1
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Yıldırım JG, Bayık Temel A. The Effect of Nurse Home-Support Program on Self-Management of Patients Receiving Oral Anticoagulation (Warfarin) Therapy. Florence Nightingale Hemsire Derg 2020; 28:13-22. [PMID: 34263181 PMCID: PMC7968461 DOI: 10.5152/fnjn.2020.19020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 09/12/2019] [Indexed: 11/22/2022] Open
Abstract
Aim Warfarin, which is widely used for preventing thromboembolic events, can cause major and minor side effects. The aim of this trial is to evaluate the effect of nurse home-support program on self-management of patients receiving warfarin therapy. Method A randomized, controlled trial was conducted using 36 selected and eligible patients who had 12-month home-visit follow-ups. The bleeding risk score, potential and preventable warfarin-related complications, patients' self-management behaviors, and anticoagulation satisfaction were examined. Data analyses were performed using parametric and nonparametric tests, split-plot analysis of variance, multiple regression analysis, and Bland and Altman plots test. Results The bleeding risk score was an effective variable for assessing patient satisfaction (p<0.05). The self-management group demonstrated decreased bleeding risk at the end of the trial. The Duke Anticoagulation Satisfaction Scale mean score represents a statistically significant improvement in the self-management group (p<0.05). Patients' self-management behaviors improved significantly in the self-management group compared to the control group (p<0.05). The number of international normalized ratio values within the target range was significantly higher in the self-management group (174/432) than in the control group (82/432). The self-management group showed significant reductions in both thromboembolic events. Conclusion This trial demonstrated evidence that use of nursing home care is effective in developing self-management behaviors, improving patient satisfaction, and preventing complications in patients receiving warfarin therapy. This model could be easily adopted and implemented by home care services and health organizations.
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Affiliation(s)
- Jülide Gülizar Yıldırım
- Department of Public Health Nursing, İzmir Katip Çelebi University Faculty of Health Sciences, İzmir, Turkey
| | - Ayla Bayık Temel
- Department of Public Health Nursing, Ege University Faculty of Nursing, İzmir, Turkey
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2
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Lameijer H, Schutte JM, Schuitemaker NWE, van Roosmalen JJM, Pieper PG. Maternal mortality due to cardiovascular disease in the Netherlands: a 21-year experience. Neth Heart J 2019; 28:27-36. [PMID: 31776914 PMCID: PMC6940401 DOI: 10.1007/s12471-019-01340-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Objective Cardiovascular disorders are the leading cause of indirect maternal mortality in Europe. The aim of this study is to present an extensive overview concerning the specific cardiovascular causes of maternal death and to identify avoidable contributing care factors related to these deaths. Methods We assessed all cases of maternal death due to cardiovascular disorders collected by a systematic national confidential enquiry of maternal deaths published by the Dutch Maternal Mortality and Morbidity Committee on behalf of the Netherlands Society of Obstetrics and Gynaecology over a 21-year period (1993–2013) in the Netherlands. Results There were 96 maternal cardiovascular deaths (maternal mortality rate due to cardiovascular diseases 2.4/100,000 liveborn children). Causes were aortic dissection (n = 20, 21%), ischaemic heart disease (n = 17, 18%), cardiomyopathies (including peripartum cardiomyopathy and myocarditis, n = 20, 21%) and (unexplained) sudden death (n = 27, 28%). Fifty-five percent of the deaths occurred postpartum (n = 55, 55%). Care factors that may have contributed to the adverse outcome were identified in 27 cases (28%). These factors were patient-related in 40% (pregnancy against medical advice, underestimation of symptoms) and healthcare-provider-related in 60% (symptoms not recognised, delay in diagnosis, delay in referral). Conclusion The maternal cardiovascular mortality ratio is low in the Netherlands and the main causes of maternal cardiovascular mortality are in line with other European reports. In a minority of cases, care factors that were possibly preventable were identified. Women with cardiovascular disease should be properly counselled about the risks of pregnancy and the symptoms of complications. Education of care providers regarding the incidence, presentation and diagnosis of cardiovascular disease during pregnancy is recommended.
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Affiliation(s)
- H Lameijer
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands. .,Department of Emergency Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
| | - J M Schutte
- Department of Obstetrics and Gynaecology, Isala Zwolle, Zwolle, The Netherlands
| | - N W E Schuitemaker
- Department of Obstetrics and Gynaecology, Diakonessen Hospital, Utrecht, The Netherlands
| | - J J M van Roosmalen
- Athena Institute, VU University, Amsterdam, The Netherlands.,Department of Obstetrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - P G Pieper
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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3
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Reisman AM, Thomas AT, Boateng P, Leitman IM. Predictors of 30-day outcomes following mitral valve repair. Ann Med Surg (Lond) 2019; 47:5-12. [PMID: 31641493 PMCID: PMC6796495 DOI: 10.1016/j.amsu.2019.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/27/2019] [Accepted: 09/05/2019] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Mitral valve repair has been established as the preferred treatment option in the management of degenerative mitral valve disease. Compared with other surgical treatment options, mitral valve repair is associated with increased survival and decreased rates of both complications and reoperations. However, among patients undergoing mitral valve repair, little is known about the predictors of postoperative outcomes. The purpose of this study is to identify preoperative patient risk factors associated with postoperative morbidity and mortality within 30 days of mitral valve repair. METHODS Data was derived from the American College of Surgeons National Surgical Quality Improvement Program database to assess patients who underwent mitral valve repair from 2011 through 2017. Preoperative risk factors were analyzed to determine their association with a variety of postoperative 30-day outcome measures. RESULTS One thousand three hundred and sixty-six patients underwent mitral valve repair; 849 (62.2%) males and 517 (37.8%) females. Ages ranged from 18 to 90 years, with a mean age of 64 years. The overall 30-day mortality was 3.1% (43 patients). Among the 12 identified risk factors associated with increased mortality on univariate analysis, pre-operative hematocrit level was the only variable significantly correlated with mortality after undergoing multivariate analysis. 259 patients (19.1%) were discharged to a location other than home, an outcome associated with 22 identified risk factors. Among these risk factors, female gender, age, dialysis, pre-operative serum sodium, pre-operative serum albumin, and partial or full living dependency remained statistically significant following multivariate analysis. 126 patients (9.2%) experienced unplanned readmission. This outcome was associated with five risk factors, of which only dyspnea upon mild exertion was significant on multivariate analysis. Reoperation occurred in 105 patients (7.7%). Of the seven identified variables associated with reoperation, patient age, pre-operative platelet count, dyspnea upon mild exertion were independent predictors on multivariate analysis. 53 patients (3.9%) underwent reintubation, which was associated with 11 identified risk factors. Among them, patient age and pre-operative INR value were predictive of reintubation on multivariate analysis. 26 patients (1.9%) experienced stroke, of whom age was the only associated risk factor on both univariate and multivariate analysis. 31 patients (2.3%) experienced acute renal failure, which correlated with 11 risk factors on univariate analysis. Of these, only patient age and pre-operative hematocrit were identified as independent predictors on multivariate analysis. CONCLUSIONS Outcomes are good following mitral valve repair. Although a substantial number of risk factors were found to be associated with adverse outcomes, only a small subset remained statistically significant following multivariate analysis. Identification of these risk factors may help guide clinical decision making with respect to which patients are the best candidates to undergo mitral valve repair.
