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Kuwahara H, Imamura T, Sobajima M, Ueno H, Kinugawa K. Regulation and Clinical Implication of Arginine Vasopressin in Patients with Severe Aortic Stenosis Referred to Trans-Catheter Aortic Valve Implantation. ACTA ACUST UNITED AC 2020; 56:medicina56040165. [PMID: 32268535 PMCID: PMC7230582 DOI: 10.3390/medicina56040165] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/03/2020] [Accepted: 04/03/2020] [Indexed: 12/28/2022]
Abstract
Background and objectives: Plasma arginine vasopressin (P-AVP) is regulated by the non-osmotic pathway in patients with heart failure (HF) and reduced ejection fraction. However, the regulation of P-AVP in patients with severe aortic stenosis (AS) remains unknown. Materials and Methods: Consecutive patients with severe AS who received trans-catheter aortic valve implantation (TAVI) between Apr 2016 and Apr 2019 were enrolled in this prospective study. Clinical data including P-AVP were obtained just before TAVI, and the correlation between P-AVP and other variables was investigated. Results: In total, 159 patients with severe AS (85.3 ± 4.6 years, male 26%) were enrolled. P-AVP was 1.45 ± 1.13 ng/mL and cardiac index was relatively preserved (2.76 ± 0.54 L/min/m2). There was no significant correlation between cardiac index and P-AVP (p > 0.05), whereas plasma osmolality had a moderate positive correlation with P-AVP (r = 0.35, p < 0.01), predominantly due to blood urea nitrogen (r = 0.27, p < 0.01). Patients with diuretics had significantly higher P-AVP than those without diuretics (1.65 ± 1.43 vs. 1.22 ± 0.57 pg/mL, p < 0.01). Two-year survivals free from HF readmission were statistically comparable irrespective of the level of pre-procedural P-AVP (p = 0.44). Conclusion: In patients with severe high-gradient AS who received TAVI, the P-AVP level was dominantly regulated by plasma osmolality instead of arterial underfilling. The clinical implication of elevated P-AVP in the TAVI candidates is the next concern.
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Abdollahi F, Lotfi-Tokaldany M, Jalali A, Ashrafi MM, Mohagheghi A, Sadeghian A, Sadeghian H. Effect of Tricuspid Valve Repair in Patients with Moderate Tricuspid Regurgitation undergoing Left-Sided Valve Surgery. Arch Iran Med 2019; 22:560-565. [PMID: 31679357] [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] [Received: 12/28/2018] [Accepted: 05/12/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The benefits of tricuspid valve (TV) repair in patients with moderate tricuspid regurgitation (TR) during left-sided valve surgery are under debate. We investigated independent predictors for reduction in TR severity following left-sided valve surgery in patients with moderate TR. METHODS In this study, we included 106 patients (male: 33%) with a mean age of 4.23 ± 12.61 years who had moderate TR and underwent mitral or aortic valve surgery between March 2012 and November 2016. Concomitant tricuspid annuloplasty was done for one group of patients based on surgeon's decision. Transthoracic echocardiography was done before and at a median followup of 4.71 months for all patients. The patients were divided into improved and unimproved TR groups, with the term "improved" signifying a reduction of at least one grade in TR severity. RESULTS Tricuspid annuloplasty was performed on 65 (61.3%) patients. TR improvement was observed in 87.7% of patients in the TV repair group and 56.1% of patients in the no-TV repair group, indicating a significant difference (P < 0.001). Tricuspid annulus diameter was not significantly different between the two groups (32.41 ± 4.68 mm in no-TV repair group and 33.87 ± 4.34 mm in TV repair group, P = 0.128). At follow-up with echocardiography, 80 (75.5%) patients were placed in the improved group and the majority of patients (71.3% vs. 30.8%; P < 0.001) underwent tricuspid repair in the improved group. TV annuloplasty was correlated with reduced TR severity following left-sided valve surgery (odds ratio [OR]: 5.19, 95% CI: 1.70-15.85, P < 0.001). TR changed from moderate to severe in 17 (17.1%) patients with no concomitant tricuspid repair, while only one patient (1.5%) with tricuspid repair showed an increased TR severity. CONCLUSION Tricuspid annuloplasty may be useful in patients who have moderate TR undergoing left-sided valve surgery regardless of the tricuspid annulus diameter, and it can play an effective role in the improvement of TR at mid-term follow-up.
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Affiliation(s)
- Fahime Abdollahi
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Arash Jalali
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Moein Ashrafi
- Young Researchers and Elites Club, Faculty of Medicine, Islamic Azad University, Yazd Branch, Yazd, Iran
| | - Abbas Mohagheghi
- Echocardiography Department, Dr. Shariati Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Afsaneh Sadeghian
- Bahar Hospital, Shahrood University of Medical Science, Shahrood, Iran
| | - Hakimeh Sadeghian
- Echocardiography Department, Dr. Shariati Hospital, Tehran University of Medical Science, Tehran, Iran
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Aldalati O, Kaura A, Khan H, Dworakowski R, Byrne J, Eskandari M, Deshpande R, Monaghan M, Wendler O, MacCarthy P. Bioprosthetic structural valve deterioration: How do TAVR and SAVR prostheses compare? Int J Cardiol 2019; 268:170-175. [PMID: 30041783 DOI: 10.1016/j.ijcard.2018.04.091] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 08/16/2017] [Revised: 03/31/2018] [Accepted: 04/20/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND The durability of TAVR prostheses has come under major scrutiny since the move towards lower risk patients. We sought to compare the rate of structural valve deterioration (SVD) over time between transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). METHODS We included all TAVR and SAVR patients (age ≥ 75 years) that were performed in our centre from 2005 until 2015. Applying the internationally "agreed on" definitions of SVD, we surveyed all available serial echocardiographic follow-ups. RESULTS We included 269 TAVR and 174 SAVR cases. Post-intervention, TAVR patients had lower mean and peak gradients but higher rate of mild aortic regurgitation. SAVR patients had longer follow-up (in months, SAVR: 53 (30, 85) Vs TAVR: 33.4 (23, 52)). SVD as per Valve Academic Research Consortium-2 (VARC-2) was similar between the two groups (TAVR 28% Vs SAVR 31%; P = 0.593) but moderate haemodynamic SVD (European Association of Percutaneous Cardiovascular Intervention (EAPCI) criteria) was more common among SAVR cases (TAVR 11.5% Vs SAVR 20.7%; P = 0.007). Using Kaplan-Meier estimates, the rate of SVD over time was not different between the two groups as per VARC-2 criteria but different when moderate haemodynamic SVD criteria were applied (Log Rank P = 0.022) in favour of TAVR. The mean gradient rose steadily over time but more so post-SAVR (β = 0.52 ± 0.24 in comparison to TAVR at every given time point; P = 0.032). CONCLUSION Structural valve deterioration is common on long-term follow-up post-TAVR. The rate is similar to post-SAVR cases according to VARC-2 criteria but less according to the moderate haemodynamic SVD criteria.
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Affiliation(s)
- Omar Aldalati
- Department of Cardiology, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
| | - Amit Kaura
- Department of Cardiology, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
| | - Habib Khan
- Department of Cardiology, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
| | - Rafal Dworakowski
- Department of Cardiology, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
| | - Jonathan Byrne
- Department of Cardiology, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
| | - Mehdi Eskandari
- Department of Cardiology, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
| | - Ranjit Deshpande
- Department of Cardiology, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
| | - Mark Monaghan
- Department of Cardiology, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
| | - Olaf Wendler
- Department of Cardiology, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
| | - Philip MacCarthy
- Department of Cardiology, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom.
