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Makkinejad A, Monaghan K, Chen SA, Wu X, Ling C, Kim K, Fukuhara S, Patel HJ, Pagani F, Deeb GM, Yang B. Aortic Annular Enlargement vs Isolated Aortic Valve Replacement in Patients With Matched Annulus. Ann Thorac Surg 2024:S0003-4975(24)00636-2. [PMID: 39102933 DOI: 10.1016/j.athoracsur.2024.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 06/14/2024] [Accepted: 07/16/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND We aimed to determine the effect of aortic annular enlargement on the midterm outcomes of aortic valve replacement surgery by comparing patients with the same-sized (≤23 mm) native aortic annuli. METHODS From January 2011 to June 2022, 1328 patients underwent isolated aortic valve replacement-1163 without aortic annular enlargement (AVR group) and 165 with aortic annular enlargement (AVR+AAE group). Propensity score matching identified 112 pairs, controlling for native aortic annulus diameter, age, sex, diabetes, chronic lung disease, dialysis, ejection fraction, prior cardiac surgery, indication, hypertension, dyslipidemia, valve type, prior stroke, prior myocardial infarction, and case status. RESULTS Demographic and preoperative variables were similar, except body surface area was larger in the AVR+AAE group (2.1 m2 vs 1.9 m2). Median native aortic annulus diameter was 23 mm in both groups. Median prosthesis size was 25 in the AVR+AAE group and 23 in the AVR group. The AVR+AAE group had longer cardiopulmonary bypass (143 vs 111 minutes) and cross-clamp (115 vs 82 minutes) times. Incidences of perioperative complications, including operative mortality (1.8% AVR+AAE vs 3.6% AVR) were similar between groups. Survival at 6 years was 98% in the AVR+AAE group and 74% in the AVR group (P = .016). Aortic annular enlargement was an independent protective factor for midterm mortality, with a hazard ratio of 0.19 (P = .006). The rate of moderate/severe patient-prosthesis mismatch was 19% in the AVR+AAE group and 31% in the AVR group (P = .16). CONCLUSIONS Patients with small native aortic annuli (≤23 mm) undergoing isolated aortic valve replacement may benefit from aortic annular enlargement.
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Affiliation(s)
| | - Katelyn Monaghan
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Sarah A Chen
- Department of Surgery, UC Davis Health, University of California Davis, Sacramento, California
| | - Xiaoting Wu
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Carol Ling
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Karen Kim
- Division of Cardiovascular & Thoracic Surgery, Department of Surgery and Perioperative Care, University of Texas at Austin, Austin, Texas
| | - Shinichi Fukuhara
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Himanshu J Patel
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Francis Pagani
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - G Michael Deeb
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Bo Yang
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.
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Makkinejad A, Satija D, Monaghan K, Kim K, Fukuhara S, Patel HJ, Yang B. The Impact of Bicuspid Aortic Valve on Long-term Outcomes After Bioprosthetic Valve Replacement. Ann Thorac Surg 2024:S0003-4975(24)00575-7. [PMID: 39033902 DOI: 10.1016/j.athoracsur.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 06/10/2024] [Accepted: 07/15/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND There are limited data comparing the outcomes of aortic valve replacement surgery between patients with bicuspid aortic valve (BAV) vs tricuspid aortic valve (TAV) morphology. METHODS From January 2000 to June 2022, 1122 patients with TAV (n = 562) or BAV (n = 560) underwent surgical aortic valve replacement for aortic stenosis with the same type of bovine pericardial stented bioprosthesis. Propensity score matching identified 350 pairs by matching for age, sex, operative status, chronic lung disease, prior stroke, diabetes, ejection fraction, renal failure on dialysis, coronary artery disease, prior cardiac surgery, and concomitant procedures. The primary end points were long-term survival and reoperation. RESULTS Perioperative outcomes, including reoperation for bleeding, atrial fibrillation, heart block requiring pacemaker, stroke, need for dialysis, and operative mortality, were similar between the matched groups. Survival at 10 years was 67% (95% CI, 59%-74%) in the BAV group and 54% (95% CI, 46%-61%) in the TAV group (P = .001). BAV valve was a significant protective factor for late mortality, with a hazard ratio of 0.60 (95% CI, 0.45-0.81; P < .001). Risk factors for late mortality included age, chronic lung disease, low ejection fraction, and renal failure on dialysis. Cumulative incidence of aortic valve reintervention at 10 years was similar between the groups at 10% in the BAV group and 4.9% in the TAV group (P = .55). CONCLUSIONS Patients with BAV likely could not be considered the same as patients with TAV when deciding on the approach of aortic valve intervention.
