2 years. Longer follow-up will be required to determine whether these newly founded concerns are justifiable.
Collapse
|
37
|
Jahangiri M. Survival after surgical aortic valve replacement in patients with bicuspid aortic valve disease. Heart 2021; 107:1113-1114. [PMID: 33795380 DOI: 10.1136/heartjnl-2021-319088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Marjan Jahangiri
- Cardiac Surgery, St George's Hospital and Medical School, London, UK
| |
Collapse
|
38
|
Hernandez-Vaquero D, Rodriguez-Caulo E, Vigil-Escalera C, Blanco-Herrera O, Berastegui E, Arias-Dachary J, Souaf S, Parody G, Laguna G, Adsuar A, Castellá M, Valderrama JF, Pulitani I, Cánovas S, Ferreiro A, García-Valentín A, Carnero M, Pareja P, Corrales JA, Blázquez JA, Macías D, Fletcher-Sanfeliu D, Martínez D, Martín E, Martín M, Margarit J, Hernández-Estefanía R, Monguió E, Otero J, Silva J. Differences in life expectancy between men and women after aortic valve replacement. Eur J Cardiothorac Surg 2021; 60:681-688. [PMID: 33772276 DOI: 10.1093/ejcts/ezab140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/18/2021] [Accepted: 01/24/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Some researchers have observed an increased number of deaths during the follow-up of young patients who undergo aortic valve replacement due to severe aortic stenosis, suggesting that this procedure does not restore their life expectancy. Our goal was to confirm these findings and explore sex-based differences. METHODS All patients between 50 and 65 years of age who underwent isolated aortic valve replacement in 27 Spanish centres during an 18-year period were included. We compared observed and expected survival at 15 years of follow-up and estimated the cumulative incidence of death from a competing risks point of view. We stratified by sex and analysed if being a woman was an independent risk factor for death. RESULTS For men, the observed survival at 10 and 15 years of follow-up was 85% [95% confidence interval (CI) 83.6%-86.4%] and 72.3% (95% CI 69.7%-74.7%), respectively whereas the expected survival was 88.1% and 78.8%. For women, the observed survival at 10 and 15 years was 85% (95% CI 82.8%-86.9%) and 73% (95% CI 69.1%-76.4%), whereas the expected survival was 94.6% and 89.4%. At 15 years of follow-up, the cumulative incidence of death due to the disease in men and women was 8.2% and 16.7%, respectively. In addition, being a woman was an independent risk factor for death (hazard ratio = 1.23 (95% CI 1.02-1.48; P = 0.03). CONCLUSIONS After the aortic valve replacement, men and women do not have their life expectancy restored, but this loss is much higher in women than in men. In addition, being a woman is a risk factor for long-term death. Reasons for these findings are unknown and must be investigated.
Collapse
Affiliation(s)
| | | | | | | | - Elisabet Berastegui
- Cardiovascular Surgery Department, Germans Trias I Pujol Hospital, Badalona, Spain
| | - Javier Arias-Dachary
- Cardiovascular Surgery Department, Reina Sofia University Hospital, Cordoba, Spain
| | - Souhayla Souaf
- Cardiovascular Surgery Department, Clinic University Hospital, Santiago de Compostela, Spain
| | - Gertrudis Parody
- Cardiovascular Surgery Department, Virgen de la Macarena University Hospital, Sevilla, Spain
| | - Gregorio Laguna
- Cardiovascular Surgery Department, Clinic University Hospital, Valladolid, Spain
| | - Alejandro Adsuar
- Cardiovascular Surgery Department, Virgen del Rocio University Hospital, Sevilla, Spain
| | - Manel Castellá
- Cardiovascular Surgery Department, Clinic Hospital, University of Barcelona, Spain
| | - José F Valderrama
- Cardiovascular Surgery Department, Regional de Malaga University Hospital, Spain
| | - Ivana Pulitani
- Cardiovascular Surgery Department, Marques de Valdecilla University Hospital, Santander, Spain
| | - Sergio Cánovas