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Affiliation(s)
- Adam M. Reisman
- Departments of Medical Education, Icahn School of Medicine at Mount Sinai, United States
| | - A. Taylor Thomas
- Departments of Medical Education, Icahn School of Medicine at Mount Sinai, United States
| | - Percy Boateng
- Departments of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, United States
| | - I. Michael Leitman
- Departments of Medical Education, Icahn School of Medicine at Mount Sinai, United States
- Departments of Surgery, Icahn School of Medicine at Mount Sinai, United States
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4
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Herron R, Nanjundappa A, Annie FH, Wood M, Embrey S, Heatherly C, Tager A. Our Experience with Transcatheter Aortic Valve Replacement Medication Outcomes from 2013 to 2016. Cureus 2019; 11:e6030. [PMID: 31824797 PMCID: PMC6886647 DOI: 10.7759/cureus.6030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 10/29/2019] [Indexed: 11/05/2022] Open
Abstract
Background Aortic stenosis is classified as stenosis that can be caused by a congenital disability in infants and children but is more commonly produced by a degenerative process of calcification and scarring of the valve in the later decades of life. High systemic pressure and hemodynamic disturbances characteristic of this area of the cardiovascular system makes the aortic valve susceptible to plaque and cholesterol buildup over time, similarly to atherosclerosis, contributing to the pathology of aortic stenosis. Thus, this study aims to assess the short and long-term clinical outcomes of risk factor reduction, post transcatheter aortic valve replacement (post-TAVR), and results of tested medication outcomes. Methods Data were obtained from Charleston Area Medical Center, which is a tertiary care 800-bed community teaching facility and was examined using STATA 11.4 (StataCorp LLC, College Station, Texas, USA), a Cox proportional hazards model to test for clinical significance. This study examined the medications aspirin, clopidogrel, beta-blockers, and angiotensin-converting enzyme (ACE) inhibitors. Additional medications analyzed included statin, anticoagulant, aspirin with clopidogrel, and beta-blocker with ACE inhibitor and statin following the procedure of transcatheter aortic valve replacement (TAVR) and the overall risk of a hazard event of mortality. Results Results suggest that clopidogrel by itself had the lower rate of mortality at one year with hazards of 0.6906, a p-value of 0.221 and a 95% confidence interval of 0.3677 - 1.259; and at three years with hazards of 0.4845, a p-value of 0.027 and a 95% confidence interval of 0.2552 - 0.9201. Statins had the second-lowest rate at one year with hazards of 0.7299 and a p-value 0.215 and a 95% confidence interval of 0.4438 - 1.200; and at three years with hazard of 0.8529 and a p-value of 0.530 and a 95% confidence interval of 0.5192 - 1.401. Both of these medications had a consistent lower hazard and/or risk of death compared to other standard medication regiments. Within our center's data, clopidogrel had the best clinical outcome. Conclusions This study showed that therapy with aspirin and clopidogrel alone did not demonstrate a significant increase in mortality versus alternative anticoagulation therapy in patients post aortic valve replacement. Clopidogrel and statin usage post-aortic valve revascularization may have a trend towards a reduction in mortality.
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Affiliation(s)
- Robert Herron
- Surgery, Charleston Area Medical Center, Charleston, USA
| | | | - Frank H Annie
- Cardiology, Charleston Area Medical Center, Charleston, USA
| | - Megan Wood
- Heart and Vascular Center, Charleston Area Medical Center, Charleston, USA
| | - Sarah Embrey
- Pharmacy, University of Charleston School of Pharmacy, Charleston, USA
| | - Carly Heatherly
- Osteopathic Medicine, West Virginia School of Osteopathic Medicine, Buckhannon, USA
| | - Alfred Tager
- Emergency Medicine, Charleston Area Medical Center, Charleston, USA
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5
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Balakrishnan K, Herman B, Koshy G. Very late bioprosthetic aortic valve thrombosis. BMJ Case Rep 2019; 12:12/5/e228871. [PMID: 31068347 DOI: 10.1136/bcr-2018-228871] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
A 79-year-old man with a history of bioprosthetic aortic valve (AV) replacement in 2008 and atrial fibrillation was admitted with acute pulmonary oedema. Transthoracic and transoesophageal echocardiograms revealed significantly elevated AV gradients and thickened AV leaflets. These findings were suggestive of bioprosthetic valve thrombosis (BVT). The patient was treated with intravenous heparin and commenced on vitamin K antagonist. BVT remains an under recognised cause of late prosthetic valve dysfunction. A lack of awareness of BVT occurring beyond 3 months post-implantation is likely to account for this. Furthermore, structural valve degeneration is the most common mechanism of late prosthetic valve dysfunction. Recognising the difference between the two aetiologies is crucial as the management plan differs significantly. Here, we report a case of very late bioprosthetic AV thrombosis diagnosed 8 years after implantation. This was successfully treated with systemic anticoagulation, thereby avoiding the need for redo cardiac surgery.
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Affiliation(s)
- Kuhendra Balakrishnan
- Cardiology, Launceston General Hospital, Launceston, Tasmania, Australia.,Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
| | - Brian Herman
- Cardiology, Launceston General Hospital, Launceston, Tasmania, Australia.,School of Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - George Koshy
- Cardiology, Launceston General Hospital, Launceston, Tasmania, Australia
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6
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Kiyose AT, Suzumura EA, Laranjeira L, Buehler AM, Santo JAE, Berwanger O, Carvalho ACDC, Paola AAD, Moises VA, Cavalcanti AB. Comparison of Biological and Mechanical Prostheses for Heart Valve Surgery: A Systematic Review of Randomized Controlled Trials. Arq Bras Cardiol 2019; 112:292-301. [PMID: 30916201 PMCID: PMC6424027 DOI: 10.5935/abc.20180272] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 09/05/2018] [Indexed: 12/03/2022] Open
Abstract
Background The choice of a mechanical (MP) or biological prosthesis (BP) for patients
with valvular heart disease undergoing replacement is still not a
consensus. Objective We aimed to determine the clinical outcomes of MP or BP placement in those
patients. Methods We conducted a systematic review and meta-analysis of randomized controlled
trials (RCTs) that compared biological prostheses and mechanical prostheses
in patients with valvular heart diseases and assessed the outcomes. RCTs
were searched in the MEDLINE, EMBASE, LILACS, CENTRAL, SCOPUS and Web of
Science (from inception to November 2014) databases. Meta-analyses were
performed using inverse variance with random effects models. The GRADE
system was used to rate the quality of the evidence. A P-value lower than
0.05 was considered significant. Results A total of four RCTs were included in the meta-analyses (1,528 patients) with
follow up ranging from 2 to 20 years. Three used old generation mechanical
and biological prostheses, and one used contemporary prostheses. No
significant difference in mortality was found between BP and MP patients
(risk ratio (RR = 1.07; 95% CI 0.99-1.15). The risk of bleeding was
significantly lower in BP patients than MP patients (RR = 0.64; 95% CI
0.52-0.78); however, reoperations were significantly more frequent in BP
patients (RR = 3.60; 95% CI 2.44-5.32). There were no statistically
significant differences between BP and MP patients with respect to systemic
arterial embolisms and infective endocarditis (RR = 0.93; 95% CI 0.66-1.31,
RR = 1.21; CI95% 0.78-1.88, respectively). Results in the trials with modern
and old prostheses were similar. Conclusions The mortality rate and the risk of thromboembolic events and endocarditis
were similar between BP and MP patients. The risk of bleeding was
approximately one third lower for BP patients than for MP patients, while
the risk of reoperations was more than three times higher for BP
patients.
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Affiliation(s)
- Alberto Takeshi Kiyose
- Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brazil.,Hospital do Coração (HCOR), São Paulo, SP - Brazil
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7
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Filip G, Litwinowicz R, Kapelak B, Piatek J, Bartus M, Konstanty-Kalandyk J, Brzezinski M, Bartus K. Mid-term follow-up after suture-less aortic heart valve implantation. J Thorac Dis 2018; 10:6128-6136. [PMID: 30622784 DOI: 10.21037/jtd.2018.10.10] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Aortic stenosis (AS) is the most common valve disease in the adult population and its prevalence increases with age. Unfortunately, older age and comorbidities significantly increase mortality, operative risk and worsen prognosis. In recent years, sutureless bioprosthesis [sutureless-aortic valve replacement (SU-AVR)] has become an alternative to standard AVR or TAVI in high-risk patients. Compared to standard AVR, the advantages of SU-AVR include shorter valve implantation, shorter aortic cross clamp (ACC) and cardiopulmonary bypass (CPB) times and higher valve EOA with more favorable hemodynamic parameters. Good early clinical and hemodynamic outcomes have been reported in several studies. However, although early SU-AVR results reported in the literature are encouraging, there are few results of long term follow-up. The aim of this study is to present long term echocardiographic hemodynamic outcomes of the Enable sutureless bioprosthesis. Methods The first human implantation of the Enable sutureless bioprosthesis was performed on the 13th January, 2005 by the authors of this manuscript. From that time until July 2008, 25 patients underwent isolated SU-AVR implantation. The median preoperative logistic EuroSCORE was 1.92±0.17 [standard deviation (SD)] and the STS score was 2.96±2.73. Preoperatively, 65.4% of patients were in NYHA class III or IV, the peak/mean gradient transaortic gradient was 84.6/52.1 mmHg. Results After the SU-AVR procedure, the average peak/mean aortic gradients were respectively: 12.9/7.1 mmHg at the intraoperative time; 18.1/9.5 mmHg at 3-6 months; 18.3/9.6 mmHg at 11-14 months; 16.9/9.3 mmHg at 2 years; 15.3/8 mmHg at 3 years; 13.4/7.1 mmHg at 4 years; 16.7/8.9 mmHg at 5 years follow-up. Other hemodynamic echocardiographic parameters such as LVOT diameter, LVOT peak velocity, LVOT TVI, valve peak velocity and valve TVI were stable during the follow-up period. Conclusions In summary, sutureless bioprostheses are safe and effective treatments for valve stenosis with excellent outcomes and hemodynamic profile which remained stable during the follow-up period. The peak and mean gradients were 16.7 and 8.9 mmHg, respectively, over a 5-year follow-up period.
