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Prajapathi S, Kapoor A, Agarwal SK, Tewari P, Pande S, Chandra B, Sahu A, Khanna R, Kumar S, Garg N, Tewari S. Does high dose statin pretreatment affect global strains in patients undergoing valve replacement. Indian J Thorac Cardiovasc Surg 2024; 40:300-310. [PMID: 38681712 PMCID: PMC11045680 DOI: 10.1007/s12055-023-01652-y] [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: 06/06/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 05/01/2024] Open
Abstract
Purpose To study the effect of rosuvastatin 40 mg (initiated 7 days prior to surgery) in patients undergoing valve replacement (VR) for rheumatic mitral valve disease on left ventricular (LV) strain and biomarker release kinetics. Methods In this randomized study, cardiac biomarkers viz. troponin I (TnI), Creatine kinase MB (CK-MB), N-terminal pro B-type natriuretic peptide (NTPBNP) were measured before surgery; and 8, 24 and 48 h postoperatively. Global LV (circumferential, global circumferential strain (GCS); longitudinal, GLS; radial, global radial strain (GRS)) strains were measured preoperatively; and 48 h and 30 days postoperatively. Results Following VR, Global Longitudinal Strain (GLS), Global Circumferential Strain (GCS) and Global Radial Strain (GRS) declined at 48 h in both statin loaded (SL) and non loaded (NL) groups. The %decline in strain was significantly lower in SL group (% change in GLS 35.8% vs 38.8%, GCS 34% vs 44.1%, GRS 45.7% vs 52.6%; p < 0.001).All strain values improved at 30 days with higher improvement in SL group (GLS -15.92 ± 2.00% vs -12.6 ± 1.66%, GCS -15.12 ± 2.93% vs -13.04 ± 2.44%; GRS 22.12 ± 6.85% vs 19.32 ± 6.48%). While TnI, CKMB, NTPBNP increased following surgery, values at 8, 24 and 48 h were lower in the SL vs. NL group. Mean change (baseline to peak biomarker value) was also significantly lower in SL group.The SL group had shorter hospital and Intensive Care Unit (ICU) stay. On Receiver Operating Characteristic Curve (ROC) analysis, baseline GCS ≤ 14% best predicted postoperative 30 day Left Ventricular Ejection Fraction (LVEF) ≤ 50%. Conclusion Pre-operative high dose rosuvastatin was "cardioprotective" with favorable effect on LV global strain and release kinetics of biomarkers. These cut-offs (described for the first time for rheumatic VR) can be used as prognostic predictors.
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Affiliation(s)
- Sudesh Prajapathi
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, 226014 India
| | - Aditya Kapoor
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, 226014 India
| | | | - Prabhat Tewari
- Cardiac Anesthesia, Sanjay Gandhi PGIMS, Lucknow, 226014 India
| | - Shantanu Pande
- Cardiovascular and Thoracic Surgery, Sanjay Gandhi PGIMS, Lucknow, 226014 India
| | - Bipin Chandra
- Cardiovascular and Thoracic Surgery, Sanjay Gandhi PGIMS, Lucknow, 226014 India
| | - Ankit Sahu
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, 226014 India
| | - Roopali Khanna
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, 226014 India
| | - Sudeep Kumar
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, 226014 India
| | - Naveen Garg
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, 226014 India
| | - Satyendra Tewari
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, 226014 India
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Santos DAM, Siciliano RF, Besen BAMP, Strabelli TMV, Sambo CT, Milczwski VDM, Goldemberg F, Tarasoutchi F, Vieira MLC, Paixão MR, Gualandro DM, Accorsi TAD, Pomerantzeff PMA, Mansur AJ. Changing trends in clinical characteristics and in-hospital mortality of patients with infective endocarditis over four decades. J Infect Public Health 2024; 17:712-718. [PMID: 38484416 DOI: 10.1016/j.jiph.2024.02.017] [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: 01/20/2024] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/24/2024] Open
Abstract
BACKGROUND Infective endocarditis continues to be a significant concern and may be undergoing an epidemiological transition. METHODS Were studied 1804 consecutive episodes of infective endocarditis between 1978 and 2022. The mean age was 48 ( ± 19), and 1162 (64%) patients were male. Temporal trends in demographic data, comorbidities, predisposing conditions, microorganisms, complications and in-hospital death have been studied over the decades (1978-1988, 1989-1999, 2000-2010 and 2011-2022). The outcomes and clinical characteristics were modeled using nonlinear cubic spline functions. FINDINGS Valve surgery was performed in 50% of the patients and overall in-hospital mortality was 30%. From the first to the fourth decade studied, the average age of patients increased from 29 to 57 years (p < 0.001), with significant declines in the occurrence of rheumatic valvular heart disease (15% to 6%; p < 0.001) and streptococcal infections (46% to 33%; p < 0.001). Healthcare-associated infections have increased (9% to 21%; p < 0.001), as have prosthetic valve endocarditis (26% to 53%; p < 0.001), coagulase-negative staphylococcal infections (4% to 11%; p < 0.001), and related-complications (heart failure, embolic events, and perivalvular abscess; p < 0.001). These changes were associated with a decline in adjusted in-hospital mortality from 34% to 25% (p = 0.019). INTERPRETATION In the 44 years studied, there was an increase in the mean age of patients, healthcare-related, prosthetic valve, coagulase-negative staphylococci/MRSA infections, and related complications. Notably, these epidemiological changes were associated with a decline in the adjusted in-hospital mortality.
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Affiliation(s)
- Diego Augusto Medeiros Santos
- Instituto do Coracao (InCor) do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | - Rinaldo Focaccia Siciliano
- Instituto do Coracao (InCor) do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | | | - Tania Mara Varejão Strabelli
- Instituto do Coracao (InCor) do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Caio Trevelin Sambo
- Instituto do Coracao (InCor) do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Vitor de Medeiros Milczwski
- Instituto do Coracao (InCor) do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Flora Goldemberg
- Instituto do Coracao (InCor) do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Flavio Tarasoutchi
- Instituto do Coracao (InCor) do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Marcelo Luiz Campos Vieira
- Instituto do Coracao (InCor) do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Milena Ribeiro Paixão
- Instituto do Coracao (InCor) do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Danielle Menosi Gualandro
- Instituto do Coracao (InCor) do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Tarso Augusto Duenhas Accorsi
- Instituto do Coracao (InCor) do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Pablo Maria Alberto Pomerantzeff
- Instituto do Coracao (InCor) do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Alfredo José Mansur
- Instituto do Coracao (InCor) do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Kim J, Lee H, Jung JH, Yoo JS. Tricuspid Edge-to-Edge Repair Versus Tricuspid Valve Replacement for Severe Tricuspid Regurgitation. Korean Circ J 2023; 53:775-786. [PMID: 37973388 PMCID: PMC10654410 DOI: 10.4070/kcj.2023.0108] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/12/2023] [Accepted: 07/04/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Tricuspid valve (TV) repair techniques other than annuloplasty remain challenging and frequently end in tricuspid valve replacement (TVR) in complicated cases. However, the results of TVR are suboptimal compared with TV repair. This study aimed to evaluate the clinical effectiveness of TV edge-to-edge repair (E2E) compared to TVR for severe tricuspid regurgitation (TR). METHODS We retrospectively reviewed 230 patients with severe TR who underwent E2E (n=139) or TVR (n=91) from 2001 to 2020. Clinical and echocardiographic results were analyzed using inverse probability of treatment weighting analysis and propensity score matching. RESULTS The two groups showed no significant differences in early mortality and morbidities. During the mean follow-up of 106.2±68.8 months, late severe TR and TV reoperation rates were not significantly different between groups. E2E group, however, showed better outcomes in overall survival (p=0.023), freedom from significant tricuspid stenosis (TS) (trans-tricuspid pressure gradient ≥5 mmHg, p=0.021), and freedom from TV-related events (p<0.001). Matched analysis showed consistent results. CONCLUSIONS E2E for severe TR presented more favorable clinical outcomes than TVR. Our study supports that E2E might be a valuable option in severe TR surgery, avoiding TVR.
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Affiliation(s)
- Jihoon Kim
- Department of Thoracic and Cardiovascular Surgery, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Korea
| | - Heemoon Lee
- Department of Thoracic and Cardiovascular Surgery, Bucheon Sejong Hospital, Bucheon, Korea.
| | - Ji-Hyun Jung
- Division of Cardiology, Department of Internal Medicine, Bucheon Sejong Hospital, Bucheon, Korea
| | - Jae Suk Yoo
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Sá MP, Van den Eynde J, Jacquemyn X, Tasoudis P, Erten O, Dokollari A, Torregrossa G, Sicouri S, Ramlawi B. Late outcomes of transcatheter aortic valve implantation in bicuspid versus tricuspid valves: Meta-analysis of reconstructed time-to-event data. Trends Cardiovasc Med 2023; 33:458-467. [PMID: 35513298 DOI: 10.1016/j.tcm.2022.04.008] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 12/19/2022]
Abstract
Based on previous meta-analyses including immediate/1-year results, individuals with bicuspid aortic valve (BAV) stenosis can undergo TAVI with similar outcomes as those with tricuspid aortic valve (TAV), but with higher rates of periprocedural complications. The widespread belief is that BAV patients would have poor results in comparison with TAV patients after TAVI over time. Therefore, we performed a systematic review with meta-analysis with reconstructed time-to-event data of studies published by January 2022 to compare late outcomes of patients with BAV versus TAV who underwent TAVI. This approach reconstructs individual patient data (IPD) based on the published Kaplan-Meier graphs. Ten studies met our eligibility criteria, including 9,071 patients with BAV and 171,070 patients with TAV. Patients with BAV had a significantly lower risk of mortality (HR 0.70, 95%CI 0.65-0.77, P<0.001), however, this result was driven by populations in which the risk score was statistically significantly lower in the BAV group (HR 0.69, 95%CI 0.63-0.76, P<0.001) and by populations in which the BAV group was statistically significantly younger (HR 0.72, 95%CI 0.64-0.81, P<0.001). In patients with selected BAV anatomy deemed favorable for TAVI, we did not find worse survival over time in comparison with patients with TAV; however, the follow-up beyond 1 year remains limited in the studies and we need more investigation for specific bicuspid anatomies with longer follow-up. Most importantly, randomized controlled trials including exclusively BAV patients treated with TAVI versus SAVR are warranted.
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Affiliation(s)
- Michel Pompeu Sá
- Department of Cardiothoracic Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, PA, USA; Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA.
| | | | - Xander Jacquemyn
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Panagiotis Tasoudis
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Ozgun Erten
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Aleksander Dokollari
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Gianluca Torregrossa
- Department of Cardiothoracic Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, PA, USA; Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Serge Sicouri
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - Basel Ramlawi
- Department of Cardiothoracic Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, PA, USA; Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
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Dowling C, Gooley R, McCormick L, Sharma RP, Yeung AC, Fearon WF, Dargan J, Khan F, Firoozi S, Brecker SJ. Ongoing experience with patient-specific computer simulation of transcatheter aortic valve replacement in bicuspid aortic valve. Cardiovasc Revasc Med 2023; 51:31-37. [PMID: 36740551 DOI: 10.1016/j.carrev.2023.01.015] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/23/2022] [Accepted: 01/18/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is increasingly being used to treat younger, lower-risk patients with bicuspid aortic valve (BAV). Patient-specific computer simulation may identify patients at risk for developing paravalvular regurgitation (PVR) and major conduction disturbance. Only limited prospective experience of this technology exist. We wished to describe our ongoing experience with patient-specific computer simulation. METHODS Patients who were referred for consideration of TAVR with a self-expanding transcatheter heart valve (THV) and had BAV identified on pre-procedural cardiac computed tomography imaging underwent patient-specific computer simulation. The computer simulations were reviewed by the Heart Team and used to guide surgical or transcatheter treatment approaches and to aid in THV sizing and positioning. Clinical outcomes were recorded. RESULTS Between May 2019 and May 2021, 16 patients with BAV were referred for consideration of TAVR with a self-expanding THV. Sievers Type 1 morphology was present in 15 patients and Type 0 in the remaining patient. Two patients were predicted to develop moderate-to-severe PVR with a TAVR procedure and these patients underwent successful surgical aortic valve replacement. In the remaining 14 patients, computer simulation was used to optimize THV sizing and positioning to minimise PVR and conduction disturbance. One patient with a low valve implantation depth developed moderate PVR and this complication was correctly predicted by the computer simulations. No patient required insertion of a new permanent pacemaker. CONCLUSION Patient-specific computer simulation may be used to guide the most appropriate treatment modality for patients with BAV. The usage of computer simulation to guide THV sizing and positioning was associated with favourable clinical outcomes.
