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Francica A, Benvegnù L, San Biagio L, Tropea I, Luciani GB, Faggian G, Onorati F. Ten-year clinical and echocardiographic follow-up of third-generation biological prostheses in the aortic position. J Thorac Cardiovasc Surg 2024; 167:1705-1713.e8. [PMID: 36404144 DOI: 10.1016/j.jtcvs.2022.10.023] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES PERIMOUNT Magna Ease (Carpentier-Edwards; PME) prostheses have been widely implanted during the past decade for aortic valve replacement (AVR). Although promising results at midterm follow-up were reported, long-term outcome has yet to be confirmed. On this study we aimed to evaluate long-term results in terms of structural valve degeneration (SVD), major clinical outcomes, long-term hemodynamic valve performance, and left ventricular remodeling. METHODS From 2010 to 2012, 689 consecutive patients underwent AVR with PME. Complete clinical 10-year follow-up was obtained. The degree of SVD was categorized on the basis of the latest guidelines. Echocardiographic data were analyzed at 1, 5, and 10 years. Competing risk analysis was performed for major events. Cumulative incidence of SVD, reoperation, and endocarditis were also assessed according to prosthetic sizes (19-21-23 mm vs 25-27-29 mm) and age (<65 vs 65-75 vs >75 years old). RESULTS The overall cumulative incidence reported for SVD ≥2 and reoperation were 3.6% and 1.9% at 10 years, respectively. An early left ventricular reverse remodeling was noted after implantation and confirmed at follow-up. Patients younger than 65 years showed higher cumulative incidence of SVD ≥2 at 10 years compared with patients aged 65 to 75 and older than 75 years (9.7% vs 2.6% vs 2.7%; P = .013), as well as of redo AVR (7.8% vs 3.3% vs 0.4%; P = .002). There was no difference in terms of SVD and redo AVR for different prosthetic size categories (P > .05). The risk of endocarditis was similar among age and size groups. CONCLUSIONS PME provides very good durability at long-term and could be considered one of the high performing third-generation bioprostheses for AVR.
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Affiliation(s)
- Alessandra Francica
- Division of Cardiac Surgery, Departments of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona Medical School, Verona, Italy.
| | - Luciana Benvegnù
- Division of Cardiac Surgery, Departments of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona Medical School, Verona, Italy
| | - Livio San Biagio
- Division of Cardiac Surgery, Departments of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona Medical School, Verona, Italy
| | - Ilaria Tropea
- Division of Cardiac Surgery, Departments of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona Medical School, Verona, Italy
| | - Giovanni Battista Luciani
- Division of Cardiac Surgery, Departments of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona Medical School, Verona, Italy
| | - Giuseppe Faggian
- Division of Cardiac Surgery, Departments of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona Medical School, Verona, Italy
| | - Francesco Onorati
- Division of Cardiac Surgery, Departments of Surgery, Dentistry, Paediatrics, and Gynaecology, University of Verona Medical School, Verona, Italy
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Jayet A, Lu H, Monney P, Verdugo-Marchese M, Gunga Z, Rancati V, Ltaief Z, Kirsch M. Thrombocytopenia among Patients Undergoing Aortic Valve Replacement Using the Sutureless Perceval S Bioprosthesis: A Retrospective Study. J Clin Med 2024; 13:1083. [PMID: 38398396 PMCID: PMC10888618 DOI: 10.3390/jcm13041083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The sutureless Perceval S bioprosthesis is associated with postoperative thrombocytopenia. Our objectives were to compare the incidence, severity, and clinical implications of thrombocytopenia after aortic valve replacement (AVR) using the Perceval S or the Trifecta bioprosthesis. METHODS Patients who underwent AVR between March 2016 and August 2019 using the Perceval or Trifecta were retrospectively included. The primary endpoint was the nadir in platelet counts within 15 days after surgery. Secondary endpoints included postoperative hemolysis and inflammatory parameters, as well as clinical and echocardiographic outcomes. RESULTS Overall, 156 patients were included (Perceval, n = 103; Trifecta, n = 53). Preoperatively, there was no difference in platelet counts between the two groups. Postoperatively, the Perceval S bioprosthesis was associated with a greater decrease in platelet counts. The nadir was reached at Day 3 for both groups, but thrombocytopenia was more severe for the Perceval S (Perceval S vs. Trifecta, 89.2 ± 37.7 × 109/L vs. 106.5 ± 34.1 × 109/L, p = 0.01). No difference regarding lactate dehydrogenase, C-reactive protein, and white blood cells count was found. All-cause 30-day mortality rates (both valves, 2%, p = 0.98), hospital lengths of stay, and re-operation rates were similar. CONCLUSION The Perceval S bioprosthesis was associated with more severe postoperative thrombocytopenia. This did not translate into higher short-term morbidity or mortality.
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Affiliation(s)
- Adrien Jayet
- Division of Cardiovascular Surgery, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (A.J.); (M.V.-M.); (Z.G.)
| | - Henri Lu
- Division of Cardiology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (H.L.)
| | - Pierre Monney
- Division of Cardiology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (H.L.)
| | - Mario Verdugo-Marchese
- Division of Cardiovascular Surgery, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (A.J.); (M.V.-M.); (Z.G.)
| | - Ziyad Gunga
- Division of Cardiovascular Surgery, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (A.J.); (M.V.-M.); (Z.G.)
| | - Valentina Rancati
- Department of Anaesthesiology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland;
| | - Zied Ltaief
- Adult Intensive Care Unit, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland;
| | - Matthias Kirsch
- Division of Cardiovascular Surgery, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (A.J.); (M.V.-M.); (Z.G.)
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Patlolla SH, Saran N, Schaff HV, Crestanello J, Pochettino A, Stulak JM, Greason KL, King KS, Lee AT, Daly RC, Dearani JA. Prosthesis choice for tricuspid valve replacement: Comparison of clinical and echocardiographic outcomes. J Thorac Cardiovasc Surg 2024; 167:668-679.e2. [PMID: 36028365 DOI: 10.1016/j.jtcvs.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 06/10/2022] [Accepted: 07/01/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVES There is limited evidence evaluating valve function and right heart remodeling after tricuspid valve replacement (TVR), as well as whether the choice of prosthesis has an impact on these outcomes. METHODS We reviewed 1043 consecutive adult patients who underwent first-time TVR; 33% had previous aortic and/or mitral valve operations. Severe tricuspid valve regurgitation (TR) was the indication for surgery in 94% patients. A mechanical valve was used in 149 (14%) patients and a bioprosthetic valve in 894 (86%). Concomitant major cardiac procedures were performed in 57% of patients. RESULTS The median age of the cohort was 68.8 (range, 25-94) years, and 57% were female. Overall survival at 5 and 10 years was 50% and 31%, respectively. Adjusted survival and cumulative incidence of reoperation after TVR were similar in patients with bioprosthetic and mechanical valves. Overall, right ventricular (RV) function and dilation improved postoperatively with the estimated proportion of patients with moderate or greater RV systolic dysfunction/dilatation decreasing by around 20% at 3 years follow-up. After adjusting for preoperative degree of dysfunction/dilatation, valve type had no effect on late improvement in RV function and dilation. Bioprosthetic TVR was associated with greater rates of recurrence of moderate or greater TR over late follow-up. Overall, a slight decline in tricuspid valve gradients was observed over time. CONCLUSIONS Mechanical and bioprosthetic valves provide comparable survival, incidence of reoperation, and recovery of RV systolic function and size after TVR. Bioprosthetic valves develop significant TR over time, and mechanical valves may have an advantage for younger patients and those needing anticoagulation.
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Affiliation(s)
| | - Nishant Saran
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
| | | | - Juan Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | | | - John M Stulak
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Katherine S King
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minn
| | - Alexander T Lee
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minn
| | - Richard C Daly
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
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4
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Ueyama HA, Xie J, Hanzel GS, Byku I, Paone G, Grubb KJ, Devireddy CM, Greenbaum AB, Babaliaros VC, Gleason PT. Hemodynamic Comparison of Resilia and Sapien 3/Ultra Transcatheter Heart Valves in Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2024; 17:e013325. [PMID: 38047373 DOI: 10.1161/circinterventions.123.013325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Affiliation(s)
- Hiroki A Ueyama
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (H.A.U., J.X., G.S.H., I.B., C.M.D., A.B.G., V.C.B., P.T.G.)
| | - Joe Xie
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (H.A.U., J.X., G.S.H., I.B., C.M.D., A.B.G., V.C.B., P.T.G.)
| | - George S Hanzel
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (H.A.U., J.X., G.S.H., I.B., C.M.D., A.B.G., V.C.B., P.T.G.)
| | - Isida Byku
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (H.A.U., J.X., G.S.H., I.B., C.M.D., A.B.G., V.C.B., P.T.G.)
| | - Gaetano Paone
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA (G.P., K.J.G.)
| | - Kendra J Grubb
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA (G.P., K.J.G.)
| | - Chandan M Devireddy
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (H.A.U., J.X., G.S.H., I.B., C.M.D., A.B.G., V.C.B., P.T.G.)
| | - Adam B Greenbaum
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (H.A.U., J.X., G.S.H., I.B., C.M.D., A.B.G., V.C.B., P.T.G.)
| | - Vasilis C Babaliaros
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (H.A.U., J.X., G.S.H., I.B., C.M.D., A.B.G., V.C.B., P.T.G.)
| | - Patrick T Gleason
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, GA (H.A.U., J.X., G.S.H., I.B., C.M.D., A.B.G., V.C.B., P.T.G.)
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Chung M, Almarzooq ZI, Xu J, Song Y, Baron SJ, Kazi DS, Yeh RW. Days at Home After Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients. Circ Cardiovasc Qual Outcomes 2023; 16:e010034. [PMID: 38084613 PMCID: PMC10752241 DOI: 10.1161/circoutcomes.123.010034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 09/23/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Days at home (DAH) represents an important patient-oriented outcome that quantifies time spent at home after a medical event; however, this outcome has not been fully evaluated for low-surgical-risk patients undergoing transcatheter aortic valve replacement (TAVR). We sought to compare 1- and 2-year DAH (DAH365 and DAH730) among low-risk patients participating in a randomized trial of TAVR with a self-expanding bioprosthesis versus surgical aortic valve replacement (SAVR). METHODS Using Medicare-linked data from the Evolut Low Risk trial, we identified 619 patients: 606 (322 TAVR/284 SAVR) and 593 (312 TAVR/281 SAVR) were analyzed at 1 and 2 years, respectively. DAH was calculated as days alive and spent outside a hospital, inpatient rehabilitation, skilled nursing facility, long-term acute care hospital, emergency department, or observation stay. Mean DAH was compared using the t test. RESULTS The mean (SD) age and female sex were 74.7 (5.1) and 74.3 (4.9) years and 34.6% (115/332) and 30.3% (87/287) in TAVR and SAVR, respectively. Postprocedural discharge to rehabilitation occurred in ≤3.0% (≤10/332) in TAVR and 4.5% (13/287) in SAVR. The mean DAH365 was comparable in TAVR versus SAVR (352.2±45.4 versus 347.8±39.0; difference in days, 4.5 [95% CI, 2.3-11.2]; P=0.20). DAH730 was also comparable in TAVR versus SAVR (701.6±106.0 versus 699.6±94.5; difference in days, 2.0 [-14.1 to 18.2]; P=0.81). Secondary outcomes DAH30 and DAH90 were higher in TAVR (DAH30, 26.0±3.6 versus 20.7±6.4; difference in days, 5.3 [4.5-6.2]; P<0.001; DAH90, 85.1±8.3 versus 78.7±13.6; difference in days, 6.4 [4.6-8.2]; P<0.001). CONCLUSIONS In the Evolut Low Risk trial linked to Medicare, low-risk patients undergoing TAVR spend a similar number of days at home at 1 and 2 years compared with SAVR. Days spent at home at 30 and 90 days were higher in TAVR. In contrast to higher-risk patients studied in prior work, there is no clear advantage of TAVR versus SAVR for DAH in the first 2 years after AVR in low-surgical-risk patients.
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Affiliation(s)
- Mabel Chung
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA
- Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Zaid I. Almarzooq
- Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Jiaman Xu
- Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Yang Song
- Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Suzanne J. Baron
- Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Department of Cardiology, Lahey Hospital & Medical Center, Burlington, MA
- Baim Institute for Clinical Research, Boston, MA
| | - Dhruv S. Kazi
- Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Robert W. Yeh
- Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
- Division of Cardiovascular Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
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Kermen S, Aupart A, Bonal M, Strella J, Aupart M, Espitalier F, Morisseau M, Bernard A, Bourguignon T. Durability of bovine pericardial mitral bioprosthesis based on Heart Valve Collaboratory echocardiographic criteria. J Thorac Cardiovasc Surg 2023:S0022-5223(23)01097-8. [PMID: 37981099 DOI: 10.1016/j.jtcvs.2023.11.021] [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: 07/13/2023] [Revised: 11/06/2023] [Accepted: 11/06/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVE This study evaluated the very long-term results of the Carpentier-Edwards pericardial bioprosthesis in the mitral position, with particular attention to structural valve deterioration based on echocardiographic criteria. METHODS From 1984 to 2016, 648 patients (mean age 68.8 years; 53.9% female) underwent mitral valve replacement using the Carpentier-Edwards PERIMOUNT pericardial bioprosthesis. Multiple valve replacements were excluded. Clinical, operative, and follow-up data were prospectively recorded. The mean follow-up was 7.8 ± 5.4 years, for a total of 5043 valve-years. The follow-up data were 98.3% complete (11 patients lost). Structural valve deterioration was determined by strict echocardiographic assessment based on Heart Valve Collaboratory criteria. RESULTS Operative mortality was 4%. A total of 322 late deaths occurred, for a linearized rate of 6.4%/valve-year. The actuarial survival rate at 15 years was 31.4 ± 2.6%. Age at implantation, male sex, and preoperative New York Heart Association class III or IV were significant risk factors affecting late survival. Actuarial freedoms from complications at 15 years were thromboembolism, 92.5 ± 1.9%; major bleeding, 93.8 ± 1.7%; endocarditis, 93.2 ± 1.3%; and explantation due to structural valve deterioration, 69.3 ± 3.5%. The median survival time for explantation due to structural valve deterioration was 21.7 years for the entire cohort (16.1 years for patients <65 years old). Based on echocardiographic data, actuarial freedom from severe and moderate/severe structural valve deterioration at 15 years were 64.0 ± 3.6% and 52.1 ± 3.6%, respectively. CONCLUSIONS With low 15-year rates of valve-related events and structural valve deterioration based on Heart Valve Collaboratory echocardiographic criteria, the Carpentier-Edwards PERIMOUNT pericardial bioprosthesis remains a reliable choice for a mitral tissue valve.
