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Porto A, Stolpe G, Badaoui R, Boudouresques V, Deutsch C, Amanatiou C, Riberi A, Gariboldi V, Collart F, Theron A. One-year clinical outcomes following Edwards INSPIRIS RESILIA aortic valve implantation in 487 young patients with severe aortic stenosis: a single-center experience. Front Cardiovasc Med 2023; 10:1196447. [PMID: 37600038 PMCID: PMC10435896 DOI: 10.3389/fcvm.2023.1196447] [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: 03/29/2023] [Accepted: 06/26/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction The use of an aortic bioprosthesis is on the rise in younger patients with severe aortic stenosis despite the risk of accelerated structural valve degeneration (SVD). In the search for an optimal valve substitute that would not be prone to SVD, the INSPIRIS bioprosthesis represents a promising solution to lowering the risk of SVD. Here, we report the 1-year outcomes of the INSPIRIS RESILIA aortic bioprosthesis in a population of young patients who underwent aortic valve replacement. Methods In this prospective single-center study, we included all consecutive patients receiving INSPIRIS RESILIA bioprosthesis between June 2017 and July 2021. Patients with isolated severe aortic regurgitation were excluded. Clinical assessment and transthoracic echocardiography were performed preoperatively and at 1 year post-operatively. The primary outcome was overall mortality at one year. Results A total of 487 patients were included. The mean age was 58.2 ± 11.5 years, 75.2% were men. Most of the interventions were elective, with a mean EuroSCORE II of 4.8 ± 7.9. The valve annulus size in most cases was either 23 mm or 25 mm. Overall mortality at 1-year was 4.1%. At 1-year, 7 patients (1.4%) had a stroke, 4 patients (0.8%) had a myocardial infarction, and 20 patients (4.1%) were hospitalized for congestive heart failure. The Kaplan-Meier estimated survival rates and survival without major adverse cardiac events at 1-year were 96.4% and 96.7%, respectively. At 1-year follow-up, 10 patients (2.1%) had endocarditis and 1 patient (0.2%) had partial prosthetic thrombosis. Pacemaker implantation at 1-year post-operative was necessary in 27 patients (5.5%). Severe patient prosthesis mismatch and severe intra valvular regurgitation were 1.2% and 0.6%, respectively. The Kaplan-Meier estimated survival rates at 1-year of no infective endocarditis preoperative and infective endocarditis preoperative were 97.9 ± 0.7% and 89.5 ± 3.3%, respectively (P < 0.001). Excluding endocarditis-related complication, no structural valve deterioration and no valve failure requiring redo surgery were reported. Conclusion This is the largest single-center descriptive study of the 1-year outcomes after INSPIRIS RESILIA bioprosthesis implantation. The EDWARDS INSPIRIS RESILIA bioprosthesis provides encouraging clinical outcomes with an excellent 1- year survival rates and good hemodynamic performance. Long-term studies are mandatory to assess valve durability.
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Affiliation(s)
- Alizee Porto
- Department of Cardiac Surgery, APHM, Timone Hospital, Marseille, France
| | - Gregoire Stolpe
- Department of Cardiac Surgery, APHM, Timone Hospital, Marseille, France
| | - Rita Badaoui
- Department of Cardiac Surgery, APHM, Timone Hospital, Marseille, France
| | | | - Cornelia Deutsch
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Cecile Amanatiou
- Department of Cardiac Surgery, APHM, Timone Hospital, Marseille, France
| | - Alberto Riberi
- Department of Cardiac Surgery, APHM, Timone Hospital, Marseille, France
| | - Vlad Gariboldi
- Department of Cardiac Surgery, APHM, Timone Hospital, Marseille, France
| | - Frédéric Collart
- Department of Cardiac Surgery, APHM, Timone Hospital, Marseille, France
| | - Alexis Theron
- Department of Cardiac Surgery, APHM, Timone Hospital, Marseille, France
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Unai S, Ozaki S, Johnston DR, Saito T, Rajeswaran J, Svensson LG, Blackstone EH, Pettersson GB. Aortic Valve Reconstruction With Autologous Pericardium Versus a Bioprosthesis: The Ozaki Procedure in Perspective. J Am Heart Assoc 2023; 12:e027391. [PMID: 36628965 PMCID: PMC9939068 DOI: 10.1161/jaha.122.027391] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background We assessed the Ozaki procedure, aortic valve reconstruction using autologous pericardium, with respect to its learning curve, hemodynamic performance, and durability compared with a stented bioprosthesis. Methods and Results From January 2007 to January 2016, 776 patients underwent an Ozaki procedure at Toho University Ohashi Medical Center. Learning curves, aortic regurgitation (AR), and peak gradient, assessed by serial echocardiograms, valve rereplacement, and survival were investigated. Valve performance and durability were compared with 627 1:1 propensity-matched patients receiving stented bovine pericardial valves implanted from 1982 to 2011 at Cleveland Clinic. Learning curves were observed for aortic clamp and cardiopulmonary bypass times, AR prevalence, and early mortality. Decreased aortic clamp time was observed over the first 300 cases. New surgeons performing parts of the procedure after case 400 resulted in a slight increase in aortic clamp and cardiopulmonary bypass times. Among matched patients, the Ozaki cohort had more AR than the PERIMOUNT cohort (severe AR at 1 and 6 years, 0.58% and 3.6% versus 0.45% and 1.0%, respectively; P[trend]=0.006), although with a steep learning curve. Peak gradient showed the opposite trend: 14 and 17 mm Hg for Ozaki and 24 and 28 mm Hg for PERIMOUNT at these times (P[trend]<0.001). Freedom from rereplacement was similar (P=0.491). Survival of the Ozaki cohort was 85% at 6 years. Conclusions Patients undergoing the Ozaki procedure had lower gradients but more recurrent AR than those receiving PERIMOUNT bioprostheses. Although recurrent AR is concerning, results confirm low risk and good midterm performance of the Ozaki procedure, supporting its continued use.