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Affiliation(s)
- Grzegorz Filip
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | - Radoslaw Litwinowicz
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | - Boguslaw Kapelak
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | - Jacek Piatek
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | - Magdalena Bartus
- Department of Experimental Pharmacology, Jagiellonian University, Krakow, Poland
| | - Janusz Konstanty-Kalandyk
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | - Maciej Brzezinski
- Department of Cardiac and Vacsular Surgery, Medical University of Gdansk, Gdansk, Poland
| | - Krzysztof Bartus
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital, Krakow, Poland
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8
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Reyes M, Reardon MJ. Transcatheter Valve Replacement: Risk Levels and Contemporary Outcomes. Methodist Debakey Cardiovasc J 2018; 13:126-131. [PMID: 29743997 DOI: 10.14797/mdcj-13-3-126] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has exploded into medical care for aortic stenosis, thus changing the treatment options for patients. TAVR is currently approved for extreme-risk, high-risk, and intermediate-risk patients with symptomatic severe aortic stenosis, and randomized trials for low-risk patients are underway. This article traces the trajectory of TAVR as a viable option for higher-risk patients and examines current outcomes.
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Affiliation(s)
- Manuel Reyes
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
| | - Michael J Reardon
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
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9
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Alfadhli J, Jeraq M, Singh V, Martinez C. Updates on transcatheter aortic valve replacement: Techniques, complications, outcome, and prognosis. J Saudi Heart Assoc 2018; 30:340-348. [PMID: 30108426 PMCID: PMC6090012 DOI: 10.1016/j.jsha.2018.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 07/10/2018] [Accepted: 07/21/2018] [Indexed: 11/25/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) initially emerged as a therapeutic option for high-risk patients with severe aortic stenosis. Advancement in technologies since the first era of TAVRs, experience from previous obstacles, and lessons learned from complications have allowed the evolution of this procedure to the current state. This review focuses on the updates on the most current devices, complications, and outcomes of TAVR.
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Affiliation(s)
- Jarrah Alfadhli
- Cardiovascular Division, University of Miami Miller School of Medicine, Miami, FL, USAUSA
- Corresponding author at: Cardiovascular Division, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Mohammed Jeraq
- Department of General Surgery, University of Miami Miller School of Medicine, Miami, FL, USAUSA
| | - Vikas Singh
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USAUSA
| | - Claudia Martinez
- Cardiovascular Division, University of Miami Miller School of Medicine, Miami, FL, USAUSA
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10
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Jansen R, Urgel K, Cramer MJ, van Aarnhem EEHL, Zwetsloot PPM, Doevendans PA, Kluin J, Chamuleau SAJ. Reference Values for Physical Stress Echocardiography in Asymptomatic Patients after Mitral Valve Repair. Front Surg 2018. [PMID: 29516004 PMCID: PMC5826059 DOI: 10.3389/fsurg.2018.00006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background Clinical decision-making in symptomatic patients after mitral valve (MV) repair remains challenging as echocardiographic reference values are lacking. In native MV disease intervention is recommended for mean transmitral pressure gradient (TPG) >15 mmHg or systolic pulmonary artery pressure (SPAP) >60 mmHg at peak exercise. Insight into standard stress echo parameters after MV repair may therefore aid to clinical decision-making during follow-up. Hypothesis Stress echocardiography derived parameters in asymptomatic patients after successful MV repair differ from current guidelines for native valves. Material and methods In 25 patients (NYHA I) after MV repair stress echocardiography was performed on a semi-supine bicycle. Doppler flow records and MV related hemodynamics at rest and peak were obtained. Linear regression analysis was performed for mean TPG and SPAP at peak, using predetermined variables and confounders. Results Mean TPG at rest (3.2 ± 1.4 mmHg) significantly increased at peak (15.0 ± 3.4 mmHg) but was always <25 mmHg. Mean SPAP at rest (21.4 ± 3.8 mmHg) significantly increased at peak (41.8 ± 8.9 mmHg) but was never >57 mmHg. Only the indexed MV ring diameter was inversely correlated to mean TPG at peak in a multivariable model. Conclusion In contrast to current recommendations in native MV disease, our data indicate that the standard value for mean TPG during stress echocardiography in asymptomatic patients after successful MV repair was above the guideline threshold of 15 mmHg in >50%, but always <25 mmHg. For SPAP, patients never reached the guideline cutoff (60 mmHg). Long-term follow-up data are needed to provide insight in clinical consequences. Baseline stress echocardiography may indicate individual reference values to compare with during follow-up. Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT02371863?term=chamuleau+AND+Mitral&rank=1.
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Affiliation(s)
- Rosemarijn Jansen
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Kim Urgel
- Department of Cardiology, St Antonius Hospital Woerden, Woerden, Netherlands
| | - Maarten J Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Peter P M Zwetsloot
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Pieter A Doevendans
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Jolanda Kluin
- Department of Cardiothoracic Surgery, Academic Medical Center Amsterdam, Amsterdam, Netherlands
| | - Steven A J Chamuleau
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
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11
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Raimundo R, Moreira S, Saraiva F, Cerqueira RJ, Teixeira P, Salgueiro E, Lourenço A, Amorim MJ, Almeida J, Pinho P, Leite-Moreira AF. Early and mid-term haemodynamic performance and clinical outcomes of St. Jude Medical Trifecta™ valve. J Thorac Dis 2018; 10:889-898. [PMID: 29607162 DOI: 10.21037/jtd.2018.01.15] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background New models of aortic bioprostheses have proven excellent early haemodynamic profile, but their mid and long-term performance warrants further systematic assessment. The aim of this study is to report clinical and haemodynamic performance of St. Jude Medical Trifecta bioprosthesis during 5 years of implantation. Methods We performed a single centre, retrospective, observational and descriptive study including all 556 individuals who underwent aortic valve replacement (AVR) with the Trifecta bioprosthesis (between July of 2011 and June of 2016). Survival and re-intervention were censored in February 2017. Postoperative ambulatory echocardiographic data was available for 490 patients. A complete clinical follow-up was available in 463 individuals (mean follow-up time, 27±17 months). Results In our sample the mean age was 73±9 years, 57.6% were male and median European System for Cardiac Operative Risk Evaluation (EuroSCORE) II was 2.9 (interquartile range, 1.6-5.8). There were 301 (54.1%) combined procedures, mostly coronary artery bypass grafting in 170 (30.6%). Overall 30-days mortality was 5.4% (n=30) and cumulative survival at 5-years was 72.3%. There were 23 (4.3%) permanent pacemaker implantations. During follow-up, 5 (0.9%) patients presented non-structural valve dysfunction (NSVD) and 4 (0.8%) underwent reoperation due to prosthesis endocarditis. At the first ambulatory evaluation transvalvular mean gradient and effective orifice area (EOA) were 10.9±4.1 mmHg and 2.0±0.5 cm2, respectively. Severe patient-prosthesis mismatch (PPM) was observed in 5 (1.1%) individuals and moderate in 52 (11.3%). Conclusions In a "real-world" clinical setting, our findings support the good overall mid-term haemodynamic and safety profile of the Trifecta bioprosthesis.
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Affiliation(s)
- Renata Raimundo
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Soraia Moreira
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Francisca Saraiva
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Rui J Cerqueira
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Serviço de Cirurgia Cardiotorácica, Centro Hospitalar de São João, Porto, Portugal
| | - Pedro Teixeira
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Elson Salgueiro
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Serviço de Cirurgia Cardiotorácica, Centro Hospitalar de São João, Porto, Portugal
| | - André Lourenço
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Serviço de Anestesiologia, Centro Hospitalar de São João, Porto, Portugal
| | - Mário J Amorim
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Serviço de Cirurgia Cardiotorácica, Centro Hospitalar de São João, Porto, Portugal
| | - Jorge Almeida
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Serviço de Cirurgia Cardiotorácica, Centro Hospitalar de São João, Porto, Portugal
| | - Paulo Pinho
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Serviço de Cirurgia Cardiotorácica, Centro Hospitalar de São João, Porto, Portugal
| | - Adelino F Leite-Moreira
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Serviço de Cirurgia Cardiotorácica, Centro Hospitalar de São João, Porto, Portugal
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Bob-Manuel T, Kadire S, Heckle MR, Wang J, Ibebuogu UN. Outcomes following transcatheter aortic valve replacement in patients with native aortic valve regurgitation. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:8. [PMID: 29404354 DOI: 10.21037/atm.2017.09.29] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Due to the absence of annular calcification for device anchoring, it is presumed that transcatheter aortic valve replacement (TAVR) is not suitable for the treatment of native aortic valve regurgitation (NAVR) resulting in very limited data and experience concerning its safety and efficacy. We sought to review published data on the safety and efficacy of TAVR in high-risk patients with NAVR. Studies including case reports, case series and original articles published between 2002 and 2016 on TAVR in patients with NAVR were identified with a systematic electronic search using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Only studies reporting data on demographic and procedural characteristics, management and follow up outcomes were analyzed. A total of 30 publications describing 182 patients were identified. Most patients (54%) were men, with a mean age of 70.1±2.6 years, mean logistic European System for Cardiac Operative Risk Evaluation score (EuroSCORE) of 21.8%±4.5% and mean Society of Thoracic Surgeons (STS) score of 8%±1.8% for mortality. The majority (87%) of patients had severe NAVR with no valvular calcification. TAVR was mostly performed through the femoral (58.8%) and apical (33.1%) approach. Device success, defined by VARC-2, was achieved in 86.3% of our study population. A second valve was required in 17 patients (9.3%) during the index procedure for residual aortic regurgitation or malposition. Post-procedure aortic regurgitation of grade 1 or less was present in 80 patients (81%). Pacemaker implantation was required post procedure in 17 patients (9.3%). The 30-day and 1-year mortality was 11.9% and 16.2%, respectively. TAVR is associated with favorable pacemaker implantation and 1-year mortality rates with a high 30-day mortality among selected patients with NAVR.