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Affiliation(s)
- Stéphane Kermen
- Department of Cardiac Surgery, Tours University Hospital, Tours, France.
| | - Arthur Aupart
- Department of Cardiac Surgery, Tours University Hospital, Tours, France
| | - Myriam Bonal
- Department of Cardiac Surgery, Tours University Hospital, Tours, France
| | - Juliette Strella
- Department of Cardiac Surgery, Tours University Hospital, Tours, France
| | - Michel Aupart
- Department of Cardiac Surgery, Tours University Hospital, Tours, France
| | - Fabien Espitalier
- Department of Anesthesiology, Tours University Hospital, Tours, France
| | - Marlène Morisseau
- Department of Cardiac Surgery, Tours University Hospital, Tours, France
| | - Anne Bernard
- Department of Cardiology, Tours University Hospital, Tours, France
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Moubarak G, Gupta S, Ladner J, Kluis A, Banwait J, DiMaio JM, Mack MJ, Szerlip MI. Valve-in-Valve Transcatheter Aortic Valve Replacement Following 2 Surgical Aortic Valve Replacements. Circ Cardiovasc Interv 2023; 16:e013305. [PMID: 37988438 DOI: 10.1161/circinterventions.123.013305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Affiliation(s)
- Ghadi Moubarak
- Baylor Scott and White Research Institute Plano, TX (G.M., S.G., J.L., A.K., J.B., J.M.D., M.J.M., M.I.S.)
| | - Swapnil Gupta
- Baylor Scott and White Research Institute Plano, TX (G.M., S.G., J.L., A.K., J.B., J.M.D., M.J.M., M.I.S.)
| | - Jonathan Ladner
- Baylor Scott and White Research Institute Plano, TX (G.M., S.G., J.L., A.K., J.B., J.M.D., M.J.M., M.I.S.)
| | - Austin Kluis
- Baylor Scott and White Research Institute Plano, TX (G.M., S.G., J.L., A.K., J.B., J.M.D., M.J.M., M.I.S.)
| | - Jasjit Banwait
- Baylor Scott and White Research Institute Plano, TX (G.M., S.G., J.L., A.K., J.B., J.M.D., M.J.M., M.I.S.)
| | - J Michael DiMaio
- Baylor Scott and White Research Institute Plano, TX (G.M., S.G., J.L., A.K., J.B., J.M.D., M.J.M., M.I.S.)
- Department of Cardiothoracic Surgery (J.M.D., M.J.M.), Baylor Scott and White The Heart Hospital Plano, TX
| | - Michael J Mack
- Baylor Scott and White Research Institute Plano, TX (G.M., S.G., J.L., A.K., J.B., J.M.D., M.J.M., M.I.S.)
- Department of Cardiothoracic Surgery (J.M.D., M.J.M.), Baylor Scott and White The Heart Hospital Plano, TX
| | - Molly I Szerlip
- Baylor Scott and White Research Institute Plano, TX (G.M., S.G., J.L., A.K., J.B., J.M.D., M.J.M., M.I.S.)
- Department of Cardiology (M.I.S.), Baylor Scott and White The Heart Hospital Plano, TX
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Dokollari A, Torregrossa G, Sicouri S, Cameli M, Mandoli GE, Kjelstrom S, Prifti E, Veshti A, Bonacchi M, Gelsomino S. Long-term prognosis in patients undergoing redo-isolated aortic valve replacement. Future Cardiol 2023; 19:685-694. [PMID: 38078413 DOI: 10.2217/fca-2023-0050] [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: 04/05/2023] [Accepted: 10/11/2023] [Indexed: 12/18/2023] Open
Abstract
Aim: To evaluate clinical outcomes after redo aortic valve replacement (AVR) with sutured valves, versus valve-in-valve transcatheter aortic valve replacement (ViV-TAVR), versus sutureless valves. Methods: We identified 113 consecutive patients undergoing redo AVR with either ViV-TAVR, redo-sutured and redo-sutureless valves between August 2010 to March 2020. Heart-team made the decision whether patient should undergo redo-sutureless versus ViV-TAVR, versus redo-sutured AVR. Results: Preoperatively, redo-sutured (n = 57), ViV-TAVR (n = 31) and redo-sutureless (n = 25) patients were compared. Postoperatively, after propensity-adjustment analysis, the redo surgical aortic valve replacement group had a higher incidence of new postoperative atrial fibrillation (POAF; p = 0.04) compared with redo-sutureless group. Follow-up outcomes analysis did not show differences among groups. Conclusion: Patients undergoing redo-sutureless AVR experienced a higher incidence of POAF compared with patients undergoing redo-sutured.
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Affiliation(s)
- Aleksander Dokollari
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Centre, Maastricht, Netherlands
- Cardiac Surgery Department, St. Boniface Hospital, University of Manitoba, Winnipeg M3B1W7, Canada
| | | | - Serge Sicouri
- Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University Hospital of Siena, Siena, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University Hospital of Siena, Siena, Italy
| | | | - Edvin Prifti
- Division of Cardiac Surgery University Hospital Center "Mother Teresa" Tirana Albania
| | - Altin Veshti
- Division of Cardiac Surgery University Hospital Center "Mother Teresa" Tirana Albania
| | - Massimo Bonacchi
- Department of Experimental & Clinical Medicine, University of Florence, Firenze, Italy
| | - Sandro Gelsomino
- Cardiovascular Research Institute Maastricht - CARIM, Maastricht University Medical Centre, Maastricht, Netherlands
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9
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Zaid S, Bapat VN, Sathananthan J, Landes U, De Backer O, Tarantini G, Grubb KJ, Kaneko T, Khalique OK, Jilaihawi H, Fukui M, Madhavan M, Cangut B, Harrington K, Thourani VH, Makkar RR, Leon MB, Mack MJ, Tang GHL. Challenges and Future Directions in Redo Aortic Valve Reintervention After Transcatheter Aortic Valve Replacement Failure. Circ Cardiovasc Interv 2023; 16:e012966. [PMID: 37988437 DOI: 10.1161/circinterventions.123.012966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) is increasingly being performed in younger and lower surgical risk patients. Reintervention for failed transcatheter heart valves will likely increase in the future as younger patients are expected to outlive the initial bioprosthesis. While redo-TAVR has emerged as an attractive and less invasive alternative to surgical explantation (TAVR-explant) to treat transcatheter heart valve failure, it may not be feasible in all patients due to the risk of coronary obstruction and impaired coronary access. Conversely, TAVR-explant can be offered to most patients who are surgical candidates, but the reported outcomes have shown high mortality and morbidity. This review provides the latest evidence, current challenges, and future directions on redo-TAVR and TAVR-explant for transcatheter heart valve failure, to guide aortic valve reintervention and facilitate patients' lifetime management of aortic stenosis.
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Affiliation(s)
- Syed Zaid
- Division of Cardiology, Baylor College of Medicine, Michael E. DeBakey VA Medical Center, Houston, TX (S.Z.)
| | - Vinayak N Bapat
- Cardiothoracic Surgery, Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (V.N.B., M.F.)
| | - Janarthanan Sathananthan
- Centre for Heart Valve Innovation and Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada (J.S.)
| | - Uri Landes
- Department of Cardiology, Edith Wolfson Medical Center, Tel-Aviv University, Holon, Israel (U.L.)
| | - Ole De Backer
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Denmark (O.D.B.)
| | | | - Kendra J Grubb
- Division of Cardiothoracic Surgery, Emory University, Atlanta, GA (K.J.G.)
| | - Tsuyoshi Kaneko
- Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO (T.K.)
| | - Omar K Khalique
- DeMatteis Cardiovascular Institute; Division of Cardiac Imaging, St. Francis Hospital & Heart Center, Roslyn, NY (O.K.K.)
| | - Hasan Jilaihawi
- Division of Cardiology, Cedars-Sinai Medical Center, The Smidt Heart Institute, Los Angeles, CA (H.J., R.R.M.)
| | - Miho Fukui
- Cardiothoracic Surgery, Minneapolis Heart Institute, Abbott Northwestern Hospital, MN (V.N.B., M.F.)
| | - Mahesh Madhavan
- Division of Cardiology, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, NY (M.M, M.B.L.)
| | - Busra Cangut
- Department of Cardiovascular Surgery, Mount Sinai Hospital, New York, NY (B.C., G.H.L.T.)
| | - Katherine Harrington
- Department of Cardiothoracic Surgery, Baylor, Scott and White the Heart Hospital, Plano, TX (K.H., M.J.M.)
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, GA (V.H.T.)
| | - Raj R Makkar
- Division of Cardiology, Cedars-Sinai Medical Center, The Smidt Heart Institute, Los Angeles, CA (H.J., R.R.M.)
| | - Martin B Leon
- Division of Cardiology, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, NY (M.M, M.B.L.)
| | - Michael J Mack
- Department of Cardiothoracic Surgery, Baylor, Scott and White the Heart Hospital, Plano, TX (K.H., M.J.M.)
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Hospital, New York, NY (B.C., G.H.L.T.)
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10
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Fu HY, Wang TC, Wang CH, Chou NK, Wu IH, Hsu RB, Huang SC, Yu HY, Chen YS, Chi NH. Long-term outcomes of aortic valve replacement in dialysis patients - a nationwide retrospective cohort study. Int J Surg 2023; 109:3430-3440. [PMID: 37526125 PMCID: PMC10651279 DOI: 10.1097/js9.0000000000000611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/11/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Improved durability of modern biologic prostheses and growing experience with the transcatheter valve-in-valve technique have contributed to a substantial increase in the use of bioprostheses in younger patients. However, discussion of prosthetic valve selection in dialysis patients remains scarce as the guidelines are updated. This study aims to compare long-term outcomes between propensity score-matched cohorts of dialysis patients who underwent primary aortic valve replacement with a mechanical prosthesis or a bioprosthesis. MATERIALS AND METHODS Longitudinal data of dialysis patients who underwent primary aortic valve replacement between 1 January 2001 and 31 December 2018, were retrieved from the National Health Insurance Research Database. RESULTS A total of 891 eligible patients were identified, of whom 243 ideally matched pairs of patients were analyzed. There was no significant difference in all-cause mortality (hazard ratio 1.11, 95% CI: 0.88-1.40) or the incidence of major adverse prosthesis-related events between the two groups (hazard ratio 1.03, 95% CI: 0.84-1.25). In patients younger than 50 years of age, using a mechanical prosthesis was associated with a significantly longer survival time across 10 years of follow-up than using a bioprosthesis (restricted mean survival time) at 10 years: 7.24 (95% CI: 6.33-8.14) years for mechanical prosthesis versus 5.25 (95% CI: 4.25-6.25) years for bioprosthesis, restricted mean survival time difference 1.99 years, 95% CI: -3.34 to -0.64). CONCLUSION A 2-year survival gain in favor of mechanical prostheses was identified in dialysis patients younger than 50 years. The authors suggest mechanical prostheses for aortic valve replacement in these younger patients.
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Affiliation(s)
- Hsun-Yi Fu
- Department of Cardiovascular Surgery, National Taiwan University Hospital Hsinchu Branch, Hsinchu
| | | | - Chih-Hsien Wang
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Nai-Kuan Chou
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - I-Hui Wu
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Ron-Bin Hsu
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Shu-Chien Huang
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsi-Yu Yu
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Yih-Sharng Chen
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Nai-Hsin Chi
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan
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11
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Tnay TD, Kang L, Mekhail A, Galvin SD. Case Series of Early Structural Valve Deterioration of Trifecta Bioprosthesis - New Zealand Experience. Ann Thorac Cardiovasc Surg 2023; 29:233-240. [PMID: 36935120 PMCID: PMC10587479 DOI: 10.5761/atcs.oa.23-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 02/14/2023] [Indexed: 03/19/2023] Open
Abstract
PURPOSE Structural valve deterioration (SVD) remains a limitation on the use of bioprosthetic valves, with patient and valve-related factors contributing to early SVD. The Trifecta valve has been reported to have excellent hemodynamics but studies have highlighted early failure. We present a review and case series at a New Zealand tertiary hospital defining early SVD as failure within 3 years of implant. METHODS A retrospective review from January 2015 to July 2019 included 525 patients undergoing surgical aortic valve replacement with 263 patients receiving an Abbott Trifecta or Trifecta Glide Technology (GT) valve. Our review found an acceptable safety profile for the valve with excellent hemodynamics, with a low mortality, stroke, and permanent pacemaker rate. RESULTS Three patients out of 263 were identified from the study period as having early SVD requiring reintervention within 3 years of valve implantation leading to a 1.14% failure rate. One of the valves that had early SVD was a new generation Trifecta GT. An additional four patients were identified to have valves implanted prior to the study period and had valve failure at greater than 3 years post implantation. Five cases had cusp tears as their mechanism of failure, raising concerns about durability. CONCLUSION The Trifecta valve has an acceptable safety profile and offers good hemodynamics due to the externally mounted leaflets. However, our experience of early SVD and failure is concerning for valve durability. Further comparison to other bioprosthetic valves and longer term follow-up are required to characterize the mechanism of failures.
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Affiliation(s)
- Trevor D Tnay
- Department of Cardiothoracic Surgery, Wellington Regional Hospital, Capital and Coast District Health Board, Wellington, New Zealand
- Department of Cardiothoracic Surgery, St Vincent's Hospital Melbourne, St Vincent's Health Australia, Melbourne, Australia
| | - Lily Kang
- Department of Cardiothoracic Surgery, St Vincent's Hospital Melbourne, St Vincent's Health Australia, Melbourne, Australia
| | - Andrew Mekhail
- Department of Cardiothoracic Surgery, Wellington Regional Hospital, Capital and Coast District Health Board, Wellington, New Zealand
| | - Sean D Galvin
- Department of Cardiothoracic Surgery, Wellington Regional Hospital, Capital and Coast District Health Board, Wellington, New Zealand
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12
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Matkovic M, Aleksic N, Bilbija I, Antic A, Lazovic JM, Cubrilo M, Milojevic A, Zivkovic I, Putnik S. Clinical Impact of Patient-Prosthesis Mismatch After Aortic Valve Replacement With a Mechanical or Biological Prosthesis. Tex Heart Inst J 2023; 50:e228048. [PMID: 37867308 PMCID: PMC10658167 DOI: 10.14503/thij-22-8048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
BACKGROUND Patient-prosthesis mismatch (PPM) may impair functional capacity and survival after aortic valve replacement. This study aimed to investigate the impact of PPM on long-term survival and quality of life after mechanical and biological aortic valve replacement. METHODS This study included 595 consecutive patients who had undergone isolated aortic valve replacement. Patients were divided into 2 groups according to prosthesis type. The baseline and operative characteristics, survival rates, complications, and quality of life of the groups with and without PPM were compared for up to 6 years. The PPM calculation was performed using the effective orifice area value provided by the manufacturer divided by the patient's body surface area. RESULTS The moderate to severe PPM rates were 69.8% and 3.7% after biological and mechanical prosthesis implantation, respectively. Mean survival for patients in the biological group who had PPM was statistically significantly shorter (50.2 months [95% CI, 45.2-55.3]) than for patients in the biological group without PPM (60.1 months [95% CI, 55.7-64.4]; P = .04). In the mechanical prosthesis group, there was no difference in mean survival between the subgroup with PPM (66.6 months [95% CI, 58.3-74.9]) and the subgroup without PPM (64.9 months [95% CI, 62.6-67.2]; P = .50). A quality-of-life questionnaire's scores did not differ between the groups. CONCLUSION Mismatch is common after biological valve implantation and statistically significantly affects long-term survival and quality of life. If the risk of PPM after implantation of a biological prosthesis is suspected, adopting strategies to avoid PPM at the time of surgery is warranted.
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Affiliation(s)
- Milos Matkovic
- Department for Cardiac Surgery, Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nemanja Aleksic
- Department for Cardiac Surgery, Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ilija Bilbija
- Department for Cardiac Surgery, Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ana Antic
- Department for Cardiac Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | - Jelena Milin Lazovic
- Department for Biostatistics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marko Cubrilo
- Department for Cardiac Surgery, Clinical Centre of Serbia, Belgrade, Serbia
| | | | - Igor Zivkovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department for Cardiac Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Svetozar Putnik
- Department for Cardiac Surgery, Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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13
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Lee HA, Wu VCC, Chan YS, Cheng YT, Lee JK, Chu PH, Chen SW. Infective endocarditis after surgical aortic or mitral valve replacement: A nationwide population-based study. J Thorac Cardiovasc Surg 2023; 166:1056-1068.e7. [PMID: 35086668 DOI: 10.1016/j.jtcvs.2021.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 12/04/2021] [Accepted: 12/15/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Evidence regarding the incidence of prosthetic valve endocarditis and its association with the use of mechanical or biologic prosthetic valves is limited. METHODS Patients who underwent aortic or mitral valve replacement in the years 2000 to 2017 were identified from Taiwan's National Health Insurance Research Database and grouped according to the type of prosthesis used (mechanical or biologic). Propensity score matching was performed to reduce confounding. RESULTS A total of 22,844 patients were included, with 11,950 (52.2%) and 10,934 (47.8%) in the mechanical prosthesis and biologic prosthesis groups, respectively. After matching, each group contained 5441 patients. During follow-up, patients with a biologic prosthesis had a significantly higher risk of infective endocarditis (IE) than those with a mechanical valve (3.4% vs 1.9%; subdistribution hazard ratio, 1.78; 95% CI, 1.40-2.26). Moreover, biologic prostheses were associated with greater risks of all-cause mortality and redo valve surgery, but lesser risks of ischemic stroke, hemorrhagic stroke, major bleeding, and gastrointestinal bleeding. In subgroup analysis, biologic prostheses were consistently associated with a greater risk of IE in all subgroups, specifically single-valve replacement-aortic, single-valve replacement-mitral, double-valve replacement, active IE (IE diagnosed during index hospitalization), any IE (active or old), and not having a history of IE. CONCLUSIONS In this nationwide population-based retrospective cohort study, biologic prosthesis use was associated with a greater risk of IE during follow-up compared with mechanical valve use. However, mechanical valve use was associated with a greater risk of ischemic stroke and hemorrhagic complications.