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Affiliation(s)
- Shinya Unai
- Department of Thoracic and Cardiovascular SurgeryHeart, Vascular, and Thoracic InstituteCleveland ClinicClevelandOH
| | - Shigeyuki Ozaki
- Department of Cardiovascular SurgeryToho University Ohashi Medical CenterTokyoJapan
| | - Douglas R. Johnston
- Department of Thoracic and Cardiovascular SurgeryHeart, Vascular, and Thoracic InstituteCleveland ClinicClevelandOH
| | - Tomohiro Saito
- Department of Cardiovascular SurgeryToho University Ohashi Medical CenterTokyoJapan
| | - Jeevanantham Rajeswaran
- Department of Quantitative Health SciencesLerner Research InstituteCleveland ClinicClevelandOH
| | - Lars G. Svensson
- Department of Thoracic and Cardiovascular SurgeryHeart, Vascular, and Thoracic InstituteCleveland ClinicClevelandOH
| | - Eugene H. Blackstone
- Department of Thoracic and Cardiovascular SurgeryHeart, Vascular, and Thoracic InstituteCleveland ClinicClevelandOH,Department of Quantitative Health SciencesLerner Research InstituteCleveland ClinicClevelandOH
| | - Gösta B. Pettersson
- Department of Thoracic and Cardiovascular SurgeryHeart, Vascular, and Thoracic InstituteCleveland ClinicClevelandOH
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Imai N, Kaminishi Y, Tsukada T, Osaka M, Sakamoto H, Mathis BJ, Suzuki Y, Hiramatsu Y. Two cases of catastrophic deterioration and multiple leaflet detachment in Trifecta valves. Gen Thorac Cardiovasc Surg 2022; 70:292-294. [PMID: 35038125 DOI: 10.1007/s11748-021-01749-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 11/17/2021] [Indexed: 11/28/2022]
Abstract
Reports of early and catastrophic acute structural valve deterioration (SVD) in Trifecta valve (Abbott, St Paul, MN, USA) with multiple leaflet detachment are rare. We encountered two cases of early SVD in Trifecta valve with tears on two leaflets. Both cases presented with acute heart failure because of aortic insufficiency, and underwent redo aortic valve replacement; one patient died due to multiple organ failure caused by cardiogenic shock. Durability issues with the Trifecta valves; thus, necessitates long-term vigilance in aortic replacement patients.
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Affiliation(s)
- Nanami Imai
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yuichiro Kaminishi
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Toru Tsukada
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Motoo Osaka
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hiroaki Sakamoto
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Bryan James Mathis
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yasuyuki Suzuki
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Yuji Hiramatsu
- Department of Cardiovascular Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
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Igarashi T, Satokawa H, Sato Y, Takase S, Wakamatsu H, Seto Y, Kurosawa H, Iwai-Takano M, Fujimiya T, Shinjo H, Ishida K, Yokoyama H. Long-term results of modified bentall procedures: 18-year experience of the flanged technique. Fukushima J Med Sci 2021; 67:119-127. [PMID: 34744087 PMCID: PMC8784198 DOI: 10.5387/fms.2021-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To evaluate the early and late outcomes of the modified Bentall procedure with the flanged technique. METHODS We reviewed the medical records of 63 patients who had undergone root replacement by the modified Bentall procedure at our institute between January 2001 and December 2018. In most cases, we adopted a composite graft constructed with a mechanical valve or bioprosthesis and a Dacron graft by the flanged technique. Since 2011, we have used Valsalva grafts. RESULTS Mean age 57 ± 16 years, range 16-80, male 43 cases. The mean follow-up was 75 ± 56 months (range 0-216). Through April 1, 2020, we could follow up on 61 cases (97%) within a six-month period. Hospital mortality was 7.9% (4.8% in elective cases). In late follow-up, eight deaths were observed. In the bio-Bentall group (n=26), no deaths or major adverse valve-related events (MARVEs) occurred. In the mechanical Bentall group (n=37), seven cases of MARVEs, including two cerebral hemorrhages and one cerebral embolism, were observed. All patients were free from MARVEs at 5 years post procedure in the bio-Bentall group, and 93.8% and 76.8% were event-free at 5 years and 10 years, respectively, in the mechanical Bentall group. CONCLUSIONS The 18-year results of the modified Bentall procedure were acceptable, providing excellent outcomes in the bio-Bentall group. The flanged technique enabled the use of a larger prosthesis, which may have resulted in good durability with the bio-Bentall procedure.
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Affiliation(s)
- Takashi Igarashi
- Department of Cardiovascular Surgery, Fukushima Medical University
| | - Hirono Satokawa
- Department of Cardiovascular Surgery, Fukushima Medical University
| | - Yoichi Sato
- Department of Cardiovascular Surgery, Yonezawa City Hospital
| | - Shinya Takase
- Department of Cardiovascular Surgery, Fukushima Medical University
| | - Hiroki Wakamatsu
- Department of Cardiovascular Surgery, Fukushima Medical University
| | - Yuki Seto
- Department of Cardiovascular Surgery, Fukushima Medical University
| | | | | | | | - Hiroharu Shinjo
- Department of Cardiovascular Surgery, Fukushima Medical University
| | - Keiichi Ishida
- Department of Cardiovascular Surgery, Fukushima Medical University
| | - Hitoshi Yokoyama
- Department of Cardiovascular Surgery, Fukushima Medical University
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Okita Y, Fujita T, Zaikokuji K, Nakajima H, Yamanaka K, Fukumura Y, Yamaguchi A, Murakami H, Yaku H, Gearhart E, Komiya T. Two-Year Results of the 17-mm Avalus Aortic Valve in the PERIGON Japan Trial. Circ J 2021; 85:1035-1041. [PMID: 33776017 DOI: 10.1253/circj.cj-20-1024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The PERIcardial SurGical AOrtic Valve ReplacemeNt (PERIGON) Japan Trial was developed to assess the safety and effectiveness of the 17-mm Avalus bioprosthesis (Medtronic, Minneapolis, MN, USA) in patients undergoing surgical aortic valve replacement.Methods and Results:The primary endpoint in the trial was the percentage of patients achieving the composite of at least 1 class improvement in New York Heart Association (NYHA) functional class at 1 year compared with baseline and effective orifice area index (EOAI) of 0.6 cm2/m2or greater at 1-year after implantation, compared with a performance goal of 60%. The present study reports outcomes through 2 years. Eleven patients were implanted (10 [91%] female, median age 78.3 years). From baseline to 1 year, 10 subjects (91%) showed an improvement in NYHA classification. At 1 year, mean (±SD) EOAI was 0.82±0.17 cm2/m2, with 10 patients (91%) having an EOAI ≥0.6 cm2/m2. As such, 9 of 11 patients (82%) successfully met the primary endpoint. One death occurred between the 1- and 2-year follow-up visits, unrelated to the valve. There were no valve reinterventions, explants, or device deficiencies through 2 years. CONCLUSIONS The PERIGON Japan Trial met its primary endpoint. Surgical implantation of the 17-mm Avalus aortic bioprosthesis can be performed with an acceptable incidence of device-related adverse events, and the valve performs effectively based on echocardiographic findings.