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Affiliation(s)
- Cameron Dowling
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia.
| | - Robert Gooley
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
| | - Liam McCormick
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
| | - Rahul P Sharma
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Alan C Yeung
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - William F Fearon
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - James Dargan
- Cardiology Clinical Academic Group, St. George's University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Faisal Khan
- Cardiology Clinical Academic Group, St. George's University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Sami Firoozi
- Cardiology Clinical Academic Group, St. George's University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Stephen J Brecker
- Cardiology Clinical Academic Group, St. George's University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
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Sá MP, Van den Eynde J, Simonato M, Hirji S, Erten O, Jacquemyn X, Tasoudis P, Dokollari A, Sicouri S, Weymann A, Ruhparwar A, Arora R, Clavel MA, Pibarot P, Ramlawi B. Late outcomes of valve-in-valve transcatheter aortic valve implantation versus re-replacement: Meta-analysis of reconstructed time-to-event data. Int J Cardiol 2023; 370:112-121. [PMID: 36370873 DOI: 10.1016/j.ijcard.2022.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 07/18/2022] [Revised: 10/19/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022]
Abstract
AIMS To evaluate all-cause mortality in ViV-TAVI versus redo SAVR in patients with failed bioprostheses. METHODS Study-level meta-analysis of reconstructed time-to-event data from Kaplan-Meier curves of non-randomized studies published by September 30, 2021. RESULTS Ten studies met our eligibility criteria and included a total of 3345 patients (1676 patients underwent ViV-TAVI and 1669 patients underwent redo SAVR). Pooling all the studies, ViV-TAVI showed a lower risk of all-cause mortality in the first 44 days [hazard ratio (HR) 0.67, 95% confidence interval (CI) 0.49-0.93, P = 0.017], with an HR reversal after 197 days favoring redo SAVR (HR 1.53; 95% CI 1.22-1.93; P < 0.001). Pooling only the matched populations (1143 pairs), ViV-TAVI showed a lower risk of all-cause mortality in the first 55 days [hazard ratio (HR) 0.63, 95% confidence interval (CI) 0.45-0.89, P < 0.001], with a reversal HR after 212 days favoring redo SAVR (HR 1.57; 95% CI 1.22-2.03; P < 0.001). The Cox regression model showed a statistically significant association of prosthesis-patient mismatch (PPM) with all-cause mortality during follow-up for ViV-TAVI (HR 1.03 per percentage increase in the study- and treatment arm-level proportion of PPM, 95% 1.02-1.05, P < 0.001). CONCLUSION ViV-TAVI is associated with a strong protective effect immediately after the procedure in comparison with redo SAVR, however, this initial advantage reverses over time and redo SAVR seems to be a protective factor for all-cause mortality after 6 months. Considering that these results are the fruit of pooling data from observational studies, they should be interpreted with caution and trials are warranted.
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Affiliation(s)
- Michel Pompeu Sá
- Department of Cardiothoracic Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, PA, USA; Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, PA, USA.
| | | | | | - Sameer Hirji
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ozgun Erten
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, PA, USA
| | - Xander Jacquemyn
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Panagiotis Tasoudis
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, PA, USA
| | - Alexander Dokollari
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, PA, USA
| | - Serge Sicouri
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, PA, USA
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Rakesh Arora
- Department of Surgery, Section of Cardiac Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marie-Annick Clavel
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Québec, Canada; Department of Medicine, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
| | - Philippe Pibarot
- Centre de Recherche de l'Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Québec, Canada; Department of Medicine, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
| | - Basel Ramlawi
- Department of Cardiothoracic Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, PA, USA; Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, PA, USA
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Parellada-Vendrell M, Prat-Masana M, Pérez-Ortega S. Mitral valve-in-valve implantation: A case report. Enfermería Intensiva (English ed ) 2023; 34:43-52. [PMID: 36774245 DOI: 10.1016/j.enfie.2021.07.004] [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: 04/08/2021] [Accepted: 07/02/2021] [Indexed: 02/11/2023]
Abstract
INTRODUCTION Mitral valve-in-valve implantation is a new therapeutic tool in the field of structural interventional cardiology for patients with bioprosthetic dysfunction due to severe mitral valve regurgitation and high surgical risk. The objective was to develop an individualised nursing care plan for a patient undergoing this procedure; the first case in our centre. CASE DESCRIPTION A 75-year-old woman, independent for activities of daily living, with a history of chronic renal failure and biological mitral valve replacement due to rheumatic valve disease. She was admitted to the acute cardiac care unit for severe symptomatic mitral valve regurgitations secondary to mitral bioprosthesis dysfunction. Heart surgery was ruled out due to comorbidities and high surgical risk, and the patient underwent percutaneous mitral valve-in-valve implantation. The implantation was successful. ASSESSMENT The nursing assessment followed Marjory Gordon's conceptual model identifying the following impaired patterns: pattern 2: bilateral malleolar oedema without pitting; pattern 3: urinary catheter and intravenous diuretic use; pattern 4: dyspnoea on moderate exertion, dry nocturnal cough, orthopnoea and respiratory disturbances, and activity intolerance; pattern 5: need for pharmacological assistance for a good night's rest. DIAGNOSES The following nursing diagnoses were established using the NANDA taxonomy: Excess fluid volume; ineffective breathing pattern; Activity intolerance and problem collaborating: Hypotension and anaemia secondary to deep thigh haematoma. PLANNING The following objectives were set based on the NOC taxonomy: Fluid balance; Respiratory status: ventilation; Cardiopulmonary status and the following NIC interventions: Hypervolaemia management; Respiratory monitoring and oxygen therapy; Vital sign monitoring and heart care. DISCUSSION Nursing interventions aimed at monitoring haemodynamic status, fluid restriction together with the efficacy of diuretic treatment achieved a negative water balance which contributed to fluid depletion improving respiratory symptoms, enabling implantation under better conditions. CONCLUSIONS Technological progress in the health sciences, and in the field of acute cardiology in particular, directly calls for training, revision and updating of critical care nursing. Given this dynamic and continually evolving process, the specialist intensive care nurse, the inclusion of the cardiovascular nurse specialist in multidisciplinary teams such as the heart team, and expanding the consultation of the haemodynamic nurse are urgently required to ensure optimal nursing care, safety, and care quality.
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Affiliation(s)
- M Parellada-Vendrell
- Unidad de Cuidados Cardiológicos Agudos, Instituto Cardiovascular, Hospital Clínic, Barcelona, Spain.
| | - M Prat-Masana
- Unidad de Cuidados Cardiológicos Agudos, Instituto Cardiovascular, Hospital Clínic, Barcelona, Spain
| | - S Pérez-Ortega
- Clínica del Instituto Cardiovascular, Hospital Clínic, Barcelona, Spain
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Dowling C, Gooley R, McCormick L, Rashid HN, Dargan J, Khan F, Firoozi S, Brecker SJ. Patient-Specific Computer Simulation to Predict Conduction Disturbance With Current-Generation Self-Expanding Transcatheter Heart Valves. Struct Heart 2022; 6:100010. [PMID: 37274548 PMCID: PMC10236875 DOI: 10.1016/j.shj.2022.100010] [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] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/19/2022] [Accepted: 02/02/2022] [Indexed: 10/18/2022]
Abstract
Background Patient-specific computer simulation may predict the development of conduction disturbance following transcatheter aortic valve replacement (TAVR). Validation of the computer simulations with current-generation devices has not been undertaken. Methods A retrospective study was performed on patients who had undergone TAVR with a current-generation self-expanding transcatheter heart valve (THV). Preprocedural computed tomography imaging was used to create finite element models of the aortic root. Procedural contrast angiography was reviewed, and finite element analysis performed using a matching THV device size and implantation depth. A region of interest corresponding to the atrioventricular bundle and proximal left bundle branch was identified. The percentage of this area (contact pressure index [CPI]) and maximum contact pressure (CPMax) exerted by THV were recorded. Postprocedural electrocardiograms were reviewed, and major conduction disturbance was defined as the development of persistent left bundle branch block or high-degree atrioventricular block. Results A total of 80 patients were included in the study. THVs were 23- to 29-mm Evolut PRO (n = 53) and 34-mm Evolut R (n = 27). Major conduction disturbance occurred in 27 patients (33.8%). CPI (28.3 ± 15.8 vs. 15.6 ± 11.2%; p < 0.001) and CPMax (0.51 ± 0.20 vs. 0.36 ± 0.24 MPa; p = 0.008) were higher in patients who developed major conduction disturbance. CPI (area under the receiver operating characteristic curve [AUC], 0.74; 95% CI, 0.63-0.86; p < 0.001) and CPMax (AUC, 0.69; 95% CI, 0.57-0.81; p = 0.006) demonstrated a discriminatory power to predict the development of major conduction disturbance. Conclusions Patient-specific computer simulation may identify patients at risk for conduction disturbance after TAVR with current-generation self-expanding THVs.
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Affiliation(s)
- Cameron Dowling
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
| | - Robert Gooley
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
| | - Liam McCormick
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
| | - Hashrul N. Rashid
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia
| | - James Dargan
- Cardiovascular Clinical Academic Group, St. George’s, University of London and St. George’s University Hospitals NHS Foundation Trust, London, UK
| | - Faisal Khan
- Cardiovascular Clinical Academic Group, St. George’s, University of London and St. George’s University Hospitals NHS Foundation Trust, London, UK
| | - Sami Firoozi
- Cardiovascular Clinical Academic Group, St. George’s, University of London and St. George’s University Hospitals NHS Foundation Trust, London, UK
| | - Stephen J. Brecker
- Cardiovascular Clinical Academic Group, St. George’s, University of London and St. George’s University Hospitals NHS Foundation Trust, London, UK
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9
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Dowling C, Gooley R, McCormick L, Firoozi S, Brecker SJ. Patient-specific computer simulation to predict long-term outcomes after transcatheter aortic valve replacement. J Cardiovasc Comput Tomogr 2021; 16:254-261. [PMID: 34887238 DOI: 10.1016/j.jcct.2021.11.014] [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: 08/10/2021] [Revised: 10/02/2021] [Accepted: 11/24/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Patient-specific computer simulation may predict the development of paravalvular regurgitation (PVR) after transcatheter aortic valve replacement (TAVR). We hypothesised that patient-specific computer simulation might identify patients at risk for long-term adverse outcomes after TAVR. METHODS A multi-centre retrospective study was performed on patients with symptomatic severe aortic stenosis who had undergone TAVR with a self-expanding transcatheter heart valve (THV). Pre-procedural cardiac computed tomography imaging was used to create finite element models of the aortic root. Finite element analysis (FEA) was performed in order to simulate the interaction between the THV and the native anatomy. The blood domain was extracted from the FEA output and computational fluid dynamics (CFD) simulation undertaken. Predicted PVR was recorded in the left ventricular outflow tract. Patients were classified into those where computer simulation predicted no significant PVR (predicted PVR from CFD <16.0 mL/s) and those where computer simulation predicted significant PVR (predicted PVR from CFD ≥16.0 mL/s). RESULTS A total of 203 patients were included in the study. THVs implanted were CoreValve (n = 20), Evolut R (n = 90) and Evolut PRO (n = 93). At 2 years, the Kaplan-Meier estimate of the rate of death from any cause was higher in the group where CFD simulation predicted significant PVR (35.8% vs. 16.3%; hazard ratio, 2.62; 95% confidence interval, 1.29 to 5.30; P = 0.006 by log-rank test). CONCLUSIONS Computer simulation may identify patients who are at a higher risk for death after TAVR.
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Affiliation(s)
- Cameron Dowling
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia.
| | - Robert Gooley
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia.
| | - Liam McCormick
- MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia.
| | - Sami Firoozi
- Cardiovascular Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom.
| | - Stephen J Brecker
- Cardiovascular Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom.
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10
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Pompeu Sá M, Sicouri S, Ramlawi B. Selection of transcatheter heart valves: The plethora of device-specific, anatomic-specific and patient-specific aspects for optimal results in transcatheter aortic valve replacement. Trends Cardiovasc Med 2021:S1050-1738(21)00118-3. [PMID: 34678424 DOI: 10.1016/j.tcm.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 10/11/2021] [Indexed: 11/23/2022]
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11
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Dalén M, Persson M, Glaser N, Sartipy U. Sex and permanent pacemaker implantation after surgical aortic valve replacement. Ann Thorac Surg 2021; 114:1621-1627. [PMID: 34648811 DOI: 10.1016/j.athoracsur.2021.09.009] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 08/23/2021] [Accepted: 09/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND We performed a nationwide population-based cohort study to investigate sex differences in rate of permanent pacemaker implantation after surgical aortic valve replacement (AVR). METHODS This study included all adult patients who underwent primary AVR in Sweden between 2005 and 2018. Study data were obtained from the SWEDEHEART register and other Swedish national health-data registers. The rate of permanent pacemaker implantation within 30 days of surgery was compared between men and women. We estimated propensity scores that was used for inverse probability of treatment weighting to account for sex differences in patient characteristics. RESULTS A total of 18131 patients were included, 11657(64%) men and 6474(36%) women. The rate of permanent pacemaker implantation did not differ between women and men (3.8% (95% CI, 3.2%-4.3%) vs. 3.7% (95%CI, 3.3%-4.1%);p=0.831). In patients <60 years of age, the rate of permanent pacemaker implantation was significantly higher in women (6.2% (95%CI, 4.3%-8.0%) vs. 3.6% (95%CI, 2.8%-4.4%);p=0.006). The odds of pacemaker implantation in patients <60 years of age was significantly higher in women (odds ratio, 1.76; 95%CI, 1.17-2.63;p=0.006). In patients aged 60-79 years and ≥80 years, the rate of pacemaker implantation did not differ between men and women. CONCLUSIONS The rate of permanent pacemaker implantation after surgical AVR in patients <60 years of age was higher in women than men. The susceptibility to conduction disturbances requiring permanent pacemaker implantation in women below 60 years warrants further investigation and should be recognized as transcatheter aortic valve replacement expands into younger patients.