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Kamiya H, Kitahara H, Kanda H, Ise H, Nakanishi S, Ishikawa N, Kunisawa T, Minol JP, Lichtenberg A, Akhyari P. Transfer of a minimally invasive mitral valve repair program from a high-volume center to a very low volume center: how many cases are necessary to maintain acceptable results? Gen Thorac Cardiovasc Surg 2019; 67:577-584. [PMID: 30659508 DOI: 10.1007/s11748-019-01065-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 04/25/2018] [Accepted: 01/07/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate whether minimally invasive mitral valve repair (MIMVR) can be transferred from a high-volume center into a very small volume center and to clarify how many cases are necessary for maintenance of this program, early outcomes of MIMVR in Asahikawa Medical University were compared with those results in patients operated by a single surgeon in Duesseldorf University Hospital. METHODS Sixty-five patients who underwent MIMVR in Asahikawa Medical University (group A) between May 2014 and July 2018 and 134 patients who underwent MIMVR in Duesseldorf University Hospital (group D) between September 2009 and January 2014 by a surgeon who started MIMVS later in Asahikawa were retrospectively analyzed. RESULTS In group D, there were more patients with ischemic mitral valve regurgitation and with annular calcification than in group A. Survival rate at 6 months and 1 year was 98.5% and 98.5% in group A and 92.9% and 91.3% in group D, respectively. EuroSCORE II was significantly higher in patients dead within 30 days and within the first year. CONCLUSIONS The present study demonstrated that MIMVR programs can be transferred with acceptable early results into very low volume centers, if the team is developed by surgeons who are well trained and experienced in MIMVR. Moreover, the present study suggested that case number for maintenance of acceptable results may be obviously less than the previous recognition that this kind of specialized surgery could be maintained with at least 50 cases annually. However, meticulous preparations for surgery are essential for satisfactory surgical outcomes.
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Affiliation(s)
- Hiroyuki Kamiya
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa, 078-8510, Japan.
| | - Hiroto Kitahara
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa, 078-8510, Japan
| | - Hirotsugu Kanda
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa, 078-8510, Japan
| | - Hayato Ise
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa, 078-8510, Japan
| | - Sentaro Nakanishi
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa, 078-8510, Japan
| | - Natsuya Ishikawa
- Department of Cardiac Surgery, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa, 078-8510, Japan
| | - Takayuki Kunisawa
- Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Midorigaoka Higashi 2-1-1-1, Asahikawa, 078-8510, Japan
| | - Jan-Philipp Minol
- Department of Cardiovascular Surgery, Duesseldorf University, Moorenstrasse 5, 40225, Duesseldorf, Germany
| | - Artur Lichtenberg
- Department of Cardiovascular Surgery, Duesseldorf University, Moorenstrasse 5, 40225, Duesseldorf, Germany
| | - Payam Akhyari
- Department of Cardiovascular Surgery, Duesseldorf University, Moorenstrasse 5, 40225, Duesseldorf, Germany
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Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Rodriguez Muñoz D, Rosenhek R, Sjögren J, Tornos Mas P, Vahanian A, Walther T, Wendler O, Windecker S, Zamorano JL. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 2017; 38:2739-2791. [PMID: 28886619 DOI: 10.1093/eurheartj/ehx391] [Citation(s) in RCA: 4170] [Impact Index Per Article: 595.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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6
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Silaschi M, Barr J, Chaubey S, Nicou N, Srirajaskanthan R, Byrne J, Ramage J, MacCarthy P, Wendler O. Optimized Outcomes Using a Standardized Approach for the Treatment of Patients with Carcinoid Heart Disease. Neuroendocrinology 2017; 104:257-263. [PMID: 27097025 DOI: 10.1159/000446213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 04/12/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Carcinoid heart disease (CHD) is common in patients with carcinoid syndrome (CS). Surgical treatment improves the poor prognosis of CHD, although the reported peri-operative mortality is high (∼17%). We attempted to improve outcomes by implementation of a protocol for the management of patients with CHD at a UK Neuroendocrine Centre of Excellence and report our experience. METHODS All patients treated for CHD between 2008 and 2015 were included. Peri-operative treatment included surgical features such as invasive pulmonary valve (PV) inspection and preservation of the tricuspid subvalvular apparatus. RESULTS A total of 11 patients were treated; the median age was 63 years (IQR: 56-70). Ten patients underwent both pulmonary valve replacement (PVR) and tricuspid valve replacement (TVR); 1 patient underwent isolated TVR. One patient had additional aortic valve replacement (AVR), another one coronary artery bypass grafting. Bioprostheses (BP) were used in all patients, stented for TVR and AVR, stentless for PVR. Invasive PV inspection caused unplanned PVR in 3 cases (27.3%). All patients were discharged home. One patient (9.1%), who had had previous TVR by another surgeon, had right heart failure (RHF) during follow-up. One death occurred due to progression of CS (day 346). The carcinoids' primary was resected in 5 patients (45.5%) 10 months (4.5-19.5) after cardiac surgery. CONCLUSION Excellent results were achieved in patients with CHD. PV stenosis can be underestimated by echocardiography; therefore, intraoperative inspection is recommended. Right ventricular geometry should be respected to prevent RHF. BP should be used, as these patients are likely to undergo future non-cardiac surgeries.