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Kono T, Takagi K, Saku K, Kikusaki S, Zaima Y, Shojima T, Takaseya T, Arinaga K, Tayama E. Evaluation of hemodynamics after mitral valve replacement with the St Jude Medical Epic bioprosthesis: a Japanese single-center experience. J Artif Organs 2021; 24:458-464. [PMID: 33770272 DOI: 10.1007/s10047-021-01262-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/17/2021] [Indexed: 11/28/2022]
Abstract
To assess the early hemodynamics after mitral valve replacement (MVR) using the St Jude Medical (SJM) Epic bioprosthesis. MVR was performed using the SJM Epic bioprosthesis in 35 patients from June 2018 to April 2020; three patients were excluded because the postoperative transthoracic echocardiography (TTE) data were unavailable. Data from postoperative TTE at 1 week and 3 months after the procedure were reviewed. The mean mitral pressure gradient (mMPG) was calculated using a continuous wave Doppler method. Left ventricular outflow tract (LVOT) was calculated using a pulse wave Doppler method. The effective orifice area (EOA) was measured from pressure half time. There were 12 men (37.5%) and 20 women (62.5%) with a mean age of 75.9 years (61-88 years). The mean body surface area was 1.51 ± 0.22 cm2. The 25 mm and 27 mm valves were used in more than 50% of cases. The mMPG was 4.9 ± 1.7 mmHg and 5.4 ± 1.6 mmHg at 1 week and 3 months after surgery, respectively. EOA was 2.18 ± 0.50 cm2 and 2.31 ± 0.59 cm2 at 1 week and 3 months after surgery, respectively. The peak velocity of the LVOT (n = 22) was 103.3 ± 21.3 cm/s and 106.8 ± 27.4 cm/s at 1 week and 3 months after surgery, respectively. No findings suggested paravalvular regurgitation and LVOT obstruction. Using the SJM Epic bioprosthesis in MVR resulted in satisfactory hemodynamics in the early postoperative period, even with small valve sizes. Further accumulation of cases and evidence, including mid- to long-term results, is required in the future.
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Affiliation(s)
- Takanori Kono
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
| | - Kazuyoshi Takagi
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
| | - Kosuke Saku
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Satoshi Kikusaki
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Yasuyuki Zaima
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Takahiro Shojima
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Tohru Takaseya
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Koichi Arinaga
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Eiki Tayama
- Department of Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
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Yoshikawa Y, Okada Y, Okita Y, Yaku H, Kobayashi J, Uesugi H, Takanashi S, Ito T, Nakao T, Koyama T, Sakaguchi T, Yamamoto K, Sawa Y. Long-Term Outcomes of the Mosaic Aortic Porcine Bioprosthesis in Japan ― Results From the Japan Mosaic Valve Long-Term Multicenter Study ―. Circ J 2020; 84:1261-1270. [DOI: 10.1253/circj.cj-19-1113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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8
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Zeng BQ, Yu SQ, Chen Y, Zhai W, Liu B, Zhan SY, Sun F. [Safety of biological valves for aortic valve replacement: A systematic review and meta-analysis]. JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2020; 52:547-556. [PMID: 32541991 DOI: 10.19723/j.issn.1671-167x.2020.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To provide a comprehensive and contemporary overview of the long-term safety outcomes after aortic valve replacements (AVR) with conventional biological heart valve (stented or stentless). METHODS English databases (Medline, Embase, Web of Science, CENTRAL, and ClinicalTrial.gov) and Chinese databases (CNKI, VIP, WanFang, and SinoMed) were searched systemically from January 1, 2000 to January 26, 2019. Eligible randomized controlled trials, non-randomized clinical trials, cohort studies (retrospective or prospective), and unselected case series were included. Strict screening of the obtained literature was conducted to extract relevant data by two reviewers. Other inclusion criteria were studied reporting on outcomes of AVR with biological valves (stented or stentless), with or without coronary artery bypass grafting (CABG) or valve repair procedure, with mean follow-up length equal to or longer than 5 years. We excluded studies that reported only a specific patient group (e.g., patients with renal failure, or pregnancy), without the report of biological valve type, or with study population size less than 100. The meta-analysis was performed using Stata 14.0 software. RESULTS In this study, 53 papers (in total 57 study groups) involving 47 803 patients were included. (1) The all-cause mortality was 6.33/100 patient-years (95%CI: 5.85-6.84). Subgroup analysis showed that the mortality rates of porcine and bovine valve prostheses were 5.69/100 patient-years (95%CI: 5.05-6.41) and 7.29/100 patient-years (95%CI: 6.53-8.13), respectively. The all-cause mortality rates for stented and stentless valve were 6.69/100 patient-years (95%CI: 6.12-7.30) and 5.21/100 patient-years (95%CI: 4.43-6.14), respectively. (2) The incidence rate of thromboembolism was 1.16/100 patient-years (95%CI: 0.96-1.40), the incidence rate of permanent pacemaker (PPM) implantation was 1.08/100 patient-years (95%CI: 0.75-1.54), the incidence rate of stroke was 0.74/100 patient-years (95%CI: 0.51-1.06), the incidence rate of structural valve dysfunction (SVD) was 0.73/100 patient-years (95%CI: 0.59-0.91), the incidence rate of major bleeding was 0.52/100 patient-years (95%CI: 0.41-0.65), the incidence rate of endocarditis was 0.38/100 patient-years (95%CI: 0.33-0.44), and the incidence rate of non-structural valve dysfunction (NSVD) was 0.20/100 patient-years (95%CI: 0.13-0.31). The total reoperation rate for biological aortic valve was 0.77/100 patient-years (95%CI: 0.65-0.91), and the SVD related reoperation rate was 0.46/100 patient-years (95%CI: 0.36-0.58). CONCLUSION The all-cause mortality for conventional biological AVR was 6.33/100 patient-years. Thromboembolism, PPM implantation, reoperation, stroke, and SVD were major long term complications.
