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Mistiaen W. Referral of Patients for Surgical Aortic Valve Replacement before and after Introduction of the Transcatheter Aortic Valve Implantation-Changing Patterns of Preoperative Characteristics and Volume and Postoperative Outcome. J Cardiovasc Dev Dis 2023; 10:jcdd10050223. [PMID: 37233190 DOI: 10.3390/jcdd10050223] [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: 04/07/2023] [Revised: 05/15/2023] [Accepted: 05/20/2023] [Indexed: 05/27/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) was first presented in 2002 as a case report. Randomized controlled trials showed that TAVI could serve as an alternative for surgical aortic valve replacement (SAVR) in high-risk patients. While the indications for TAVI have expanded into low-risk groups, favorable results of SAVR in elderly showed an increase in application of surgical treatment in this age category. This review aims to explore the effect of the introduction of TAVI in the referral for SAVR with respect to volume, patient profile, early outcome, and use of mechanical heart valves. Results show that the volume of SAVR has increased in several cardiac centers. In a small minority of series, age and risk score of the referred patients also increased. In most of the series, early mortality rate reduced. These findings, however are not universal. Different management policies could be responsible for this observation. Moreover, some patients in whom aortic valve replacement in whatever form is indicated still do not receive adequate treatment. This can be due to several reasons. Heart teams consisting of interventional cardiologists and cardiac surgeons should become a universal approach in order to minimize the number of untreated patients.
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Affiliation(s)
- Wilhelm Mistiaen
- Faculty of Medicine & Health Sciences, University of Antwerp, 2610 Antwerp, Belgium
- Department of Health and Sciences, Artesis-Plantijn University of Applied Sciences, 2000 Antwerp, Belgium
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Introduction of transcatheter aortic valve replacement technology increases overall aortic valve surgical volume: Evaluating the Florida experience. Surgery 2021; 171:757-761. [PMID: 34953612 DOI: 10.1016/j.surg.2021.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/28/2021] [Accepted: 10/03/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Transcatheter aortic valve replacement technology is increasingly used for aortic valve stenosis. We sought to evaluate the adoption of transcatheter aortic valve replacement technology with respect to overall surgical aortic valve replacement volume in Florida. METHODS The 2010-2019 Florida Agency for Health Care Administration data set was queried. Difference-in-difference analysis was used to evaluate the impact of transcatheter aortic valve replacement on the total aortic valve surgical volume of transcatheter aortic valve replacement versus nonperforming hospitals. Length of stay and elements of charges were compared for the raw and 1:1 propensity matched data. RESULTS A total of 46,032 surgical aortic valve procedures were performed at 88 hospitals. Transcatheter aortic valve replacement performing hospitals experienced a 21% increase in total aortic valve surgical volume. Length of stay was significantly less for patients undergoing transcatheter aortic valve replacement. Propensity matched transcatheter aortic valve replacement patients had less gross total charges. CONCLUSION Introduction of transcatheter aortic valve replacement technology significantly increased overall surgical aortic valve volume and may be associated with less gross total hospital charges.
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Malvindi PG, Luthra S, Giritharan S, Kowalewski M, Ohri S. Long-term survival after surgical aortic valve replacement in patients aged 80 years and over. Eur J Cardiothorac Surg 2021; 60:671-678. [PMID: 33778852 DOI: 10.1093/ejcts/ezab135] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/08/2021] [Accepted: 02/11/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Surgical aortic valve replacement can be safely performed in people aged 80 years and older with early benefits on both symptomatic and prognostic ground. While new approaches are advocated to treat this elderly and frail population, data on long-term outcomes are not available. METHODS We conducted a retrospective analysis of 1870 patients aged 80 years and over who underwent first time surgical aortic valve replacement during the period 2000-2019. The Kaplan-Meier method was used to calculate survival and comparisons among groups were performed by log-rank test. Cox analysis was used to determine the independent risk factors for late mortality. RESULTS The patients' mean age was 84 years and 53% were male. Isolated aortic valve replacement was performed in 42% of the patients, and coronary artery bypass grafting (n = 956), mitral valve (n = 94) or aortic surgery (n = 69) were associated in the remaining cases. One hundred eighty-one patients (8%) sustained at least 1 postoperative complication (reopening for bleeding or tamponade 3%, renal replacement therapy 3%, new cerebral stroke 1.5%). In-hospital mortality was 3.2% in the overall population (60/1870) and 2.2% after isolated aortic valve replacement (18/790). Survival was 90%, 66%, 31% and 14% at 1, 5, 10 and 15 years, respectively, and was similar to the expected survival of a sex- and age-matched population (log-rank P = 0.96). A complicated postoperative course was an independent risk factor for mortality during the follow-up [hazard ratio 1.32 (1.03, 1.68), P = 0.026]. CONCLUSIONS Surgical aortic valve replacement can be performed with an acceptable early mortality rate and provides excellent long-term survival in people aged 80 years and older.
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Affiliation(s)
| | - Suvitesh Luthra
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton, UK
| | - Suresh Giritharan
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton, UK
| | - Mariusz Kowalewski
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton, UK.,Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Sunil Ohri
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton, UK
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Abstract
There is consensus on important aspects of managing heart valve disease. Despite this, many patients are managed by general physicians or cardiologists without specialist competencies in valve disease, which leads to suboptimal outcomes. Multidisciplinary heart valve clinics bring together cardiologists, surgeons, nurses, and in some countries scientists to deliver expert guidelines and experience-driven optimal care. Patients are referred at the optimal time for interventions at heart valve centers, defined by strict standards of facilities and processes. Valve networks link valve clinic, heart valve center, and the community to improve the passage of patients at every level of care.
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Affiliation(s)
- John B Chambers
- Cardiothoracic Center, Guy's and St Thomas' Hospitals, Westminster Bridge Road, London SE1 7EH, UK.