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Affiliation(s)
- Hsiu-An Lee
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan; Division of Cardiovascular Surgery, Department of Surgery, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Victor Chien-Chia Wu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Yi-Shin Chan
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Yu-Ting Cheng
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Jen-Kuang Lee
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Laboratory Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan; Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Pao-Hsien Chu
- Department of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan
| | - Shao-Wei Chen
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan; Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan.
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14
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Chabry Y, Dhayni K, Kamel S, Caus T, Bennis Y. Prevention by the CXCR2 antagonist SCH527123 of the calcification of porcine heart valve cusps implanted subcutaneously in rats. Front Cardiovasc Med 2023; 10:1227589. [PMID: 37781314 PMCID: PMC10540224 DOI: 10.3389/fcvm.2023.1227589] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/08/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction Calcification is a main cause of bioprosthetic heart valves failure. It may be promoted by the inflammation developed in the glutaraldehyde (GA)-fixed cusps of the bioprosthesis. We tested the hypothesis that antagonizing the C-X-C chemokines receptor 2 (CXCR2) may prevent the calcification of GA-fixed porcine aortic valves. Materiel and methods Four-week-old Sprague Dawley males were transplanted with 2 aortic valve cusps isolated from independent pigs and implanted into the dorsal wall. Four groups of 6 rats were compared: rats transplanted with GA-free or GA-fixed cusps and rats transplanted with GA-fixed cusps and treated with 1 mg/kg/day SCH5217123 (a CXCR2 antagonist) intraperitoneally (IP) or subcutaneously (SC) around the xenograft, for 14 days. Then, rats underwent blood count before xenografts have been explanted for histology and biochemistry analyses. Results A strong calcification of the xenografts was induced by GA pre-incubation. However, we observed a significant decrease in this effect in rats treated with SCH527123 IP or SC. Implantation of GA-fixed cusps was associated with a significant increase in the white blood cell count, an effect that was significantly prevented by SCH527123. In addition, the expression of the CD3, CD68 and CXCR2 markers was reduced in the GA-fixed cusps explanted from rats treated with SCH527123 as compared to those explanted from non-treated rats. Conclusion The calcification of GA-fixed porcine aortic valve cusps implanted subcutaneously in rats was significantly prevented by antagonizing CXCR2 with SCH527123. This effect may partly result from an inhibition of the GA-induced infiltration of T-cells and macrophages into the xenograft.
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Affiliation(s)
- Yuthiline Chabry
- MP3CV Laboratory, UR UPJV 7517, Amiens, France
- Department of Cardiac Surgery, Bichat Hospital, Paris, France
- LVTS unit, INSERM, Paris, France
| | | | - Saïd Kamel
- MP3CV Laboratory, UR UPJV 7517, Amiens, France
- Department of Clinical Biochemistry, CHU Amiens-Picardie, Amiens, France
| | - Thierry Caus
- MP3CV Laboratory, UR UPJV 7517, Amiens, France
- Department of Cardiac Surgery, CHU Amiens-Picardie, Amiens, France
| | - Youssef Bennis
- MP3CV Laboratory, UR UPJV 7517, Amiens, France
- Department of Clinical Pharmacology, CHU Amiens-Picardie, Amiens, France
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15
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Fazzari F, Baggiano A, Fusini L, Ghulam Ali S, Gripari P, Junod D, Mancini ME, Maragna R, Mushtaq S, Pontone G, Pepi M, Muratori M. Early Biological Valve Failure: Structural Valve Degeneration, Thrombosis, or Endocarditis? J Clin Med 2023; 12:5740. [PMID: 37685807 PMCID: PMC10488994 DOI: 10.3390/jcm12175740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/24/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
Biological valve failure (BVF) is an inevitable condition that compromises the durability of biological heart valves (BHVs). It stems from various causes, including rejection, thrombosis, and endocarditis, leading to a critical state of valve dysfunction. Echocardiography, cardiac computed tomography, cardiac magnetic resonance, and nuclear imaging play pivotal roles in the diagnostic multimodality workup of BVF. By providing a comprehensive overview of the pathophysiology of BVF and the diagnostic approaches in different clinical scenarios, this review aims to aid clinicians in their decision-making process. The significance of early detection and appropriate management of BVF cannot be overstated, as these directly impact patients' prognosis and their overall quality of life. Ensuring timely intervention and tailored treatments will not only improve outcomes but also alleviate the burden of this condition on patients' life. By prioritizing comprehensive assessments and adopting the latest advancements in diagnostic technology, medical professionals can significantly enhance their ability to manage BVF effectively.
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Affiliation(s)
- Fabio Fazzari
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138 Milan, Italy; (A.B.); (L.F.); (S.G.A.); (P.G.); (D.J.); (M.E.M.); (R.M.); (S.M.); (G.P.); (M.P.); (M.M.)
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16
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Caus T, Chabry Y, Nader J, Fusellier JF, De Brux JL. Trends in SAVR with biological vs. mechanical valves in middle-aged patients: results from a French large multi-centric survey. Front Cardiovasc Med 2023; 10:1205770. [PMID: 37701140 PMCID: PMC10493300 DOI: 10.3389/fcvm.2023.1205770] [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: 04/14/2023] [Accepted: 06/16/2023] [Indexed: 09/14/2023] Open
Abstract
Background/introduction Currently, despite continued issues with durability ( 1), biological prosthetic valves are increasingly chosen over mechanical valves for surgical aortic valve replacement (SAVR) in adult patients of all ages, at least in Western countries. For younger patients, this choice means assuming the risks associated with a redo SAVR or valve-in-valve procedure. Purpose To assess the use of mechanical vs. biological valve prostheses for SAVR relative to patient's age and implant time in a large population extracted from the French National Database EPICARD. Methods Patients in EPICARD undergoing SAVR from 2007 to 2022 were included from 22 participating public or private centers chosen to represent a balanced representation of centre sizes and geographical discrepancies. Patients with associated pathology of the aorta (aneurysm or dissection) and requiring a vascular aortic prosthesis were excluded. Comparisons were made amongst centers, valve choice, implant date range, and patient age. Results We considered 101,070 valvular heart disease patients and included 72,375 SAVR (mean age 71.4 ± 12.2 years). We observed a mechanical vs. biological prosthesis ratio (MBPR) of 0.14 for the overall population. Before 50 years old (y-o), MBPR was >1.3 (p < 0.001) while patients above 60 years-old received principally biological SAVR (p < 0.0001). Concerning patients between 50 and 60 years-old patients, MPVR was 1.04 (p = 0.03). Patients 50-60 years-old from the first and second study duration quartile (before August 2015) received preferentially mechanical SAVR (p < 0.001). We observed a shift towards more biological SAVR (p < 0.001) for patients from the third and fourth quartile to reach a MBPR at 0.43 during the last years of the series. Incidentally, simultaneous mitral valve replacement were more common in case of mechanical SAVR (p < 0.0001), while associated CABGs were more frequent in case of biological SAVR (p < 0.0001). Conclusion In a large contemporary French patient population, real world practice showed a recent shift towards a lower age-threshold for biological SAVR as compared to what would suggest contemporary guidelines.
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Affiliation(s)
- Thierry Caus
- Department of Cardiac Surgery University Hospital Amiens-Picardie, Amiens, France
- Laboratoire MP3CV-University Picarde Jules Vernes-UR7517, Amiens, France
| | - Yuthiline Chabry
- Laboratoire MP3CV-University Picarde Jules Vernes-UR7517, Amiens, France
- Department of Cardiac Surgery University Paris Diderot, Paris, France
| | - Joseph Nader
- Department of Thoracic and Cardiovascular Surgery, Clinique du Millénaire, Montpellier, France
| | | | - Jean Louis De Brux
- Department of Cardiac Surgery, University Hospital of Angers, Angers, France
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17
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Lanz J, Möllmann H, Kim WK, Burgdorf C, Linke A, Redwood S, Hilker M, Joner M, Thiele H, Conzelmann L, Conradi L, Kerber S, Thilo C, Toggweiler S, Prendergast B, Husser O, Stortecky S, Deckarm S, Künzi A, Heg D, Walther T, Windecker S, Pilgrim T. Final 3-Year Outcomes of a Randomized Trial Comparing a Self-Expanding to a Balloon-Expandable Transcatheter Aortic Valve. Circ Cardiovasc Interv 2023:e012873. [PMID: 37417229 DOI: 10.1161/circinterventions.123.012873] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
BACKGROUND In the SCOPE I trial (Safety and Efficacy of the Symetis ACURATE Neo/TF Compared to the Edwards SAPIEN 3 Bioprosthesis), transcatheter aortic valve implantation with the self-expanding ACURATE neo (NEO) did not meet noninferiority compared with the balloon-expandable SAPIEN 3 (S3) device regarding a composite end point at 30 days due to higher rates of prosthetic valve regurgitation and acute kidney injury. Data on long-term durability of NEO are scarce. Here, we report whether early differences between NEO and S3 translate into differences in clinical outcomes or bioprosthetic valve failure 3 years after transcatheter aortic valve implantation. METHODS Patients with severe aortic stenosis were randomized to transfemoral transcatheter aortic valve implantation with NEO or S3 at 20 European centers. Clinical outcomes at 3 years are compared using Cox proportional or Fine-Gray subdistribution hazard models by intention-to-treat. Bioprosthetic valve failure is reported for the valve-implant cohort. RESULTS Among 739 patients, 84 of 372 patients (24.3%) had died in the NEO and 85 of 367 (25%) in the S3 group at 3 years. Comparing NEO with S3, the 3-year rates of all-cause death (hazard ratio, 0.98 [95% CI, 0.73-1.33]), stroke (subhazard ratio, 1.04 [95% CI, 0.56-1.92]), and hospitalization for congestive heart failure (subhazard ratio, 0.74 [95% CI, 0.51-1.07]) were similar between the groups. Aortic valve reinterventions were required in 4 NEO and 3 S3 patients (subhazard ratio, 1.32 [95% CI, 0.30-5.85]). New York Heart Association functional class ≤II was observed in 84% (NEO) and 85% (S3), respectively. Mean gradients remained lower after NEO at 3 years (8 versus 12 mm Hg; P<0.001). CONCLUSIONS Early differences between NEO and S3 did not translate into significant differences in clinical outcomes or bioprosthetic valve failure throughout 3 years. REGISTRATION URL: https://clinicaltrials.gov, Unique identifier: NCT03011346.
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Affiliation(s)
- Jonas Lanz
- Department of Cardiology, Inselspital, Bern University Hospital, Switzerland (J.L., S.S., S.W., T.P.)
| | - Helge Möllmann
- Department of Internal Medicine I, St-Johannes-Hospital, Dortmund, Germany (H.M.)
| | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany (W.-K.K.)
| | | | - Axel Linke
- Department of Internal Medicine and Cardiology, Heart Center Dresden, Technische Universität Dresden, Germany (A.L.)
| | - Simon Redwood
- Department of Cardiology, St Thomas' Hospital, London, United Kingdom (S.R., B.P.)
| | - Michael Hilker
- Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany (M.H.)
| | - Michael Joner
- German Heart Centre, Technical University of Munich, Germany (M.J.)
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig, Germany (H.T.)
| | - Lars Conzelmann
- Department of Cardiac Surgery, Helios Klinik, Karlsruhe, Germany (L. Conzelmann)
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Germany (L. Conradi)
| | - Sebastian Kerber
- Department of Cardiology, Cardio-vascular Center Bad Neustadt, Germany (S.K.)
| | - Christian Thilo
- Department of Internal Medicine I, RoMed Klinikum Rosenheim, Germany (C.T.)
| | - Stefan Toggweiler
- Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland (S.T.)
| | - Bernard Prendergast
- Department of Cardiology, St Thomas' Hospital, London, United Kingdom (S.R., B.P.)
| | - Oliver Husser
- Department of Cardiology and Intensive Care Medicine, Augustinum Klinik Munich (O.H.)
| | - Stefan Stortecky
- Department of Cardiology, Inselspital, Bern University Hospital, Switzerland (J.L., S.S., S.W., T.P.)
| | - Sarah Deckarm
- Clinical Trials Unit Bern, University of Bern, Switzerland (S.D., A.K., D.H.)
| | - Arnaud Künzi
- Clinical Trials Unit Bern, University of Bern, Switzerland (S.D., A.K., D.H.)
| | - Dik Heg
- Clinical Trials Unit Bern, University of Bern, Switzerland (S.D., A.K., D.H.)
| | - Thomas Walther
- Department of Cardiac and Vascular Surgery, University Hospital Frankfurt, Germany (T.W.)
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, Switzerland (J.L., S.S., S.W., T.P.)
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, Switzerland (J.L., S.S., S.W., T.P.)
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18
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Grashuis P, Khargi SD, Veen K, el Osrouti A, Bemelmans-Lalezari S, Cornette JM, Roos-Hesselink JW, Takkenberg JJ, Mokhles MM. Pregnancy outcomes in women with a mitral valve prosthesis: A systematic review and meta-analysis. JTCVS Open 2023; 14:102-122. [PMID: 37425470 PMCID: PMC10328972 DOI: 10.1016/j.xjon.2023.05.001] [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] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 04/26/2023] [Accepted: 05/02/2023] [Indexed: 07/11/2023]
Abstract
Objectives To evaluate the ongoing debate concerning the choice of valve prosthesis for women requiring mitral valve replacement (MVR) and who wish to conceive. Bioprostheses are associated with risk of early structural valve deterioration. Mechanical prostheses require lifelong anticoagulation and carry maternal and fetal risks. Also, the optimal anticoagulation regimen during pregnancy after MVR remains unclear. Methods A systematic review and meta-analysis was conducted of studies reporting on pregnancy after MVR. Valve- and anticoagulation-related maternal and fetal risks during pregnancy and 30 days' postpartum were analyzed. Results Fifteen studies reporting 722 pregnancies were included. In total, 87.2% of pregnant women had a mechanical prosthesis and 12.5% a bioprosthesis. Maternal mortality risk was 1.33% (95% confidence interval [CI], 0.69-2.56), any hemorrhage risk 6.90% (95% CI, 3.70-12.88). Valve thrombosis risk was 4.71% (95% CI, 3.06-7.26) in patients with mechanical prostheses. 3.23% (95% CI, 1.34-7.75) of the patients with bioprostheses experienced early structural valve deterioration. Of these, the mortality was 40%. Pregnancy loss risk was 29.29% (95% CI, 19.74-43.47) with mechanical prostheses versus 13.50% (95% CI, 4.31-42.30) for bioprostheses. Switching to heparin during the first trimester demonstrated a bleeding risk of 7.78% (95% CI, 3.71-16.31) versus 4.08% (95% CI, 1.17-14.28) for women on oral anticoagulants throughout pregnancy and a valve thrombosis risk of 6.99% (95% CI, 2.08-23.51) versus 2.89% (95% CI, 1.40-5.94). Administration of anticoagulant dosages greater than 5 mg resulted in a risk of fetal adverse events of 74.24% (95% CI, 56.11-98.23) versus 8.85% (95% CI, 2.70-28.99) in ≤5 mg. Conclusions A bioprosthesis seems the best option for women of childbearing age who are interested in future pregnancy after MVR. If mechanical valve replacement is preferred, the favorable anticoagulation regimen is continuous low-dose oral anticoagulants. Shared decision-making remains priority when choosing a prosthetic valve for young women.