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Affiliation(s)
- Tamunoinemi Bob-Manuel
- Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center/Methodist University Hospital, Memphis, TN, USA
| | - Siri Kadire
- Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center/Methodist University Hospital, Memphis, TN, USA
| | - Mark R Heckle
- Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center/Methodist University Hospital, Memphis, TN, USA
| | - Jiajing Wang
- Division of Biostatistics & Epidemiology, Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Uzoma N Ibebuogu
- Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center/Methodist University Hospital, Memphis, TN, USA
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13
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Description and Validation of TAVIApp: A Novel Mobile Application for Support of Physicians in the Management of Aortic Stenosis-Management of Aortic Stenosis with TAVIApp. BIOMED RESEARCH INTERNATIONAL 2017; 2017:9027597. [PMID: 29270437 PMCID: PMC5705902 DOI: 10.1155/2017/9027597] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 10/11/2017] [Indexed: 11/17/2022]
Abstract
Background Aortic stenosis (AS) is the most common heart valve disease in developed countries. The advent of transcatheter aortic valve implantation (TAVI) significantly improved patients' outcome but made clinical management more complex. The aim of the present study was to describe TAVIApp, a mobile app we developed to guide the management of AS, and test its efficacy. Methods and Results Clinical cases comprising 42 patients with AS were blindly evaluated by (A) an interventional cardiologist, assisted by the Heart Team (EXPERT), (B) young residents in cardiology, and (C) a young resident supported by TAVIApp. There was poor concordance between Group A and Group B with low performance by young residents (k = 0.52; p < 0.001). However, concordance increased to an optimal value when young residents were supported by TAVIApp (k = 1.0; p < 0.001) for the diagnosis of severe AS and eligibility assessment. Furthermore, regarding the selection of the most appropriate prosthesis size, concordance to Group A was poor without TAVIApp support (Group B) (k = 0.78; p = 0.430), but excellent with TAVIApp (k = 1.0; p < 0.001). Conclusions This study is the first describing and validating a new mobile application to support the management of AS. TAVIApp supports cardiologists in the evaluation of stenosis severity, eligibility for TAVI or AVR, and selection of the most appropriate prosthesis size in individual patients.
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14
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Cheema B, Ambrosy AP, Kaplan RM, Senni M, Fonarow GC, Chioncel O, Butler J, Gheorghiade M. Lessons learned in acute heart failure. Eur J Heart Fail 2017; 20:630-641. [PMID: 29082676 DOI: 10.1002/ejhf.1042] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 09/18/2017] [Accepted: 09/20/2017] [Indexed: 12/11/2022] Open
Abstract
Acute heart failure (HF) is a global pandemic with more than one million admissions to hospital annually in the US and millions more worldwide. Post-discharge mortality and readmission rates remain unchanged and unacceptably high. Although recent drug development programmes have failed to deliver novel therapies capable of reducing cardiovascular morbidity and mortality in patients hospitalized for worsening chronic HF, hospitalized HF registries and clinical trial databases have generated a wealth of information improving our collective understanding of the HF syndrome. This review will summarize key insights from clinical trials in acute HF and hospitalized HF registries over the last several decades, focusing on improving the management of patients with HF and reduced ejection fraction.
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Affiliation(s)
- Baljash Cheema
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Andrew P Ambrosy
- Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | - Rachel M Kaplan
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Michele Senni
- Cardiovascular Department, Papa Giovannni XXIII Hospital, Bergamo, Italy
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, CA, USA
| | - Ovidiu Chioncel
- Institute of Emergency for Cardiovascular Diseases 'Prof. C.C. Iliescu', Cardiology 1, UMF Carol Davila, Bucharest, Romania
| | | | - Mihai Gheorghiade
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
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15
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Duckheim M, Bensch C, Kittlitz L, Götz N, Klee K, Groga-Bada P, Mizera L, Gawaz M, Zuern C, Eick C. Deceleration capacity of heart rate predicts 1-year mortality of patients undergoing transcatheter aortic valve implantation. Clin Cardiol 2017; 40:919-924. [PMID: 28846802 DOI: 10.1002/clc.22748] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 05/20/2017] [Accepted: 05/27/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Risk prediction in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) is challenging. Development of novel markers for patient risk assessment is of great clinical value. Deceleration capacity (DC) of heart rate is a strong risk predictor in post-infarction patients. HYPOTHESIS DC provides prognostic information in patients undergoing TAVI. METHODS We enrolled 374 consecutive patients with severe AS undergoing TAVI. All patients received 24-hour Holter recording or continuous heart-rate monitoring to assess DC before intervention. Primary endpoint was all-cause mortality after 1 year. RESULTS Forty-nine patients (13.1%) died within 1 year. DC was significantly lower in nonsurvivors than in survivors (1.2 ± 4.8 ms vs 3.3 ± 2.9 ms; P < 0.001), whereas the logistic EuroSCORE and EuroSCORE II were comparable between groups (logistic EuroSCORE: 27.3% ± 17.0% vs 22.9% ± 14.2%; P = 0.122; EuroSCORE II: 8.0% ± 6.9% vs 6.7% ± 4.8%, P = 0.673). One-year mortality in the 116 patients with impaired DC (<2.5 ms) was significantly higher than in patients with normal DC (23.3% vs 8.5%; P < 0.001). In multivariate Cox regression analysis that included DC, sex, paroxysmal atrial fibrillation, hemoglobin level before TAVI, and logistic EuroSCORE, DC was the strongest predictor of 1-year mortality (hazard ratio: 0.88, 95% confidence interval: 0.85-0.94, P < 0.001). DC yielded an AUC in the ROC analysis of 0.645. CONCLUSIONS DC of heart rate is a strong and independent predictor of 1-year mortality in patients with severe AS undergoing TAVI.
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Affiliation(s)
- Martin Duckheim
- Department of Internal Medicine III, Department of Cardiology, Eberhard Karls University of Tübingen, Germany
| | - Charlotte Bensch
- Department of Internal Medicine III, Department of Cardiology, Eberhard Karls University of Tübingen, Germany
| | - Linn Kittlitz
- Department of Internal Medicine III, Department of Cardiology, Eberhard Karls University of Tübingen, Germany
| | - Nin Götz
- Department of Internal Medicine III, Department of Cardiology, Eberhard Karls University of Tübingen, Germany
| | - Katharina Klee
- Department of Internal Medicine III, Department of Cardiology, Eberhard Karls University of Tübingen, Germany
| | - Patrick Groga-Bada
- Department of Internal Medicine III, Department of Cardiology, Eberhard Karls University of Tübingen, Germany
| | - Lars Mizera
- Department of Internal Medicine III, Department of Cardiology, Eberhard Karls University of Tübingen, Germany
| | - Meinrad Gawaz
- Department of Internal Medicine III, Department of Cardiology, Eberhard Karls University of Tübingen, Germany
| | - Christine Zuern
- Department of Internal Medicine III, Department of Cardiology, Eberhard Karls University of Tübingen, Germany
| | - Christian Eick
- Department of Internal Medicine III, Department of Cardiology, Eberhard Karls University of Tübingen, Germany
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16
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Elmaraezy A, Ismail A, Abushouk AI, Eltoomy M, Saad S, Negida A, Abdelaty OM, Abdallah AR, Aboelfotoh AM, Hassan HM, Elmaraezy AG, Morsi M, Althaher F, Althaher M, AlSafadi AM. Efficacy and safety of transcatheter aortic valve replacement in aortic stenosis patients at low to moderate surgical risk: a comprehensive meta-analysis. BMC Cardiovasc Disord 2017; 17:234. [PMID: 28836953 PMCID: PMC5571502 DOI: 10.1186/s12872-017-0668-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 08/17/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Recently, transcatheter aortic valve replacement (TAVR) has become the procedure of choice in high surgical risk patients with aortic stenosis (AS). However, its value is still debated in operable AS cases. We performed this meta-analysis to compare the safety and efficacy of TAVR to surgical aortic valve replacement (SAVR) in low-to-moderate surgical risk patients with AS. METHODS A systematic search of five authentic databases retrieved 11 eligible studies (20,056 patients). Relevant Data were pooled as risk ratios (RRs) or standardized mean differences (SMD), with their 95% confidence interval, using Comprehensive Meta-Analysis and RevMan software for windows. RESULTS At one-year of follow-up, the pooled effect-estimates showed no significant difference between TAVR and SAVR groups in terms of all-cause mortality (RR 1.02, 95% CI [0.83, 1.26], stroke (RR 0.83, 95%CI [0.56, 1.21]), myocardial infarction (RR 0.82, 95% CI [0.57, 1.19]), and length of hospital stay (SMD -0.04, 95% CI [-0.34, 0.26]). The incidence of major bleeding (RR 0.45, 95% CI [0.24, 0.86]) and acute kidney injury (RR 0.52, 95% CI [0.30, 0.88]) was significantly lower in the TAVR group, compared to the SAVR group. However, TAVR was associated with a higher risk of permanent pacemaker implantation (RR 2.57, 95% CI [1.36, 4.86]), vascular-access complications at 1 year (RR 1.99, 95%CI [1.04, 3.80]), and paravalvular aortic regurgitation at 30 days (RR 3.90, 95% CI [1.25, 12.12]), compared to SAVR. CONCLUSIONS Due to the comparable mortality rates in SAVR and TAVR groups and the lower risk of life-threatening complications in the TAVR group, TAVR can be an acceptable alternative to SAVR in low-to-moderate risk patients with AS. However, larger trials with longer follow-up periods are required to compare the long-term outcomes of both techniques.
