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Kiekenap J, Sun X, Hao Y, Steitz M, Breitenstein-Attach A, Emeis J, Berger F, Schmitt B. Long-term function of a novel autologous transcatheter pulmonary heart valve implant in an adult animal model. Catheter Cardiovasc Interv 2024; 103:597-606. [PMID: 38440908 DOI: 10.1002/ccd.30992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 02/15/2024] [Accepted: 02/17/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Current heart valve implants entail major disadvantages in the treatment for younger patients or those with congenital heart defects. AIM Evaluation of novel transcatheter pulmonary valve implant made from autologous pericardium with natural crosslinking agent in an in vitro setup and in vivo animal model METHODS: Valves were tested in a pulse duplicator according to ISO-standard 5840. For in vivo studies computer tomography was performed to measure sheep's native pulmonary valve dimensions. Pericardium was harvested by thoracotomy, personalized implants were manufactured and deployed in pulmonary valve position of the same sheep. Every 3 months implant functionality was evaluated by intracardiac echocardiography, intracardiac pressure measurements and cardiac magnetic resonance imaging (cMRI). Implants were explanted for macroscopic and histological examination. RESULTS In vitro experiments showed compliance with regulatory requirements in terms of valve opening and insufficiency. Five sheep successfully received an autologous valve implant. Two animals had to be euthanized due to trauma sustained in the stable. Long-term valve function was excellent in three out of four animals with median implant cMRI regurgitation fraction of 9% (n = 4) at 3 months, 8% (n = 3) at 6, 8% (n = 3) at 9, 12% (n = 3) at 13, 8% (n = 2) at 17% and 8% (n = 2) at 20.5 months after implantation. Despite good adherence to neighboring tissue and endothelization, histological assessment revealed some signs of degeneration. CONCLUSION Transcatheter pulmonary valve implants showed promising function for up to 20.5 months encouraging research to further improve this approach.
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Affiliation(s)
- Jonathan Kiekenap
- DHZC (Deutsches Herzzentrum der Charité), Charité - University Medicine, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Xiaolin Sun
- DHZC (Deutsches Herzzentrum der Charité), Charité - University Medicine, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Yimeng Hao
- DHZC (Deutsches Herzzentrum der Charité), Charité - University Medicine, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Marvin Steitz
- DHZC (Deutsches Herzzentrum der Charité), Charité - University Medicine, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Alexander Breitenstein-Attach
- DHZC (Deutsches Herzzentrum der Charité), Charité - University Medicine, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Jasper Emeis
- DHZC (Deutsches Herzzentrum der Charité), Charité - University Medicine, Berlin, Germany
| | - Felix Berger
- DHZC (Deutsches Herzzentrum der Charité), Charité - University Medicine, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Boris Schmitt
- DHZC (Deutsches Herzzentrum der Charité), Charité - University Medicine, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
- BIH (Berlin Institute of Health), Berlin, Germany
- BCRT (BIH Center of Regenerative Therapies), Berlin, Germany
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Andreeva A, Coti I, Werner P, Scherzer S, Kocher A, Laufer G, Andreas M. Aortic Valve Replacement in Adult Patients with Decellularized Homografts: A Single-Center Experience. J Clin Med 2023; 12:6713. [PMID: 37959179 PMCID: PMC10650916 DOI: 10.3390/jcm12216713] [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: 09/01/2023] [Revised: 10/16/2023] [Accepted: 10/17/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND decellularized aortic homografts (DAH) represent a promising alternative for aortic valve replacement in young adults due to their low immunogenicity and thrombogenicity. Herein, we report our midterm, single-center experience in adult patients with non-frozen DAH from corlife. METHODS safety, durability, and hemodynamic performance were evaluated according to current guidelines in all consecutive patients who had received a DAH at our center since 03/2016. RESULTS seventy-three (mean age 47 ± 11 years, 68.4% (n = 50) male) patients were enrolled. The mean diameter of the implanted DAH was 24 ± 2 mm. Mean follow-up was 36 ± 27 months, with a maximum follow-up of 85 months and cumulative follow-up of 215 years. No cases of stenosis were observed, in four (5.5%) cases moderate aortic regurgitation occurred, but no reintervention was required. No cases of early mortality, non-structural dysfunction, reoperation, valve endocarditis, or thrombosis were observed. Freedom from bleeding and thromboembolic events was 100%; freedom from re-intervention was 100%; survival was 98.6% (n = 72). CONCLUSIONS early and mid-term results showed low mortality and 100% freedom from reoperation, thromboembolic events, and bleeding at our center. However, in order for this novel approach to be established as a valid alternative to aortic valve replacement in young patients, long-term data are required.
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Affiliation(s)
- Alexandra Andreeva
- Department of Cardiac Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; (I.C.); (P.W.); (S.S.); (A.K.); (G.L.); (M.A.)
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Sadat N, Lojenburg JH, Scharfschwerdt M, Fujta B, Ensminger S. Impact of different in vitro models on functional performance of the self-expanding transcatheter heart valve. Eur J Cardiothorac Surg 2023; 64:ezad333. [PMID: 37773993 DOI: 10.1093/ejcts/ezad333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/23/2023] [Accepted: 09/28/2023] [Indexed: 10/01/2023] Open
Abstract
OBJECTIVES Transcatheter heart valves (THVs) are investigated according to International Organization for Standardization requirements using in vitro heart simulators to evaluate hydrodynamic performance. In contrast to surgical valves, a THV's performance heavily depends on the configuration and shape of the aortic anulus. In International Organization for Standardization regulations, there is no detailed definition for the construction of a compartment in which a THV has to be tested. Therefore, the aim of this in vitro study was to compare different in vitro models for functional testing of THVs. METHODS Porcine aortic conduits (23-mm diameter) were implanted in Dacron prostheses and calcified with double-distilled water and calcification buffer at 37°C over 83 million cycles in a Hi-Cycler (durability testing) mimicking nearly 3 patient-years. Hydrodynamic testing of Evolut PRO 26 mm was performed within 3 models (plexiglass, native conduit and calcified conduit; all 23-mm diameter) at a frequency of 64 bpm and different stroke volumes (55-105 ml). RESULTS Calcified conduits showed significantly higher mean pressure gradients (MPG) and lower effective orifice areas (EOA) in comparison to native conduits (without THV; P < 0.001). EOA and MPG of Evolut PRO differed depending on the model tested. Calcified conduits resulted in the lowest EOA and highest MPG of the THV compared to plexiglass and the native conduit. Full expansion of the THV was least impaired in the native conduit, while lowest geometric orifice area, lowest minimal internal diameter and highest pin-wheeling index of Evolut PRO were seen in the calcified conduit. CONCLUSIONS Full expansion and functional performance of the Evolut PRO THV depends on the configuration of the testing compartment in an in vitro setting.
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Affiliation(s)
- Najla Sadat
- Department of Cardiac and Thoracic Vascular Surgery, University Medical Center Schleswig-Holstein, Luebeck, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Germany
| | - John Habakuk Lojenburg
- Department of Cardiac and Thoracic Vascular Surgery, University Medical Center Schleswig-Holstein, Luebeck, Germany
| | - Michael Scharfschwerdt
- Department of Cardiac and Thoracic Vascular Surgery, University Medical Center Schleswig-Holstein, Luebeck, Germany
| | - Buntaro Fujta
- Department of Cardiac and Thoracic Vascular Surgery, University Medical Center Schleswig-Holstein, Luebeck, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Germany
| | - Stephan Ensminger
- Department of Cardiac and Thoracic Vascular Surgery, University Medical Center Schleswig-Holstein, Luebeck, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Germany
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Kim M, Kim HR, Lee SH, Lee S, Joo H. Aortic valve replacement in patients aged 50 to 69 years: Analysis using Korean National Big Data. J Card Surg 2022; 37:3623-3630. [PMID: 36054455 PMCID: PMC9825912 DOI: 10.1111/jocs.16908] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND The aim of this study was to compare the clinical outcomes and long-term survival in patients who underwent isolated aortic valve replacement (AVR) with mechanical versus bioprosthetic valves. METHODS Patients aged 50-69 years who had undergone AVR from 2002 to 2018 were identified and their characteristics were collected from Korean National Health Information Database formed by the National Health Insurance Service, Republic of Korea. Of the 5792 patients, 1060 patients were excluded due to missing values on characteristics. Of the 4732 study patients, 1945 patients (41.1%) had received bioprosthetic valves (Group B) and 2787 patients (58.9%) had received mechanical valves (Group M). A propensity score-matched analysis was performed to match 1429 patients in each group. Data on mortality, cardiac mortality, reoperations, cerebrovascular accidents, and bleeding complications were obtained. RESULTS The overall survival rates at 5 and 10 years postoperatively were 87.8% and 75.2% in the matched Group B and 91.2% and 76.7% in the matched Group M, respectively (p = .140). Freedom from cardiac death rates at postoperative 5 and 10 years were 95.6% and 92.4% in the matched Group B and 96.0% and 92.1% in the matched Group M, respectively (p = .540). The cumulative incidence of reoperation was higher in the matched Group B than in the matched Group M (p = .007), and the cumulative incidence of major bleeding was higher in the matched Group M than in the matched Group B (p = .039). CONCLUSION In patients aged 50-69 years who underwent isolated AVR, the patients who received bioprosthetic valves showed similar cardiac mortality-free survival and long-term survival rates to the patients who received mechanical valves.