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Affiliation(s)
- Miriam Silaschi
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
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Abstract
We aimed to evaluate whether blood conservation strategies including intraoperative autologous donation (IAD) could reduce perioperative blood transfusion for patients undergoing cardiac valve replacement including mitral valve replacement, aortic valve replacement (AVR), and double valve replacement (DVR).A total of 726 patients were studied over a 3-year period (2011-2013) after the implementation of IAD and were compared with 919 patients during the previous 36-month period (January 2008-December 2010). The method of small-volume retrograde autologous priming, strict blood transfusion standard together with IAD constituted a progressive blood-saving strategy.Baseline characteristics and preoperative information showed no statistically significant difference between IAD group and non-IAD group. Most of the postoperative morbidities are statistically the same in the 2 groups. Chest tube output (415.2 vs 1029.8 mL, P < 0.001) and postoperative respiratory failure (5.9% vs 8.6%, P = 0.039) favored the IAD group, whereas hematocrit levels were more favorable in the non-IAD group (30.3% vs 33.0% at the end of the operation, P < 0.001; 30.4% vs 31.5% at the time of discharge). The use of blood product transfusion was higher in the non-IAD group (22.6% vs 43.3%, P < 0.001). Binary multivariate logistic regression analysis showed that high age, non-IAD, DVR surgery, and absent smoking history are associated with a higher risk of intra-/postoperative blood transfusion.Blood conservation is effective and safe in cardiac valve replacement surgeries. The use of intraoperative autologous donation can lead to improved outcomes including a significantly lower rate of intra-/postoperative blood transfusion and postoperative complications.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Haige Zhao
- Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
- Correspondence: Haige Zhao, Department of Cardiothoracic Surgery, The First Affiliated Hospital of Zhejiang University, 79 Qingchun Road, 310003 Hangzhou, China (e-mail: )
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8
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Borg H. [Valve surgery and prestige]. Lakartidningen 2016; 113:DXUZ. [PMID: 26928692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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9
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Tornvall P, Rexius H, Vasko P. [Percutaneous aortic valve implantation requires access to thoracic surgery]. Lakartidningen 2016; 113:DUHI. [PMID: 26785270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Per Tornvall
- Institutionen för klinisk forskning och utbildning, Södersjukhuset - Stockholm, Sweden - Stockholm, Sweden
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Taniguchi T, Morimoto T, Shiomi H, Ando K, Kanamori N, Murata K, Kitai T, Kawase Y, Izumi C, Miyake M, Mitsuoka H, Kato M, Hirano Y, Matsuda S, Nagao K, Inada T, Murakami T, Takeuchi Y, Yamane K, Toyofuku M, Ishii M, Minamino-Muta E, Kato T, Inoko M, Ikeda T, Komasa A, Ishii K, Hotta K, Higashitani N, Kato Y, Inuzuka Y, Maeda C, Jinnai T, Morikami Y, Sakata R, Kimura T. Initial Surgical Versus Conservative Strategies in Patients With Asymptomatic Severe Aortic Stenosis. J Am Coll Cardiol 2015; 66:2827-2838. [PMID: 26477634 DOI: 10.1016/j.jacc.2015.10.001] [Citation(s) in RCA: 215] [Impact Index Per Article: 23.9] [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: 08/26/2015] [Revised: 10/02/2015] [Accepted: 10/02/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Current guidelines generally recommend watchful waiting until symptoms emerge for aortic valve replacement (AVR) in asymptomatic patients with severe aortic stenosis (AS). OBJECTIVES The study sought to compare the long-term outcomes of initial AVR versus conservative strategies following the diagnosis of asymptomatic severe AS. METHODS We used data from a large multicenter registry enrolling 3,815 consecutive patients with severe AS (peak aortic jet velocity >4.0 m/s, or mean aortic pressure gradient >40 mm Hg, or aortic valve area <1.0 cm(2)) between January 2003 and December 2011. Among 1,808 asymptomatic patients, the initial AVR and conservative strategies were chosen in 291 patients, and 1,517 patients, respectively. Median follow-up was 1,361 days with 90% follow-up rate at 2 years. The propensity score-matched cohort of 582 patients (n = 291 in each group) was developed as the main analysis set for the current report. RESULTS Baseline characteristics of the propensity score-matched cohort were largely comparable, except for the slightly younger age and the greater AS severity in the initial AVR group. In the conservative group, AVR was performed in 41% of patients during follow-up. The cumulative 5-year incidences of all-cause death and heart failure hospitalization were significantly lower in the initial AVR group than in the conservative group (15.4% vs. 26.4%, p = 0.009; 3.8% vs. 19.9%, p < 0.001, respectively). CONCLUSIONS The long-term outcome of asymptomatic patients with severe AS was dismal when managed conservatively in this real-world analysis and might be substantially improved by an initial AVR strategy. (Contemporary Outcomes After Surgery and Medical Treatment in Patients With Severe Aortic Stenosis Registry; UMIN000012140).
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Affiliation(s)
- Tomohiko Taniguchi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
| | - Norio Kanamori
- Division of Cardiology, Shimada Municipal Hospital, Shimada, Japan
| | - Koichiro Murata
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yuichi Kawase
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Chisato Izumi
- Department of Cardiology, Tenri Hospital, Tenri, Japan
| | - Makoto Miyake
- Department of Cardiology, Tenri Hospital, Tenri, Japan
| | - Hirokazu Mitsuoka
- Division of Cardiology, Nara Hospital, Kinki University Faculty of Medicine, Ikoma, Japan
| | - Masashi Kato
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Yutaka Hirano
- Department of Cardiology, Kinki University Hospital, Osakasayama, Japan
| | - Shintaro Matsuda
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazuya Nagao
- Department of Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
| | - Tsukasa Inada
- Department of Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
| | | | - Yasuyo Takeuchi
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | | | - Mamoru Toyofuku
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Mitsuru Ishii
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Eri Minamino-Muta
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takao Kato
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Moriaki Inoko
- Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Tomoyuki Ikeda
- Department of Cardiology, Hikone Municipal Hospital, Hikone, Japan
| | - Akihiro Komasa
- Department of Cardiology, Kansai Electric Power Hospital, Osaka, Japan
| | - Katsuhisa Ishii
- Department of Cardiology, Kansai Electric Power Hospital, Osaka, Japan
| | - Kozo Hotta
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | | | - Yoshihiro Kato
- Department of Cardiology, Saiseikai Noe Hospital, Osaka, Japan
| | - Yasutaka Inuzuka
- Department of Cardiology, Shiga Medical Center for Adults, Moriyama, Japan
| | - Chiyo Maeda
- Department of Cardiology, Hamamatsu Rosai Hospital, Hamamatsu, Japan
| | - Toshikazu Jinnai
- Department of Cardiology, Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Yuko Morikami
- Department of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan
| | - Ryuzo Sakata
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
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Kasel AM, Shivaraju A, Schneider S, Krapf S, Oertel F, Burgdorf C, Ott I, Sumer C, Kastrati A, von Scheidt W, Thilo C. Standardized methodology for transfemoral transcatheter aortic valve replacement with the Edwards Sapien XT valve under fluoroscopy guidance. J Invasive Cardiol 2014; 26:451-461. [PMID: 25198489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To provide a simplified, standardized methodology for a successful transfemoral transcatheter aortic valve replacement (TAVR) procedure with the Sapien XT valve in patients with severe aortic stenosis (AS). BACKGROUND TAVR is currently reserved for patients with severe, symptomatic AS who are inoperable or at high operative risk. In many institutions, TAVR is performed under general anesthesia with intubation or with conscious sedation. In addition, many institutions still use transesophageal echo (TEE) during the procedure for aortic root angulations and positioning of the valve prior to implantation. Methods. We enrolled 100 consecutive patients (mean age, 80 ± 7 years; range, 50-94 years; female n=59) with severe symptomatic AS. Annulus measurements were based on computed tomography angiograms. All patients underwent fluoroscopy-guided transfemoral TAVR with little to no sedation and without simultaneous TEE. RESULTS TAVR was predominantly performed with the use of local and central analgesics; only 36% of our cohort received conscious sedation. Procedural success of TAVR was 99%. Transthoracic echocardiography before discharge excluded aortic regurgitation (AR) >2 in all patients (AR >1; n=6). In-hospital stroke rate was 6%. The vessel closure system was successfully employed in 96%. Major vascular complication rate was 1%. The 30-day mortality was 2%. CONCLUSIONS Fluoroscopy-guided TAVR with the use of just analgesics with or without conscious sedation is safe and effective, and this potentially enables a more time-effective and cost-effective procedure. This paper provides simplified, stepwise guidance on how to perform transfemoral TAVR with the Sapien XT valve.
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Affiliation(s)
- Albert M Kasel
- Department of Cardiovascular Disease, Deutsches Herzzentrum München, Lazarettstraße 36, 80636 Munich, Germany.
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12
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Grunkemeier GL, Wu Y, Wang L, Hamilton C. Bayesian stopping guidelines for heart valve premarket approval studies. J Thorac Cardiovasc Surg 2014; 148:2813-7.e1. [PMID: 25135236 DOI: 10.1016/j.jtcvs.2014.06.085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 06/13/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The Data Monitoring Committee (DMC) for the premarket approval (PMA) study of a new heart valve prosthesis convenes periodically to review the accumulating results of the study, and determines, among other things, whether there is enough concern with safety to stop the study. Their deliberations are largely subjective, based on their combined experience and expertise, but an objective aid to evaluating complication rates, usually called a stopping rule, is desirable. METHODS The US Food and Drug Administration has designated objective performance criteria (OPC) for 7 heart valve complications. At the end of the PMA study, when approximately 800 patient-years have been accumulated, the complication rates must compare favorably with the OPC. Given the results to date at an interim review of the data, we use a Bayesian approach to compute the probability of passing the OPC test by the end of study. RESULTS We provide a method that the DMC can use to predict the probability of passing the OPC test for each complication, and a graphical aid for each number of events, observed at 100 patient-year intervals. CONCLUSIONS Although the DMC ultimately uses combined experience and expertise to make the decision to stop a PMA valve study, we have provided an objective assessment of the probability of the valve ultimately passing the OPC test to aid in making that decision.