- Cardiovascular Surgery Department, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - Andrea Ferreiro
- Cardiovascular Surgery Department, Virgen de las Nieves University Hospital, Granada, Spain
| | | | - Manuel Carnero
- Cardiovascular Surgery Department, San Carlos University Hospital, Madrid, Spain
| | - Pilar Pareja
- Cardiovascular Surgery Department, Virgen de la Salud University Hospital, Toledo, Spain
| | - José A Corrales
- Cardiovascular Surgery Department, Badajoz University Hospital, Badajoz, Spain
| | - José A Blázquez
- Cardiovascular Surgery Department, La Paz University Hospital, Madrid, Spain
| | - Diego Macías
- Cardiovascular Surgery Department, Puerta del Mar University Hospital, Cadiz, Spain
| | | | - Daniel Martínez
- Cardiovascular Surgery Department, Puerta del Hierro University Hospital, Madrid, Spain
| | - Elio Martín
- Cardiovascular Surgery Department, Leon University Hospital, Leon, Spain
| | - Miren Martín
- Cardiovascular Surgery Department, Ramon y Cajal University Hospital, Madrid, Spain
| | - Juan Margarit
- Cardiovascular Surgery Department, De la Ribera Public University Hospital, Alzira, Spain
| | | | - Emilio Monguió
- Cardiovascular Surgery Department, La Princesa University Hospital, Madrid, Spain
| | - Juan Otero
- Cardiovascular Surgery Department, Virgen de la Victoria University Hospital, Malaga, Spain
| | - Jacobo Silva
- Cardiac Surgery Department, Central University Hospital of Asturias, Oviedo, Spain
| |
Collapse
|
39
|
Bakhtiary F, Ahmad AES, Autschbach R, Benedikt P, Bonaros N, Borger M, Dewald O, Feyrer R, Geißler HJ, Grünenfelder J, Lam KY, Leyh R, Liebold A, Czesla M, Mehdiani A, Pollari F, Salamate S, Strauch J, Vötsch A, Weber A, Wendt D, Botta B, Bramlage P, Zierer A. Impact of pre-existing comorbidities on outcomes of patients undergoing surgical aortic valve replacement - rationale and design of the international IMPACT registry. J Cardiothorac Surg 2021; 16:51. [PMID: 33766089 PMCID: PMC7993500 DOI: 10.1186/s13019-021-01434-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 03/16/2021] [Indexed: 11/18/2022] Open
Abstract
Background Degenerative aortic valve disease accounts for 10–20% of all cardiac surgical procedures. The impact of pre-existing comorbidities on the outcome of patients undergoing surgical aortic valve replacement (SAVR) needs further research. Methods The IMPACT registry is a non-interventional, prospective, open-label, multicenter, international registry with a follow-up of 5 years to assess the impact of pre-existing comorbidities of patients undergoing SAVR with the INSPIRIS RESILIA aortic valve on outcomes. IMPACT will be conducted across 25 sites in Austria, Germany, The Netherlands and Switzerland and intends to enroll approximately 500 patients. Patients will be included if they are at least 18 years of age and are scheduled to undergo SAVR with the INSPIRIS RESILIA Aortic Valve with or without concomitant ascending aortic root replacement and/or coronary bypass surgery. The primary objective is to determine all-cause mortality at 1, 3, and 5 years post SAVR. Secondary objectives include cardiac-related and valve-related mortality and structural valve deterioration including hemodynamics and durability, valve performance and further clinical outcomes in the overall study population and in specific patient subgroups characterized by the presence of chronic kidney disease, hypertension, metabolic syndrome and/or chronic inflammation. Discussion IMPACT is a prospective, multicenter European registry, which will provide much-needed data on the impact of pre-existing comorbidities on patient outcomes and prosthetic valve performance, and in particular the performance of the INSPIRIS RESILIA, in a real-world setting. The findings of this study may help to support and expand appropriate patient selection for treatment with bioprostheses. Trial registration ClinicalTrials.gov identifier: NCT04053088.