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Affiliation(s)
- Pepijn Grashuis
- Department of Cardiothoracic Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Shanti D.M. Khargi
- Department of Cardiothoracic Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Kevin Veen
- Department of Cardiothoracic Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Azzeddine el Osrouti
- Department of Cardiothoracic Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | - Jérôme M.J. Cornette
- Department of Obstetrics and Fetal Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | | | - Mostafa M. Mokhles
- Department of Cardiothoracic Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
- Department of Cardiothoracic Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
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19
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Pandya PK, Park MH, Zhu Y, Woo YJ. Biomechanical analysis of novel leaflet geometries for bioprosthetic valves. JTCVS Open 2023; 14:77-86. [PMID: 37425479 PMCID: PMC10328959 DOI: 10.1016/j.xjon.2023.04.007] [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: 08/02/2022] [Revised: 03/23/2023] [Accepted: 04/05/2023] [Indexed: 07/11/2023]
Abstract
Objectives Although bioprosthetic valves have excellent hemodynamic properties and can eliminate the need for lifelong anticoagulation therapy, these devices are associated with high rates of reoperation and limited durability. Although there are many distinct bioprosthesis designs, all bioprosthetic valves have historically featured a trileaflet pattern. This in silico study examines the biomechanical effect of modulating the number of leaflets in a bioprosthetic valve. Methods Bioprosthetic valves with 2 to 6 leaflets were designed in Fusion 360 using quadratic spline geometry. Leaflets were modeled with standard mechanical parameters for fixed bovine pericardial tissue. A mesh of each design was structurally evaluated using finite element analysis software Abaqus CAE. Maximum von Mises stresses during valve closure were assessed for each leaflet geometry in both the aortic and mitral position. Results Computational analysis demonstrated that increasing the number of leaflets is associated with reduction in leaflet stresses. Compared with the standard trileaflet design, a quadrileaflet pattern reduces leaflet maximum von Mises stresses by 36% in the aortic position and 38% in the mitral position. Maximum stress was inversely proportional to the square of the leaflet quantity. Surface area increased linearly and central leakage increased quadratically with leaflet quantity. Conclusions A quadrileaflet pattern was found to reduce leaflet stresses while limiting increases in central leakage and surface area. These findings suggest that modulating the number of leaflets can allow for optimization of the current bioprosthetic valve design, which may translate to more durable valve replacement bioprostheses.
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Affiliation(s)
- Pearly K. Pandya
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif
- Department of Mechanical Engineering, Stanford University, Stanford, Calif
| | - Matthew H. Park
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif
- Department of Mechanical Engineering, Stanford University, Stanford, Calif
| | - Yuanjia Zhu
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif
- Department of Bioengineering, Stanford University, Stanford, Calif
| | - Y. Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif
- Department of Bioengineering, Stanford University, Stanford, Calif
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20
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Tchetche D, de Biase C. Bioprosthetic Valve Fracture: Timing Matters. JACC Cardiovasc Interv 2023; 16:540-541. [PMID: 36922039 DOI: 10.1016/j.jcin.2023.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/10/2023] [Indexed: 03/18/2023]
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21
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Batumalai V, Carr M, Jameson M, Crawford D, Jelen U, Pagulayan C, Twentyman T, Hong A, de Leon J. MR-Linac guided adaptive stereotactic ablative body radiotherapy for recurrent cardiac sarcoma with mitral valve bioprosthesis - a case report. J Med Radiat Sci 2023. [PMID: 36890690 DOI: 10.1002/jmrs.669] [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: 09/14/2022] [Accepted: 02/21/2023] [Indexed: 03/10/2023] Open
Abstract
We present the first case in the literature of a 78-year-old woman with recurrent cardiac sarcoma adjacent to a bioprosthetic mitral valve treated with magnetic resonance linear accelerator (MR-Linac) guided adaptive stereotactic ablative body radiotherapy (SABR). The patient was treated using a 1.5 T Unity MR-Linac system (Elekta AB, Stockholm, Sweden). The mean gross tumour volume (GTV) size was 17.9 cm3 (range 16.6-18.9 cm3 ) based on daily contours and the mean dose received by the GTV was 41.4 Gy (range 40.9-41.6 Gy) in five fractions. All fractions were completed as planned and the patient tolerated the treatment well with no acute toxicity reported. Follow-up appointments at 2 and 5 months after the last treatment showed stable disease and good symptomatic relief. Results of transthoracic echocardiogram after radiotherapy showed that the mitral valve prosthesis was normally seated with regular functionality. This study provides evidence that MR-Linac guided adaptive SABR is a safe and viable option for the treatment of recurrent cardiac sarcoma with mitral valve bioprosthesis.
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Affiliation(s)
- Vikneswary Batumalai
- GenesisCare, Sydney, New South Wales, Australia.,School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Madeline Carr
- GenesisCare, Sydney, New South Wales, Australia.,Centre for Medical and Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia
| | - Michael Jameson
- GenesisCare, Sydney, New South Wales, Australia.,School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia.,Centre for Medical and Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia
| | | | | | | | | | - Angela Hong
- GenesisCare, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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22
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Dallan LAP, Tang G, Forrest JK, Reardon MJ, Szeto WY, Kodali SK, Baeza C, Eisenberg R, Attizzani GF. Transcatheter Aortic Valve Replacement in Large Annuli Valves With the Supra-Annular, Self-Expandable Evolut Platform in a Real-World Registry. Circ Cardiovasc Interv 2023; 16:e012623. [PMID: 36943929 PMCID: PMC10022658 DOI: 10.1161/circinterventions.122.012623] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Transcatheter aortic valve replacement is approved for treatment of patients with severe aortic stenosis across the spectrum of risk. While considering broader indications for use, transcatheter aortic valve replacement in large native annuli has become increasingly important. METHODS Patients with tricuspid aortic stenosis undergoing transcatheter aortic valve replacement using the Evolut R or Evolut PRO+ 34 mm valves (Medtronic, Minneapolis, MN) in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry between October 2016 and September 2020 were stratified according to in range (>12%) device oversizing and below range (0%-12%) device oversizing. Patients undergoing valve-in-valve procedures, having a baseline annulus size <26 or ≥34 mm, or without computed tomography angiography measured annulus size were excluded. Percentage of oversizing was calculated as [(valve diameter-annulus diameter)×100/annulus diameter]. RESULTS Transcatheter aortic valve replacement in patients with large annuli was performed in 8017 patients with a mean (±SD) age 79.3±7.9 years and 94% were male. Below range (n=1096) was less common than in range oversizing (n=6921). At 1-year follow-up, mortality (19.6% versus 14.9%; P=0.001), aortic valve reintervention (2.1% versus 0.6%; P<0.001) and valve-related readmission rates (3.2% versus 2.0%; P=0.014) were higher in the below range device oversizing group versus in range group respectively. In a multivariable Cox proportional hazards regression model, when controlling for clinically relevant covariates, below range device oversizing was associated with higher 1-year all-cause mortality (HR, 1.28 [CI, 1.07-1.51]; P=0.005). CONCLUSIONS Results from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry in patients with large annuli valves using 34mm Evolut R/PRO+ valves suggest that in range (>12%) device oversizing delivered better clinical outcomes than implantation with below range (0%-12%) device oversizing.
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Affiliation(s)
- Luis Augusto P Dallan
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, OH (L.A.P.D., C.B., G.F.A.)
| | - Gilbert Tang
- Departments of Internal Medicine and Surgery, Mount Sinai Beth Israel, New York (G.T.)
| | - John K Forrest
- Departments of Internal Medicine and Surgery Yale University School of Medicine, New Haven, CT (J.K.F.)
| | - Michael J Reardon
- Department of Cardiothoracic Surgery, Methodist DeBakey Heart and Vascular Center, Houston Methodist, Houston, TX (M.J.R.)
| | - Wilson Y Szeto
- University of Pennsylvania School of Medicine, Philadelphia (W.Y.S.)
| | - Susheel K Kodali
- Structural Heart & Valve Center, New York Presbyterian/Columbia University Medical Center, New York (S.K.K.)
| | - Cristian Baeza
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, OH (L.A.P.D., C.B., G.F.A.)
| | | | - Guilherme F Attizzani
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, OH (L.A.P.D., C.B., G.F.A.)
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23
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Scotti A, Baggio S, Pagnesi M, Barbanti M, Adamo M, Eitan A, Estévez-Loureiro R, Veulemans V, Toggweiler S, Mylotte D, De Marco F, Giannini F, Ferlini M, Naber CK, Buono A, Schofer J, Rottbauer W, Van Mieghem NM, Khogali S, Taramasso M, Pilgrim T, Sinning JM, Zweiker D, Montorfano M, Van der Heyden JAS, Brugaletta S, Ielasi A, Hamm CW, Vanhaverbeke M, Costa G, Massussi M, Alarcón R, Zeus T, Lunardi M, Testa L, Di Ienno L, Lanzillo G, Wolf A, Maffeo D, Ziviello F, Saccocci M, Windecker S, Sedaghat A, Schmidt A, Brouwer J, Regueiro A, Reimers B, Kim WK, Sondergaard L, Colombo A, Mangieri A, Latib A. Temporal Trends and Contemporary Outcomes After Transcatheter Aortic Valve Replacement With Evolut PRO/PRO+ Self-Expanding Valves: Insights From the NEOPRO/NEOPRO-2 Registries. Circ Cardiovasc Interv 2023; 16:e012538. [PMID: 36649387 DOI: 10.1161/circinterventions.122.012538] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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] [Indexed: 01/18/2023]
Abstract
BACKGROUND In recent years, transcatheter aortic valve replacement (TAVR) techniques and technology have continuously improved. Data regarding the impact of these advancements on outcomes in large real-world settings are still limited. The aim of this study was to investigate temporal trends and assess contemporary outcomes after TAVR with Evolut PRO/PRO+ supra-annular self-expanding valves. METHODS This study included patients enrolled in the multicenter NEOPRO (A Multicenter Comparison of Acurate NEO Versus Evolut PRO Transcatheter Heart Valves) and NEOPRO-2 (A Multicenter Comparison of ACURATE NEO2 Versus Evolut PRO/PRO+ Transcatheter Heart Valves 2) registries who underwent transfemoral TAVR with Evolut PRO/PRO+. Procedural dates (August 2017 through November 2021) were stratified in quartiles (Q) and used to investigate temporal trends in TAVR outcomes. Predischarge, 30-day Valve Academic Research Consortium-3 defined, and 1-year outcomes were evaluated. RESULTS In total, 1616 patients from 28 centers were included. Over time, patients had lower Society of Thoracic Surgeon-Predicted Risk of Mortality score (Q1-4, 4.1% [2.8-6.3%], 3.7% [2.6-5.3%], 3.3% [2.4-4.9%], 2.9% [2.2-4.3%]; P<0.001) and more moderate or heavy valve calcification (Q1-4, 80%, 80%, 82%, 88%; P=0.038). Overall Valve Academic Research Consortium-3 technical success was 94.1%, with 30-day and 1-year all-cause mortality of 2.4% and 10%, respectively. Throughout the study period, procedures were associated with higher rates of 30-day device success (Q1-4, 81.2%, 82.2%, 82.0%, 88.0%; Cochran-Armitage P=0.023) and early safety (Q1-4, 66.8%, 67.5%, 74.0%, 77.6%; Cochran-Armitage P<0.001), with fewer permanent pacemaker implantations (Q1-4: 15.3%, 20.0%, 12.1%, 11.6%; Cochran-Armitage P=0.023) and residual mild or greater paravalvular leaks (Q1-4, 50.4%, 42.1%, 36.5%, 35.8%; Cochran-Armitage P<0.001). CONCLUSIONS TAVR with Evolut PRO/PRO+ self-expanding valve is safe and effective. Despite the treatment of heavier calcified anatomies, procedural outcomes are improving over time with less need for pacemaker implantation and less significant paravalvular leaks.
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Affiliation(s)
- Andrea Scotti
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (A.S., A.L.)
| | - Sara Baggio
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy (S.B., B.R., A.C., A.M.).,IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy (S.B., B.R., A.C., A.M.)
| | - Matteo Pagnesi
- Cardiothoracic Department, ASST Spedali Civili di Brescia University of Brescia, Italy (M.P., M.A., M. Massussi).,Department of Medical Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy (M.P., M.A., M. Massussi)
| | - Marco Barbanti
- Department of Cardiology, C.A.S.T. Policlinico G. Rodolico, Catania, Italy (M.B., G.C.)
| | - Marianna Adamo
- Cardiothoracic Department, ASST Spedali Civili di Brescia University of Brescia, Italy (M.P., M.A., M. Massussi).,Department of Medical Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy (M.P., M.A., M. Massussi)
| | - Amnon Eitan
- Department of Cardiology, Carmel Medical Center, Haifa, Israel (A.E.)
| | - Rodrigo Estévez-Loureiro
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute, Vigo, Spain (R.E.-L., R.A.)
| | - Verena Veulemans
- Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Germany (V.V., T.Z.)
| | - Stefan Toggweiler
- Heart Center Lucerne, Department of Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland (S.T.)
| | - Darren Mylotte
- Department of Cardiology, Galway University Hospitals, Ireland (D.M., M.L.)
| | | | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy (F.G., L.D.I.)
| | - Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (M.F., G.L.)
| | - Christoph K Naber
- Contilia Heart and Vascular Centre, Elisabeth-Krankenhaus Essen, Germany (C.K.N., A.W.)
| | - Andrea Buono
- Interventional Cardiology Unit, Fondazione Poliambulanza, Brescia, Italy (A.B., D.M.)
| | - Joachim Schofer
- Department for Percutaneous Treatment of Structural Heart Disease, Albertinen Heart Center, Hamburg, Germany (J.S.).,MVZ Department Structural Heart Disease, Asklepios St Georg Clinic, Hamburg, Germany (J.S.)
| | - Wolfgang Rottbauer
- Department of Internal Medicine II, University Hospital Ulm, Germany (W.R., S.W.)
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands (N.M.V.M., F.Z.)
| | - Saib Khogali
- Heart and Lung Center, New Cross Hospital, Wolverhampton, UK (S.K.)
| | - Maurizio Taramasso
- Division of Cardiothoracic Surgery, HerzZentrum Hirslanden Zürich, Switzerland (M.T., M.S.)
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland (T.P.)
| | - Jan-Malte Sinning
- Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Germany (J.-M.S., A. Sedaghat)
| | - David Zweiker
- Division of Cardiology, Medical University of Graz, Austria (D.Z., A. Schmidt)
| | - Matteo Montorfano
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy (M. Montorfano)
| | - Jan A S Van der Heyden
- Department of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands (J.A.S.V.d.H., J.B.).,Interventional Cardiology Unit, AZ Sint-Jan Hospital, Bruges, Belgium (J.A.S.V.d.H.)
| | - Salvatore Brugaletta
- Clinic Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain (S.B., A.R.)
| | - Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy (A.I.)
| | - Christian W Hamm
- Department of Cardiology and Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany (C.W.H., W.-K.K.)
| | - Maarten Vanhaverbeke
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (M.V., L.S.)
| | - Giuliano Costa
- Department of Cardiology, C.A.S.T. Policlinico G. Rodolico, Catania, Italy (M.B., G.C.)
| | - Mauro Massussi
- Cardiothoracic Department, ASST Spedali Civili di Brescia University of Brescia, Italy (M.P., M.A., M. Massussi).,Department of Medical Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy (M.P., M.A., M. Massussi)
| | - Robert Alarcón
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute, Vigo, Spain (R.E.-L., R.A.)