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Affiliation(s)
- Gary L Grunkemeier
- Medical Data Research Center, Providence Health & Services, Portland, Ore
| | - YingXing Wu
- Medical Data Research Center, Providence Health & Services, Portland, Ore.
| | - Lian Wang
- Medical Data Research Center, Providence Health & Services, Portland, Ore
| | - Cody Hamilton
- Department of Global Clinical Operations, Edwards Lifesciences, Irvine, Calif
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Mascherbauer J. The 2014 AHA/ACC valve disease guideline: new stages of disease, new treatment options, and a call for earlier intervention. Wien Klin Wochenschr 2014; 126:458-9. [PMID: 25123144 DOI: 10.1007/s00508-014-0579-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Julia Mascherbauer
- Universitätsklinik für Innere Medizin II, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Vienna, Austria,
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Grinberg M. Valvular heart team. Arq Bras Cardiol 2014; 103:e15-7. [PMID: 25120089 PMCID: PMC4126767 DOI: 10.5935/abc.20140099] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 03/14/2014] [Accepted: 03/14/2014] [Indexed: 11/20/2022] Open
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Tommaso CL, Fullerton DA, Feldman T, Dean LS, Hijazi ZM, Horlick E, Weiner BH, Zahn E, Cigarroa JE, Ruiz CE, Bavaria J, Mack MJ, Cameron DE, Bolman RM, Miller DC, Moon MR, Mukherjee D, Trento A, Aldea GS, Bacha EA. SCAI/AATS/ACC/STS operator and institutional requirements for transcatheter valve repair and replacement: Part II. Mitral valve. Ann Thorac Surg 2014; 98:765-77. [PMID: 24835557 DOI: 10.1016/j.athoracsur.2014.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 05/07/2014] [Accepted: 05/08/2014] [Indexed: 01/22/2023]
Affiliation(s)
- Carl L Tommaso
- Cardiac Cath Lab, North Shore Cardiologists, North Shore University Health System, Skokie, Illinois.
| | - David A Fullerton
- Cardiothoracic Surgery, University of Colorado Denver, Aurora, Colorado
| | - Ted Feldman
- Cardiac Catheterization Laboratory, Evanston Hospital, Evanston, Illinois; Cardiology Division, Evanston Hospital, Evanston, Illinois
| | - Larry S Dean
- University of Washington School of Medicine, Seattle, Washington; UW Medicine Regional Heart Center, Seattle, Washington
| | - Ziyad M Hijazi
- Rush Center for Congenital & Structural Heart Disease, Chicago, Illinois; Pediatric Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Eric Horlick
- Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | - Bonnie H Weiner
- Saint Vincent Hospital at Worcester Medical Center/Fallon Clinic, Worcester, Massachusetts; Boston Biomedical Associates, Northborough, Massachusetts
| | - Evan Zahn
- Cedars-Sinai Medical Center, Los Angeles, California
| | - Joaquin E Cigarroa
- Department of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Carlos E Ruiz
- Lenox Hill Heart and Vascular Institute of New York, New York, New York
| | - Joseph Bavaria
- Division of Cardiothoracic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael J Mack
- Cardiovascular Council Dallas, Heart Hospital Baylor Plano, Plano, Texas
| | - Duke E Cameron
- The Dana and Albert "Cubby" Broccoli Center for Aortic Diseases, The Johns Hopkins Hospital, Baltimore, Maryland
| | - R Morton Bolman
- Division of Cardiac Surgery, Harvard Medical School, Boston, Massachusetts
| | - D Craig Miller
- Cardiovascular Surgical Physiology Research Laboratories, Stanford University Medical Center, Stanford, California; Cardiovascular Surgery, Falk CV Research Center, Stanford, California
| | - Marc R Moon
- Division of Cardiothoracic Surgery, Washington University, St. Louis, Missouri
| | | | - Alfredo Trento
- Division of Cardiothoracic Surgery, Cedar Sinai Medical Center, Los Angeles, California
| | - Gabriel S Aldea
- Regional Heart Center, University of Washington Medical Center, Seattle, Washington
| | - Emile A Bacha
- Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian/Columbia University Medical Center, New York, New York; Pediatric Cardiac Surgery, Morgan Stanley Children's Hospital of New York, New York, New York
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Durand E, Blanchard D, Chassaing S, Gilard M, Laskar M, Borz B, Lafont A, Barbey C, Godin M, Tron C, Zegdi R, Chatel D, Le Page O, Litzler PY, Bessou JP, Danchin N, Cribier A, Eltchaninoff H. Comparison of two antiplatelet therapy strategies in patients undergoing transcatheter aortic valve implantation. Am J Cardiol 2014; 113:355-60. [PMID: 24169016 DOI: 10.1016/j.amjcard.2013.09.033] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 09/27/2013] [Accepted: 09/27/2013] [Indexed: 11/15/2022]
Abstract
Dual antiplatelet therapy is commonly used in patients undergoing transcatheter aortic valve implantation (TAVI), but the optimal antiplatelet regimen is uncertain and remains to be determined. The objective of this study was to compare 2 strategies of antiplatelet therapy in patients undergoing TAVI. A strategy using monoantiplatelet therapy (group A, n = 164) was prospectively compared with a strategy using dual antiplatelet therapy (group B, n = 128) in 292 consecutive patients undergoing TAVI. The primary end point was a combination of mortality, major stroke, life-threatening bleeding (LTB), myocardial infarction, and major vascular complications at 30 days. All adverse events were adjudicated according to the Valve Academic Research Consortium. The primary end point occurred in 22 patients (13.4%) in the group A and in 30 patients (23.4%) in the group B (hazard ratio 0.51, 95% confidence interval 0.28 to 0.94, p = 0.026). LTB (3.7% vs 12.5%, p = 0.005) and major bleedings (2.4% vs 13.3%, p <0.0001) occurred less frequently in the group A, whereas the incidence of stroke (1.2% vs 4.7%, p = 0.14) and myocardial infarction (1.2% vs 0.8%, p = 1.0) was not significantly different between the 2 groups. The benefit of a strategy using mono versus dual antiplatelet therapy persisted after multivariate adjustment and propensity score analysis (hazard ratio 0.53, 95% confidence interval 0.28 to 0.95, p = 0.033). In conclusion, a strategy using mono versus dual antiplatelet therapy in patients undergoing TAVI reduces LTB and major bleedings without increasing the risk of stroke and myocardial infarction. The results of our study question the justification of dual antiplatelet therapy and require confirmation in a randomized trial.