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Affiliation(s)
- Ahmed Elmaraezy
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- NovaMed Medical Research Association, Cairo, Egypt
| | - Ammar Ismail
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- NovaMed Medical Research Association, Cairo, Egypt
| | | | - Moutaz Eltoomy
- Genetic Engineering & Biotechnology Research Institute (GEBRI), University of Sadat City, Sadat City, Egypt
| | - Soha Saad
- Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Ahmed Negida
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | | | | | | | | | - Mahmoud Morsi
- Faculty of Medicine, Minoufia University, Shebin El-Kom, Egypt
| | - Farah Althaher
- Faculty of Medicine, Misr University for science and technology (MUST), 6th of October City, Giza, Egypt
| | - Moath Althaher
- Faculty of Medicine, Misr University for science and technology (MUST), 6th of October City, Giza, Egypt
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17
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Villemain O, Robin J, Bel A, Kwiecinski W, Bruneval P, Arnal B, Rémond M, Tanter M, Messas E, Pernot M. Pulsed Cavitational Ultrasound Softening: a new non-invasive therapeutic approach of calcified bioprosthetic valve stenosis. JACC Basic Transl Sci 2017; 2:372-383. [PMID: 29367953 PMCID: PMC5777603 DOI: 10.1016/j.jacbts.2017.03.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 03/03/2017] [Accepted: 03/05/2017] [Indexed: 12/05/2022]
Abstract
BACKGROUND The majority of prosthetic heart valves currently implanted are tissue valves that can be expected to calcify with time and eventually fail. Surgical or percutaneous redux valve replacement is associated with higher rate of complications. We propose a novel non-invasive therapeutic approach based on the use of pulsed cavitational ultrasound (PCU) to improve the valvular function of degenerative calcified bioprosthesis. OBJECTIVES Our study aims to demonstrate in vitro and in vivo on an ovine model that PCU can significantly improve the bioprosthesis opening by softening remotely the calcified stiff cusps. METHODS All the experiments were performed on calcified bioprosthetic valves explanted from human patients. PCU was performed in vitro on calcified bioprosthesis mounted on a hydraulic bench with pulsatile flow (n=8) and in vivo on an ovine model with implanted calcified bioprosthesis (n=7). We used 3D echocardiography, pressure and flow sensors, quantitative stiffness evaluation using shear wave elastography, micro-CT imaging and histology to evaluate in vitro and in vivo the effect of PCU. RESULTS The transvalvular gradient was found to decrease by a mean of 50% after PCU in both in vitro (from 21.1±3.9 to 9.6±1.7 mmHg, p<0.001) and in vivo setup (from 16.2±3.2 to 8.2±1.3 mmHg, p<0.001), with a decrease of valve stiffness (in vitro: from 105.8±9 to 46.6±4 kPa, p<0.001; in vivo: from 82.6±10 to 41.7±7 kPa, p<0.001) and an increase of valve area (from 1.10±0.1 to 1.58±0.1 cm2, p<0.001). Histology and micro-CT imaging showed modifications of calcification structure without loss of calcification volume or alteration of the leaflet superficial structures. CONCLUSIONS We have demonstrated in vitro and in vivo that PCU can decrease a calcified bioprosthesis stenosis by softening the leaflets remotely. This new non-invasive approach has the potential to improve the outcome of patients with severe bioprosthesis stenosis.
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Affiliation(s)
- Olivier Villemain
- Institut Langevin, Ecole Supérieure de Physique Chimie Industrielles de Paris, Centre National de la Recherche Scientifique, Inserm U979, PSL Research University, Paris, France
- Hôpital Européen Georges Pompidou, Université Paris Descartes, Cardio-Vascular Departement, UMR 970, Paris, France
| | - Justine Robin
- Institut Langevin, Ecole Supérieure de Physique Chimie Industrielles de Paris, Centre National de la Recherche Scientifique, Inserm U979, PSL Research University, Paris, France
| | - Alain Bel
- Hôpital Européen Georges Pompidou, Cardiovascular Surgery, Université Paris Descartes, Laboratoire de Recherche Biochirurgical, Paris, France
| | - Wojciech Kwiecinski
- Institut Langevin, Ecole Supérieure de Physique Chimie Industrielles de Paris, Centre National de la Recherche Scientifique, Inserm U979, PSL Research University, Paris, France
| | - Patrick Bruneval
- Hôpital Européen Georges Pompidou, Université Paris Descartes, Department of Pathology, Paris, France
| | - Bastien Arnal
- Institut Langevin, Ecole Supérieure de Physique Chimie Industrielles de Paris, Centre National de la Recherche Scientifique, Inserm U979, PSL Research University, Paris, France
| | | | - Mickael Tanter
- Institut Langevin, Ecole Supérieure de Physique Chimie Industrielles de Paris, Centre National de la Recherche Scientifique, Inserm U979, PSL Research University, Paris, France
| | - Emmanuel Messas
- Hôpital Européen Georges Pompidou, Université Paris Descartes, Cardio-Vascular Departement, UMR 970, Paris, France
| | - Mathieu Pernot
- Institut Langevin, Ecole Supérieure de Physique Chimie Industrielles de Paris, Centre National de la Recherche Scientifique, Inserm U979, PSL Research University, Paris, France
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18
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Gentry III JL, Phelan D, Desai MY, Griffin BP. The Role of Stress Echocardiography in Valvular Heart Disease: A Current Appraisal. Cardiology 2017; 137:137-150. [DOI: 10.1159/000460274] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 02/07/2017] [Indexed: 01/10/2023]
Abstract
Stress echocardiography is a widely available, safe, low-cost, versatile imaging modality which is becoming increasingly recognized as a valuable tool in the assessment of patients with native and prosthetic left-sided valvular heart disease. It provides a quantitative assessment to help guide clinical decision-making when discordance exists between symptoms and severity of valve disease. Exercise (treadmill or bicycle) remains the preferred stress modality, but pharmacological augmentation with dobutamine can be used if needed. Low-dose dobutamine stress echocardiography is specifically valuable in patients with low-flow, low-gradient aortic stenosis when attempting to differentiate true severe aortic stenosis from pseudo-severe aortic stenosis. Stress echocardiography not only identifies high-risk features that indicate need for earlier surgery, it also provides useful information for the peri- and postoperative period, including long-term outcome, risk stratification to guide monitoring frequency, and offers guidance for eligibility in competitive sports participation. As research continues to expand the utility of stress echocardiography in the management of patients with valvular heart disease, future research should focus on the recognition of newer parameters identifying high-risk features including subsequent validation in a large population.