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Affiliation(s)
- Magnus Dalén
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
| | - Michael Persson
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Natalie Glaser
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Stockholm South General Hospital, Stockholm, Sweden
| | - Ulrik Sartipy
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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12
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Ricco JB, Castagnet H, Christiaens L, Palazzo P, Lamy M, Mergy J, Corbi P, Neau JP. Predictors of Early Stroke or Death in Patients Undergoing Transcatheter Aortic Valve Implantation. J Stroke Cerebrovasc Dis 2021; 30:105912. [PMID: 34130105 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105912] [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: 02/02/2021] [Revised: 05/05/2021] [Accepted: 05/23/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND/OBJECTIVE While postoperative stroke is a known complication of Transcatheter Aortic Valve Implantation (TAVI), predictors of early stroke occurrence have not been specifically reviewed. The objective of this study was to estimate the predictors and incidence of stroke during the first 30 days post-TAVI. METHODS A cohort of 506 consecutive patients having undergone TAVI between January 2017 and June 2019 was extracted from a prospective database. Preoperative, intraoperative and postoperative characteristics were analyzed by univariate analysis followed by logistic regression to find predictors of the occurrence of stroke or death within the first 30 days after the procedure. RESULTS Incidence of stroke within 30 days post-TAVI was 4.9%, [CI 95% 3.3-7.2], i.e., 25 strokes. Four out of the 25 patients (16%) with a stroke died within 30 days post-TAVI. After logistic regression analysis, the predictors of early stroke related to TAVI were: CHA2Ds2VASc score ≥ 5 (odds ratio [OR] 2.62; 95% CI: 1.06-6.49; p = .037), supra-aortic access vs. femoral access (OR: 9.00, 95%CI: 2.95-27.44; p = .001) and introduction post-TAVI of a single vs. two or three antithrombotic agents (OR: 5.13; CI 95%: 1.99 to 13.19; p = .001). Over the 30-day period, bleeding occurred in 28 patients (5.5%), in 25 of whom, it was associated with femoral or iliac artery access injury. Anti-thrombotic regimen was not associated with bleeding; two patients out of 48 (4.1%) bled with a single anti-thrombotic regimen vs. 26 patients out of 458 (5.6%) with a dual or triple anti-thrombotic regimen (p = 0.94). The overall 30-day mortality rate was 3.9%, [95% CI 2.5-6.0]. Patients with a single post-TAVI antithrombotic agent (OR: 44.07 [CI 95% 13.45-144.39]; p < .0001) and patients with previous coronary artery bypass surgery or coronary artery stenting (OR: 6.16, [CI 95% 1.99-21.29]; p = .002) were at significantly higher risk of death within the 30-day period. CONCLUSION In this large-scale single-center retrospective study, a single post-TAVI antithrombotic regimen independently predicted occurrence of early stroke or death. Dual or triple antithrombotic regimen was not associated with a higher risk of bleeding and should be considered as an option in patients undergoing TAVI.
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Affiliation(s)
- Jean-Baptiste Ricco
- Department of Clinical Research, CHU La Milétrie, Poitiers, France and University of Poitiers, France..
| | - Hélène Castagnet
- Department of Neurology, CHU La Milétrie, Poitiers, France and University of Poitiers, France
| | - Luc Christiaens
- Department of Cardiology, CHU La Milétrie, Poitiers, France and University of Poitiers, France
| | - Paola Palazzo
- Department of Neurology, CHU La Milétrie, Poitiers, France and University of Poitiers, France
| | - Matthias Lamy
- Department of Neurology, CHU La Milétrie, Poitiers, France and University of Poitiers, France
| | - Jean Mergy
- Department of Cardiology, CHU La Milétrie, Poitiers, France and University of Poitiers, France
| | - Pierre Corbi
- Department of Cardiothoracic Surgery, CHU La Milétrie, Poitiers, France and University of Poitiers, France (PC.,)
| | - Jean-Philippe Neau
- Department of Neurology, CHU La Milétrie, Poitiers, France and University of Poitiers, France
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13
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Zhou XY, Xu LF, Chang X, Sun L, Guo Z. [Application of autologous platelet-rich plasma separation in cardiac valve replacement: a random clinical trial]. Zhonghua Wai Ke Za Zhi 2020; 58:924-928. [PMID: 33249810 DOI: 10.3760/cma.j.cn112139-20191231-00647] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To examine the blood protective effect of autologous platelet-rich plasma separation for cardiac valve replacement under cardiopulmonary bypass. Methods: Sixty patients who underwent cardiac valve replacement under cardiopulmonary bypass from August 2018 to May 2019 in Shanghai Chest Hospital, Shanghai Jiao Tong University were randomly divided into control and treatment groups(each 30 cases). There were 33 males and 27 females, aged (52.0±8.4) years (range: 35 to 65 years). Autologous platelet separation was performed in the treatment group after anaesthesia administration and was completed before systemic heparinisation. Platelet separation was not performed in the control group. The thromboelastogram, blood routine, blood coagulation, perioperative fluid infusion, allogeneic blood transfusion, postoperative pleural fluid volume and postoperative fibrinogen were recorded before the operation, and 1 hour and 24 hours post operation. The two groups' data was compared by t test, Kruskal-Wallis test, Mann-Whitney U test or χ(2) test. Repeated measurement analysis of variance was used to compare platelet and coagulation indexes at different times. Results: The perioperative red blood cell transfusion of 0, 1~2, 3~4,>4 units with 6, 11, 1, 12 cases in treatment group and 14, 8, 6, 2 cases in control group (Z=-2.516, P=0.012). The postoperative fibrinogen of 0, 1, 2 units with 19, 2, 9 cases in treat group and 26, 2, 2 cases in control group (Z=-2.190, P=0.029). There was no significant difference in the cost of blood transfusion between the two groups during admission ((1 732±1 275) yuan vs. (1 176±941) yuan; t=-1.570, P=0.125). Conclusion: The use of autologous platelet-rich plasma separation can reduce the amount of allogeneic blood transfusion during valvular surgery under cardiopulmonary bypass.
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Affiliation(s)
- X Y Zhou
- Department of Cardiac Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - L F Xu
- Department of Cardiac Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - X Chang
- Department of Cardiac Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - L Sun
- Department of Cardiac Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Z Guo
- Department of Cardiac Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
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14
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Vigelius-Rauch U, Zajonz T, Sander M. [Anesthesiological implications of minimally invasive valve interventions : Transcatheter aortic valve implantation, clip reconstruction on the mitral and tricuspid valve]. Anaesthesist 2021; 70:97-111. [PMID: 33006625 DOI: 10.1007/s00101-020-00847-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Catheter-guided interventional implantation of cardiac valves is one of the main developments in cardiology over the past 15 years. It is characterized by a close interdisciplinary cooperation in the heart team (H-team), which consists of cardiac anesthesiologists, cardiologists and heart surgeons. This co-responsibility for anesthesia, which is demanded by the legislator (Federal Joint Committee, G‑BA, July 2015), includes not only qualified training for the cardiac anesthesiologist, including transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) but also several years of experience in cardiac anesthesia and correlates with the recommendations of the German Society for Anaesthesiology and Intensive Care Medicine. In accompaniment with the demographic development, the number of heart valve diseases increases with age. More than 50% of all heart operations are performed on patients over the age of 70 years and nearly 20% on patients over the age of 80 years. Minimally invasive procedures are outstanding opportunities for patients who were initially classified as inoperable. Therefore, anesthesiologists must have precise knowledge of the possible complications related to the procedure itself. Additionally, it challenges the anesthesiologist with unconventional situations in the care of older patients who are exposed to a higher risk. The aforementioned risks are organic functional restrictions, increasing number of comorbidities and more severe exposure due to malnutrition and frailty; however, monitoring methods are also being developed aiming for patient-specific anesthesia management and analgesia treatment. This article discusses the interventional procedures of heart valvular diseases as well as the hemodynamic changes associated with the procedures from the anesthesiologist's point of view. To present examples, we have selected transcatheter aortic valve replacement (TAVR) and the interventional procedure of mitral and tricuspid valve insufficiency called MitraClip and TricaClip. A thorough examination of the procedural risk rate shows that despite minimizing the surgical intervention by miniaturizing the devices, the presence of an experienced cardiac anesthesiologist is obligatory.
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15
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Hiremath CS, Jain AR, Garg A, Gupta N, Mishra YK, Meharwal ZS, Thakur N, Maslekar AA, Shastri N. Clinical outcomes and hemodynamic performance of Dafodil™ aortic and mitral pericardial bioprosthesis: 1-year results from Dafodil-1 first-in-human trial. J Cardiothorac Surg 2020; 15:140. [PMID: 32539847 PMCID: PMC7294644 DOI: 10.1186/s13019-020-01154-7] [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: 03/12/2020] [Accepted: 05/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bioprosthesis has been increasingly implanted for the treatment of transvalvular disease across the world. A new Dafodil™ pericardial bioprosthesis (Meril Life Sciences Pvt. Ltd., India) recently approved by Conformité Européenne (CE) is a tri-leaflet, stented, bovine valve. The purpose of Dafodil-1 first-in-human trial was to evaluate clinical safety and performance (including hemodynamic parameters) of the Dafodil pericardial bioprosthesis in patients who underwent aortic or mitral valve replacement. METHODS This prospective, multicenter clinical trial enrolled 60 patients (Aortic: 30 patients; Mitral: 30 patients) from seven sites across India. Safety endpoints were early (≤30 days) and late (> 30 days) mortality and valve-related morbidity. The performance endpoints were hemodynamic performance, improvement in NYHA functional class, and change in the quality of life using SF-12v1 health survey. RESULTS From July 2017 to July 2018, 60 patients underwent implantation of the Dafodil pericardial bioprosthesis. Post-operatively, NYHA functional class significantly improved in all the patients (Aortic: 90% NYHA class-I and 10% NYHA class-II; Mitral: 96.55% NYHA class-I and 3.45% NYHA class-II; P < 0.001). There was no death in aortic valve replacement patients till 12-month. In mitral valve replacement patients, early mortalities occurred in three patients, and late mortality occurred in one patient; none of these were valve-related. Freedom from all-cause mortality reported was 93.33% at 12-month. Mean aortic pressure gradient decreased from 52.71 ± 24.47 mmHg [with 0.89 ± 0.70 cm2 effective orifice area (EOA)] pre-operatively to 14.49 ± 6.58 mmHg (EOA: 1.85 ± 0.27 cm2) at 12-month. Overall, the mitral mean pressure gradient and EOA were 4.41 ± 1.69 mmHg and 2.67 ± 0.48 cm2, respectively, at 12-month. Significant improvement (P < 0.05) in the patients' quality of life was reported at all follow-ups. CONCLUSIONS The clinical safety and performance of the Dafodil pericardial bioprosthesis were favourable at 12-month. Moreover, a study with a larger patient population and longer follow-up is warranted to further assess the device. TRIAL REGISTRATION Dafodil-1 trial has been prospectively registered on 10/07/2017 under Clinical Trial Registry-India (http://www.ctri.nic.in). (Registration number: CTRI/2017/07/009008).
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Affiliation(s)
- C S Hiremath
- Department of Cardiothoracic Vascular Surgery, Sri Sathya Sai Institute of Higher Medical Sciences, Whitefield, Bengaluru, Karnataka, 560066, India
| | - Anil R Jain
- Department of Cardiovascular and Thoracic Surgery, Epic Hospital, Sola, Ahmedabad, Gujarat, 380081, India
| | - Anurag Garg
- Department of Cardiovascular and Thoracic Surgery, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pimpri, Pune, Maharashtra, 411018, India
| | - Nirmal Gupta
- Department of Cardiovascular and Thoracic Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226014, India
| | - Yugal K Mishra
- Department of Cardiac Science, Manipal Hospital, Dwarka, New Delhi, 110075, India
| | - Zile Singh Meharwal
- Department of Cardiovascular Surgery, Fortis Escorts Heart Institute & Research Centre, Okhla Road, New Delhi, 110025, India
| | - Nityanand Thakur
- Department of Cardiovascular and Thoracic Surgery, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Jay Prakash Narayan road, Pune, Maharashtra, 411001, India
| | - Atul A Maslekar
- Department of Cardiac Surgery - Adult, Narayana Multispeciality Hospital, Rakhial, Ahmedabad, Gujarat, 380023, India
| | - Naman Shastri
- Department of Anaesthesia and Intensive Care, Epic Hospital, Sola, Sarkhej - Gandhinagar Highway, Opp. Kargil Petrol Pump, Ahmedabad, Gujarat, 380081, India.