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Affiliation(s)
- Eric Durand
- University Paris-Descartes; AP-HP; European Georges Pompidou Hospital, Departments of Cardiology and Cardiac Surgery, Paris, France; University Hospital of Rouen, Hospital Charles Nicolle, Departments of Cardiology and Thoracic and Cardiovascular Surgery, INSERM UMR 1096, Rouen, France.
| | - Didier Blanchard
- University Paris-Descartes; AP-HP; European Georges Pompidou Hospital, Departments of Cardiology and Cardiac Surgery, Paris, France; Clinique Saint Gatien, Departments of Cardiology and Cardiac Surgery, Tours, France
| | - Stephan Chassaing
- Clinique Saint Gatien, Departments of Cardiology and Cardiac Surgery, Tours, France
| | - Martine Gilard
- Université de Bretagne Occidentale, Department of Cardiology, CHU de la Cavale Blanche, EA 4524, Brest, France
| | - Marc Laskar
- University Hospital Dupuytren, Department of cardiac Surgery, Limoges, France
| | - Bogdan Borz
- University Hospital of Rouen, Hospital Charles Nicolle, Departments of Cardiology and Thoracic and Cardiovascular Surgery, INSERM UMR 1096, Rouen, France
| | - Antoine Lafont
- University Paris-Descartes; AP-HP; European Georges Pompidou Hospital, Departments of Cardiology and Cardiac Surgery, Paris, France
| | - Christophe Barbey
- Clinique Saint Gatien, Departments of Cardiology and Cardiac Surgery, Tours, France
| | - Matthieu Godin
- University Hospital of Rouen, Hospital Charles Nicolle, Departments of Cardiology and Thoracic and Cardiovascular Surgery, INSERM UMR 1096, Rouen, France
| | - Christophe Tron
- University Hospital of Rouen, Hospital Charles Nicolle, Departments of Cardiology and Thoracic and Cardiovascular Surgery, INSERM UMR 1096, Rouen, France
| | - Rachid Zegdi
- University Paris-Descartes; AP-HP; European Georges Pompidou Hospital, Departments of Cardiology and Cardiac Surgery, Paris, France
| | - Didier Chatel
- Clinique Saint Gatien, Departments of Cardiology and Cardiac Surgery, Tours, France
| | - Olivier Le Page
- Clinique Saint Gatien, Departments of Cardiology and Cardiac Surgery, Tours, France
| | - Pierre-Yves Litzler
- University Hospital of Rouen, Hospital Charles Nicolle, Departments of Cardiology and Thoracic and Cardiovascular Surgery, INSERM UMR 1096, Rouen, France
| | - Jean-Paul Bessou
- University Hospital of Rouen, Hospital Charles Nicolle, Departments of Cardiology and Thoracic and Cardiovascular Surgery, INSERM UMR 1096, Rouen, France
| | - Nicolas Danchin
- University Paris-Descartes; AP-HP; European Georges Pompidou Hospital, Departments of Cardiology and Cardiac Surgery, Paris, France
| | - Alain Cribier
- University Hospital of Rouen, Hospital Charles Nicolle, Departments of Cardiology and Thoracic and Cardiovascular Surgery, INSERM UMR 1096, Rouen, France
| | - Hélène Eltchaninoff
- University Hospital of Rouen, Hospital Charles Nicolle, Departments of Cardiology and Thoracic and Cardiovascular Surgery, INSERM UMR 1096, Rouen, France
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Abstract
The number of patients with aortic stenosis (AS) has been increasing over recent decades with the longer life expectancy of the general population. AS is life-threatening without surgery and since many elderly patients have a variety of comorbid conditions, 30-40 % of those with severe AS have been denied surgery. However, recent data on standard aortic valve replacement (AVR) for octogenarians have revealed excellent outcomes, with 2.4-6.8 % early mortality and similar survival rates of octogenarians who undergo AVR vs. the general population. The reported incidences of postoperative stroke, dialysis, and pacemaker implantation were 2.4, 2.6, and 4.6 %, respectively. Transcatheter aortic valve replacement (TAVR) is the alternative therapy for patients who are not able to undergo standard AVR and it is developing rapidly. The placement of aortic transcatheter valves (PARTNER) trial showed acceptable early outcomes. The mortality rates from any cause were 3.4 % in the TAVR group and 6.5 % in the AVR group at 30 days, 24.2 and 26.8 % at 1 year, and 33.9 and 35.0 % at 2 years, respectively. Stroke rate was higher in the TAVR group than in the AVR group (3.4 vs. 1.9 %). Vascular complications and paravalvular leakage are frequent procedure-related complications, which must be addressed because they are associated with increased mortality.
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Affiliation(s)
- Hiroyuki Tsukui
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, 8-1 Kawada Shinjuku, Tokyo, 162-8666, Japan,
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Sade RM. Should access to transcatheter aortic valve replacement be limited to high-volume surgical centers? J Thorac Cardiovasc Surg 2013; 145:1439-40. [PMID: 23523039 DOI: 10.1016/j.jtcvs.2013.02.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 02/27/2013] [Indexed: 11/28/2022]
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Dzemeshkevich AS, Raskin VV, Malikova MS, Frolova IV, Korolev SV, Akchurin RS, Dzemeshkevich SL. [The mitral valve dysplasia in adults: the choice of surgical tactics]. Khirurgiia (Mosk) 2013:40-44. [PMID: 23503382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Early and long-term results of hereditary mitral valve dysplasia surgical treatment were obtained in 203 patients. All patients were divided in 2 groups: 73 (36%) patients after valve-preserving operations and 130 patients after universal chorda-preserving valve prosthetics. The choice of treatment modality depended on the type of anatomical changes and overall surgical volume. Hospital lethality rate was 2.46%. Surgery led to satisfactory functional results, thus, 83.3% of the operated patients have I-II NYHA functional class. Analysis of the own experience allowed to mark out factors, contraindicating the durable plastic mitral valve.
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Kappetein AP, Head SJ, Généreux P, Piazza N, van Mieghem NM, Blackstone EH, Brott TG, Cohen DJ, Cutlip DE, van Es GA, Hahn RT, Kirtane AJ, Krucoff MW, Kodali S, Mack MJ, Mehran R, Rodés-Cabau J, Vranckx P, Webb JG, Windecker S, Serruys PW, Leon MB. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. J Am Coll Cardiol 2012; 60:1438-54. [PMID: 23036636 DOI: 10.1016/j.jacc.2012.09.001] [Citation(s) in RCA: 1414] [Impact Index Per Article: 117.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES The aim of the current Valve Academic Research Consortium (VARC)-2 initiative was to revisit the selection and definitions of transcatheter aortic valve implantation (TAVI) clinical endpoints to make them more suitable to the present and future needs of clinical trials. In addition, this document is intended to expand the understanding of patient risk stratification and case selection. BACKGROUND A recent study confirmed that VARC definitions have already been incorporated into clinical and research practice and represent a new standard for consistency in reporting clinical outcomes of patients with symptomatic severe aortic stenosis (AS) undergoing TAVI. However, as the clinical experience with this technology has matured and expanded, certain definitions have become unsuitable or ambiguous. METHODS AND RESULTS Two in-person meetings (held in September 2011 in Washington, DC, USA, and in February 2012 in Rotterdam, the Netherlands) involving VARC study group members, independent experts (including surgeons, interventional and non-interventional cardiologists, imaging specialists, neurologists, geriatric specialists, and clinical trialists), the US Food and Drug Administration (FDA), and industry representatives, provided much of the substantive discussion from which this VARC-2 consensus manuscript was derived. This document provides an overview of risk assessment and patient stratification that need to be considered for accurate patient inclusion in studies. Working groups were assigned to define the following clinical endpoints: mortality, stroke, myocardial infarction, bleeding complications, acute kidney injury, vascular complications, conduction disturbances and arrhythmias, and a miscellaneous category including relevant complications not previously categorized. Furthermore, comprehensive echocardiography recommendations are provided for the evaluation of prosthetic valve (dys)function. Definitions for the quality of life assessments are also reported. These endpoints formed the basis for several recommended composite endpoints. CONCLUSIONS This VARC-2 document has provided further standardization of endpoint definitions for studies evaluating the use of TAVI, which will lead to improved comparability and interpretability of the study results, supplying an increasingly growing body of evidence with respect to TAVI and/or surgical aortic valve replacement. This initiative and document can furthermore be used as a model during current endeavors of applying definitions to other transcatheter valve therapies (for example, mitral valve repair).
