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Chatlaong T, Kosum P, Tumkosit M, Limjareon T. Unusual cause of severe transvalvular eccentric jet AR: early structure valve deterioration of Trifecta valves by flail leaflet undergoing valve-in-valve transcatheter aortic valve replacement. BMJ Case Rep 2024; 17:e256369. [PMID: 38395470 PMCID: PMC10895215 DOI: 10.1136/bcr-2023-256369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
The Trifecta tissue valve (Abbott, Illinois, USA) is an externally mounted bovine pericardial aortic valve (AV) prosthesis with adequate haemodynamic performance and better early results than another option. However, concerns have been raised about its durability. Recently, reports have emerged about an increased incidence of early structural valve failure after Trifecta implantation, where leaflet tear(s) with dehiscence along the stent post was the primary mode of early failure. In this article, we present the case of a patient in her 70s, 7 years after AV replacement with a Trifecta valve, who developed progressive dyspnoea. Physical examination revealed signs of chronic severe aortic regurgitation (AR). The initial transthoracic echocardiogram showed severe transvalvular AR, but the aetiology could not be determined. Cardiac computed tomography (CT) revealed a flail non-coronary cusp of the Trifecta bioprosthetic valve without vegetation. After discussion, we concluded that our patient was suitable for valve-in-valve transcatheter aortic valve replacement (ViV TAVR).
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Affiliation(s)
- Thirath Chatlaong
- Division of Cardiovascular Medicine, Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Paisit Kosum
- Division of Cardiovascular Medicine, Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Monravee Tumkosit
- Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Radiology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Thitima Limjareon
- Cardiac Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Hashem AM, Elkhapery A, Mohamed A, Buttar R, Khalouf A, Mohamed MS, Abbas F, Rehman SU, Eisa M, Baibhav B, Rai D, Depta JP. Rates and Predictors of Structural Valve Degeneration and Failure of Trifecta Bioprosthetic Valve Over a 5-year Follow-up Period: A Single-center Experience. J Cardiovasc Echogr 2024; 34:7-13. [PMID: 38818315 PMCID: PMC11135815 DOI: 10.4103/jcecho.jcecho_74_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/14/2024] [Accepted: 02/29/2024] [Indexed: 06/01/2024] Open
Abstract
Introduction The Trifecta bioprosthetic valve has been commonly used for surgical aortic valve replacement (SAVR). Multiple studies have been done to define the rate of structural valve degeneration (SVD) and failure (SVF), but the outcomes are still debatable. Therefore, we aim to conduct this single-center study to estimate the rate and predictors of SVD/SVF. Methodology This retrospective observational cohort single-center study was conducted between 2014 and 2019 among Trifecta SAVR patients. Data were patient's characteristics collected from electronic medical records at baseline and follow-up (3-5 years). Statistical analysis was performed with a significance level of P ≤ 0.05. Results A total of 271 eligible patients were identified. Most of our sample were males (57.9%), with a mean age of 71.1 ± 10.6 years. The mean baseline preoperative ejection fraction (EF) was 53.0%, with no change (P = 0.88) in the immediate postoperative EF (53.6%). A most recent follow-up EF revealed a significant increase of EF (55.2%), P = 0.01. Furthermore, there was a significant increase from peak velocity to PVMRE (mean difference [MD] ± standard error of mean (SEM) [0.15 ± 0.04], P < 0.01), an increase in pressure gradient (PGIPE) to PGMRE (MD ± SEM [1.70 ± 0.49], P < 0.01), and a decrease in Doppler velocity index (DVIIPE) to DVIMRE (MD ± SEM [-0.037 ± 0.01], P = 0.01). Regarding the SVF rate, 13 (4.8%) patients had failed valves requiring replacement throughout the study period. Conclusions Over a 5-year follow-up period, 4.8% had SVF with an SVD of 23.2%, with the majority of SVD not being clinically significant except in six patients. These results corroborate with a previously published study suggesting a bad clinical outcome of Trifecta valve placement.