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Affiliation(s)
| | - Divyaam Satija
- The Ohio State University College of Medicine, The Ohio State University, Columbus, Ohio
| | - Katelyn Monaghan
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Karen Kim
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Shinichi Fukuhara
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Himanshu J Patel
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Bo Yang
- Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.
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Bakhtiary F, Silaschi M, El-Sayed Ahmad A, Salamate S, Meuris B. Multicentre experience of sutureless prostheses inside degenerated stentless aortic valves and bioroots. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae088. [PMID: 38696749 PMCID: PMC11088739 DOI: 10.1093/icvts/ivae088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/30/2024] [Indexed: 05/04/2024]
Abstract
OBJECTIVES Patients with failed stentless aortic prostheses are a challenging population to treat, as reoperative procedures may be complex and catheter-based treatments are associated with a high rate of procedural events. Reoperative surgery using sutureless valves may be an alternative. METHODS In this multicentre experience, we assess outcomes of 17 patients who underwent reoperative surgery using the Perceval valve (Corcym UK Limited, London, UK) inside Freestyle prosthesis (Medtronic Inc., Dublin, Ireland) or bioroots from 2018 to 2023. RESULTS Mean age was 71.1 ± standard deviation 15.1 years and mean EuroSCORE II was 13.5 ± 15.8%, Society of Thoracic Surgeons Score was 5.9 ± 11.7%. Mean transvalvular gradient at baseline was 25.3 ± 19.9 mmHg and left ventricular ejection fraction was 53.5 ± standard deviation 8.5%. In 70.6% (12/17), moderate or severe aortic regurgitation was present. Implant success was 100%. Aortic cross-clamp time was 44.5 ± standard deviation 23.6 min. No patient needed a pacemaker and no mild paravalvular regurgitation occurred. Mean gradient was 12.5 ± 4.7 mmHg; 30-day mortality was 5.9% (1/17). CONCLUSIONS Rate of mortality was lower than predicted by EuroSCORE II in these high-risk patients and haemodynamic outcomes were favourable. Heart teams should consider this treatment concept when discussing patients with failed stentless valves or bioroots.
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Affiliation(s)
- Farhad Bakhtiary
- Department of Cardiac Surgery, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Miriam Silaschi
- Department of Cardiac Surgery, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Ali El-Sayed Ahmad
- Department of Cardiac Surgery, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Saad Salamate
- Department of Cardiac Surgery, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Bart Meuris
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
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Yang B. Aortic Valve Replacement vs Aortic Valve Replacement + Annular Enlargement: Apples to Oranges? Ann Thorac Surg 2024; 117:479-480. [PMID: 36842563 DOI: 10.1016/j.athoracsur.2023.02.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/28/2023]
Affiliation(s)
- Bo Yang
- Department of Cardiac Surgery, University of Michigan, 1500 E Medical Center Dr, 5155 Frankel Cardiovascular Center, Ann Arbor, MI 48109.
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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] [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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Chikwe J. Editor's Choice: The Most Cited Journal in Our Specialty. Ann Thorac Surg 2022; 114:613-617. [PMID: 36039411 DOI: 10.1016/j.athoracsur.2022.07.022] [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: 07/27/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Joanna Chikwe
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
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Williams E, El-Hamamsy I. Stentless Aortic Valves: Quo Vadis? Ann Thorac Surg 2022; 114:734-735. [PMID: 35288082 DOI: 10.1016/j.athoracsur.2022.02.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 02/19/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Elbert Williams
- Department of Cardiovascular Surgery, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, 1190 5(th) Avenue, New York, NY, 10029
| | - Ismail El-Hamamsy
- Department of Cardiovascular Surgery, The Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, 1190 5(th) Avenue, New York, NY, 10029.
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