Collapse
Affiliation(s)
- Farhad Bakhtiary
- Division of Cardiac Surgery, Heart Center Siegburg-Wuppertal, University Witten-Herdecke, Ringstr. 49, 53721, Siegburg, Germany.
| | - Ali El-Sayed Ahmad
- Division of Cardiac Surgery, Heart Center Siegburg-Wuppertal, University Witten-Herdecke, Ringstr. 49, 53721, Siegburg, Germany
| | | | - Peter Benedikt
- Kepler University Hospital Linz, Linz; and Hospital Wels-Grieskirchen, Wels, Austria
| | | | | | | | | | - Hans-Joachim Geißler
- Kepler University Hospital Linz, Linz; and Hospital Wels-Grieskirchen, Wels, Austria
| | | | - Ka Yan Lam
- Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Rainer Leyh
- University Hospital Wuerzburg, Wuerzburg, Germany
| | | | | | | | - Francesco Pollari
- Cardiac Surgery, Klinikum Nürnberg - Paracelsus Medical University, Nuremberg, Germany
| | - Saad Salamate
- Division of Cardiac Surgery, Heart Center Siegburg-Wuppertal, University Witten-Herdecke, Ringstr. 49, 53721, Siegburg, Germany
| | | | - Andreas Vötsch
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Medical University, Salzburg, Austria
| | | | | | - Beate Botta
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Andreas Zierer
- Kepler University Hospital Linz, Linz; and Hospital Wels-Grieskirchen, Wels, Austria
| |
Collapse
|
40
|
Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 143:e72-e227. [PMID: 33332150 DOI: 10.1161/cir.0000000000000923] [Citation(s) in RCA: 569] [Impact Index Per Article: 189.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
41
|
Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 143:e35-e71. [PMID: 33332149 DOI: 10.1161/cir.0000000000000932] [Citation(s) in RCA: 353] [Impact Index Per Article: 117.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIM This executive summary of the valvular heart disease guideline provides recommendations for clinicians to diagnose and manage valvular heart disease as well as supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from January 1, 2010, to March 1, 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, Cochrane, Agency for Healthcare Research and Quality Reports, and other selected database relevant to this guideline. Structure: Many recommendations from the earlier valvular heart disease guidelines have been updated with new evidence and provides newer options for diagnosis and treatment of valvular heart disease. This summary includes only the recommendations from the full guideline which focus on diagnostic work-up, the timing and choice of surgical and catheter interventions, and recommendations for medical therapy. The reader is referred to the full guideline for graphical flow charts, text, and tables with additional details about the rationale for and implementation of each recommendation, and the evidence tables detailing the data considered in developing these guidelines.
Collapse
|
42
|
Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 77:e25-e197. [PMID: 33342586 DOI: 10.1016/j.jacc.2020.11.018] [Citation(s) in RCA: 848] [Impact Index Per Article: 282.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
43
|
Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O’Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary. J Am Coll Cardiol 2021; 77:450-500. [DOI: 10.1016/j.jacc.2020.11.035] [Citation(s) in RCA: 272] [Impact Index Per Article: 90.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
44
|
Flemister DC, Hatoum H, Guhan V, Zebhi B, Lincoln J, Crestanello J, Dasi LP. Effect of Left and Right Coronary Flow Waveforms on Aortic Sinus Hemodynamics and Leaflet Shear Stress: Correlation with Calcification Locations. Ann Biomed Eng 2020; 48:2796-2808. [PMID: 33145675 PMCID: PMC11022940 DOI: 10.1007/s10439-020-02677-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 10/22/2020] [Indexed: 12/22/2022]
Abstract
Coronary flow induces hemodynamic alterations in the aortic sinus region. The objectives of this study are to: (1) investigate the differences among sinus hemodynamics and leaflet wall shear stresses engendered by the left versus right versus non-coronary flow and (2) correlate respective wall shear stresses with leaflet calcification in patients. A left heart simulator flow loop with a tunable coronary circuit provided physiological coronary flow waveforms corresponding to the left coronary cusp case (LCC), right coronary cusp case (RCC), and non-coronary cusp case (NCC). High spatio-temporal resolution particle image velocimetry was conducted to quantify leaflet wall shear stress and sinus vorticity fields and to measure aortic leaflet tip kinematics. Thirty-one patients with severe calcific aortic valve disease were segmented from CT data for the calcific volumes in their respective left, right, and non-coronary cusps. Leaflet tip position during systole shows the RCC has a wider leaflet opening compared to LCC and NCC. Velocity and vorticity fields combined with leaflet position data show that sinus vorticity is diminished (peak ~ 43 s-1) in the LCC while RCC and NCC maintain high vorticity (~ 1200 and ~ 950 s-1 respectively). WSS magnitudes greater than 0.3 Pa show 20 and 81% greater occurrences in the LCC and RCC respectively compared to NCC. Significant differences [X2 (2, n = 31) = 7.31, p = 0.0258] between the calcification levels in each cusp of the patient population. Coronary flow differences between LCC, RCC, and NCC show significant impact on leaflet kinematics and sinus flow hemodynamics. Clinical data correlations of the coronary flow cases indicate the left coronary cusp has a higher likelihood of calcification compared to the right.