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Affiliation(s)
- Anas Mohamad Hashem
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | - Ahmed Elkhapery
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | - Amr Mohamed
- Department of Cardiovascular, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Rupinder Buttar
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | - Amani Khalouf
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | | | - Faiz Abbas
- Department of Cardiovascular, Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, New York, United States of America
| | - Saif ur Rehman
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | - Mahmoud Eisa
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York
| | - Bipul Baibhav
- Department of Cardiovascular, Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, New York, United States of America
| | - Devesh Rai
- Department of Cardiovascular, Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, New York, United States of America
| | - Jeremiah P. Depta
- Department of Cardiovascular, Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, New York, United States of America
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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] [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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Yokoyama Y, Sakurai Y, Kuno T, Takagi H, Fukuhara S. Externally mounted versus internally mounted leaflet aortic bovine pericardial bioprosthesis: meta-analysis. Gen Thorac Cardiovasc Surg 2023; 71:207-215. [PMID: 36598643 DOI: 10.1007/s11748-022-01904-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/29/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Recent studies reported higher-than-expected rates of early structural valve degeneration (SVD) and/or reoperation of externally mounted leaflet aortic bioprosthesis compared with others. This meta-analysis aims to compare the outcomes of bioprostheses with externally versus internally mounted leaflet design in patients who underwent surgical aortic valve replacement (SAVR). METHODS MEDLINE and EMBASE were searched through November 2021 to identify comparative studies investigating outcomes following SAVR with either externally or internally mounted leaflet aortic bioprosthesis. Outcomes of interest were reoperation for SVD or any cause and all-cause mortality. RESULTS Our analysis included 15 observational studies that enrolled a total of 23,539 patients who underwent SAVR using externally mounted (n = 9338; 39.7%) or internally mounted leaflet (n = 14,201; 60.3%) bioprostheses. Externally mounted valves consisted of the Trifecta (Abbott, St Paul, MN) (n = 6146) and the Mitroflow (LivaNova, London, UK) (n = 3192), and all internally mounted valves were the Perimount (Edwards Lifesciences, Irvine, CA). Externally mounted valves compared with the Perimount were associated with higher reoperation rates for SVD [hazard ratio (HR) 3.55, 95% confidence interval (CI) 2.67-4.72; P < 0.001] and any cause (HR 9.36, 95% CI 3.70-23.67; P < 0.001). Furthermore, externally mounted valves demonstrated higher all-cause mortalities (HR 1.33, 95% CI 1.13-1.56; P < 0.001). CONCLUSIONS The present study summarizing updated evidence revealed higher reoperation rates and all-cause mortalities in patients with externally mounted leaflet aortic bioprostheses compared with those with internally mounted design. Choosing the right SAVR valve type is critical part of lifetime management of aortic valve disease.
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Affiliation(s)
- Yujiro Yokoyama
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Yosuke Sakurai
- Department of Surgery, Marshall University Joan Edwards School of Medicine, Huntington, WV, USA
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th St, Bronx, NY, 10467-2401, USA.
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Shinichi Fukuhara
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
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5
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Durabilidad de la bioprótesis Trifecta™ a medio plazo: experiencia de un centro. CIRUGIA CARDIOVASCULAR 2022. [DOI: 10.1016/j.circv.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Malvindi PG, Kattach H, Luthra S, Ohri S. Modes of failure of Trifecta aortic valve prosthesis. Interact Cardiovasc Thorac Surg 2022; 35:6554752. [PMID: 35348698 PMCID: PMC9297516 DOI: 10.1093/icvts/ivac086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/23/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Pietro Giorgio Malvindi
- Wessex Cardiothoracic Centre, Department of Cardiac Surgery, University Hospital Southampton, Southampton, UK
| | - Hassan Kattach
- Wessex Cardiothoracic Centre, Department of Cardiac Surgery, University Hospital Southampton, Southampton, UK
