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Taira K, Kanade R, Yammine M, Tannous H, Kumar S. Alpha gal syndrome, a relative not absolute contraindication to the use of bovine pericardium to close an intracardiac septal defect: a case report. J Cardiothorac Surg 2024; 19:221. [PMID: 38627833 PMCID: PMC11020787 DOI: 10.1186/s13019-024-02763-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 03/30/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Alpha-gal syndrome is an allergic condition in which individuals develop an immune-mediated hypersensitivity response when consuming red meat and its derived products. Its diagnosis is important in individuals undergoing cardiac surgery, as patients frequently require large doses of unfractionated heparin or the insertion of surgical implants, both of which are porcine or bovine in origin. There are currently no guidelines for heparin administration in alpha-gal patients, with even less knowledge regarding the long-term clinical implications of these patients after receiving bioprosthetic valve replacements or other prostheses. CASE PRESENTATION We present the case of a 31-year-old male who underwent cardiac surgery in the setting of alpha-gal syndrome for a large atrial septal defect (ASD) and mitral valve prolapse (MVP). The patient continues to do well one year after undergoing a mitral valve repair, tricuspid valve repair and an ASD closure using bovine pericardium. He sustained no adverse reaction to the use of heparin products or the presence of a bovine pericardial patch. This rare case was managed by a multidisciplinary team consisting of cardiothoracic surgery, cardiac anesthesiology, and allergy/immunology that led to an optimal outcome despite the patient's pertinent allergic history. CONCLUSIONS This case highlights that the use of bovine pericardium and porcine heparin to close septal defects in patients with milder forms of alpha-gal allergy can be considered if other options are not available. Further studies are warranted to investigate the long-term outcomes of such potential alpha-gal containing prostheses and heparin exposure and establish the optimal decision making algorithm and prophylactic regimen.
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Affiliation(s)
- Kimi Taira
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA.
- Department of Surgery, Division of Cardiothoracic Surgery, Stony Brook University Hospital, 101 Nicolls Rd, Stony Brook, NY, 11794, USA.
| | - Rahul Kanade
- Department of Surgery, Division of Cardiothoracic Surgery, Stony Brook University Hospital, 101 Nicolls Rd, Stony Brook, NY, 11794, USA
| | - Maroun Yammine
- Department of Surgery, Division of Cardiothoracic Surgery, Stony Brook University Hospital, 101 Nicolls Rd, Stony Brook, NY, 11794, USA
| | - Henry Tannous
- Department of Surgery, Division of Cardiothoracic Surgery, Stony Brook University Hospital, 101 Nicolls Rd, Stony Brook, NY, 11794, USA
| | - Sathappan Kumar
- Department of Surgery, Division of Cardiothoracic Surgery, Stony Brook University Hospital, 101 Nicolls Rd, Stony Brook, NY, 11794, USA
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2
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Konstantinov IE, Moscoso B, Ishigami S, Zubritskiy A, Marliau R. Truncal valve repair in an adolescent with severe annular dilatation. Multimed Man Cardiothorac Surg 2023; 2023. [PMID: 38095294 DOI: 10.1510/mmcts.2023.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Approximately 20% of patients with truncus arteriosus might need a truncal valve procedure within 20 years after anatomical repair due to regurgitation. These patients commonly develop valve regurgitation due to root dilatation with a sufficient amount of good quality valvular tissue. Thus, the reduction of the truncal annulus is the single most important factor to achieve durable repair, especially in patients in whom the Ross procedure is not an option.
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Affiliation(s)
| | - Bosco Moscoso
- Cardiovascular Surgery Department. Hospital Clínic Barcelona, Spain
| | - Shuta Ishigami
- Department of Cardiothoracic Surgery, Royal Children's Hospital, Melbourne, Australia
| | - Alexey Zubritskiy
- Department of Cardiothoracic Surgery, Royal Children's Hospital, Melbourne, Australia
| | - Regina Marliau
- Department of Cardiothoracic Surgery, Royal Children's Hospital, Melbourne, Australia
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3
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Notenboom ML, Rhellab R, Etnel JRG, van den Bogerd N, Veen KM, Taverne YJHJ, Helbing WA, van de Woestijne PC, Bogers AJJC, Takkenberg JJM. Aortic valve repair in neonates, infants and children: a systematic review, meta-analysis and microsimulation study. Eur J Cardiothorac Surg 2023; 64:ezad284. [PMID: 37584683 PMCID: PMC10502195 DOI: 10.1093/ejcts/ezad284] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 07/24/2023] [Accepted: 08/14/2023] [Indexed: 08/17/2023] Open
Abstract
OBJECTIVES To support clinical decision-making in children with aortic valve disease, by compiling the available evidence on outcome after paediatric aortic valve repair (AVr). METHODS A systematic review of literature reporting clinical outcome after paediatric AVr (mean age at surgery <18 years) published between 1 January 1990 and 23 December 2021 was conducted. Early event risks, late event rates and time-to-event data were pooled. A microsimulation model was employed to simulate the lives of individual children, infants and neonates following AVr. RESULTS Forty-one publications were included, encompassing 2 623 patients with 17 217 patient-years of follow-up (median follow-up: 7.3 years; range: 1.0-14.4 years). Pooled mean age during repair for aortic stenosis in children (<18 years), infants (<1 year) or neonates (<30 days) was 5.2 ± 3.9 years, 35 ± 137 days and 11 ± 6 days, respectively. Pooled early mortality after stenosis repair in children, infants and neonates, respectively, was 3.5% (95% confidence interval: 1.9-6.5%), 7.4% (4.2-13.0%) and 10.7% (6.8-16.9%). Pooled late reintervention rate after stenosis repair in children, infants and neonates, respectively, was 3.31%/year (1.66-6.63%/year), 6.84%/year (3.95-11.83%/year) and 6.32%/year (3.04-13.15%/year); endocarditis 0.07%/year (0.03-0.21%/year), 0.23%/year (0.07-0.71%/year) and 0.49%/year (0.18-1.29%/year); and valve thrombosis 0.05%/year (0.01-0.26%/year), 0.15%/year (0.04-0.53%/year) and 0.19%/year (0.05-0.77%/year). Microsimulation-based mean life expectancy in the first 20 years for children, infants and neonates with aortic stenosis, respectively, was 18.4 years (95% credible interval: 18.1-18.7 years; relative survival compared to the matched general population: 92.2%), 16.8 years (16.5-17.0 years; relative survival: 84.2%) and 15.9 years (14.8-17.0 years; relative survival: 80.1%). Microsimulation-based 20-year risk of reintervention in children, infants and neonates, respectively, was 75.2% (72.9-77.2%), 53.8% (51.9-55.7%) and 50.8% (47.0-57.6%). CONCLUSIONS Long-term outcomes after paediatric AVr for stenosis are satisfactory and dependent on age at surgery. Despite a high hazard of reintervention for valve dysfunction and slightly impaired survival relative to the general population, AVr is associated with low valve-related event occurrences and should be considered in children with aortic valve disease.
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Affiliation(s)
- Maximiliaan L Notenboom
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Reda Rhellab
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Jonathan R G Etnel
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Nova van den Bogerd
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Kevin M Veen
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Yannick J H J Taverne
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Willem A Helbing
- Department of Paediatrics, Div. of Cardiology, Erasmus University Medical Centre, Rotterdam, Netherlands
| | | | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Johanna J M Takkenberg
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
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4
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Iwasieczko A, Gaddam M, Gaweda B, Goodyke A, Mathur M, Lin CY, Zagorski J, Solarewicz M, Cohle S, Rausch M, Timek TA. Valvular complex and tissue remodelling in ovine functional tricuspid regurgitation. Eur J Cardiothorac Surg 2023; 63:ezad115. [PMID: 36951551 DOI: 10.1093/ejcts/ezad115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 03/06/2023] [Accepted: 03/22/2023] [Indexed: 03/24/2023] Open
Abstract
OBJECTIVES Pathophysiology of function tricuspid regurgitation (FTR) is incompletely understood. We set out to comprehensively evaluate geometric and tissue remodelling of the tricuspid valve complex in ovine FTR. METHODS Twenty adult sheep underwent left thoracotomy and pulmonary artery banding (PAB) to induce right heart pressure overload and FTR. After 8 weeks, 17 surviving animals and 10 healthy controls (CTL) underwent sternotomy, echocardiography and implantation of sonomicrometry crystals on right ventricle and tricuspid valvular apparatus. Haemodynamic and sonomicrometry data were acquired in all animals after weaning from cardiopulmonary bypass. Leaflet tissue was harvested for pentachrome histologic analysis and biomechanical testing. RESULTS Animal weight was 62 ± 5 and 63 ± 3 kg for CTL and PAB, respectively (P = 0.6). At terminal procedure, systolic pulmonary artery pressure was 22 ± 3 and 40 ± 7 mmHg for CTL and PAB, respectively (P = 0.0001). The mean TR grade (+0-4) was 0.8 ± 0.4 and 3.2 ± 1.2 (P = 0.0001) for control and banded animals, respectively. Right ventricle volume (126 ± 13 vs 172 ± 34 ml, P = 0.0019), tricuspid annular area (651 ± 109 vs 865 ± 247 mm2, P = 0.037) and area between papillary muscle tips (162 ± 51 vs 302 ± 75 mm2, P = 0.001) increased substantially while systolic excursion of anterior leaflet decreased significantly (23.8 ± 6.1° vs 7.4 ± 4.5°, P = 0.001) with banding. Total leaflet surface area increased from 806 ± 94 to 953 ± 148 mm2 (P = 0.009), and leaflets became thicker and stiffer. CONCLUSIONS Detailed analysis of the tricuspid valve complex revealed significant ventricular, annular, subvalvular and leaflet remodelling to be associated with ovine functional tricuspid regurgitation. Durable surgical repair of severe FTR may require a multi-level approach to the valvular apparatus.
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Affiliation(s)
- Artur Iwasieczko
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, MI, USA
- Department of Cardiac Surgery, State Clinical Hospital Number 2, University of Rzeszow, Rzeszow, Poland
| | | | - Boguslaw Gaweda
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, MI, USA
- Department of Cardiac Surgery, State Clinical Hospital Number 2, University of Rzeszow, Rzeszow, Poland
| | - Austin Goodyke
- Research Department, Spectrum Health, Grand Rapids, MI, USA
| | - Mrudang Mathur
- Department of Biomedical Engineering, University of Texas at Austin, Austin, TX, USA
| | - Chien-Yu Lin
- Department of Biomedical Engineering, University of Texas at Austin, Austin, TX, USA
| | | | - Monica Solarewicz
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, MI, USA
| | - Stephen Cohle
- Department of Pathology, Spectrum Health, Grand Rapids, MI, USA
| | - Manuel Rausch
- Department of Biomedical Engineering, University of Texas at Austin, Austin, TX, USA
| | - Tomasz A Timek
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, MI, USA
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5
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Haranal M, Sivalingam S. Aortic valve repair in the pediatric population: emerging role of aortic valve neocuspidization (AVNeo procedure). Indian J Thorac Cardiovasc Surg 2023; 39:262-270. [PMID: 37124595 PMCID: PMC10140244 DOI: 10.1007/s12055-023-01473-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/27/2023] Open
Abstract
Management of aortic valve diseases in children is challenging owing to the quality and quantity of the native tissue for repair, limitations in the currently available biological materials to supplement the repair and to achieve a long-lasting durable repair in an annulus where there is still growth potential. The aortic valve neocuspidization (AVNeo) procedure has emerged as a versatile alternative strategy in the armamentarium of pediatric aortic valve reconstructions that are currently available. In this review article, the focus of the discussion will be on the various aortic valve repair procedures in the pediatric population, with a special emphasis on the emerging role of AVNeo procedure in pediatrics and its outcomes.
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Affiliation(s)
- Maruti Haranal
- Department of Pediatric Cardiac Surgery, U N Mehta Institute of Cardiology and Research, Ahmedabad, Gujarat India
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6
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Ching S, Cianciulli AR, Flynn M, Silvestro E, Sabin P, Lasso A, Ghosh RM, Gillespie MJ, Jolley MA. Physical Simulation of Transcatheter Edge-to-Edge Repair using Image-Derived 3D Printed Heart Models. Ann Thorac Surg Short Rep 2023; 1:40-45. [PMID: 36909146 PMCID: PMC9996204 DOI: 10.1016/j.atssr.2022.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Transcatheter edge-to-edge valve repair (TEER) is a complex procedure requiring delivery and alignment of the device to the target valve, which can be challenging in atypical or surgically palliated anatomy. We demonstrate application of virtual and physical simulation to plan optimal TEER access and catheter path in normal and congenitally abnormal cardiac anatomy. Methods Three heart models were created from three-dimensional (3D) images and 3D printed, including two with congenital heart disease. TEER catheter course was simulated both virtually and physically using a commercial TEER system. Results We demonstrate application of modeling in three patients, including two with congenital heart disease and a Fontan circulation. Access site and pathway to device delivery was simulated by members of a multidisciplinary valve team. Virtual and physical simulation were compared. Conclusions Virtual and physical simulation of TEER using 3D printed heart models is feasible and may be beneficial for planning and simulation, particularly in patients with complex anatomy. Future work is required to demonstrate application in the clinical setting.