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16
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Moon I, Kim M, Choi JW, Park JB, Hwang HY, Kim HK, Kim YJ, Kim KH, Kim KB, Sohn DW, Lee SP. Early Surgery versus Watchful Waiting in Patients with Moderate Aortic Stenosis and Left Ventricular Systolic Dysfunction. Korean Circ J 2020; 50:791-800. [PMID: 32725989 PMCID: PMC7441005 DOI: 10.4070/kcj.2020.0037] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 01/29/2020] [Revised: 04/20/2020] [Accepted: 05/12/2020] [Indexed: 12/03/2022] Open
Abstract
Background and Objectives Severe aortic stenosis (AS) with left ventricular systolic dysfunction (LVSD) is a class I indication for aortic valve replacement (AVR) but this recommendation is not well established in those at the stage of moderate AS. We investigate the clinical impact of AVR among patients with moderate AS and LVSD. Methods From 2001 to 2017, we consecutively identified patients with moderate AS and LVSD, defined as aortic valve area 1.0–1.5 cm2 and left ventricular ejection fraction <50%. The primary outcome was all-cause death. The outcomes were compared between those who underwent early surgical AVR (within 2 years of index echocardiography) at the stage of moderate AS versus those who were followed medically without AVR at the outpatient clinic. Results Among 255 patients (70.1±11.3 years, male 62%), 37 patients received early AVR. The early AVR group was younger than the medical observation group (63.1±7.9 vs. 71.3±11.4) with a lower prevalence of hypertension and chronic kidney disease. During a median 1.8-year follow up, 121 patients (47.5%) died, and the early AVR group showed a significantly lower all-cause death rate than the medical observation group (5.03PY vs. 18.80PY, p<0.001). After multivariable Cox-proportional hazard regression adjusting for age, sex, comorbidities, and laboratory data, early AVR at the stage of moderate AS significantly reduced the risk of death (hazard ratio, 0.43; 95% confidence interval 0.20–0.91; p=0.028). Conclusions In patients with moderate AS and LVSD, AVR reduces the risk of all-cause death. A prospective randomized trial is warranted to confirm our findings.
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Affiliation(s)
- Inki Moon
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Minkwan Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jae Woong Choi
- Department of Cardiovascular Thoracic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Jun Bean Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ho Young Hwang
- Department of Cardiovascular Thoracic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hyung Kwan Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yong Jin Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kyung Hwan Kim
- Department of Cardiovascular Thoracic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Ki Bong Kim
- Department of Cardiovascular Thoracic Surgery, Seoul National University Hospital, Seoul, Korea
| | - Dae Won Sohn
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seung Pyo Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
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17
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Gold BM, Parekh DR, Kearney DL, Silva GV, Fish RD, Stainback RF. Forme Fruste Cor Triatriatum Dexter by Transesophageal Echocardiography and Its Impact on Percutaneous Heart Procedures: A Case Series. ACTA ACUST UNITED AC 2019; 3:189-199. [PMID: 31709369 PMCID: PMC6833460 DOI: 10.1016/j.case.2019.05.004] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cor triatriatum dexter (CTD) can complicate percutaneous atrial septal interventions. Clinically silent (forme fruste) CTD is detectable by new echocardiography techniques. Using these techniques could improve patient selection and guide interventions.
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Affiliation(s)
- Benjamin M Gold
- Department of Internal Medicine, Baylor College of Medicine, Houston, Texas
| | - Dhaval R Parekh
- Department of Cardiology, Texas Heart Institute, Houston, Texas.,Department of Cardiology, Baylor St. Luke's Medical Center, Houston, Texas.,Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Debra L Kearney
- Department of Pathology, Texas Children's Hospital, Houston, Texas.,Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas
| | - Guilherme V Silva
- Department of Cardiology, Texas Heart Institute, Houston, Texas.,Department of Cardiology, Baylor St. Luke's Medical Center, Houston, Texas.,Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - R David Fish
- Department of Cardiology, Texas Heart Institute, Houston, Texas.,Department of Cardiology, Baylor St. Luke's Medical Center, Houston, Texas
| | - Raymond F Stainback
- Department of Cardiology, Texas Heart Institute, Houston, Texas.,Department of Cardiology, Baylor St. Luke's Medical Center, Houston, Texas.,Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
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18
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El Midany AA, Mostafa EA, Hikal T, Elbarbary MG, Doghish A, Khorshid R, Abdelgawad BM, Sharaa M, El-Sokkary IN, Hossiny ME, Abdelmoaty H, Elkhonezy BA. Incidence and predictors of mismatch after mechanical mitral valve replacement. Asian Cardiovasc Thorac Ann 2019; 27:535-541. [PMID: 31390876 DOI: 10.1177/0218492319869560] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Patient-prosthesis mismatch after mitral valve replacement has an unfavorable postoperative hemodynamic outcome, which underlines the importance of identifying and preventing prosthesis- and patient-related risk factors. This study was conducted to determine the incidence and identify possible predictors of patient-prosthesis mismatch. Methods A prospective study was conducted on 715 patients with a mean age of 42 ± 11 years who underwent mechanical mitral valve replacement between 2013 and 2017. The effective orifice area of the prostheses was estimated by the continuity equation, and a mismatch was defined as an effective orifice area index ≤1.2 cm2·m−2. The mean clinical and echocardiographic follow-up was 26.74 ± 11.58 months. Multivariate regression analysis was performed to identify predictors of patient-prosthesis mismatch. Results Patient-prosthesis mismatch was detected in 382 (53.4%) patients. A small mechanical prosthesis (<27 mm) was inserted in 54.3%. Mortality during follow-up was 9% (65 patients). Patient-prosthesis mismatch was identified in patients with preoperative rheumatic mitral valve pathology, associated tricuspid regurgitation, higher New York Heart Association class, preoperative atrial fibrillation, mitral stenosis, and small preoperative left ventricular dimensions. Multivariate analysis identified mitral stenosis, preoperative atrial fibrillation, and small postoperative left ventricular end-diastolic dimension as risk factors for patient-prosthesis mismatch. Conclusion Patient-prosthesis mismatch is a common sequela after mechanical mitral valve replacement. Identification of predictors of patient-prosthesis mismatch can help so that a preoperative strategy can be implemented to avoid its occurrence.
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Affiliation(s)
- Ashraf Ah El Midany
- 1 Department of Cardiovascular & Thoracic Surgery, Ain-Shams University Hospital, Faculty of Medicine, Cairo, Egypt
| | - Ezzeldin A Mostafa
- 1 Department of Cardiovascular & Thoracic Surgery, Ain-Shams University Hospital, Faculty of Medicine, Cairo, Egypt
| | - Tamer Hikal
- 1 Department of Cardiovascular & Thoracic Surgery, Ain-Shams University Hospital, Faculty of Medicine, Cairo, Egypt
| | - Mostafa G Elbarbary
- 1 Department of Cardiovascular & Thoracic Surgery, Ain-Shams University Hospital, Faculty of Medicine, Cairo, Egypt
| | - Ayman Doghish
- 1 Department of Cardiovascular & Thoracic Surgery, Ain-Shams University Hospital, Faculty of Medicine, Cairo, Egypt
| | - Ramy Khorshid
- 1 Department of Cardiovascular & Thoracic Surgery, Ain-Shams University Hospital, Faculty of Medicine, Cairo, Egypt
| | - Basem M Abdelgawad
- 2 Department of Cardiovascular & Thoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt
| | - Mohamed Sharaa
- 3 Department of Cardiovascular & Thoracic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ismail N El-Sokkary
- 3 Department of Cardiovascular & Thoracic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohamed El Hossiny
- 3 Department of Cardiovascular & Thoracic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Haytham Abdelmoaty
- 3 Department of Cardiovascular & Thoracic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Bahaa A Elkhonezy
- 3 Department of Cardiovascular & Thoracic Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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19
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Kisamori E, Otani S, Yamamoto T, Nishiki M, Yamada Y, Matsumoto T. Concomitant aortic valve replacement, mitral valve replacement, and coronary artery bypass grafting for aortic stenosis and mitral regurgitation in a patient with relapsing polychondritis. Gen Thorac Cardiovasc Surg 2020; 68:185-9. [PMID: 31041726 DOI: 10.1007/s11748-019-01130-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 04/23/2019] [Indexed: 10/26/2022]
Abstract
Relapsing polychondritis is a rare multi-system disease characterized by inflammation in cartilaginous structures and other connective tissues. Cardiovascular complications occur in 10-51% of the patients. We report a case of concomitant aortic valve replacement, mitral valve replacement, and coronary artery bypass grafting in a patient with relapsing polychondritis. A 71-year-old female with relapsing polychondritis on prednisolone (5 mg/day) for 15 years presented at our hospital for further evaluation of valvular disease. Severe aortic stenosis and severe mitral regurgitation were diagnosed. We performed aortic and mitral valve replacement. During surgery, we found connective tissue surrounding the intima of the sinus of Valsalva and stenosis of the right coronary artery ostium, which was not noted on preoperative coronary angiography. We removed the tissue and performed bypass grafting to the right coronary artery. Postoperative recovery was uneventful, and she was discharged 27 days after surgery.
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20
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Lee JS, Kim KH, Choi JW, Hwang HY, Kim KB. Surgical Treatment of Degenerative Mitral Valve Regurgitation in the Elderly: Comparison of Early and Long-Term Outcomes Using Propensity Score Matching Analysis. Korean J Thorac Cardiovasc Surg 2018; 51:367-375. [PMID: 30588444 PMCID: PMC6301326 DOI: 10.5090/kjtcs.2018.51.6.367] [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] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/01/2018] [Accepted: 10/01/2018] [Indexed: 12/03/2022]
Abstract
Background It is unclear whether mitral valve (MV) repair for degenerative mitral regurgitation (MR) provides the same advantages in the elderly that it does in the general population. Methods From 1994 to 2016, 188 elderly patients (mean age, 68.3±5.50 years) underwent MV repair (n=153) or MV replacement (n=35) for primary degenerative MR. Early and long-term outcomes were compared before and after propensity score matching (PSM). Results Before PSM, there was a significant difference in operative mortality (p=0.011). Overall survival and freedom from cardiac-related death (CRD) at 5, 10, and 15 years were significantly higher in patients who underwent MV repair (p=0.039 and p=0.007, respectively). In the multivariable analysis, MV replacement was an independent risk factor of CRD. After PSM, operative mortality was not significantly lower in patients who underwent MV repair (p=0.125). Overall survival and freedom from CRD at 5, 10, and 15 years showed no significant difference between the 2 groups in the PSM cohort (p=0.207, p=0.47, respectively). There was no significant difference in freedom from reoperation before or after PSM (p=0.963 and p=0.575, respectively). Conclusion MV repair for primary degenerative MR might be a valid option in the elderly population if successful repair is possible.
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Affiliation(s)
- Joon Seok Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine
| | - Kyung Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine
| | - Jae Woong Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine
| | - Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine
| | - Ki-Bong Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine
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21
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Liu H, Yang Y, Lu YT, Zhu LM, Zhu D, Guo YQ, Wang W, Wei L, Wang CS; Hamidi. [Transapical transcatheter aortic valve replacement for high risk pure non-calcified aortic regurgitation: two years outcome of a multi-center study]. Zhonghua Wai Ke Za Zhi 2018; 56:910-5. [PMID: 30497118 DOI: 10.3760/cma.j.issn.0529-5815.2018.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To report on the two years outcome of Chinese multi-center study of the treatment of high risk non-calcified pure aortic regurgitation with transcatheter heart valve replacement (TAVR) using domestic made J-Valve™ system. Methods: The national multi-center clinical study of the treatment of high risk non-calcified pure aortic regurgitation with transcatheter heart valve replacement using domestic made J-Valve™ system was conducted during the period from April 2014 to July 2015. The follow-up time was up to 2 years. Forty-three cases with predominant aortic valve regurgitation were enrolled for transapical implantation of the J-Valve™ system from 3 Chinese centers, including 16 patients from Zhongshan Hospital, Fudan University, 23 patients from West China Hospital, Sichuan University, and 4 patients from Fuwai Cardiovascular Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. There were 30 males and 13 females in this cohort. The age of the patients was (74±6) years (range: 61 to 84 years). The patiens were all sympotmatic preoperatively. All patients were considered at prohibitive or high risk for surgical valve replacement (Logistic European System for Cardiac Operative Risk Evaluation of (25.5±5.3)%, range: 20.0% to 44.4%) after evaluation by an interdisciplinary heart team. Comprehensive clinical and echocardiographic assessments were scheduled before discharge and at 30 days, 12 months, and 24 months after the procedure. Results: One patients was converted to surgical aortic valve replacement (SAVR) due to valve embolism into the arch. The other 42 cases had J-Valve™ systems implanted successfully. One patient died from multi-organ disorder due to paravalvular leak (PVL) during perioperative period. There was no acute myocardial infarction, stroke or coronary obstruction during the perioperative period. The median follow-up time was 725 days (range: 6 to 1 082 days). There were 5 patients died during the 2 years, follow-up, 2 patients had stroke, 2 patients had permanent pacemaker implanted. Three patients had valve related reinterventions: One for intraoperative valve embolism into the aortic arch followed by a conversion to SAVR which was mentioned above. One patient underwent SAVR on the postoperative day 6 due to moderate PVL and ventricular dysfunction. One patient underwent SAVR 6 months after primary procedure due to prosthesis thrombosis and severe aortic valve stenosis.Thirty-six patients with J-valve™ implanted survived to the latest echocardiogram follow-up, 25 patients had trivial or less PVL, 9 patients had mild PVL, and the transvalvular gradient after valve implantation was favorable at (9.8±5.8) mmHg (1 mmHg=0.133 kPa). Conclusions: Transapical implantation of domestic made J-Valve™ transcatheter heart valve system for patients with predominant aortic regurgitation has a excellent early outcome. This novel technology is safe and effective.