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Pourafkari L, Ghaffari S, Ahmadi M, Tajlil A, Aslanabadi N, Nader ND. Pulmonary hypertension in rheumatic mitral stenosis revisited. Herz 2016; 42:746-751. [PMID: 27928594 DOI: 10.1007/s00059-016-4509-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 11/04/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND In patients with mitral stenosis (MS), pulmonary hypertension (PH) is a significant contributor to the associated morbidity. We aimed to study factors associated with the presence of significant PH (sPH) and whether incorporating body surface area (BSA) in the mitral valve area (MVA) would improve the predictive value of the latter. METHODS The medical records of 558 patients with severe MS undergoing percutaneous balloon mitral commissurotomy were evaluated over a period of 8 years. Factors associated with the presence of significant PH (sPH) defined as mPAP ≥ 40 mm Hg were examined. RESULTS A total of 558 patients (423 women) were enrolled. Overall, 153 (27%) patients had sPH. Patients with sPH were similar to the rest of the subjects in terms of demographics, body habitus, blood group, and incidence of atrial fibrillation. Among echocardiographic findings, absolute MVA, indexed MVA, and mean transmitral valve gradient were associated with the presence of sPH. Transmitral valve gradient during right heart catheterization had the highest area under the curve for an association with sPH. CONCLUSION Age, gender, heart rhythm, and blood group were not associated with the presence of sPH in severe MS. The predictive value of the indexed MVA for the presence of sPH was not higher than that of absolute MVA.
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Affiliation(s)
- L Pourafkari
- Cardiovascular Research Center, Tabriz University of Medical Science, Tabriz, Iran
- Department of Anesthesiology, University at Buffalo, Buffalo, NY, USA
| | - S Ghaffari
- Cardiovascular Research Center, Tabriz University of Medical Science, Tabriz, Iran
| | - M Ahmadi
- Cardiovascular Research Center, Tabriz University of Medical Science, Tabriz, Iran
| | - A Tajlil
- Cardiovascular Research Center, Tabriz University of Medical Science, Tabriz, Iran
| | - N Aslanabadi
- Cardiovascular Research Center, Tabriz University of Medical Science, Tabriz, Iran
| | - N D Nader
- Department of Anesthesiology, University at Buffalo, Buffalo, NY, USA.
- Department of Anesthesiology, 77 Goodell Street, Suite # 550, 14203, Buffalo, NY, USA.
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20
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Hwang TW, Kim SO, Lee SY, Kim SH, Choi EY, Jang SI, Park SJ, Kwon HW, Lim HB, Lee CH, Choi ES. Impact of postoperative duration of Aspirin use on longevity of bioprosthetic pulmonary valve in patients who underwent congenital heart disease repair. KOREAN JOURNAL OF PEDIATRICS 2016; 59:446-450. [PMID: 27895692 PMCID: PMC5118504 DOI: 10.3345/kjp.2016.59.11.446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 09/06/2016] [Accepted: 09/12/2016] [Indexed: 11/27/2022]
Abstract
Purpose Generally, aspirin is used as a protective agent against thrombogenic phenomenon after pulmonary valve replacement (PVR) using a bioprosthetic valve. However, the appropriate duration of aspirin use is unclear. We analyzed the impact of postoperative duration of aspirin use on the longevity of bioprosthetic pulmonary valves in patients who underwent repair for congenital heart diseases. Methods We retrospectively reviewed the clinical data of 137 patients who underwent PVR using a bioprosthetic valve between January 2000 and December 2003. Among these patients, 89 were included in our study and divided into groups I (≤12 months) and II (>12 months) according to duration of aspirin use. We analyzed echocardiographic data from 9 to 11 years after PVR. Pulmonary vale stenosis and regurgitation were classified as mild, moderate, or severe. Results The 89 patients consisted of 53 males and 36 females. Their mean age was 14.3±8.9 years (range, 2.6–48 years) and body weight was 37.6±14.7 kg (range, 14–72 kg). The postoperative duration of aspirin use was 7.3±2.9 months in group I and 32.8±28.4 months in group II. However, no significant difference in sex ratio, age, body weight, type of bioprosthetic valve, and number of early redo-PVRs. In the comparison of echocardiographic data about 10 years later, no significant difference in pulmonary valve function was found. The overall freedom rate from redo-PVR at 10 years showed no significant difference (P=0.498). Conclusion Our results indicated no benefit from long-term aspirin medication (>6 months) in patients who underwent PVR with a bioprosthetic valve.
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Affiliation(s)
- Tae-Woong Hwang
- Department of Pediatrics, Sejong General Hospital, Bucheon, Korea
| | - Sung-Ook Kim
- Department of Pediatrics, Sejong General Hospital, Bucheon, Korea
| | - Sang-Yun Lee
- Department of Pediatrics, Sejong General Hospital, Bucheon, Korea
| | - Seong-Ho Kim
- Department of Pediatrics, Sejong General Hospital, Bucheon, Korea
| | - Eun-Young Choi
- Department of Pediatrics, Sejong General Hospital, Bucheon, Korea
| | - So-Ick Jang
- Department of Pediatrics, Sejong General Hospital, Bucheon, Korea
| | - Su-Jin Park
- Department of Pediatrics, Sejong General Hospital, Bucheon, Korea
| | - Hye-Won Kwon
- Department of Pediatrics, Sejong General Hospital, Bucheon, Korea
| | - Hyo-Bin Lim
- Department of Pediatrics, Sejong General Hospital, Bucheon, Korea
| | - Chang-Ha Lee
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Korea
| | - Eun-Seok Choi
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Korea
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Assessment of the accuracy of common clinical thresholds for cardiac morphology and function by transthoracic echocardiography. J Echocardiogr 2016; 15:27-36. [PMID: 27817093 DOI: 10.1007/s12574-016-0322-4] [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: 07/12/2016] [Revised: 10/16/2016] [Accepted: 10/24/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND We evaluated the ability of transthoracic echocardiography (TTE) to correctly identify abnormal left ventricular (LV) size, function, and mass when compared to cardiac magnetic resonance (CMR). Whilst numerous studies have compared TTE and CMR with respect to correlation between measurements and study reproducibility, few have employed categorical analysis relevant to clinical practice. METHODS Two hundred and fifteen consecutive patients who underwent both TTE and CMR were evaluated for the presence of abnormal LV size, systolic function, and mass. Abnormal LV systolic function was further categorized into grades (mild, moderate, and severe). Quantification of LV morphology and function was performed on TTE and CMR according to published guidelines. The level of agreement between TTE and CMR was compared across binary and categorical variables using Cohen's kappa. RESULTS Compared to CMR, TTE demonstrated excellent agreement in identification of abnormal versus normal function (κ = 0.87). However, agreement across grades of LV function was less strong (κ = 0.63). Whilst agreement for identification of severe LV dysfunction was good (κ = 0.68), this would still lead to misclassification of severe dysfunction in approximately one in seven cases. Agreement between TTE and CMR was moderate to good for identification of LV dilation (κ = 0.43-0.63), but poor for identification of increased mass (κ = 0.04). CONCLUSIONS Whilst in clinical practice TTE performs well in identification of normal versus abnormal systolic function, it has substantial limitations across grades of dysfunction and in the assessment of LV size and mass. These limitations have important implications when considering management decisions for patients based on thresholds of LV morphology or function.
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Wang N, Tsai YC, Niles N, Tchantchaleishvili V, Di Eusanio M, Yan TD, Phan K. Transcatheter aortic valve implantation (TAVI) versus sutureless aortic valve replacement (SUAVR) for aortic stenosis: a systematic review and meta-analysis of matched studies. J Thorac Dis 2016; 8:3283-3293. [PMID: 28066608 DOI: 10.21037/jtd.2016.11.100] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND With improving technologies and an increasingly elderly populations, there have been an increasing number of therapeutic options available for patients requiring aortic valve replacement. Recent evidence suggests that transcatheter aortic valve implantation (TAVI) is one suitable option for high risk inoperable patients, as well as high risk operable patients. Sutureless valve technology has also been developed concurrently, with facilitates surgical aortic valve replacement (SUAVR) by allow resection and replacement of the native aortic valve with minimal sutures and prosthesis anchoring required. For patients amenable for both TAVI and SUAVR, the evidence is unclear with regards to the benefits and risks of either approach. The objectives are to compare the perioperative outcomes and intermediate-term survival rates of TAVI and SUAVR in matched or propensity score matched studies. METHODS A systematic literature search was performed to include all matched or propensity score matched studies comparing SUAVR versus TAVI for severe aortic stenosis. A meta-analysis with odds ratios (OR) and mean differences were performed to compare key outcomes including paravalvular regurgitation and short and intermediate term mortality. RESULTS Six studies met our inclusion criteria giving a total of 741 patients in both the SUAVR and TAVI arm of the study. Compared to TAVI, SUAVR had a lower incidence of paravalvular leak (OR =0.06; 95% CI: 0.03-0.12, P<0.01). There was no difference in perioperative mortality, however SUAVR patients had significantly better survival rates at 1 (OR =2.40; 95% CI: 1.40-4.11, P<0.01) and 2 years (OR =4.62; 95% CI: 2.62-8.12, P<0.01). CONCLUSIONS The present study supports the use of minimally invasive SUAVR as an alternative to TAVI in high risk patients requiring aortic replacement. The presented results require further validation in prospective, randomized controlled studies.