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Germany (V.V., T.Z.)
| | - Mattia Lunardi
- Department of Cardiology, Galway University Hospitals, Ireland (D.M., M.L.)
| | - Luca Testa
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Milan, Italy (L.T.)
| | - Luca Di Ienno
- Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, Cotignola, Italy (F.G., L.D.I.)
| | - Giuseppe Lanzillo
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy (M.F., G.L.)
| | - Alexander Wolf
- Contilia Heart and Vascular Centre, Elisabeth-Krankenhaus Essen, Germany (C.K.N., A.W.)
| | - Diego Maffeo
- Interventional Cardiology Unit, Fondazione Poliambulanza, Brescia, Italy (A.B., D.M.)
| | - Francesca Ziviello
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands (N.M.V.M., F.Z.)
| | - Matteo Saccocci
- Division of Cardiothoracic Surgery, HerzZentrum Hirslanden Zürich, Switzerland (M.T., M.S.)
| | - Stephan Windecker
- Department of Internal Medicine II, University Hospital Ulm, Germany (W.R., S.W.)
| | - Alexander Sedaghat
- Department of Cardiology, Heart Center Bonn, University Hospital Bonn, Germany (J.-M.S., A. Sedaghat)
| | - Albrecht Schmidt
- Division of Cardiology, Medical University of Graz, Austria (D.Z., A. Schmidt)
| | - Jorn Brouwer
- Department of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands (J.A.S.V.d.H., J.B.)
| | - Ander Regueiro
- Clinic Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain (S.B., A.R.)
| | - Bernhard Reimers
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy (S.B., B.R., A.C., A.M.).,IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy (S.B., B.R., A.C., A.M.)
| | - Won-Keun Kim
- Department of Cardiology and Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany (C.W.H., W.-K.K.)
| | - Lars Sondergaard
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (M.V., L.S.)
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy (S.B., B.R., A.C., A.M.).,IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy (S.B., B.R., A.C., A.M.)
| | - Antonio Mangieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy (S.B., B.R., A.C., A.M.).,IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy (S.B., B.R., A.C., A.M.)
| | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (A.S., A.L.)
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Falcetta G, Del Re F, Pratali S, Bortolotti U. Replacement of a Calcified Aortic Valve in a Porcine Aortic Root with the Perceval Sutureless Bioprosthesis. Aorta (Stamford) 2022; 10:302-303. [PMID: 36539148 PMCID: PMC9767758 DOI: 10.1055/s-0042-1757795] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We report a 79-year-old patient who had aortic valve replacement (AVR) using a porcine aortic root. Due to degeneration of the porcine aortic valve, he required reoperation during which a heavily calcified porcine root and aortic annulus prevented insertion of any traditional bioprosthesis. AVR was achieved using a sutureless bioprosthesis, combined with mitral valve replacement. The present case confirms the feasibility and advantages of using sutureless valve implantation in complex and high-risk redo procedures.
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Affiliation(s)
- Giosuè Falcetta
- Section of Cardiac Surgery, Department of Cardiac Thoracic and Vascular Surgery, University Hospital, Pisa, Italy
| | - Federico Del Re
- Section of Cardiac Surgery, Department of Cardiac Thoracic and Vascular Surgery, University Hospital, Pisa, Italy
| | - Stefano Pratali
- Section of Cardiac Surgery, Department of Cardiac Thoracic and Vascular Surgery, University Hospital, Pisa, Italy
| | - Uberto Bortolotti
- Section of Cardiac Surgery, Department of Cardiac Thoracic and Vascular Surgery, University Hospital, Pisa, Italy,Address for correspondence Uberto Bortolotti, MD Largo Traiano 23, 35036 Montegrotto TermeItaly
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25
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Mendoza CE, Rivera H. Structural changes in explanted TAVR valves: Digging to find the answer. J Card Surg 2022; 37:5443-5444. [PMID: 35870164 DOI: 10.1111/jocs.16788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 01/06/2023]
Affiliation(s)
- Cesar E Mendoza
- Division of Cardiovascular Disease, Jackson Memorial Hospital, Miami, Florida, USA
| | - Hector Rivera
- Division of Cardiovascular Disease, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida, USA
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Tsui S, Rosenbloom M, Abel J, Swanson J, Haverich A, Zacharias J, Schorlemmer G, Cohen G, Moulton M, Lange R. Eight-year outcomes of aortic valve replacement with the Carpentier-Edwards PERIMOUNT Magna Ease valve. J Card Surg 2022; 37:4999-5010. [PMID: 36378942 PMCID: PMC10100054 DOI: 10.1111/jocs.17140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 10/29/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The Carpentier-Edwards PERIMOUNT Magna Ease valve is a third-generation bioprosthesis for aortic valve replacement (AVR). This is a postapproval study reporting on its 8-year outcomes. METHODS Adults undergoing AVR with the Magna Ease valve between October 2007 and December 2012 were enrolled for this prospective, nonrandomized, single-arm, and multicenter study. Assessments occurred preoperatively, at hospital discharge, 6 months, 1 year, and annually thereafter for up to 8 years. Outcomes included safety endpoints, hemodynamic performance, and New York Heart Association (NYHA) functional class. RESULTS Of the 258 study patients, 67.5% were in NYHA Class I or II, and 32.5% were in NYHA Class III or IV at baseline. Concomitant procedures were performed in 44.2%. Total follow-up was 1597.6 patient-years, and median follow-up was 7 years (interquartile range: 5.5-8.0 years). Eight years following AVR, the functional class remained improved from baseline with 93.9% in NYHA Class I/II and 6.1% in NYHA Class III; 38 deaths had occurred, 8 of which were valve related; freedom from all-cause mortality was 80.7% (95% confidence intervals: 74.9, 86.4); freedom from valve-related mortality was 95.8% (92.8, 98.8); freedom from reintervention, explant, major bleeding events, and structural valve deterioration was 89.8% (85.1, 94.6), 94.8% (91.7, 97.9), 85.1% (80.0, 90.1), and 90.1% (84.7, 95.4), respectively; effective orifice area was 1.5 ± 0.5 cm2 , the mean gradient was 14.8 ± 8.3 mmHg, and 88.6% of patients had no or trivial aortic regurgitation. CONCLUSIONS This study demonstrated satisfactory safety and sustained hemodynamic and functional improvements at 8 years following AVR with the Magna Ease valve.
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Affiliation(s)
- Steven Tsui
- Department of Cardiothoracic Surgery and Transplantation, Royal Papworth Hospital, Cambridge, UK
| | - Michael Rosenbloom
- Division of Cardiothoracic Surgery, Cooper University Hospital, Camden, New Jersey, USA
| | - James Abel
- Division of Cardiac and Thoracic Surgery, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeffrey Swanson
- Providence Heart Valve Clinic, Providence St Vincent's Hospital, Portland, Oregon, USA
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Medizinische Hochschule Hannover, Hannover, Germany
| | - Joseph Zacharias
- Department of Cardiothoracic Surgery, Blackpool Victoria Hospital, Blackpool, UK
| | - Gilbert Schorlemmer
- Department of Cardiac, Vascular and Thoracic Surgery, St Mark's Hospital, Salt Lake, Utah, USA
| | - Gideon Cohen
- Department of Surgery, Division of Cardiac Surgery, Sunnybrook Health Sciences Center, North York, Ontario, Canada
| | - Michael Moulton
- Division of Cardiothoracic Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Rüdiger Lange
- Department of Cardiovascular Surgery, German Heart Center Munich, Munich, Bavaria, Germany
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El-Sayed Ahmad A, Giammarino S, Salamate S, Fehske W, Sirat S, Amer M, Bramlage P, Bakhtiary F, Doss M. Clinical performance of a novel bioprosthetic surgical aortic valve in a German high-volume center. J Card Surg 2022; 37:4833-4840. [PMID: 36403275 DOI: 10.1111/jocs.17198] [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: 04/08/2022] [Revised: 09/23/2022] [Accepted: 10/26/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND AIM Bioprosthetic surgical aortic valve replacement (SAVR) is increasingly adopted in younger patients. We aimed to analyze mid-term follow-up data after SAVR to assess the performance of the prosthesis. METHODS Data were collected from a single-center series of 154 patients, who underwent SAVR with a bioprosthetic heart valve with the RESILIA tissue at our Heart Centre in Siegburg. All procedural and midterm patient outcomes were documented. RESULTS Patients had a mean age of 56.8 ± 9.9 years, 35.7% were female, and the mean logistic European system for cardiac operative risk evaluation (EuroSCORE) was 3.4 ± 3.6%. Diabetes (12.3%), atrial fibrillation (10.4%), and chronic obstructive pulmonary disease (COPD) (5.8%) were common comorbidities. The mean surgery duration was 163.8 ± 73.4 min, with the 23 mm (34.4%) and 25 mm (33.8%) heart valves being most frequently implanted. At 3-year follow-up, mean pressure gradient was 13.9 ± 5.9 mmHg, peak gradient was 23.6 ± 7.7 mmHg, and effective orifice area (EOA) was 1.9 ± 0.4 cm². No patient died during the operation, 3 (2.1%) patients within 30 days, and 4 (2.7%) thereafter with an overall mortality of n = 7. Of the surviving patients, 97.8% were in New York Heart Association (NYHA) class I/II and none had structural valve deterioration (SVD). CONCLUSION Results of our single-center study indicate favorable procedural outcomes. The safety outcomes confirm preliminary earlier results of this novel bioprosthesis but include more patients and a longer midterm follow-up.
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Affiliation(s)
- Ali El-Sayed Ahmad
- Division of Cardiac Surgery, Heart Centre Siegburg-Wuppertal, University Witten-Herdecke, Witten, Germany
| | - Sabrina Giammarino
- Division of Cardiac Surgery, Heart Centre Siegburg-Wuppertal, University Witten-Herdecke, Witten, Germany
| | - Saad Salamate
- Division of Cardiac Surgery, Heart Centre Siegburg-Wuppertal, University Witten-Herdecke, Witten, Germany.,Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - Wolfgang Fehske
- Division of Cardiac Surgery, Heart Centre Siegburg-Wuppertal, University Witten-Herdecke, Witten, Germany
| | - Sami Sirat
- Division of Cardiac Surgery, Heart Centre Siegburg-Wuppertal, University Witten-Herdecke, Witten, Germany
| | - Mohamed Amer
- Division of Cardiac Surgery, Heart Centre Siegburg-Wuppertal, University Witten-Herdecke, Witten, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Farhad Bakhtiary
- Division of Cardiac Surgery, Heart Centre Siegburg-Wuppertal, University Witten-Herdecke, Witten, Germany.,Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - Mirko Doss
- Division of Cardiac Surgery, Heart Centre Siegburg-Wuppertal, University Witten-Herdecke, Witten, Germany
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Muacevic A, Adler JR, Eiró V, Nunes da Costa J. Dermal Matrices: Do We Always Know What Is Going On? Cureus 2022; 14:e31979. [PMID: 36582564 PMCID: PMC9795081 DOI: 10.7759/cureus.31979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 11/29/2022] Open
Abstract
The use of dermal matrices in abdominal wall reconstruction has gained increased attention over time, particularly in contaminated fields. One of their advantages is the greater capacity to resist infection. We report a case of a 36-year-old man, with congenital bladder exstrophy and neobladder reconstruction during childhood. He presented to us with an abdominal hernia associated with a vesicocutaneous fistula. We used a bovine-derived dermal matrix (SurgiMend®, TEI Biosciences, MA, USA) for reinforcement of the abdominal repair considering its laboratory-proven mechanical superiority regarding strength. The early postoperative period was complicated by an infection that led to mesh disintegration and the need for surgical revision. We believe that matrix digestion by bacterial enzymes culminated in rapid breakdown of the product. Further investigations are warranted to determine optimal selection criteria and indications of bioprosthesis in contaminated wounds. Surgeons should be cautious when selecting a biologic mesh in these cases, favoring meshes with a better integration profile.
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Kuohn LR, Ro R, Bamira D, Vainrib A, Freedberg R, Galloway A, Williams MR, Saric M. Bacterial endocarditis with AACEK (HACEK) organisms. Echocardiography 2022; 39:1348-1358. [PMID: 36198094 DOI: 10.1111/echo.15440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/07/2022] [Accepted: 07/03/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Gram-negative organisms of the AACEK group, formerly known as HACEK, rarely cause endocarditis. CASE SERIES We present three cases of bacterial endocarditis, involving native and prosthetic valves, caused by AACEK organisms. In two patients, Cardiobacterium hominis was the responsible organism, and in a third, Aggregatibacter aphrophilus was implicated. A dental source of infection was identified in two patients, and in all three patients, the presentation of endocarditis was subacute. DISCUSSION This case series highlights the indolent nature of infection with the AACEK organisms. It also demonstrates the crucial role of multimodality imaging, especially transesophageal echocardiography, in the diagnosis of AACEk endocarditis of both native and prosthetic valves, and in delineating the extent of abscess in those with prosthetic valve infection.
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Affiliation(s)
- Lindsey R Kuohn
- Leon H Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Richard Ro
- Leon H Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Daniel Bamira
- Leon H Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Alan Vainrib
- Leon H Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Robin Freedberg
- Leon H Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
| | - Aubrey Galloway
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York, USA
| | - Mathew R Williams
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, New York, USA
| | - Muhamed Saric
- Leon H Charney Division of Cardiology, New York University Langone Health, New York, New York, USA
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Sadat N, Scharfschwerdt M, Tim S, Aboud A, Saisho H, Ensminger S, Fujita B. Functional performance of eight small surgical aortic valve bioprostheses: An in vitro study. Eur J Cardiothorac Surg 2022; 62:6673140. [PMID: 35993864 DOI: 10.1093/ejcts/ezac426] [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: 02/24/2022] [Revised: 05/31/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Selection of a surgical aortic valve bioprosthesis (SAV) model for treatment of aortic valve disease remains controversial. The aim of this study was to characterize the functional performance of eight SAV models in a standardized in vitro setting. METHODS The hydrodynamic performance of eight SAVs with labelled size 21 mm (Avalus™, Hancock® II, Mosaic® UltraTM, Perimount®, Perimount® Magna Ease, EpicTM Supra, Trifecta™ GT; Freestyle®) was investigated in a pulse duplicator. Transvalvular pressure gradients and effective orifice area (EOA) were recorded. The geometrical orifice area (GOA) and physical dimensions of the valves were determined, and new functional dimensions were introduced. RESULTS Mean pressure gradient (MPG) and EOA differed significantly between the analyzed SAVs. The Epic presented with the lowest EOA and highest MPG, while the Trifecta showed the highest EOA and the lowest MPG. We introduce a useful way to determine the minimal internal diameter and a new measure termed 'relative orifice area' to characterize a valve's performance. CONCLUSIONS SAVs showed significant differences in their hydrodynamic performance despite the same label size. This finding was related to the construction of the valves. We introduce a new measure that characterizes the functional performance of a valve model and size for treatment of an aortic annulus of a specific size. Our data emphasize that SAV selection should carefully be done using an individual patient approach and that future research is necessary to improve the current generation of SAVs.
