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Hariri EH, Badwan O, Kassab J, Layoun H, Skoza W, Burton R, Harb SC, Puri R, Reed GW, Krishnaswamy A, Svensson LG, Kapadia S. Role of aortic valve replacement in moderate aortic stenosis: a 10-year outcomes study. Open Heart 2024; 11:e002616. [PMID: 38769066 PMCID: PMC11110558 DOI: 10.1136/openhrt-2024-002616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/12/2024] [Indexed: 05/22/2024] Open
Abstract
OBJECTIVE Patients with moderate aortic stenosis (AS) exhibit high morbidity and mortality. Limited evidence exists on the role of aortic valve replacement (AVR) in this patient population. To investigate the benefit of AVR in moderate AS on survival and left ventricular function. METHODS In a retrospective cohort study, patients with moderate AS between 2008 and 2016 were selected from the Cleveland Clinic echocardiography database and followed until 2018. Patients were classified as receiving AVR or managed medically (clinical surveillance). All-cause and cardiovascular mortality were assessed by survival analyses. Temporal haemodynamic and structural changes were assessed with longitudinal analyses using linear mixed effects models. RESULTS We included 1421 patients (mean age, 75.3±5.4 years and 39.9% women) followed over a median duration of 6 years. Patients in the AVR group had lower risk of all-cause (adjusted HR (aHR)=0.51, 95% CI: 0.34 to 0.77; p=0.001) and cardiovascular mortality (aHR=0.50, 95% CI: 0.31 to 0.80; p=0.004) compared with those in the clinical surveillance group irrespective of sex, receipt of other open-heart surgeries and underlying malignancy. These findings were seen only in those with preserved left ventricular ejection fraction (LVEF) ≥50%. Further, patients in the AVR group had a significant trend towards an increase in LVEF and a decrease in right ventricular systolic pressure compared with those in the clinical surveillance group. CONCLUSIONS In patients with moderate AS, AVR was associated with favourable clinical outcomes and left ventricular remodelling.
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Affiliation(s)
- Essa H Hariri
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Osamah Badwan
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Joseph Kassab
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Habib Layoun
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Warren Skoza
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Robert Burton
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Serge C Harb
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Grant W Reed
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
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Fesharaki MJ, Akbari T, Bayat F, Ghadirzadeh E, Charkazi E. The importance of intraoperative echocardiography in the early detection of mitral regurgitation as a postsurgical sequel of aortic valve replacement: a case report. J Med Case Rep 2023; 17:474. [PMID: 37907935 PMCID: PMC10619244 DOI: 10.1186/s13256-023-04176-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 09/11/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Mitral leaflet perforation (MLP) can rarely be a consequence of aortic valve replacement (AVR), resulting in mitral regurgitation (MR). Determining the cause and severity of MLP following AVR is crucial in preventing hemodynamic consequences, such as pulmonary hypertension and biventricular remodeling. However, the diagnosis of this rare complication requires detailed echocardiographic evaluations. CASE PRESENTATION In this paper, we report a 37-year-old Persian male with progressive dyspnea on exertion diagnosed with severe MR caused by anterior MLP following AVR and discuss the importance of intraoperative transesophageal echocardiography (TEE) in the proper and on-time diagnosis of this rare complication. CONCLUSION During AVR procedure, an evaluation with TEE could be beneficial for identifying and treating such condition. Echocardiography is beneficial in providing real-time guidance during surgery, early detection of potential complications, treatment of such complications if present, and prevention of adverse outcomes.