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Affiliation(s)
- Stephen Ching
- Children's Hospital of Philadelphia, Department of Anesthesia and Critical Care, Philadelphia, PA
| | - Alana R Cianciulli
- Children's Hospital of Philadelphia, Department of Anesthesia and Critical Care, Philadelphia, PA
| | - Maura Flynn
- Children's Hospital of Philadelphia, Department of Anesthesia and Critical Care, Philadelphia, PA
| | - Elizabeth Silvestro
- Children's Hospital of Philadelphia, Department of Radiology, Philadelphia, PA
| | - Patricia Sabin
- Children's Hospital of Philadelphia, Department of Anesthesia and Critical Care, Philadelphia, PA
| | | | - Reena M Ghosh
- Children's Hospital of Philadelphia, Division of Pediatric Cardiology, Philadelphia, PA
| | - Matthew J Gillespie
- Children's Hospital of Philadelphia, Division of Pediatric Cardiology, Philadelphia, PA
| | - Matthew A Jolley
- Children's Hospital of Philadelphia, Department of Anesthesia and Critical Care, Philadelphia, PA
- Children's Hospital of Philadelphia, Division of Pediatric Cardiology, Philadelphia, PA
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7
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Mahmood M, Ghumman GM, Ahsan M, Singh H, Avula SR, Alo S, Al-Dabbas M, Ali SS, Kabour A. Management of Right Atrial Thrombus During MitraClip Implantation: A Case Report and Review of Literature. Cardiovasc Revasc Med 2023; 47:97-99. [PMID: 35624011 DOI: 10.1016/j.carrev.2022.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 01/25/2023]
Abstract
Transcatheter mitral valve repair (TMVR) is a relatively novel approach for treatment of symptomatic severe mitral regurgitation. Intra procedural thrombus formation is a rare but potential complication. Herein, we describe a case of large right atrial thrombus formation after transseptal puncture, that was successfully managed using aspiration thrombectomy.
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Affiliation(s)
- Mobasser Mahmood
- Electrophysiology Fellowship, University of Missouri, Columbia, MO
| | | | - Muhammad Ahsan
- Department of Cardiology, Mercy Health St Vincent Medical Center, Toledo, OH
| | - Hemindermeet Singh
- Department of Cardiology, Mercy Health St Vincent Medical Center, Toledo, OH
| | - Sindhu R Avula
- Interventional Cardiology, University of Kansas Medical Center, Kansas City, KS
| | - Sinan Alo
- Department of Cardiology, Mercy Health St Vincent Medical Center, Toledo, OH
| | - Ma'en Al-Dabbas
- Department of Cardiology, Mercy Health St Vincent Medical Center, Toledo, OH
| | - Syed Sohail Ali
- Department of Cardiology, Mercy Health St Vincent Medical Center, Toledo, OH
| | - Ameer Kabour
- Department of Cardiology, Mercy Health St Vincent Medical Center, Toledo, OH
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8
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Luciani GB, Cullurà G, Segreto A, Ardigò A, Hoxha S, Rossetti L, Prioli MA, Faggian G. Long-term Outcomes of the Ross Procedure for Young Patients with Aortic Valve Disease. Semin Thorac Cardiovasc Surg 2023; 35:115-124. [PMID: 35341966 DOI: 10.1053/j.semtcvs.2021.11.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/08/2021] [Indexed: 11/11/2022]
Abstract
To define current role of the Ross operation in young patients, the outcome in those followed longer than 20 years were assessed. Between 1994 and 2020, 81 consecutive patients, 70 of 11 male and/or female, mean age 27 years underwent Ross procedure, accruing 20 years of follow-up or longer. Sixty-four had bicuspid valve (79%) and 54 (67%) aortic insufficiency, while 15 (19%) had undergone prior operations. Surgery consisted in root replacement in 53 patients, cylinder inclusion in 20 and sub-coronary graft in 8. There were 7 late deaths in 80 hospital survivors (median follow-up 21 years, IQR 20-23), with 88% ± 5% survival at 25 years. Thirty-four patients required left, 6 left and/or right and 1 right heart valve reoperation, on average 13 years after Ross procedure. Reoperation was valve-sparing in 18 (45%) patients and valve and/or root replacement in 22. Ten (24%) reoperated patients required a second reoperation 18 years after Ross procedure. Freedom from autograft reoperation was 46% ± 6%, while from autograft valve replacement was 60% ± 7%, thanks to autograft valve-sparing. Freedom from isolated right valve reoperation was 98% ± 4%. No mortality was associated with any of the 51 reoperations. Root technique was associated with reoperation (P = 0.024). Age at follow-up was 50 years (IQR 36-60), with 70 (96%) patients in NYHA class I and 6 (55%) women carrying out pregnancies. Young patients undergoing the Ross procedure enjoy unprecedented survival well into the third decade of follow-up, even when faced with reoperation. At 25 years risk of autograft reoperation is consistent, while negligible for homograft. Technical improvements at operation and valve-sparing at reoperation may prolong autograft valve durability.
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Affiliation(s)
- Giovanni Battista Luciani
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy.
| | - Gianluca Cullurà
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy
| | - Antonio Segreto
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy
| | - Andrea Ardigò
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy
| | - Stiljan Hoxha
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy
| | - Lucia Rossetti
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy; Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Maria Antonia Prioli
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy; Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Giuseppe Faggian
- Division of Cardiac Surgery, Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy
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9
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Gillinov M, Hodges K, Burns DJP. Mitral valve repair made simple. Eur J Cardiothorac Surg 2022; 63:6965027. [PMID: 36579862 DOI: 10.1093/ejcts/ezac589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 12/28/2022] [Indexed: 12/30/2022]
Affiliation(s)
- Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Kevin Hodges
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Daniel J P Burns
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
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10
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Abstract
Tricuspid regurgitation is a frequent and serious condition but tricuspid valve (TV) surgery, that may be a valve replacement when a repair is not feasible, is rarely performed. Recent development of transcatheter TV interventions offers new options for those high-surgical risk patients, especially TV replacement for patients who are not eligible for transcatheter TV repair. In this review, we describe indications and outcome after surgical TV replacement, and devices available or in development for transcatheter TV replacement.
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Affiliation(s)
- Julien Dreyfus
- Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France.
| | - Gilles D Dreyfus
- Department of Cardiac Surgery, Montsouris Institute, Paris, France
| | - Maurizio Taramasso
- Cardiovascular Surgical Department, University Hospital of Zurich, Zurich, Switzerland
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11
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Milioglou I, Janko MR, Hassan HU, ElHaq M, Filby SJ, Pelletier MP. Idiopathic posterior papillary muscle rupture; a case report. BMC Cardiovasc Disord 2022; 22:151. [PMID: 35387586 PMCID: PMC8988393 DOI: 10.1186/s12872-022-02570-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 03/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Papillary muscle rupture is a rare condition. Its clinical presentation, diagnosis and management can be very challenging for the clinician. CASE PRESENTATION A 73-year-old woman with hypertension presented with chest pain, ST-segment changes, and elevated serum troponin levels. Coronary angiography was normal. Echocardiography revealed normal ventricular function, flail posterior mitral leaflet, and severe mitral regurgitation. She underwent emergent mitral valve replacement. CONCLUSION The diagnostic and management strategies of this uncommon presentation are discussed.
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Affiliation(s)
- Ioannis Milioglou
- Departments of Cardiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA.
| | - Matthew R Janko
- Departments of Cardiac Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Hafeez Ul Hassan
- Departments of Cardiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Mohammed ElHaq
- Departments of Pathology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Steven J Filby
- Departments of Cardiology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Marc P Pelletier
- Departments of Cardiac Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
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12
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Amabile A, Hameed I, Shang M, LaLonde MR, Geirsson A, Krane M. Unilateral percutaneous cannulation and endoaortic balloon management in robotic-assisted cardiac surgery: The least invasive approach. Multimed Man Cardiothorac Surg 2022; 2022. [PMID: 35377971 DOI: 10.1510/mmcts.2022.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Totally endoscopic, robotic-assisted cardiac surgery has been increasingly utilized for valvular surgery. Peripheral cannulation with endoaortic balloon occlusion offers a safe approach for initiation of cardiopulmonary bypass during such procedures. We present a step-by-step demonstration of unilateral percutaneous femoral cannulation, endoaortic balloon positioning, and decannulation in a patient undergoing totally endoscopic, robotic-assisted mitral valve repair.
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Affiliation(s)
- Andrea Amabile
- Division of Cardiac Surgery, Department of Surgery, Yale University School of Medicine
| | | | - Michael Shang
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, CT USA
| | | | - Arnar Geirsson
- Section of Cardiac Surgery, Yale University School of Medicine
| | - Markus Krane
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, CT
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13
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Mah K, Khoo NS, Martin BJ, Maruyama M, Alvarez S, Rebeyka IM, Smallhorn J, Colen T. Insights from 3D Echocardiography in Hypoplastic Left Heart Syndrome Patients Undergoing TV Repair. Pediatr Cardiol 2022; 43:735-743. [PMID: 34812910 DOI: 10.1007/s00246-021-02780-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/15/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Tricuspid regurgitation (TR) in hypoplastic left heart syndrome (HLHS) is associated with morbidity and mortality. TR mechanisms and the impact of tricuspid valve repair (TVR) are unclear. We examined HLHS TR mechanisms, TVR's impact on tricuspid valve (TV), and features of poor TVR durability. METHODS We retrospectively compared 35 HLHS TVR cases and 35 age/stage-matched HLHS controls who do not undergo TVR. Pre-operative 3-dimensional echocardiography (3DE) assessed overall TV morphology (prolapse, normal, tethered), leaflet morphology, vena contracta area, and TR location. Two-dimensional echocardiography measured TV annulus diameter, RV fractional area change (RVFAC), sphericity, and TR grade at three time points (pre-op, early post-op, and latest follow-up). RESULTS Pre-op, TVR group, and controls had no difference in age, RV function or shape, or TV dimension. TVR group most commonly had anterior leaflet prolapse followed by septal leaflet prolapse or tethering. TR jet arises centrally (63%) and anterior septally (26%). Posterior annuloplasty (69%), commissuroplasty (37%), and leaflet repair (37%) were surgical techniques commonly performed. At early post-op, TR grade and TV annulus decreased. At latest follow-up, TV annulus remained reduced; however, 50% had significant TR. 25% required TV reoperation. Larger vena contracta at TVR was associated with significant TR. CONCLUSION HLHS patients undergoing TVR had more anterior leaflet prolapse and central TR. While TVR initially reduces annular size and TR grade, 50% redevelop significant TR despite maintained annular reduction. The association of greater TR severity prior to repair with post-op recurrence raises the consideration for earlier repair of TR in HLHS patients.
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Affiliation(s)
- Kandice Mah
- Division of Cardiology, Stollery Children's Hospital, University of Alberta, 8440-112 St NW, Unit 4C2.25, Edmonton, AB, T6G 2B7, Canada
| | - Nee Scze Khoo
- Division of Cardiology, Stollery Children's Hospital, University of Alberta, 8440-112 St NW, Unit 4C2.25, Edmonton, AB, T6G 2B7, Canada
| | - Billie-Jean Martin
- Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA, USA
| | - Michiko Maruyama
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Silvia Alvarez
- Division of Cardiology, Stollery Children's Hospital, University of Alberta, 8440-112 St NW, Unit 4C2.25, Edmonton, AB, T6G 2B7, Canada
| | - Ivan M Rebeyka
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Jeffrey Smallhorn
- Division of Cardiology, Stollery Children's Hospital, University of Alberta, 8440-112 St NW, Unit 4C2.25, Edmonton, AB, T6G 2B7, Canada
| | - Timothy Colen
- Division of Cardiology, Stollery Children's Hospital, University of Alberta, 8440-112 St NW, Unit 4C2.25, Edmonton, AB, T6G 2B7, Canada.
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Lewis A, Hakemi E, Lopez D, Cubeddu RJ. MitraClip repair of right-sided atrioventricular valve in a patient with congenitally corrected transposition of the great arteries: a case report. Eur Heart J Case Rep 2022; 6:ytab479. [PMID: 35047745 PMCID: PMC8759502 DOI: 10.1093/ehjcr/ytab479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/13/2021] [Accepted: 11/15/2021] [Indexed: 12/11/2022]
Abstract
Background Patients with congenitally corrected transposition of the great arteries (ccTGA) often develop tricuspid valve (systemic atrioventricular valve) dysfunction due to right ventricular overload and dilatation, but isolated mitral valve (MV) disease is rarely found. Isolated mitral (subpulmonic atrioventricular valve) interventions, specifically catheter-directed, have not been reported up to date. Case summary A man with ccTGA is evaluated for dyspnoea. Multimodality imaging assessment confirmed severe right-sided MV regurgitation due to prolapse. In light of high surgical risk, a minimally invasive transcatheter MitraClip procedure was pursued. Discussion To our knowledge, this is the first case of successful MV repair via percutaneous approach using MitraClip in a patient with ccTGA and biventricular failure. Our case illustrates the safety and feasibility of the edge-to-edge procedure in such a rare instance, but also the importance of multimodality imaging (both invasive and non-invasive) and the Heart Team approach when caring for these complex patients.