Collapse
Affiliation(s)
- Dorma C Flemister
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
| | - Hoda Hatoum
- Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle, Atlanta, GA, 30313, USA
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, 49931, USA
| | - Varshini Guhan
- Department of Neuroscience, The Ohio State University, Columbus, OH, USA
| | - Banafsheh Zebhi
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Joy Lincoln
- Department of Pediatric Cardiology, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | | | - Lakshmi P Dasi
- Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle, Atlanta, GA, 30313, USA.
| |
Collapse
|
45
|
Nappi F, Spadaccio C, Moon MR. A management framework for left sided endocarditis: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1627. [PMID: 33437826 PMCID: PMC7791223 DOI: 10.21037/atm-20-4439] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Left sided endocarditis (LSE) can include the entirety or portion of mitral and/or aortic valve and the structures in their anatomical contiguity and represent a significant portion of emergency surgical activity. Literature and guidelines on the management of LSE relies mainly on observational studies given the difficulty in designing randomized trials in emergency settings. Heart teams (HT) are often called in to difficult decisions on the most appropriate strategy to adopted in case of LSE. Decision-making should take into account the localization and the extension of the infection, patient preoperative status and comorbidities, presence of a previous valve prosthesis and best timing for surgery. Despite evidence suggests that early surgery may improve survival in patients with complicated infective endocarditis (IE), an increased risk of recurrence and postoperative valvular dysfunctions has been reported. The most important factors associated with long-term outcomes are preoperative multiorgan failure, prosthetic mechanical valve IE, vegetation size ≥15 mm, and timing of surgical treatment. Importantly, up to one third of potential candidates do not undergo surgery and these patients experience extremely high mortality rates. Another important point regards the choice of the optimal valve substitute to be used according to the different clinical situation. The lack of RCT in this field and the difficulty to design this type of studies in the case of non-elective conditions further complicates the possibility to achieve a univocal consensus on the best strategy to be adopted in each form of LSE and further validation studies are needed. On the basis of the current evidences a decisional algorithm is proposed summarizing all the crucial aspects in the management of LSE.
Collapse
Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
| | - Cristiano Spadaccio
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Glasgow, UK.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Marc R Moon
- Department of Cardiac Thoracic Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| |
Collapse
|
46
|
Paille M, Senage T, Roussel JC, Manigold T, Piccoli M, Chapelet G, Le Tourneau T, Karakachoff M, Berrut G, de Decker L, Boureau AS. Association of Preoperative Geriatric Assessment With Length of Stay After Combined Cardiac Surgery. Ann Thorac Surg 2020; 112:763-769. [PMID: 33227273 DOI: 10.1016/j.athoracsur.2020.09.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 08/22/2020] [Accepted: 09/22/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND For older patients undergoing cardiac surgery, geriatric factors are known to increase postoperative complications and prolong length of stay (LOS). Comprehensive geriatric assessment (CGA) is an evidence-based method for geriatric evaluation to develop an individualized-care plan to optimize physical, functional, and social issues. This study analyzed the association between preoperative CGA and hospital LOS after combined cardiac surgery. METHODS This retrospective monocentric study included all patients aged 75 years and greater who underwent combined cardiac surgery between 2014 and 2017. Hospital LOS, intensive care unit LOS, and postoperative complications were compared between patients with or without preoperative CGA before and after propensity-score matching. RESULTS Mean age of the 407 patients was 79.6 years; 114 underwent a preoperative CGA (28%). For 305 patients (74.9%), coronary artery bypass was associated with aortic valve replacement. After propensity-score matching, a significant difference was found between the 2 groups (preoperative CGA versus none) for in-hospital LOS (12 versus 13 days; P = .04) and intensive care unit LOS (3 versus 4 days; P = .01). In multivariable analysis, a significant association remained between hospital LOS and CGA (P = .02), renal function (P = .02), mitral replacement (P = .001), and complications (P = .001). CONCLUSIONS Our results favor the use of systematic preoperative CGA. These encouraging results need to be validated by prospective studies that assess the impact of individualized-care plan established after CGA on postoperative outcomes. With an aging population, efforts are required to determine how to implement preoperative individualized-care plans to improve postoperative outcomes for vulnerable patients undergoing cardiac surgery.