| | - Patrizio Lancellotti
- Department of Cardiology, Heart Valve Clinic, CHU Sart Tilman, Rue de l'hôpital 1, 4000 Liège, Belgium
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Zheng Y, Li T. Association between transcatheter aortic valve implantation or replacement and mortality, and major adverse events after coronary artery bypass grafting. IJC HEART & VASCULATURE 2018; 21:57-63. [PMID: 30310852 PMCID: PMC6178209 DOI: 10.1016/j.ijcha.2018.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/29/2018] [Accepted: 08/22/2018] [Indexed: 11/09/2022]
Abstract
Background In recent years, many people are opting for minimally invasive surgery in China. Patients undergoing transcatheter aortic valve implantation or replacement (TAVIR) with previous coronary artery bypass grafting (CABG) have higher risks of death and major complications. Materials/methods PubMed and Embase were searched for all comparison studies between TAVIR with and without prior CABG and mortality as a primary outcome, irrespective of surgical risk, to investigate whether patients with prior CABG can undergo TAVIR. Randomized controlled trials and propensity-score-matched cohort studies were eligible for inclusion. The outcomes of interest included 30-day, 6-month, and 1-year mortality and 30-day complications. If significant heterogeneity was found in the random-effects meta-analyses, a sensitivity analysis that individually removed each study was conducted. Results Five studies reported results on patients undergoing TAVIR with or without prior CABG. Compared with the non-CABG cohort, the CABG cohort showed no significant difference in the 30-day, 6-month, and 1-year mortality and the 30-day risk of major complications, except life-threatening bleeding. However, for the 30-day risk of life-threatening bleeding, the morbidity of CABG cohort was significantly lower than that of the non-CABG cohort (risk ratio 0.555; 95% confidence interval 0.35–0.85; P = 0.006; I2 = 0%). Conclusions Patients with prior CABG can undergo TAVIR. Patients undergoing TAVIR without prior CABG need more attention because of a higher risk of life-threatening bleeding.
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Affiliation(s)
- Yue Zheng
- The Third Central Clinical College of Tianjin Medical University, Tianjin 300170, China.,Tianjin Key Laboratory of Artificial Cell, China.,Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China.,Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Tong Li
- The Third Central Hospital of Tianjin, 83 Jintang Road, Hedong District, Tianjin 300170, China.,Tianjin Key Laboratory of Artificial Cell, China.,Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China.,Tianjin Institute of Hepatobiliary Disease, Tianjin, China
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6
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Mori M, Bin Mahmood SU, Geirsson A, Yun JJ, Cleman MW, Forrest JK, Mangi AA. Trends in volume and risk profiles of patients undergoing isolated surgical and transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2018; 93:E337-E342. [DOI: 10.1002/ccd.27855] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 07/30/2018] [Accepted: 08/10/2018] [Indexed: 01/22/2023]
Affiliation(s)
- Makoto Mori
- Section of Cardiac SurgeryYale University School of Medicine New Haven Connecticut
| | | | - Arnar Geirsson
- Section of Cardiac SurgeryYale University School of Medicine New Haven Connecticut
| | - James J. Yun
- Section of Cardiac SurgeryYale University School of Medicine New Haven Connecticut
| | - Michael W. Cleman
- Section of Cardiovascular MedicineYale University School of Medicine New Haven Connecticut
| | - John K. Forrest
- Section of Cardiovascular MedicineYale University School of Medicine New Haven Connecticut
| | - Abeel A. Mangi
- Section of Cardiac SurgeryYale University School of Medicine New Haven Connecticut
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Maximus S, Milliken JC, Danielsen B, Shemin R, Khan J, Carey JS. Implementation of transcatheter aortic valve replacement in California: Influence on aortic valve surgery. J Thorac Cardiovasc Surg 2018; 155:1447-1456. [PMID: 29554785 DOI: 10.1016/j.jtcvs.2017.07.092] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 07/14/2017] [Accepted: 07/21/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Transcatheter aortic valve replacement (TAVR) procedures were introduced in 2011. Initially, procedures were limited to patients who were not surgical candidates, but subsequently high-risk surgical candidates were considered for TAVR. The influence on aortic valve surgery in California is unknown. METHODS The California Office of Statewide Health Planning and Development hospitalized patient discharge database was queried for the years 2009 through 2014. isolated surgical aortic valve and aortic valve/coronary artery bypass graft (SAVR) and TAVR procedures were identified by International Classification of Diseases-9th revision clinical modification procedure codes. Seven TAVR programs were introduced in 2011, 12 in 2012, 3 in 2013, and 6 in 2014. SAVR procedure volumes were compared from the 2 years before institution with SAVR volumes during the year(s) after institution of the TAVR program in these 28 hospitals. RESULTS Overall, surgical volumes increased during the first, second, and third years after implementation of TAVR procedures. Among 7 hospitals with 4-year programs, surgical volumes increased to a maximum of 15.5% during the third year, then began to decrease. The hospital performing the largest number of TAVR procedures showed a marked decrease in SAVR volume by the fourth year, suggesting a shift of SAVR candidates to TAVR. Among all hospitals with 4-year programs, TAVR exceeded SAVR procedures by the fourth year. In California overall, SAVR increased during 2011 through 2013, due primarily to increasing volume of isolated SAVR procedures. Statewide, isolated SAVR increased from a yearly average of 3111 procedures during 2009-2010 to 3592 (+15.5%) in 2013, then decreased slightly in 2014. SAVR plus coronary artery bypass graft procedures decreased during the same time period. CONCLUSIONS After implementation of TAVR, hospital SAVR volumes increased moderately, then began to decrease by the fourth year, when TAVR volume exceeded SAVR. Surgical candidates may be identified during evaluation for TAVR, resulting in increased SAVR volume. Increasing SAVR volume may also be related to improved patient and provider awareness of aortic valve disease.
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Affiliation(s)
- Steven Maximus
- Division of Cardiothoracic Surgery, Department of Surgery, University of California Irvine Medical Center, Orange, Calif.
| | - Jeffrey C Milliken
- Division of Cardiothoracic Surgery, Department of Surgery, University of California Irvine Medical Center, Orange, Calif
| | | | - Richard Shemin
- University of California Los Angeles Ronald Reagan Medical Center, Los Angeles, Calif
| | - Junaid Khan
- East Bay Cardiac Surgery Center, Oakland, Calif
| | - Joseph S Carey
- Division of Cardiothoracic Surgery, Department of Surgery, University of California Irvine Medical Center, Orange, Calif
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8
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Vaquerizo B, Bleiziffer S, Wottke M, Spaziano M, Eschenbach L, Lange R, Piazza N. Impact of transcatheter aortic valve implantation on surgical aortic valve. Int J Cardiol 2017; 243:145-149. [DOI: 10.1016/j.ijcard.2017.05.074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 04/22/2017] [Accepted: 05/17/2017] [Indexed: 10/19/2022]
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Hansen TB, Berg SK, Sibilitz KL, Zwisler AD, Norekvål TM, Lee A, Buus N. Patient perceptions of experience with cardiac rehabilitation after isolated heart valve surgery. Eur J Cardiovasc Nurs 2017; 17:45-53. [DOI: 10.1177/1474515117716245] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Little evidence exists on whether cardiac rehabilitation is effective for patients after heart valve surgery. Yet, accepted recommendations for patients with ischaemic heart disease continue to support it. To date, no studies have determined what heart valve surgery patients prefer in a cardiac rehabilitation programme, and none have analysed their experiences with it. Aims: The purpose of this qualitative analysis was to gain insight into patients’ experiences in cardiac rehabilitation, the CopenHeartVR trial. This trial specifically assesses patients undergoing isolated heart valve surgery. Methods: Semi-structured interviews were conducted with nine patients recruited from the intervention arm of the trial. The intervention consisted of a physical training programme and a psycho-educational intervention. Participants were interviewed three times: 2–3 weeks, 3–4 months and 8–9 months after surgery between April 2013 and October 2014. Data were analysed using qualitative thematic analysis. Results: Participants had diverse needs and preferences. Two overall themes emerged: cardiac rehabilitation played an important role in (i) reducing insecurity and (ii) helping participants to take active personal responsibility for their health. Despite these benefits, participants experienced existential and psychological challenges and musculoskeletal problems. Participants also sought additional advice from healthcare professionals both inside and outside the healthcare system. Conclusions: Even though the cardiac rehabilitation programme reduced insecurity and helped participants take active personal responsibility for their health, they experienced existential, psychological and physical challenges during recovery. The cardiac rehabilitation programme had several limitations, having implications for designing future programmes.
