1
|
Fu B, Liu X, Wei R, Chen Q, Guo Z, Jiang N. Bovine pericardial versus porcine stented replacement mitral valves: early hemodynamic performance and clinical results of a randomized comparison of the Perimount and the Mosaic valves. J Thorac Dis 2021; 13:262-269. [PMID: 33569206 PMCID: PMC7867808 DOI: 10.21037/jtd-20-3274] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To compare the hemodynamic and clinical outcomes following mitral valve replacement with the Perimount valve with those of the Mosaic valve. Methods A total of 145 consecutive patients with rheumatic heart valve disease who underwent single bioprosthetic mitral valve replacement were randomized to receive either the Perimount (n=72) valve or the Mosaic bioprosthesis (n=73). The mean age of patients was 72.1 years (range, 58-89 years) with a sex distribution of 55.2% female and 44.8% male. Patients underwent follow up transthoracic echocardiography at 3 months and 1 year postoperatively. We compared demographics, preoperative clinical data, operative data, hemodynamic profiles, and clinical outcomes. Results The cross-clamp time was similar, with 50.7±15.3 minutes for the Perimount and 50.7±21.8 minutes for the Mosaic bioprosthesis. The total bypass time was also similar, with 91.3±25.7 minutes for the Perimount and 87.8±25.6 minutes for the Mosaic valve. The peak and mean pressure gradients were lower in the Perimount group for all valve sizes and the difference was statistically significant at 1 year. The effective orifice area (EOA) was slightly larger in the Perimount valve (1.98±0.21 vs. 1.89±0.71 cm2, P=0.538) postoperatively, but there was no significant difference at 1 year. There were no differences in preoperative or postoperative left atrium diameter (LAD), left ventricular diastolic diameter (LVDD), left ventricular systolic diameter (LVSD), left ventricular ejection fraction (LVEF), pulmonary artery pressure (PAP). The mortality and major complications rate were similar between the two groups. Conclusions The Perimount prostheses is superior to the Mosaic prostheses after mitral valve replacement, achieving statistically significant lower gradients and larger EOA when compared on the basis of manufacturer-labeled valve sizes. Both valves appear to provide satisfactory clinical results.
Collapse
Affiliation(s)
- Bo Fu
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, China.,Tianjin Medical University, Tianjin, China
| | - Xiankun Liu
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, China.,Tianjin Medical University, Tianjin, China
| | - Runsheng Wei
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, China.,Tianjin Medical University, Tianjin, China
| | - Qingliang Chen
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Zhigang Guo
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Nan Jiang
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, China
| |
Collapse
|
2
|
Qi L, Liu S, Qiang Y, Zhao H, Liu R, Cheng D, Song B, Guan Q. Clinical mid-term outcomes of the Chinese-made CL-V bileaflet mechanical heart valve in Chinese patients. J Thorac Dis 2021; 13:10-17. [PMID: 33569180 PMCID: PMC7867806 DOI: 10.21037/jtd-20-2644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background The CL-V full-carbon bileaflet mechanical heart valve is a novel Chinese-made prosthetic valve. This study evaluated the mid-term outcomes of the CL-V bileaflet mechanical heart valve after implantation in Chinese patients. Methods This study retrospectively enrolled a total of 38 consecutive patients who underwent elective mechanical heart valve replacement (MHVR) with two different valve types from April 2004 and May 2010, including 18 patients with the CL-V bileaflet mechanical heart valve (44.4% male, mean age 47.4±6.2 years, mean body weight 64.7±11.9 kg) and 20 patients with the St. Jude mechanical heart valve (45.0% male, mean age 49.7±7.6 years, mean body weight 66.1±11.1 kg). All patients underwent follow-up clinical evaluations in the outpatient department at all-time points. Results No complications occurred during the mean 61.3 months follow-up time (range, 47–102 months). The cardiothoracic ratios (52.7%±4.5% vs. 50.1%±4.0%), left atrium diameter (46.5±7.6 vs. 44.8±9.3 mm), left ventricular diastolic diameter (47.6±4.9 vs. 48.2±8.5 mm) and left ventricular ejection fraction (65.4%±8.7% vs. 64.5%±8.0%) were not significantly different between the two groups (P>0.05). Transthoracic Doppler echocardiography showed that the hemodynamic indexes were not significantly different between the two groups at 1 year and 3 years (P>0.05). Furthermore, no significant differences were found between the two groups in hemocompatibility indexes at both 6 months and 3 years postoperatively (P>0.05). Conclusions The mid-term follow-up results of the CL-V bileaflet mechanical heart valve were similar to those of the St. Jude Medical heart valve, which showed stable hemodynamics and good blood compatibility. Chinese-made CL-V bileaflet mechanical heart valves can be a substitute for St. Jude Medical heart valves, and can be widely used in cardiac surgery. Trial registration Chinese Clinical Trial Registry ChiCTR2000034158.