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Affiliation(s)
- Min‐Seok Kim
- Department of Thoracic and Cardiovascular Surgery, Cardiovascular Center, Myongji HospitalHanyang University College of MedicineSeoulKorea
| | - Hae Rim Kim
- Department of Statistics, College of Natural ScienceUniversity of SeoulSeoulKorea
| | - Seung Hyun Lee
- Division of Cardiovascular Surgery, Severance Cardiovascular HospitalYonsei University College of MedicineSeoulKorea
| | - Sak Lee
- Division of Cardiovascular Surgery, Severance Cardiovascular HospitalYonsei University College of MedicineSeoulKorea
| | - Hyun‐Chel Joo
- Division of Cardiovascular Surgery, Severance Cardiovascular HospitalYonsei University College of MedicineSeoulKorea
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Veres G, Benke K, Stengl R, Weber P, Marina E, Szabó G, Karck M. Long-Term Outcomes Stratified by Age in Patients with a Mechanical versus Biological Mitral Valve Replacement. J Cardiovasc Dev Dis 2022; 9:jcdd9100339. [PMID: 36286291 PMCID: PMC9604289 DOI: 10.3390/jcdd9100339] [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: 09/04/2022] [Revised: 09/24/2022] [Accepted: 10/04/2022] [Indexed: 11/05/2022] Open
Abstract
Objectives: Balancing anticoagulation and reoperation risks determines prostheses choice (mechanical/biological) for mitral valve replacement. We aimed to re-evaluate the outcomes after biological versus mechanical mitral valve replacement. Methods: We compared long-term benefits and risks of mechanical and biological prostheses in 2056 patients (52% men, 48% women; 65.4 ± 12.1 years) who underwent mitral valve replacements between 1993−2017, in a retrospective single-centre study. Data sources included prospective institutional database, social registry, general practitioner data and follow-up questionnaire. Patients were stratified by age: < = 39 y (n = 82), 40−49 y (n = 164), 50−59 y (n = 335), 60−69 y (n = 593), 70−79 y (n = 743) and > = 80 y (n = 139). Long-term outcomes (mortality, reoperations, bleeding) were analysed. Results: Altogether, 1308 mechanical (53% men, 47% women; 61.5 ± 11.7 years) and 748 biological (50% men, 50% women; 72.3 ± 9.6 years) valves were implanted. The reason for valve replacement was stenosis in 162, insufficiency in 823 and combined in 323 cases for mechanical, while it was 46, 567 and 135 for biological valves, respectively. Overall cumulative survival was higher with mechanical prosthesis (mean: 139 ± 4 vs. 102 ± 5 months, 10 y: 55% vs. 33%, p < 0.0001). Subgroup analysis revealed higher survival among patients receiving mechanical prosthesis up to 60 years (< = 39 y p = 0.047, 40−49 y p < 0.0001, 50−59 y p = 0.001). In patients 60−69 years, overall survival did not differ; however, in survivors beyond 8 years, mechanical prosthesis showed improved survival (p = 0.014). While between 70−79 years survival was nearly identical, for above 80 years, patients had a higher survival with biological prosthesis (p = 0.014). Conclusion: The present data demonstrated a higher survival of mechanical prosthesis in a wide range of patients after mitral valve replacement.
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Affiliation(s)
- Gábor Veres
- Department of Cardiac Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube Str. 40, 06120 Halle (Saale), Germany
- Correspondence: or ; Tel.: +49-345-5572759; Fax: +49-345-5572782
| | - Kálmán Benke
- Department of Cardiac Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube Str. 40, 06120 Halle (Saale), Germany
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, 1122 Budapest, Hungary
| | - Roland Stengl
- Heart and Vascular Center, Semmelweis University, Városmajor u. 68, 1122 Budapest, Hungary
| | - Petra Weber
- Department of Cardiac Surgery, University of Heidelberg, INF 326, 69120 Heidelberg, Germany
| | - Ereva Marina
- Department of Cardiac Surgery, University of Heidelberg, INF 326, 69120 Heidelberg, Germany
| | - Gábor Szabó
- Department of Cardiac Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube Str. 40, 06120 Halle (Saale), Germany
- Department of Cardiac Surgery, University of Heidelberg, INF 326, 69120 Heidelberg, Germany
| | - Matthias Karck
- Department of Cardiac Surgery, University of Heidelberg, INF 326, 69120 Heidelberg, Germany
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Biofabrication of Sodium Alginate Hydrogel Scaffolds for Heart Valve Tissue Engineering. Int J Mol Sci 2022; 23:ijms23158567. [PMID: 35955704 PMCID: PMC9368972 DOI: 10.3390/ijms23158567] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 12/10/2022] Open
Abstract
Every year, thousands of aortic valve replacements must take place due to valve diseases. Tissue-engineered heart valves represent promising valve substitutes with remodeling, regeneration, and growth capabilities. However, the accurate reproduction of the complex three-dimensional (3D) anatomy of the aortic valve remains a challenge for current biofabrication methods. We present a novel technique for rapid fabrication of native-like tricuspid aortic valve scaffolds made of an alginate-based hydrogel. Using this technique, a sodium alginate hydrogel formulation is injected into a mold produced using a custom-made sugar glass 3D printer. The mold is then dissolved using a custom-made dissolving module, revealing the aortic valve scaffold. To assess the reproducibility of the technique, three scaffolds were thoroughly compared. CT (computed tomography) scans showed that the scaffolds respect the complex native geometry with minimal variations. The scaffolds were then tested in a cardiac bioreactor specially designed to reproduce physiological flow and pressure (aortic and ventricular) conditions. The flow and pressure profiles were similar to the physiological ones for the three valve scaffolds, with small variabilities. These early results establish the functional repeatability of this new biofabrication method and suggest its application for rapid fabrication of ready-to-use cell-seeded sodium alginate scaffolds for heart valve tissue engineering.
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Quader M, Wolfe L, Median A, Fonner C, Ailawadi G, Crosby I, Speir A, Rich J, Lapar D, Kasirajan V. Isolated aortic valve replacement with bio-prostheses in patients age 50 to 65 years: a decade of statewide data on cost and patient outcomes. THE JOURNAL OF CARDIOVASCULAR SURGERY 2022; 63:382-389. [PMID: 25216214 DOI: 10.23736/s0021-9509.20.08338-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Guidelines for choice of replacement valve-mechanical versus bio-prosthetic, are well established for patients aged <50 and >65 years. We studied the trends and implications of aortic valve replacement (AVR) with mechanical versus bioprosthetic valve in patients aged 50 to 65 years. METHODS STS and cost database of 17 centers for isolated AVR surgery were analyzed by dividing them into bioprosthetic valve (BV) or mechanical valve (MV) groups. RESULTS From 2002 to 2011, 3,690 patients had AVR, 18.6% with MV and 81.4% with BV. Use of BV for all ages increased from 71.5% in 2002 to 87% in 2011. There were 1127 (30.5%) patients in the age group 50-65 years. Use of BV in this group almost doubled, 39.6% in 2002 to 76.8% in 2011. Mean age of patients in BV group was higher (59.2±4.2 years vs. 56.7±4.3 years, P≤0.0001). Preoperative renal failure, heart failure and chronic obstructive pulmonary disease favored use of BV, whereas preoperative atrial fibrillation favored AVR with MV. Mortality (MV 2.2% vs. BV 2.36%) and other postoperative outcomes between the groups were similar. Cost of valve replacement increased for both groups (MV $26,191 in 2002 to $42,592 in 2011; BV $27,404 in 2002 to $44,257 in 2011). CONCLUSIONS Use of bioprostheses for AVR has increased; this change is more pronounced in patients aged 50-65 years. Specific preoperative risk factors influence the choice of valve for AVR. Postoperative outcomes between the two groups were similar. Long-term implications of this changing practice, in particular, reoperation for bioprosthetic valve degeneration should be examined.
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Affiliation(s)
- Mohammed Quader
- Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, VA, USA -
| | - Luke Wolfe
- Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Angel Median
- Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Gorav Ailawadi
- Division of Cardiothoracic Surgery, University of Virginia Health Sciences, Charlottesville, VA, USA
| | - Ivan Crosby
- Division of Cardiothoracic Surgery, University of Virginia Health Sciences, Charlottesville, VA, USA
| | | | - Jeffrey Rich
- Mid Atlantic Cardiothoracic Surgery Ltd., Norfolk, VA, USA
| | - Damien Lapar
- Division of Cardiothoracic Surgery, University of Virginia Health Sciences, Charlottesville, VA, USA
| | - Vigneshwar Kasirajan
- Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, VA, USA
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Replacement of a Björk-Shiley tilting disc mitral valve prosthesis 33 years after initial replacement. Indian J Thorac Cardiovasc Surg 2022; 38:300-303. [PMID: 35529003 PMCID: PMC9023639 DOI: 10.1007/s12055-021-01267-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 10/19/2022] Open
Abstract
Björk-Shiley tilting disc prosthesis was the first tilting disc prosthesis to be used worldwide on a large-scale basis. Herein, we report a case of a 67-year-old male presenting with severe prosthetic valvular dysfunction. He had undergone mitral valve replacement with Björk-Shiley valve at some other center in 1987. The surgical challenge was to replace that with an adequately sized prosthesis. To achieve that, we removed all the previously preserved posterior cusp and then reconstructed the sub-valvular apparatus. The patient had a smooth post-operative recovery. This case report highlights the longest reported survival of a Björk-Shiley mitral valve and specific challenges faced during such redo cases.