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Affiliation(s)
- Tina B Hansen
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Selina K Berg
- The Heart Centre, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Kirstine L Sibilitz
- The Heart Centre, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Ann D Zwisler
- National Centre of Rehabilitation and Palliation, University of Southern Denmark and University Hospital of Odense, Odense, Denmark
| | - Tone M Norekvål
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Anne Lee
- Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Niels Buus
- Faculty of Nursing and Midwifery, University of Sydney, Australia
- St Vincent’s Private Hospital Sydney, Australia
- St Vincent’s Hospital Sydney, Australia
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10
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Marciniak A, Glover K, Sharma R. Cohort profile: prevalence of valvular heart disease in community patients with suspected heart failure in UK. BMJ Open 2017; 7:e012240. [PMID: 28131996 PMCID: PMC5278264 DOI: 10.1136/bmjopen-2016-012240] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the proportion of suspected heart failure patients with significant valvular heart disease. Early diagnosis of valve disease is essential as delay can limit treatment and negatively affect prognosis for undiagnosed patients. The prevalence of unsuspected valve disease in the community is uncertain. PARTICIPANTS We prospectively evaluated 79 043 patients, between 2001 and 2011, who were referred to a community open access echocardiography service for suspected heart failure. All patients underwent a standard transthoracic echocardiogram according to British Society of Echocardiography guidelines. FINDINGS TO DATE Of the total number, 29 682 patients (37.5%) were diagnosed with mild valve disease, 8983 patients (11.3%) had moderate valve disease and 2134 (2.7%) had severe valve disease. Of the total number of patients scanned, the prevalence of aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation was 10%, 8.4%, 1%, and 12.5% respectively. 18% had tricuspid regurgitation. 5% had disease involving one or more valves. CONCLUSIONS Of patients with suspected heart failure in the primary care setting, a significant proportion have important valvular heart disease. These patients are at high risk of future cardiac events and will require onward referral for further evaluation. We recommend that readily available community echocardiography services should be provided for general practitioners as this will result in early detection of valve disease.
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Affiliation(s)
- Anna Marciniak
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, London, UK
| | | | - Rajan Sharma
- Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, London, UK
- InHealth Echotech, Southsea, UK
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Minimally Invasive Versus Conventional Aortic Valve Replacement: A Propensity-Matched Study From the UK National Data. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 11:15-23; discussion 23. [PMID: 26926521 PMCID: PMC4791314 DOI: 10.1097/imi.0000000000000236] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Minimally invasive aortic valve replacement (MIAVR) has been demonstrated as a safe and effective option but remains underused. We aimed to evaluate outcomes of isolated MIAVR compared with conventional aortic valve replacement (CAVR).
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12
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Lou X, Forcillo J, Thourani VH. Implementing the Transcatheter Aortic Valve Replacement Heart Team: Complementary, Not Competitive, to Surgical Aortic Valve Replacement Volume and Outcomes. Semin Thorac Cardiovasc Surg 2016; 28:361-362. [PMID: 28043444 DOI: 10.1053/j.semtcvs.2016.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Xiaoying Lou
- Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia
| | - Jessica Forcillo
- Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia
| | - Vinod H Thourani
- Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, Georgia.
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Attia RQ, Hickey GL, Grant SW, Bridgewater B, Roxburgh JC, Kumar P, Ridley P, Bhabra M, Millner RWJ, Athanasiou T, Casula R, Chukwuemka A, Pillay T, Young CP. Minimally Invasive versus Conventional Aortic Valve Replacement: A Propensity-Matched Study from the UK National Data. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016. [DOI: 10.1177/155698451601100104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Rizwan Q. Attia
- Department of Cardiothoracic Surgery, Guy's and St Thomas’ Hospital, London, UK
| | - Graeme L. Hickey
- Centre for Health Informatics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- National Institute for Cardiovascular Outcomes Research, Institute of Cardiovascular Science, University College London, London, UK
| | - Stuart W. Grant
- Centre for Health Informatics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Department of Cardiothoracic Surgery, Manchester Academic Health Science Centre, University Hospital of South Manchester, Wythenshawe, UK
| | - Ben Bridgewater
- Centre for Health Informatics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- National Institute for Cardiovascular Outcomes Research, Institute of Cardiovascular Science, University College London, London, UK
- Department of Cardiothoracic Surgery, Manchester Academic Health Science Centre, University Hospital of South Manchester, Wythenshawe, UK
| | - James C. Roxburgh
- Department of Cardiothoracic Surgery, Guy's and St Thomas’ Hospital, London, UK
| | - Pankaj Kumar
- Department of Cardiothoracic Surgery, Morriston Hospital, Morriston, Swansea, UK
| | - Paul Ridley
- Department of Cardiothoracic Surgery North Staffordshire Royal Infirmary, University Hospital of North Staffordshire NHS Trust, Stoke-on-Trent, UK
| | - Moninder Bhabra
- Department of Cardiothoracic Surgery, Heart and Lung Centre, New Cross Hospital, Wolverhampton, UK
| | - Russell W. J. Millner
- Department of Cardiothoracic Surgery, Lancashire Cardiac Centre, Victoria Hospital NHS Trust, Blackpool, UK
| | - Thanos Athanasiou
- Department of Cardiothoracic Surgery, Hammersmith Hospital, London, UK
| | - Roberto Casula
- Department of Cardiothoracic Surgery, Hammersmith Hospital, London, UK
| | - Andrew Chukwuemka
- Department of Cardiothoracic Surgery, Hammersmith Hospital, London, UK
| | - Thasee Pillay
- Department of Cardiothoracic Surgery, The Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK
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Ad N, Holmes SD, Shuman DJ, Rongione AJ, Massimiano PS, Speir AM, Pritchard G, Yazdani S, Raybuck BD. The Effect of Initiation of a Transcatheter Aortic Valve Replacement Program in the Treatment of Severe Aortic Stenosis. Semin Thorac Cardiovasc Surg 2016; 28:353-360. [DOI: 10.1053/j.semtcvs.2016.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2016] [Indexed: 11/11/2022]
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15
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Martin E, Dagenais F, Voisine P, Dumont E, Charbonneau E, Baillot R, Kalavrouziotis D, Mohammadi S. Surgical aortic valve replacement outcomes in the transcatheter era. J Thorac Cardiovasc Surg 2015; 150:1582-8. [DOI: 10.1016/j.jtcvs.2015.08.077] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 08/17/2015] [Accepted: 08/23/2015] [Indexed: 10/23/2022]
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16