Collapse
Affiliation(s)
- Liang Qi
- Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Lanzhou, China.,The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Shidong Liu
- Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Lanzhou, China.,The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| | - Yan Qiang
- Energy and Power Engineering College, Lanzhou University of Technology, Lanzhou, China.,School of Energy and Environment, Southeast University, Nanjing, China
| | - Honglin Zhao
- Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Lanzhou, China
| | - Ruisheng Liu
- Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Lanzhou, China
| | - Dianwei Cheng
- Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Lanzhou, China
| | - Bing Song
- Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Lanzhou, China
| | - Quanlin Guan
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, China
| |
Collapse
|
3
|
Liu C, Yang Y, Du L, Chen S, Zhang J, Zhang C, Zhou J. Platelet-leukocyte aggregate is associated with adverse events after surgical intervention for rheumatic heart disease. Sci Rep 2019; 9:13069. [PMID: 31506454 PMCID: PMC6737193 DOI: 10.1038/s41598-019-49253-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 08/16/2019] [Indexed: 02/05/2023] Open
Abstract
Platelet-leukocyte aggregate (PLA) is implicated in the etiology of both vascular lesions and cardiovascular events. This prospective cohort study aimed to examine the prognostic value of PLA for major adverse cardiac and cerebrovascular events (MACCE) and perioperative adverse events (AEs) in patients with rheumatic heart disease undergoing surgical intervention by Cox proportional hazard regression and logistic regression. A total of 244 patients were included, of whom 7 were lost to follow-up. Among the analyzed 237 subjects who completed 3-year follow-up, 30 experienced MACCE and 38 experienced perioperative AEs. Preoperative PLA was higher in subjects who developed MACCE (13.32%) than in those who did not (8.69%, p = 0.040). In multivariate regression, elevated PLA was associated with increased MACCE (hazard ratio 1.51 for each quartile, 95% CI 1.07-2.13; p = 0.020), and perioperative AEs (odds ratio 1.61, 95% CI 1.14-2.26; p = 0.007). The optimal PLA cut-off for predicting MACCE was 6.8%. Subjects with PLA > 6.8% had a higher prevalence of MACCE (17.1% vs. 5.5%, p = 0.009) and perioperative AEs (19.9% vs. 8.6%, p = 0.018). Kaplan-Meier analysis showed shorter MACCE-free survival in patients with PLA > 6.8% (p = 0.007, log rank). Elevated preoperative PLA is associated with increased MACCE and perioperative AEs in patients with rheumatic valve disease undergoing surgical intervention.
Collapse
Affiliation(s)
- Chaonan Liu
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yang Yang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China.,Department of Anesthesiology, Affiliated Hospital of Guiyang Medical College, Guiyang, China
| | - Lei Du
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Si Chen
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jie Zhang
- Key Laboratory of Transplant Engineering and Immunology, West China Hospital, Sichuan University, Chengdu, China
| | - Chongwei Zhang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Zhou
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China.
| |
Collapse
|
4
|
Zhang HW, Gu J, Xiao ZH, Li YJ, Yang P, Huang Y, Lu C, Zhang EY, Hu J. Global longitudinal strain in prosthesis-patient mismatch: relation to left ventricular mass regression and outcomes. J Cardiovasc Med (Hagerstown) 2019; 20:434-441. [PMID: 31090559 DOI: 10.2459/jcm.0000000000000819] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIMS Aortic prosthesis-patient mismatch (PPM) increases left ventricular (LV) afterload and prevents LV mass regression (LVMR) after surgery. This study was designed to investigate the association between the baseline global longitudinal strain (GLS) and the postoperative LVMR, and its relation to adverse outcomes. METHODS A total of 316 patients with aortic stenosis undergoing isolated mechanical prosthesis implantation were screened, and data from 91 patients with aortic PPM and 165 non-PPM patients were retrospectively collected. All 256 patients underwent measurement of GLS by two-dimensional speckle-tracking echocardiography preoperatively, and were followed up for postoperative changes of LV mass index (LVMi) and other clinical outcomes. RESULTS During the follow-up, LVMi in PPM patients decreased significantly from 139.6 ± 20.8 to 119.6 ± 26.5 g/m (P < 0.001). These patients were divided into two groups according to the median value of the reduction rate of LVMi at final follow-up, and preoperative GLS markedly decreased in PPM patients with insignificant reduction in LVMi. Multivariate analysis identified preoperative GLS (odds ratio 3.45, 95% confidence interval 1.27-11.05, P = 0.002) and preoperative LVMi (odds ratio 2.87, 95% confidence interval 1.21-8.13, P = 0.012) as independently associated with an insignificant LVMR. Moreover, PPM patients with limited reduction in LVMi were at an increased risk of cardiac death and major adverse valve-related events. CONCLUSION In patients with aortic PPM early after surgery, reduced preoperative GLS could be a novel sensitive risk factor for a limited regression of LV hypertrophy, and this is associated with an increased risk of adverse events in PPM patients.