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6524995. [DOI: 10.1093/ejcts/ezac073] [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: 05/30/2021] [Revised: 12/30/2021] [Accepted: 01/24/2022] [Indexed: 11/15/2022] Open
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6585867. [DOI: 10.1093/ejcts/ezac286] [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: 09/13/2021] [Revised: 04/11/2022] [Accepted: 04/28/2022] [Indexed: 11/12/2022] Open
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Attia T, Yang Y, Svensson LG, Toth AJ, Rajeswaran J, Blackstone EH, Johnston DR. Similar long-term survival after isolated bioprosthetic versus mechanical aortic valve replacement: A propensity-matched analysis. J Thorac Cardiovasc Surg 2021; 164:1444-1455.e4. [PMID: 33892946 DOI: 10.1016/j.jtcvs.2020.11.181] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 08/26/2020] [Accepted: 11/02/2020] [Indexed: 10/31/2022]
Abstract
OBJECTIVES Improved durability and preference to avoid anticoagulation have led to increasing use of bioprostheses in younger patients despite the need for eventual reoperation. Therefore, we compared in-hospital complications, reoperation, and survival after bioprosthetic and mechanical aortic valve replacement. METHODS From January 1990 to January 2020, 6143 patients underwent isolated aortic valve replacement at Cleveland Clinic; 637 patients received a mechanical prosthesis and 5506 a bioprosthesis. Propensity matching identified 527 well-matched pairs (83% of possible matches) for comparison of perioperative outcomes. The average age of patients was 54 years in the bioprosthesis group and 55 years in the mechanical prosthesis group. Random Forest machine-learning analysis was performed to compare survival using the entire cohort of 6143 patients. RESULTS Among matched patients, major in-hospital complications, including stroke, deep sternal wound infection, and reoperation for bleeding, were similar, as was in-hospital mortality (2 in the bioprosthesis group [0.38%] vs 3 in the mechanical prosthesis group [0.57%]; P > .9). Patients receiving a bioprosthesis had shorter hospital stays (median 6 vs 7 days, P < .0001). Fifty-one patients (32% at 14 years) in the bioprosthesis group and 17 patients in the mechanical prosthesis group (8% at 14 years) underwent reoperation (P [log-rank] < .0001); 5-year survival after reoperation was 85% versus 82% (P = .6). Risk-adjusted Random Forest prediction of 18-year survival was 60% in the bioprosthetic group and 58% in the mechanical prosthesis group. CONCLUSIONS Aortic valve bioprostheses are associated with excellent short-term outcomes and 18-year survival similar to that of patients receiving mechanical valves. Reoperation does not adversely affect survival. These results suggest that risk for reoperation alone should not deter the use of bioprostheses in younger patients.
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Affiliation(s)
- Tamer Attia
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland, Ohio
| | - Yanzhi Yang
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Research Institute, Cleveland, Ohio
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland, Ohio
| | - Andrew J Toth
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | | | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland, Ohio; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Douglas R Johnston
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland, Ohio.
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Tiwana JK, Otto CM. Contemporary Workup and Management of Asymptomatic Patients with Severe Aortic Stenosis. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00837-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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13
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Christ T, Paun AC, Grubitzsch H, Holinski S, Falk V, Dushe S. Long-term results after the Ross procedure with the decellularized AutoTissue Matrix P® bioprosthesis used for pulmonary valve replacement. Eur J Cardiothorac Surg 2020; 55:885-892. [PMID: 30508165 DOI: 10.1093/ejcts/ezy377] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/25/2018] [Accepted: 10/04/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Since 1967, the Ross procedure has been performed to treat aortic valve disease using homografts for pulmonary valve replacement. The decellularized Matrix P® prosthesis was developed to overcome (some) limitations of homografts. Until now, the long-term outcome data have been unavailable. METHODS Between 2002 and 2010, the Ross procedures using the Matrix P prosthesis were performed in 492 adult patients (mean age 57.2 ± 10.6 years, range 21-73 years) at our institution. Patient data were prospectively collected and analysed (3617.3 patient-years, mean follow-up 7.7 ± 4.3 years). Completeness of follow-up at 1, 5 and 10 years was 98.4%, 94.5% and 91.0%, respectively. RESULTS Hospital mortality was 3.9% (n = 19). During follow-up, 121 patients died resulting in a survival rate at 5, 10 and 12.5 years of 82.8 ± 1.7%, 70.4 ± 2.3% and 62.4 ± 2.9%, respectively. Echocardiography revealed a high incidence of relevant dysfunction of the Matrix P prosthesis and subsequent right ventricular failure. Primary reoperation/reintervention was necessary for 150 Matrix P and 48 autografts. Freedom from pulmonary valve reoperation at 5, 10 and 12.5 years was 76.2 ± 2.1%, 58.6 ± 2.9% and 53.4 ± 3.4%, respectively. The autograft function and the left ventricular function showed similar results as previously reported with a freedom from autograft reoperation at 5, 10 and 12.5 years of 91.8 ± 1.4%, 86.1 ± 2.0% and 86.1 ± 2.0%, respectively. CONCLUSIONS The Matrix P prosthesis used for the right ventricular outflow tract reconstruction in the Ross procedure showed unfavourable long-term echocardiographic results with a high rate of reoperation/reintervention for structural pulmonary valve failure. As a consequence, long-term survival of this patient cohort was impaired. Based on these findings, the use of the Matrix P prosthesis for pulmonary valve replacement for Ross procedures in adults should not be recommended.
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Affiliation(s)
- Torsten Christ
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Alexandru Claudiu Paun
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Herko Grubitzsch
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sebastian Holinski
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Simon Dushe
- Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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14
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Bartus K, Litwinowicz R, Sadowski J, Filip G, Kowalewski M, Suwalski P, Mazur P, Kędziora A, Jasiński M, Deja M, Kuśmierczyk M, Czub P, Zembala M, Jemielity M, Pawlaczyk R, Tobota Z, Maruszewski B, Kapelak B. Bioprosthetic or mechanical heart valves: prosthesis choice for borderline patients?-Results from 9,616 cases recorded in Polish national cardiac surgery registry. J Thorac Dis 2020; 12:5869-5878. [PMID: 33209419 PMCID: PMC7656432 DOI: 10.21037/jtd-19-3586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 06/05/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND In middle-aged patients undergoing aortic valve replacement (AVR), the selection of prosthesis type is a complex process. Current guidelines do not unequivocally indicate the type of prosthesis (bioprosthetic or mechanical) recommended for patients between 60-70 years of age. The aim of the study was to present the trends in AVR prosthesis selection in borderline patients over a 10-year period, based on real-life registry data. METHODS The study population comprised of 9,616 consecutive patients aged between 60-70 years, who underwent isolated AVR between 2006 and 2016 in all cardiac surgery departments in Poland. Data were extracted from the Polish National Registry of Cardiac Surgery. RESULTS Among 27,797 consecutive AVR procedures, patients aged 60-70 years represented 34.6% of the population operated on. From 2006 to 2016, bioprosthetic valves (BVs) were implanted in 53.9% cases, (and) mechanical valves (MVs) in 42.1%. The proportion of different valve types changed in time: from 77.5% of MVs vs. 22.5% of BVs in 2006 to 23.2% of MVs vs. 76.8% of BVs in 2016 (P<0.001). The most commonly implanted BV was the Hancock II (used in 36.4% of BV implantations), the most commonly used MV was the Saint Jude Mechanical prosthesis (implanted in 36.4% of MV implantation cases). A multivariable model identified smaller annulus [OR (95% CI) 0.89 (0.86-0.92), P<0.001], atrial fibrillation [OR (95% CI) 1.32 (1.05-1.67), P=0.017], male sex [OR (95% CI) 1.47 (1.24-1.74), P<0.001] and year of implantation [OR (95% CI) 0.75 (0.71-0.79), P<0.001] as predictors of MV implantation. CONCLUSIONS Patients aged 60-70 years represent more than one-third of all AVR patients. Between 2006 and 2016, the proportion of implanted prostheses has changed dramatically. In 2016 BVs were implanted in nearly 75% of AVR cases, three times more often than in 2006.
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Affiliation(s)
- Krzysztof Bartus
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | - Radosław Litwinowicz
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | - Jerzy Sadowski
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | - Grzegorz Filip
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | - Mariusz Kowalewski
- Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Piotr Suwalski
- Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Piotr Mazur
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | - Anna Kędziora
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | - Marek Jasiński
- Department of Cardiac Surgery, University Hospital in Wroclaw, Wroclaw Medical University, Wroclaw, Poland
| | - Marek Deja
- Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland
| | - Mariusz Kuśmierczyk
- Department of Cardiosurgery and Transplantology, The Cardinal Stefan Wyszynski Institute of Cardiology, Warsaw, Poland
| | - Pawel Czub
- Department of Cardiac Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Michal Zembala
- Silesian Center for Heart Disease, Zabrze, Poland
- Department of Cardiac Surgery, Vascular Surgery and Transplantology Silesian Medical University Katowice, Katowice, Poland
| | - Marek Jemielity
- Department of Cardiac Surgery and Transplantology, University Hospital of Lord Transfiguration, Poznan University of Medical Sciences, Poznan, Poland
| | - Rafał Pawlaczyk
- Department of Cardiac Surgery, Medical University of Gdansk, Gdansk, Poland
| | - Zdzisław Tobota
- Department for Pediatric Cardiothoracic Surgery, Children's Memorial Health Institute, Warsaw, Poland
| | - Bohdan Maruszewski
- Department for Pediatric Cardiothoracic Surgery, Children's Memorial Health Institute, Warsaw, Poland
| | - Boguslaw Kapelak
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital, Krakow, Poland
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15
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Abstract
Interest in the mitral valve has increased over the past few years with the development of new technologies that allow intervention in patients previously deemed too ill for treatment. This increased attention has resulted in a significant increase in publications on the mitral valve, the majority of which focus on mitral regurgitation and mitral valve surgery/intervention. The focus of this review is on publications in the past few years that offer additional insights into our understanding and management of mitral valve disease and specifically mitral regurgitation. It will discuss mitral valve anatomy, epidemiology of mitral valve disease, changes in the 2017 management guidelines, management of mitral bioprosthetic valves, transcatheter mitral valve procedures and the repair of rheumatic valves.