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Affiliation(s)
- Nelson Wang
- Department of Medicine, University of Sydney, Sydney, Australia
| | - Yi-Chin Tsai
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Natasha Niles
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | | | - Marco Di Eusanio
- Cardiac Surgery Unit, Cardiovascular Department, 'G. Mazzini' Hospital Piazza Italia, Teramo, Italy
| | - Tristan D Yan
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Kevin Phan
- Department of Medicine, University of Sydney, Sydney, Australia;; The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
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Hellhammer K, Zeus T, Verde PE, Veulemanns V, Kahlstadt L, Wolff G, Erkens R, Westenfeld R, Navarese EP, Merx MW, Rassaf T, Kelm M. Red cell distribution width in anemic patients undergoing transcatheter aortic valve implantation. World J Cardiol 2016; 8:220-230. [PMID: 26981217 PMCID: PMC4766272 DOI: 10.4330/wjc.v8.i2.220] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 10/03/2015] [Accepted: 11/25/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the impact of red blood cell distribution width on outcome in anemic patients undergoing transcatheter aortic valve implantation (TAVI).
METHODS: In a retrospective single center cohort study we determined the impact of baseline red cell distribution width (RDW) and anemia on outcome in 376 patients with aortic stenosis undergoing TAVI. All patients were discussed in the institutional heart team and declined for surgical aortic valve replacement due to high operative risk. Collected data included patient characteristics, imaging findings, periprocedural in hospital data, laboratory results and follow up data. Blood samples for hematology and biochemistry analysis were taken from every patient before and at fixed intervals up to 72 h after TAVI including blood count and creatinine. Descriptive statistics were used for patient’s characteristics. Kaplan-Meier survival curves were used for time to event outcomes. A recursive partitioning regression and classification was used to investigate the association between potential risk factors and outcome variables.
RESULTS: Mean age in our study population was 81 ± 6.1 years. Anemia was prevalent in 63.6% (n = 239) of our patients. Age and creatinine were identified as risk factors for anemia. In our study population, anemia per se did influence 30-d mortality but did not predict longterm mortality. In contrast, a RDW > 14% showed to be highly predictable for a reduced short- and longterm survival in patients with aortic valve disease after TAVI procedure.
CONCLUSION: Age and kidney function determine the degree of anemia. The anisocytosis of red blood cells in anemic patients supplements prognostic information in addition to that derived from the WHO-based definition of anemia.
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Mayr NP, Michel J, Bleiziffer S, Tassani P, Martin K. Sedation or general anesthesia for transcatheter aortic valve implantation (TAVI). J Thorac Dis 2015; 7:1518-26. [PMID: 26543597 DOI: 10.3978/j.issn.2072-1439.2015.08.21] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Transfemoral transcatheter aortic valve implantation (TAVI) is nowadays a routine therapy for elderly patients with severe aortic stenosis (AS) and high perioperative risk. With growing experience, further development of the devices, and the expansion to "intermediate-risk" patients, there is increasing interest in performing this procedure under conscious sedation (TAVI-S) rather than the previously favoured approach of general anesthesia (TAVI-GA). The proposed benefits of TAVI-S include; reduced procedure time, shorter intensive care unit (ICU) length of stay, reduced need for intraprocedural vasopressor support, and the potential to perform the procedure without the direct presence of an anesthetist for cost-saving reasons. To date, no randomized trial data exists. We reviewed 13 non-randomized studies/registries reporting data from 6,718 patients undergoing TAVI (3,227 performed under sedation). Patient selection, study methods, and endpoints have differed considerably between published studies. Reported rates of in-hospital and longer-term mortality are similar for both groups. Up to 17% of patients undergoing TAVI-S require conversion to general anesthesia during the procedure, primarily due to vascular complications, and urgent intubation is frequently associated with hemodynamic instability. Procedure related factors, including hypotension, may compound preexisting age-specific renal impairment and enhance the risk of acute kidney injury. Hypotonia of the hypopharyngeal muscles in elderly patients, intraprocedural hypercarbia, and certain anesthetic drugs, may increase the aspiration risk in sedated patients. General anesthesia and conscious sedation have both been used successfully to treat patients with severe AS undergoing TAVI with similar reported short and long-term mortality outcomes. The authors believe that the significant incidence of complications and unplanned conversion to general anesthesia during TAVI-S mandates the start-to-finish presence of an experienced cardiac anesthetist in order to optimize patient outcomes. Good quality randomized data is needed to determine the optimal anesthetic regimen for patients undergoing TAVI.
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Affiliation(s)
- N Patrick Mayr
- 1 Institut für Anästhesiologie, 2 Klinik für Herz- und Kreislauferkrankungen, 3 Klinik für Herz- und Gefäßchirurgie, Deutsches Herzzentrum München des Freistaates Bayern, Technische Universität München, F.R. Germany
| | - Jonathan Michel
- 1 Institut für Anästhesiologie, 2 Klinik für Herz- und Kreislauferkrankungen, 3 Klinik für Herz- und Gefäßchirurgie, Deutsches Herzzentrum München des Freistaates Bayern, Technische Universität München, F.R. Germany
| | - Sabine Bleiziffer
- 1 Institut für Anästhesiologie, 2 Klinik für Herz- und Kreislauferkrankungen, 3 Klinik für Herz- und Gefäßchirurgie, Deutsches Herzzentrum München des Freistaates Bayern, Technische Universität München, F.R. Germany
| | - Peter Tassani
- 1 Institut für Anästhesiologie, 2 Klinik für Herz- und Kreislauferkrankungen, 3 Klinik für Herz- und Gefäßchirurgie, Deutsches Herzzentrum München des Freistaates Bayern, Technische Universität München, F.R. Germany
| | - Klaus Martin
- 1 Institut für Anästhesiologie, 2 Klinik für Herz- und Kreislauferkrankungen, 3 Klinik für Herz- und Gefäßchirurgie, Deutsches Herzzentrum München des Freistaates Bayern, Technische Universität München, F.R. Germany
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MitraClip and Transcatheter Aortic Valve Implantation (TAVI): State of the Art 2015. Curr Heart Fail Rep 2015; 12:379-88. [PMID: 26472189 DOI: 10.1007/s11897-015-0275-3] [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: 10/22/2022]
Abstract
The feasibility, safety, and efficacy of transcatheter heart valve (THV) therapies such as MitraClip and transcatheter aortic valve implantation (TAVI) have made them valid therapeutic options in high-risk or inoperable patients with heart failure (HF). Randomized controlled trials (RCTs) demonstrated noninferiority and superiority in terms of efficacy for 12 months of TAVI versus surgical replacement and optimal medical therapy, respectively. With regard to MitraClip, noninferiority was first demonstrated in four subgroups at 12 months and then later at 4-year follow-up. This difference in clinical outcomes between the two therapies is consistent with the discrepancy in the level of recommendation and class of evidence for TAVI and MitraClip according to recent international guidelines (IB vs. IIbC, respectively). Data from ongoing RCTs and national registries will help establish the reciprocal role and hierarchy among THV therapies, surgery, and medical treatment in patients with HF.
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26
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Repack A, Ziganshin BA, Elefteriades JA, Mukherjee SK. Comparison of Quality of Life Perceived by Patients with Bioprosthetic versus Mechanical Valves after Composite Aortic Root Replacement. Cardiology 2015; 133:3-9. [DOI: 10.1159/000438783] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 07/15/2015] [Indexed: 11/19/2022]
Abstract
Objective: To assess whether postoperative quality of life (QOL) for composite aortic root replacement patients differs according to whether it is based on the use of mechanical valves or bioprosthetic valves. Methods: The study included 146 consecutive patients who underwent composite aortic root replacement at our institution from January 2010 to April 2014 with bioprosthetic (34.9%, n = 51) and mechanical (65.1%, n = 95) valves. Patient-perceived QOL was measured by administering the Short Form (SF)-36v2 Health Survey and a series of supplemental questions to further evaluate valve-specific differences. Final survey participation (n = 121) included 82.9% of the qualifying patients, and involved 76.5% (39/51) of those with bioprosthetic valves and 86.3% (82/95) of those with mechanical valves. Reasons for not completing the survey included 5 expired patients (3.4%), 1 lost due to a language barrier (0.7%), 6 who refused to participate (4.1%) and 13 who were lost to follow-up (8.9%). The mean follow-up time was 32 months (range 4-56 months). Results: Patients in the bioprosthetic valve group were older (mean age 67.5 ± 13.6 years) and included more females (25.6% or 10/39) than those in the mechanical valve group (mean age 56.6 ± 12.0 years; 11.0% or 9/82 were female). No significant differences were found between the bioprosthetic and mechanical valve groups for any QOL aspects scored by the SF-36v2 survey. All 8 domains and 2 summary scales comprising the QOL evaluation were above national norms calculated using gender- and age-matched, norm-based scoring for a standard national average of 50. The supplemental questions indicated satisfaction with each valve type despite characteristics that were of concern to patients. In the mechanical valve group, 90.2% (74/82) reported that the audible valve click was not troublesome, 85.4% (70/82) that taking a blood thinner regularly did not affect daily life and 81.7% (67/82) that blood testing for anticoagulation therapy was not troublesome. Conclusions: Receiving a tissue or a mechanical valve does not directly affect postoperative QOL. Answers to supplemental questions suggest that prior concerns with mechanical valves do not affect patients in the commonly anticipated negative manner. The preconception of a heavy QOL burden for mechanical composite grafts is contradicted by this study.