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Affiliation(s)
- Najla Sadat
- Department of Cardiac and Thoracic Vascular Surgery, University Medical Center Schleswig-Holstein, Lübeck Campus, Germany
| | - Michael Scharfschwerdt
- Department of Cardiac and Thoracic Vascular Surgery, University Medical Center Schleswig-Holstein, Lübeck Campus, Germany
| | - Schaller Tim
- Department of Cardiac and Thoracic Vascular Surgery, University Medical Center Schleswig-Holstein, Lübeck Campus, Germany
| | - Anas Aboud
- Department of Cardiac and Thoracic Vascular Surgery, University Medical Center Schleswig-Holstein, Lübeck Campus, Germany
| | - Hiroyuki Saisho
- Department of Cardiac and Thoracic Vascular Surgery, University Medical Center Schleswig-Holstein, Lübeck Campus, Germany
| | - Stephan Ensminger
- Department of Cardiac and Thoracic Vascular Surgery, University Medical Center Schleswig-Holstein, Lübeck Campus, Germany
| | - Buntaro Fujita
- Department of Cardiac and Thoracic Vascular Surgery, University Medical Center Schleswig-Holstein, Lübeck Campus, Germany
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31
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Farmer DM, Díez JG, Orozco-Sevilla V, Coselli JS. Use of a self-expanding transcatheter valve for a degenerated INTUITY valve. J Card Surg 2022; 37:3413-3416. [PMID: 35811483 DOI: 10.1111/jocs.16746] [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: 06/23/2022] [Accepted: 06/25/2022] [Indexed: 11/28/2022]
Abstract
Valve-in-valve transcatheter aortic valve replacement for degenerated surgical bioprosthesis is becoming a more common therapeutic option. Rapid-deployment valves are novel, have distinct structural differences from standard surgical valves, and are increasingly used in minimal-access surgery. We report the case of a 61-year-old man who developed severe stenosis of an Edwards INTUITY Elite rapid-deployment valve and who subsequently underwent successful valve-in-valve placement of a self-expanding transcatheter valve. To our knowledge, this is the first description of the technical aspects of and considerations for using the self-expanding transcatheter platform in the Edwards INTUITY Elite valve.
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Affiliation(s)
- Douglas M Farmer
- Michael E. DeBakey Department of Surgery, Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas, USA.,Texas Heart Institute, Houston, Texas, USA
| | - Jose G Díez
- Texas Heart Institute, Houston, Texas, USA.,Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas, USA
| | - Vicente Orozco-Sevilla
- Michael E. DeBakey Department of Surgery, Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas, USA.,Texas Heart Institute, Houston, Texas, USA
| | - Joseph S Coselli
- Michael E. DeBakey Department of Surgery, Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas, USA.,Texas Heart Institute, Houston, Texas, USA
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32
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Glaser N, Sartipy U. Critical appraisal of a registry study: aortic valve replacement in patients aged 50-69 years. Eur J Cardiothorac Surg 2022; 62:6604737. [PMID: 35678567 PMCID: PMC9233339 DOI: 10.1093/ejcts/ezac340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 06/01/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- 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 Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
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Malmberg M, Anttila V, Rautava P, Gunn J, Kytö V. Long-term outcomes of mechanical versus biological valve prosthesis in native mitral valve infective endocarditis. SCAND CARDIOVASC J 2022; 56:132-137. [PMID: 35652503 DOI: 10.1080/14017431.2022.2079712] [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] [Indexed: 10/18/2022]
Abstract
Objectives. To study the long-term outcomes of mitral valve replacement with mechanical or biological valve prostheses in native mitral valve infective endocarditis patients. Desing. We conducted a retrospective, nationwide, multicenter cohort study with patients aged ≤70 years who were treated with mitral valve replacement for native mitral valve infective endocarditis in Finland between 2004 and 2017. Results. The endpoints were all-cause mortality, ischemic stroke, major bleeding, and mitral valve reoperations. The results were adjusted for baseline features (age, gender, comorbidities, history of drug abuse, concomitant surgeries, operational urgency, and surgical center). The median follow-up time was 6.1 years. The 12-year cumulative mortality rates were 36% for mechanical prostheses and 74% for biological prostheses (adj. HR 0.40; CI: 0.17-0.91; p = 0.03). At follow-up, the ischemic stroke had occurred in 19% of patients with mechanical prosthesis and 33% of those with a biological prosthesis (adj. p = 0.52). The major bleeding rates within the 12-year follow-up period were 30% for mechanical prosthesis and 13% for a biological prosthesis (adj. p = 0.29). The mitral valve reoperation rates were 13% for mechanical prosthesis and 12% for a biological prosthesis (adj. p = 0.50). Drug abuse history did not have a significant modifying impact on the results (interaction p = 0.51 for mortality and ≥0.13 for secondary outcomes). Conclusion. The use of mechanical mitral valve prosthesis is associated with lower long-term mortality compared to the biological prosthesis in non-elder native mitral valve infective endocarditis patients. The routine choice of biological mitral valve prostheses for this patient group is not supported by the results.
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Affiliation(s)
- Markus Malmberg
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Vesa Anttila
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Päivi Rautava
- Department of Public Health, University of Turku, Turku, Finland.,Turku Clinical Research Centre, Turku University Hospital, Turku, Finland
| | - Jarmo Gunn
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Ville Kytö
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland.,Centre for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland.,Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Administrative Center, Hospital District of Southwest Finland, Turku, Finland.,Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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Mazine A, David TE, Stoklosa K, Chung J, Lafreniere-Roula M, Ouzounian M. Improved Outcomes Following the Ross Procedure Compared With Bioprosthetic Aortic Valve Replacement. J Am Coll Cardiol 2022; 79:993-1005. [PMID: 35272805 DOI: 10.1016/j.jacc.2021.12.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [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: 06/21/2021] [Revised: 11/15/2021] [Accepted: 12/08/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND The ideal aortic valve substitute for young and middle-aged adults remains elusive. OBJECTIVES This study sought to compare the long-term outcomes of patients undergoing the Ross procedure and those receiving bioprosthetic aortic valve replacements (AVRs). METHODS Consecutive patients aged 16-60 years who underwent a Ross procedure or surgical bioprosthetic AVR at the Toronto General Hospital between 1990 and 2014 were identified. Propensity score matching was used to account for differences in baseline characteristics. The primary outcome was all-cause mortality. Secondary outcomes included valve reintervention, valve deterioration, endocarditis, thromboembolic events, and permanent pacemaker implantation. RESULTS Propensity score matching yielded 108 pairs of patients. The median age was 41 years (IQR: 34-47 years). Baseline characteristics were similar between the matched groups. There was no operative mortality in either group. Mean follow-up was 14.5 ± 7.2 years. All-cause mortality was lower following the Ross procedure (HR: 0.35; 95% CI: 0.14-0.90; P = 0.028). Using death as a competing risk, the Ross procedure was associated with lower rates of reintervention (HR: 0.21; 95% CI: 0.10-0.41; P < 0.001), valve deterioration (HR: 0.25; 95% CI: 0.14-0.45; P < 0.001), thromboembolic events (HR: 0.15; 95% CI: 0.05-0.50; P = 0.002), and permanent pacemaker implantation (HR: 0.22; 95% CI: 0.07-0.64; P = 0.006). CONCLUSIONS In this propensity-matched study, the Ross procedure was associated with better long-term survival and freedom from adverse valve-related events compared with bioprosthetic AVR. In specialized centers with sufficient expertise, the Ross procedure should be considered the primary option for young and middle-aged adults undergoing AVR.
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Affiliation(s)
- Amine Mazine
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital and the University of Toronto, Toronto, Ontario, Canada
| | - Tirone E David
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital and the University of Toronto, Toronto, Ontario, Canada
| | - Klaudiusz Stoklosa
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital and the University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Chung
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital and the University of Toronto, Toronto, Ontario, Canada
| | - Myriam Lafreniere-Roula
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital and the University of Toronto, Toronto, Ontario, Canada
| | - Maral Ouzounian
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital and the University of Toronto, Toronto, Ontario, Canada.
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35
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Porterie J, Salaun E, Ternacle J, Clavel MA, Dagenais F. Stress exercise haemodynamic performance and opening reserve of a stented bovine pericardial aortic valve bioprosthesis. J Card Surg 2022; 37:618-627. [PMID: 35020229 DOI: 10.1111/jocs.16220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Despite unusual high rates of patient-prosthesis mismatch (PPM), excellent midterm clinical outcomes have been reported after surgical aortic valve replacement (SAVR) with the Avalus™ bioprosthetic valve (Medtronic). To elucidate this "PPM conundrum," the Avalus valve haemodynamics were assessed during exercise testing. METHODS Of the 148 patients who had undergone SAVR with the Avalus valve at our institution, 30 were randomly selected among those in whom stress test was deemed feasible and underwent a resting transthoracic echocardiography immediately followed by exercise echocardiography. Severe PPM was defined as indexed effective orifice area (iEOA) ≤ 0.65 cm2 /m2 and moderate PPM as iEOA > 0.65 and ≤ 0.85 cm2 /m2 . Measured PPM was determined with the use of the measured iEOA at rest or stress, while the estimated PPM was based on the estimated iEOA, derived from the mean EOA reported for each valve size in the manufacturer chart. RESULTS Measured EOA significantly increased from rest to peak exercise in all PPM groups (p < .05) and the rates of moderate and severe measured PPM decreased from 40% and 20% to 27% and 0%, respectively. The patients with low-flow state (flow < 250 ml/s) had significantly lower measured rest EOA (p = .03). On the basis of the estimated iEOA, there was no severe PPM and 19 patients had moderate PPM (63.3%), with a significantly lower opening reserve than the patients without estimated PPM (p = .04). The estimated iEOA was more reliably correlated to the measured iEOA at maximal stress than the measured iEOA at rest, especially in patients with a low-flow state. CONCLUSIONS This study supports the concept of an opening reserve of the Avalus valve to explain the PPM conundrum and promotes the use of exercise Doppler-echocardiography to complete the assessment of mismatch, especially in patients with a low-flow state. Published estimated EOA seems reliable to predict the haemodynamic performance of the Avalus valve, whether the flow conditions at rest.
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Affiliation(s)
- Jean Porterie
- Department of Cardiac Surgery, Heart and Lung University Institute, Quebec City, Quebec, Canada
| | - Erwan Salaun
- Department of Clinical Research, Heart and Lung University Institute, Quebec City, Quebec, Canada.,Department of Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Julien Ternacle
- Department of Clinical Research, Heart and Lung University Institute, Quebec City, Quebec, Canada.,Department of Cardiology, Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, France
| | - Marie-Annick Clavel
- Department of Clinical Research, Heart and Lung University Institute, Quebec City, Quebec, Canada.,Department of Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - François Dagenais
- Department of Cardiac Surgery, Heart and Lung University Institute, Quebec City, Quebec, Canada
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Vitanova K, Wirth F, Boehm J, Burri M, Lange R, Krane M. Surgical Aortic Valve Replacement-Age-Dependent Choice of Prosthesis Type. J Clin Med 2021; 10:5554. [PMID: 34884256 DOI: 10.3390/jcm10235554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Recently, the use of surgically implanted aortic bioprostheses has been favoured in younger patients. We aimed to analyse the long-term survival and postoperative MACCE (Major Adverse Cardiovascular and Cerebral Event) rates in patients after isolated aortic valve replacement. Methods: We conducted a single-centre observational retrospective study, including all consecutive patients with isolated aortic valve replacement. 1:1 propensity score matching of the preoperative baseline characteristics was performed. Results: A total of 2172 patients were enrolled in the study. After propensity score matching the study included 428 patients: 214 biological vs. 214 mechanical prostheses, divided into two subgroups: group A < 60 years and group B > 60 years. The mean follow-up time was 7.6 ± 3.9 years. Estimated survival was 97 ± 1.9% and 89 ± 3.4% at 10 years for biological and mechanical prosthesis, respectively in group A (p = 0.06). In group B the survival at 10 years was 79.1 ± 5.8% and 69.8 ± 4.4% for biological and mechanical prosthesis, respectively (p = 0.83). In group A, patients with a bioprosthesis exhibited a tendency for higher cumulative incidence MACCE rates compared to patients with a mechanical prosthesis, p = 0.83 (bio 7.3 ± 5.3% vs. mech 4.6 ± 2.2% at 10 years). In group B, patients with a mechanical prosthesis showed a tendency for higher cumulative incidence MACCE rates compared to patients with bioprosthesis, p = 0.86 (bio 4.3 ± 3.1% vs. mech 9.1 ± 3.1% at 10 years). Conclusions: Long-term survival after surgical aortic valve replacement is similar in patients with a biological and mechanical prosthesis, independent of the patients’ age. Moreover, younger patients (<60 years) with bioprosthesis showed a survival benefit, compared to patients with mechanical prosthesis in this age group.
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Kherallah RY, Koneru S, Krajcer Z, Preventza O, Dougherty KG, McCormack ML, Costello BT, Coulter S, Strickman NE, Plana Gomez JC, Mortazavi A, Díez JG, Livesay JJ, Coselli JS, Silva GV. Hemodynamic outcomes after valve-in-valve transcatheter aortic valve replacement: a single-center experience. Ann Cardiothorac Surg 2021; 10:630-640. [PMID: 34733690 DOI: 10.21037/acs-2021-tviv-131] [Citation(s) in RCA: 3] [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: 07/24/2021] [Accepted: 08/26/2021] [Indexed: 11/06/2022]
Abstract
Background Valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) has emerged as a safe, effective alternative to redo aortic valve surgery in high-risk patients with degenerated surgical bioprosthetic valves. However, ViV-TAVR has been associated high postprocedural valvular gradients, compared with TAVR for native-valve aortic stenosis. Methods We performed a retrospective study of all patients who underwent ViV-TAVR for a degenerated aortic valve bioprosthesis between January 1, 2013 and March 31, 2019 at our center. The primary outcome was postprocedural mean aortic valve gradient. Outcomes were compared across surgical valve type (stented versus stentless), surgical valve internal diameter (≤19 versus >19 mm), and transcatheter aortic valve type (self-expanding vs. balloon-expandable). Results Overall, 89 patients underwent ViV-TAVR. Mean age was 69.0±12.6 years, 61% were male, and median Society of Thoracic Surgeons Predicted Risk of Mortality score was 5.4 [interquartile range, 3.2-8.5]. Bioprosthesis mode of failure was stenotic (58% of patients), regurgitant (24%), or mixed (18%). The surgical valve was stented in 75% of patients and stentless in 25%. The surgical valve's internal diameter was ≤19 mm in 45% of cases. A balloon-expandable transcatheter valve was used in 53% of procedures. Baseline aortic valve area and mean gradients were 0.87±0.31 cm2 and 36±18 mmHg, respectively. These improved after ViV-TAVR to 1.38±0.55 cm2 and 18±11 mmHg at a median outpatient follow-up of 331 [67-394] days. Higher postprocedural mean gradients were associated with surgical valves having an internal diameter ≤19 mm (24±13 versus 16±8, P=0.002) and with stented surgical valves (22±11 versus 12±6, P<0.001). Conclusions ViV-TAVR is an effective option for treating degenerated surgical aortic bioprostheses, with acceptable hemodynamic outcomes. Small surgical valves and stented surgical valves are associated with higher postprocedural gradients.
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Affiliation(s)
- R Yazan Kherallah
- Division of Internal Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Srikanth Koneru
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA.,Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Zvonimir Krajcer
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA.,Department of Cardiology, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, TX, USA
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.,Department of Cardiovascular Surgery, Texas Heart Institute and CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, TX, USA
| | - Kathryn G Dougherty
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA.,Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Department of Cardiology, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, TX, USA
| | - Melissa L McCormack
- Division of Internal Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Briana T Costello
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA.,Department of Cardiology, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, TX, USA
| | | | - Neil E Strickman
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA.,Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Department of Cardiology, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, TX, USA
| | - Juan Carlos Plana Gomez
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA.,Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Ali Mortazavi
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA.,Department of Cardiology, CHI St. Luke's Health-Baylor St. Luke's Medical Center, Houston, TX, USA
| | - Jose G Díez
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA.,Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - James J Livesay
- Department of Cardiovascular Surgery, Texas Heart Institute and CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, TX, USA
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.,Department of Cardiovascular Surgery, Texas Heart Institute and CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, TX, USA
| | - Guilherme V Silva
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA.,Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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38
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Ivert T, Dalén M. Late leaflet dehiscence in a bovine bioprosthesis-mimicked COVID-19 infection. SAGE Open Med Case Rep 2021; 9:2050313X211048039. [PMID: 34567558 PMCID: PMC8461114 DOI: 10.1177/2050313x211048039] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/04/2021] [Indexed: 11/24/2022] Open
Abstract
Symptoms mimicking COVID-19 infection, pulmonary emboli, or septicemia delayed diagnosis of aortic bioprosthesis failure. A 71-year-old man was admitted emergently with shortness of breath, fever, cough, and chest pain. Echocardiography performed after 2 days showed diastolic regurgitation in an aortic perimount pericardial bioprosthesis implanted 12 years previously. An urgent reoperation disclosed that one pericardial cusp was torn from the stent of the valve. We have not previously encountered sudden pericardial leaflet dehiscence of an internally mounted pericardial valve that caused heart failure and found no literature report like our finding.