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Affiliation(s)
- Antonio Lewis
- Section of Cardiac Imaging and Structural Heart Disease, Robert and Suzanne Tomsich Department of Cardiology, Heart and Vascular Institute, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Desk 23/24, Weston, FL 33331, USA
| | - Emad Hakemi
- Section of Cardiac Imaging and Structural Heart Disease, Robert and Suzanne Tomsich Department of Cardiology, Heart and Vascular Institute, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Desk 23/24, Weston, FL 33331, USA
| | - David Lopez
- Section of Cardiac Imaging and Structural Heart Disease, Robert and Suzanne Tomsich Department of Cardiology, Heart and Vascular Institute, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Desk 23/24, Weston, FL 33331, USA
| | - Robert J Cubeddu
- Section of Cardiac Imaging and Structural Heart Disease, Robert and Suzanne Tomsich Department of Cardiology, Heart and Vascular Institute, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Desk 23/24, Weston, FL 33331, USA
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15
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Iddawela S, Joseph PJS, Ganeshan R, Shah HI, Olatigbe TAT, Anyu AT, Hadi K, Tarmahomed A, Harky A. Paediatric mitral valve disease - from presentation to management. Eur J Pediatr 2022; 181:35-44. [PMID: 34309707 DOI: 10.1007/s00431-021-04208-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
Mitral valve diseases are relatively rare in the paediatric population; however, they can cause considerable mortality and morbidity worldwide. Acquired causes are a major contributor to cardiovascular disease burden in the paediatric population. Diseases can be detected before birth, at birth, or when the child is older and presents with symptoms of advanced heart failure. Definitive management consists of surgical intervention, with mitral valve replacement being the gold standard.Conclusion: Repair has been gaining popularity; however, its outcomes require further study. Percutaneous mitral balloon valvuloplasty is an emerging technique which holds promise as a bridge to surgical treatment. The effect of these interventions on quality of life must be emphasised and requires further study. What is Known: • The epidemiology of mitral valve disease in the paediatric population - predominant causes include rheumatic disease and congenital defects. • Mitral valve repair and replacement are the standard treatment methods for paediatric mitral valve disease. What is New: • Emergence of percutaneous mitral valve interventions and their potential as bridge-to-surgery or definitive treatment in high-risk surgical candidates. • Recent evidence comparing mitral valve repair and replacement in the paediatric population demonstrates increasing popularity of repair techniques.
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16
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Singh N, Kim H, Haydock DA. Isolated Tricuspid Valve Surgery: the Auckland Experience 2011-2019. Heart Lung Circ 2021; 31:582-589. [PMID: 34711497 DOI: 10.1016/j.hlc.2021.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/28/2021] [Accepted: 09/18/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Isolated tricuspid valve surgery is an uncommon operation. Historical reports, including a previous review from our unit, demonstrated high morbidity and mortality associated with this operation. Many of these patients had severely impaired right ventricular function at the time of the surgery. Since our previous review, we have actively encouraged our local cardiologists to refer patients with severe isolated tricuspid disease for surgery before right ventricular remodelling occurs. This present study was performed to assess our current results. MATERIAL AND METHODS A prospectively-maintained hospital database was used to identify all adult non-congenital patients receiving standalone tricuspid valve repair or replacement at New Zealand's largest cardiothoracic surgical unit from July 2011 to July 2019. Additional demographic and clinical data were collected by review of patient electronic records. RESULTS During the 8-year study period, a total of 50 patients underwent isolated tricuspid valve surgery. Most patients were operated on for functional (40%) or rheumatic (30%) tricuspid disease. The majority of patients underwent surgery when the right ventricular function preoperatively was normal (30%) or mildly/moderately impaired (60%). Over half the patient sample (56%) underwent valve replacement. The 30-day mortality rate and stroke rate were 6% and 2% respectively. The medium-term survival was 80% at 4 years mean follow-up. CONCLUSION Isolated tricuspid surgery is no longer a high mortality operation when it is performed on patients who have preserved right ventricular function.
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Affiliation(s)
- Navneet Singh
- Department of Cardiothoracic Surgery, Auckland City Hospital, Auckland, New Zealand.
| | - Hannah Kim
- The University of Auckland Medical School, Auckland, New Zealand
| | - David A Haydock
- Department of Cardiothoracic Surgery, Auckland City Hospital, Auckland, New Zealand
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17
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Lim JH, Kwak JG, Min J, Cho S, Kim WH. Long-Term Outcomes of Atrioventricular Valve Surgery in Patients with Functional Single Ventricle: Should We Avoid Valve Replacement? Pediatr Cardiol 2021; 42:1546-1553. [PMID: 34235550 DOI: 10.1007/s00246-021-02639-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 05/08/2021] [Indexed: 11/26/2022]
Abstract
Atrioventricular valve regurgitation (AVVR) is associated with increased morbidity and mortality in patients with single ventricle physiology. The purpose of this study was to evaluate the long-term results of the surgical management of AVVR and to analyze the effects of AV valve replacement. The medical records of 38 single ventricle patients who underwent atrioventricular valve surgery more than once between January 2001 and March 2018 were retrospectively reviewed. We analyzed and compared clinical data of patients who underwent valve replacement as an initial treatment (n = 8) for AVVR with patients who initially underwent valve repair (n = 30). The median follow-up duration was 98.1 months (range, 0.9-209.6 months). There was one early mortality and seven late mortalities. Freedom from reoperation between the two groups at 15 years of follow-up was significantly different: 18.3% in the repair group and 100% in the replacement group (p = 0.013). The replacement group showed a better overall survival rate (100%) at 15 years than the repair group (68.5%) without statistical significance (p = 0.097). All mortalities occurred in the repair group. Nine patients in the repair group (30%) and one patient in the replacement group (12.5%) showed preoperative ventricular dysfunction. RV-type single ventricle with atrioventricular (AV) valve annular dilatation was found out as a risk factor of AVV replacement both in univariate (p = 0.04) and multivariate (p = 0.004) analysis. AV valve replacement might be considered as a primary treatment option for patients who have an annular dilation with an RV-type single ventricle rather than repeated valvuloplasty.
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Affiliation(s)
- Jae Hong Lim
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Puchon, Republic of Korea
| | - Jae Gun Kwak
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Jooncheol Min
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Sungkyu Cho
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Woong-Han Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, College of Medicine, Seoul National University, Seoul, Republic of Korea.
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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18
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Eleyan L, Khan AA, Musollari G, Chandiramani AS, Shaikh S, Salha A, Tarmahomed A, Harky A. Infective endocarditis in paediatric population. Eur J Pediatr 2021; 180:3089-3100. [PMID: 33852085 DOI: 10.1007/s00431-021-04062-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 03/26/2021] [Accepted: 04/04/2021] [Indexed: 12/16/2022]
Abstract
Infective endocarditis is very uncommon in children; however, when it does arise, it can lead to severe consequences. The biggest risk factor for paediatric infective endocarditis today is underlying congenital heart defects. The most common causative organisms are Staphylococcus aureus and the viridans group of streptococci. The spectrum of symptoms varies widely in children and this produces difficulty in the diagnosis of infective endocarditis. Infective endocarditis in children is reliant on the modified Duke criteria. The use of blood cultures remains the most effective microbiological test for pathogen identification. However, in blood culture-negative infective endocarditis, serology testing and IgG titres are more effective for diagnosis. Imaging techniques used include echocardiograms, computed tomography and positron emission tomography. Biomarkers utilised in diagnosis are C-reactive protein, with recent literature reviewing the use of interleukin-15 and C-C motif chemokine ligand for reliable risk prediction. The American Heart Association (AHA) and European Society of Cardiology (ESC) guidelines have been compared to describe the differences in the approach to infective endocarditis in children. Medical intervention involves the use of antimicrobial treatment and surgical interventions include the repair and replacement of cardiac valves. Quality of life is highly likely to improve from surgical intervention.Conclusion: Over the past decades, there have been great advancements in clinical practice to improve outcomes in patients with infective endocarditis. Nonetheless, further work is required to better investigative and manage such high risk cohort. What is Known: • The current diagnostic techniques including 'Duke's criteria' for paediatric infective endocarditis diagnosis • The current management guidelines utilised for paediatric infective endocarditis What is New: • The long-term outcomes of patients that underwent medical and surgical intervention • The quality of life of paediatric patients that underwent medical and surgical intervention.
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Affiliation(s)
- Loay Eleyan
- School of Medicine, Faculty of Health and Life Science, University of Liverpool, Liverpool, UK
| | - Ameer Ahmed Khan
- School of Medicine, Faculty of Health and Life Science, University of Liverpool, Liverpool, UK
| | - Gledisa Musollari
- Imperial College London, Exhibition Road, South Kensington, London, SW7 2BU, UK
| | | | - Simran Shaikh
- St. Georges University of London, Cranmer Terrace, Tooting, London, SW17 0RE, UK
| | - Ahmad Salha
- St. Georges University of London, Cranmer Terrace, Tooting, London, SW17 0RE, UK
| | - Abdulla Tarmahomed
- Department of Paediatric Cardiology, Alder Hey Children's Hospital, Liverpool, UK
| | - Amer Harky
- Department of Congenital Cardiac Surgery, Alder Hey Children Hospital, Liverpool, UK. .,Department of Cardio-thoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.
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19
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De Paulis R. The fatal attraction of repairing bicuspid valves. Eur J Cardiothorac Surg 2021; 61:655-656. [PMID: 34568937 DOI: 10.1093/ejcts/ezab412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/08/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ruggero De Paulis
- Cardiac Surgery Department, European Hospital, Rome, Italy.,UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy
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20
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de Meester C, Vanovershelde JL, Jahanyar J, Tamer S, Mastrobuoni S, Van Dyck M, Navarra E, Poncelet A, Astarci P, El Khoury G, de Kerchove L. Long-term durability of bicuspid aortic valve repair: a comparison of 2 annuloplasty techniques. Eur J Cardiothorac Surg 2021; 60:286-294. [PMID: 33495781 DOI: 10.1093/ejcts/ezaa471] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/14/2020] [Accepted: 11/22/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To compare long-term outcomes after bicuspid aortic valve (BAV) repair utilizing the Cabrol annuloplasty versus valve sparing Reimplantation technique. METHODS From 1996 to 2018, 340 consecutive patients underwent BAV repair. Eighty underwent Cabrol annuloplasty and 189 underwent Reimplantation. Exclusion criteria were re-repairs (n = 6), active endocarditis (n = 4), no annuloplasty (n = 41) and ring or suture annuloplasty (n = 20). We compared both groups for survival, reoperations, valve related events and recurrent severe aortic regurgitation (AR > 2+). Inverse probability weighting (IPW) was used to balance the 2 groups. Cox regression analysis was used to identify outcome predictors. RESULTS After weighting, pre- and intraoperative characteristics were similar between groups, except for aorta replacement techniques and operative time, which was longer in the Reimplantation group (P < 0.001). At 12 years, overall survival was similar between groups (IPW: Cabrol 97 ± 2% vs Reimplantation 94 ± 3%, P = 0.52). Freedom from reoperation and freedom from AR > 2+ were significantly lower in the Cabrol group (reoperation IPW: 69 ± 9% vs 91 ± 4%, P = 0.004 and AR > 2+ IPW: 71 ± 8% vs 97 ± 2%, P < 0.001). The Reimplantation technique was the only independent predictor of reoperation (hazard ratio 0.31; confidence interval 0.19-0.7; P = 0.005). CONCLUSIONS In this study, comparing 2 annuloplasty strategies for BAV repair, we found statistically significant differences in long-term durability favouring the Reimplantation technique, and no differences in overall survival. The results support our current strategy of Reimplantation technique and repair of AR in patients with BAV. Cabrol annuloplasty is obsolete and should be generally abandoned in patients undergoing BAV repair for AR.
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Affiliation(s)
- Christophe de Meester
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCL), Louvain-la-Neuve, Belgium
| | - Jean-Louis Vanovershelde
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCL), Louvain-la-Neuve, Belgium.,Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Jama Jahanyar
- Division of Cardiothoracic and Vascular Surgery, Department of Cardiovascular Medicine, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Saadallah Tamer
- Division of Cardiothoracic and Vascular Surgery, Department of Cardiovascular Medicine, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Stefano Mastrobuoni
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCL), Louvain-la-Neuve, Belgium.,Division of Cardiothoracic and Vascular Surgery, Department of Cardiovascular Medicine, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Michel Van Dyck
- Division of Anesthesiology, Department of Acute Medicine, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Emiliano Navarra
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCL), Louvain-la-Neuve, Belgium.,Division of Cardiothoracic and Vascular Surgery, Department of Cardiovascular Medicine, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Alain Poncelet
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCL), Louvain-la-Neuve, Belgium.,Division of Cardiothoracic and Vascular Surgery, Department of Cardiovascular Medicine, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Parla Astarci
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCL), Louvain-la-Neuve, Belgium.,Division of Cardiothoracic and Vascular Surgery, Department of Cardiovascular Medicine, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Gebrine El Khoury
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCL), Louvain-la-Neuve, Belgium.,Division of Cardiothoracic and Vascular Surgery, Department of Cardiovascular Medicine, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Laurent de Kerchove
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCL), Louvain-la-Neuve, Belgium.,Division of Cardiothoracic and Vascular Surgery, Department of Cardiovascular Medicine, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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21
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Zakkar M, Bruno VD, Zacek P, Di Centa I, Acar C, Khelil N, Debauchez M, Lansac E. Isolated aortic insufficiency valve repair with external ring annuloplasty: a standardized approach. Eur J Cardiothorac Surg 2021; 57:308-316. [PMID: 31292613 DOI: 10.1093/ejcts/ezz193] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 05/02/2019] [Accepted: 05/05/2019] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES Aortic valve (AV) insufficiency with normal root and ascending aorta is most frequently treated by valve replacement with significant prosthetic-related complications and reduced life expectancy. We compared the outcomes of a new standardized isolated AV repair approach using an external aortic annuloplasty ring at the subvalvular level (single ring annuloplasty) and the role of an additional supravalvular ring at the sinotubular junction (double ring annuloplasty). METHODS Single centre data were collected from the Aortic Valve Insufficiency and ascending aorta Aneurysm InternATiOnal Registry (AVIATOR) between 2003 and 2017. A total of 93 patients (56 single ring and 37 double ring) underwent isolated AV repair. RESULTS The overall 30-day mortality rate and the need for a permanent pacemaker were 1% and 2%, respectively. The overall survival rate at 6 years was similar for sex- and age-matched members of the general population (89% vs 95%; P = 0.1) and did not differ between the double and single ring groups (82% vs 93%; P = 0.4) at 6 years. There were no thromboembolic or bleeding events in the entire cohort. However, at 6 years, the cumulative incidence of valve-related reintervention was 26% in the single ring annuloplasty group compared to 3% in the double ring annuloplasty (P = 0.02) group. Similarly, at 6 years, the cumulative incidence of moderate-to-severe (>2) aortic insufficiency was 30% in the single ring annuloplasty group compared to 0% in the double ring annuloplasty group (P = 0.007). CONCLUSIONS Standardized AV repair with external ring annuloplasty has a survival rate similar to that of the general population. The additional stabilization of the sinotubular junction with a second supravalvular ring (double ring annuloplasty) is associated with better outcomes compared to single subvalvular annuloplasty. It can be considered as a first line intervention for patients with isolated aortic insufficiency and pliable leaflets.