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Affiliation(s)
- B Q Zeng
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - S Q Yu
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - Y Chen
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - W Zhai
- Beijing Center for ADR Monitoring, Beijing 100024, China
| | - B Liu
- Beijing Center for ADR Monitoring, Beijing 100024, China
| | - S Y Zhan
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - F Sun
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
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Chen J, Yang J, Zhang L, Ma W, Lu S, Wang C, Hong T. Optimizations of stent and tissue leaflets in a new surgical bovine pericardial valve. J Thorac Dis 2020; 11:4855-4858. [PMID: 31903276 DOI: 10.21037/jtd.2019.10.32] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jinmiao Chen
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.,Shanghai Engineering Research Center of Heart Valve, Shanghai 200032, China.,Shanghai Institute of Cardiovascular Disease, Shanghai 200032, China
| | - Jun Yang
- Shanghai Cingular Biotech Corporation, Shanghai 201318, China
| | - Li Zhang
- Shanghai Cingular Biotech Corporation, Shanghai 201318, China
| | - Wenrui Ma
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.,Shanghai Engineering Research Center of Heart Valve, Shanghai 200032, China.,Shanghai Institute of Cardiovascular Disease, Shanghai 200032, China
| | - Shuyang Lu
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.,Shanghai Engineering Research Center of Heart Valve, Shanghai 200032, China.,Shanghai Institute of Cardiovascular Disease, Shanghai 200032, China
| | - Chunsheng Wang
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.,Shanghai Engineering Research Center of Heart Valve, Shanghai 200032, China.,Shanghai Institute of Cardiovascular Disease, Shanghai 200032, China
| | - Tao Hong
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.,Shanghai Engineering Research Center of Heart Valve, Shanghai 200032, China.,Shanghai Institute of Cardiovascular Disease, Shanghai 200032, China
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Nakatsu T, Minakata K, Tanaka S, Minatoya K, Nishizawa J, Ohno N, Esaki J, Ueyama K, Koyama T, Hanyu M, Tamura N, Komiya T, Saito Y, Kanemitsu N, Soga Y, Shiraga K, Nakayama S, Nonaka M, Sakaguchi G, Nishimura K, Yamanaka K. Intermediate-term outcomes of aortic valve replacement with bioprosthetic or mechanical valves in patients on hemodialysis. J Thorac Cardiovasc Surg 2019; 157:2177-2186.e3. [DOI: 10.1016/j.jtcvs.2018.08.104] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 08/07/2018] [Accepted: 08/26/2018] [Indexed: 10/28/2022]
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Yamashita K, Fukushima S, Shimahara Y, Hamatani Y, Kanzaki H, Fukuda T, Izumi C, Yasuda S, Kobayashi J, Fujita T. Early outcomes of transcatheter aortic valve implantation for degenerated aortic bioprostheses in Japanese patients: insights from the AORTIC VIV study. Gen Thorac Cardiovasc Surg 2019; 67:1038-1047. [DOI: 10.1007/s11748-019-01133-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 04/25/2019] [Indexed: 01/12/2023]
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12
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Yamashita K, Fukushima S, Shimahara Y, Yamasaki T, Matsumoto Y, Kawamoto N, Tadokoro N, Kakuta T, Hamatani Y, Okada A, Takahama H, Amaki M, Hasegawa T, Kanzaki H, Izumi C, Yasuda S, Kobayashi J, Fujita T. Study Protocol for Transcatheter Aortic Valve Replacement for a Degenerated Aortic Bioprosthesis in a Japanese Cohort. Circ Rep 2019; 1:102-106. [PMID: 33693120 PMCID: PMC7890281 DOI: 10.1253/circrep.cr-18-0023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background:
The valve-in-valve (VIV) procedure is being increasingly performed in high-risk patients with a degenerated bioprosthesis in an aortic position in Western countries. The early safety and efficacy of the VIV procedure, however, remain unclear in Japanese patients with a small aortic annulus. We present the protocol for a study designed to evaluate the early safety and efficacy of the VIV procedure in the aortic position in Japanese patients. Methods and Results:
The prospective, single-center, non-comparative, clinical study of the VIV procedure for the aortic position (AORTIC VIV study) commenced in August 2016 and will end in March 2020. Patients will be monitored for ≥1 month after the VIV procedure. The targeted number of patients is 11. Eligible patients are those who have undergone transcatheter aortic valve replacement for a surgical valve (including stented or stentless bioprosthetic valves), or for a transcatheter heart valve. The VIV procedure is performed in high-operative-risk patients with substantial prosthetic valve stenosis, and regurgitation and heart failure resistant to medical treatment (unless the patient meets an exclusion criterion). The safety and efficacy of the VIV procedure will be evaluated in accordance with the Valve Academic Research Consortium-2 initiative. Conclusions:
The AORTIC VIV study will clarify the early safety and efficacy of the VIV procedure in Japanese patients.
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Affiliation(s)
- Kizuku Yamashita
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center Suita Japan.,William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London London UK
| | - Satsuki Fukushima
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center Suita Japan
| | - Yusuke Shimahara
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center Suita Japan
| | - Takuma Yamasaki
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center Suita Japan
| | - Yorihiko Matsumoto
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center Suita Japan
| | - Naonori Kawamoto
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center Suita Japan
| | - Naoki Tadokoro
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center Suita Japan
| | - Takashi Kakuta
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center Suita Japan
| | - Yasuhiro Hamatani
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Suita Japan
| | - Atsushi Okada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Suita Japan
| | - Hiroyuki Takahama
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Suita Japan
| | - Makoto Amaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Suita Japan
| | - Takuya Hasegawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Suita Japan
| | - Hideaki Kanzaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Suita Japan
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Suita Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Suita Japan
| | - Junjiro Kobayashi
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center Suita Japan
| | - Tomoyuki Fujita
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center Suita Japan
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13
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Yamashita K, Fujita T, Fukushima S, Shimahara Y, Kume Y, Matsumoto Y, Kawamoto N, Hitsumoto T, Ito N, Hamatani Y, Okada A, Takahama H, Amaki M, Hasegawa T, Sugano Y, Kanzaki H, Anzai T, Yasuda S, Kobayashi J. Transcatheter Aortic Valve Implantation for Degenerated 19-mm Aortic Bioprosthetic Valve. Circ J 2018; 82:289-292. [DOI: 10.1253/circj.cj-17-0851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kizuku Yamashita
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Tomoyuki Fujita
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Satsuki Fukushima
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Yusuke Shimahara
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Yuta Kume
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Yorihiko Matsumoto
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Naonori Kawamoto
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Tatsuro Hitsumoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Nobuyasu Ito
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yasuhiro Hamatani
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Atsushi Okada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hiroyuki Takahama
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Makoto Amaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Takuya Hasegawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yasuo Sugano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hideaki Kanzaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Junjiro Kobayashi
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
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14
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Bioprosthetic Aortic Valve Durability: A Meta-Regression of Published Studies. Ann Thorac Surg 2017; 104:1080-1087. [DOI: 10.1016/j.athoracsur.2017.02.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 01/12/2017] [Accepted: 02/06/2017] [Indexed: 11/17/2022]
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15
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Lee SI, Lee KS, Kim JB, Choo SJ, Chung CH, Lee JW, Jung SH. Early Antithrombotic Therapy after Bioprosthetic Aortic Valve Replacement in Elderly Patients: A Single-Center Experience. Ann Thorac Cardiovasc Surg 2017; 23:128-134. [PMID: 28367855 DOI: 10.5761/atcs.oa.16-00297] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Early antithrombotic therapy after bioprosthetic aortic valve replacement (AVR) is controversial. This study aimed to retrospectively compare between warfarin and aspirin treatment in the 3 months after bioprosthetic AVR for elderly patients more than 60 years old, and to determine the optimal antithrombotic therapy. METHODS This retrospective study included 479 patients in single center from January 1994 to June 2014. Patients were divided into two groups (Wa group, warfarin; As group, aspirin). We searched our computerized clinical database for thromboembolic or bleeding events. Propensity score analysis was conducted to adjust for selection bias. RESULTS All patients, except one patient, were followed-up in the out-patient department for 3 months after the operation. In all, 86 propensity-matched patient-pairs were derived. Early operative outcomes were similar in both the groups. There are one patient of thromboembolic event and three patients of bleeding events, but the prevalence was not significantly different (p >0.999). CONCLUSION The incidence of thromboembolic and bleeding events during early 3 months after bioprosthetic AVR were similar in Wa and As groups. If the patient does not have indications of warfarin, early antithrombotic therapy with aspirin only may be easier and more feasible for elderly patients.