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Santoro G, Bedogni F, Ambrosini V, Berti S, Petronio AS, Ramondo A, Salvi A, Sorropago G, Ussia GP, Cremonesi A. [Transcatheter aortic valve implantation in patients with severe symptomatic aortic stenosis: position statement of the Italian Society of Interventional Cardiology (SICI-GISE) on minimum standards for hospitals and operators]. G Ital Cardiol (Rome) 2012; 13:772-776. [PMID: 23096589 DOI: 10.1714/1168.12956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
At present, transcatheter aortic valve implantation (TAVI) is a proven treatment option for patients with symptomatic degenerative aortic stenosis at high risk for conventional surgery. In countries where TAVI is currently performed, the number of procedures and centers involved has been continuously increasing. The present document from the Italian Society of Interventional Cardiology (SICI-GISE) aims to improve the available evidence and current consensus on this topic through the definition of training needs and knowledge base for both operators and centers.
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Dağdelen S, Alhan C. Transcatheter aortic valve implantation applications in Turkey; the role of the heart team approach. ACTA ACUST UNITED AC 2012; 12:531. [PMID: 22728738 DOI: 10.5152/akd.2012.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Wright J. Re: Cardiac surgery in the Pacific Islands. ANZ J Surg 2012; 82:284-5. [PMID: 22510193 DOI: 10.1111/j.1445-2197.2012.06009.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Holmes DR, Mack MJ, Kaul S, Agnihotri A, Alexander KP, Bailey SR, Calhoon JH, Carabello BA, Desai MY, Edwards FH, Francis GS, Gardner TJ, Kappetein AP, Linderbaum JA, Mukherjee C, Mukherjee D, Otto CM, Ruiz CE, Sacco RL, Smith D, Thomas JD. 2012 ACCF/AATS/SCAI/STS expert consensus document on transcatheter aortic valve replacement. J Am Coll Cardiol 2012; 59:1200-54. [PMID: 22300974 DOI: 10.1016/j.jacc.2012.01.001] [Citation(s) in RCA: 544] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Shah PM, Raney AA. New echocardiography-based classification of mitral valve pathology: relevance to surgical valve repair. J Heart Valve Dis 2012; 21:37-40. [PMID: 22474740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A new echocardiography-based classification of mitral valve pathology is proposed, the adoption of which may provide a uniform approach to the assessment of individual cases by the cardiologist, cardiac anesthesiologist, and surgeon. This type of approach may facilitate the planning and execution of valve repair techniques, with higher rates of success than are currently reported.
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Affiliation(s)
- Pravin M Shah
- Hoag Heart Valve Center, Newport Beach, California 92658, USA.
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Abstract
Prosthesis-patient mismatch (PPM) is present when the effective orifice area of the inserted prosthetic valve is too small in relation to body size. Its main hemodynamic consequence is to generate higher than expected gradients through normally functioning prosthetic valves. The purpose of this review is to present an update on the present state of knowledge with regard to diagnosis, prognosis, and prevention of PPM. PPM is a frequent occurrence (20% to 70% of aortic valve replacements) that has been shown to be associated with worse hemodynamics, less regression of left ventricular hypertrophy, more cardiac events, and lower survival. Moreover, as opposed to most other risk factors, PPM can largely be prevented by using a prospective strategy at the time of operation.
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Affiliation(s)
- Jean G Dumesnil
- Quebec Heart and Lung Institute, 2725 Chemin Sainte-Foy, Québec, Quebec, Canada G1V-4G5.
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Lozano I, Calvo D, Rondan J. Letter by Lozano et al regarding articles, "transcatheter valve-in-valve implantation for failed bioprosthetic heart valves" and "percutaneous therapy for valvular heart disease: a huge advance and a huge challenge to do it right". Circulation 2011; 123:e15. [PMID: 21263002 DOI: 10.1161/circulationaha.110.964148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kukulski T, Kubicius A, Streb W, Kalarus Z. [Multiple valve disease - a complex problem requiring an individualised approach to diagnostics and treatment]. Kardiol Pol 2011; 69:1204-1207. [PMID: 22090242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Tomasz Kukulski
- Oddział Kliniczny Kardiologii, Katedra Kardiologii, Wrodzonych Wad Serca i Elektroterapii, Śląski Uniwersytet Medyczny, Śląskie Centrum Chorób Serca, Zabrze.
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D'Errigo P, Fusco D, Grossi C, Ramondo AB, Ranucci M, Santini F, Santoro G, Seccareccia F, Tamburino C. [OBSERVANT: observational study of appropriateness, efficacy and effectiveness of AVR-TAVI procedures for the treatment of severe symptomatic aortic stenosis. Study protocol]. G Ital Cardiol (Rome) 2010; 11:897-909. [PMID: 21355337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
RATIONALE Severe symptomatic aortic stenosis (SSAS) is the most common acquired valvular heart disease in the western world, and its prevalence is strongly linked to the phenomenon of population ageing. After symptom onset, patients with SSAS, if untreated, show very poor prognoses, unavoidably reaching complete disability status with a significant reduction in survival. Although aortic valve replacement (AVR) is the definitive therapy for this kind of patients, a new, less-invasive alternative like transcatheter aortic valve implantation (TAVI) has been considered, at least for a large proportion of patients with very high or prohibitive operative risks. OBSERVANT represents the first observational multicenter perspective study on the comparative effectiveness of TAVI, AVR, and medical therapy in the Italian population with SSAS. MATERIALS AND METHODS In the participating hospitals, to define the patient risk profile for each patient with SSAS, data on demographic characteristics, health status prior to intervention and presence of comorbidities will be collected. Moreover, complete information on the type of intervention will be gathered. Mortality within 30 days from intervention is the primary adverse outcome. Secondary outcomes include mortality within 12 and 24 months and the incidence of in-hospital major adverse cardiac and cerebrovascular events. Clinical monitoring procedures will allow assessment of the reliability and completeness of the database and help maintain constant quality control. To compare the effectiveness of AVR, TAVI, and medical treatment in terms of medium- and long-term outcomes, accounting for possible differences in patient case-mix among the three treatment groups, risk adjustment techniques will be applied. EXPECTED RESULTS Short-, medium-, and long-term outcome in patients undergoing one of the three SSAS treatments; use, appropriateness, and economic and organizational impact of TAVI and AVR procedures; specific "indication criteria" to guarantee appropriate patient selection for AVR or TAVI; new pre-procedure risk score, specific for the elderly Italian population; guidelines on TAVI procedure coding and a system of administrative follow-up to be proposed to the regional health systems for managing the use of the AVR or TAVI procedures. CONCLUSIONS The complete knowledge base derived from this study will be directly transferable to professionals and policy makers, giving them evidence-based results for use in their decision-making process.