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Affiliation(s)
- Wendy Tsang
- Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
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16
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Rodríguez-Caulo EA, Macías D, Adsuar A, Ferreiro A, Arias-Dachary J, Parody G, Fernández F, Daroca T, Rodríguez-Mora F, Garrido JM, Muñoz-Carvajal I, Barquero JM, Valderrama JF, Melero JM. Biological or mechanical prostheses for isolated aortic valve replacement in patients aged 50–65 years: the ANDALVALVE study. Eur J Cardiothorac Surg 2019; 55:1160-1167. [DOI: 10.1093/ejcts/ezy459] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/07/2018] [Accepted: 11/22/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Emiliano A Rodríguez-Caulo
- Cardiovascular Surgery Service, University Hospital Virgen de la Victoria, Málaga CIBERCV Cardiovascular Diseases, Health Institute Carlos III, Madrid, Spain
| | - Diego Macías
- Cardiovascular Surgery Service, University Hospital Puerta del Mar, Cádiz, Spain
| | - Alejandro Adsuar
- Cardiovascular Surgery Service, University Hospital Virgen del Rocío, Sevilla, Spain
| | - Andrea Ferreiro
- Cardiovascular Surgery Service, University Hospital Virgen de las Nieves, Granada, Spain
| | | | - Gertrudis Parody
- Cardiovascular Surgery Service, University Hospital Virgen Macarena, Sevilla, Spain
| | - Frank Fernández
- Cardiovascular Surgery Service, Regional University Hospital, Málaga, Spain
| | - Tomás Daroca
- Cardiovascular Surgery Service, University Hospital Puerta del Mar, Cádiz, Spain
| | - Felipe Rodríguez-Mora
- Cardiovascular Surgery Service, University Hospital Virgen del Rocío, Sevilla, Spain
| | - José M Garrido
- Cardiovascular Surgery Service, University Hospital Virgen de las Nieves, Granada, Spain
| | | | - José M Barquero
- Cardiovascular Surgery Service, University Hospital Virgen Macarena, Sevilla, Spain
| | - José F Valderrama
- Cardiovascular Surgery Service, Regional University Hospital, Málaga, Spain
| | - José M Melero
- Cardiovascular Surgery Service, University Hospital Virgen de la Victoria, Málaga CIBERCV Cardiovascular Diseases, Health Institute Carlos III, Madrid, Spain
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17
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Complementary Role of the Computed Biomodelling through Finite Element Analysis and Computed Tomography for Diagnosis of Transcatheter Heart Valve Thrombosis. BIOMED RESEARCH INTERNATIONAL 2018; 2018:1346308. [PMID: 30426001 PMCID: PMC6217904 DOI: 10.1155/2018/1346308] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 09/04/2018] [Accepted: 10/02/2018] [Indexed: 11/24/2022]
Abstract
Introduction The TAVR procedure is associated with a substantial risk of thrombosis. Current guidelines recommend catheter-based aortic valve implantation for prohibitive-high-risk patients with severe aortic valve stenosis but acknowledge that the aetiology and mechanism of thrombosis are unclear. Methods From 2015 to 2018, 607 patients with severe aortic valve stenosis underwent either self-expandable or balloon-expandable catheter-based aortic valve implantation at our institute. A complementary study was designed to support computed tomography as a predictor of complications using an advanced biomodelling process through finite element analysis (FEA). The primary evaluation of study was the thrombosis of the valve at 12 months. Results At 12 months, 546 patients had normal valvular function. 61 patients had THVT while 6 showed thrombosis and dislodgement with deterioration to NYHA Class IV requiring rehospitalization. The FEA biomodelling revealed a strong link between solid uncrushed calcifications, delayed dislodgement of TAVR and late thrombosis. We observed an interesting phenomenon of fibrosis/calcification originating at the level of the misplaced valve, which was the primary cause of coronary obstruction. Conclusion The use of cardiac CT and predictive biomodelling should be integrated into routine practice for the selection of TAVR candidates and as a predictor of negative outcomes given the lack of accurate investigations available. This would assist in effective decision-making and diagnosis especially in a high-risk cohort of patients.
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18
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Reyes M, Reardon MJ. Transcatheter Valve Replacement: Risk Levels and Contemporary Outcomes. Methodist Debakey Cardiovasc J 2018; 13:126-131. [PMID: 29743997 DOI: 10.14797/mdcj-13-3-126] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has exploded into medical care for aortic stenosis, thus changing the treatment options for patients. TAVR is currently approved for extreme-risk, high-risk, and intermediate-risk patients with symptomatic severe aortic stenosis, and randomized trials for low-risk patients are underway. This article traces the trajectory of TAVR as a viable option for higher-risk patients and examines current outcomes.
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Affiliation(s)
- Manuel Reyes
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
| | - Michael J Reardon
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
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19
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Reul RM, Ramchandani MK, Reardon MJ. Transcatheter Aortic Valve-in-Valve Procedure in Patients with Bioprosthetic Structural Valve Deterioration. Methodist Debakey Cardiovasc J 2018; 13:132-141. [PMID: 29743998 DOI: 10.14797/mdcj-13-3-132] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Surgical aortic valve replacement is the gold standard procedure to treat patients with severe, symptomatic aortic valve stenosis or insufficiency. Bioprosthetic valves are used for surgical aortic valve replacement with a much greater prevalence than mechanical valves. However, bioprosthetic valves may fail over time because of structural valve deterioration; this often requires intervention due to severe bioprosthetic valve stenosis or regurgitation or a combination of both. In select patients, transcatheter aortic valve replacement is an alternative to surgical aortic valve replacement. Transcatheter valve-in-valve (ViV) replacement is performed by implanting a transcatheter heart valve within a failing bioprosthetic valve. The transcatheter ViV operation is a less invasive procedure compared with reoperative surgical aortic valve replacement, but it has been associated with specific complications and requires extensive preoperative work-up and planning by the heart team. Data from experimental studies and analyses of results from clinical procedures have led to strategies to improve outcomes of these procedures. The type, size, and implant position of the transcatheter valve can be optimized for individual patients with knowledge of detailed dimensions of the surgical valve and radiographic and echocardiographic measurements of the patient's anatomy. Understanding the complexities of the ViV procedure can lead surgeons to make choices during the original surgical valve implantation that can make a future ViV operation more technically feasible years before it is required.
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Affiliation(s)
- Ross M Reul
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
| | - Mahesh K Ramchandani
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
| | - Michael J Reardon
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
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20
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Yan W, Shah P, Hiebert B, Pozeg Z, Ghorpade N, Singal RK, Manji RA, Arora RC. Long-term non-institutionalized survival and rehospitalization after surgical aortic and mitral valve replacements in a large provincial cardiac surgery centre. Interact Cardiovasc Thorac Surg 2018; 27:131-138. [PMID: 29462406 DOI: 10.1093/icvts/ivy018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 01/14/2018] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Long-term quality of life following open surgical valve replacement is an increasingly important outcome to patients and their caregivers. This study examines non-institutionalized survival and rehospitalization within our surgical aortic valve replacement (AVR) and mitral valve replacement (MVR) populations. METHODS A retrospective single-centre study of all consecutive open surgical valve replacements between 1995 and 2014 was undertaken. Clinical data were linked to provincial administrative data for 3219 patients who underwent AVR, MVR or double (aortic and mitral) valve replacement with or without concomitant coronary artery bypass grafting (CABG). Non-institutionalized survival and cumulative incidence of rehospitalization was examined up to 15 years. RESULTS Follow-up was complete for 96.9% of the 2146 patients who underwent AVR ± CABG (66.7% of the overall cohort), 878 who underwent MVR ± CABG (27.3%) and 195 who underwent double (aortic and mitral) valve replacement ± CABG (6.0%) with a median follow-up time of 5.6 years. Overall non-institutionalized survival was 35.4% at 15 years, and the cumulative incidence of rehospitalization was 34.4%, 63.2% and 87.0% at 1, 5 and 15 years, respectively, without significant differences between valve procedure cohorts. Both non-institutionalized survival and cumulative incidence of rehospitalization improved in more recent eras, despite increasing age and comorbidities. CONCLUSIONS Non-institutionalized survival and rehospitalization data for up to 15 years suggest good functional outcomes long after surgical AVR and/or MVR. Continued improvements are seen in these metrics over the past 2 decades. This provides a unique insight into the quality of life after surgical valve replacement in the ageing demographics with valvular heart disease.
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Affiliation(s)
- Weiang Yan
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Cardiac Sciences Program, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Pallav Shah
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Cardiac Sciences Program, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Brett Hiebert
- Cardiac Sciences Program, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Zlatko Pozeg
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Cardiac Sciences Program, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Nitin Ghorpade
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Cardiac Sciences Program, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Rohit K Singal
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Cardiac Sciences Program, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Rizwan A Manji
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Cardiac Sciences Program, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
| | - Rakesh C Arora
- Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.,Cardiac Sciences Program, Winnipeg Regional Health Authority, Winnipeg, MB, Canada
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21
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Rodríguez-Caulo EA, Otero-Forero JJ, Sánchez-Espín G, Mataró MJ, Guzón A, Porras C, Villaescusa J, Such M, Melero JM. 15 years outcomes following bioprosthetic versus mechanical aortic valve replacement in patients aged 50–65 years with isolated aortic stenosis. CIRUGIA CARDIOVASCULAR 2018. [DOI: 10.1016/j.circv.2018.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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22
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van Steenberghe M, Schubert T, Gerelli S, Bouzin C, Guiot Y, Xhema D, Bollen X, Abdelhamid K, Gianello P. Porcine pulmonary valve decellularization with NaOH-based vs detergent process: preliminary in vitro and in vivo assessments. J Cardiothorac Surg 2018; 13:34. [PMID: 29695259 PMCID: PMC5918872 DOI: 10.1186/s13019-018-0720-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 04/05/2018] [Indexed: 12/01/2022] Open
Abstract
Background Glutaraldehyde fixed xenogeneic heart valve prosthesis are hindered by calcification and lack of growth potential. The aim of tissue decellularization is to remove tissue antigenicity, avoiding the use of glutaraldehyde and improve valve integration with low inflammation and host cell recolonization. In this preliminary study, we investigated the efficacy of a NaOH-based process for decellularization and biocompatibility improvement of porcine pulmonary heart valves in comparison to a detergent-based process (SDS-SDC0, 5%). Methods Native cryopreserved porcine pulmonary heart valves were treated with detergent and NaOH-based processes. Decellularization was assessed by Hematoxylin and eosin/DAPI/alpha-gal/SLA-I staining and DNA quantification of native and processed leaflets, walls and muscles. Elongation stress test investigated mechanical integrity of leaflets and walls (n = 3 tests/valve component) of valves in the native and treated groups (n = 4/group). Biochemical integrity (collagen/elastin/glycosaminoglycans content) of leaflet-wall and muscle of the valves (n = 4/group) was assessed and compared between groups with trichrome staining (Sirius Red/Miller/Alcian blue). Secondly, a preliminary in vivo study assessed biocompatibility (CD3 and CD68 immunostaining) and remodeling (Hematoxylin and eosin/CD31 and ASMA immunofluorescent staining) of NaOH processed valves implanted in orthotopic position in young Landrace pigs, at 1 (n = 1) and 3 months (n = 2). Results Decellularization was better achieved with the NaOH-based process (92% vs 69% DNA reduction in the wall). Both treatments did not significantly alter mechanical properties. The detergent-based process induced a significant loss of glycosaminoglycans (p < 0,05). In vivo, explanted valves exhibited normal morphology without any sign of graft dilatation, degeneration or rejection. Low inflammation was noticed at one and three months follow-up (1,8 +/− 3,03 and 0,9836 +/− 1,3605 CD3 cells/0,12 mm2 in the leaflets). In one animal, at three months we documented minimal calcification in the area of sinus leaflet and in one, microthrombi formation on the leaflet surface at 1 month. The endoluminal side of the valves showed partial reendothelialization. Conclusions NaOH-based process offers better porcine pulmonary valve decellularization than the detergent process. In vivo, the NaOH processed valves showed low inflammatory response at 3 months and partial recellularization. Regarding additional property of securing, this treatment should be considered for the new generation of heart valves prosthesis. Graphical abstract Graphical abstract of the study![]()
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Affiliation(s)
- Mathieu van Steenberghe
- Pôle de Chirurgie Expérimentale et Transplantation (CHEX), Institut de Recherche Expérimentale et Clinique (IREC), Secteur des Sciences de la Sante, Université Catholique de Louvain, Avenue Hippocrate 55/B1.55.04, B-1200, Brussels, Belgium. .,Service de chirurgie cardiaque et vasculaire, Clinique Cecil, avenue Louis Ruchonnet 53, 1003, Lausanne, Switzerland.