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Affiliation(s)
- Seok In Lee
- Department of Thoracic and Cardiovascular Surgery, Gil Medical Center, Gachon University, Incheon, Korea
| | - Kyo Seon Lee
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, College of Medicine, Gwangju, Korea
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suk Jung Choo
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheol Hyun Chung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Won Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Ho Jung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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16
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Puskas JD, Bavaria JE, Svensson LG, Blackstone EH, Griffith B, Gammie JS, Heimansohn DA, Sadowski J, Bartus K, Johnston DR, Rozanski J, Rosengart T, Girardi LN, Klodell CT, Mumtaz MA, Takayama H, Halkos M, Starnes V, Boateng P, Timek TA, Ryan W, Omer S, Smith CR. The COMMENCE trial: 2-year outcomes with an aortic bioprosthesis with RESILIA tissue†. Eur J Cardiothorac Surg 2017; 52:432-439. [DOI: 10.1093/ejcts/ezx158] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 04/14/2017] [Indexed: 12/11/2022] Open
Affiliation(s)
- John D. Puskas
- Department of Cardiovascular Surgery, Mount Sinai Saint Luke’s, New York, NY, USA
| | - Joseph E. Bavaria
- Department of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Lars G. Svensson
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Eugene H. Blackstone
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Bartley Griffith
- Department of Thoracic and Cardiovascular Surgery, University of Maryland, Baltimore, MD, USA
| | - James S. Gammie
- Department of Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - David A. Heimansohn
- Department of Cardiothoracic Surgery, St Vincent Heart Center, Indianapolis, IN, USA
| | - Jerzy Sadowski
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | - Krzysztof Bartus
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | - Douglas R. Johnston
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Todd Rosengart
- Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Leonard N. Girardi
- Department of Cardiothoracic Surgery, New York Presbyterian Hospital, New York, NY, USA
| | | | - Mubashir A. Mumtaz
- Department of Cardiovascular and Thoracic Surgery, Pinnacle Health, Harrisburg, PA, USA
| | - Hiroo Takayama
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University-New York Presbyterian Hospital, New York, NY, USA
| | - Michael Halkos
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Vaughn Starnes
- Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Percy Boateng
- Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York, NY, USA
| | - Tomasz A. Timek
- Division of Cardiothoracic Surgery, Spectrum Health Medical Group, Grand Rapids, MI, USA
| | - William Ryan
- Department of Cardiovascular Surgery, Heart Hospital Baylor, Plano, TX, USA
| | - Shuab Omer
- Department of Cardiovascular Surgery, Michael E DeBakey VA Medical Center, Houston, TX, USA
| | - Craig R. Smith
- Department of Surgery, Columbia Presbyterian Medical Center, New York, NY, USA
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17
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Katada Y, Nakagawa S, Minakata K, Odaka M, Taue H, Sato Y, Yonezawa A, Kayano Y, Yano I, Nakatsu T, Sakamoto K, Uehara K, Sakaguchi H, Yamazaki K, Minatoya K, Sakata R, Matsubara K. Efficacy of protocol-based pharmacotherapy management on anticoagulation with warfarin for patients with cardiovascular surgery. J Clin Pharm Ther 2017; 42:591-597. [PMID: 28503837 DOI: 10.1111/jcpt.12560] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 04/20/2017] [Indexed: 01/21/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE Anticoagulation therapy with warfarin requires periodic monitoring of prothrombin time-international normalized ratio (PT-INR) and adequate dose adjustments based on the data to minimize the risk of bleeding and thromboembolic events. In our hospital, we have developed protocol-based pharmaceutical care, which we called protocol-based pharmacotherapy management (PBPM), for warfarin therapy. The protocol requires pharmacists to manage timing of blood sampling for measuring PT-INR and warfarin dosage determination based on an algorithm. This study evaluated the efficacy of PBPM in warfarin therapy by comparing to conventional pharmaceutical care. METHODS From October 2013 to June 2015, a total of 134 hospitalized patients who underwent cardiovascular surgeries received post-operative warfarin therapy. The early series of patients received warfarin therapy as the conventional care (control group, n=77), whereas the latter received warfarin therapy based on the PBPM (PBPM group, n=68). These patients formed the cohort of the present study and were retrospectively analysed. RESULTS The indications for warfarin included aortic valve replacement (n=56), mitral valve replacement (n=4), mitral valve plasty (n=22) and atrial fibrillation (n=29). There were no differences in patients' characteristics between both groups. The percentage time in therapeutic range in the first 10 days was significantly higher in the PBPM group (47.1%) than that in the control group (34.4%, P<.005). The average time to reach the steady state was significantly (P<.005) shorter in the PBPM group compared to the control group (7.3 vs 8.6 days). WHAT IS NEW AND CONCLUSION Warfarin therapy based on our novel PBPM was clinically safe and resulted in significantly better anticoagulation control compared to conventional care.
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Affiliation(s)
- Y Katada
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - S Nakagawa
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - K Minakata
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - M Odaka
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - H Taue
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - Y Sato
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - A Yonezawa
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - Y Kayano
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
| | - I Yano
- Department of Pharmacy, Kobe University Hospital, Kobe, Japan
| | - T Nakatsu
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - K Sakamoto
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - K Uehara
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - H Sakaguchi
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - K Yamazaki
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - K Minatoya
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - R Sakata
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - K Matsubara
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan
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18
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Ohira S, Miyata H, Doi K, Motomura N, Takamoto S, Yaku H. Risk model of aortic valve replacement after cardiovascular surgery based on a National Japanese Database. Eur J Cardiothorac Surg 2017; 51:347-353. [PMID: 28186293 DOI: 10.1093/ejcts/ezw247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 06/06/2016] [Accepted: 06/09/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Suguru Ohira
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroaki Miyata
- Japan Cardiovascular Surgery Database Organization, Tokyo, Japan
| | - Kiyoshi Doi
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Noboru Motomura
- Japan Cardiovascular Surgery Database Organization, Tokyo, Japan
| | | | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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19
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Kume Y, Fujita T, Fukushima S, Hata H, Shimahara Y, Matsumoto Y, Yamashita K, Kobayashi J. Reducing Prosthesis-Patient Mismatch With Edwards Magna Prosthesis for Aortic Valve Replacement. Circ J 2017; 81:468-475. [DOI: 10.1253/circj.cj-16-0768] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yuta Kume
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Tomoyuki Fujita
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Satsuki Fukushima
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Hiroki Hata
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Yusuke Shimahara
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Yorihiko Matsumoto
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Kizuku Yamashita
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
| | - Junjiro Kobayashi
- Department of Cardiac Surgery, National Cerebral and Cardiovascular Center
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20
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Nishioka N, Yamada A, Ujihira K, Iba Y, Maruyama R, Hatta E, Kurimoto Y, Nakanishi K. Outcomes of surgical aortic valve replacement using Carpentier-Edwards PERIMOUNT bioprosthesis series in elderly patients with severe aortic valve stenosis: a retrospective cohort study. Gen Thorac Cardiovasc Surg 2016; 64:728-734. [PMID: 27491542 DOI: 10.1007/s11748-016-0698-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 07/21/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We sought to compare the outcomes of Carpentier-Edwards PERIMOUNT (CEP), Magna and Magna Ease valves in Japanese elderly patients with severe aortic valve stenosis (AS). METHODS We retrospectively identified 136 patients (mean age 76.61 ± 5.5 years old) who had undergone isolated surgical aortic valve replacement (SAVR) using CEP, Magna, and Magna Ease valves at a single institution, from January 2001 to December 2013. We compared the valves according to their survival rates, freedom from major adverse cardiovascular and cerebrovascular events (MACCE), and durability and hemodynamic performance by echocardiographic data. RESULTS The thirty-day mortality after isolated SAVR in all the valve groups was "zero". The differences among the three groups in terms of survival rates, freedom from MACCE at 2 years, durability and hemodynamic performance of the valves by echocardiographic data was not statistically significant. CONCLUSION All CEP, Magna and Magna Ease valves seemed to be similarly useful in Japanese elderly patients with severe AS. Our data did not clearly support the superiority of one valve over another. A longer follow-up period might be necessary to compare the durability and hemodynamic performance of these valves with more certainty.