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Tuzcu EM. [Editorial Comment: going behind the ordinary: transcatheter aortic valve implantation]. Turk Kardiyol Dern Ars 2010; 38:264-266. [PMID: 20935433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
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Hage FG, Nanda NC. Guidelines for the evaluation of prosthetic valves with echocardiography and Doppler ultrasound: value and limitations. Echocardiography 2010; 27:91-3. [PMID: 20380666 DOI: 10.1111/j.1540-8175.2009.01132.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Parrinello G, Torres D, Paterna S, Mezzero M, Di Pasquale P, Trapanese C, Cardillo M, Licata G. Giant left atrium in a woman with mitral prosthetic valve malfunction and history of rheumatic heart disease. Intern Emerg Med 2009; 4:435-7. [PMID: 19636673 DOI: 10.1007/s11739-009-0280-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2009] [Accepted: 06/09/2009] [Indexed: 10/20/2022]
Affiliation(s)
- Gaspare Parrinello
- Biomedical Department of Internal and Specialist Medicine Policlinico Paolo Giaccone, University Hospital of Palermo, Piazza Delle Cliniche 2, 90127 Palermo, Italy
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Piazza N, Cutlip DE, Onuma Y, Kappetein AP, de Jaegere P, Serruys PW. Clinical endpoints in transcatheter aortic valve implantation: a call to ARC for standardised definitions. EUROINTERVENTION 2009; 5:29-31. [PMID: 19577979 DOI: 10.4244/eijv5i1a5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Bonow RO, Carabello BA, Chatterjee K, de Leon AC, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O'Gara PT, O'Rourke RA, Otto CM, Shah PM, Shanewise JS. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 2008; 118:e523-661. [PMID: 18820172 DOI: 10.1161/circulationaha.108.190748] [Citation(s) in RCA: 802] [Impact Index Per Article: 50.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Abildstrøm SZ, Kruse M, Rasmussen S, Madsen JK, Nielsen PH, Madsen M. [The Danish Heart Registry--a clinical database]. Ugeskr Laeger 2008; 170:532-536. [PMID: 18291083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
INTRODUCTION The Danish Heart Registry (DHR) keeps track of all coronary angiographies (CATH), percutaneous coronary interventions (PCI), coronary artery bypass grafting (CABG), and adult heart valve surgery performed in Denmark. DHR is a clinical database established in order to follow the activity and quality of the procedures mentioned. MATERIALS AND METHODS Information concerning each procedure, age, gender, and co-morbidity of the patient was collected. Each patient was followed with respect to survival for 30 days by linkage to the central personal registry in Denmark. Mortality was estimated by the Kaplan-Meier method and comparisons of 30-day mortality between centres were carried out in Cox proportional hazard models. RESULTS The mortality within 30 days after PCI was 3.2% and closely related to the indication for PCI: ST-elevation myocardial infarction (STEMI) 6.8%; non-STEMI & unstable angina pectoris 1.9% and stable angina pectoris 0.5%. The 30-day mortality after PCI on the indication STEMI did not differ between the five centres, P=0.30. Mortality within 30 days after isolated CABG was 2.6% and was closely related to the EuroSCORE. The 30-day mortality after isolated CABG did not differ between the five centres, P=0.12. CONCLUSION The 30-day mortality was closely related to the indication for PCI and the EuroSCORE for patients undergoing CABG. There were no significant differences in 30-day mortality between centres after either primary PCI or isolated CABG.
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Affiliation(s)
- Steen Zabell Abildstrøm
- Københavns Universitet, Statens Institut for Folkesundhed, Arhus Universitetshospital, Skejby.
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Albertini A, Dell'Amore A, Zussa C, Lamarra M. Modified Bentall operation: the double sewing ring technique. Eur J Cardiothorac Surg 2007; 32:804-6. [PMID: 17766138 DOI: 10.1016/j.ejcts.2007.07.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2007] [Revised: 07/11/2007] [Accepted: 07/11/2007] [Indexed: 11/25/2022] Open
Abstract
The Bentall-DeBono operation is the technique of choice for aortic root replacement. As more patients do not accept or have contraindications to lifelong anticoagulation, the biological Bentall operation is a good option for these patients, even though complex reoperations would then be required for bioprosthesis degeneration. We studied a modified technique to simplify the reoperations in patients undergoing biological Bentall procedure. A bioprosthetic valved conduit was obtained creating two separate sewing rings at different levels of the vascular graft. One ring was used to sew the bioprosthesis on the vascular graft. The second ring was used to fix the vascular graft on the native aortic annulus. In case of reoperation, the bioprosthesis could be removed cutting only the suture on the first ring. Then the same ring could be used to fix the new prosthesis. Since 2006, we have performed 12 biological Bentall operations with our modification. The mean age was 63.2 years (range 43-77 years), the mean cardiopulmonary time was 79+/-12 min and the mean aortic cross-clamping time was 68+/-10 min. We had no in-hospital mortality; the postoperative period was uneventful in all patients. In our experience this modification seems to be simple and reproducible, without increasing the operative risk and postoperative morbidity.
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Affiliation(s)
- Alberto Albertini
- Department Cardiovascular Surgery, Villa Maria Cecilia Hospital, Via Corriera 1, Cotignola, Lugo (RA), Italy
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Weiss J. [Valve replacement: are minimal invasive procedures the future?]. Dtsch Med Wochenschr 2007; 132:p15. [PMID: 17654412 DOI: 10.1055/s-2007-979422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Spiegelstein D, Ghosh P, Sternik L, Tager S, Shinfeld A, Raanani E. Current strategies of mitral valve repair. Isr Med Assoc J 2007; 9:303-9. [PMID: 17491227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND During the last decade new surgical techniques for mitral valve repair were developed. We have been using those techniques in order to widen the spectrum of patients eligible for MV repair. OBJECTIVES To assess the operative and mid-term results a wide variety of surgical techniques. METHODS From January 2004 through December 2006, 213 patients underwent MV repair in our institution. Valve pathology was degenerative in 123 patients (58%), ischemic in 37 (17%), showed annular dilatation in 25 (12%), endocarditis in 16 (8%), was rheumatic in 13 (6%), and due to other causes in 14 (7%). Preoperative New York Heart Association score was 2.35 +/- 0.85 and ejection fraction 53 +/- 12%. Isolated MV repair was performed in 90 patients (42%) and 158 concomitant procedures were done in 123 patients (58%). A wide variety of surgical techniques was used in order to increase the number of repairs compared to valve replacement. RESULTS There were 7 in-hospital deaths (3.3%). NYHA class improved from 2.19 +/- 0.85 to 1.4 +/- 0.6, and freedom from reoperation was 100%. Echocardiography follow-up of patients with degenerative MV revealed that 93% of the patients (115/123) were free of mitral regurgitation greater than 2+ grade. In patients operated by a minimal invasive approach there were no conversions to stemotomy, no late deaths, none required reoperation, and 96% were free of MR greater than 2+ grade. The use of multiple surgical techniques enabled the repair of more than 80% of pure MR cases. CONCLUSIONS MV repair provides good perioperative and mid-term results, and supports the preference for MV repair over replacement, when feasible. Multiple valve repair techniques tailored to different pathologies increases the feasibility of mitral repair.
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Affiliation(s)
- Dan Spiegelstein
- Department of Cardiothoracic Surgery, Sheba Medical Center, Tel Hashomer, Israel.