Collapse
Affiliation(s)
| | - Thomas Senage
- Department of Thoracic and Cardiovascular Surgery, Institut du Thorax, University Hospital, Nantes, France
| | - Jean-Christian Roussel
- Department of Thoracic and Cardiovascular Surgery, Institut du Thorax, University Hospital, Nantes, France; Université de Nantes, CHU Nantes, CNRS, INSERM, Institut du Thorax, Nantes, France
| | - Thibaut Manigold
- Department of Cardiology, Institut du Thorax, University Hospital, Nantes, France
| | - Matthieu Piccoli
- Department of Geriatrics, Hopital Broca, Université Paris-Descartes, Paris, France
| | | | - Thierry Le Tourneau
- Université de Nantes, CHU Nantes, CNRS, INSERM, Institut du Thorax, Nantes, France
| | | | - Gilles Berrut
- Department of Geriatrics, University Hospital, Nantes, France
| | - Laure de Decker
- Department of Geriatrics, University Hospital, Nantes, France
| | - Anne Sophie Boureau
- Department of Geriatrics, University Hospital, Nantes, France; Université de Nantes, CHU Nantes, CNRS, INSERM, Institut du Thorax, Nantes, France.
| |
Collapse
|
47
|
Kostyunin A, Mukhamadiyarov R, Glushkova T, Bogdanov L, Shishkova D, Osyaev N, Ovcharenko E, Kutikhin A. Ultrastructural Pathology of Atherosclerosis, Calcific Aortic Valve Disease, and Bioprosthetic Heart Valve Degeneration: Commonalities and Differences. Int J Mol Sci 2020; 21:E7434. [PMID: 33050133 PMCID: PMC7587971 DOI: 10.3390/ijms21207434] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/05/2020] [Accepted: 10/08/2020] [Indexed: 01/24/2023] Open
Abstract
Atherosclerosis, calcific aortic valve disease (CAVD), and bioprosthetic heart valve degeneration (alternatively termed structural valve deterioration, SVD) represent three diseases affecting distinct components of the circulatory system and their substitutes, yet sharing multiple risk factors and commonly leading to the extraskeletal calcification. Whereas the histopathology of the mentioned disorders is well-described, their ultrastructural pathology is largely obscure due to the lack of appropriate investigation techniques. Employing an original method for sample preparation and the electron microscopy visualisation of calcified cardiovascular tissues, here we revisited the ultrastructural features of lipid retention, macrophage infiltration, intraplaque/intraleaflet haemorrhage, and calcification which are common or unique for the indicated types of cardiovascular disease. Atherosclerotic plaques were notable for the massive accumulation of lipids in the extracellular matrix (ECM), abundant macrophage content, and pronounced neovascularisation associated with blood leakage and calcium deposition. In contrast, CAVD and SVD generally did not require vasculo- or angiogenesis to occur, instead relying on fatigue-induced ECM degradation and the concurrent migration of immune cells. Unlike native tissues, bioprosthetic heart valves contained numerous specialised macrophages and were not capable of the regeneration that underscores ECM integrity as a pivotal factor for SVD prevention. While atherosclerosis, CAVD, and SVD show similar pathogenesis patterns, these disorders demonstrate considerable ultrastructural differences.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Anton Kutikhin
- Department of Experimental Medicine, Research Institute for Complex Issues of Cardiovascular Diseases, 6 Sosnovy Boulevard, 650002 Kemerovo, Russia; (A.K.); (R.M.); (T.G.); (L.B.); (D.S.); (N.O.); (E.O.)