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Affiliation(s)
- Mustafa Zakkar
- Department of Cardiac Surgery, L'Institut Mutualiste Montsouris, Paris, France.,Department of Cardiovascular Sciences, University of Leicester, Clinical Sciences Wing, Glenfield Hospital, Leicester, UK
| | - Vito D Bruno
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol, UK
| | - Pavel Zacek
- Department of Cardiac Surgery, Charles University Hospital in Prague, Faculty of Medicine, Hradec Kralove, Czech Republic
| | | | - Christophe Acar
- Department of Cardiac Surgery, L'Institut Mutualiste Montsouris, Paris, France
| | - Nizar Khelil
- Department of Cardiac Surgery, L'Institut Mutualiste Montsouris, Paris, France
| | - Mathieu Debauchez
- Department of Cardiac Surgery, L'Institut Mutualiste Montsouris, Paris, France
| | - Emmanuel Lansac
- Department of Cardiac Surgery, L'Institut Mutualiste Montsouris, Paris, France
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22
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Ooms JF, Geleijnse ML, Spitzer E, Ren B, Van Wiechen MP, Hokken TW, Daemen J, de Jaegere PPT, Van Mieghem NMDA. Transcatheter mitral valve repair in proportionate and disproportionate functional mitral regurgitation-insights from a small cohort study. Neth Heart J 2021; 29:359-364. [PMID: 34105050 PMCID: PMC8271066 DOI: 10.1007/s12471-021-01583-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2021] [Indexed: 11/30/2022] Open
Abstract
Background Functional mitral regurgitation (FMR) can be subclassified based on its proportionality relative to left ventricular function and end-diastolic volume. FMR proportionality could help identify responders to transcatheter edge-to-edge mitral valve repair (MitraClip) in terms of residual FMR and/or clinical improvement. Methods This single-centre retrospective cohort study evaluated the feasibility of determining FMR proportionality in symptomatic heart failure patients with reduced left ventricular function who were treated with MitraClip for ≥ moderate-to-severe FMR. Baseline proportionate (pFMR) and disproportionate FMR (dFMR) were distinguished. Patient characteristics and MitraClip procedural outcomes were described. Results From an overall cohort of 81 eligible FMR patients, 23/81 (28%) had to be excluded due to missing transthoracic echocardiogram parameters, 22/81 were excluded based on FMR severity. The remaining cohort, of 36/81 patients (44%), could be classified into dFMR (n = 26) or pFMR (n = 10). Conduction disorders were numerically increased in dFMR. All cases requiring > 2 clips were in the dFMR group and absence of FMR reduction occurred more frequently with dFMR. Point of view/Conclusion Important limitations in terms of imaging acquisition affect the translation of the FMR proportionality concept to a real-world data set. We did observe different demographic and FMR response patterns in patients with proportionate and disproportionate FMR that warrant further investigation. Supplementary Information The online version of this article (10.1007/s12471-021-01583-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- J F Ooms
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M L Geleijnse
- Department of Echocardiography, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - E Spitzer
- Department of Echocardiography, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - B Ren
- Department of Echocardiography, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M P Van Wiechen
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - T W Hokken
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J Daemen
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - P P T de Jaegere
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - N M D A Van Mieghem
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands.
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Meuris B, Vervoort D, De Praetere H, Rex S, Van De Bruaene A, Herijgers P, Rega F, Verbrugghe P. Starting an aortic valve repair program: is it worthwhile? Aortic valve repair compared to replacement. Eur J Cardiothorac Surg 2021; 60:1369-1377. [PMID: 34021336 DOI: 10.1093/ejcts/ezab200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/12/2021] [Accepted: 03/20/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES Increasing evidence suggests that aortic valve (AV) repair may have better long-term outcomes than AV replacement for aortic insufficiency. However, most literature is limited to centres of excellence and has not sufficiently been replicated in nascent programs. This single-centre experience of a newly established AV repair program aims to compare short-term outcomes of AV sparing versus replacement surgery. METHODS A retrospective cohort study of patients who underwent elective surgery for aortic regurgitation or aortic root dilatation at the Leuven University Hospital between 2013 and 2018 was performed. Patients with a critically ill presentation, endocarditis, aortic stenosis or requiring redo surgery were excluded. Patients were assigned to repair versus replacement based on preoperative intention to preserve the AV. Nearest neighbour propensity score matching was performed to compare both groups. Safety (mortality, morbidity), efficiency (cross-clamp and bypass times) and efficacy end points (repair rate, postoperative echocardiography) were compared. RESULTS One hundred and seven patients underwent AV surgery (48 repair, 59 replacement), from which 2 groups of 23 matched patients were created. There were 1 death and 2 reoperations after repair and no death and 1 reoperation after replacement. Extracorporeal circulation and aortic cross-clamp time were significantly longer while ventilation and total hospital stay were significantly shorter after AV repair. Echocardiographic follow-up showed comparable aortic regurgitation but lower transvalvular gradients after repair. Freedom from major complications was comparable in both cohorts. CONCLUSIONS Early results suggest the feasibility of replicating experienced centres' perioperative and short-term outcomes in nascent programs.
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Affiliation(s)
- Bart Meuris
- Department of Cardiac Surgery, UZ Leuven, Leuven, Belgium
| | - Dominique Vervoort
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Steffen Rex
- Department of Anesthesiology, UZ Leuven, Leuven, Belgium
| | | | - Paul Herijgers
- Department of Cardiac Surgery, UZ Leuven, Leuven, Belgium
| | - Filip Rega
- Department of Cardiac Surgery, UZ Leuven, Leuven, Belgium
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Mayr B, Burri M, Strbad M, Cleuziou J, Hager A, Ewert P, Hörer J, Lange R, Ono M. Common atrioventricular valve surgery in children with functional single ventricle. Eur J Cardiothorac Surg 2021; 60:1419-1427. [PMID: 34008032 DOI: 10.1093/ejcts/ezab220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 03/11/2021] [Accepted: 03/24/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES A common atrioventricular valve (CAVV) is considered to be a risk factor for early and late deaths in patients with functional single ventricle (FSV). CAVV surgery in patients with FSV is challenging and there is limited knowledge of the outcomes of CAVV repair with univentricular physiology. METHODS We reviewed all CAVV surgical procedures in patients with FSV who underwent univentricular palliation. End points of the study were survival after CAVV surgery and cumulative incidence of reoperation. RESULTS Between 1984 and 2019, 66 children with CAVV and FSV underwent single-ventricle palliation, of whom 45.5% (30/66) required CAVV surgery. Indication for surgery was moderate CAVV regurgitation in 40% (12/30) and severe CAVV regurgitation in 60% (18/30). CAVV repair was performed in 93.3% (28/30) and CAVV replacement in 6.7% (2/30). The median age and weight at surgery were 0.9 years (interquartile range 0.3-1.8) and 6.5 kg (interquartile range 3.9-8.7), respectively. Operative and late mortality were 23.3% and 8.7%, respectively. Survival and cumulative incidence of reoperation at 4 years after CAVV surgery were 68.9% [standard deviation (SD): 8.7] and 35.8% (SD: 9.1), respectively. Fontan completion was achieved in 60% (18/30). Survival at 4 years after birth was 69.7% (SD: 8.5) in 30 patients with CAVV surgery, whereas it was 83% (SD: 6.3) in 36 patients without CAVV surgery (P = 0.32). CONCLUSIONS CAVV surgery in patients with FSV is associated with substantial mortality and a high incidence of reoperation.
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Affiliation(s)
- Benedikt Mayr
- Department of Cardiovascular Surgery, German Heart Center Munich at the Technical University of Munich, Munich, Germany.,Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Insure (Institute for Translational Cardiac Surgery), Munich, Germany
| | - Melchior Burri
- Department of Cardiovascular Surgery, German Heart Center Munich at the Technical University of Munich, Munich, Germany.,Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Insure (Institute for Translational Cardiac Surgery), Munich, Germany
| | - Martina Strbad
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Insure (Institute for Translational Cardiac Surgery), Munich, Germany.,Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.,Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Julie Cleuziou
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Insure (Institute for Translational Cardiac Surgery), Munich, Germany.,Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.,Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Alfred Hager
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich at the Technical University of Munich, Munich, Germany
| | - Peter Ewert
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich at the Technical University of Munich, Munich, Germany
| | - Jürgen Hörer
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Insure (Institute for Translational Cardiac Surgery), Munich, Germany.,Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.,Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
| | - Rüdiger Lange
- Department of Cardiovascular Surgery, German Heart Center Munich at the Technical University of Munich, Munich, Germany.,Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Insure (Institute for Translational Cardiac Surgery), Munich, Germany.,DZHK (German Center for Cardiovascular Research) - partner site Munich Heart Alliance, Munich, Germany
| | - Masamichi Ono
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Insure (Institute for Translational Cardiac Surgery), Munich, Germany.,Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany.,Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany
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25
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Shibata T, Takahashi Y, Fujii H, Morisaki A, Abe Y. Surgical considerations for atrial functional regurgitation of the mitral and tricuspid valves based on the etiological mechanism. Gen Thorac Cardiovasc Surg 2021; 69:1041-9. [PMID: 33970433 DOI: 10.1007/s11748-021-01629-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 03/29/2021] [Indexed: 10/25/2022]
Abstract
Atrial functional mitral regurgitation is a hot research topic in the field of mitral valve disease. Atrial functional mitral regurgitation is distinctly different from ventricular functional mitral regurgitation. The surgical indications for atrial functional mitral regurgitation have not been well established because of the small amount of evidence gathered to date. Mitral annular plication with an artificial ring is an essential surgical procedure because dilatation of the mitral valve annulus is a main factor underlying this pathology. Most of these cases can be treated by mitral annuloplasty alone. However, additional procedures, such as application of artificial chordae to the anterior leaflet for pseudo-prolapse, and posterior leaflet augmentation with a pericardial patch, are required in advanced cases with a giant left atrium and extremely enlarged mitral annulus. Chronic atrial fibrillation causes enlargement of the right and left atria. This pathology is a bilateral atrioventricular valve disease (dual-valve disease). Therefore, the conventional guidelines of single-valve disease should not be applied. Although atrial functional tricuspid regurgitation is underappreciated, tricuspid annuloplasty should be considered for most patients to prevent future regurgitation. In addition to the mitral and tricuspid valve procedure, integrated surgical management, including plication of the atrium and left appendage closure, is required. This review summarizes the current considerations of surgical treatment for atrial functional regurgitation of the mitral and tricuspid valves based on the etiological mechanism.
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26
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Brega C, Raviola E, Lansac E, Albertini A. Coronary spasm: unpredictability and safety in treatment key role of hybrid setting. Interact Cardiovasc Thorac Surg 2021; 33:637-639. [PMID: 33912969 DOI: 10.1093/icvts/ivab128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/21/2021] [Accepted: 03/31/2021] [Indexed: 11/13/2022] Open
Abstract
The present case highlights the crucial role of hybrid setting for diagnosis and treatment of refractory coronary spasms.