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Cleland JGF, Coletta AP, Abdellah AT, Nasir M, Hobson N, Freemantle N, Clark AL. Clinical trials update from the American Heart Association 2006: OAT, SALT 1 and 2, MAGIC, ABCD, PABA-CHF, IMPROVE-CHF, and percutaneous mitral annuloplasty. Eur J Heart Fail 2007; 9:92-7. [PMID: 17188569 DOI: 10.1016/j.ejheart.2006.12.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
This article provides information and a commentary on trials presented at the American Heart Association meeting held in November 2006, relevant to the pathophysiology, prevention and treatment of heart failure. All reports should be considered as preliminary data, as analyses may change in the final publication. The OAT study failed to show a benefit of PCI over optimal medical therapy in patients with persistent total occlusion of the infarct related artery following a myocardial infarction. In SALT 1 and 2, tolvaptan was found to correct hyponatraemia of various aetiologies; however, whether this has an impact on heart failure prognosis requires further evaluation. A placebo controlled study of myocardial implantation of skeletal myoblasts in patients with moderate to severe LVSD (MAGIC) showed equivocal/uncertain effects, long term follow-up data are awaited. The ABCD study which compared the ability of an invasive and a non-invasive test to identify patients at risk of arrhythmic events prior to ICD implantation, suggested that the two strategies were comparable, although the practical value of either test remains uncertain and the study had many major flaws. The PABA-CHF study hinted that pulmonary vein antrum isolation might be more effective than AV node ablation with bi-ventricular pacing for the treatment of patients with heart failure in atrial fibrillation. In IMPROVE-CHF, an NT-pro BNP guided treatment strategy was found to reduce the cost of managing patients with acute breathlessness.
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Affiliation(s)
- John G F Cleland
- Department of Cardiology, Postgraduate Medical Institute, Division of Cardiovascular and Respiratory Studies, University of Hull, Castle Hill Hospital, Cottingham, Kingston-upon-Hull, HU16 5JQ, UK
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Affiliation(s)
- Richard Hopkins
- Brown Medical School, Collis Cardiac Surgical Research Laboratory, Division of Cardiothoracic Surgery, Providence, RI, USA.
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Bleiziffer S, Eichinger WB, Hettich I, Guenzinger R, Ruzicka D, Bauernschmitt R, Lange R. Prediction of valve prosthesis-patient mismatch prior to aortic valve replacement: which is the best method? Heart 2006; 93:615-20. [PMID: 17164480 PMCID: PMC1955566 DOI: 10.1136/hrt.2006.102764] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND To predict the occurrence of valve prosthesis-patient mismatch (VP-PM) after aortic valve replacement (AVR), the surgeon needs to estimate the postoperative effective orifice area index (EOAI). AIM To compare different methods of predicting VP-PM. METHODS The effective orifice area (EOA) of 383 patients who had undergone AVR between July 2000 and January 2005 with various aortic valve prostheses was obtained echocardiographically 6 months after the operation. We tested the efficacy of (1) EOAI calculated from the echo data obtained in our own laboratory, (2) indexed geometric orifice area, (3) EOAI estimated from charts provided by prosthesis manufacturers (which are based either on in vitro or on echo data) and (4) EOAI estimated from reference echo data published in the literature to predict VP-PM. RESULTS Sensitivity and specificity to predict VP-PM were 53% and 83% (method 1), 80% and 53% (charts based on echo data, parts of method 3) and 71% and 67% (method 4) using reference data derived from echocardiographic examinations. The sensitivity of method 2 and of charts based on in vitro data (parts of method 3) to predict VP-PM was 0-17%. The incidence of severe VP-PM could be reduced from 8.7% to 0.8% after the introduction of the systematic estimation of the EOAI at the time of operation (p = 0.003, method 1). CONCLUSIONS The best method of predicting VP-PM is the use of mean (SD) EOAs derived from echocardiographic examinations, whereas the use of in vitro data or the geometric orifice area is unreliable. After the surgeon's anticipation of VP-PM prior to AVR, the incidence of VP-PM could be reduced.
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Affiliation(s)
- Sabine Bleiziffer
- Clinic for Cardiovascular Surgery, German Heart Center Munich, Munich, Germany.
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Kulik A, Rubens FD, Baird D, Wells PS, Kearon C, Mesana TG, Lam BK. Early postoperative anticoagulation after mechanical valve replacement: a Canadian survey. J Heart Valve Dis 2006; 15:581-7. [PMID: 16901058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY The optimal approach to anticoagulation during the early postoperative period after mechanical valve replacement, by which early thromboembolism is prevented without bleeding complications, is not yet known. The study aim was to examine the practice patterns of Canadian cardiac surgeons with regard to early postoperative anticoagulation after mechanical valve implantation. METHODS A questionnaire was sent to 100 Canadian cardiac surgeons in July 2004, and 57 responses were received. Data were collected regarding the approaches to early postoperative anticoagulation following uncomplicated isolated mechanical aortic valve replacement (AVR) and mitral valve replacement (MVR). RESULTS Heparin was administered routinely after AVR and MVR by 63% and 68% of surgeons, respectively. This was most commonly initiated on postoperative day (POD) 1, and given either subcutaneously (AVR, 28%; MVR, 25%) or intravenously (AVR, 33%; MVR, 42%). Alternatively, low-molecular-weight heparin was used by 21% and 23% of surgeons after AVR and MVR, respectively. Oral warfarin was usually started on POD 1 (72% and 68%, respectively), with 40% prescribing an initial dose between 2.5 and 5.0 mg, and 51% administering between 5.1 and 7.5 mg. When heparin was not used, oral anticoagulation was more often administered earlier (AVR, p = 0.003; MVR, p = 0.006), but not at higher doses (AVR, p = 0.07; MVR, p = 0.2). Following surgery, aspirin was prescribed by 61% and 65% of surgeons after AVR and MVR, respectively. CONCLUSION The study results highlighted a significant variability in the management of early postoperative anticoagulation after mechanical valve implantation. The clinical impact of these findings is unknown, and can only be assessed through a prospective trial.
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Affiliation(s)
- Alexander Kulik
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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Huh J, Bakaeen F. Heart valve replacement: which valve for which patient? Curr Cardiol Rep 2006; 8:109-16. [PMID: 16524537 DOI: 10.1007/s11886-006-0021-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The ideal heart valve substitute would show no deterioration or thrombogenicity, offer no resistance to blood flow, and be easy to implant. However, such a valve does not exist and we must accept compromises in some of these qualities based on our patients' needs. In selection of cardiac valve prosthesis, valve-related factors such as durability, thrombogenicity, and fluid dynamics should be carefully matched to patient-related factors such as age, size, life expectancy, comorbidities, plans for pregnancy, and lifestyle. In addition, surgeon- or operation-related factors should be considered. Technical aspects of implantation, ease of reoperation, and operative mortalities may tip the risk and benefit balance in a particular direction. We review currently available heart valve prostheses and the clinical factors that are involved in selection of a heart valve substitute.
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Affiliation(s)
- Joseph Huh
- Michael E. DeBakey Veterans Affairs Medical Center (112), 2002 Holcombe Boulevard, Houston, TX 77030, USA.
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Butchart EG, Gohlke-Bärwolf K, Antunes MJ, Tornos P, Caterina RD, Cormier B, Prendergast B, Jung B, Bjornstad H, Report C, Hall RJC, Vahanian A. [Management of patients after valvular heart surgery. Guidelines of the European Cardiologic Society]. Kardiol Pol 2006; 64:282-94; discussion 295-6. [PMID: 16583331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Affiliation(s)
- Eric G Butchart
- Department of Cardiothoracic Surgery, University of Wales, Heath Park, Cardiff, UK.
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