| | - Thomas Schubert
- Service d'orthopédie et de traumatologie de l'appareil locomoteur, Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, B-1200, Brussels, Belgium.,Unité de thérapie tissulaire et cellulaire de l'appareil locomoteur, Cliniques universitaires Saint Luc, Avenue Hippocrate 10, B-1200, Brussels, Belgium
| | - Sébastien Gerelli
- Service de chirurgie cardiaque, Centre hospitalier Annecy-Genevois, site Annecy, 1 Avenue de l'Hopital, F-74370, Pringy, France
| | - Caroline Bouzin
- Institut de Recherche Expérimentale et Clinique (IREC), IREC Imaging Platform (2IP), Université catholique de Louvain, Avenue Hippocrate 55/B1.55.20, B-1200, Brussels, Belgium
| | - Yves Guiot
- Service d'anatomie pathologique, Cliniques universitaires Saint Luc, Avenue Hippocrate 10, B-1200, Brussels, Belgium
| | - Daela Xhema
- Pôle de Chirurgie Expérimentale et Transplantation (CHEX), Institut de Recherche Expérimentale et Clinique (IREC), Secteur des Sciences de la Sante, Université Catholique de Louvain, Avenue Hippocrate 55/B1.55.04, B-1200, Brussels, Belgium
| | - Xavier Bollen
- Institute of Mechanics, Materials and Civil Engineering, Mechatronic, Electrical Energy, and Dynamic Systems (MEED), Secteur des Sciences et Technologies, Université Catholique de Louvain, Place du Levant 2/L5.04.02, B-1348, Louvain-la-Neuve, Belgium
| | - Karim Abdelhamid
- Service d'oncologie, Centre hospitalier universitaire vaudois, Rue du Bugnon 46, CH-1011, Lausanne, Vaud, Switzerland
| | - Pierre Gianello
- Pôle de Chirurgie Expérimentale et Transplantation (CHEX), Institut de Recherche Expérimentale et Clinique (IREC), Secteur des Sciences de la Sante, Université Catholique de Louvain, Avenue Hippocrate 55/B1.55.04, B-1200, Brussels, Belgium
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23
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Bourguignon T, Espitalier F, Pantaleon C, Vermes E, El-Arid JM, Loardi C, Karam E, Candolfi P, Ivanes F, Aupart M. Bioprosthetic mitral valve replacement in patients aged 65 years or younger: long-term outcomes with the Carpentier–Edwards PERIMOUNT pericardial valve†. Eur J Cardiothorac Surg 2018; 54:302-309. [DOI: 10.1093/ejcts/ezy029] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 01/10/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Thierry Bourguignon
- Department of Cardiothoracic Surgery, Trousseau University Hospital, Tours, France
| | - Fabien Espitalier
- Department of Cardiothoracic Surgery, Trousseau University Hospital, Tours, France
| | - Clémence Pantaleon
- Department of Cardiothoracic Surgery, Trousseau University Hospital, Tours, France
| | - Emmanuelle Vermes
- Department of Cardiothoracic Surgery, Trousseau University Hospital, Tours, France
| | - Jean Marc El-Arid
- Department of Cardiothoracic Surgery, Trousseau University Hospital, Tours, France
| | - Claudia Loardi
- Department of Cardiothoracic Surgery, Trousseau University Hospital, Tours, France
| | - Elias Karam
- Department of Cardiothoracic Surgery, Trousseau University Hospital, Tours, France
| | - Pascal Candolfi
- Department of Biostatistics, Edwards Lifesciences, Nyon, Switzerland
| | - Fabrice Ivanes
- Department of Cardiology, Trousseau University Hospital, Tours, France
| | - Michel Aupart
- Department of Cardiothoracic Surgery, Trousseau University Hospital, Tours, France
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24
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Joshi Y, Achouh P, Menasché P, Fabiani JN, Berrebi A, Carpentier A, Latremouille C, Jouan J. Multiple reoperations on the aortic valve: outcomes and implications for future potential valve-in-valve strategy†. Eur J Cardiothorac Surg 2017; 53:1251-1257. [DOI: 10.1093/ejcts/ezx469] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 11/28/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Paul Achouh
- Department of Cardiovascular Surgery, Georges Pompidou European Hospital and University Paris-Descartes, Sorbonne Paris-Cité, Paris, France
| | - Philippe Menasché
- Department of Cardiovascular Surgery, Georges Pompidou European Hospital and University Paris-Descartes, Sorbonne Paris-Cité, Paris, France
- INSERM UMR 970, Paris, France
| | - Jean-Noel Fabiani
- Department of Cardiovascular Surgery, Georges Pompidou European Hospital and University Paris-Descartes, Sorbonne Paris-Cité, Paris, France
| | - Alain Berrebi
- Department of Cardiovascular Surgery, Georges Pompidou European Hospital and University Paris-Descartes, Sorbonne Paris-Cité, Paris, France
| | - Alain Carpentier
- Department of Cardiovascular Surgery, Georges Pompidou European Hospital and University Paris-Descartes, Sorbonne Paris-Cité, Paris, France
| | - Christian Latremouille
- Department of Cardiovascular Surgery, Georges Pompidou European Hospital and University Paris-Descartes, Sorbonne Paris-Cité, Paris, France
| | - Jérôme Jouan
- Department of Cardiovascular Surgery, Georges Pompidou European Hospital and University Paris-Descartes, Sorbonne Paris-Cité, Paris, France
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25
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Fujita B, Ensminger S, Bauer T, Möllmann H, Beckmann A, Bekeredjian R, Bleiziffer S, Schäfer E, Hamm CW, Mohr FW, Katus HA, Harringer W, Walther T, Frerker C. Trends in practice and outcomes from 2011 to 2015 for surgical aortic valve replacement: an update from the German Aortic Valve Registry on 42 776 patients. Eur J Cardiothorac Surg 2017; 53:552-559. [DOI: 10.1093/ejcts/ezx408] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/28/2017] [Indexed: 02/03/2023] Open
Affiliation(s)
- Buntaro Fujita
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Stephan Ensminger
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Timm Bauer
- Department of Cardiology, University of Giessen, Giessen, Germany
| | - Helge Möllmann
- Department of Internal Medicine, St.-Johannes-Hospital, Dortmund, Germany
| | - Andreas Beckmann
- German Society of Thoracic, Cardiac and Vascular Surgery, Berlin, Germany
| | - Raffi Bekeredjian
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Sabine Bleiziffer
- Clinic for Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
| | - Elke Schäfer
- BQS Institute for Quality and Patient Safety, Düsseldorf, Germany
| | - Christian W Hamm
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Friedrich W Mohr
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Hugo A Katus
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Wolfgang Harringer
- Department of Thoracic and Cardiovascular Surgery, Klinikum Braunschweig, Braunschweig, Germany
| | - Thomas Walther
- Department of Cardiac Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Christian Frerker
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
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Goldstone AB, Chiu P, Baiocchi M, Lingala B, Patrick WL, Fischbein MP, Woo YJ. Mechanical or Biologic Prostheses for Aortic-Valve and Mitral-Valve Replacement. N Engl J Med 2017; 377:1847-1857. [PMID: 29117490 PMCID: PMC9856242 DOI: 10.1056/nejmoa1613792] [Citation(s) in RCA: 417] [Impact Index Per Article: 59.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND In patients undergoing aortic-valve or mitral-valve replacement, either a mechanical or biologic prosthesis is used. Biologic prostheses have been increasingly favored despite limited evidence supporting this practice. METHODS We compared long-term mortality and rates of reoperation, stroke, and bleeding between inverse-probability-weighted cohorts of patients who underwent primary aortic-valve replacement or mitral-valve replacement with a mechanical or biologic prosthesis in California in the period from 1996 through 2013. Patients were stratified into different age groups on the basis of valve position (aortic vs. mitral valve). RESULTS From 1996 through 2013, the use of biologic prostheses increased substantially for aortic-valve and mitral-valve replacement, from 11.5% to 51.6% for aortic-valve replacement and from 16.8% to 53.7% for mitral-valve replacement. Among patients who underwent aortic-valve replacement, receipt of a biologic prosthesis was associated with significantly higher 15-year mortality than receipt of a mechanical prosthesis among patients 45 to 54 years of age (30.6% vs. 26.4% at 15 years; hazard ratio, 1.23; 95% confidence interval [CI], 1.02 to 1.48; P=0.03) but not among patients 55 to 64 years of age. Among patients who underwent mitral-valve replacement, receipt of a biologic prosthesis was associated with significantly higher mortality than receipt of a mechanical prosthesis among patients 40 to 49 years of age (44.1% vs. 27.1%; hazard ratio, 1.88; 95% CI, 1.35 to 2.63; P<0.001) and among those 50 to 69 years of age (50.0% vs. 45.3%; hazard ratio, 1.16; 95% CI, 1.04 to 1.30; P=0.01). The incidence of reoperation was significantly higher among recipients of a biologic prosthesis than among recipients of a mechanical prosthesis. Patients who received mechanical valves had a higher cumulative incidence of bleeding and, in some age groups, stroke than did recipients of a biologic prosthesis. CONCLUSIONS The long-term mortality benefit that was associated with a mechanical prosthesis, as compared with a biologic prosthesis, persisted until 70 years of age among patients undergoing mitral-valve replacement and until 55 years of age among those undergoing aortic-valve replacement. (Funded by the National Institutes of Health and the Agency for Healthcare Research and Quality.).