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Affiliation(s)
- Carlotta Brega
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, RA, Italy
| | - Eliana Raviola
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, RA, Italy
| | - Emmanuel Lansac
- Department of Cardiac Surgery, Institute Mutualiste Montsouris, Paris, France
| | - Alberto Albertini
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, RA, Italy
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Okamoto K, Umeno T, Shuto T, Wada T, Anai H, Nishida H, Nakayama Y, Miyamoto S. Three-month outcomes of aortic valve reconstruction using collagenous membranes (biosheets) produced by in-body tissue architecture in a goat model: a preliminary study. BMC Cardiovasc Disord 2021; 21:184. [PMID: 33858334 PMCID: PMC8050917 DOI: 10.1186/s12872-021-01988-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 04/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Autologous pericardium is widely used as a plastic material in intracardiac structures, in the pulmonary artery, and in aortic valve leaflets. For aortic valve reconstruction (AVRec) using the Ozaki procedure, it has produced excellent clinical results over a 10-year period. In-body tissue architecture (iBTA), which is based on the phenomenon of tissue encapsulation of foreign materials, can be used to prepare autologous prosthetic tissues. In this preliminary study, we examined whether biosheets can be used as valve leaflet material for glutaraldehyde-free AVRec by subchronic implantation experiments in goats and evaluated its performance compared with glutaraldehyde-treated autologous pericardium for AVRec. METHODS Biosheets were prepared by embedding molds for two months into the dorsal subcutaneous spaces of goats. Autogenic biosheets (n = 4) cut into the shape of the valve were then implanted to the aortic valve annulus of four goats for three months without glutaraldehyde treatment. Autologous pericardium (n = 4) was used in four goats as a control. Valve function was observed using echocardiography. RESULTS All goats survived the three-month study period. With biosheets, the leaflet surfaces were very smooth and, on histology, partially covered with a thin neointima (including endothelial cells). Biosheets were more thoroughly assimilated into the aortic root compared with autologous pericardium. CONCLUSIONS For the first time, biosheets were used for large animal AVRec. Biosheets could function as leaflets in the aortic position and may have the ability to assimilate into native valves.
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Affiliation(s)
- Keitaro Okamoto
- Department of Cardiovascular Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Yufu , Oita , 879-5593, Japan. .,Department of Cardiovascular Surgery, Oita University Hospital, Oita, Japan.
| | - Tadashi Umeno
- Department of Cardiovascular Surgery, Oita University Hospital, Oita, Japan
| | - Takashi Shuto
- Department of Cardiovascular Surgery, Oita University Hospital, Oita, Japan
| | - Tomoyuki Wada
- Department of Cardiovascular Surgery, Oita University Hospital, Oita, Japan
| | - Hirofumi Anai
- Clinical Engineering, Faculty of Medicine, Oita University, Yufu, Oita, Japan
| | - Haruto Nishida
- Department of Pathology, Oita University Hospital, Oita, Japan
| | | | - Shinji Miyamoto
- Department of Cardiovascular Surgery, Oita University Hospital, Oita, Japan
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Bonaros N, Czerny M, Pfausler B, Müller S, Bartel T, Thielmann M, Shehada SE, Folliguet T, Obadia JF, Holfeld J, Lorusso R, Parolari A, Müller L, Grimm M, Ruttmann-Ulmer E. Infective endocarditis and neurologic events: indications and timing for surgical interventions. Eur Heart J Suppl 2020; 22:M19-M25. [PMID: 33664636 PMCID: PMC7916418 DOI: 10.1093/eurheartj/suaa167] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A therapeutic dilemma arises when infective endocarditis (IE) is complicated by a neurologic event. Postponement of surgery up to 4 weeks is recommended by the guidelines, however, this negatively impacts outcomes in many patients with an urgent indication for surgery due to uncontrolled infection, disease progression, or haemodynamic deterioration. The current literature is ambiguous regarding the safety of cardiopulmonary bypass in patients with recent neurologic injury. Nevertheless, most publications demonstrate a lower risk for secondary haemorrhagic conversion of uncomplicated ischaemic lesions than the risk for recurrent embolism under antibiotic treatment. Here, we discuss the current literature regarding neurologic stroke complicating IE with an indication for surgery.
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Affiliation(s)
- Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Martin Czerny
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Bettina Pfausler
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Silvana Müller
- Department of Internal Medicine III, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Bartel
- Department of Cardiology Mediclinic City, Hospital Dubai, Dubai, United Arab Emirates
| | - Matthias Thielmann
- Clinic for Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, Essen, Germany
| | - Sharaf-Eldin Shehada
- Clinic for Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, Essen, Germany
| | - Thierry Folliguet
- Department of Cardiac Surgery and Transplantation, Henry Mondor Hospital, Paris, France
| | - Jean-Francois Obadia
- Department of Cardiac Surgery and Transplantation, Louis Pradel Hospital, Lyon, France
| | - Johannes Holfeld
- Department of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Roberto Lorusso
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maaastricht, The Netherlands
| | | | - Ludwig Müller
- Department of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Michael Grimm
- Department of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Elfriede Ruttmann-Ulmer
- Department of Cardiac Surgery, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
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29
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Rodríguez-Palomares JF, Lozano-Torres J, Dentamaro I, Valente FX, Avilés AS, García-Moreno LG, Sabaté PR, Otaegui I, Rosique BM, Calabria HC, Masip AE, Mas PT, Ferreira-González I, González-Alujas MT. Predictors of cardiovascular outcomes after surgery in severe tricuspid regurgitation: clinical, imaging and hemodynamic prospective study. ACTA ACUST UNITED AC 2020; 74:655-663. [PMID: 33960932 DOI: 10.1016/j.rec.2020.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES Severe tricuspid regurgitation (TR) is a prevalent valve disease with a high mortality rate. Current guidelines do not define specific thresholds at which patients should be considered for surgery or percutaneous procedures. Thus, patients are usually referred for intervention at a late stage of the disease. This study aimed to assess predictors of cardiovascular outcomes in a prospective cohort of patients with severe TR referred for surgery. METHODS This was an observational, prospective, nonrandomized study. All patients underwent surgery for severe TR based on current clinical guidelines. Complete anamnesis, blood test, echocardiogram, cardiovascular magnetic resonance and right and left catheterization were performed. Patients were followed up in the outpatient department and a combined endpoint (hospitalization for heart failure and cardiovascular mortality) was registered. RESULTS Forty-three consecutive patients were included (age: 66.9 ± 9.6 years, 67.4% female). Tricuspid annuloplasty was performed in all patients. After a median follow-up of 38 months, 12 patients (27.9%) showed the combined endpoint and 7 (16.3%) died. Above all clinical, blood and imaging data, the indexed right ventricular end-diastolic volume constituted the best predictor of the combined endpoint (HR, 1.1; P = .02) and cardiovascular mortality (HR, 1.1; P = .05). Furthermore, indexed right ventricular end-diastolic volume was associated with TR recurrence after surgery, with no impact on clinical outcomes. CONCLUSIONS In patients with severe TR referred for surgery, right ventricular remodeling assessed by cardiovascular magnetic resonance constituted the best independent predictor of cardiovascular outcomes at follow-up.
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Affiliation(s)
- José F Rodríguez-Palomares
- Departamento de Cardiología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Jordi Lozano-Torres
- Departamento de Cardiología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Ilaria Dentamaro
- Departamento de Cardiología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Filipa X Valente
- Departamento de Cardiología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Augusto Sao Avilés
- Departamento de Cardiología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; Unidad de Estadística y Bioinformática (UEB), Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Laura Gutiérrez García-Moreno
- Departamento de Cardiología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Pau Rello Sabaté
- Departamento de Cardiología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Imanol Otaegui
- Departamento de Cardiología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Beatriz Mínguez Rosique
- Unidad de Hepatología, Departamento de Medicina Interna, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut of Research, CIBERehd, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Hug Cuéllar Calabria
- Servicio de Radiología, Institut de Diagnòstic per la imatge (IDI), Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Artur Evangelista Masip
- Departamento de Cardiología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Pilar Tornos Mas
- Departamento de Cardiología, Hospital Quirónsalud, Barcelona, Spain
| | - Ignacio Ferreira-González
- Departamento de Cardiología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - María Teresa González-Alujas
- Departamento de Cardiología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
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Abstract
Dystrophic aortic insufficiency accounts for the majority of Western cases of aortic insufficiency and can be divided into the three phenotypes of isolated aortic insufficiency, dilated aortic root, and dilated ascending aorta. Each of these phenotypes is associated with a dilated annulus and/or sinotubular junction. Recent international guidelines recommend reimplantation or remodeling with aortic annuloplasty for valve-sparing root replacement, as well as consideration of aortic valve repair in cases of aortic insufficiency. A dilated aortic annulus is a major risk factor for failure of aortic valve repair procedures, indicating the need to address the annulus at the time of aortic valve or root repair. Calibrated annuloplasty should be performed at sub- and supravalular levels in order to restore the ratio of the sinotubular junction and annulus and be adapted according to the phenotype of the root and ascending aorta. Standardization of aortic valve repair techniques with use of a calibrated annuloplasty will improve dissemination of techniques and rate of aortic valve repair. Current medical evidence shows that aortic valve repair is safe, produces better quality of life, and reduces valve-related mortality compared to prosthetic valve replacement.
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Affiliation(s)
- Pouya Youssefi
- Department of Cardiac Surgery, Institut Mutualiste Montsouris, Paris, France
| | - Emmanuel Lansac
- Department of Cardiac Surgery, Institut Mutualiste Montsouris, Paris, France
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Barth S, Hautmann MB, Arvaniti E, Kikec J, Kerber S, Zacher M, Halbfass P, Ranosch P, Lehmkuhl L, Foldyna B, Lüsebrink U, Hamm K. Mid-term hemodynamic and functional results after transcatheter mitral valve leaflet repair with the new PASCAL device. Clin Res Cardiol 2020; 110:628-639. [PMID: 32845361 DOI: 10.1007/s00392-020-01733-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/12/2020] [Indexed: 10/23/2022]
Abstract
AIMS To examine the functional and hemodynamic mid-term outcome at 5 months of mitral regurgitation (MR) reduction using the PASCAL repair system. METHODS AND RESULTS Between July 2019 and February 2020 31 consecutive patients with MR 3 +/4 + (mean age 77.5 years, all in New York Heart Association (NYHA) class III-IV, STS score 9.1 ± 7.4) underwent MR reduction in our institute using the PASCAL device. 61.3% had a functional, 29.0% a degenerative, and 9.7% a mixed etiology. Successful implantation was achieved in 30/31 (96.8%) patients. 27/31 patients (87.1%) completed 5-month follow-up with clinical, echocardiographic, laboratory and hemodynamic assessment. At 5 months, 70.4% of the patients had MR grade ≤ 1 (p < 0.001). 85.2% were in NYHA class I or II (p < 0.001). Six-minute walk distance improved by 145 m (p = 0.010), Kansas City cardiomyopathy questionnaire and European quality of life 5 dimensions questionnaire (EQ5D) improved by 31 (p < 0.001) and 9 points (p = 0.001), respectively. Mean pulmonary capillary wedge pressure decreased significantly from 22.1 ± 9 mmHg to 17.3 ± 8 mmHg (p = 0.041) and right atrial pressure from 10.3 ± 6 mmHg to 8.0 ± 6 mmHg (p = 0.013) from baseline to 5 months. In addition, propensity score matching showed that PASCAL and MitraClip procedures resulted in equally hemodynamic and functional improvement. CONCLUSION MR reduction of severe MR with the PASCAL device is feasible and safe regardless of etiologies. Mid-term follow-up at 5 months showed a sustained MR reduction, improvement of exercise capacity, quality of life, proBNP levels and hemodynamics regarding pulmonary capillary wedge pressure and right atrial pressure.
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Affiliation(s)
- Sebastian Barth
- Department of Cardiology, Cardiovascular Center Bad Neustadt, Von-Guttenberg-Straße 11, 97616, Bad Neustadt a.d. Saale, Germany.
| | - Martina B Hautmann
- Department of Cardiology, Cardiovascular Center Bad Neustadt, Von-Guttenberg-Straße 11, 97616, Bad Neustadt a.d. Saale, Germany
| | - Eleni Arvaniti
- Department of Cardiology, Cardiovascular Center Bad Neustadt, Von-Guttenberg-Straße 11, 97616, Bad Neustadt a.d. Saale, Germany
| | - Jan Kikec
- Department of Cardiology, Cardiovascular Center Bad Neustadt, Von-Guttenberg-Straße 11, 97616, Bad Neustadt a.d. Saale, Germany
| | - Sebastian Kerber
- Department of Cardiology, Cardiovascular Center Bad Neustadt, Von-Guttenberg-Straße 11, 97616, Bad Neustadt a.d. Saale, Germany
| | - Michael Zacher
- Department of Cardiac Surgery, Cardiovascular Center Bad Neustadt, Bad Neustadt a.d. Saale, Germany
| | - Philipp Halbfass
- Department of Cardiology, Cardiovascular Center Bad Neustadt, Von-Guttenberg-Straße 11, 97616, Bad Neustadt a.d. Saale, Germany
| | - Patrick Ranosch
- Department of Cardiology, Cardiovascular Center Bad Neustadt, Von-Guttenberg-Straße 11, 97616, Bad Neustadt a.d. Saale, Germany
| | - Lukas Lehmkuhl
- Department of Radiology, Cardiovascular Center Bad Neustadt, Bad Neustadt a.d. Saale, Germany
| | - Borek Foldyna
- Department of Radiology, Cardiovascular Center Bad Neustadt, Bad Neustadt a.d. Saale, Germany
| | - Ulrich Lüsebrink
- Department of Cardiology, University of Marburg, Marburg, Germany
| | - Karsten Hamm
- Department of Cardiology, ANregiomed Klinikum Ansbach, Ansbach, Germany
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Enomoto M, Suzuki T, Kinoshita T, Takashima N, Minamidate N, Lee J, Wakisaka H, Asai T. Outcomes of surgical treatment for active infective endocarditis of mitral valve compared using complexity scoring. Gen Thorac Cardiovasc Surg 2021; 69:434-43. [PMID: 32749599 DOI: 10.1007/s11748-020-01456-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate our surgical treatment outcomes of active infective endocarditis (IE) of mitral valve in relation to the patients' complexity scores. METHODS We reviewed 51 patients who underwent surgical treatment for active IE on the mitral valve, in our hospital between September 2002 and November 2016. We adapted a complexity scoring scale to describe the range of parts suffering vegetation and damage, assigning the following weighting: weight 1 for each posterior segment; weight 2 for each anterior segment, commissural segment, left atrium, or left ventricle; weight 3 if the annulus was involved or if pathology extended to a prior mitral operation site. A total of 51 patients were identified and categorized by complexity score into two groups: 1-2: Simple (n = 19); ≥ 3: Complex (n = 32). RESULTS MV repair was achieved in 18 patients (95%) in the Simple group and 26 patients (81%) in the Complex group. In the Complex there were 2 in-hospital deaths (6%). There were none in the Simple. The 5-year survival rates were 100% in the Simple and 79.6% in the Complex (P < 0.05). The 5-year rates of freedom from mitral regurgitation were 77.8% in the Simple and 91.5% in the Complex (P = 0.63). The 5-year rates of freedom from recurrence of IE were 93.3% in the Simple and 92.2% in the Complex (P = 0.76). CONCLUSIONS We found consistent outcomes in terms of recurrent mitral regurgitation and recurrence of IE, regardless of lesion complexity.