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Affiliation(s)
- Naritomo Nishioka
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, 12-1-40, Maeda 1-jo, Teine-ku, Sapporo, Hokkaido, 006-8555, Japan.
| | - Akira Yamada
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, 12-1-40, Maeda 1-jo, Teine-ku, Sapporo, Hokkaido, 006-8555, Japan
| | - Kosuke Ujihira
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, 12-1-40, Maeda 1-jo, Teine-ku, Sapporo, Hokkaido, 006-8555, Japan
| | - Yutaka Iba
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, 12-1-40, Maeda 1-jo, Teine-ku, Sapporo, Hokkaido, 006-8555, Japan
| | - Ryushi Maruyama
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, 12-1-40, Maeda 1-jo, Teine-ku, Sapporo, Hokkaido, 006-8555, Japan
| | - Eiichiro Hatta
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, 12-1-40, Maeda 1-jo, Teine-ku, Sapporo, Hokkaido, 006-8555, Japan
| | - Yoshihiko Kurimoto
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, 12-1-40, Maeda 1-jo, Teine-ku, Sapporo, Hokkaido, 006-8555, Japan
| | - Katsuhiko Nakanishi
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, 12-1-40, Maeda 1-jo, Teine-ku, Sapporo, Hokkaido, 006-8555, Japan
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21
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Bileaflet mechanical valve replacement: an assessment of outcomes with 30 years of follow-up. Interact Cardiovasc Thorac Surg 2016; 23:599-607. [DOI: 10.1093/icvts/ivw196] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 04/19/2016] [Indexed: 11/14/2022] Open
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22
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Okamoto Y, Yamamoto K, Yoshii S. Early and Late Outcomes of Aortic Valve Replacement Using Bioprosthetic Versus Mechanical Valve in Elderly Patients: A Propensity Analysis. J Card Surg 2016; 31:195-202. [PMID: 26889744 DOI: 10.1111/jocs.12719] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY There is still controversy on the use of mechanical valves to treat elderly patients with a small aortic annulus who require aortic valve replacement (AVR). We compared our results in elderly patients who underwent AVR with a bioprosthetic or mechanical valve. Propensity matching adjusted for baseline differences in this study. METHODS Between January 2001 and July 2014, 277 patients aged ≥75 years old who underwent AVR were enrolled. Of 277 patients, 104 patients were selected using propensity score matching analysis. Out of this cohort, 52 patients underwent AVR with a bioprosthetic valve (B group) and the remainder AVR with a mechanical valve (M group). RESULTS There were no significant differences between the B and M groups in 30 days mortality (1.9% vs. 5.8%, p = 0.618). The incidence of patient-prosthesis mismatch (PPM) after AVR tended to be lower in the M group than in the B group. The overall survival rates in the B and M groups at eight years were 72.8% and 73.3%, respectively (p = 0.473). No significant differences between the two groups were observed in freedom from valve-related death, cardiac events, bleeding events, or stroke events. CONCLUSIONS AVR in elderly patients achieved relatively good short-term and long-term outcomes, and the incidence rates of valve-related complications after using a mechanical valve were low. In a selected population of elderly patients, a mechanical valve may be acceptable. doi: 10.1111/jocs.12719 (J Card Surg 2016;31:195-202).
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Affiliation(s)
- Yuki Okamoto
- Department of Cardiovascular Surgery, Tachikawa Medical Center, Nagaoka City, Nigata, Japan
| | - Kazuo Yamamoto
- Department of Cardiovascular Surgery, Tachikawa Medical Center, Nagaoka City, Nigata, Japan
| | - Shinpei Yoshii
- Department of Cardiovascular Surgery, Tachikawa Medical Center, Nagaoka City, Nigata, Japan
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23
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You JH, Jeong DS, Sung K, Kim WS, Carriere KC, Lee YT, Park PW. Aortic Valve Replacement With Carpentier-Edwards: Hemodynamic Outcomes for the 19-mm Valve. Ann Thorac Surg 2016; 101:2209-16. [PMID: 26872735 DOI: 10.1016/j.athoracsur.2015.11.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 10/06/2015] [Accepted: 11/09/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND To compare hemodynamic performance and clinical outcomes after aortic valve replacement for aortic stenosis with the 19-mm Carpentier-Edwards pericardial bioprosthesis versus larger valves. METHODS Between January 1998 and December 2013, 447 consecutive patients underwent aortic valve replacement for aortic stenosis with the Carpentier-Edwards Perimount (n = 61) or Magna bioprostheses (n = 386). Based on the implanted valve size, the patients were classified into three groups: a 19-mm group (n = 54), a 21-mm group (n = 154), and a 23-mm to 27-mm group (n = 239). The in vivo effective orifice area index was measured by transthoracic echocardiography 12 months after operation (n = 331). The mean follow-up time was 4.9 ± 3.5 (maximum 15.4) years. RESULTS There were three early deaths (0.7%). At 10 years, overall survival (84.1%) was unaffected by patient-prosthesis mismatch (18.7%, 62 patients), and freedom from structural valve deterioration and endocarditis was 100% and 97.1%, respectively. Although the 19-mm group was significantly older and had a higher incidence of patient-prosthesis mismatch (n = 14, 30.4%), there were no significant differences in early outcomes, overall survival, cardiac-related mortality, or serial reduction of left ventricular mass index in comparison with patients with a larger bioprostheses. Independent risk factors for all-cause mortality were age, male gender, combined coronary artery bypass graft, and low hemoglobin level. CONCLUSION The Carpentier-Edwards pericardial bioprosthesis appears to be associated with acceptable clinical outcomes and hemodynamic profile.