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Singh V, Badheka AO, Patel SV, Patel NJ, Thakkar B, Patel N, Arora S, Patel N, Patel A, Savani C, Ghatak A, Panaich SS, Jhamnani S, Deshmukh A, Chothani A, Sonani R, Patel A, Bhatt P, Dave A, Bhimani R, Mohamad T, Grines C, Cleman M, Forrest JK, Mangi A. Comparison of Inhospital Outcomes of Surgical Aortic Valve Replacement in Hospitals With and Without Availability of a Transcatheter Aortic Valve Implantation Program (from a Nationally Representative Database). Am J Cardiol 2015; 116:1229-36. [PMID: 26297512 DOI: 10.1016/j.amjcard.2015.07.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 07/12/2015] [Accepted: 07/12/2015] [Indexed: 11/28/2022]
Abstract
We hypothesized that the availability of a transcatheter aortic valve implantation (TAVI) program in hospitals impacts the overall management of patients with aortic valve disease and hence may also improve postprocedural outcomes of conventional surgical aortic valve replacement (SAVR). The aim of the present study was to compare the inhospital outcomes of SAVR in centers with versus without availability of a TAVI program in an unrestricted large nationwide patient population >50 years of age. SAVRs performed on patients aged >50 years were identified from the Nationwide Inpatient Sample (NIS) for the years 2011 and 2012 using the International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes. SAVR cases were divided into 2 categories: those performed at hospitals with a TAVI program (SAVR-TAVI) and those without (SAVR-non-TAVI). A total of 9,674 SAVR procedures were identified: 4,526 (46.79%) in the SAVR-TAVI group and 5,148 (53.21%) in SAVR-non-TAVI group. The mean age of the study population was 70.2 ± 0.1 years with majority (53%) of the patients aged >70 years. The mean Charlson's co-morbidity score for patients in SAVR-TAVI group was greater (greater percentage of patients were aged >80 years, had hypertension, congestive heart failure, renal failure, and peripheral arterial disease) than that of patients in SAVR-non-TAVI group (1.6 vs 1.4, p <0.001). The propensity score matching analysis showed a statistically significant lower inhospital mortality (1.25% vs 1.72%, p = 0.001) and complications rate (35.6% vs 37.3%, p = 0.004) in SAVR-TAVI group compared to SAVR-non-TAVI group. The mean length of hospital stay was similar in the 2 groups the cost of hospitalization was higher in the SAVR-TAVI group ($43,894 ± 483 vs $41,032 ± 473, p <0.0001). Having a TAVI program was a significant predictor of reduced mortality and complications rate after SAVR in multivariate analysis. In conclusion, this largest direct comparative analysis demonstrates that SAVRs performed in centers with a TAVI program are associated with significantly lower mortality and complications rates compared to those performed in centers without a TAVI program.
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Affiliation(s)
- Vikas Singh
- Cardiology Department, University of Miami Miller School of Medicine, Miami, Florida
| | - Apurva O Badheka
- Interventional Cardiology Department, The Everett Clinic, Everett, Washington.
| | - Samir V Patel
- Internal Medicine Department, Western Reserve Health System, Youngstown, Ohio
| | - Nileshkumar J Patel
- Cardiology Department, University of Miami Miller School of Medicine, Miami, Florida
| | - Badal Thakkar
- Epidemiology Department, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Nilay Patel
- Internal Medicine Department, Saint Peter's University Hospital, New Brunswick, New Jersey
| | - Shilpkumar Arora
- Internal Medicine Department, Mount Sinai St. Luke's Roosevelt Hospital, New York, New York
| | - Nish Patel
- Cardiology Department, University of Miami Miller School of Medicine, Miami, Florida
| | - Achint Patel
- Public Health Department, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Chirag Savani
- Epidemiology Department, New York Medical College, Valhalla, New York
| | - Abhijit Ghatak
- Cardiology Department, University of Miami Miller School of Medicine, Miami, Florida
| | | | - Sunny Jhamnani
- Interventional Cardiology Department, The Everett Clinic, Everett, Washington
| | | | - Ankit Chothani
- Internal Medicine Department, MedStar Washington Hospital Center, Washington, DC
| | - Rajesh Sonani
- Internal Medicine Department, Emory University School of Medicine, Atlanta, Georgia
| | - Aashay Patel
- Internal Medicine Department, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania
| | - Parth Bhatt
- Internal Medicine Department, Saint Peter's University Hospital, New Brunswick, New Jersey
| | - Abhishek Dave
- Public Health Department, Texas A&M Medical Centre, College Station, Texas
| | - Ronak Bhimani
- Internal Medicine Department, St. Vincent Charity Medical Centre, Cleveland, Ohio
| | - Tamam Mohamad
- Cardiology Department, Detroit Medical Center, Detroit, Michigan
| | - Cindy Grines
- Cardiology Department, Detroit Medical Center, Detroit, Michigan
| | - Michael Cleman
- Cardiology Department, Yale School of Medicine, New Haven, Connecticut
| | - John K Forrest
- Cardiology Department, Yale School of Medicine, New Haven, Connecticut
| | - Abeel Mangi
- Cardiology Department, Yale School of Medicine, New Haven, Connecticut
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Changes in Risk Profile and Outcomes of Patients Undergoing Surgical Aortic Valve Replacement From the Pre- to Post-Transcatheter Aortic Valve Replacement Eras. Ann Thorac Surg 2015; 101:110-7. [PMID: 26384440 DOI: 10.1016/j.athoracsur.2015.06.083] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 06/09/2015] [Accepted: 06/22/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND With initiation of transcatheter aortic valve replacement (TAVR) programs, centers may see changes in surgical aortic valve replacement (SAVR) populations and related outcomes because of more high-risk patients undergoing TAVR rather than SAVR. Little data exist on the potential changes in the risk profiles and outcomes of SAVR patients from the pre- to post-TAVR eras. As such, this study sought to evaluate changes in the SAVR population at a tertiary referral center after TAVR program initiation. METHODS Using a single-center valve surgical database, annual volume, patient characteristics, operative details, and predicted and observed mortality for patients undergoing isolated SAVR or SAVR + coronary artery bypass grafting (CABG) from 2006 to 2013 were evaluated. Patients were divided into 3 eras: (1) pre-TAVR (January 2006-June 2009), (2) transition (July 2009-March 2011), and (3) TAVR (April 2011-June 2013). The primary analysis compared predicted and observed mortality in pre-TAVR and TAVR eras. RESULTS From 2006 to 2013, 1,380 SAVR patients were identified, with 505 (36.6%), 330 (23.9%), and 545 (39.5%) patients from the pre-TAVR, transition, and TAVR eras, respectively. SAVR case volume increased from 131 to 256 cases per year (95.4% increase) from the pre-TAVR to the post-TAVR eras. Predicted risk of mortality (PROM) for SAVR patients from the pre-TAVR to TAVR eras by The Society of Thoracic Surgeons (STS)-PROM was stable near 3.8% (p = 0.82). Crude 30-day SAVR mortality trended down from 2.8% in the pre-TAVR era to 1.5% in the post-TAVR era (p = 0.23). CONCLUSIONS Consistent with previous studies, initiation of a TAVR program was associated with increased SAVR volume. Risk profiles for SAVR patients in the TAVR era remained similar by the STS-PROM, indicating generally stable risk among surgical patients after launching a TAVR program. These data suggest that significant changes in the risk profiles of SAVR patients should not be expected with the initiation of a TAVR program. Further research will need to reevaluate these changes once TAVR becomes more widely available.