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Yuan ZS, Zhou YZ, Liao XB, Luo JW, Shen KJ, Hu YR, Gu L, Li JM, Tan CM, Chen HM, Zhou XM. Apelin attenuates the osteoblastic differentiation of aortic valve interstitial cells via the ERK and PI3-K/Akt pathways. Amino Acids 2015; 47:2475-82. [PMID: 26142632 PMCID: PMC4633450 DOI: 10.1007/s00726-015-2020-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 05/28/2015] [Indexed: 12/13/2022]
Abstract
Aortic valve calcification (AVC), which used to be recognized as a passive and irreversible process, is now widely accepted as an active and regulated process characterized by osteoblastic differentiation of aortic valve interstitial cells (AVICs). Apelin, the endogenous ligand for G-protein-coupled receptor APJ, was found to have protective cardiovascular effects in several studies. However, the effects and mechanisms of apelin on osteoblastic differentiation of AVICs have not been elucidated. Using a pro-calcific medium, we devised a method to produce calcific human AVICs. These cells were used to study the relationship between apelin and the osteoblastic calcification of AVICs and the involved signaling pathways. Alkaline phosphatase (ALP) activity/expression and runt-related transcription factor 2 (Runx2) expression were examined as hallmark proteins in this research. The involved signaling pathways were studied using the extracellular signal-regulated kinase (ERK) inhibitor, PD98059, and the phosphatidylinositol 3-kinase (PI3-K) inhibitor, LY294002. The results indicate that apelin attenuates the expression and activity of ALP, the expression of Runx2, and the formation of mineralized nodules. This protective effect was dependent on the dose of apelin, reaching the maximum at 100 pM, and was connected to activity of ERK and Akt (a downstream effector of PI3-K). The activation of ERK and PI3-K initiated the effects of apelin on ALP activity/expression and Runx2, but PD98059 and LY294002 abolished the effect. These results demonstrate that apelin attenuates the osteoblastic differentiation of AVICs via the ERK and PI3-K/Akt pathway.
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Affiliation(s)
- Zhao-shun Yuan
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, People's Republic of China
| | - Yang-zhao Zhou
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, People's Republic of China
| | - Xiao-bo Liao
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, People's Republic of China
| | - Jia-wen Luo
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, People's Republic of China
| | - Kang-jun Shen
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, People's Republic of China
| | - Ye-rong Hu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, People's Republic of China
| | - Lu Gu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, People's Republic of China
| | - Jian-ming Li
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, People's Republic of China
| | - Chang-ming Tan
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, People's Republic of China
| | - He-ming Chen
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, People's Republic of China.
| | - Xin-min Zhou
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, People's Republic of China.
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Kossaify A, Akiki V. Echocardiographic assessment of mitral valve regurgitation, pattern and prevalence, expanding clinical awareness through an institutional survey with the perspective of a quality improvement project. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2014; 8:71-7. [PMID: 25210482 PMCID: PMC4149403 DOI: 10.4137/cmc.s17367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 07/09/2014] [Accepted: 07/15/2014] [Indexed: 11/05/2022]
Abstract
BACKGROUND Mitral regurgitation (MR) is frequently reported in everyday echocardiograms; accurate assessment is essential for appropriate management and decision making. OBJECTIVE We performed a self-audit in order to define the prevalence and pattern of MR and to evaluate methods of assessment with the perspective of developing a quality improvement project. METHODS AND SETTING This retrospective analytical study was conducted in a university hospital. INCLUSION CRITERIA age more than 18 years and medical records available within the facility, including a "complete" medical history. Using the picture archiving and communication system, we reviewed 961 echocardiograms performed over a 6-month period. The methods of assessment of native mitral valve regurgitation were reported, and also relevant medical data were collected using an electronic archiving system. RESULTS AND DISCUSSION Among the 961 patients reviewed, 322 (33.50%) had MR, with variable grades. MR pattern (organic versus functional) was not specified in 49.68% of cases. "Eyeball" assessment and "color jet area" were the most frequently used methods for MR assessment (90.06% and 27.95%, respectively), while "vena contracta" and "flow convergence" methods were rarely implemented (1.55% and 2.17%, respectively). Discussion is made according to current guidelines, while showing the strengths and weaknesses of each method. CONCLUSION The prevalence of MR was 33.50%, and in nearly half of cases, the MR pattern was not specified. Qualitative and semi-quantitative methods of assessment were mostly used; quantitative assessment should be implemented more frequently, in accordance with current guidelines. Increasing clinical awareness by creating and implementing a quality improvement project is essential in this context.
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Affiliation(s)
- Antoine Kossaify
- Echocardiography unit, Cardiology division, USEK-University Hospital Notre Dame de Secours, St Charbel Street, Byblos, Lebanon
| | - Vanessa Akiki
- Echocardiography unit, Cardiology division, USEK-University Hospital Notre Dame de Secours, St Charbel Street, Byblos, Lebanon
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Dzudie A, Kengne AP, Thienemann F, Sliwa K. Predictors of hospitalisations for heart failure and mortality in patients with pulmonary hypertension associated with left heart disease: a systematic review. BMJ Open 2014; 4:e004843. [PMID: 25011987 PMCID: PMC4120416 DOI: 10.1136/bmjopen-2014-004843] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES Left heart disease (LHD) is the main cause of pulmonary hypertension (PH), but little is known regarding the predictors of adverse outcome of PH associated with LHD (PH-LHD). We conducted a systematic review to investigate the predictors of hospitalisations for heart failure and mortality in patients with PH-LHD. DESIGN Systematic review. DATA SOURCES PubMed MEDLINE and SCOPUS from inception to August 2013 were searched, and citations identified via the ISI Web of Science. STUDY SELECTION Studies that reported on hospitalisation and/or mortality in patients with PH-LHD were included if the age of participants was greater than 18 years and PH was diagnosed using Doppler echocardiography and/or right heart catheterisation. Two reviewers independently selected studies, assessed their quality and extracted relevant data. RESULTS In all, 45 studies (38 from Europe and USA) were included among which 71.1% were of high quality. 39 studies were published between 2003 and 2013. The number of participants across studies ranged from 46 to 2385; the proportion of men from 21% to 91%; mean/median age from 63 to 82 years; and prevalence of PH from 7% to 83.3%. PH was consistently associated with increased mortality risk in all forms of LHD, except for aortic valve disease where findings were inconsistent. Six of the nine studies with data available on hospitalisations reported a significant adverse effect of PH on hospitalisation risk. Other predictors of adverse outcome were very broad and heterogeneous including right ventricular dysfunction, functional class, left ventricular function and presence of kidney disease. CONCLUSIONS PH is almost invariably associated with increased mortality risk in patients with LHD. However, effects on hospitalisation risk are yet to be fully characterised; while available evidence on the adverse effects of PH have been derived essentially from Caucasians.
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Affiliation(s)
- Anastase Dzudie
- Douala General Hospital and Buea Faculty of Health Sciences, Douala, Cameroon
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Andre Pascal Kengne
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Friedrich Thienemann
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Faculty of Health Sciences, Clinical Infectious Diseases Research Initiative, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Karen Sliwa
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Cape Heart Group, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
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van der Boon RMA, Houthuizen P, Nuis RJ, van Mieghem NM, Prinzen F, de Jaegere PPT. Clinical implications of conduction abnormalities and arrhythmias after transcatheter aortic valve implantation. Curr Cardiol Rep 2014; 16:429. [PMID: 24281975 DOI: 10.1007/s11886-013-0429-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) has become an established treatment option for patients with aortic stenosis at prohibitive risk to undergo surgical aortic valve replacement. Despite conveying obvious clinical benefits and a decreasing frequency of complications, the occurrence of new conduction abnormalities and arrhythmias remains an important issue. Generally considered a minor complication, they may have a profound impact on prognosis and quality of life after TAVI. Therefore the purpose of this review is to assess and discuss the available information on clinical implications of both new conduction abnormalities and arrhythmias after TAVI.
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Affiliation(s)
- Robert M A van der Boon
- Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
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