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22
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Yun Y, Kim YH, Kwon JE. The change of QRS duration after pulmonary valve replacement in patients with repaired tetralogy of Fallot and pulmonary regurgitation. Korean J Pediatr 2018; 61:362-365. [PMID: 30360038 PMCID: PMC6258967 DOI: 10.3345/kjp.2018.06765] [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] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 10/24/2018] [Indexed: 11/27/2022]
Abstract
Purpose This study aimed to analyze changes in QRS duration and cardiothoracic ratio (CTR) following pulmonary valve replacement (PVR) in patients with tetralogy of Fallot (TOF). Methods Children and adolescents who had previously undergone total repair for TOF (n=67; median age, 16 years) who required elective PVR for pulmonary regurgitation and/or right ventricular out tract obstruction were included in this study. The QRS duration and CTR were measured pre- and postoperatively and postoperative changes were evaluated. Results Following PVR, the CTR significantly decreased (pre-PVR 57.2%±6.2%, post-PVR 53.8%±5.5%, P=0.002). The postoperative QRS duration showed a tendency to decrease (pre-PVR 162.7±26.4 msec, post-PVR 156.4±24.4 msec, P=0.124). QRS duration was greater than 180 msec in 6 patients prior to PVR. Of these, 5 patients showed a decrease in QRS duration following PVR; QRS duration was less than 180 msec in 2 patients, and QRS duration remained greater than 180 msec in 3 patients, including 2 patients with diffuse postoperative right ventricular outflow tract hypokinesis. Six patients had coexisting arrhythmias before PVR; 2 patients, atrial tachycardia; 3 patients, premature ventricular contraction; and 1 patient, premature atrial contraction. None of the patients presented with arrhythmia following PVR. Conclusion The CTR and QRS duration reduced following PVR. However, QRS duration may not decrease below 180 msec after PVR, particularly in patients with right ventricular outflow tract hypokinesis. The CTR and ECG may provide additional clinical information on changes in right ventricular volume and/or pressure in these patients.
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Affiliation(s)
- Yuni Yun
- Division of Pediatric Cardiology, Department of Pediatrics, Kyungpook National University Children's Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Yeo Hyang Kim
- Division of Pediatric Cardiology, Department of Pediatrics, Kyungpook National University Children's Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jung Eun Kwon
- Division of Pediatric Cardiology, Department of Pediatrics, Kyungpook National University Children's Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
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23
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Sangani NK, Naliath SM. Fever and large pericardial effusion after valve surgery: can be malaria. Asian Cardiovasc Thorac Ann 2018; 27:224-225. [PMID: 30269522 DOI: 10.1177/0218492318805337] [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] [Indexed: 11/17/2022]
Abstract
A 37-year-old man underwent mechanical mitral valve replacement for rheumatic heart disease. One week after discharge, he presented with high-grade fever with chills, malaise, and shortness of breath. Echocardiography showed pericardial effusion with no evidence of vegetation. A blood malaria antigen test was positive for Plasmodium falciparum. One week after initiation of antimalarial medication, echocardiography revealed almost complete resolution of the pericardial effusion. Infective endocarditis is a common cause of fever after valvular heart surgery. Malaria can be considered in the differential diagnosis of fever and pericardial effusion after valvular surgery, especially in malaria-endemic countries.
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Affiliation(s)
- Niravkumar K Sangani
- Department of Cardiothoracic Surgery, Ahalia Hospital-Mussafah, Abu Dhabi, United Arab Emirates
| | - Santosh Mathew Naliath
- Department of Cardiothoracic Surgery, Ahalia Hospital-Mussafah, Abu Dhabi, United Arab Emirates
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24
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Ishimaru K, Araki K, Sakamoto S, Sawa Y. Hand-sewn trileaflet valve in the right ventricular outflow tract. Asian Cardiovasc Thorac Ann 2018; 27:213-216. [PMID: 30249111 DOI: 10.1177/0218492318798232] [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] [Indexed: 11/17/2022]
Abstract
A 4-year-old girl with pulmonary regurgitation after complete repair of tetralogy of Fallot, underwent an alternative surgical repair for pulmonary valve replacement. Hand-sewn trileaflet valve reconstruction using expanded polytetrafluoroethylene membrane is a feasible method for pulmonary regurgitation in such a young child in whom a large-sized bioprosthetic valve cannot be implanted.
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Affiliation(s)
- Kazuhiko Ishimaru
- 1 Department of Cardiovascular Surgery, Kanazawa Medical University, Ishikawa, Japan
| | - Kanta Araki
- 2 Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shigeru Sakamoto
- 1 Department of Cardiovascular Surgery, Kanazawa Medical University, Ishikawa, Japan
| | - Yoshiki Sawa
- 2 Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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25
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Abstract
Background Most previous studies dealing with predictors of surgical outcome in prosthetic valve endocarditis included patients with aortic and/or mitral valve prostheses. Here, we concentrate on isolated prosthetic mitral endocarditis due to heterogeneity of epidemiological data, anatomical factors, and surgical techniques between mitral, prosthetic mitral, and aortic endocarditis between prosthetic mitral and prosthetic aortic endocarditis. Methods Data of 40 patients reoperated upon due to isolated prosthetic mitral endocarditis between July 2015 and March 2017 were retrospectively collected and analyzed. Results Independent predictors of major postoperative complications on multivariate analysis were: no blood cultures before referral (odds ratio 6.36, 95% confidence interval: 1.44-28.15), inadequate response to medical treatment (odds ratio 11.38, 95% confidence interval: 1.29-100.25), and serum creatinine ≥2.0 mg·dL-1 (odds ratio 4.56, 95% confidence interval: 1.07-19.36). Independent predictors of hospital mortality were: congestive heart failure (odds ratio 30.91, 95% confidence interval: 2.02 to 473.87), embolization (odds ratio 18.24, 95% confidence interval:1.94-171.91), peri-annular extension of infection (odds ratio 12.68, 95% confidence interval: 1.30-123.43), serum creatinine on admission > 2 mg·dL-1 (odds ratio 9.67, 95% confidence interval: 1.97-47.48), and early prosthetic valve endocarditis (odds ratio 7.80, 95% confidence interval: 1.35-45.00). EuroSCORE II > 5.93% was associated with the highest predictive value for hospital mortality (area under the curve 0.813). Conclusion Certain factors can predict morbidity and mortality in surgery for isolated mitral prosthetic valve endocarditis. EuroSCORE II has a good ability to predict hospital mortality in surgery for mitral prosthetic valve endocarditis.
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Affiliation(s)
- Mohamad Nagy
- Department of Cardiothoracic Surgery, Cairo University, Egypt
| | - Hesham Alkady
- Department of Cardiothoracic Surgery, Cairo University, Egypt
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26
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Chow SC, Lee AP, Ho AM, Chan HH, Underwood MJ, Wan S. Redo tricuspid valve operation in patients with 1 st-generation mitral prostheses. Asian Cardiovasc Thorac Ann 2018; 26:524-528. [PMID: 30099881 DOI: 10.1177/0218492318795545] [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] [Indexed: 11/17/2022]
Abstract
Background In patients with remarkably enlarged cardiac chambers and history of implantation of older types of mitral valve prosthesis, the considerations for reoperative tricuspid valve surgery are not limited to the risks of sternal reentry but also include the dilemma of whether to carry out prophylactic replacement of the normal functioning but outdated prosthesis or leave it in situ. Methods We reviewed our surgical strategy and postoperative 5-year follow-up findings in two patients who underwent redo tricuspid surgery 3 to 4 decades after mechanical mitral valve replacement. Both patients presented with significant symptoms of progressive right heart failure due to severe tricuspid regurgitation, despite optimal medical therapy. Results We found the beating-heart approach to be an effective and safe method for redo tricuspid surgery. Both first-generation mitral mechanical prostheses were not replaced and have remained well functional upon the patients' postoperative 5-year follow-up, respectively. Conclusion For patients with normal functioning first-generation mechanical mitral prostheses, whether to prophylactically replace the prosthesis should be based on an individualized risk-benefit analysis.
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Affiliation(s)
- Simon Cy Chow
- 1 Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Alex Pw Lee
- 2 Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Anthony Mh Ho
- 3 Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Herman Hm Chan
- 1 Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Malcolm J Underwood
- 1 Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Song Wan
- 1 Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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27
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Horehledova B, Mihl C, Hendriks BMF, Eijsvoogel NG, Vainer J, Veenstra LF, Wildberger JE, Das M. Do CTA measurements of annular diameter, perimeter and area result in different TAVI prosthesis sizes? Int J Cardiovasc Imaging 2018; 34:1819-1829. [PMID: 29909590 PMCID: PMC6208923 DOI: 10.1007/s10554-018-1394-1] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 06/06/2018] [Indexed: 11/30/2022]
Abstract
Incorrect prosthesis size has direct impact on patient outcome after transcatheter aortic valve implantation (TAVI) procedure. Currently, annular diameter, area or perimeter may be used for prosthesis size selection. The aim was to evaluate whether the use different annular dimensions would result in the selection of different prosthesis sizes, when assessed in the same TAVI-candidate during the same phase of a cardiac cycle. Fifty consecutive TAVI-candidates underwent retrospectively ECG-gated computed tomography angiography (CTA). Aortic root dimensions were assessed in the 20% phase of the R–R interval. Annular short diameter, perimeter and area were used to select the prosthesis size, based on the industry recommendations for a self-expandable (Medtronic CoreValve; MCV) and balloon-expandable (Edwards Sapien XT Valve; ESV) valve. Complete agreement on selected prosthesis size amongst all three annular dimensions was observed in 62% (31/50; ESV) and 30% (15/50; MCV). Short aortic annulus measurement resulted in a smaller prosthesis size in 20% (10/50; ESV) and in 60% of cases (30/50; MCV) compared to the size suggested by both annular perimeter and area. In 18% (9/50; ESV) and 10% of cases (5/50; MCV) a larger prosthesis would have been selected based on annular perimeter compared to annular diameter and area. Prosthesis size derived from area was always in agreement with at least one other parameter in all cases. Aortic annulus area appears to be the most robust parameter for TAVI-prosthesis size selection, regardless of the specific prosthesis size. Short aortic annulus diameter may underestimate the prosthesis size, while use of annular perimeter may lead to size overestimation in some cases.
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Affiliation(s)
- Barbora Horehledova
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands. .,CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Casper Mihl
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Babs M F Hendriks
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Nienke G Eijsvoogel
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jindrich Vainer
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Leo F Veenstra
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Joachim E Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marco Das
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Diagnostic and Interventional Radiology, Helios Kliniken Duisburg GmbH, Duisburg, Germany
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Abstract
It is well known that a heavily calcified mitral valve significantly increases the perioperative and postoperative risks of mitral valve surgery. A 71-year-old woman was referred to our department with severe mitral valve disease. Cardiac imaging revealed extremely severe calcification of the entire left heart. Surgery was performed through a median sternotomy with standard cardiopulmonary bypass. After dilating the mitral orifice with a balloon, we replaced the valve with a transcatheter Edwards Sapiens 3 aortic valve under direct vision. Seven months after the procedure, the patient was doing well and no longer suffered from dyspnea.
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Affiliation(s)
- Elise Lupon
- 1 Department of Cardiac Surgery, Paul Sabatier University, Toulouse, France
| | - Anais Lemaire
- 2 Department of Cardiac Surgery, University Hospital Rangueil, Toulouse, France
| | - Christophe Cron
- 2 Department of Cardiac Surgery, University Hospital Rangueil, Toulouse, France
| | - Bertrand Marcheix
- 1 Department of Cardiac Surgery, Paul Sabatier University, Toulouse, France
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29
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Abstract
A 76-year-old woman who had been on hemodialysis for 3 years developed ischemic mitral valve insufficiency, tricuspid insufficiency, and chronic atrial fibrillation, and underwent cardiac surgery. On the 4th postoperative day, she experienced a sudden disturbance of consciousness, aphasia, and limb ataxia. Brain computed tomography and magnetic resonance imaging showed no abnormalities. Wernicke's encephalopathy was suspected and the patient was given vitamin B1, whereupon her symptoms gradually improved. On the 42nd postoperative day, she was free of neurological symptoms and discharged.