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Affiliation(s)
- Andrew B Goldstone
- From the Departments of Cardiothoracic Surgery (A.B.G., P.C., B.L., W.L.P., M.P.F., Y.J.W.) and Health Research and Policy (A.B.G., P.C.) and the Stanford Prevention Research Center, Department of Medicine (M.B.), School of Medicine, Stanford University, Stanford, CA
| | - Peter Chiu
- From the Departments of Cardiothoracic Surgery (A.B.G., P.C., B.L., W.L.P., M.P.F., Y.J.W.) and Health Research and Policy (A.B.G., P.C.) and the Stanford Prevention Research Center, Department of Medicine (M.B.), School of Medicine, Stanford University, Stanford, CA
| | - Michael Baiocchi
- From the Departments of Cardiothoracic Surgery (A.B.G., P.C., B.L., W.L.P., M.P.F., Y.J.W.) and Health Research and Policy (A.B.G., P.C.) and the Stanford Prevention Research Center, Department of Medicine (M.B.), School of Medicine, Stanford University, Stanford, CA
| | - Bharathi Lingala
- From the Departments of Cardiothoracic Surgery (A.B.G., P.C., B.L., W.L.P., M.P.F., Y.J.W.) and Health Research and Policy (A.B.G., P.C.) and the Stanford Prevention Research Center, Department of Medicine (M.B.), School of Medicine, Stanford University, Stanford, CA
| | - William L Patrick
- From the Departments of Cardiothoracic Surgery (A.B.G., P.C., B.L., W.L.P., M.P.F., Y.J.W.) and Health Research and Policy (A.B.G., P.C.) and the Stanford Prevention Research Center, Department of Medicine (M.B.), School of Medicine, Stanford University, Stanford, CA
| | - Michael P Fischbein
- From the Departments of Cardiothoracic Surgery (A.B.G., P.C., B.L., W.L.P., M.P.F., Y.J.W.) and Health Research and Policy (A.B.G., P.C.) and the Stanford Prevention Research Center, Department of Medicine (M.B.), School of Medicine, Stanford University, Stanford, CA
| | - Y Joseph Woo
- From the Departments of Cardiothoracic Surgery (A.B.G., P.C., B.L., W.L.P., M.P.F., Y.J.W.) and Health Research and Policy (A.B.G., P.C.) and the Stanford Prevention Research Center, Department of Medicine (M.B.), School of Medicine, Stanford University, Stanford, CA
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Martin E, Mohammadi S, Jacques F, Kalavrouziotis D, Voisine P, Doyle D, Perron J. Clinical Outcomes Following the Ross Procedure in Adults: A 25-Year Longitudinal Study. J Am Coll Cardiol 2017; 70:1890-1899. [PMID: 28982503 DOI: 10.1016/j.jacc.2017.08.030] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 08/05/2017] [Accepted: 08/14/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Very few reports of long-term outcomes of patients who underwent the Ross procedure have been published. OBJECTIVES The authors reviewed their 25-year experience with the Ross procedure with the aim of defining very-long-term survival and factors associated with Ross-related failure. METHODS Between January 1990 and December 2014, the Ross procedure was performed in 310 adults (mean age 40.8 years) at a single institution. All patients were prospectively added to a dedicated cardiac surgery registry. Complete post-operative clinical examination and history were obtained, and transthoracic echocardiography was performed according to a standardized protocol. There was no loss to follow-up. Median follow-up was 15.1 years and up to 25 years. RESULTS Bicuspid aortic valve was diagnosed in 227 patients (73.2%), and the most common indication for surgery was aortic stenosis (n = 225 [72.6%]). Freedom from any Ross-related reintervention was 92.9% and 70.1% at 10 and 20 years, respectively. Independent risk factors for pulmonary autograft degeneration were pre-operative large aortic annulus (hazard ratio: 1.1; p = 0.01), pre-operative aortic insufficiency (hazard ratio: 2.7; p = 0.002), and concomitant replacement of the ascending aorta (hazard ratio: 7.7; p = 0.0003). There were 4 hospital deaths (1.3%), and overall survival at 10 and 20 years was 94.1% and 83.6%, respectively. Long-term survival was not significantly different in patients who required Ross-related reintervention (log-rank p = 0.70). However, compared with the general population, survival was significantly lower in patients following the Ross procedure when matched on age and sex (p < 0.0001). CONCLUSIONS The Ross procedure was associated with excellent long-term valvular outcomes and survival, regardless of the need for reintervention. Adults presenting with aortic insufficiency or a dilated aortic annulus or ascending aorta were at greater risk for reintervention. Unlike previous reports, long-term survival was lower in Ross patients compared with matched subjects.
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Affiliation(s)
- Elisabeth Martin
- Division of Cardiac Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Université Laval, Quebec City, Quebec, Canada
| | - Siamak Mohammadi
- Division of Cardiac Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Université Laval, Quebec City, Quebec, Canada
| | - Frederic Jacques
- Division of Cardiac Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Université Laval, Quebec City, Quebec, Canada
| | - Dimitri Kalavrouziotis
- Division of Cardiac Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Université Laval, Quebec City, Quebec, Canada
| | - Pierre Voisine
- Division of Cardiac Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Université Laval, Quebec City, Quebec, Canada
| | - Daniel Doyle
- Division of Cardiac Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Université Laval, Quebec City, Quebec, Canada
| | - Jean Perron
- Division of Cardiac Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Université Laval, Quebec City, Quebec, Canada.
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Haji Zeinali AM, Abbasi K, Saheb Jam M, Yazdani S, Mortazavi SH. Transcatheter heart valve in valve implantation with Edwards SAPIEN bioprosthetic valve for different degenerated bioprosthetic valve positions (First Iranian ViV report with mid-term follow up). J Cardiovasc Thorac Res 2017; 9:152-157. [PMID: 29118948 PMCID: PMC5670337 DOI: 10.15171/jcvtr.2017.26] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 09/21/2017] [Indexed: 01/08/2023] Open
Abstract
Introduction: After early successful experience with transcatheter aortic valve replacement (TAVR), concept of transcatheter implantation of a new valve within a failing bioprosthetic valve emerged. Valve-in-valve (ViV) implantation seems to be a simpler option for high risk surgical patients.
Methods: We performed five ViV procedures in different valve positions. We included patients with failing bioprosthetic valves with high surgical risk due to concomitant comorbidities. We performed 2 transapical ViV procedures for failing mitral bioprosthetic valves, 1 transfemoral procedure for failing pulmonary valve and 2 transfemoral ViV implantation for failing tricuspid bioprosthetic valves.
Results: The procedures were successfully completed in all 5 cases with initial excellent fluoroscopic and echocardiographic verification. There was no valve embolization or paravalvular leakage in any of the cases. Transcatheter valve function was appropriate with echocardiography. Post procedural clinical adverse events like pleural effusion and transient ischemic attack were managed successfully. In midterm follow up all cases remained in appropriate functional class except from the transcatheter pulmonary valve which became moderately stenotic and regurgitant.
Conclusion: As the first Iranian all-comers case series with midterm follow up for ViV implantation, we had no mortality. Interestingly none of our patients had neurologic sequelae after the procedure. Midterm follow up for our patients was acceptable with good functional class and appropriate echocardiographic findings. Due to high surgical risk of the redo procedure after failing of a bioprosthetic valve especially in elderly patients with comorbidities, ViV implantation would be a good alternative to surgery for this high risk group.
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Affiliation(s)
| | - Kyomars Abbasi
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Saheb Jam
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahrooz Yazdani
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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Schnittman SR, Adams DH, Itagaki S, Toyoda N, Egorova NN, Chikwe J. Bioprosthetic aortic valve replacement: Revisiting prosthesis choice in patients younger than 50 years old. J Thorac Cardiovasc Surg 2017; 155:539-547.e9. [PMID: 29110948 DOI: 10.1016/j.jtcvs.2017.08.121] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 05/18/2017] [Accepted: 08/24/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Aortic prosthesis choice is controversial in young adults because robust comparative outcome data are lacking. We therefore compared mortality and morbidity in young adults after bioprosthetic versus mechanical aortic valve replacement. METHODS This was a retrospective analysis of 5111 patients aged 18 to 50 years undergoing primary aortic valve replacement in California and New York State from 1997 to 2006. Median follow-up time was 11.8 years (maximum 18.9 years). The primary endpoint was mortality; secondary endpoints were stroke, bleeding, and reoperation. Propensity score matching yielded 1175 patient pairs. RESULTS Bioprosthetic valves increased from 14% to 47% of aortic valve replacements between 1997 and 2014 (P < .001). There was no survival difference with bioprosthetic versus mechanical aortic valves in the propensity score-matched cohort: actuarial 15-year survival was 79.0% (95% confidence interval [CI], 75.8%-81.8%) versus 81.5% (95% CI, 78.5%-84.2%) respectively (hazard ratio [HR], 1.14; 95% CI, 0.93-1.40, P = .20). No interaction was found between age and prosthesis choice on survival (Pinteraction = 0.16). After bioprosthetic valve replacement, stroke rates were lower (5.4% [95% CI, 3.8%-7.2%] vs 8.1% [95% CI, 6.3%-10.2%], HR 0.62 [95% CI 0.43-0.91]), bleeding rates were lower (4.2% [95% CI, 3.0-5.6%] vs 8.4% [95% CI, 6.6-10.4%], HR 0.48 [95% CI, 0.33-0.69]), but reoperation rates were greater (24.5% [95% CI, 21.3%-27.8%] vs 9.3% [95% CI, 7.2%-11.7%], HR 5.9 [95% CI 3.2-11.0]) at 15 years versus mechanical valve replacement. CONCLUSIONS Although lifetime risks are represented incompletely, these findings suggest that in adults aged 18-50 years, bioprostheses are a reasonable alternative to mechanical valves for aortic valve replacement.