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Affiliation(s)
- Ji Hoon You
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Thoracic and Cardiovascular Surgery, Seoul Veterans Hospital, Seoul, Korea
| | - Dong Seop Jeong
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kiick Sung
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wook Sung Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - K C Carriere
- Department of Mathematical and Statistical Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Tak Lee
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Pyo Won Park
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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24
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Nishida T, Sonoda H, Oishi Y, Tanoue Y, Tatewaki H, Shiokawa Y, Tominaga R. Long-Term Comparison of Three Types of Aortic St. Jude Medical Mechanical Prosthesis in Japanese Patients. Circ J 2015; 79:2193-200. [PMID: 26248571 DOI: 10.1253/circj.cj-15-0268] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The long-term results achieved with aortic St. Jude Medical (SJM) mechanical prostheses in various age groups of Japanese patients have not been previously compared or reported. METHODS AND RESULTS Since 1981, a total of 240 SJM valves were implanted in 79 patients using the Standard model, in 58 patients with the Hemodynamic Plus model, and in 103 patients with the Regent model for aortic valve replacement (AVR). Follow-up was completed for 2,397 patient-years in 97.5% of the patients, among whom the effect of age was compared, and the subjects were divided into younger (<65 years) and older (≥65 years) groups. Hospital mortality rate was 2.5%. No structural valve deterioration was observed during the follow-up period. In addition, no significant differences were observed in long-term survival between the 3 models. In contrast, significantly better rates of freedom from all-cause death (P<0.0001), valve-related death (P=0.0018) and valve-related morbidity (P=0.0021), including bleeding events (P=0.0007), were observed in the younger group (n=157, 50.6±1.0 years old) than in the older group (n=83, 72.5±0.7 years old). CONCLUSIONS All types of SJM valve used for single AVR achieved satisfactory early and long-term results in each age group even 25 years after surgery. When selecting this prosthesis for elderly patients, however, relatively worse performance may be expected compared with that observed in younger patients.
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Affiliation(s)
- Takahiro Nishida
- Department of Cardiovascular Surgery, Kyushu University Graduate School of Medical Sciences
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25
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Tatsuishi W, Nakano K, Kubota S, Asano R, Kataoka G. Identification of Coronary Artery Orifice to Prevent Coronary Complications in Bioprosthetic and Transcatheter Aortic Valve Replacement. Circ J 2015; 79:2157-61. [PMID: 26227280 DOI: 10.1253/circj.cj-15-0415] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The aim of this study was to identify anatomical variations in coronary artery orifices among high-risk patients with a small aortic root undergoing bioprosthetic aortic valve replacement (BAVR) and transcatheter aortic valve replacement (TAVR) in order to prevent coronary orifice obstruction perioperatively. METHODS AND RESULTS Coronary orifice and root structure were identified in 400 patients using aortic multidetector-row computed tomography (MDCT). We measured the aortic root diameter; intercommissural distances; and distance from coronary orifice to valve annulus, commissure, and sinotubular junction. We examined positional relationships between the coronary orifice and stent post, or sewing cuff of the bioprosthetic valve and leaflet of the transcatheter aortic valve. Most left coronary artery orifices were distributed near the center of the non-left and left-right commissures; right ones were relatively distributed on the non-right commissural side. Thirty-four patients (8.5%) with BAVR (coronary orifice near the commissure: 31, 7.8%; low takeoff: 5, 1.3%; and both: 2) and 39 (9.8%) with TAVR were at risk for coronary orifice obstruction. During BAVR, one-stitch rotation of the stent and one-stitch rotation with intra-annular implantation were used in near-commissure and low takeoff cases, respectively. During TAVR, percutaneous coronary intervention may be required in the height of the coronary orifice was ≤10 mm from the base of the ventricle aortic junction. CONCLUSIONS Potential coronary complications during BAVR and TAVR in high-risk patients for coronary obstruction were identified using preoperative aortic MDCT. Choice of appropriate surgical technique or valve is essential.
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Affiliation(s)
- Wataru Tatsuishi
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Medical Center East
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Morimoto K, Hoashi T, Kagisaki K, Yoshimatsu J, Shiraishi I, Ichikawa H, Kobayashi J, Nakatani T, Yagihara T, Kitamura S, Fujita T. Impact of Ross Operation on Outcome in Young Female Adult Patients Wanting to Have Children. Circ J 2015; 79:1976-83. [PMID: 26118461 DOI: 10.1253/circj.cj-15-0410] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The most appropriate valve substitute at aortic valve replacement (AVR) for young female adult patients wanting to have children is unclear. METHODS AND RESULTS Between 1992 and 2013, 12 consecutive female patients aged >18 (median, 22.5 years; range, 18-34 years) underwent Ross operation (Ross group). Between 1984 and 2013, 9 consecutive female patients aged >18 (median, 30 years; range, 22-39 years) underwent AVR with bioprosthesis (bioprosthesis group). There was 1 late mortality in the bioprosthesis group, due to prosthetic valve endocarditis (PVE). Freedom from reoperation for aortic valve at 15 years was 90.0% in the Ross group, and 57.1% in the bioprosthesis group (log-rank, P=0.098). One in the Ross group underwent reoperation for aortic regurgitation (AR), whereas 4 in the bioprosthesis group did so for aortic stenosis (AS) in 2, combined AS and AR in 1, and PVE in 1. Five patients in the Ross group and 3 in the bioprosthesis group had 7 and 4 uneventful pregnancies, respectively. AR progressed during the perinatal period in a total of 7 of 11 pregnancies. No AS was seen at discharge, after 5 years, or during pregnancy in the Ross group. CONCLUSIONS The long-term outcome of Ross operation for female patients wanting to have children is excellent. Although subclinical pulmonary autograft valve regurgitation during pregnancy was often observed, pulmonary autograft stenosis did not occur, therefore it would be an ideal option for patients wanting to have children.
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Affiliation(s)
- Kazuki Morimoto
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center
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Sezai A, Shiono M. Selection of prosthetic valve and evidence--need for the development of Japan's own guidelines. Ann Thorac Cardiovasc Surg 2015; 21:305-13. [PMID: 26062580 DOI: 10.5761/atcs.ra.15-00134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE In 2014, the American Heart Association (AHA)/American College of Cardiology (ACC) guidelines were largely revised with regard to the selection of prosthetic valves. (1) A mechanical prosthesis is reasonable for aortic valve replacement (AVR) or mitral valve replacement (MVR) in patients less than 60 years of age, (2) A bioprosthesis is reasonable in patients more than 70 years of age, and (3) Either a bioprosthetic or mechanical valve is reasonable in patients between 60 and 70 years of age.Japan faces the unprecedented population aging, and moreover, the average life expectancy is longer among the Japanese than the Westerners. In Japan, whether this choice is appropriate seems questionable. METHODS This time, with the revision of the AHA/ACC guidelines, it might be necessary to take into consideration the average life expectancy of Japanese people and revise the Japanese guidelines accordingly. RESULTS We should consider whether 60-70 years should be set as a gray zone regarding the age criteria for choosing biological valves, or if the age should be set higher relative to that specified in the western guidelines, given the longer Japanese life expectancy. CONCLUSION We believe that the development of unique, Japanese guidelines for the selection of prosthetic valves will allow us to provide appropriate selection and treatment for each patient.