| | - Suvitesh Luthra
- Wessex Cardiothoracic Centre, Department of Cardiac Surgery, University Hospital Southampton, Southampton, UK
- University of Southampton , Southampton, UK
| | - Sunil Ohri
- Wessex Cardiothoracic Centre, Department of Cardiac Surgery, University Hospital Southampton, Southampton, UK
- University of Southampton , Southampton, UK
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Klautz RJM, Dagenais F, Reardon MJ, Lange R, Moront MG, Labrousse L, Weissman NJ, Rao V, Patel HJ, Liu F, Sabik JF. Surgical aortic valve replacement with a stented pericardial bioprosthesis: 5-year outcomes. Eur J Cardiothorac Surg 2022; 62:6631229. [PMID: 35789382 PMCID: PMC9346377 DOI: 10.1093/ejcts/ezac374] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/21/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This analysis evaluated the safety, durability, and haemodynamic performance of a stented bovine pericardial valve through 5 years of follow-up in patients with an indication for surgical aortic valve replacement (SAVR). METHODS Kaplan-Meier analysis was used to estimate the incidence of survival and valve-related thromboembolism, major paravalvular leak (PVL), endocarditis, structural valve deterioration (SVD), and reintervention. Mean aortic gradient and New York Heart Association (NYHA) class were also evaluated. RESULTS 1118 patients have received the Avalus valve (Medtronic); 564 have completed 5-year follow-up. Median follow-up was 4.85 years (4810 patient-years total follow-up). At baseline, mean age was 70.2 ± 9.0 years; 75.1% of patients were male. STS predicted risk of mortality was 2.0 ± 1.4%. Most patients were in NYHA class II (46.8%) or III (40.3%). At 5 years follow-up, the overall Kaplan-Meier survival rate was 88.1% (85.9-90.0%). The Kaplan-Meier event rates were 5.6% (4.3-7.2%) for thromboembolism, 4.4% (3.2-6.0%) for endocarditis, 0.2% (0.0-0.7%) for major PVL, and 3.2% (2.3-4.6%) for reintervention. There were no cases of SVD. Mean gradient decreased from 42.1 ± 17.1 mmHg at baseline, to 13.1 ± 4.7 mmHg at discharge, and remained stable at 12.5 ± 4.6 mmHg at 5 years. More than 95% of patients were in NYHA class I/II 5 years after surgery. CONCLUSIONS The findings of a high survival rate, excellent safety, no SVD, and stable haemodynamic performance and functional status through 5 years of follow-up are encouraging. Additional follow-up is needed to assess the long-term durability of this contemporary surgical bioprosthesis.
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Affiliation(s)
- Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - François Dagenais
- Division of Cardiac Surgery, Quebec Heart and Lung Institute, Quebec, Quebec, Canada
| | - Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Rüdiger Lange
- Department of Cardiovascular Surgery, German Heart Centre Munich, Munich, Germany
| | - Michael G Moront
- Department of Cardiothoracic Surgery, ProMedica Toledo Hospital, Toledo, Ohio
| | - Louis Labrousse
- Medico-Surgical Department of Valvulopathies, Bordeaux Heart University Hospital, Bourdeaux-Pessac, France
| | - Neil J Weissman
- MedStar Health Research Institute, MedStar Health, Washington, DC
| | - Vivek Rao
- Department of Surgery, Toronto General Hospital, Toronto, Ontario, Canada
| | - Himanshu J Patel
- Department of Cardiac Surgery, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Fang Liu
- Cardiac Surgery Clinical Research and Medical Science, Medtronic, Mounds View, Minnesota
| | - Joseph F Sabik
- Department of Surgery, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio
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Suzuki R, Ito T, Suzuki M, Ohori S, Takayanagi R, Miura S. Trifecta versus Perimount Magna Ease aortic valves: Failure mechanisms. Asian Cardiovasc Thorac Ann 2022; 30:797-806. [PMID: 35603636 PMCID: PMC9373186 DOI: 10.1177/02184923221100994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background There are increasing reports of early externally mounted pericardial Trifecta
bioprosthesis failure. We compared the hemodynamic performance of Trifecta
and Carpentier–Edwards Perimount Magna Ease valves to determine the failure
mechanism. Methods We retrospectively included 270 consecutive patients (age: 73.4 ± 8.2 years;
57.5% male; mean follow-up: 48.0 ± 20.3 months) who underwent aortic valve
replacement from 2014 to 2021 at a single center and compared the Trifecta
(N = 137) and Carpentier–Edwards Perimount Magna Ease
valve (N = 133) patients. Results The prosthetic valve major aortic regurgitation incidence was higher for the
Trifecta than that for the Carpentier–Edwards Perimount Magna Ease valve
(6.3% vs. 0%, P < 0.009). Among the Trifecta failures,
33% developed structural valve deterioration, but all requiring redo aortic
valve replacement developed major prosthetic valve aortic regurgitation.