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30
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Kim DJ, Kim HH, Lee SY, Lee S, Chang BC. Early Clinical Experience with Sutureless Aortic Valve Replacement for Severe Aortic Stenosis. Korean J Thorac Cardiovasc Surg 2018; 51:1-7. [PMID: 29430422 PMCID: PMC5796611 DOI: 10.5090/kjtcs.2018.51.1.1] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 07/10/2017] [Accepted: 07/11/2017] [Indexed: 11/26/2022]
Abstract
Background Sutureless aortic valve replacement (SU-AVR) has been developed as an alternative surgical treatment for patients with symptomatic severe aortic stenosis (AS). The aim of this study was to evaluate the clinical outcomes of SU-AVR through an assessment of hemodynamic performance and safety. Methods From December 2014 to June 2016, a total of 12 consecutive patients with severe AS underwent SU-AVR. The endpoints were overall survival and valve-related complications (paravalvular leakage, valve thrombosis, migration, endocarditis, and permanent pacemaker implantation). The mean follow-up duration was 18.1±8.6 months. Results The mean age of the patients was 77.1±5.8 years and their mean Society of Thoracic Surgeons score was 9.2±17.7. The mean cardiopulmonary bypass and aortic cross-clamp times were 94.5±37.3 minutes and 54.9±12.5 minutes, respectively. Follow-up echocardiography showed good prosthesis function with low transvalvular pressure gradients (mean, 13.9±8.6 mm Hg and peak, 27.2±15.0 mm Hg) at a mean of 9.9±4.2 months. No cases of primary paravalvular leakage, valve thrombosis, migration, or endocarditis were reported. A new permanent pacemaker was implanted in 1 patient (8.3%). The 1-year overall survival rate was 83.3%±10.8%. Conclusion Our initial experience with SU-AVR demonstrated excellent early clinical outcomes with good hemodynamic results. However, there was a high incidence of permanent pacemaker implantation compared to the rate for conventional AVR, which is a problem that should be solved.
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Affiliation(s)
- Do Jung Kim
- Department of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Hyo-Hyun Kim
- Department of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Shin-Young Lee
- Department of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Sak Lee
- Department of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Byung-Chul Chang
- Department of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine
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31
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García Vieites M, Martinez-Sapiña Llanas MJ, Gómez Zincke M, Bouzas Zubeldía B, Bautista-Hernandez V. Mitral valve replacement via a left thoracotomy in dextrocardia and situs solitus. Asian Cardiovasc Thorac Ann 2018; 26:142-145. [PMID: 29338299 DOI: 10.1177/0218492318755180] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Dextrocardia with situs solitus and severe mitral regurgitation is a rare clinical presentation which posse a surgical challenge and requires specific preoperative planning. A 54-year-old women with this anatomy, multiple thoracic procedures, and severe mitral valve regurgitation underwent successful mitral valve replacement with a 27-mm mechanical prosthesis through a left thoracotomy under ventricular fibrillation, on the basis of computed tomography findings. We emphasize the importance of preoperative planning and a surgical approach through a left thoracotomy and under ventricular fibrillation.
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Affiliation(s)
- María García Vieites
- 1 Department of Cardiovascular Surgery, 16811 Coruna University Hospital , Coruna, Spain
| | | | - Marcos Gómez Zincke
- 1 Department of Cardiovascular Surgery, 16811 Coruna University Hospital , Coruna, Spain
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32
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Kawada S, Kuriyama M, Kotani Y, Tsushima S, Tanabe A, Kioka Y. Nonbacterial thrombotic endocarditis involving all four cardiac valves. Asian Cardiovasc Thorac Ann 2017; 26:44-46. [PMID: 29212343 DOI: 10.1177/0218492317748091] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This report describes a case of nonbacterial thrombotic endocarditis caused by Waldenström macroglobulinemia, with diffuse endocardial lesions and involvement of all 4 cardiac valves. A 77-year-old man presented with heart failure due to severe regurgitation of all 4 cardiac valves; surgical repair using bioprosthetic valves was indicated. A pathological study revealed fibrin-triggered thrombus formation that confirmed the diagnosis of nonbacterial thrombotic endocarditis. In cases of nonbacterial thrombotic endocarditis, the underlying cause should be investigated.
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Affiliation(s)
- Sachiko Kawada
- 1 Department of Cardiovascular Surgery, Cardiovascular Centre, 13757 Fukuyama City Hospital , Hiroshima, Japan
| | - Mitsuhito Kuriyama
- 1 Department of Cardiovascular Surgery, Cardiovascular Centre, 13757 Fukuyama City Hospital , Hiroshima, Japan
| | - Yasuhiro Kotani
- 2 Department of Cardiovascular Surgery, Okayama University Hospital, Okayama, Japan
| | - Shou Tsushima
- 3 Department of Cardiovascular Internal Medicine, Cardiovascular Centre, Fukuyama City Hospital, Hiroshima, Japan
| | - Atsushi Tanabe
- 1 Department of Cardiovascular Surgery, Cardiovascular Centre, 13757 Fukuyama City Hospital , Hiroshima, Japan
| | - Yukio Kioka
- 1 Department of Cardiovascular Surgery, Cardiovascular Centre, 13757 Fukuyama City Hospital , Hiroshima, Japan
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33
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Abstract
An unoperated 45-year-old man with double-inlet single left ventricle, transposed great arteries, ventricular septal defect, and pulmonary stenosis presented with mitral and pulmonary valvular vegetations unresponsive to antibiotic therapy. The initial diagnosis was made with echocardiography, and the morphology was delineated with computed tomography and magnetic resonance imaging. The patient underwent mitral valve replacement with a mechanical valve and pulmonary valve vegetectomy. He recovered well and he is currently well two years after the operation.
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Affiliation(s)
- Safak Alpat
- Department of Cardiovascular Surgery, Hacettepe University School of Medicine, Ankara, Turkey
| | - Metin Demircin
- Department of Cardiovascular Surgery, Hacettepe University School of Medicine, Ankara, Turkey
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Abstract
A 42-year-old man with dilated cardiomyopathy and endstage heart failure was evaluated for heart transplantation. He received a MitraClip and Carillon annuloplasty device for functional mitral regurgitation as palliation for his heart failure. Subsequently, he underwent successful heart transplantation.
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Affiliation(s)
- Nainar Madhu Sankar
- 1 Department of Cardiothoracic Surgery, Frontier Lifeline Hospital, Chennai, Tamil Nadu, India
| | - Salla Sweta Ramani
- 1 Department of Cardiothoracic Surgery, Frontier Lifeline Hospital, Chennai, Tamil Nadu, India
| | - Rajaram Anantharaman
- 2 Department of Cardiology, Frontier Lifeline Hospital, Chennai, Tamil Nadu, India
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Lee SH, Youn YN, Chang BC, Joo HC, Lee S, Yoo KJ. Effect of Patient-Prosthesis Mismatch in Aortic Position on Late-Onset Tricuspid Regurgitation and Clinical Outcomes after Double Valve Replacement. Yonsei Med J 2017; 58:968-974. [PMID: 28792140 PMCID: PMC5552651 DOI: 10.3349/ymj.2017.58.5.968] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 06/08/2017] [Accepted: 06/27/2017] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Significant late-onset tricuspid regurgitation (TR) is unfortunately common after double valve replacement (DVR); however, its underlying factors remain undefined. We evaluated the effect of aortic patient-prosthesis mismatch (PPM) on late-onset TR and clinical outcomes after DVR. MATERIALS AND METHODS Of the 2392 consecutive patients who underwent aortic valve replacement between January 1990 and May 2014 at our institution, we retrospectively studied 462 patients who underwent DVR (excluding concomitant tricuspid valvular annuloplasty or replacement). Survival and freedom from grade >3 TR were compared between PPM (n=152) and non-PPM (n=310) groups using the Kaplan-Meier method. RESULTS Although the overall survival rates were similar between the two groups at 5 and 10 years (95%, 91% vs. 96%, 93%, p=0.412), grade >3 TR-free survival was significantly lower in the PPM group (98%, 91% vs. 99%, 95%, p=0.014). Small body-surface area, atrial fibrillation, PPM, and subaortic pannus were risk factors for TR progression. However, aortic prosthesis size and trans-valvular pressure gradient were not significant factors for either TR progression or overall survival. CONCLUSION Aortic PPM in DVR, regardless of mitral prosthesis size, was associated with late TR progression, but was not significantly correlated with overall survival. Therefore, we recommend careful echocardiographic follow-up for the early detection of TR progression in patients with aortic PPM in DVR.
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Affiliation(s)
- Seung Hyun Lee
- Division of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Nam Youn
- Division of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Chul Chang
- Division of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Chel Joo
- Division of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sak Lee
- Division of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
| | - Kyung Jong Yoo
- Division of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Hegazy YY, Rayan A, Bauer S, Keshk N, Bauer K, Ennker I, Ennker J. Current indications for stentless aortic bioprostheses. Asian Cardiovasc Thorac Ann 2017; 26:19-27. [PMID: 28699388 DOI: 10.1177/0218492317721411] [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] [Indexed: 11/16/2022]
Abstract
The best aortic prostheses have been debated for decades. The introduction of stentless aortic bioprostheses was aimed at improving hemodynamics and potentially the durability of aortic bioprostheses. Despite the good short- and long-term outcomes after implantation of stentless aortic bioprostheses, their use remains limited owing to the technically demanding implantation techniques. Nevertheless, stentless aortic bioprostheses might be of special benefit in certain indications, where they could be a valuable addition to the surgical armamentarium.
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Affiliation(s)
- Yasser Y Hegazy
- 1 Department of Cardiac Surgery, Heart Institute Lahr/Baden, Lahr, Germany.,2 Department of Cardio-Thoracic Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Amr Rayan
- 1 Department of Cardiac Surgery, Heart Institute Lahr/Baden, Lahr, Germany.,2 Department of Cardio-Thoracic Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Stefan Bauer
- 1 Department of Cardiac Surgery, Heart Institute Lahr/Baden, Lahr, Germany
| | - Noha Keshk
- 1 Department of Cardiac Surgery, Heart Institute Lahr/Baden, Lahr, Germany
| | - Kerstin Bauer
- 1 Department of Cardiac Surgery, Heart Institute Lahr/Baden, Lahr, Germany
| | - Ina Ennker
- 3 Department of Plastic-, Aesthetic-, Hand- and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
| | - Jürgen Ennker
- 1 Department of Cardiac Surgery, Heart Institute Lahr/Baden, Lahr, Germany.,4 Faculty of Health, School of Medicine, University of Witten Herdecke, Witten, Germany
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Friedman T, Cohen O, Ziser A, Kerner A, Bitton-Worms K, Bolotin G. Emboli and cognitive state in surgical vs. transcatheter aortic valve replacement. Asian Cardiovasc Thorac Ann 2017. [PMID: 28648116 DOI: 10.1177/0218492317717794] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Neurologic complications and neurocognitive impairment due to cerebral emboli are common following heart surgery. This study aimed to compare the number of emboli detected in the middle cerebral artery in open aortic valve replacement, apical and femoral transcatheter aortic valve replacement, and also to test for an association between the number of emboli captured in each procedure and changes in the patient's cognitive state. Methods Forty-four patients were enrolled in the study, 36 of whom were included in the final analyses: 14 underwent open aortic valve replacement, 2 had femoral transcatheter aortic valve replacement, and 10 had apical transcatheter aortic valve replacement. The number of emboli was detected by middle cerebral artery intraoperative transcranial Doppler ultrasound. The day before the elective surgery and 6-12 weeks later, all patients underwent neurocognitive evaluations by the Mini-Mental State Examination; the difference was tested for an association with the number of emboli. Results Open aortic valve replacement resulted in a significantly greater number of emboli (8555, range 2999-12489) than apical (1962, range 521-3850) or femoral (1220, range 948-1946) transcatheter approaches ( p = 0.003). Both transcatheter approaches yielded a comparable amount of emboli ( p = 0.798). No significant association was observed between the change in Mini-Mental State Examination score and the mean number of emboli ( r = 0.026; p = 0.907). Conclusions Compared to transcatheter aortic valve replacement, more cerebral emboli are detected during surgical aortic valve replacement; however, this does not appear to adversely affect a patient's cognitive state.