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Affiliation(s)
- Akira Sezai
- Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
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Sezai A, Osaka S, Yaoita H, Ishii Y, Arimoto M, Hata H, Shiono M. Long-Term Outcome of Prosthetic Valve Replacement in Japanese Patients Aged 65 Years or Older: Are Guidelines for Prosthetic Valve Selection Based on Overseas Data Appropriate for Japanese Patients? Ann Thorac Cardiovasc Surg 2015; 21:254-60. [PMID: 26004117 DOI: 10.5761/atcs.oa.15-00062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Based on the revised AHA/ACC guidelines, it might be necessary to take into consideration the average life expectancy of Japanese people and revise the Japanese guidelines accordingly. Accordingly, we performed the present study to compare the long-term outcome in patients aged 65 years or older who underwent prosthetic valve replacement at our hospital using mechanical valves or biological valves. METHODS We have performed valve replacement in 416 patients aged 65 years or older (mechanical: 157; biological: 244). RESULTS There was no significant difference between the mechanical and biological valve for the actuarial survival rate. As for the valve-related complication free rate, in the mechanical valve group, the rates were significantly higher for all patients, aortic valve replacement (AVR) patients, and mitral valve replacement (MVR) patients. CONCLUSIONS Following revision of the AHA/ACC guidelines for selection of prosthetic valves, it is necessary to investigate whether patients aged 60-70 represent the gray zone for selecting valves as in US and European guidelines, or whether a higher age is more appropriate in view of the longer average life expectancy in Japan. Accordingly, further evaluation of the long-term outcome for mechanical and biological valves in Japanese patients is needed to obtain evidence for preparation of original Japanese guidelines on prosthetic valve selection.
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Affiliation(s)
- Akira Sezai
- The Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan
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Minakata K, Tanaka S, Takahara Y, Kaneko T, Usui A, Shimamoto M, Okawa Y, Yaku H, Yamanaka K, Tamura N, Sakata R. Long-term durability of pericardial valves in the aortic position in younger patients: when does reoperation become necessary? J Card Surg 2015; 30:405-13. [PMID: 25786674 DOI: 10.1111/jocs.12537] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND We sought to assess the long-term durability of pericardial valves in patients at age <65 years undergoing aortic valve replacement (AVR), and to determine the timing of redo operations due to structural valve deterioration (SVD). METHODS From 1986 to 2001, a total of 574 adult patients underwent AVR with pericardial valves in nine hospitals in Japan. Of these, 53 patients were at age <65 years (group Y). These patients were compared with those of age ≥ 65 (group O, n = 521). RESULTS The mean follow-up duration was 9.5 years in group Y and 8.1 years in group O. Freedom from reoperation due to SVD was 100% at five years, 90.8% at 10 years, and 47.2% at 15 years in group Y, and 99.3% at five years, 97.4% at 10 years, and 94.4% at 15 years in group O (log-rank test, p < 0.01). In those who required redo AVR in group Y (n = 12), the mean time from initial operation to reoperation was 12.1 years. The reoperation-free survival curve started to decline after eight years postoperation in group Y. CONCLUSIONS Redo AVR started to become necessary eight years after surgery in the patients who underwent AVR with pericardial valve at age <65 years. In addition, approximately half of those patients required reoperation due to SVD by 15 years postoperatively.
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Affiliation(s)
- Kenji Minakata
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Matsumoto Y, Fujita T, Hata H, Shimahara Y, Sato S, Kobayashi J. Hemodynamic Performance and Durability of Mosaic Bioprostheses for Aortic Valve Replacement, up to 13 Years. Circ J 2015; 79:1044-51. [DOI: 10.1253/circj.cj-14-0990] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yorihiko Matsumoto
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Hiroki Hata
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Yusuke Shimahara
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Shunsuke Sato
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
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Minakata K, Tanaka S, Okawa Y, Kaneko T, Okonogi S, Usui A, Abe T, Tamura N, Yanagi S, Sakata R. Twenty-Year Outcome of Aortic Valve Replacement With St. Jude Medical Mechanical Valves in Japanese Patients. Circ J 2015; 79:2380-8. [DOI: 10.1253/circj.cj-15-0793] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Shiro Tanaka
- Kyoto University Graduate School of Public Health
| | - Yohei Okawa
- Cardiovascular Center Hokkaido Ohno Hospital
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Tosello F, Florens E, Caruba T, Lebeller C, Mimoun L, Milan A, Fabiani JN, Boutouyrie P, Menasché P, Lillo-Lelouet A. Atrial fibrillation at mid-term after bioprosthetic aortic valve replacement – implications for anti-thrombotic therapy. Circ J 2014; 79:70-6. [PMID: 25482295 DOI: 10.1253/circj.cj-14-0684] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Little is known about mid-term (3-month) postoperative atrial fibrillation (MT-POAF) in patients treated with bioprosthetic aortic valve replacement (BAVR). The aim of this study was to describe the natural history, identify the predictors and investigate the potential consequences in terms of anti-thrombotic therapy. METHODS AND RESULTS During a longitudinal, prospective study, 219 patients were treated with BAVR early (7 days) and at mid-term postoperatively (30 and 90 days). POAF was monitored and risk factors were identified on logistic regression analysis. History of previous AF (OR, 3.08; 95% CI: 1.35-6.98), early POAF (OR, 5.93; 95% CI: 2.96-11.8), and BMI (per 5 kg/m(2): OR, 1.46; 95% CI: 1.03-2.09), were independent predictors for MT-POAF whereas sex, age and Euroscore were not. Results were identical when restricted to the 176 patients free from preoperative AF. In this subgroup, 36 patients (20.4%) had MT-POAF; 33 out of 174 (18.7%) would have required anticoagulation (CHA2DS2VASc score ≥ 1). Conversely, patients with BMI <27.7 and sinus rhythm at early follow-up had a very low risk of MT-POAF (OR, 0.16; 95% CI: 0.06-0.42). CONCLUSIONS There was a higher than expected occurrence of MT-POAF in patients treated with BAVR, particularly in overweight patients with early POAF. This raises the question of implementing an anti-thrombotic therapy in these patients at higher risk of delayed atrial arrhythmia.
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Nishida T, Sonoda H, Oishi Y, Tatewaki H, Tanoue Y, Shiokawa Y, Tominaga R. Long-Term Results of Aortic Valve Replacement With Mechanical Prosthesis or Carpentier-Edwards Perimount Bioprosthesis in Japanese Patients According to Age. Circ J 2014; 78:2688-95. [DOI: 10.1253/circj.cj-14-0466] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Takahiro Nishida
- Department of Cardiovascular Surgery, Kyushu University Graduate School of Medical Sciences
| | - Hiromichi Sonoda
- Department of Cardiovascular Surgery, Kyushu University Graduate School of Medical Sciences
| | - Yasuhisa Oishi
- Department of Cardiovascular Surgery, Kyushu University Graduate School of Medical Sciences
| | - Hideki Tatewaki
- Department of Cardiovascular Surgery, Kyushu University Graduate School of Medical Sciences
| | - Yoshihisa Tanoue
- Department of Cardiovascular Surgery, Kyushu University Graduate School of Medical Sciences
| | - Yuichi Shiokawa
- Department of Cardiovascular Surgery, Kyushu University Graduate School of Medical Sciences
| | - Ryuji Tominaga
- Department of Cardiovascular Surgery, Kyushu University Graduate School of Medical Sciences
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