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Affiliation(s)
- Mehrdad Jafari Fesharaki
- Fellowship of Echocardiography, Department of Cardiology, School of Medicine, Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tooba Akbari
- Fellowship of Echocardiography, Department of Cardiology, School of Medicine, Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Fariba Bayat
- Fellowship of Echocardiography, Department of Cardiology, School of Medicine, Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Erfan Ghadirzadeh
- Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran
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Taha FA, Naeim H, Amoudi O, Alnozha F, Almutairi M, Abuelatta R. Transcatheter Mitral Valve Repair Technique in Specific Severe Mitral Regurgitation: Tips, Tricks, and Outcomes. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2022; 6:100043. [PMID: 37274546 PMCID: PMC10236813 DOI: 10.1016/j.shj.2022.100043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 03/06/2022] [Accepted: 04/14/2022] [Indexed: 06/06/2023]
Abstract
Background In specific patients with severe mitral regurgitation (MR), mitral valve (MV) pathology is unique and requires creative transcatheter repair techniques. This study aimed to evaluate the feasibility and safety of a new transcatheter MV repair technique, using occluder devices in symptomatic high-surgical-risk patients with severe MR, either due to MV leaflet (MVL) perforations or due to post-clips residual MR, and to report on their 6-month outcomes. Methods The study enrolled all high-risk patients with severe MR due to MVL perforations and post-clips residual MR who underwent transcatheter MV repair using occluder devices, from November 2016 to August 2019. Results The study enrolled 16 patients; 9 (56.25%) with MVL perforations and 7 (43.75%) with post-MitraClip (Abbott Laboratories, Abbott Park, Illinois) residual MR, with a mean age of 55.75 ± 16.69 years. Mean perforation/jet diameters were 5.75 ± 1.67 and 6.5 ± 1.93 mm, and the mean 3D-vena contracta area was 0.54 ± 0.14 cm2. Perforations were crossed retrograde (transaortic in 7 [43.75%] patients and transapical in 2 [12.5%] patients), and post-MitraClip devices residual jets were crossed antegrade (transvenous/transseptal). Six (37.5%) patients required arteriovenous loop formation for device deployment, that was antegrade transvenous/transseptal in 13 (81.25%) patients and retrograde transapical in 3 (18.75%) patients. Devices used were Amplatzer-ASO in 10 (62.5%) patients and Amplatzer-VP-II in 6 (37.5%) patients. Mean procedural and fluoroscopy times were 55.13 ± 16.24 and 16.25 ± 4.03 minutes, respectively. Patients passed successfully, without MV gradient change or device-related complications. Conclusions Transcatheter MV repair of MVL perforations/post-clips residual MR is a new, feasible, and safe technique for high-surgical-risk patients.
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Affiliation(s)
- Fatma Aboalsoud Taha
- Adult Cardiology Department, Madinah Cardiac Center, Madinah, Saudi Arabia
- Cardiology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Hesham Naeim
- Adult Cardiology Department, Madinah Cardiac Center, Madinah, Saudi Arabia
| | - Osama Amoudi
- Adult Cardiology Department, Madinah Cardiac Center, Madinah, Saudi Arabia
| | - Fareed Alnozha
- Adult Cardiology Department, Madinah Cardiac Center, Madinah, Saudi Arabia
| | - Mansour Almutairi
- Adult Cardiology Department, Madinah Cardiac Center, Madinah, Saudi Arabia
| | - Reda Abuelatta
- Adult Cardiology Department, Madinah Cardiac Center, Madinah, Saudi Arabia
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Kumar N, Kumar JE, Hussain N, Gorelik L, Essandoh MK, Whitson BA, Bhatt AM, Flores AS, Hachem A, Sawyer TR, Iyer MH. New or Worsened Mitral Regurgitation After Surgical Aortic Valve Replacement: A Systematic Review. Semin Cardiothorac Vasc Anesth 2020; 25:173-184. [PMID: 33356967 DOI: 10.1177/1089253220982202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND New or worsened mitral regurgitation (MR) is an uncommon yet serious complication after surgical aortic valve replacement (SAVR). While there have been numerous reports of its occurrence, there is little consensus regarding its presentation and management. This systematic review summarizes the evidence in the current literature surrounding new or worsened MR after SAVR and analyzes its potential implications. METHODS Databases were examined for all articles and abstracts reporting on new or worsened MR after SAVR. Data collected included number of patients studied; patient characteristics; incidences of new or worsened MR; timing of diagnosis; and treatment. RESULTS Thirty-six full-text citations were included in this review. The prevalence of new or worsened MR after SAVR was 8.4%. Sixteen percent of new MR occurrences were from an organic etiology, and 83% of new MR occurrences were that of a functional etiology. Most diagnoses were made in the late or unspecified postoperative period using echocardiography (range: 0 minutes to 18 years postoperatively). While no patients died from this complication, 7.7% of patients (16 out of 207) required emergent procedural re-intervention. CONCLUSIONS This systematic review underscores the importance of identifying new or worsened MR following SAVR and accurate scoring of MR severity to guide treatment. It also outlines the associated clinical measures commonly documented following this complication, and the usefulness of transesophageal echocardiography for the detection of significant MR. These results reflect the current, limited state of the literature on this topic and warrant further investigation into MR detection and management strategies in SAVR patients.