Collapse
Affiliation(s)
| | - Jun Gu
- Department of Cardiovascular Surgery
| | | | - Ya-Jiao Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Peng Yang
- Department of Cardiovascular Surgery
| | - Yao Huang
- Department of Cardiovascular Surgery
| | - Chen Lu
- Department of Cardiovascular Surgery
| | | | - Jia Hu
- Department of Cardiovascular Surgery
| |
Collapse
|
5
|
Zhang L, Long Y, Xiao H, Yang J, Toulon P, Zhang Z. Use of D-dimer in oral anticoagulation therapy. Int J Lab Hematol 2018; 40:503-507. [PMID: 29806239 DOI: 10.1111/ijlh.12864] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/16/2018] [Indexed: 12/17/2022]
Abstract
Individualized anticoagulation management and improvement of the safety and effectiveness of oral anticoagulant have always been the focus of clinicians' attention. D-dimer, a sensitive marker of thrombosis and coagulation activation, is not only traditionally used in the diagnosis of venous thromboembolism, acute aortic dissection, and disseminated intravascular coagulation but can also be used as a helpful marker in the management of oral anticoagulant, including evaluating the anticoagulation quality, predicting clinical outcomes, and determining the optimal duration and intensity of anticoagulation.
Collapse
Affiliation(s)
- L Zhang
- Department of Clinical Laboratory and Pathology, Wuhan Asia Heart Hospital, Wuhan, China
| | - Y Long
- Heart Center, Wuhan Asia Heart Hospital, Wuhan, China
| | - H Xiao
- Heart Center, Wuhan Asia Heart Hospital, Wuhan, China
| | - J Yang
- Department of Clinical Laboratory and Pathology, Wuhan Asia Heart Hospital, Wuhan, China
| | - P Toulon
- Service d'Hématologie Biologique, CHU Pasteur, Université Nice Sofia-Antipolis, Nice, France
| | - Z Zhang
- Department of Clinical Laboratory and Pathology, Wuhan Asia Heart Hospital, Wuhan, China
| |
Collapse
|
6
|
Zhang L, Zheng X, Long Y, Wu M, Chen Y, Yang J, Liu Z, Zhang Z. D-dimer to guide the intensity of anticoagulation in Chinese patients after mechanical heart valve replacement: a randomized controlled trial. J Thromb Haemost 2017; 15:1934-1941. [PMID: 28762606 DOI: 10.1111/jth.13782] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Indexed: 11/27/2022]
Abstract
Essentials Low anticoagulation intensity reduces bleeding but increases thrombosis during warfarin therapy. Elevated D-dimer level is associated with increased thrombosis events. D-dimer can be used to find potential thrombosis in those receiving low intensity therapy. D-dimer-guided therapy may be the optimal strategy for those with mechanical heart valve replacement. SUMMARY Background Controversies remain regarding the optimal anticoagulation intensity for Chinese patients after mechanical heart valve replacement despite guidelines having recommended a standard anticoagulation intensity. Objectives To investigate whether D-dimer could be used to determine the optimal anticoagulation intensity in Chinese patients after mechanical heart valve replacement. Patients/Methods This was a prospective, randomized controlled clinical study. A total of 748 patients following mechanical heart valve replacement in Wuhan Asia Heart Hospital were randomized to three groups at a ratio of 1 : 1 : 1. Patients in two control groups received warfarin therapy based on constant standard intensity (international normalized ratio [INR], 2.5-3.5; n = 250) and low intensity (INR, 1.8-2.6; n = 248), respectively. In the experimental group (n = 250), warfarin therapy was initiated at low intensity, then those with elevated D-dimer levels were adjusted to standard intensity. All patients were followed-up for 24 months until the occurrence of endpoints, including bleeding events, thrombotic events and all-cause mortality. Results A total of 718 patients were included in the analysis. Fifty-three events occurred during follow-up. There was less hemorrhage (3/240 vs. 16/241; hazard ratio [HR], 0.18; 95% confidence interval [CI], 0.07-0.45) and all-cause mortality (4/240 vs. 12/241; HR, 0.33; 95% CI, 0.12-0.87) observed in the D-dimer-guided group than in the standard-intensity group. A lower incidence of thrombotic events was also observed in the D-dimer-guided group when compared with the low-intensity group (5/240 vs. 14/237; HR, 0.35; 95% CI, 0.14-0.85). Overall, the total events were less in the D-dimer-guided group (9/240) when compared with the other two control groups (24/241, 20/237; HR, 0.37, 0.44; 95% CI, 0.19-0.72, 0.21-0.90 Conclusions The D-dimer-guided adjustment of anticoagulation intensity could reduce adverse events in Chinese patients after mechanical heart valve replacement. TRIAL REGISTRY NCT01996657; ClinicalTrials.gov.