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Abstract
Intravenous drug use has increased substantially over the past decade, with heroin abuse more than doubling. Injection drug use-related infective endocarditis hospitalizations have similarly increased over the same period. Right-sided infective endocarditis is strongly associated with intravenous drug use, and 90% of right-sided endocarditis involves the tricuspid valve. During the period of the opioid epidemic, tricuspid-related endocarditis rates have increased, while the incidence of surgery for tricuspid endocarditis has increased as much as five-fold. Within this context, optimizing surgical technique for valve repair is increasingly important. In this report, we examine the indications for tricuspid valve surgery for endocarditis, describe specific techniques for tricuspid valve leaflet repair and augmentation, and assess postoperative care and surgical outcomes after both tricuspid valve repair and replacement for infective endocarditis.
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Affiliation(s)
| | - Tessa M F Watt
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI
| | - Aaron M Williams
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI
| | - Matthew A Romano
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI
| | - Steven F Bolling
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI
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Lo Rito M, Grandinetti M, Muzio G, Varrica A, Frigiola A, Micheletti A, Chessa M, Giamberti A. Results for tricuspid valve surgery in adults with congenital heart disease other than Ebstein's anomaly†. Eur J Cardiothorac Surg 2019; 56:706-713. [PMID: 30919906 DOI: 10.1093/ejcts/ezz093] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/25/2019] [Accepted: 02/03/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Tricuspid valve (TV) surgery in the adult with congenital heart disease (ACHD) is a frequently performed procedure. The aim of this study was to analyse postoperative and medium-term outcomes. METHODS We conducted a single-centre retrospective study of patients with ACHD who underwent TV surgery (January 2000-December 2016); patients with Ebstein's anomalies were excluded. Operative and clinical records were reviewed. Outcomes considered were survival, grade of insufficiency/stenosis and TV reoperation at follow-up. RESULTS A total of 128 patients with ACHD had TV surgery for functional regurgitation (n = 95), dysplasia (n = 23) and systemic TV (n = 10). Median age was 40.8 years [interquartile range (IQR) 25.3]; 55.5% were men. Preoperative regurgitation was classified as mild (n = 8), moderate (n = 47) and severe (n = 70). The TV was repaired in 109 as follows: ring annuloplasty (n = 43), de Vega annuloplasty (n = 29), Wooler annuloplasty (n = 13), commissural plasty (n = 9), Kay annuloplasty (n = 7) and others (n = 8). The TV was replaced in 19 patients with biological (n = 10) and mechanical (n = 9) prostheses. The median hospital stay was 12 days (IQR 10). The overall mortality rate was 8.6% (n = 11): 2 hospital deaths (1.6%) and 9 late deaths. Survival was 93% [95% confidence interval (CI) 85-97%] at 5 years and 83% (95% CI 70-91%) at 10 years. The median follow-up period was 4.95 years (IQR 7.7) with 1 TV reoperation. Echocardiographic assessment showed ≥moderate regurgitation in 34 (34.3%) patients. Suture plasty had a significantly higher incidence of TV regurgitation ≥moderate compared to ring annuloplasty (48.9% vs 26.3%; P = 0.033). CONCLUSIONS TV surgery in the ACHD is frequently associated with other main procedures. Stabilizing the TV annulus with a prosthetic ring guarantees lower recurrence of moderate to severe regurgitation compared to suture plasty repair.
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Affiliation(s)
- Mauro Lo Rito
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Maria Grandinetti
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Giulia Muzio
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alessandro Varrica
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alessandro Frigiola
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Angelo Micheletti
- Pediatric and Adult Congenital Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Massimo Chessa
- Pediatric and Adult Congenital Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alessandro Giamberti
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
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El-Hag-Aly MA, El Swaf YF, Elkassas MH, Hagag MG, Allam HK. Moderate ischemic mitral incompetence: does it worth more ischemic time? Gen Thorac Cardiovasc Surg 2019; 68:492-498. [PMID: 31552590 DOI: 10.1007/s11748-019-01212-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 09/17/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Ischemic mitral regurgitation (IMR) is a common finding following myocardial infarction or ischemia. Management of moderate IMR is still a hot topic. Adding mitral valve repair (MVr) to coronary artery bypass grafting (CABG) is questionable. The goal of this study was to assess and compare short-term clinical and echocardiographic results of moderate IMR treated by CABG alone versus another group of patients treated by CABG plus MVr. METHODS Eighty consecutive patients with ischemic heart disease (IHD) and moderate IMR were divided randomly into two equal groups: group I (40) had only CABG and group II (40) had CABG plus MVr. Patients were evaluated at 1-week, 3-months and 1-year intervals postoperatively. RESULTS After 1-year follow-up, our study revealed statistically significant improvement in the grade of mitral regurgitation (MR) in group II than group I. The mean value for effective regurgitant orifice area (EROA) was 0.22 ± 0.13 for group I versus 0.03 ± 0.03 for group II (P = 0.001) and for vena contracta (VC), it was 3.8 ± 2.24 for group I versus 0.4 ± 0.49 for group II (P = 0.000). There was also a significant reduction in the New York Heart Association (NYHA) functional class in both groups. CONCLUSIONS MVr can be performed safely and concomitantly with CABG in patients having moderate IMR, and its addition to CABG have significant short-term impact on clinical or echocardiographic outcome of patients.
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Affiliation(s)
- Mohammed A El-Hag-Aly
- Cardiothoracic Surgery Department, Faculty of Medicine, Menoufia University, Yassin Abdel Ghaffar Street, Shebin El-Kom, 32511, Menoufia, Egypt
| | - Yasser F El Swaf
- Cardiothoracic Surgery Department, Mahalla Cardiac Institute, Mahalla, Gharbia, Egypt
| | - Marwan H Elkassas
- Cardiothoracic Surgery Department, Faculty of Medicine, Suez Canal University, Suez, Egypt
| | - Mohamed G Hagag
- Cardiothoracic Surgery Department, Faculty of Medicine, Menoufia University, Yassin Abdel Ghaffar Street, Shebin El-Kom, 32511, Menoufia, Egypt.
| | - Heba Khodary Allam
- Public Health and Community Medicine Department, Faculty of Medicine, Menoufia University, Shebin El-Kom, Menoufia, Egypt
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Bristow P, Kurosawa A, Fuentes VL, Rutherford L, Brockman D. Surgical valvulotomy for tricuspid valve stenosis in a dog. J Vet Cardiol 2019; 23:142-148. [PMID: 31174724 DOI: 10.1016/j.jvc.2019.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/18/2019] [Accepted: 04/21/2019] [Indexed: 11/16/2022]
Abstract
A 2-year, 4-month-old neutered female Labrador retriever was brought for evaluation of right-sided congestive heart failure. Echocardiographic examination revealed tricuspid valve dysplasia with only two small orifices in the valve resulting in severe tricuspid stenosis. The dog underwent a right fifth lateral intercostal thoracotomy and surgical tricuspid valvulotomy, under cardiopulmonary bypass. The stenosis was relieved by dividing the valve leaflets between the two orifices with continuation to the commissures, creating a 'bileaflet' valve. The dog made a good recovery initially, with echocardiography at 48 h after surgery showing a reduction in tricuspid valve E and A wave velocities and pressure half-time (from 230 ms to 65 ms). She was discharged five days after surgery, and spironolactone, benazepril, pimobendan, and clopidogrel were prescribed. The dog was re-presented two days later having collapsed, with pyrexia, facial swelling, and pitting edema on the ventral neck and intermandibular region. Investigations did not reveal an underlying cause, and the clinical signs resolved with supportive therapy. Two years after surgery, the dog was free of clinical signs with normal exercise tolerance and only mild tricuspid regurgitation on echocardiography, with discontinuation of all medications.
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Affiliation(s)
- P Bristow
- Queen Mother Hospital for Animals, Royal Veterinary College, Hawkshead Lane, North Mymms, AL9 7TA, United Kingdom.
| | - A Kurosawa
- Queen Mother Hospital for Animals, Royal Veterinary College, Hawkshead Lane, North Mymms, AL9 7TA, United Kingdom
| | - V Luis Fuentes
- Queen Mother Hospital for Animals, Royal Veterinary College, Hawkshead Lane, North Mymms, AL9 7TA, United Kingdom
| | - L Rutherford
- Queen Mother Hospital for Animals, Royal Veterinary College, Hawkshead Lane, North Mymms, AL9 7TA, United Kingdom
| | - D Brockman
- Queen Mother Hospital for Animals, Royal Veterinary College, Hawkshead Lane, North Mymms, AL9 7TA, United Kingdom
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Rego A, Cheung PC, Harris WJ, Brady KM, Newman J, Still R. Pericardial closure with extracellular matrix scaffold following cardiac surgery associated with a reduction of postoperative complications and 30-day hospital readmissions. J Cardiothorac Surg 2019; 14:61. [PMID: 30876459 PMCID: PMC6419853 DOI: 10.1186/s13019-019-0871-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 02/17/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND A prospective, multi-center study (RECON) was conducted to evaluate the clinical outcomes of pericardial closure using a decellularized extracellular matrix (ECM) graft derived from porcine small intestinal submucosa. METHODS Patients indicated for open cardiac surgery with pericardial closure using ECM were eligible for the RECON study cohort. Postoperative complications and readmission of the RECON patients were compared to the patient cohort in the Nationwide Readmissions Database (NRD). Inverse probability of treatment weighting was used to control the differences in patient demographics, comorbidities, and risk factors. RESULTS A total of 1420 patients at 42 centers were enrolled, including 923 coronary artery bypass grafting (CABG) surgeries and 436 valve surgeries. Significantly fewer valve surgery patients in the RECON cohort experienced pleural effusion (3.1% vs. 13.0%; p < 0.05) and pericardial effusion (1.5% vs. 2.6%; p < 0.05) than in the NRD cohort. CABG patients in the RECON cohort were less likely to suffer bleeding (1.2% vs. 2.9%; p < 0.05) and pericardial effusion (0.2% vs. 2.2%, p < 0.05) than those in the NRD cohort. The 30-day all-cause hospital readmission rate was significantly lower among RECON patients than NRD patients following both valve surgery (HR: 0.34; p < 0.05) and CABG surgery (HR: 0.42; p < 0.05). In the RECON study, 14.4% of CABG patients and 27.0% of valve patients had postoperative atrial fibrillation as compared to previously reported risks, which generally ranges from 20 to 30% after CABG and from 35 to 50% after valve surgery. CONCLUSIONS Pericardial closure with ECM following cardiac surgery is associated with a reduction in the proportion of patients with pleural effusion, pericardial effusion, and 30-day readmission compared to a nationwide database. TRIAL REGISTRATION NCT02073331 , Registered on February 27, 2014.
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Affiliation(s)
- Alfredo Rego
- South Florida Heart & Lung Institute, 3650 NW 82nd Ave, Doral, FL, 33166, USA.
| | - Patricia C Cheung
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
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He F, Jiao Y, Ma K, Hua Z, Zhang H, Yan J, Yang K, Pang K, Zhang S, Qi L, Wang G, Feng Z, Li S. Outcomes of Common Atrioventricular Valve Repair in Patients With Single-Ventricle Physiology - Indication, Timing and Repair Techniques. Circ J 2019; 83:647-653. [PMID: 30745490 DOI: 10.1253/circj.cj-18-0916] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Common atrioventricular valve (CAVV) repair in patients with a single ventricle remains a great challenge and a refractory issue for pediatric cardiac surgeons. Methods and Results: From January 2007 to April 2018, 37 consecutive patients with a single ventricle who underwent CAVV repair were included in the study group. Patients were divided into 2 groups based on the repair technique: patients in Group A were treated using the bivalvation technique, and patients in Group B underwent conventional repair techniques; baseline data were similar between groups. The inhospital and follow-up mortality were 5.4% (2/37) and 11.4% (4/35), respectively. After a follow-up of 65.5±29.3 months, the estimated 1-, 5-, and 10-year overall survival rates were 94.6%, 83.4%, and 77.0%, respectively. The rates of freedom from CAVV failure were 94.3%, 72.7%, and 62.9% after 1, 5, and 10 years, respectively. In the multivariate analysis, the independent factors for CAVV repair failure were repair technique (P=0.004) and heterotaxy syndrome (P=0.003). A total of 30 patients (81.1%) completed total cavopulmonary connection (TCPC); 3 patients required re-intervention; 24 of 31 patients (77.4%) were in New York Heart Association classes II and I at the latest follow-up. CONCLUSIONS Outcomes of CAVV repair in patients palliated by single-ventricular surgery are acceptable. The bivalvation technique is a simple and effective technique.