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Grant SW, Hickey GL, Ludman P, Moat N, Cunningham D, de Belder M, Blackman DJ, Hildick-Smith D, Uppal R, Kendall S, Bridgewater B. Activity and outcomes for aortic valve implantations performed in England and Wales since the introduction of transcatheter aortic valve implantation. Eur J Cardiothorac Surg 2015; 49:1164-73. [PMID: 26276837 DOI: 10.1093/ejcts/ezv270] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 06/30/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The first transcatheter aortic valve implantation (TAVI) in England and Wales was performed in 2007. This study presents the subsequent national activity and outcomes for both TAVI and aortic valve replacement (AVR). METHODS Data for all AVR and TAVI procedures between January 2006 and December 2012 in England and Wales were included. The number of procedures, patient characteristics, in-hospital and 30-day mortality, postoperative length of stay (PLOS) and survival were analysed separately for: isolated AVR; AVR + coronary artery bypass graft (CABG) surgery; AVR + other surgery and TAVI. RESULTS The number of TAVIs increased from 66 in 2007 (0.8% of all implants) to 1186 in 2012 (10.9% of all implants). AVR activity also increased over the study period. TAVI patients were older and had a higher mean logistic EuroSCORE than all AVR groups. The 30-day mortality rates were 2.1% for isolated AVR, 3.9% for AVR + CABG, 7.7% for AVR + other surgery and 6.2% for TAVI. In-hospital mortality has significantly improved for all groups. The 5-year survival rates were 82.6% for isolated AVR, 81.7% for AVR + CABG, 74.5% for AVR + other surgery and 46.1% for TAVI. The median PLOS after TAVI was similar to that of isolated AVR but shorter than that of the other AVR groups. CONCLUSIONS Since the introduction of TAVI, there has been an increase in both TAVI and AVR activity. TAVIs now represent over 10% of all aortic valve implants. There are distinct differences between procedural groups with respect to patient risk factors. Outcomes for all procedural groups have improved, but long-term TAVI results are required before its role in the treatment of aortic stenosis can be fully defined.
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Affiliation(s)
- Stuart W Grant
- Department of Cardiothoracic Surgery, Manchester Academic Health Science Centre, University of Manchester, University Hospital of South Manchester, Manchester, UK National Institute for Cardiovascular Outcomes Research (NICOR), University College London, London, UK
| | - Graeme L Hickey
- National Institute for Cardiovascular Outcomes Research (NICOR), University College London, London, UK Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, The Farr Institute @ HeRC, Liverpool, UK
| | - Peter Ludman
- National Institute for Cardiovascular Outcomes Research (NICOR), University College London, London, UK Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK
| | - Neil Moat
- National Institute for Cardiovascular Outcomes Research (NICOR), University College London, London, UK Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - David Cunningham
- National Institute for Cardiovascular Outcomes Research (NICOR), University College London, London, UK
| | - Mark de Belder
- National Institute for Cardiovascular Outcomes Research (NICOR), University College London, London, UK Department of Cardiothoracic Services, The James Cook University Hospital, Middlesbrough, UK
| | | | | | - Rakesh Uppal
- Department of Cardiothoracic Surgery, Barts Health, St Bartholomew's Hospital, London, UK William Harvey Research Institute and NIHR Cardiovascular Biomedical Research Unit, Barts and the London School of Medicine, London, UK
| | - Simon Kendall
- National Institute for Cardiovascular Outcomes Research (NICOR), University College London, London, UK Department of Cardiothoracic Services, The James Cook University Hospital, Middlesbrough, UK
| | - Ben Bridgewater
- Department of Cardiothoracic Surgery, Manchester Academic Health Science Centre, University of Manchester, University Hospital of South Manchester, Manchester, UK National Institute for Cardiovascular Outcomes Research (NICOR), University College London, London, UK
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Affiliation(s)
- Ben Bridgewater
- University Hospital of South Manchester NHS Foundation Trust
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20
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Rozen G, Fefer P, Shinfeld A, Sternik L, Guetta V, Malachy A, Levin S, Feinberg M, Raanani E, Segev A. The changing characteristics and outcomes of patients undergoing surgical aortic valve replacement in the transcatheter aortic valve implantation era. J Cardiovasc Med (Hagerstown) 2015; 16:261-6. [DOI: 10.2459/jcm.0000000000000097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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21
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Liu FZ, Xue YM, Liao HT, Zhan XZ, Guo HM, Huang HL, Fang XH, Wei W, Rao F, Deng H, Liu Y, Lin WD, Wu SL. Five-year epidemiological survey of valvular heart disease: changes in morbidity, etiological spectrum and management in a cardiovascular center of Southern China. J Thorac Dis 2015; 6:1724-30. [PMID: 25589965 DOI: 10.3978/j.issn.2072-1439.2014.11.21] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 10/15/2014] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The objective of the present study is to analyze the epidemiological profile of patients with abnormal valvular structure and function and highlight the etiological spectrum and management of valvular heart disease (VHD) in a single cardiovascular center of Southern China in five years. METHODS The retrospective study included 19,428 consecutive patients (9,441 men and 9,987 women with a mean age of 52.03±20.50 years) with abnormal valvular structure and function who were screened by transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE) at the in-patient department of Guangdong General Hospital from January 2009 to December 2013. Data on baseline characteristics, potential etiology, treatment strategies and discharge outcomes were collected from electronic medical records. RESULTS There were 13,549 (69.7%) patients with relatively definite etiology for VHD. VHD was rheumatic in 7,197 (37.0%) patients, congenital in 2,697 (13.9%), degenerative in 2,241 (11.5%), ischemic in 2,460 (12.7%). The prevalence decreased significantly in rheumatic VHD from 2009 to 2013 (from 42.8% to 32.8%, P<0.001), but increased markedly in congenital VHD (from 9.0% to 