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Affiliation(s)
- Torbjörn Ivert
- Departments of Cardiothoracic Surgery and Molecular Medicine and Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Dalén
- Departments of Cardiothoracic Surgery and Molecular Medicine and Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
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39
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Gallo F, Gallone G, Kim WK, Reifart J, Veulemans V, Zeus T, Toggweiler S, De Backer O, Søndergaard L, Mangieri A, Khokhar A, De Marco F, Regazzoli D, Reimers B, Muntané-Carol G, Estévez-Loureiro R, Espino A, Moscarelli M, Armario X, Mylotte D, Gorla R, Bhadra OD, Conradi L, Marroquin Donday LA, Nombela-Franco L, Barbanti M, Reddavid C, Criscione E, Brugaletta S, Regueiro A, Pérez-Fuentes P, Nicolini E, Piva T, Tzanis G, Rodes-Cabau J, Colombo A, Giannini F. Horizontal Aorta in Transcatheter Self-Expanding Valves: Insights From the HORSE International Multicentre Registry. Circ Cardiovasc Interv 2021; 14:e010641. [PMID: 34455799 DOI: 10.1161/circinterventions.121.010641] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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] [Indexed: 12/12/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Francesco Gallo
- Interventional Cardiology Unit, GVM Care and Research Maria Cecilia Hospital (F.G., A.M., A.K., A.C.)
| | - Guglielmo Gallone
- Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy (G.G.)
| | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany (W.-K.K., J.R.)
| | - Jörg Reifart
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany (W.-K.K., J.R.)
| | - Verena Veulemans
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Düsseldorf, Germany (V.V., T.Z.)
| | - Tobias Zeus
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Düsseldorf, Germany (V.V., T.Z.)
| | | | - Ole De Backer
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (O.D.B., L.S.)
| | - Lars Søndergaard
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Denmark (O.D.B., L.S.)
| | - Antonio Mangieri
- Interventional Cardiology Unit, GVM Care and Research Maria Cecilia Hospital (F.G., A.M., A.K., A.C.)
| | - Arif Khokhar
- Interventional Cardiology Unit, GVM Care and Research Maria Cecilia Hospital (F.G., A.M., A.K., A.C.)
| | - Federico De Marco
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (F.D.M., R.G.)
| | - Damiano Regazzoli
- Humanitas Clinical and Research Center-IRCCS, Rozzano-Milano, Italy (D.R., B.R.)
| | - Bernhard Reimers
- Humanitas Clinical and Research Center-IRCCS, Rozzano-Milano, Italy (D.R., B.R.)
| | - Guillem Muntané-Carol
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada (G.M.-C., J.R.-C.)
| | | | - Antonio Espino
- Interventional Cardiology Unit, Hospital Álvaro Cunqueiro, Vigo, Spain (R.E.-L., A.E.)
| | - Marco Moscarelli
- Department of Cardiovascular Surgery, GVM Care & Research, Bari, Italy (M.M.)
| | - Xavier Armario
- Department of Cardiology, National University of Ireland, Galway (NUIG), Ireland (X.A., D.M.)
| | - Darren Mylotte
- Department of Cardiology, National University of Ireland, Galway (NUIG), Ireland (X.A., D.M.)
| | - Riccardo Gorla
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy (F.D.M., R.G.)
| | - Oliver Daniel Bhadra
- Department for Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Germany (O.D.B., L.C.)
| | - Lenard Conradi
- Department for Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Germany (O.D.B., L.C.)
| | | | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain (L.A.M.D., L.N.-F.)
| | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy (M.B., C.R., E.C.)
| | - Claudia Reddavid
- Division of Cardiology, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy (M.B., C.R., E.C.)
| | - Enrico Criscione
- Division of Cardiology, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy (M.B., C.R., E.C.)
| | - Salvatore Brugaletta
- Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (S.B., A.R., P.P.-F.)
| | - Ander Regueiro
- Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (S.B., A.R., P.P.-F.)
| | - Pedro Pérez-Fuentes
- Cardiovascular Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (S.B., A.R., P.P.-F.)
| | - Elisa Nicolini
- Interventional Cardiology, Ospedali Riuniti di Ancona, Italy (E.N., T.P.)
| | - Tommaso Piva
- Interventional Cardiology, Ospedali Riuniti di Ancona, Italy (E.N., T.P.)
| | - Giorgos Tzanis
- Department of Interventional Cardiology, Henry Dunant Hospital Center, Athens, Greece (G.T.)
| | - Josep Rodes-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada (G.M.-C., J.R.-C.)
| | - Antonio Colombo
- Interventional Cardiology Unit, GVM Care and Research Maria Cecilia Hospital (F.G., A.M., A.K., A.C.)
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40
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Lopes MP, Rosa VEE, Palma JH, Vieira MLC, Fernandes JRC, de Santis A, Spina GS, Fonseca RDJ, de Sá Marchi MF, Abizaid A, de Brito FS, Tarasoutchi F, Sampaio RO, Ribeiro HB. Transcatheter Valve-in-Valve Procedures for Bioprosthetic Valve Dysfunction in Patients With Rheumatic vs. Non-Rheumatic Valvular Heart Disease. Front Cardiovasc Med 2021; 8:694339. [PMID: 34422923 PMCID: PMC8373457 DOI: 10.3389/fcvm.2021.694339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/29/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Bioprosthetic heart valve has limited durability and lower long-term performance especially in rheumatic heart disease (RHD) patients that are often subject to multiple redo operations. Minimally invasive procedures, such as transcatheter valve-in-valve (ViV) implantation, may offer an attractive alternative, although data is lacking. The aim of this study was to evaluate the baseline characteristics and clinical outcomes in rheumatic vs. non-rheumatic patients undergoing ViV procedures for severe bioprosthetic valve dysfunction. Methods: Single center, prospective study, including consecutive patients undergoing transcatheter ViV implantation in aortic, mitral and tricuspid position, from May 2015 to September 2020. RHD was defined according to clinical history, previous echocardiographic and surgical findings. Results: Among 106 patients included, 69 had rheumatic etiology and 37 were non-rheumatic. Rheumatic patients had higher incidence of female sex (73.9 vs. 43.2%, respectively; p = 0.004), atrial fibrillation (82.6 vs. 45.9%, respectively; p < 0.001), and 2 or more prior surgeries (68.1 vs. 32.4%, respectively; p = 0.001). Although, device success was similar between groups (75.4 vs. 89.2% in rheumatic vs. non-rheumatic, respectively; p = 0.148), there was a trend toward higher 30-day mortality rates in the rheumatic patients (21.7 vs. 5.4%, respectively; p = 0.057). Still, at median follow-up of 20.7 [5.1–30.4] months, cumulative mortality was similar between both groups (p = 0.779). Conclusion: Transcatheter ViV implantation is an acceptable alternative to redo operations in the treatment of patients with RHD and severe bioprosthetic valve dysfunction. Despite similar device success rates, rheumatic patients present higher 30-day mortality rates with good mid-term clinical outcomes. Future studies with a larger number of patients and follow-up are still warranted, to firmly conclude on the role transcatheter ViV procedures in the RHD population.
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Affiliation(s)
- Mariana Pezzute Lopes
- Heart Institute (InCor) Clinical Hospital, University of Sáo Paulo, Sáo Paulo, Brazil
| | | | - José Honório Palma
- Heart Institute (InCor) Clinical Hospital, University of Sáo Paulo, Sáo Paulo, Brazil
| | | | | | - Antonio de Santis
- Heart Institute (InCor) Clinical Hospital, University of Sáo Paulo, Sáo Paulo, Brazil
| | | | | | | | - Alexandre Abizaid
- Heart Institute (InCor) Clinical Hospital, University of Sáo Paulo, Sáo Paulo, Brazil
| | | | - Flavio Tarasoutchi
- Heart Institute (InCor) Clinical Hospital, University of Sáo Paulo, Sáo Paulo, Brazil
| | - Roney Orismar Sampaio
- Heart Institute (InCor) Clinical Hospital, University of Sáo Paulo, Sáo Paulo, Brazil
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41
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Abstract
Mitral transcatheter therapies represent the treatment of choice for all patients deemed unsuitable for cardiac surgery. So far, the largest clinical experience has been limited to percutaneous repair techniques. However, given the complexity and heterogeneity of mitral valve anatomy and pathology, transcatheter mitral valve implantation will widen the mitral valve therapies horizon, toward a patient-tailored approach. Current data about transcatheter mitral valve implantation is still limited and, although some data are promising, there are still some issues to be addressed. This review provides a comprehensive insight into the available devices and describes potential advantages and limitations of transcatheter mitral valve implantation.
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Affiliation(s)
- Giulio Russo
- University of Zurich, Switzerland (G.R., M. Gennari,. M.G., A.P., M.T.).,Fondazione Policlinico Universitario A. Gemelli, IRCSS, Roma, Italy (G.R., D.P.).,Università Cattolica del Sacro Cuore, Roma, Italy (G.R., D.P.)
| | - Marco Gennari
- University of Zurich, Switzerland (G.R., M. Gennari,. M.G., A.P., M.T.).,IRCCS Centro Cardiologico Monzino, Milan, Italy (M. Gennari)
| | - Mara Gavazzoni
- University of Zurich, Switzerland (G.R., M. Gennari,. M.G., A.P., M.T.)
| | - Daniela Pedicino
- Fondazione Policlinico Universitario A. Gemelli, IRCSS, Roma, Italy (G.R., D.P.).,Università Cattolica del Sacro Cuore, Roma, Italy (G.R., D.P.)
| | - Alberto Pozzoli
- University of Zurich, Switzerland (G.R., M. Gennari,. M.G., A.P., M.T.).,Heart Surgery Unit, Cardiocentro Ticino, Lugano, Switzerland (A.P.)
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42
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Araki Y, Teramoto C, Konishi Y, Terada T, Kawaguchi O. Left Ventricular Outflow Tract Obstruction of Double Valve Re-Replacement Using Bioprosthesis. Ann Thorac Cardiovasc Surg 2021; 27:207-210. [PMID: 30089759 PMCID: PMC8343031 DOI: 10.5761/atcs.cr.18-00094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
We present a case of left ventricular outflow tract (LVOT) obstruction after double valve re-replacement with bioprostheses. A 72-year-old man, who had undergone double valve replacement (DVR) with bioprosthetic valves 9 years previously, underwent re-replacement of valves because of structural valve deterioration. However, owing to LVOT obstruction related to the bioprosthesis in the mitral position, acute pulmonary edema occurred immediately after surgery. LVOT obstruction was diagnosed by emergent cardiac catheterization. So prompt re-replacement surgery using a mechanical prosthesis was performed.
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Affiliation(s)
- Yoshimori Araki
- Department of Cardiac Surgery, Toyota Kosei Hospital, Toyota, Aichi, Japan
| | - Chikao Teramoto
- Department of Cardiac Surgery, Toyota Kosei Hospital, Toyota, Aichi, Japan
| | - Yasunobu Konishi
- Department of Cardiac Surgery, Toyota Kosei Hospital, Toyota, Aichi, Japan
| | - Takafumi Terada
- Department of Cardiac Surgery, Toyota Kosei Hospital, Toyota, Aichi, Japan
| | - Osamu Kawaguchi
- Department of Cardiac Surgery, Toyota Kosei Hospital, Toyota, Aichi, Japan
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43
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Testa L, Agnifili M, Van Mieghem NM, Tchétché D, Asgar AW, De Backer O, Latib A, Reimers B, Stefanini G, Trani C, Colombo A, Giannini F, Bartorelli A, Wojakowski W, Dabrowski M, Jagielak D, Banning AP, Kharbanda R, Moreno R, Schofer J, van Royen N, Pinto D, Serra A, Segev A, Giordano A, Brambilla N, Popolo Rubbio A, Casenghi M, Oreglia J, De Marco F, Tanja R, McCabe JM, Abizaid A, Voskuil M, Teles R, Biondi Zoccai G, Bianchi G, Sondergaard L, Bedogni F. Transcatheter Aortic Valve Replacement for Degenerated Transcatheter Aortic Valves: The TRANSIT International Project. Circ Cardiovasc Interv 2021; 14:e010440. [PMID: 34092097 DOI: 10.1161/circinterventions.120.010440] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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] [Indexed: 02/05/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Luca Testa
- IRCCS Policlinico S. Donato, Milan, Italy (L.T., M.A., N.B., A.P.R., M.C., F.D.M., G.B., F.B.)
| | - Mauro Agnifili
- IRCCS Policlinico S. Donato, Milan, Italy (L.T., M.A., N.B., A.P.R., M.C., F.D.M., G.B., F.B.)
| | | | - Didier Tchétché
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France (D.T.)
| | | | - Ole De Backer
- Rigshospitalet, Copenhagen University Hospital, Denmark (O.D.B.)
| | | | - Bernhard Reimers
- Humanitas Research Center, IRCCS, Rozzano-Milan, Italy (B.R., G.S.)
| | - Giulio Stefanini
- Humanitas Research Center, IRCCS, Rozzano-Milan, Italy (B.R., G.S.)
| | - Carlo Trani
- Policlinico Universitario A. Gemelli, Rome, Italy (C.T.)
| | - Antonio Colombo
- Maria Cecilia Hospital, Cotignola, Ravenna, Italy (A.C., F.G.)
| | | | - Antonio Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy (A.B.).,Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Italy (A.B.)
| | | | - Maciej Dabrowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland (M.D.)
| | | | | | | | - Raul Moreno
- Hospital La Paz, IdiPAZ, CIBER-CV, Madrid, Spain (R.M.)
| | - Joachim Schofer
- MVZ Department Structural Heart Disease at St. Georg, Hamburg, Germany (J.S.)
| | - Niels van Royen
- Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.)
| | - Duane Pinto
- Beth Israel Deaconess Medical Center, Boston, MA (D.P.)
| | - Antoni Serra
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (A. Serra)
| | - Amit Segev
- The Heart and Vascular Center, Chaim Sheba Medical Center, Israel (A. Segev)
| | | | - Nedy Brambilla
- IRCCS Policlinico S. Donato, Milan, Italy (L.T., M.A., N.B., A.P.R., M.C., F.D.M., G.B., F.B.)
| | - Antonio Popolo Rubbio
- IRCCS Policlinico S. Donato, Milan, Italy (L.T., M.A., N.B., A.P.R., M.C., F.D.M., G.B., F.B.)
| | - Matteo Casenghi
- IRCCS Policlinico S. Donato, Milan, Italy (L.T., M.A., N.B., A.P.R., M.C., F.D.M., G.B., F.B.)
| | | | - Federico De Marco
- IRCCS Policlinico S. Donato, Milan, Italy (L.T., M.A., N.B., A.P.R., M.C., F.D.M., G.B., F.B.)
| | - Rudolph Tanja
- Heart and Diabetes Center NRW, Bad Oeynhausen, Germany (R. Tanja)
| | | | | | | | - Rui Teles
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal (R. Teles)
| | - Giuseppe Biondi Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Italy (G.B.Z.)
| | - Giovanni Bianchi
- IRCCS Policlinico S. Donato, Milan, Italy (L.T., M.A., N.B., A.P.R., M.C., F.D.M., G.B., F.B.)
| | | | - Francesco Bedogni
- IRCCS Policlinico S. Donato, Milan, Italy (L.T., M.A., N.B., A.P.R., M.C., F.D.M., G.B., F.B.)