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Affiliation(s)
- Fengpu He
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Yiping Jiao
- Psychological Teaching and Research Department, Hangzhou Armed Police Officer School
| | - Kai Ma
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Zhongdong Hua
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Hao Zhang
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Jun Yan
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Keming Yang
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Kunjing Pang
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Sen Zhang
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Lei Qi
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Guanxi Wang
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Zicong Feng
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
| | - Shoujun Li
- Pediatric Cardiac Surgery Center, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College
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Abstract
PURPOSE OF REVIEW This report aims to define the clinical and anatomic variables key in determining patient suitability for transcatheter mitral valve therapies. RECENT FINDINGS Candidacy for transcatheter mitral valve repair requires weighing the clinical variables that may impact the ability to improve patient symptoms and prolong survival that include left ventricular ejection fraction, symptom severity, pulmonary hypertension, and magnitude of residual regurgitation or stenosis. Individualized selection of transcatheter repair or replacement based on patho-anatomy is being explored. The primary goal is achieving significant reduction in mitral regurgitation. Transcatheter mitral valve replacement requires rigorous anatomic screening using computed tomography and candidates should be able to take oral anticoagulation. Selection of patients for transcatheter mitral valve repair is complex and requires intimate knowledge of clinical variables and specific device limitations.
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Cho S, Kim WH, Kwak JG, Lee JR, Kim YJ. Surgical results of mitral valve repair for congenital mitral valve stenosis in paediatric patients. Interact Cardiovasc Thorac Surg 2018; 25:877-882. [PMID: 29106557 DOI: 10.1093/icvts/ivx203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 05/24/2017] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Mitral valve (MV) repairs have been performed in paediatric patients with congenital MV stenosis. However, congenital MV stenosis lesions are a heterogeneous group of lesions, and their repair remains challenging. METHODS From March 1999 to September 2014, MV repair was performed in 22 patients with congenital MV stenosis. The median age was 10.3 months (ranging from 22 days to 9.1 years), and the mean body weight was 7.9 ± 4.0 kg at the time of the operation. Multiple-level left-side heart obstructions were present in 9 (45%) patients. RESULTS The main aetiology of the mitral stenosis was a supravalvular mitral ring in 8 patients, valvular stenosis in 4 patients, a parachute deformity of the papillary muscles in 4 patients and other abnormal papillary muscles in 6 patients. The mean MV pressure gradient improved from 10.4 ± 3.9 mmHg to 3.4 ± 1.7 mmHg after MV repair (n = 18, P < 0.0001). The mean follow-up duration was 6.7 ± 5.4 years. One patient died postoperatively due to septic shock. Four patients required a second operation (2 patients for mitral stenosis, 1 patient for left ventricular outflow tract obstruction and mitral stenosis and 1 patient for mitral regurgitation). Among them, 2 patients died: 1 patient died due to cardiopulmonary bypass weaning failure and another patient died due to multiple cerebral infarcts. At the last follow-up, the mean MV pressure gradient was 4.5 ± 3.1 mmHg for all patients who did not have reoperation, and moderate or greater mitral insufficiency was detected in 3 patients. At 10 years, the survival rate was 85.9 ± 7.6%, and the freedom from reoperation rate was 77.5 ± 10.1%. In the log-rank test, MV repair in the neonate was associated with mortality (P = 0.010), and presentation of mitral insufficiency was associated with reoperation (P = 0.003). CONCLUSIONS MV repair in paediatric patients with congenital mitral stenosis showed acceptable results. The follow-up echocardiogram also revealed satisfactory results. Close follow-up is necessary to detect the development of postoperative mitral stenosis or regurgitation.
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Affiliation(s)
- Sungkyu Cho
- Department of Cardiovascular Surgery, Sejong General Hospital, Bucheon, South Korea
| | - Woong-Han Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul, South Korea
| | - Jae Gun Kwak
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul, South Korea
| | - Jeong Ryul Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul, South Korea
| | - Yong Jin Kim
- Department of Cardiovascular Surgery, Sejong General Hospital, Bucheon, South Korea
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Zanobini M, Loardi C, Poggio P, Tamborini G, Veglia F, Di Minno A, Myasoedova V, Mammana LF, Biondi R, Pepi M, Alamanni F, Saccocci M. The impact of pericardial approach and myocardial protection onto postoperative right ventricle function reduction. J Cardiothorac Surg 2018; 13:55. [PMID: 29866151 PMCID: PMC5987597 DOI: 10.1186/s13019-018-0726-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 05/09/2018] [Indexed: 11/17/2022] Open
Abstract
Background The reduction of RV function after cardiac surgery is a well-known phenomenon. It could persist up-to one year after the operation and often leads to an incomplete recovery at follow-up echocardiographic control. The aim of the present study is to analyze the impact of different modalities of pericardial incision (lateral versus anterior) and of myocardial protection protocols (Buckberg versus Custodiol) onto postoperative RV dynamic by relating two- and three-dimensional echocardiographic parameters in patients undergoing mitral valve repair through minimally invasive or traditional surgery approach. Methods We have analyzed 44 consecutive patients with severe degenerative mitral regurgitation who underwent mitral reparation with different surgical approach and cardioplegia type: Group 1 (17 pts): sternotomy with Buckberg cardioplegia protocol; Group 2 (10 pts): sternotomy with Custodiol cardioplegia; Group 3 (17 pts): mini-invasive surgery with Custodiol cardioplegia. Two-dimensional transthoracic echocardiography was performed pre- and 6 months post-surgery to evaluate RV function by tricuspid annular plane systolic excursion (TAPSE). Results All patients underwent successful and uneventful. A postoperative TAPSE reduction was found in all groups. However, mini-invasive patients experienced a significant reduced variation versus traditional surgery. Conclusions Mini-invasive mitral repair, with lateral incision of pericardium, reduces postoperative TAPSE fall, while cardioplegia protocol fails to have an impact onto longitudinal RV function. In our study, the RV seems to experience a clinically irrelevant geometrical modification too, whose entity appears to be less evident in case of lateral pericardial approach. These results could strengthen the use of minimally invasive approach also to preserve RV function.
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Affiliation(s)
- Marco Zanobini
- Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS, University of Milan, Via Parea, 4, 20138, Milan, Italy
| | - Claudia Loardi
- Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS, University of Milan, Via Parea, 4, 20138, Milan, Italy
| | - Paolo Poggio
- Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS, University of Milan, Via Parea, 4, 20138, Milan, Italy
| | - Gloria Tamborini
- Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS, University of Milan, Via Parea, 4, 20138, Milan, Italy
| | - Fabrizio Veglia
- Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS, University of Milan, Via Parea, 4, 20138, Milan, Italy
| | - Alessandro Di Minno
- Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS, University of Milan, Via Parea, 4, 20138, Milan, Italy
| | - Veronika Myasoedova
- Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS, University of Milan, Via Parea, 4, 20138, Milan, Italy
| | - Liborio Francesco Mammana
- Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS, University of Milan, Via Parea, 4, 20138, Milan, Italy
| | - Raoul Biondi
- Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS, University of Milan, Via Parea, 4, 20138, Milan, Italy
| | - Mauro Pepi
- Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS, University of Milan, Via Parea, 4, 20138, Milan, Italy
| | - Francesco Alamanni
- Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS, University of Milan, Via Parea, 4, 20138, Milan, Italy
| | - Matteo Saccocci
- Department of Cardiac Surgery, Centro Cardiologico Monzino IRCCS, University of Milan, Via Parea, 4, 20138, Milan, Italy. .,Heart Center, University Hospital of Zürich, University of Zürich, Zürich, CH, Switzerland.
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King G, Gentles TL, Winlaw DS, Cordina R, Bullock A, Grigg LE, Alphonso N, Radford DJ, Zannino D, Buratto E, d'Udekem Y. Common atrioventricular valve failure during single ventricle palliation†. Eur J Cardiothorac Surg 2018; 51:1037-1043. [PMID: 28369323 DOI: 10.1093/ejcts/ezx025] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 01/03/2017] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To determine the risk of atrioventricular valve failure (valve intervention or moderate or greater regurgitation) during the lifetime of patients with single ventricle physiology and common atrioventricular valve. METHODS Patients' data were extracted from an existing bi-national, population based registry. A retrospective review of their medical records was undertaken to determine the incidence of atrioventricular valve repair/replacement or moderate or greater regurgitation. RESULTS From a registry of 1468 Fontan survivors, 136 patients with common atrioventricular valve were identified. Complete echocardiographic follow-up was available for 114 patients. Median length of follow-up was 10.2 years (interquartile range 5-15 years). Twenty-five year survival and freedom from Fontan failure were 94% [95% confidence interval (CI), 88-100%] and 74% (95% CI, 64-87%), respectively. Twenty-eight patients underwent 24 initial repairs and 4 replacements. The 24 patients undergoing repair subsequently needed 6 re-repairs, 2 replacements and 8 had moderate or greater regurgitation at last follow-up. Four-year freedom from atrioventricular valve repair failure was 50% (95% CI, 34-75%). An additional 30 patients developed moderate or greater atrioventricular valve regurgitation (6 New York Heart Association ≥3, 10 Fontan failures, 0 deaths). Cumulative incidence of the composite endpoint of atrioventricular valve failure at 28 years was 62% (95% CI, 49-74%). CONCLUSIONS Patients with single ventricle physiology and common atrioventricular valve experience a continuous decline in valve function. The majority of patients experience valve failure in the first 30 years of life.
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Affiliation(s)
- Gregory King
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia
| | - Thomas L Gentles
- Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand
| | - David S Winlaw
- Heart Centre for Children, The Children's Hospital at Westmead, Sydney, Australia
| | - Rachel Cordina
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Andrew Bullock
- Department of Cardiology, Princess Margaret Hospital for Children, Perth, Australia
| | - Leeanne E Grigg
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
| | - Nelson Alphonso
- Queensland Paediatric Cardiac Services, Lady Cilento Children's Hospital, Brisbane, Australia
| | - Dorothy J Radford
- Adult Congenital Heart Unit, The Prince Charles Hospital, Brisbane, Australia
| | - Diana Zannino
- Heart Research, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Edward Buratto
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia.,Heart Research, Murdoch Childrens Research Institute, Melbourne, Australia.,Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, Australia
| | - Yves d'Udekem
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia.,Heart Research, Murdoch Childrens Research Institute, Melbourne, Australia.,Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, Australia
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43
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Scanlan AB, Nguyen AV, Ilina A, Lasso A, Cripe L, Jegatheeswaran A, Silvestro E, McGowan FX, Mascio CE, Fuller S, Spray TL, Cohen MS, Fichtinger G, Jolley MA. Comparison of 3D Echocardiogram-Derived 3D Printed Valve Models to Molded Models for Simulated Repair of Pediatric Atrioventricular Valves. Pediatr Cardiol 2018; 39:538-547. [PMID: 29181795 PMCID: PMC5831483 DOI: 10.1007/s00246-017-1785-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/22/2017] [Indexed: 12/20/2022]
Abstract
Mastering the technical skills required to perform pediatric cardiac valve surgery is challenging in part due to limited opportunity for practice. Transformation of 3D echocardiographic (echo) images of congenitally abnormal heart valves to realistic physical models could allow patient-specific simulation of surgical valve repair. We compared materials, processes, and costs for 3D printing and molding of patient-specific models for visualization and surgical simulation of congenitally abnormal heart valves. Pediatric atrioventricular valves (mitral, tricuspid, and common atrioventricular valve) were modeled from transthoracic 3D echo images using semi-automated methods implemented as custom modules in 3D Slicer. Valve models were then both 3D printed in soft materials and molded in silicone using 3D printed "negative" molds. Using pre-defined assessment criteria, valve models were evaluated by congenital cardiac surgeons to determine suitability for simulation. Surgeon assessment indicated that the molded valves had superior material properties for the purposes of simulation compared to directly printed valves (p < 0.01). Patient-specific, 3D echo-derived molded valves are a step toward realistic simulation of complex valve repairs but require more time and labor to create than directly printed models. Patient-specific simulation of valve repair in children using such models may be useful for surgical training and simulation of complex congenital cases.