Freedom at 5 years from redo aortic valve replacement due to structural
valve deterioration was significantly lower for Trifecta (89.4% vs. 100%,
P = 0.003). The reoperation hazards were determined for
Trifecta (vs. Carpentier–Edwards Perimount Magna Ease): 11.6 (1.47–90.9;
P = 0.02), prosthetic valve aortic regurgitation: 2.38
(1.70–3.32; P < 0.01), structural valve deterioration:
20.82 (4.08–106.2; P < 0.01), 5-year mean
transprosthetic pressure gradient: 1.14 per 1-point increase (1.03–1.24;
P = 0.007), and urgent surgery: 10.1 (2.59–39.0;
P = 0.001). The Cox regression analysis identified that
prosthetic valve aortic regurgitation solely contributed to redo aortic
valve replacement (hazard ratio: 2.38; confidence intervals: 1.70–3.32). Conclusions Significantly, more early failures occurred with the Trifecta valve than the
Carpentier–Edwards Perimount Magna Ease valve but the Trifecta showed
reasonable mean transprosthetic pressure gradient over time. Prosthetic
valve aortic regurgitation and calcific structural valve deterioration
synergistically contributed to Trifecta valve failure alternatively.
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Affiliation(s)
- Ryo Suzuki
- Department of Cardiovascular Surgery, Hokkaido Ohno Memorial Hospital, Hokkaido, Japan
| | - Toshiro Ito
- Department of Cardiovascular Surgery, Hokkaido Ohno Memorial Hospital, Hokkaido, Japan
| | - Masato Suzuki
- Department of Cardiovascular Surgery, Hokkaido Ohno Memorial Hospital, Hokkaido, Japan
| | - Shunsuke Ohori
- Department of Cardiovascular Surgery, Hokkaido Ohno Memorial Hospital, Hokkaido, Japan
| | - Ryo Takayanagi
- Department of Cardiovascular Surgery, Hokkaido Ohno Memorial Hospital, Hokkaido, Japan
| | - Shiro Miura
- Department of Cardiovascular Surgery, Hokkaido Ohno Memorial Hospital, Hokkaido, Japan
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Kattach H, Barlow CW, Ohri SK. Structural valve deterioration of a pericardial bioprosthesis. JTCVS OPEN 2022; 9:84-85. [PMID: 36003450 PMCID: PMC9390506 DOI: 10.1016/j.xjon.2021.10.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Hassanabad AF, Ahsan MR, Hibino M. Valve deterioration: A victim of construct over time? J Card Surg 2022; 37:1230-1232. [DOI: 10.1111/jocs.16325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Ali F. Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences Libin Cardiovascular Institute, Cumming School of Medicine Calgary Alberta Canada
| | - Muhammad R. Ahsan
- Section of Cardiac Surgery, Department of Cardiac Sciences Libin Cardiovascular Institute, Cumming School of Medicine Calgary Alberta Canada
| | - Makoto Hibino
- Department of Cardiac Surgery University Hospitals Cleveland Medical Center, Case Western Reserve University Cleveland Ohio USA
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Structural Valvular Degeneration of Bioprosthetic Aortic Valves: A Network Meta-analysis. J Thorac Cardiovasc Surg 2022:S0022-5223(22)00027-7. [DOI: 10.1016/j.jtcvs.2021.12.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 11/21/2022]
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Errico K, Hui DS. Commentary: Wagering on Trifecta. J Thorac Cardiovasc Surg 2022:S0022-5223(22)00105-2. [DOI: 10.1016/j.jtcvs.2022.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/29/2022]
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First there was a whisper; now there is a roar- We need to see the ten-year data. Ann Thorac Surg 2021; 112:1431-1432. [PMID: 33600793 DOI: 10.1016/j.athoracsur.2020.12.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 12/16/2020] [Indexed: 11/22/2022]
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