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Affiliation(s)
- Nicolas Kumar
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.,The Ohio State University College of Medicine, Columbus, OH, USA
| | - Julia E Kumar
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Nasir Hussain
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Leonid Gorelik
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Michael K Essandoh
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Bryan A Whitson
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, OH, USA
| | - Amar M Bhatt
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Antolin S Flores
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ali Hachem
- Central Michigan University College of Medicine, Mt. Pleasant, MI, USA
| | - Tamara R Sawyer
- Central Michigan University College of Medicine, Mt. Pleasant, MI, USA
| | - Manoj H Iyer
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Solari S, Tamer S, Aphram G, Mastrobuoni S, Navarra E, Noirhomme P, Poncelet A, Astarci P, Rubay J, El Khoury G, De Kerchove L. Aortic valve repair in endocarditis: scope and results. Indian J Thorac Cardiovasc Surg 2020; 36:104-112. [PMID: 33061191 DOI: 10.1007/s12055-019-00831-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 03/26/2019] [Accepted: 05/02/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose Infective endocarditis (IE) remains a prevalent and life-threatening disease. The choice to repair or replace the infected valve still remains a matter of debate, especially in aortic valve (AV) infections. We retrospectively analyze our two decades of experience in aortic valve repair (AVr) in IE. Long-term outcomes are described with particular attention to the impact of valve configuration and the use of patch techniques. Methods From September 1998 to June 2017, 42 patients underwent AVr in a single center for IE. Techniques include leaflet patch repair and resuspension and aortic annulus stabilization. Results Hospital mortality was 2.4% (n = 1). The median follow-up was 90.6 months. Survival was 89 ± 9.4% and 76.6 ± 16% at 5 and 10 years, respectively, with no significant differences between tricuspid aortic valve (TAV) and bicuspid aortic valve (BAV). Freedom from reoperation was 100% and 92.9 ± 7.1% in TAV and 81.8 ± 18.2% and 46.8 ± 28.8% in BAV at 5 and 10 years, respectively (TAV vs BAV, p = 0.02). BAV, degree of preoperative aortic insufficiency, and AVr including patch were factors predicting a higher risk of reoperation during the follow-up. Conclusion In our experience, AVr is a safe, feasible, and efficient choice in selected patients with healed or active IE. Durability of the repair is excellent in patients with limited lesions and in patients with TAV even with patch repair. Reoperations occurred principally in patients with BAV and severe preoperative AI, in whom patch repair was performed. In those patients, we actually recommend to replace the valve in case of active endocarditis.
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Affiliation(s)
- Silvia Solari
- Department of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Av Hippocrate 10, 1200 Brussels, Belgium
| | - Saadallah Tamer
- Department of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Av Hippocrate 10, 1200 Brussels, Belgium
| | - Gaby Aphram
- Department of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Av Hippocrate 10, 1200 Brussels, Belgium
| | - Stefano Mastrobuoni
- Department of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Av Hippocrate 10, 1200 Brussels, Belgium
| | - Emiliano Navarra
- Department of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Av Hippocrate 10, 1200 Brussels, Belgium
| | - Philippe Noirhomme
- Department of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Av Hippocrate 10, 1200 Brussels, Belgium
| | - Alain Poncelet
- Department of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Av Hippocrate 10, 1200 Brussels, Belgium
| | - Parla Astarci
- Department of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Av Hippocrate 10, 1200 Brussels, Belgium
| | - Jean Rubay
- Department of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Av Hippocrate 10, 1200 Brussels, Belgium
| | - Gébrine El Khoury
- Department of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Av Hippocrate 10, 1200 Brussels, Belgium
| | - Laurent De Kerchove
- Department of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Av Hippocrate 10, 1200 Brussels, Belgium