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Affiliation(s)
- Samuel R Schnittman
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - David H Adams
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Shinobu Itagaki
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Nana Toyoda
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Natalia N Egorova
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Joanna Chikwe
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, NY; Division of Cardiothoracic Surgery, Stony Brook University Hospital, New York, NY.
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Castriota F, Nerla R, Micari A, Cavazza C, Bedogni F, Testa L, Montorfano M, Del Giglio M, Cremonesi A. Transcatheter Aortic Valve-in-Valve Implantation Using Lotus Valve for Failed Surgical Bioprostheses. Ann Thorac Surg 2017; 104:638-644. [DOI: 10.1016/j.athoracsur.2016.11.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 11/03/2016] [Accepted: 11/07/2016] [Indexed: 10/20/2022]
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Puskas JD, Bavaria JE, Svensson LG, Blackstone EH, Griffith B, Gammie JS, Heimansohn DA, Sadowski J, Bartus K, Johnston DR, Rozanski J, Rosengart T, Girardi LN, Klodell CT, Mumtaz MA, Takayama H, Halkos M, Starnes V, Boateng P, Timek TA, Ryan W, Omer S, Smith CR. The COMMENCE trial: 2-year outcomes with an aortic bioprosthesis with RESILIA tissue†. Eur J Cardiothorac Surg 2017; 52:432-439. [DOI: 10.1093/ejcts/ezx158] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 04/14/2017] [Indexed: 12/11/2022] Open
Affiliation(s)
- John D. Puskas
- Department of Cardiovascular Surgery, Mount Sinai Saint Luke’s, New York, NY, USA
| | - Joseph E. Bavaria
- Department of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Lars G. Svensson
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Eugene H. Blackstone
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Bartley Griffith
- Department of Thoracic and Cardiovascular Surgery, University of Maryland, Baltimore, MD, USA
| | - James S. Gammie
- Department of Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - David A. Heimansohn
- Department of Cardiothoracic Surgery, St Vincent Heart Center, Indianapolis, IN, USA
| | - Jerzy Sadowski
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | - Krzysztof Bartus
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | - Douglas R. Johnston
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Todd Rosengart
- Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Leonard N. Girardi
- Department of Cardiothoracic Surgery, New York Presbyterian Hospital, New York, NY, USA
| | | | - Mubashir A. Mumtaz
- Department of Cardiovascular and Thoracic Surgery, Pinnacle Health, Harrisburg, PA, USA
| | - Hiroo Takayama
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University-New York Presbyterian Hospital, New York, NY, USA
| | - Michael Halkos
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Vaughn Starnes
- Department of Surgery, University of Southern California, Los Angeles, CA, USA
| | - Percy Boateng
- Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York, NY, USA
| | - Tomasz A. Timek
- Division of Cardiothoracic Surgery, Spectrum Health Medical Group, Grand Rapids, MI, USA
| | - William Ryan
- Department of Cardiovascular Surgery, Heart Hospital Baylor, Plano, TX, USA
| | - Shuab Omer
- Department of Cardiovascular Surgery, Michael E DeBakey VA Medical Center, Houston, TX, USA
| | - Craig R. Smith
- Department of Surgery, Columbia Presbyterian Medical Center, New York, NY, USA
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Bowdish ME, Kumar SR, Starnes VA. The Ross procedure: an excellent option in the right hands. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:471. [PMID: 28090527 DOI: 10.21037/atm.2016.11.32] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Michael E Bowdish
- Division of Cardiothoracic Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, CA, USA;; The Heart Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - S Ram Kumar
- Division of Cardiothoracic Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, CA, USA;; The Heart Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Vaughn A Starnes
- Division of Cardiothoracic Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, CA, USA;; The Heart Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
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Lee W, Long C, Ramsoondar J, Ayares D, Cooper DKC, Manji RA, Hara H. Human antibody recognition of xenogeneic antigens (NeuGc and Gal) on porcine heart valves: could genetically modified pig heart valves reduce structural valve deterioration? Xenotransplantation 2016; 23:370-80. [DOI: 10.1111/xen.12254] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 07/07/2016] [Indexed: 02/02/2023]
Affiliation(s)
- Whayoung Lee
- Thomas E. Starzl Transplantation Institute; University of Pittsburgh; Pittsburgh PA USA
| | - Cassandra Long
- Thomas E. Starzl Transplantation Institute; University of Pittsburgh; Pittsburgh PA USA
| | | | | | - David K. C. Cooper
- Thomas E. Starzl Transplantation Institute; University of Pittsburgh; Pittsburgh PA USA
| | - Rizwan A. Manji
- Department of Surgery; University of Manitoba; Winnipeg MB Canada
- Cardiac Sciences Program; Winnipeg Regional Health Authority and St Boniface Hospital; Winnipeg MB Canada
| | - Hidetaka Hara
- Thomas E. Starzl Transplantation Institute; University of Pittsburgh; Pittsburgh PA USA
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Jaffer IH, Whitlock RP. A mechanical heart valve is the best choice. HEART ASIA 2016; 8:62-4. [PMID: 27326236 DOI: 10.1136/heartasia-2015-010660] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 02/10/2016] [Indexed: 11/03/2022]
Abstract
The choice of prosthesis type in patients with valvular heart disease should always be individualised. The treating heart team must weigh the concerns surrounding durability of bioprosthetic valves compared with mechanical valves and the need for lifelong anticoagulation required with mechanical valves. In general, guidelines recommend that patients under the age of 60 would benefit from a mechanical valve, and those over 70 would benefit from a bioprosthetic valve. We would argue, in this context, that the most appropriate choice for this patient would be undertaking a mitral valve replacement with a mechanical prosthesis. This recommendation is based on two considerations: first, there is a high likelihood of failure of a bioprosthesis within an unacceptably short period of time, which would then necessitate a higher risk reoperation. Second, there is high likelihood of needing long-term anticoagulation in a patient with severe mitral stenosis due to the development of atrial fibrillation. While we do acknowledge the difficulty in managing long-term anticoagulation of patients in rural settings, there have nonetheless been significant advancements in this realm with the use of pharmacist-led thrombosis clinics and point of care international normalised ratio (INR) devices in the treatment of rural patients in low-income and middle-income countries. For these reasons, therefore, we would strongly advocate for a mechanical valve in this 44-year-old patient from a rural setting.
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Affiliation(s)
- Iqbal H Jaffer
- Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada; Division of Cardiac Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Richard P Whitlock
- Division of Cardiac Surgery, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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Yousefi A, Bark DL, Dasi LP. Effect of Arched Leaflets and Stent Profile on the Hemodynamics of Tri-Leaflet Flexible Polymeric Heart Valves. Ann Biomed Eng 2016; 45:464-475. [PMID: 27307007 DOI: 10.1007/s10439-016-1674-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 05/30/2016] [Indexed: 12/31/2022]
Abstract
Polymeric heart valves (PHV) can be engineered to serve as alternatives for existing prosthetic valves due to higher durability and hemodynamics similar to bioprosthetic valves. The purpose of this study is to evaluate the effect of geometry on PHVs coaptation and hemodynamic performance. The two geometric factors considered are stent profile and leaflet arch length, which were varied across six valve configurations. Three models were created with height to diameter ratio of 0.6, 0.7, and 0.88. The other three models were designed by altering arch height to stent diameter ratio, to be 0, 0.081, and 0.116. Particle image velocimetry experiments were conducted on each PHV to characterize velocity, vorticity, turbulent characteristics, effective orifice area, and regurgitant fraction. This study revealed that the presence of arches as well as higher stent profile reduced regurgitant flow down to 5%, while peak systole downstream velocity reduced to 58% and Reynolds Shear Stress values reduced 40%. Further, earlier reattachment of the forward flow jet was observed in PHVs with leaflet arches. These findings indicate that although both geometric factors help diminish the commissural gap during diastole, leaflet arches induce a larger jet opening, yielding to earlier flow reattachment and lower energy dissipation.
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Affiliation(s)
- Atieh Yousefi
- Department of Biomedical Engineering, Dorothy Davis Heart and Lung Research Institute, The Ohio State University, 473 W 12th Avenue, Columbus, OH, 43210, USA
| | - David L Bark
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Lakshmi P Dasi
- Department of Biomedical Engineering, Dorothy Davis Heart and Lung Research Institute, The Ohio State University, 473 W 12th Avenue, Columbus, OH, 43210, USA.