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44
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Tуumentseva NV, Khramtsova YS, Artashyan OS, Yushkov BG. The Possibility of Using Bioprostheses for Autoplasty of Skull Bone Defects (an Experimental Study). Bull Exp Biol Med 2021; 171:105-108. [PMID: 34046787 DOI: 10.1007/s10517-021-05181-9] [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: 06/17/2020] [Indexed: 11/28/2022]
Abstract
The possibility of obtaining a connective tissue bioprosthesis on a cellulose implant placed under the skin and its further use in cranioplasty was demonstrated in experiments on rats. A positive dynamics of bone tissue formation on the basis of the obtained bioprosthesis was revealed.
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Affiliation(s)
- N V Tуumentseva
- Institute of Immunology and Physiology, Ural Division of Russian Academy of Sciences, Yekaterinburg, Russia. .,Institute of Medical Cell Technology, Yekaterinburg, Russia.
| | - Yu S Khramtsova
- Institute of Immunology and Physiology, Ural Division of Russian Academy of Sciences, Yekaterinburg, Russia
| | - O S Artashyan
- Institute of Immunology and Physiology, Ural Division of Russian Academy of Sciences, Yekaterinburg, Russia
| | - B G Yushkov
- Institute of Immunology and Physiology, Ural Division of Russian Academy of Sciences, Yekaterinburg, Russia.,Institute of Medical Cell Technology, Yekaterinburg, Russia
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45
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Kim PJH, Richards N, Feindel CMS, Butany J. Valve-in-valve prosthesis-late morphological findings. Cardiovasc Pathol 2021; 54:107345. [PMID: 33989796 DOI: 10.1016/j.carpath.2021.107345] [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: 02/03/2021] [Revised: 05/03/2021] [Accepted: 05/03/2021] [Indexed: 11/25/2022] Open
Abstract
Since its implantation in 2002, transcatheter aortic valve implantation (TAVI) has become the preferred intervention for patients with severe aortic stenosis and significant co-morbidities. In 2007, it was adopted as a rescue procedure for failed bioprosthetic valves, now known as the valve-in-valve (VIV) procedure. Unlike other modes of treatment with a multitude of phase 4 post-marketing surveillance (PMS) data, use of these valves have increased rapidly even without long term durability data on this procedure and the near lack of information on the pathology of failed transcatheter aortic valve replacement (TAVR) bioprosthesis and especially after the VIV procedure. We present a case of a late explanted VIV bioprosthesis (ten (10) years post-initial aortic valve replacement and five (5) years post-VIV procedure) in a 65-year-old male with multiple morphologic findings. Further availability of standardized morphologic data from explanted bioprosthetic valves is essential to aid in understanding the pathophysiology of tissue degeneration of the TAVI valve, and ultimately to improve patient outcomes by identifying possible early interventional strategies.
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Affiliation(s)
- Patrick J H Kim
- University of Toronto, Departments of Laboratory Medicine & Pathobiology & Departments of Pathology & Cardiovascular Surgery, Toronto General Hospital, University Health Network, Toronto, Canada
| | - Natasha Richards
- University of Toronto, Departments of Laboratory Medicine & Pathobiology & Departments of Pathology & Cardiovascular Surgery, Toronto General Hospital, University Health Network, Toronto, Canada; Institute of Forensic Science and Legal Medicine, Ministry of National Security, 2(1/2) Hope Boulevard, Kingston 6, Jamaica
| | - Christopher M S Feindel
- Division of Cardiovascular Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Jagdish Butany
- University of Toronto, Departments of Laboratory Medicine & Pathobiology & Departments of Pathology & Cardiovascular Surgery, Toronto General Hospital, University Health Network, Toronto, Canada
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Abstract
Background The surgical treatment of aortic infections (AIs) is challenging. In situ aortic reconstructions represent nowadays the favored therapy for fit patients and xenogeneic materials are used increasingly. The aim of this study was to present our experience with xenogeneic reconstructions for AI using self-made bovine pericardium tubes and/or the biosynthetic Omniflow® II graft. Methods This retrospective single-center study included all patients undergoing xenogeneic aortic and aortoiliac reconstructions from December 2015 to June 2020. Patient comorbidities, symptoms, procedural characteristics, types of pathogens and postoperative outcomes were analyzed. Results Twenty-eight patients [23 male (82%), median age 68 (range, 28–84) years] were included. Ten patients (36%) had native AIs and 18 (64%) had graft infections, including 3 (11%) aortoesophageal and 2 (7%) aortoduodenal fistulas (ADF). Twenty-four patients (86%) were symptomatic, the most common symptoms being contained aortic rupture (n=8) and sepsis (n=4). The surgical procedures were infra- and juxtarenal aortic repairs (n=11, 39% and n=7, 25%), thoracoabdominal aortic repairs (type IV: n=1, 4%; type V: n=3, 11%), descending thoracic aortic repairs (n=4, 14%) and 2 reconstructions (7%) involving the ascending aorta/aortic arch. Most were urgent (n=10, 43%) or emergent operations (n=11, 35%). Identification of pathogen(s), mostly Gram-positive bacteria, was possible in 25 patients (89%). Twelve patients (43%) had polymicrobial infections and 6 (21%) infections with multi-resistant bacteria. In-hospital mortality was 32% (n=9) due to acute cardiac failure (1/9), endocarditis (1/9), bleeding (3/9) and sepsis (4/9). The most frequent complications were transient need for dialysis (n=12, 43%) and persisting sepsis (n=11, 39%). Two early occlusions of Omniflow® II grafts were observed (7%). Median follow-up (FU), during which 2 patients died of non-aortic causes, was 14 months (95% CI: 9–19 months). Freedom from reoperation was 100%, there was no evidence for reinfection during FU. Conclusions Xenogeneic orthotopic reconstructions for AI can be performed at all aortic levels. Combining bovine pericardium and the Omniflow® II graft can be useful for reconstructing the branched aortic segments and both materials show appropriate early to midterm outcomes. Nonetheless, AIs are serious conditions associated with relevant morbidity/mortality rates, even in a specialized center.
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Affiliation(s)
- Paula R Keschenau
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | - Alexander Gombert
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | - Mohammed E Barbati
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | - Houman Jalaie
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | - Johannes Kalder
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | - Michael J Jacobs
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, RWTH University Hospital Aachen, Aachen, Germany.,European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, AZM University Hospital Maastricht, Maastricht, The Netherlands
| | - Drosos Kotelis
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, RWTH University Hospital Aachen, Aachen, Germany
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Nagaraja V, Krishnaswamy A, Reed G, Yun J, Kapadia SR. Novel Electrosurgical Bailout Technique for Acute Left Main Occlusion Post Redo-Transcatheter Aortic Valve Replacement in a Surgical Bioprosthesis: A New Arsenal in a Structural Interventionalist's Armamentarium. Circ Cardiovasc Interv 2021; 14:e010466. [PMID: 33877863 DOI: 10.1161/circinterventions.120.010466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Vinayak Nagaraja
- Department of Cardiovascular Medicine (V.N., A.K., G.R., S.R.K.), Cleveland Clinic Foundation, OH
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine (V.N., A.K., G.R., S.R.K.), Cleveland Clinic Foundation, OH
| | - Grant Reed
- Department of Cardiovascular Medicine (V.N., A.K., G.R., S.R.K.), Cleveland Clinic Foundation, OH
| | - James Yun
- Department of Thoracic and Cardiovascular Surgery (J.Y.), Cleveland Clinic Foundation, OH
| | - Samir R Kapadia
- Department of Cardiovascular Medicine (V.N., A.K., G.R., S.R.K.), Cleveland Clinic Foundation, OH
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Saxena A, Salve GG, Betts K, Arora N, Cole AD, Sholler GF, Orr Y, Ayer JG, Winlaw DS. Outcomes Following Heterotopic Placement of Right Ventricle to Pulmonary Artery Conduits. World J Pediatr Congenit Heart Surg 2021; 12:220-229. [PMID: 33684013 DOI: 10.1177/2150135120975769] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 11/17/2022]
Abstract
BACKGROUND We sought to evaluate the outcomes following right ventricle to pulmonary artery (RV-PA) conduit placement in pediatric patients, excluding those with a RV-PA conduit for the Ross procedure which is associated with improved conduit durability, partly related to its orthotopic position. METHODS Outcomes for 119 patients who underwent RV-PA conduit placement at a single institution from January 2004 to December 2016 were reviewed. Primary outcome measures were reintervention-free survival (RFS) and overall survival. Survival analyses were performed using the Kaplan-Meier method, and risk factors associated with reintervention were evaluated. RESULTS The median age at the time of conduit placement was 6 months (interquartile range, IQR: 1-14), and the median length of follow-up was 63 months (range: 0-156). During follow-up, 39 patients required conduit-related reintervention, while 6 patients died perioperatively with an overall survival of 90% at 10 years. Among the remaining 113 patients, the RFS at one, five, and ten years was 91% (84%-95%), 72% (60%-80%), and 33% (16%-50%), respectively. The median time to conduit replacement in the series was 43.5 months (IQR: 19.3-76.2). The use of a pulmonary homograft was associated with improved RFS (P = .03), and this was particularly pronounced in comparison with aortic homografts in neonates. Infection was the indication for replacement in only one patient. CONCLUSIONS The majority of the conduits placed during the neonatal period required conduit replacement before the age of five years. Endocarditis was not a common indication for replacement. In neonates and infants, we prefer pulmonary homografts for most indications.
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Affiliation(s)
- Akshat Saxena
- Heart Centre for Children, The 8538Children's Hospital at Westmead, New South Wales, Australia
| | - Gananjay G Salve
- Heart Centre for Children, The 8538Children's Hospital at Westmead, New South Wales, Australia
| | - Kim Betts
- 64827School of Public Health, Curtin University, Perth, Australia
| | - Nitin Arora
- Heart Centre for Children, The 8538Children's Hospital at Westmead, New South Wales, Australia
| | - Andrew D Cole
- Heart Centre for Children, The 8538Children's Hospital at Westmead, New South Wales, Australia
| | - Gary F Sholler
- Heart Centre for Children, The 8538Children's Hospital at Westmead, New South Wales, Australia.,School of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Yishay Orr
- Heart Centre for Children, The 8538Children's Hospital at Westmead, New South Wales, Australia.,School of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Julian G Ayer
- Heart Centre for Children, The 8538Children's Hospital at Westmead, New South Wales, Australia.,School of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - David S Winlaw
- Heart Centre for Children, The 8538Children's Hospital at Westmead, New South Wales, Australia.,School of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
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Kim WK, Walther T, Burgdorf C, Möllmann H, Linke A, Redwood S, Thilo C, Hilker M, Joner M, Thiele H, Conzelmann L, Conradi L, Kerber S, Schymik G, Prendergast B, Husser O, Blumenstein J, Stortecky S, Heg D, Künzi A, Jüni P, Windecker S, Pilgrim T, Lanz J. One-Year Outcomes of a Randomized Trial Comparing a Self-Expanding With a Balloon-Expandable Transcatheter Aortic Valve. Circulation 2021; 143:1267-1269. [PMID: 33750210 DOI: 10.1161/circulationaha.120.052251] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany (W.-K.K.)
| | - Thomas Walther
- Department of Cardiac, Thoracic and Thoracic Vascular Surgery, University Hospital Frankfurt, Germany (T.W.)
| | | | - Helge Möllmann
- Department of Internal Medicine I, St-Johannes-Hospital, Dortmund, Germany (H.M., O.H., J.B.)
| | - Axel Linke
- Department of Internal Medicine and Cardiology, Heart Center Dresden, Technische Universität Dresden, Germany (A.L.)
| | - Simon Redwood
- Department of Cardiology, St Thomas' Hospital, London, United Kingdom (S.R., B.P.)
| | | | - Michael Hilker
- Department of Cardiothoracic Surgery, University Medical Center, Regensburg, Germany (M.H.)
| | - Michael Joner
- Deutsches Herzzentrum München, Cardiology and Technische Universität München and German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (M.J.)
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Germany (H.T.)
| | - Lars Conzelmann
- Department of Cardiac Surgery, Helios Klinik, Karlsruhe, Germany (L. Conzelmann)
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Germany (L. Conradi)
| | - Sebastian Kerber
- Department of Cardiology, Cardiovascular Center Bad Neustadt, Germany (S.K.)
| | - Gerhard Schymik
- Department of Cardiology, Städtisches Klinikum Karlsruhe, Germany (G.S.)
| | - Bernard Prendergast
- Department of Cardiology, St Thomas' Hospital, London, United Kingdom (S.R., B.P.)
| | - Oliver Husser
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany (W.-K.K.)
| | - Johannes Blumenstein
- Department of Internal Medicine I, St-Johannes-Hospital, Dortmund, Germany (H.M., O.H., J.B.)
| | - Stefan Stortecky
- Department of Cardiology, Inselspital, Bern University Hospital, Switzerland (S.S., S.W., T.P., J.L.)
| | - Dik Heg
- Clinical Trials Unit, University of Bern, Switzerland (D.H., A.K.)
| | - Arnaud Künzi
- Clinical Trials Unit, University of Bern, Switzerland (D.H., A.K.)
| | - Peter Jüni
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada (P.J.)
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, Switzerland (S.S., S.W., T.P., J.L.)
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, Switzerland (S.S., S.W., T.P., J.L.)
| | - Jonas Lanz
- Department of Cardiology, Inselspital, Bern University Hospital, Switzerland (S.S., S.W., T.P., J.L.)
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50
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Hayes DE, Rhee DW, Hisamoto K, Smith D, Ro R, Vainrib AF, Bamira D, Zhou F, Saric M. Two cases of acute endocarditis misdiagnosed as COVID-19 infection. Echocardiography 2021; 38:798-804. [PMID: 33715241 PMCID: PMC8251260 DOI: 10.1111/echo.15021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 01/12/2021] [Revised: 02/16/2021] [Accepted: 02/21/2021] [Indexed: 12/26/2022] Open
Abstract
The COVID‐19 pandemic has presented countless new challenges for healthcare providers including the challenge of differentiating COVID‐19 infection from other diseases. COVID‐19 infection and acute endocarditis may present similarly, both with shortness of breath and vital sign abnormalities, yet they require very different treatments. Here, we present two cases in which life‐threatening acute endocarditis was initially misdiagnosed as COVID‐19 infection during the height of the pandemic in New York City. The first was a case of Klebsiella pneumoniae mitral valve endocarditis leading to papillary muscle rupture and severe mitral regurgitation, and the second a case of Streptococcus mitis aortic valve endocarditis with heart failure due to severe aortic regurgitation. These cases highlight the importance of careful clinical reasoning and demonstrate how cognitive errors may impact clinical reasoning. They also underscore the limitations of real‐time reverse transcription‐polymerase chain reaction (RT‐PCR) for SARS‐CoV‐2 testing and illustrate the ways in which difficulty interpreting results may also influence clinical reasoning. Accurate diagnosis of acute endocarditis is critical given that surgical intervention can be lifesaving in unstable patients.
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Affiliation(s)
- Dena E Hayes
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - David W Rhee
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Kazuhiro Hisamoto
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, USA
| | - Deane Smith
- Department of Cardiothoracic Surgery, New York University Langone Health, New York, NY, USA
| | - Richard Ro
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Alan F Vainrib
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Daniel Bamira
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Fang Zhou
- Department of Pathology, New York University Langone Health, New York, NY, USA
| | - Muhamed Saric
- Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA
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