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Affiliation(s)
- Tom Friedman
- 1 Department of Cardiac Surgery, Rambam Health Care Campus and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Oved Cohen
- 1 Department of Cardiac Surgery, Rambam Health Care Campus and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Avishai Ziser
- 2 Department of Anesthesia, Rambam Health Care Campus and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Arthur Kerner
- 3 Department of Cardiology, Rambam Health Care Campus and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Keren Bitton-Worms
- 1 Department of Cardiac Surgery, Rambam Health Care Campus and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Gil Bolotin
- 1 Department of Cardiac Surgery, Rambam Health Care Campus and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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38
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Qiu ZB, Chen X, Xu M, Jiang YS, Wang LM, Huang FH, Liu PS, Wang R, Xiang F, Shao JJ, Qin W. [Efficacy of mitral valve repair versus replacement in severe ischemic mitral regurgitation]. Zhonghua Yi Xue Za Zhi 2017; 97:1705-9. [PMID: 28606278 DOI: 10.3760/cma.j.issn.0376-2491.2017.22.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To compare the mortality, survival rate and the therapeutic efficacy between mitral valve repair and replacement as treatment for severe ischemic mitral regurgitation (IMR), and explore the middle- and long-term outcomes. Methods: Between January 2000 and January 2016, 378 patients with severe IMR underwent coronary artery bypass grafting (CABG) combined with mitral valve repair (n=162) or mitral valve replacement (n=216) in the Department of Cardiovascular Surgery of Nanjing First Hospital. Clinical data, in-hospital morbidity and mortality of patients were retrospectively reviewed. The patients were followed up for the long term survival rate, heart function and re-admission. Results: No statistically significant differences of baseline data and operation details were found between the two groups except for left ventricular end-diastolic diameter[(61.3±10.2)mm in replacement group vs (56.2±9.0)mm in repair group, P<0.001]. Seven patients died during the perioperative period, with a total operation mortality of 1.9%.No significant difference of mortality was found between the two groups (5 cases in the replacement group and 2 cases in the repair group). The early outcome after the surgery showed that the rate of low cardiac output and ventricular arrhythmia of patients were significantly higher in the replacement group compared with the repair group (both P<0.05). The mortality of patients received mitral valve replacement was better than who received mitral valve repair when left ventricular end-diastolic diameter was over 65 mm (5.9% vs 10.0%, P=0.036). No significant differences were observed between the two groups in the middle- and -long term survival rate (87% for replacement group vs 85% for repair group, P=0.568). The follow-up time was 1-85 (52.8±21.5) months and the follow-up rate was 93%. The rate of valve-related complications was significantly higher in the repair group compared with the replacement group (8.82% vs 3.82%, P=0.003). Conclusions: We should choose the surgical methods carefully (replacement or repair) for severe IMR patients according to degree of left ventricular remodeling and pathological changes of mitral valve. Mitral valve replacement with preservation of the subvalvular apparatus is a safe and effective surgical alternative for mitral valve repair, especially for patients with complications or complex reflux.
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Raja DC, Palanisamy V, Chidambaram K, Pandurangi U, Mullasari AS, Sethuratnam R. Repair of a Submitral Aneurysm with associated left atrial wall dissection. Asian Cardiovasc Thorac Ann 2017; 26:392-395. [PMID: 28537419 DOI: 10.1177/0218492317713425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We describe a case of submitral aneurysm in a 40-year-old man, which was distinctive in its anatomy and pathophysiology. The patient had a congenital submitral aneurysm located in the anterolateral part of the mitral annulus, complicated by dissection of the left atrial wall, severe mitral regurgitation, and compression of the left circumflex artery. He was managed successfully with aid of a comprehensive preoperative evaluation with all available imaging guidance and methodical surgical techniques, resulting in exclusion of the aneurysm, mitral valve replacement, and a graft to the left circumflex artery.
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Affiliation(s)
- Deep Chandh Raja
- Institute of Cardio-Vascular Diseases, Madras Medical Mission, Chennai, India
| | | | - Kumar Chidambaram
- Institute of Cardio-Vascular Diseases, Madras Medical Mission, Chennai, India
| | - Ulhas Pandurangi
- Institute of Cardio-Vascular Diseases, Madras Medical Mission, Chennai, India
| | | | - Rajan Sethuratnam
- Institute of Cardio-Vascular Diseases, Madras Medical Mission, Chennai, India
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Niclauss L, Delay D, Pfister R, Colombier S, Kirsch M, Prêtre R. Low pacemaker incidence with continuous-sutured valves: a retrospective analysis. Asian Cardiovasc Thorac Ann 2017; 25:350-356. [PMID: 28530122 DOI: 10.1177/0218492317712309] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Permanent pacemaker implantation after surgical aortic valve replacement depends on patient selection and risk factors for conduction disorders. We aimed to identify risk criteria and obtain a selected group comparable to patients assigned to transcatheter aortic valve implantation. Methods Isolated sutured aortic valve replacements in 994 patients treated from 2007 to 2015 were reviewed. Demographics, hospital stay, preexisting conduction disorders, surgical technique, and etiology in patients with and without permanent pacemaker implantation were compared. Reported outcomes after transcatheter aortic valve implantation were compared with those of a subgroup including only degenerative valve disease and first redo. Results The incidence of permanent pacemaker implantation was 2.9%. Longer hospital stay ( p = 0.01), preexisting rhythm disorders ( p < 0.001), complex prosthetic endocarditis ( p = 0.01), and complex redo ( p < 0.001) were associated with permanent pacemaker implantation. Although prostheses were sutured with continuous monofilament in the majority of cases (86%), interrupted pledgetted sutures were used more often in the pacemaker group ( p = 0.002). In the subgroup analysis, the incidence of permanent pacemaker implantation was 2%; preexisting rhythm disorders and the suture technique were still major risk factors. Conclusion Permanent pacemaker implantation depends on etiology, preexisting rhythm disorders, and suture technique, and the 2% incidence compares favorably with the reported 5- to 10-fold higher incidence after transcatheter aortic valve implantation. Cost analysis should take this into account. Often dismissed as minor complication, permanent pacemaker implantation increases the risks of endocarditis, impaired myocardial recovery, and higher mortality if associated with prosthesis regurgitation.
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Affiliation(s)
- Lars Niclauss
- Department of Cardiovascular Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Dominique Delay
- Department of Cardiovascular Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Raymond Pfister
- Department of Cardiovascular Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Sebastien Colombier
- Department of Cardiovascular Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Matthias Kirsch
- Department of Cardiovascular Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - René Prêtre
- Department of Cardiovascular Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
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Bruno P, Di Cesare A, Nesta M, Cammertoni F, Mazza A, Paraggio L, Rosenhek R, Burzotta F, Crea F, Trani C, Massetti M. Rapid-deployment or transcatheter aortic valves in intermediate-risk patients? Asian Cardiovasc Thorac Ann 2017; 25:264-270. [PMID: 28361580 DOI: 10.1177/0218492317704773] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background Transcatheter aortic valve implantation and rapid-deployment aortic valve replacement represent two emerging therapies for patients with intermediate surgical risk and severe aortic stenosis. However, head-to-head comparisons between such novel therapies are lacking. Methods Severe aortic stenosis patients with intermediate surgical risk treated with rapid-deployment valve replacement at our institution were identified and compared with a propensity-matched population of patients who underwent transcatheter aortic valve replacement. Postoperative echocardiographic findings, in-hospital and midterm clinical outcomes were compared. Results We identified 60 patients who received transcatheter ( n = 30) or rapid-deployment ( n = 30) valve replacement. On postoperative echocardiography, freedom from paravalvular regurgitation was higher in the rapid-deployment valve group ( p < 0.001), while postoperative mean transprosthetic gradient was lower in the transcatheter valve group ( p = 0.03). Permanent pacemaker implantation was required more frequently in transcatheter valve patients ( p = 0.01). Postoperative atrial fibrillation was more common in the rapid-deployment valve group ( p = 0.03). Hospital mortality was similarly low in both groups ( p = 0.33). At midterm follow-up, mortality was comparable ( p = 0.42) but the rapid-deployment valve group still had a lower degree of paravalvular regurgitation. Conclusions Transcatheter and rapid-deployment valve replacement are promising treatment options for patients with intermediate surgical risk. These two techniques are associated with specific patterns of prosthesis function and postoperative complications. Further evaluation of the clinical impact of these therapies in this patient population is needed.
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Affiliation(s)
- Piergiorgio Bruno
- 1 Department of Cardiovascular Sciences, A. Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy
| | - Alessandro Di Cesare
- 1 Department of Cardiovascular Sciences, A. Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy
| | - Marialisa Nesta
- 1 Department of Cardiovascular Sciences, A. Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy
| | - Federico Cammertoni
- 1 Department of Cardiovascular Sciences, A. Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy
| | - Andrea Mazza
- 1 Department of Cardiovascular Sciences, A. Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy
| | - Lazzaro Paraggio
- 1 Department of Cardiovascular Sciences, A. Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy
| | - Raphael Rosenhek
- 2 Department of Cardiology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Francesco Burzotta
- 1 Department of Cardiovascular Sciences, A. Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy
| | - Filippo Crea
- 1 Department of Cardiovascular Sciences, A. Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy
| | - Carlo Trani
- 1 Department of Cardiovascular Sciences, A. Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy
| | - Massimo Massetti
- 1 Department of Cardiovascular Sciences, A. Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy
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Markman PL, Tantiongco JP, Bennetts JS, Baker RA. High-Sensitivity Troponin Release Profile After Cardiac Surgery. Heart Lung Circ 2016; 26:833-839. [PMID: 28131774 DOI: 10.1016/j.hlc.2016.09.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 08/31/2016] [Accepted: 09/06/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND Postoperative serum troponin levels and perioperative myocardial infarction (MI) rates correlate with mortality and morbidity following cardiac surgery. The objective of this study was to document the release profile of high sensitivity troponin T (hsTnT) following different cardiac operations. METHODS Patients undergoing one of five different isolated cardiac surgical procedures (eligible preoperative hsTnT <29ng/L, serum creatinine < 0.2mmol/L) were recruited prospectively. Serum hsTnT was measured at 0, 4, 6, 8, 10, 12, 24 and 72hours after the first surgical insult to myocardium, together with daily electrocardiographs. RESULTS There were 10 patients in the on-pump coronary artery bypass group and 5 each in the remaining groups (off-pump coronary artery bypass, open aortic valve replacement, transcutaneous aortic valve implantation and mitral valve replacement). Five additional patients were excluded due to perioperative MI or renal failure. Median [range] of peak hsTnT was 241[99-566], 64[50-136], 353[307-902], 115[112-275], and 918[604-1166] ng/L, respectively. Operations with the lowest peak hsTnT values peaked earliest (four hours) while those with highest values peaked latest (eight hours). CONCLUSION After cardiac surgery, the hsTnT profile peaks four to eight hours after the initial surgical insult. The magnitude and timing of the peak correlates to the expected degree of surgically-induced myocardial injury.
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Affiliation(s)
| | - John-Paul Tantiongco
- Flinders Medical Centre, Adelaide, SA, Australia; Flinders University, Adelaide, SA, Australia
| | - Jayme S Bennetts
- Flinders Medical Centre, Adelaide, SA, Australia; Flinders University, Adelaide, SA, Australia
| | - Robert A Baker
- Flinders Medical Centre, Adelaide, SA, Australia; Flinders University, Adelaide, SA, Australia.
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Dayan V, Stanham R, Soca G, Genta F, Mariño J, Lorenzo A. Early surgery after angiography in patients scheduled for valve replacement. Asian Cardiovasc Thorac Ann 2016; 25:18-23. [PMID: 28074703 DOI: 10.1177/0218492316680496] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background There are limited data regarding the risks of cardiac surgery early after coronary angiography in patients scheduled for isolated aortic and/or mitral valve replacement. Our aim was to evaluate the risk of early surgery after coronary angiography in these patients. Methods We retrospectively analyzed data of 1044 patients who underwent isolated aortic and/or mitral valve replacement from 2006 to 2014. Baseline, operative, and postoperative variables were collected. The patients were divided into 3 groups based on the interval between coronary angiography and surgery: ≤3 days ( n = 216), 4-7 days ( n = 109), and ≥8 days ( n = 719). We evaluated hospital mortality and postoperative acute kidney injury. Subgroup analysis was performed according to preoperative creatinine clearance. Results Postoperative creatinine clearance was lower in patients who underwent surgery ≤3 days after coronary angiography (63.57 ± 38.52 mL min-1) compared to ≥8 days after coronary angiography (74.56 ± 54.25 mL min-1, p = 0.015). Patients who underwent surgery ≤3 days after coronary angiography had higher hospital mortality when preoperative creatinine clearance was ≤60 mL min-1 (12% vs. 4% for creatinine clearance ≤and >60 mL min-1, respectively; p = 0.039). Predictors of hospital mortality were New York Heart Association class and postoperative creatinine clearance. Conclusion Hospital mortality was higher in patients with decreased preoperative renal function who underwent surgery within the first 3 days after coronary angiography. Delaying surgery in this subgroup of patients could be a good strategy.
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Affiliation(s)
- Victor Dayan
- National Institute of Cardiac Surgery, Montevideo, Uruguay
| | | | - Gerardo Soca
- National Institute of Cardiac Surgery, Montevideo, Uruguay
| | - Fernando Genta
- National Institute of Cardiac Surgery, Montevideo, Uruguay
| | - Jorge Mariño
- National Institute of Cardiac Surgery, Montevideo, Uruguay
| | - Alvaro Lorenzo
- National Institute of Cardiac Surgery, Montevideo, Uruguay
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Abstract
Maroteaux-Lamy syndrome is a very rare multisystem disorder. Cardiac valve surgery is common in these patients who present a unique set of perioperative and intraoperative challenges to the surgeon and treating team. We describe successful mitral valve replacement using an inverted aortic prosthesis in a 29-year-old lady with Maroteaux-Lamy syndrome, with a good result at 10 months.