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Biswas I, Singh RS, Ghosh A, Sivakumar P. A rare case of injury to aorto-mitral curtain during mitral valve replacement surgery. Ann Card Anaesth 2020; 23:380-381. [PMID: 32687111 PMCID: PMC7559976 DOI: 10.4103/aca.aca_185_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Indranil Biswas
- Cardiac Anaesthesia Division, Department of Anaesthesia, Pain and Perioperative Medicine, Kolkata, West Bengal, India
| | - Ravi S Singh
- Cardiac Anaesthesia Division, Department of Anaesthesia, Pain and Perioperative Medicine, Kolkata, West Bengal, India
| | - Amarnath Ghosh
- Department of Cardiothoracic and Vascular Surgery, Apollo Gleneagles Hospital, Kolkata, West Bengal, India
| | - Poornima Sivakumar
- Department of Cardiothoracic and Vascular Surgery, Apollo Gleneagles Hospital, Kolkata, West Bengal, India
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A rare cause of mitral regurgitation after aortic valve replacement: Iatrogenic mitral valve perforation. Anatol J Cardiol 2020; 25:53-54. [PMID: 33432932 DOI: 10.14744/anatoljcardiol.2020.31766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Sengun B, Yıldırım I, Yıldız Ö, Çeliker A. Retrograde transcatheter closure of anterior mitral valve leaflet perforation. Ann Pediatr Cardiol 2019; 12:312-314. [PMID: 31516291 PMCID: PMC6716313 DOI: 10.4103/apc.apc_162_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Transcatheter closure of mitral valve leaflet perforation is a very rarely performed and a difficult procedure for repairing the defect. Herein, we are the first to report on both the safety and feasibility of percutaneous retrograde transcatheter closure of anterior mitral valve leaflet perforation with an AMPLATZER™ Duct Occluder II (6 mm × 6 mm, ADO II; Abbott Vascular, IL, USA) device in a 19-year-old patient with a severe mitral valve regurgitation following cardiac surgery.
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Affiliation(s)
- Berke Sengun
- Department of Pediatric Cardiology, Koç University School of Medicine, Istanbul, Turkey
| | - Işıl Yıldırım
- Department of Pediatric Cardiology, Koç University School of Medicine, Istanbul, Turkey
| | - Ömer Yıldız
- Department of Cardiology, Koç University School of Medicine, Istanbul, Turkey
| | - Alpay Çeliker
- Department of Pediatric Cardiology, Koç University School of Medicine, Istanbul, Turkey
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Why I choose to repair and not to replace the aortic valve? Gen Thorac Cardiovasc Surg 2018; 67:20-24. [PMID: 29623558 DOI: 10.1007/s11748-018-0920-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 03/29/2018] [Indexed: 02/06/2023]
Abstract
Aortic valve replacement whether surgical or transcutaneous remains an option for the treatment of severe aortic valve disease; however, current prosthetic devices are associated with complications including, but no limited to, valve thrombosis and thromboembolic events, bleeding events associated with anticoagulation use, prosthetic valve endocarditis and structural valve deterioration. In this effect, aortic valve repair (AVr) has become an attractive alternative in circumventing these potential complications by preservation of the native aortic valve apparatus. In this article, we attempt to present the progress made for AVr over the last two decades. We also wish to highlight the critical steps for successful AVr and the outcome data that demonstrate that can be first-choice treatment in selected patients and finally to emphasize on the key steps for further future development.
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Ibrahim NE, Lopez-Candales A. Left Ventricular Outflow Tract Pseudoaneurysm Formation Following Three Aortic Valve Replacement Surgeries. Heart Views 2016; 16:161-3. [PMID: 26900423 PMCID: PMC4738499 DOI: 10.4103/1995-705x.172209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We present a case of a pseudoaneurysm arising from the left ventricular outflow tract/aortic root as a complication of aortic valve surgery. A 45-year-old Nigerian female presented to our institution's emergency department with chest discomfort. She had three bioprosthetic aortic valve replacements in the preceding year at an outside institution for aortic regurgitation and wanted a second opinion on remaining surgical options. The learning points relevant to this case are as follows: (1) Recognizing potential complications postmultiple valve surgeries, (2) screening patients for chronic infections and rheumatologic conditions that can contribute to failed valve surgeries.
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