| |
Collapse
|
48
|
Hirji SA, Percy ED, McGurk S, Malarczyk A, Harloff MT, Yazdchi F, Sabe AA, Bapat VN, Tang GH, Bhatt DL, Thourani VH, Leon MB, O’Gara P, Shah PB, Kaneko T. Incidence, Characteristics, Predictors, and Outcomes of Surgical Explantation After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2020; 76:1848-1859. [DOI: 10.1016/j.jacc.2020.08.048] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/19/2020] [Accepted: 08/19/2020] [Indexed: 12/22/2022]
|
49
|
Nappi F, Avtaar Singh SS, Timofeeva I. Learning From Controversy: Contemporary Surgical Management of Aortic Valve Endocarditis. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2020; 14:1179546820960729. [PMID: 33088184 PMCID: PMC7545763 DOI: 10.1177/1179546820960729] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 08/30/2020] [Indexed: 12/27/2022]
Abstract
Aortic valve replacement is the commonest cardiac surgical operation performed worldwide for infective endocarditis (IE). Long-term durability and avoidance of infection relapse are goals of the procedure. However, no detailed guidelines on prosthesis selection and surgical strategies guided by the comprehensive evaluation of the extension of the infection and its microbiological characteristics, clinical profile of the patient, and risk of infection recurrence are currently available. Conventional mechanical or stented xenografts are the preferred choice for localized aortic infection. However, in cases of complex IE with the involvement of the root or the aortomitral continuity, the use of homograft is suggested according to the surgeon and center experience. Homograft use should be counterbalanced against the risk of structural degeneration. Prosthetic bioroot or prosthetic valved conduit (mechanical and bioprosthetic) are also potentially suitable alternatives. Further development of preservation techniques enabling longer durability of allogenic substitutes is required. We evaluate the current evidence for the use of valve substitutes in aortic valve endocarditis and propose an evidence-based algorithm to guide the choice of therapy. We performed a systemic review to clarify the contemporary surgical management of aortic valve endocarditis.
Collapse
Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
| | - Sanjeet Singh Avtaar Singh
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Glasgow, UK
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Irina Timofeeva
- Department of Imaging, Centre Cardiologique du Nord de Saint-Denis, Paris, France
| |
Collapse
|
50
|
Nappi F, Singh SSA, Spadaccio C, Acar C. Revisiting the guidelines and choice the ideal substitute for aortic valve endocarditis. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:952. [PMID: 32953752 PMCID: PMC7475423 DOI: 10.21037/atm-20-1522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Aortic valve replacement is the most commonly performed cardiac surgical operation worldwide for infective endocarditis (IE). Long-term durability and avoidance of infection relapse are the treatment goals. However, no detailed guidelines on prosthesis selection and surgical strategy are available. Management should be guided by a comprehensive evaluation of infection extension and its microbiological characteristics, the clinical profile of the patient and the risk of infection recurrence. We conducted a literature search of the PubMed database, EMBASE and Cochrane Library (through November 2019) for studies reporting to the use of biological substitutes in aortic valve endocarditis (AVE). Studies comparing long-term outcomes in the use of allogenic and autologous with conventional prostheses were investigated. Conventional mechanical or stented xenografts are the preferred choice for localized aortic infection. In cases of complex IE with the involvement of the root or the aorto-mitral continuity, the use of homografts are recommended, according to surgeon's and center experience. Homograft use needs to be balanced against the risk of structural degeneration. Prosthetic bioroot or prosthetic valved conduit with a mechanical or bioprosthetic valve are acceptable alternatives. The choice of aortic valves substitute and surgical strategy in IE is multifaceted. Principles guiding the selection of prosthesis and surgical approach rely on the long-term durability and the avoidance of infection relapse. A decisional algorithm considering the extension of the infection and its microbiological characteristics, the clinical profile of the patient and the risk of infection recurrence is provided. A multidisciplinary effort is required to achieve consistent outcomes.
Collapse
Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, North Cardiological Center, Saint-Denis, Paris, France
| | - Sanjeet Singh Avtaar Singh
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Glasgow, UK.,University of Glasgow Institute of Cardiovascular and Medical Sciences, Glasgow, UK
| | - Cristiano Spadaccio
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Glasgow, UK.,University of Glasgow Institute of Cardiovascular and Medical Sciences, Glasgow, UK
| | - Christophe Acar
- Department of Cardiovascular Surgery, Heart Institute, la Pitie Salpetriere Hospital, Paris, France
| |
Collapse
|