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Affiliation(s)
- Douglas Jw Bell
- 1 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia
| | - Cheng He
- 1 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia
| | - John L Pauli
- 2 Department of Anatomical Pathology, The Prince Charles Hospital, Chermside, Australia
| | - Rishendran Naidoo
- 1 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia
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Ennker J, Meilwes M, Pons-Kuehnemann J, Niemann B, Grieshaber P, Ennker IC, Boening A. Freestyle stentless bioprosthesis for aortic valve therapy: 17-year clinical results. Asian Cardiovasc Thorac Ann 2016; 24:868-874. [PMID: 27926465 DOI: 10.1177/0218492316675244] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Aortic valve replacement with stentless bioprostheses has been shown to produce lower aortic gradients than stented bioprostheses, thus facilitating left ventricular mass regression and preventing heart failure. We sought to determine the long-term results of stentless biological aortic valve replacement over a 17-year follow-up. METHODS Between 1996 and 2012, 2551 patients underwent isolated aortic valve replacement with a stentless prosthesis (Medtronic Freestyle) at a single center. The mean patient age was 72 ± 10 years, 55% were male, 24.1% were in New York Heart Association class I and II, 9.6% had undergone previous surgery, 18.1% had coronary artery disease, and 23.1% had diabetes. For the long-term follow-up, patients were contacted in writing and by telephone; follow-up was 96.3% complete, resulting in 11,546 patient-years. RESULTS At 30 days, mortality (5.4%), renal failure (3.9%), myocardial infarction (0.7%), and stroke (1.4%) rates were acceptable. During long-term follow-up of 1-17 years, the bleeding rate (2.9%) was higher than the thromboembolic event rate (0.7%) despite 18.1% of patients being on oral anticoagulants. New pacemaker implantation (4.5%; 0.87 events/100 patient-years), neurological disorders (5%; 0.52 events/100 patient-years), valve insufficiency (0.7%; 0.16 events/100 patient-years), paravalvular leakage (0.4%; 0.09 events/100 patient-years) and reoperation due to valvular complications (0.7%; 0.38 events/100 patient-years) were rare. Long-term survival was 41.8% ± 1.6 after 10 years, 21.3% ± 2.3 after 15 years, and 12.1% ± 3.9 after 17 years. CONCLUSION Long-term results after aortic valve replacement with stentless biological prostheses compare favorably with those obtained with stented bioprostheses.
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Affiliation(s)
- Juergen Ennker
- Heart Center, Helios Hospital Siegburg Germany.,Faculty of Medicine, Witten-Herdecke University, Witten, Germany
| | - Markus Meilwes
- Institute of Medical Statistics, Justus-Liebig University Giessen, Giessen, Germany.,Department of Cardiovascular Surgery, Justus-Liebig University Giessen, Giessen, Germany
| | | | - Bernd Niemann
- Department of Cardiovascular Surgery, Justus-Liebig University Giessen, Giessen, Germany
| | - Philippe Grieshaber
- Department of Cardiovascular Surgery, Justus-Liebig University Giessen, Giessen, Germany
| | - Ina C Ennker
- Hannover Medical School, Department of Plastic and Reconstructive Surgery, Hannover, Germany
| | - Andreas Boening
- Department of Cardiovascular Surgery, Justus-Liebig University Giessen, Giessen, Germany
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Hanedan MO, Mataracı İ, Yürük MA, Özer T, Sayar U, Arslan AK, Ziyrek U, Yücel M. Early Outcomes of Sutureless Aortic Valves. Korean J Thorac Cardiovasc Surg 2016; 49:165-70. [PMID: 27298793 PMCID: PMC4900858 DOI: 10.5090/kjtcs.2016.49.3.165] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 02/06/2016] [Accepted: 02/12/2016] [Indexed: 12/04/2022]
Abstract
Background In elderly high-risk surgical patients, sutureless aortic valve replacement (AVR) should be an alternative to standard AVR. The potential advantages of sutureless aortic prostheses include reducing cross-clamping and cardiopulmonary bypass (CPB) time and facilitating minimally invasive surgery and complex cardiac interventions, while maintaining satisfactory hemodynamic outcomes and low rates of paravalvular leakage. The current study reports our single-center experience regarding the early outcomes of sutureless aortic valve implantation. Methods Between October 2012 and June 2015, 65 patients scheduled for surgical valve replacement with symptomatic aortic valve disease and New York Heart Association function of class II or higher were included to this study. Perceval S (Sorin Biomedica Cardio Srl, Sallugia, Italy) and Edwards Intuity (Edwards Lifesciences, Irvine, CA, USA) valves were used. Results The mean age of the patients was 71.15±8.60 years. Forty-four patients (67.7%) were female. The average preoperative left ventricular ejection fraction was 56.9±9.93. The CPB time was 96.51±41.27 minutes and the cross-clamping time was 60.85±27.08 minutes. The intubation time was 8.95±4.19 hours, and the intensive care unit and hospital stays were 2.89±1.42 days and 7.86±1.42 days, respectively. The mean quantity of drainage from chest tubes was 407.69±149.28 mL. The hospital mortality rate was 3.1%. A total of five patients (7.69%) died during follow-up. The mean follow-up time was 687.24±24.76 days. The one-year survival rate was over 90%. Conclusion In the last few years, several models of valvular sutureless bioprostheses have been developed. The present study evaluating the single-center early outcomes of sutureless aortic valve implantation presents the results of an innovative surgical technique, finding that it resulted in appropriate hemodynamic conditions with acceptable ischemic time.
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Affiliation(s)
- Muhammet Onur Hanedan
- Department of Cardiovascular Surgery, Ahi Evren Thorax Cardiovascular Surgery Education and Research Hospital
| | - İlker Mataracı
- Department of Cardiovascular Surgery, Ahi Evren Thorax Cardiovascular Surgery Education and Research Hospital
| | - Mehmet Ali Yürük
- Department of Cardiovascular Surgery, Ahi Evren Thorax Cardiovascular Surgery Education and Research Hospital
| | - Tanıl Özer
- Department of Cardiovascular Surgery, Ahi Evren Thorax Cardiovascular Surgery Education and Research Hospital
| | - Ufuk Sayar
- Department of Cardiovascular Surgery, Ahi Evren Thorax Cardiovascular Surgery Education and Research Hospital
| | - Ali Kemal Arslan
- Department of Cardiovascular Surgery, Ahi Evren Thorax Cardiovascular Surgery Education and Research Hospital
| | - Uğur Ziyrek
- Department of Cardiovascular Surgery, Ahi Evren Thorax Cardiovascular Surgery Education and Research Hospital
| | - Murat Yücel
- Department of Cardiovascular Surgery, Ahi Evren Thorax Cardiovascular Surgery Education and Research Hospital
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47
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Abstract
Temporary epicardial pacing wire placement is a common procedure in cardiac surgery. However, it is difficult to perform in totally endoscopic cardiac surgery. We describe a simple new technique to place temporary epicardial pacing wires quickly and safely.
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Affiliation(s)
- Tao Yu
- Department of Cardiac Surgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Xiaoshen Zhang
- Department of Cardiac Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Keli Huang
- Department of Cardiac Surgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
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48
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Abstract
Preserving the subvalvular mitral valve apparatus during mitral valve replacement is extremely important to minimize progressive postoperative left ventricular remodeling and dysfunction. We describe a simple and reproducible surgical technique that prevents the complications that can occur after total mitral anterior leaflet preservation.
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Affiliation(s)
- Javier Gualis
- Department of Cardiac Surgery, Complejo Asistencial Universitario de León, León, Spain
| | - Mario Castaño
- Department of Cardiac Surgery, Complejo Asistencial Universitario de León, León, Spain
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49
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Johansson M, Nozohoor S, Bjursten H, Ragnarsson S, Götberg M, Kimblad PO, Zindovic I, Sjögren J. Late survival and heart failure after transcatheter aortic valve implantation. Asian Cardiovasc Thorac Ann 2016; 24:318-25. [PMID: 26966020 DOI: 10.1177/0218492316637712] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Short-term survival in patients undergoing transcatheter aortic valve implantation is favorable. Our aim was to evaluate late survival and composite clinical endpoints specified by the Valve Academic Research Consortium-2, including rehospitalization for congestive heart failure. METHODS Between January 2008 and April 2014, 166 consecutive patients with severe symptomatic aortic stenosis underwent 168 transcatheter aortic valve implantation procedures at our facility. This cohort was compared with propensity score-matched aortic valve replacement patients. Event rates were estimated by the Kaplan-Meier method and compared using the log-rank test. Cox regression analysis was performed to determine predictors of outcome. RESULTS Although 30-day mortality rates following both procedures were similar (4.2% and 4.8%; p = 0.81), significant differences were seen in corresponding rates of survival (51.7% ± 5.8% vs. 72.3% ± 4.3%; p < 0.001) and cumulative rehospitalization for congestive heart failure (41.3% ± 7.2% vs. 23% ± 4.3%; p = 0.006). New York Heart Association functional class IV preoperative status was an independent risk factor for rehospitalization due to congestive heart failure (p = 0.015). CONCLUSIONS This study confirms the merit of transcatheter aortic valve implantation in high-risk patients with aortic stenosis, although late survival proved inferior to that of aortic valve replacement in propensity score-matched subjects. Early safety was excellent for both treatment groups, however, patients undergoing transcatheter aortic valve implantation had a higher incidence of rehospitalization for congestive heart failure and myocardial infarction during follow-up. Patients with severe congestive heart failure should be carefully monitored and aggressively treated to improve outcomes.
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Affiliation(s)
- Malin Johansson
- Department of Cardiothoracic Surgery, Cardiothoracic Anesthesia and Intensive Care, Skane University Hospital, Lund, Sweden Department of Clinical Sciences, Lund Cardiothoracic Surgery, Lund, Sweden
| | - Shahab Nozohoor
- Department of Cardiothoracic Surgery, Cardiothoracic Anesthesia and Intensive Care, Skane University Hospital, Lund, Sweden Department of Clinical Sciences, Lund Cardiothoracic Surgery, Lund, Sweden
| | - Henrik Bjursten
- Department of Cardiothoracic Surgery, Cardiothoracic Anesthesia and Intensive Care, Skane University Hospital, Lund, Sweden Department of Clinical Sciences, Lund Cardiothoracic Surgery, Lund, Sweden
| | - Sigurdur Ragnarsson
- Department of Cardiothoracic Surgery, Cardiothoracic Anesthesia and Intensive Care, Skane University Hospital, Lund, Sweden Department of Clinical Sciences, Lund Cardiothoracic Surgery, Lund, Sweden
| | - Matthias Götberg
- Department of Coronary Heart Disease, Skane University Hospital, Lund, Sweden Department of Clinical Sciences, Lund Cardiology, Lund, Sweden
| | - Per Ola Kimblad
- Department of Cardiothoracic Surgery, Cardiothoracic Anesthesia and Intensive Care, Skane University Hospital, Lund, Sweden Department of Clinical Sciences, Lund Cardiothoracic Surgery, Lund, Sweden
| | - Igor Zindovic
- Department of Cardiothoracic Surgery, Cardiothoracic Anesthesia and Intensive Care, Skane University Hospital, Lund, Sweden Department of Clinical Sciences, Lund Cardiothoracic Surgery, Lund, Sweden
| | - Johan Sjögren
- Department of Cardiothoracic Surgery, Cardiothoracic Anesthesia and Intensive Care, Skane University Hospital, Lund, Sweden Department of Clinical Sciences, Lund Cardiothoracic Surgery, Lund, Sweden
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50
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Abstract
BACKGROUND Special consideration may be required for surgical treatment in Takayasu arteritis because inflammation may cause serious complications such as valve detachment or dilatation of the residual aorta. We evaluated our surgical outcome of treatment for aortic regurgitation and aortic root dilatation in Takayasu arteritis. METHODS Between December 1983 and January 2013, 22 cardiac operations were performed in 20 patients with aortic regurgitation due to Takayasu arteritis. Aortic valve replacement was carried out in 6 patients, and aortic root replacement in 16. Of these 16 patients, composite graft replacement was undertaken in 6, composite graft replacement plus coronary artery bypass grafting in 2, composite graft replacement plus total or partial arch replacement in 7, and valve-sparing aortic root replacement with hemiarch replacement in one. RESULTS The operative mortality (within 30 days) was 4.5% and the 5-year survival rate was 90.9%. Early surgical reintervention was not required in any patient. Neither valve detachment nor composite graft detachment was noted. Two patients required redo aortic root replacement due to pseudoaneurysm formation and severe aortic regurgitation during follow-up. Late dilatation of the residual thoracoabdominal or abdominal aorta was observed in 2 patients, and both were treated surgically. CONCLUSIONS The early surgical outcome was acceptable but surgical reintervention was required because of late dilatation of the residual aorta or recurrent aortic regurgitation due to annular dilatation, and longstanding careful follow-up will be needed.
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Affiliation(s)
- Yuji Kaku
- Department of Cardiovascular Surgery, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Shigeyuki Aomi
- Department of Cardiovascular Surgery, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Hideyuki Tomioka
- Department of Cardiovascular Surgery, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Kenji Yamazaki
- Department of Cardiovascular Surgery, Tokyo Women's Medical University Hospital, Tokyo, Japan
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