Collapse
Affiliation(s)
- L Zhang
- Department of Clinical Laboratory and Pathology, Wuhan Asia Heart Hospital, Wuhan University, Wuhan, China
| | - X Zheng
- Laboratory of Molecular Cardiology, Wuhan Asia Heart Hospital, Wuhan University, Wuhan, China
| | - Y Long
- Heart Center, Wuhan Asia Heart Hospital, Wuhan University, Wuhan, China
| | - M Wu
- Heart Center, Wuhan Asia Heart Hospital, Wuhan University, Wuhan, China
| | - Y Chen
- Department of Clinical Laboratory and Pathology, Wuhan Asia Heart Hospital, Wuhan University, Wuhan, China
| | - J Yang
- Department of Clinical Laboratory and Pathology, Wuhan Asia Heart Hospital, Wuhan University, Wuhan, China
| | - Z Liu
- Department of Clinical Laboratory and Pathology, Wuhan Asia Heart Hospital, Wuhan University, Wuhan, China
| | - Z Zhang
- Department of Clinical Laboratory and Pathology, Wuhan Asia Heart Hospital, Wuhan University, Wuhan, China
| |
Collapse
|
7
|
Hu J, Qian H, Li YJ, Gu J, Zhao JJ, Zhang EY. Seventeen-millimeter St. Jude Medical Regent valve in patients with small aortic annulus: dose moderate prosthesis-patient mismatch matter? J Cardiothorac Surg 2014; 9:17. [PMID: 24438101 PMCID: PMC3896805 DOI: 10.1186/1749-8090-9-17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 01/02/2014] [Indexed: 02/05/2023] Open
Abstract
Background The study was designed to evaluate the effects of moderate prosthesis-patient mismatch (defined as 0.65 cm2/m2 < indexed effective orifice area ≤ 0.85 cm2/m2) on midterm outcomes after isolated aortic valve replacement with a 17-mm St. Jude Medical Regent valve in a large series of patients, and to determine if these effects are influenced by patient confounding variables. Methods One-hundred and six patients with and without moderate prosthesis-patient mismatch early after implantation of a 17-mm Regent valve at aortic position were included. Both clinical and echocardiographic assessments were performed preoperatively, at discharge and during follow-up period (mean follow-up time 52.6 ± 11.9 months). Results The prevalence of moderate prosthesis-patient mismatch was documented in 46 patients (43.4%) at discharge. During the follow-up period, no difference in the regression of left ventricular mass, decrease of transvalvular pressure gradients, mortality and prosthesis-related complications was observed between patients with and without moderate prosthesis-patient mismatch. After adjustment for several risk factors, moderate prosthesis-patient mismatch was associated with increased midterm mortality in patients with baseline left ventricular ejection fraction < 50% (HR: 1.80, p = 0.02), but with normal prognosis in those with preserved LV function. Younger age (cut off value = 65 years) was not an independent predictor of increased midterm mortality and valve-related complications in patients with moderate prosthesis-patient mismatch. Conclusions Moderate prosthesis-patient mismatch after aortic valve replacement with a small mechanical prosthesis is associated with increased mortality and adverse events in patients with pre-existing left ventricular dysfunction. Selected patients with small aortic annulus can experience satisfactory clinical improvements and midterm survival after aortic valve replacement with a 17-mm Regent valve.
Collapse
Affiliation(s)
| | | | | | | | | | - Er-yong Zhang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
| |
Collapse
|