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Affiliation(s)
- Adam B Scanlan
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Alex V Nguyen
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Anna Ilina
- Laboratory for Percutaneous Surgery, Queen's University, Kingston, ON, USA
| | - Andras Lasso
- Laboratory for Percutaneous Surgery, Queen's University, Kingston, ON, USA
| | - Linnea Cripe
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Anusha Jegatheeswaran
- Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Elizabeth Silvestro
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Francis X McGowan
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Christopher E Mascio
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Stephanie Fuller
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Thomas L Spray
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Meryl S Cohen
- Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Gabor Fichtinger
- Laboratory for Percutaneous Surgery, Queen's University, Kingston, ON, USA
| | - Matthew A Jolley
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
- Division of Pediatric Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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44
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Sughimoto K, Konstantinov IE, d'Udekem Y, Brink J, Zannino D, Brizard CP. Mid-term outcomes of congenital mitral valve surgery: Shone's syndrome is a risk factor for death and reintervention. Interact Cardiovasc Thorac Surg 2018; 25:734-739. [PMID: 29049550 DOI: 10.1093/icvts/ivx211] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 05/29/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To study the recent trends and outcomes of congenital mitral valve surgery in children. METHODS From 2008 to 2014, 84 procedures in 66 consecutive patients (41 procedures in 31 patients with mitral stenosis and 43 procedures in 35 patients with mitral regurgitation) were retrospectively evaluated. The mean age at surgery was 4.3 ± 5.4 years, and 27 patients (41%) were neonates or infants. RESULTS Seven (11%) patients died during the follow-up period of 3.2 ± 2.3 years and 5 (71%) were <1 year. Ten mitral valve replacements were performed in 8 patients, including 1 pulmonary valve homograft, 3 Contegra conduits of 12 mm thickness in the intra-annular position and 6 mechanical valves. Shone's syndrome, dysplastic valve, a need for valve replacement and age <1 year were the risk factors for death or reoperation in a univariable analysis, while in a multivariable analysis of all patients, valve replacement and age <1 year remained as risk factors. In a multivariable analysis of 27 patients aged <1 year, mitral valve dysplasia was a significant risk factor for reoperation or death. The 5-year rate of freedom from death or reoperation in neonates or infants was 55% and that in patients aged >1 year was 88% (P = 0.003). CONCLUSIONS An age of <1 year, mitral valve dysplasia and a need for mitral valve replacement were associated with a higher incidence of death or reoperation. Primary mitral valve replacement or univentricular strategy may have to be considered for symptomatic neonates with Shone's syndrome.
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Affiliation(s)
- Koichi Sughimoto
- Department of Cardiac Surgery, The Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Igor E Konstantinov
- Department of Cardiac Surgery, The Royal Children's Hospital Melbourne, Parkville, VIC, Australia.,Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Yves d'Udekem
- Department of Cardiac Surgery, The Royal Children's Hospital Melbourne, Parkville, VIC, Australia.,Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Johann Brink
- Department of Cardiac Surgery, The Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Diana Zannino
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Christian P Brizard
- Department of Cardiac Surgery, The Royal Children's Hospital Melbourne, Parkville, VIC, Australia.,Department of Paediatrics, Faculty of Medicine, The University of Melbourne, Melbourne, VIC, Australia.,Murdoch Children's Research Institute, Melbourne, VIC, Australia
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45
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Abdelgawad A, Ramadan M, Arafat H, Abdel Aziz A. Tricuspid valve repair with Dacron band versus DeVega or segmental annuloplasty. Hospital outcome and short term results. Egypt Heart J 2017; 69:241-246. [PMID: 29622984 PMCID: PMC5883503 DOI: 10.1016/j.ehj.2017.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 05/11/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The purpose of this study was to compare the hospital outcome and short term results of tricuspid valve (TV) repair with three repair techniques for functional tricuspid regurgitation (TR), namely, flexible Dacron band, DeVega and segmental annuloplasty. METHODS A total of 60 patients underwent TV repair at National Heart Institute from January 2013 to November 2014, of which 20 had DeVega procedure (DV), 20 had a segmental annuloplasty (SA) procedure and 20 had a Dacron band (DB) procedure. Concomitant procedures done for rheumatic left sided valve pathology consisted of mitral valve replacement in 70% of patients, and double valve replacement in 30% of patients. Clinical and echocardiographic follow-up data were obtained. Follow-up was 100% complete and was concluded after one year. RESULTS All demographic criteria and preoperative characteristics of the three studied groups were comparable except for preoperative right ventricular (RVEDD) size that was significantly bigger in Dacron band group as compared to the other two groups (3.18 ± 0.43 cm compared to 3.00 ± 0.33 cm (DV) and to 2.88 ± 0.35 cm (SA), p value of (0.045)). Similarly, all operative and postoperative criteria were comparable among the study groups. Noticeably, (RVEDD) size remodeled better postoperatively in (DB) group as compared to the other two groups, (2.54 ± 0.26 cm compared to 2.83 ± 0.311 cm (DV) and to 2.72 ± 0.29 cm (SA), mean difference values were group (0.64 ± 0.47 cm) for (DB) compared to (0.18 ± 0.29 cm) for (DV) or to (0.16 ± 0.45 cm) for (SA) with p value of 0.000. The majority of patients in each group did not have tricuspid regurgitation (TR) or mild degree (+1) of (TR) on discharge. After one year of follow-up, most of the patient had either no regurgitation or grade (+1 TR). Two patients (10%) in DV group and one patient (5%) in SA group had (+3 TR). There was no statistical significance in the incidence of hospital mortality, only one patient died in DB and one in DV group (5%) and no death happened after hospital mortality for the three groups after one year. CONCLUSIONS The three techniques are options to repair the tricuspid valve, however, placement of Dacron band in patients undergoing tricuspid valve repair is associated with better RV remodelling, and hence, a probable better right ventricular performance and better outcome of repair is expected. A higher number of patients are needed with longer follow up period to appreciate the effect on survival and rate of freedom from tricuspid regurgitation and re-intervention.
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Affiliation(s)
| | - Mona Ramadan
- Anesthesia Department, National Heart Institute, Egypt
| | - Heba Arafat
- Anesthesia Department, Nasser Institute, Egypt
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46
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Compton F, Wahed A, Gregoric I, Kar B, Dasgupta A, Tint H. Can Tranexamic Acid Reduce Blood Loss during Major Cardiac Surgery? A Pilot Study. Ann Clin Lab Sci 2017; 47:600-603. [PMID: 29066488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We examined the effectiveness of tranexamic acid in preventing intraoperative blood loss during major cardiac surgery. Out of initial 81 patients undergoing major cardiac surgery (both coronary artery bypass and valve repair procedures) at our teaching hospital, sixty-seven patients were selected for this study. We compared estimated blood loss, decrease in percent hemoglobin and hematocrit following surgery between two groups of patients (none of them received any blood product during surgery), one group receiving no tranexamic acid (n=17) and another group receiving tranexamic acid (n=25). In the second study, we combined these patients with patients receiving modest amounts of blood products (1-2 unit) and compared these parameters between two groups of patients (25 patients received no tranexamic acid, 42 patients received tranexamic acid). In patients who received no blood product during surgery, those who received no tranexamic acid showed statistically significant (independent t-test two tailed at p<0.05) reduced estimated blood loss (mean: 713.5 mL, SD: 351.6, n=17) compared to those who received tranexamic acid (mean: 987.2 mL, SD: 459.9, n=25). We observed similar results when the patients receiving no blood products and patients receiving modest amount of blood products were combined based on the use of tranexamic acid or not. No statistically significant difference was observed in percent reduced hemoglobin or hematocrit following surgery in any group of patients. We conclude that intraoperative antifibrinolytic therapy with tranexamic acid does not reduce intraoperative blood loss during major cardiac surgery which contradicts popular belief.
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Affiliation(s)
- Frances Compton
- Department of Pathology and Laboratory Medicine, The University of Texas McGovern Medical School at Houston, Houston, TX, USA
| | - Amer Wahed
- Department of Pathology and Laboratory Medicine, The University of Texas McGovern Medical School at Houston, Houston, TX, USA
| | - Igor Gregoric
- Department of Surgery, The University of Texas McGovern Medical School at Houston, Houston, TX, USA
| | - Biswajit Kar
- Department of Medicine, The University of Texas McGovern Medical School at Houston, Houston, TX, USA
| | - Amitava Dasgupta
- Department of Pathology and Laboratory Medicine, The University of Texas McGovern Medical School at Houston, Houston, TX, USA
| | - Hlaing Tint
- Department of Pathology and Laboratory Medicine, The University of Texas McGovern Medical School at Houston, Houston, TX, USA
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47
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Tasoglu I, Avci T, Collaku A, Paç M. The problematic of polytetrafluoroethylene membranes for valvular repair. Eur J Cardiothorac Surg 2017; 51:805. [PMID: 28040675 DOI: 10.1093/ejcts/ezw396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 10/19/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Irfan Tasoglu
- Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Germany
| | - Tugba Avci
- Department of Toxicology, Veterinary Control Institute, Konya, Turkey
| | - Ardit Collaku
- GlaxoSmithKline Consumer, Healthcare, Parsippany, NJ, USA
| | - Mustafa Paç
- Department of Immunology, The Children's Memorial Health Institute, Warsaw, Poland
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48
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Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener HC, Heidbuchel H, Hendriks J, Hindricks G, Manolis AS, Oldgren J, Popescu BA, Schotten U, Van Putte B, Vardas P. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 2016; 37:2893-2962. [PMID: 27567408 DOI: 10.1093/eurheartj/ehw210] [Citation(s) in RCA: 4664] [Impact Index Per Article: 583.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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49
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Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener HC, Heidbuchel H, Hendriks J, Hindricks G, Manolis AS, Oldgren J, Popescu BA, Schotten U, Van Putte B, Vardas P, Agewall S, Camm J, Baron Esquivias G, Budts W, Carerj S, Casselman F, Coca A, De Caterina R, Deftereos S, Dobrev D, Ferro JM, Filippatos G, Fitzsimons D, Gorenek B, Guenoun M, Hohnloser SH, Kolh P, Lip GYH, Manolis A, McMurray J, Ponikowski P, Rosenhek R, Ruschitzka F, Savelieva I, Sharma S, Suwalski P, Tamargo JL, Taylor CJ, Van Gelder IC, Voors AA, Windecker S, Zamorano JL, Zeppenfeld K. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace 2016; 18:1609-1678. [PMID: 27567465 DOI: 10.1093/europace/euw295] [Citation(s) in RCA: 1305] [Impact Index Per Article: 163.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Stefan Agewall
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - John Camm
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Gonzalo Baron Esquivias
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Werner Budts
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Scipione Carerj
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Filip Casselman
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Antonio Coca
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Raffaele De Caterina
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Spiridon Deftereos
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Dobromir Dobrev
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - José M Ferro
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Gerasimos Filippatos
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Donna Fitzsimons
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Bulent Gorenek
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Maxine Guenoun
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Stefan H Hohnloser
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Philippe Kolh
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Gregory Y H Lip
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Athanasios Manolis
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - John McMurray
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Piotr Ponikowski
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Raphael Rosenhek
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Frank Ruschitzka
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Irina Savelieva
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Sanjay Sharma
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Piotr Suwalski
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Juan Luis Tamargo
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Clare J Taylor
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Isabelle C Van Gelder
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Adriaan A Voors
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Stephan Windecker
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Jose Luis Zamorano
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
| | - Katja Zeppenfeld
- The disclosure forms of all experts involved in the development of these guidelines are available on the ESC website http://www.escardio.org/guidelines
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50
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Bassin L, Weiss B, Cranney G, Gimpel D, Gilhooly P, Smith R, Akhunji Z, Grant P, Wolfenden H. Operative Outcomes with Myxomatous Mitral Valve Repair: Experience with 586 Patients. Heart Lung Circ 2016; 25:870-3. [PMID: 27131928 DOI: 10.1016/j.hlc.2016.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 02/05/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION American Heart Association (AHA) guidelines recommend mitral valve repair for myxomatous mitral regurgitation whenever possible to prevent LV dysfunction and early mortality. Here we review our early operative outcomes with mitral valve repair for myxomatous mitral regurgitation. METHODS We collected data from 586 consecutive patients that underwent mitral repair for myxomatous disease at the Prince Henry and Prince of Wales Hospitals Sydney between 1997 and 2012. All patients had pre- and postoperative transthoracic echocardiograms. RESULTS In the first 30 days postoperatively there were five deaths (0.9%), four strokes (0.7%) and five transient ischaemic attacks (TIAs) (0.9%). Repair involved resection in 55.5%, neochordal reconstruction in 41.6%, and in 2.9% a combination of both. There was increasing use of neochordae since 2006. At discharge 99% had mitral regurgitation (MR) ≤ mild and ≤ trivial in 79.5%. For posterior leaflet disease neochordae had improved MR at discharge compared with resection (85% vs 78%, P<0.05). Preoperative triscupid regurgitation (TR) and pulmonary hypertension > mild were associated with a greater degree of MR at discharge (P<0.05) for reasons that are unclear. CONCLUSION We have shown excellent early results for mitral repair with very low operative mortality and excellent freedom from significant MR. Successful mitral repairs with low morbidity have resulted in a pattern of early referral in keeping with the current guidelines.
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Affiliation(s)
- L Bassin
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - B Weiss
- Department of Cardiothoracic Surgery, The Prince of Wales Hospital, Sydney, NSW, Australia; School of Medicine, University of Notre Dame Sydney, Sydney, NSW, Australia
| | - G Cranney
- Department of Cardiology, The Prince of Wales Hospital, Sydney, NSW, Australia
| | - D Gimpel
- School of Medicine, University of Notre Dame Sydney, Sydney, NSW, Australia
| | - P Gilhooly
- School of Medicine, University of Notre Dame Sydney, Sydney, NSW, Australia
| | - R Smith
- School of Medicine, University of Notre Dame Sydney, Sydney, NSW, Australia
| | - Z Akhunji
- Department of Cardiothoracic Surgery, The Prince of Wales Hospital, Sydney, NSW, Australia
| | - P Grant
- Department of Cardiothoracic Surgery, The Prince of Wales Hospital, Sydney, NSW, Australia
| | - H Wolfenden
- Department of Cardiothoracic Surgery, The Prince of Wales Hospital, Sydney, NSW, Australia
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