12.3%, P<0.001), ischemic VHD (from 9.2% to 11.3%, P=0.003) and degenerative VHD (from 8.8% to 14.5%, P<0.001). Meantime, the prevalence of ischemic VHD increased after the age of 45, similar to that of degenerative VHD. From 2009 to 2013, the proportion of patients with VHD undergoing open cardiac valvular surgery decreased (from 49.5% to 44.3%, P<0.001) and that of patients treated with general medication increased (from 49.2% to 54.1%, P<0.001). However, there was markedly increment in video-assisted thoracoscopic surgery (VATS) from 2009 to 2013 (from 0.3% to 4.4%, P<0.001). Increasing tendencies were showed in aortic mechanical valve replacement (from 32.1% to 34.5%, P=0.001) and double mechanical valve replacement (from 20.9% to 22.3%, P=0.035), especially in mitral valvuloplasty (from 8.5% to 15.7%, P<0.001). However, the proportion of patients undergoing bioprosthetic valve replacement decreased from 2009 to 2013 (from 26.3% to 15.5%, P<0.001). CONCLUSIONS Despite a significant shift from rheumatic towards degenerative etiology from 2009 to 2013, rheumatic VHD remains the leading etiology in Southern China, with a significant increase in the prevalence of ischemic, congenital and degenerative VHD. General medication and cardiac valvular surgery remain the main treatment options. The proportion of VATS increased markedly from 2009 to 2013, and mechanical valve replacement and mitral valvuloplasty showed an increasing tendency.
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Affiliation(s)
- Fang-Zhou Liu
- 1 Guangdong Cardiovascular Institute, Guangdong Province Key Laboratory of Structural Heart Disease, 2 Research Center of Medical Science, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Yu-Mei Xue
- 1 Guangdong Cardiovascular Institute, Guangdong Province Key Laboratory of Structural Heart Disease, 2 Research Center of Medical Science, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Hong-Tao Liao
- 1 Guangdong Cardiovascular Institute, Guangdong Province Key Laboratory of Structural Heart Disease, 2 Research Center of Medical Science, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Xian-Zhang Zhan
- 1 Guangdong Cardiovascular Institute, Guangdong Province Key Laboratory of Structural Heart Disease, 2 Research Center of Medical Science, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Hui-Ming Guo
- 1 Guangdong Cardiovascular Institute, Guangdong Province Key Laboratory of Structural Heart Disease, 2 Research Center of Medical Science, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Huan-Lei Huang
- 1 Guangdong Cardiovascular Institute, Guangdong Province Key Laboratory of Structural Heart Disease, 2 Research Center of Medical Science, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Xian-Hong Fang
- 1 Guangdong Cardiovascular Institute, Guangdong Province Key Laboratory of Structural Heart Disease, 2 Research Center of Medical Science, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Wei Wei
- 1 Guangdong Cardiovascular Institute, Guangdong Province Key Laboratory of Structural Heart Disease, 2 Research Center of Medical Science, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Fang Rao
- 1 Guangdong Cardiovascular Institute, Guangdong Province Key Laboratory of Structural Heart Disease, 2 Research Center of Medical Science, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Hai Deng
- 1 Guangdong Cardiovascular Institute, Guangdong Province Key Laboratory of Structural Heart Disease, 2 Research Center of Medical Science, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Yang Liu
- 1 Guangdong Cardiovascular Institute, Guangdong Province Key Laboratory of Structural Heart Disease, 2 Research Center of Medical Science, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Wei-Dong Lin
- 1 Guangdong Cardiovascular Institute, Guangdong Province Key Laboratory of Structural Heart Disease, 2 Research Center of Medical Science, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Shu-Lin Wu
- 1 Guangdong Cardiovascular Institute, Guangdong Province Key Laboratory of Structural Heart Disease, 2 Research Center of Medical Science, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
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The Association of Transcatheter Aortic Valve Replacement Availability and Hospital Aortic Valve Replacement Volume and Mortality in the United States. Ann Thorac Surg 2014; 98:2016-22; discussion 2022. [DOI: 10.1016/j.athoracsur.2014.07.051] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 07/24/2014] [Accepted: 07/30/2014] [Indexed: 12/20/2022]
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Iung B, Vahanian A. Epidemiology of acquired valvular heart disease. Can J Cardiol 2014; 30:962-70. [PMID: 24986049 DOI: 10.1016/j.cjca.2014.03.022] [Citation(s) in RCA: 208] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 02/19/2014] [Accepted: 03/07/2014] [Indexed: 02/02/2023] Open
Abstract
Population-based studies including systematic echocardiographic examinations are required to assess the prevalence of valvular heart disease. In industrialized countries, the prevalence of valvular heart disease is estimated at 2.5%. Because of the predominance of degenerative etiologies, the prevalence of valvular disease increases markedly after the age of 65 years, in particular with regard to aortic stenosis and mitral regurgitation, which accounts for 3 in 4 cases of valvular disease. Rheumatic heart disease still represents 22% of valvular heart disease in Europe. The prevalence of secondary mitral regurgitation cannot be assessed reliably but it seems to be a frequent disease. The incidence of infective endocarditis is approximately 30 cases per million individiuals per year. Its stability is associated with marked changes in its presentation. Patients are getting older and staphylococcus is now becoming the microorganism most frequently responsible. Heath care-associated infections are the most likely explanation of changes in the microbiology of infective endocarditis. In developing countries, rheumatic heart disease remains the leading cause of valvular heart disease. Its prevalence is high, between 20 and 30 cases per 1000 subjects when using systematic echocardiographic screening. In conclusion, the temporal and geographical heterogeneity illustrates the effect of socioeconomic status and changes in life expectancy on the frequency and presentation of valvular heart disease. A decreased burden of valvular disease would require the elaboration of preventive strategies in industrialized countries and an improvement in the socioeconomic environment in developing countries.
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Affiliation(s)
- Bernard Iung
- Cardiology Department, Bichat Hospital, and Paris 7 Diderot University, Paris, France.
| | - Alec Vahanian
- Cardiology Department, Bichat Hospital, and Paris 7 Diderot University, Paris, France
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Meier P, Franzen O, Lansky AJ. Almanac 2013: novel non-coronary cardiac interventions. Wien Klin Wochenschr 2013; 125:766-75. [PMID: 24337591 DOI: 10.1007/s00508-013-0481-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Recent innovations in interventional cardiology have dramatically expanded the therapeutic options for patients with cardiac conditions. Interventional cardiology is no longer limited to the treatment of coronary artery disease but allows also treatment of valvular disease, stroke prevention, hypertension, etc. One of the most important new treatment options is the percutaneous treatment for aortic valve stenosis (transcatheter aortic valve implantation), since aortic valve disease is a rather common problem in elderly patients, with many of them at high risk for surgery. Similarly, mitral regurgitation is often associated with comorbidities which make surgery high risk. The MitraClip is a promising percutaneous alternative to surgical valve repair or replacement. Other procedures discussed in this review are the percutaneous left atrial appendage closure as a non-pharmacologic therapy to prevent strokes, and renal denervation for resistant hypertension. This review explains the basic principles of these procedures, the most important clinical evidence, and also provides additional recent clinical data on each of these them.
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Affiliation(s)
- Pascal Meier
- Yale-UCL Cardiovascular Research Program, The Heart Hospital, University College London Hospitals UCLH, 16-18 Westmoreland Street, W1G 8PH, London, UK,
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Isolated aortic valve replacement in octogenarians before and after the introduction of trans-catheter aortic valve implantation. Heart Lung Circ 2013; 23:249-55. [PMID: 24252451 DOI: 10.1016/j.hlc.2013.10.083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 08/22/2013] [Accepted: 10/17/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND Trans-catheter aortic valve implantation (TAVI) became available at Auckland City Hospital in 2011 for patients with severe aortic stenosis in whom surgical aortic valve replacement (AVR) was deemed at high risk. We assessed whether introduction of TAVI affected the characteristics and outcomes of octogenarians undergoing AVR. METHODS Isolated AVR performed in patients ≥80 years of age during 2008-2012 were divided into two groups, pre- and post-TAVI introduction, for analyses. RESULTS Isolated AVR was undertaken in 35 and 33 octogenarians pre- and post-TAVI introduction. The post-TAVI group were older (84.2 vs 82.3 years, P=0.003), had lower ejection fraction (P=0.026), more had inpatient surgery (76% vs 29%, P<0.001), with higher EuroSCORE II (5.4 vs 3.9%, P=0.033). Operative mortality was 0.0% in both groups. One-year survival was similar (97.6% vs 94.3%, P=0.613), but composite morbidity was lower in the post-TAVI group (9.1% vs 31.4%, P=0.035). Chronic respiratory disease (P=0.043) independently predicted mortality during follow-up, while number of coronary vessel>50% stenosis (P=0.050), creatinine clearance (P=0.016) and being in the pre-TAVI era group (P=0.022) predicted composite morbidity. CONCLUSIONS Since TAVI was introduced, mean age and risk scores significantly increased in octogenarians undergoing AVR, while mortality rates remained similar and composite morbidity decreased.
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Pereira E, Silva G, Caeiro D, Fonseca M, Sampaio F, Fonseca C, Primo J, Simões L, Vouga L, Gama V. Cirurgia cardíaca na estenose aórtica severa: o que mudou com o advento do tratamento percutâneo? Rev Port Cardiol 2013; 32:749-56. [DOI: 10.1016/j.repc.2013.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 11/11/2012] [Accepted: 04/11/2013] [Indexed: 10/26/2022] Open
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27
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Pereira E, Silva G, Caeiro D, Fonseca M, Sampaio F, Fonseca C, Primo J, Simões L, Vouga L, Gama V. What has changed in surgical treatment of severe aortic stenosis with the advent of percutaneous intervention? REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.repce.2013.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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28
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Cao C, Ang SC, Indraratna P, Manganas C, Bannon P, Black D, Tian D, Yan TD. Systematic review and meta-analysis of transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis. Ann Cardiothorac Surg 2013; 2:10-23. [PMID: 23977554 DOI: 10.3978/j.issn.2225-319x.2012.11.09] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 11/15/2012] [Indexed: 02/05/2023]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has emerged as an acceptable treatment modality for patients with severe aortic stenosis who are deemed inoperable by conventional surgical aortic valve replacement (AVR). However, the role of TAVI in patients who are potential surgical candidates remains controversial. METHODS A systematic review was conducted using five electronic databases, identifying all relevant studies with comparative data on TAVI versus AVR. The primary endpoint was all-cause mortality. A number of periprocedural outcomes were also assessed according to the Valve Academic Research Consortium endpoint definitions. RESULTS Fourteen studies were quantitatively assessed and included for meta-analysis, including two randomized controlled trials and eleven observational studies. Results indicated no significant differences between TAVI and AVR in terms of all-cause and cardiovascular related mortality, stroke, myocardial infarction or acute renal failure. A subgroup analysis of randomized controlled trials identified a higher combined incidence of stroke or transient ischemic attacks in the TAVI group compared to the AVR group. TAVI was also found to be associated with a significantly higher incidence of vascular complications, permanent pacemaker requirement and moderate or severe aortic regurgitation. However, patients who underwent AVR were more likely to experience major bleeding. Both treatment modalities appeared to effectively reduce the transvalvular mean pressure gradient. CONCLUSIONS The available data on TAVI versus AVR for patients at a higher surgical risk showed that major adverse outcomes such as mortality and stroke appeared to be similar between the two treatment modalities. Evidence on the outcomes of TAVI compared with AVR in the current literature is limited by inconsistent patient selection criteria, heterogeneous definitions of clinical endpoints and relatively short follow-up periods. The indications for TAVI should therefore be limited to inoperable surgical candidates until long-term data become available.
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Affiliation(s)
- Christopher Cao
- The Systematic Review Unit, The Collaborative Research (CORE) Group, Sydney, Australia; ; Department of Cardiothoracic Surgery, St George Hospital, Sydney, Australia
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Abstract
Recent innovations in interventional cardiology have dramatically expanded the therapeutic options for patients with cardiac conditions. Interventional cardiology is no longer limited to the treatment of coronary artery disease but allows also treatment of valvular disease, stroke prevention, hypertension, etc. One of the most important new treatment options is the percutaneous treatment for aortic valve stenosis (transcatheter aortic valve implantation), since aortic valve disease is a rather common problem in elderly patients, with many of them at high risk for surgery. Similarly, mitral regurgitation is often associated with comorbidities which make surgery high risk. The MitraClip is a promising percutaneous alternative to surgical valve repair or replacement. Other procedures discussed in this review are the percutaneous left atrial appendage closure as a non-pharmacologic therapy to prevent strokes, and renal denervation for resistant hypertension. This review explains the basic principles of these procedures, the most important clinical evidence, and also provides additional recent clinical data on each of these them.
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Affiliation(s)
- Pascal Meier
- Yale--UCL Cardiovascular Research Program, The Heart Hospital, University College London Hospitals UCLH, London, UK.
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Arden C, Chambers JB, Sandoe J, Ray S, Prendergast B, Taggart D, Westaby S, Grothier L, Wilson J, Campbell B, Gohlke-Bärwolf C, Mestres CA, Rosenhek R, Pibarot P, Otto CM. Can we improve the detection of heart valve disease? Heart 2013; 100:271-3. [DOI: 10.1136/heartjnl-2013-304223] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Meier P, Timmis A. Almanac 2012: Interventional cardiology. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.repce.2013.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Almanac 2012: Interventional cardiology. Rev Port Cardiol 2013. [DOI: 10.1016/j.repc.2013.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Meier P, Timmis A. Almanac 2012: Interventional cardiology. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2013; 83:138-48. [PMID: 23499246 DOI: 10.1016/j.acmx.2013.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 01/16/2013] [Indexed: 11/18/2022] Open
Affiliation(s)
- Pascal Meier
- The Heart Hospital, University College London Hospitals UCLH, London, UK.
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Bridgewater B. Almanac 2012: Adult cardiac surgery. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2013; 83:64-71. [PMID: 23453923 DOI: 10.1016/j.acmx.2013.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 01/15/2013] [Indexed: 11/19/2022] Open
Affiliation(s)
- Ben Bridgewater
- University Hospital of South Manchester, Manchester, United Kingdom.
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35
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Meier P, Timmis A. Almanac 2012: Interventional cardiology. Egypt Heart J 2013. [DOI: 10.1016/j.ehj.2012.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Bridgewater B. Almanac 2012 adult cardiac surgery: The national society journals present selected research that has driven recent advances in clinical cardiology. Egypt Heart J 2013. [DOI: 10.1016/j.ehj.2012.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Bridgewater B. Almanac 2012: adult cardiac surgery: the national society journals present selected research that has driven recent advances in clinical cardiology. Rev Port Cardiol 2013; 32:173-80. [PMID: 23369506 DOI: 10.1016/j.repc.2012.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 11/15/2012] [Indexed: 11/17/2022] Open
Abstract
This review covers the important publications in adult cardiac surgery in the last few years, including the current evidence base for surgical revascularisation and the use of off-pump surgery, bilateral internal mammary arteries and endoscopic vein harvesting. The changes in conventional aortic valve surgery are described alongside the outcomes of clinical trials and registries for transcatheter aortic valve implantation, and the introduction of less invasive and novel approaches of conventional aortic valve replacement surgery. Surgery for mitral valve disease is also considered, with particular reference to surgery for asymptomatic degenerative mitral regurgitation.
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Bridgewater B. Almanac 2012: Adult cardiac surgery: The national society journals present selected research that has driven recent advances in clinical cardiology. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.repce.2013.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Conradi L, Seiffert M, Treede H, Rudolph V, Silaschi M, Blankenberg S, Baldus S, Reichenspurner H. Towards an integrated approach to mitral valve disease: implementation of an interventional mitral valve programme and its impact on surgical activity†. Eur J Cardiothorac Surg 2013; 44:324-8; discussion 328-9. [DOI: 10.1093/ejcts/ezs704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Subramanian S, Rastan AJ, Holzhey D, Haensig M, Kempfert J, Borger MA, Walther T, Mohr FW. Conventional aortic valve replacement in transcatheter aortic valve implantation candidates: a 5-year experience. Ann Thorac Surg 2012; 94:726-9; discussion 729-30. [PMID: 22818966 DOI: 10.1016/j.athoracsur.2012.04.068] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 04/14/2012] [Accepted: 04/18/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Patient selection for transcatheter aortic valve implantation (TAVI) remains highly controversial. Some screened patients subsequently undergo conventional aortic valve replacement (AVR) because they are unsuitable TAVI candidates. This study examined the indications and outcomes for these patients, thereby determining the efficacy of the screening process. METHODS Between January 2006 and December 2010, 79 consecutive patients (49% men), aged older than 75 years with high surgical risk, were screened for TAVI, but subsequently underwent conventional AVR through a partial or complete sternotomy. The indications, demographics, and outcomes of this cohort were studied. RESULTS Mean age was 80.4±3.6 years. Mean left ventricular ejection fraction was 0.55±0.16, and the mean logistic European System for Cardiac Operative Risk Evaluation was 13%±7%. Of the 79 patients, 6 (7.6%) had prior cardiac surgical procedures. Indications for TAVI denial after patient evaluations were a large annulus in 31 (39%), acceptable risk profile for AVR in 24 (30%), need for urgent operation in 11 (14%), and concomitant cardiovascular pathology in 5 (6%). Mean cross-clamp time was 55±14 minutes, and cardiopulmonary bypass time was 81±21 minutes. Concomitant procedures included a Maze in 12 patients (15%). Postoperative morbidity included permanent stroke in 2 (2.5%), respiratory failure in 9 (11%), and pacemaker implantation in 2 (2.5%). Hospital mortality was 1.3% (1 of 79). Cumulative survival at 6, 12, and 36 months was 88.5%, 87.1% and 72.7%, respectively. CONCLUSIONS Our existing patient evaluation process accurately defines an acceptable risk cohort for conventional AVR. The late mortality rate reflects the advanced age and comorbidities of this cohort. The data suggest that overzealous widening of TAVI inclusion criteria may be inappropriate.
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Almanac 2011: valvular heart disease. The national society journals present selected research that has driven recent advances in clinical cardiology. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2012. [DOI: 10.1016/j.repce.2012.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Almanac 2011: valvular heart disease. The national society journals present selected research that has driven recent advances in clinical cardiology. Rev Port Cardiol 2012; 31:337-50. [DOI: 10.1016/j.repc.2012.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 01/04/2012] [Indexed: 11/21/2022] Open
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Rosenhek R. Almanac 2011: Valvular heart disease. The national society journals present selected research that has driven recent advances in clinical cardiology. Egypt Heart J 2012. [DOI: 10.1016/j.ehj.2012.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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The Progression of a Transcatheter Aortic Valve Program: A Decision Analysis of More Than 680 Patient Referrals. Ann Thorac Surg 2011; 92:2072-6; discussion 2076-7. [DOI: 10.1016/j.athoracsur.2011.06.060] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Revised: 06/15/2011] [Accepted: 06/16/2011] [Indexed: 11/24/2022]
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