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Gonska B, Seeger J, Rodewald C, Scharnbeck D, Rottbauer W, Wöhrle J. Transfemoral valve-in-valve implantation for degenerated bioprosthetic aortic valves using the new balloon-expandable Edwards Sapien 3 valve. Catheter Cardiovasc Interv 2016; 88:636-643. [DOI: 10.1002/ccd.26565] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 03/28/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Birgid Gonska
- Department Of Internal Medicine II; University of Ulm; Ulm Germany
| | - Julia Seeger
- Department Of Internal Medicine II; University of Ulm; Ulm Germany
| | | | | | | | - Jochen Wöhrle
- Department Of Internal Medicine II; University of Ulm; Ulm Germany
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Soulami RB, Verhoye JP, Duc HN, Castro M, Auffret V, Anselmi A, Haigron P, Ruggieri VG. Computer-Assisted Transcatheter Heart Valve Implantation in Valve-in-Valve Procedures. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016. [DOI: 10.1177/155698451601100307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Réda Belhaj Soulami
- Department of Thoracic and Cardio-Vascular Surgery, Pontchaillou University Hospital, Rennes, France
- LTSI Laboratory, INSERM 1099U, Rennes 1 University, Rennes, France
| | - Jean-Philippe Verhoye
- Department of Thoracic and Cardio-Vascular Surgery, Pontchaillou University Hospital, Rennes, France
- LTSI Laboratory, INSERM 1099U, Rennes 1 University, Rennes, France
| | - Hung Nguyen Duc
- LTSI Laboratory, INSERM 1099U, Rennes 1 University, Rennes, France
| | - Miguel Castro
- LTSI Laboratory, INSERM 1099U, Rennes 1 University, Rennes, France
| | - Vincent Auffret
- LTSI Laboratory, INSERM 1099U, Rennes 1 University, Rennes, France
- Department of Cardiology, Pontchaillou University Hospital, Rennes, France
| | - Amedeo Anselmi
- Department of Thoracic and Cardio-Vascular Surgery, Pontchaillou University Hospital, Rennes, France
- LTSI Laboratory, INSERM 1099U, Rennes 1 University, Rennes, France
| | - Pascal Haigron
- LTSI Laboratory, INSERM 1099U, Rennes 1 University, Rennes, France
| | - Vito Giovanni Ruggieri
- Department of Thoracic and Cardio-Vascular Surgery, Pontchaillou University Hospital, Rennes, France
- LTSI Laboratory, INSERM 1099U, Rennes 1 University, Rennes, France
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Computer-Assisted Transcatheter Heart Valve Implantation in Valve-in-Valve Procedures. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016; 11:193-200. [DOI: 10.1097/imi.0000000000000259] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objective Valve-in-valve (ViV) procedures are increasingly being considered as an alternative to redo surgery for the treatment of degenerated bioprosthetic heart valves in patients with excessive reoperative risk. The objective of our study was to evaluate the feasibility of computer guidance in transcatheter heart valve (THV) implantation during ViV procedures. Methods Preprocedural electrocardiogram-gated computed tomography–scan images were processed using semiautomatic segmentation of the degenerated bioprosthesis’ radiopaque landmarks and of the ascending aorta. Virtual three-dimensional (3D) reconstructions were created. A virtual plane was subsequently added to the 3D reconstructions, indicating the optimal landing plane of the THV inside the tissue valve. Within a hybrid operating theater, a 3D/2D registration was used to superimpose the 3D reconstructions, while dynamic tracking was allowed to maintain the superimposition onto the fluoroscopic images. The THV was afterward implanted according to the optimal landing plane. Projection of the ascending aorta and the coronary arteries was used to assess the risk of coronary ostia obstruction. Results Between January 2014 and October 2014, nine patients underwent aortic ViV procedures in our institution. Among those nine patients, five procedures were retrospectively evaluated as a validation step using the proposed method. The mean (SD) superimposition error was 1.1 (0.75) mm. Subsequently, two live cases were prospectively carried out using our approach, successfully implanting the THV inside the degenerated tissue valve. Conclusions Our study demonstrates the feasibility of a computer-guided implantation of THV in ViV procedures. Moreover, it suggests that augmented reality may increase the reliability of THV implantation inside degenerated bioprostheses through better reproducibility.
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Choudhary SK, Talwar S, Airan B. Choice of prosthetic heart valve in a developing country. HEART ASIA 2016; 8:65-72. [PMID: 27326237 PMCID: PMC4898620 DOI: 10.1136/heartasia-2015-010650] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 03/29/2016] [Accepted: 03/30/2016] [Indexed: 11/04/2022]
Abstract
Mechanical prostheses and stented xenografts (bioprosthesis) are most commonly used substitutes for aortic and mitral valve replacement. The mechanical valves have the advantage of durability but are accompanied with the risk of thromboembolism, problems of long-term anticoagulation, and associated risk of bleeding. In contrast, bioprosthetic valves do not require long-term anticoagulation, but carry the risk of structural valve degeneration and re-operation. A mechanical valve is favoured in young patients (<40 years) if reliable anticoagulation is ensured. In elderly patients (>60 years), a bioprosthesis is a suitable substitute. In middle-aged patients (40-60 years), risk of re-operation in a bioprosthesis is equal to that of bleeding in a mechanical valve. Traditionally, a bioprosthesis is opted in patients with limited life expectancy. Calculation of life expectancy, based solely upon chronological age, is erroneous. In developing countries, the calculated life expectancy is much lower than that of Western population, hence age related Western cut-offs are not valid in developing countries. Besides age, cardiac condition of the patient, systemic illnesses, socio-economic status, gender and geographical location also decide the life expectancy of the patients. Selection of the prosthetic valve substitute should be based on: aspiration of the patient, life expectancy, socio-economic and educational background, occupation of the patient, availability, cost, monitoring of anti-coagulation, monitoring of valve function and other valve related complications, and possibility of re-operation.
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Affiliation(s)
- Shiv Kumar Choudhary
- Cardiothoracic Centre, All India Institute of Medical Sciences , New Delhi , India
| | - Sachin Talwar
- Cardiothoracic Centre, All India Institute of Medical Sciences , New Delhi , India
| | - Balram Airan
- Cardiothoracic Centre, All India Institute of Medical Sciences , New Delhi , India
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Nielsen PH, Hjortdal V, Modrau IS, Jensen H, Kimose HH, Terp K, Poulsen SH, Smerup M, Nielsen SL. Durability after aortic valve replacement with the Mitroflow versus the Perimount pericardial bioprosthesis: a single-centre experience in 2393 patients. Eur J Cardiothorac Surg 2016; 49:1705-10. [PMID: 26984983 DOI: 10.1093/ejcts/ezv432] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 11/12/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study compares the durability and risk of reoperation in patients undergoing aortic valve replacement (AVR) with either a Mitroflow or a Carpentier-Edwards (CE) pericardial bioprosthesis. Since AVR with bioprosthetic valves has increased progressively in recent years as compared to mechanical valves, especially in patients aged 60-70 years, there has been renewed interest in the long-term durability of current pericardial bioprostheses. METHODS We compared 440 AVR with Mitroflow valves with 1953 AVR with CE pericardial valves implanted from 1999 to 2014 with regard to reoperation, reoperation for structural valve deterioration (SVD) and all-cause mortality. RESULTS Ten-year freedom from explant of any cause was higher for CE Perimount (98 ± 0.7%) than for Mitroflow (95 ± 1.4%, P < 0.01). Reasons for explant for CE Perimount were SVD (n = 2), endocarditis (n = 8) and paraprosthetic leak (n = 10). The reasons for explant for Mitroflow were SVD (n = 11), endocarditis (n = 3) SVD and pericarditis (n = 1) and paraprosthetic leak (n = 2). Ten-year freedom from explant due to SVD was higher for CE Perimount (100%) than for Mitroflow (96%) (P < 0.01). In small aortic annuli (bioprosthesis size 19-21 mm), freedom from SVD at 10 years for CE Perimount and Mitroflow was 100 versus 96%, respectively. By multivariate analysis, it was found that bioprosthesis size was not a risk factor for SVD. The choice of valve type could not be demonstrated to influence long-term survival. CONCLUSIONS The Mitroflow pericardial bioprosthesis provides less than optimal mid- and long-term durability compared with the CE Perimount pericardial valve, especially for small aortic diameter implants (19 and 21 mm). This study hereby confirms the existence of a real risk of valvular deterioration of the Mitroflow valve that might compromise the prognosis of the patients.
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Affiliation(s)
- Per Hostrup Nielsen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Vibeke Hjortdal
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Ivy Susanne Modrau
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Jensen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Hans-Henrik Kimose
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Kim Terp
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Steen Hvitfelt Poulsen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Smerup
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Sten Lyager Nielsen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
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Al Mosa AF, Omair A, Arifi AA, Najm HK. Mitral valve replacement for mitral stenosis: A 15-year single center experience. J Saudi Heart Assoc 2016; 28:232-8. [PMID: 27688670 PMCID: PMC5034490 DOI: 10.1016/j.jsha.2016.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 02/02/2016] [Accepted: 02/11/2016] [Indexed: 11/25/2022] Open
Abstract
Objectives Mitral valve replacement with either a bioprosthetic or a mechanical valve is the treatment of choice for severe mitral stenosis. However, choosing a valve implant type is still a subject of debate. This study aimed to evaluate and compare the early and late outcomes of mitral valve replacement [mechanical (MMV) vs. bioprosthetic (BMV)] for severe mitral stenosis. Methods A retrospective cohort study was performed on data involving mitral stenosis patients who have undergone mitral valve replacement with either BMV (n = 50) or MMV (n = 145) valves from 1999 to 2012. Data were collected from the patients’ records and follow-up through telephone calls. Data were analyzed for early and late mortality, New York Heart Association (NYHA) functional classes, stroke, pre- and postoperative echocardiographic findings, early and late valve-related complications, and survival. Chi-square test, logistic regression, Kaplan–Meier curve, and dependent proportions tests were some of the tests employed in the analysis. Results A total of 195 patients were included in the study with a 30-day follow-up echocardiogram available for 190 patients (97.5%), while 103 (53%) were available for follow-up over the telephone. One patient died early postoperatively; twelve patients died late in the postoperative period, six in the bioprosthesis group and six in the mechanical group. The late mortality had a significant association with postoperative stroke (p < 0.001) and postoperative NYHA Classes III and IV (p = 0.002). Postoperative NYHA class was significantly associated with age (p = 0.003), pulmonary disease (p = 0.02), mitral valve implant type (p = 0.01), and postoperative stroke (p = 0.02); 14 patients had strokes in the mechanical (9) and in the bioprosthetic (5) groups. NYHA classes were significantly better after the replacement surgeries (p < 0.001). BMV were significantly associated with worse survival (p = 0.03), worse NYHA postoperatively (p = 0.01), and more reoperations (p = 0.006). Survival was significantly better with MMV (p = 0.03). When the two groups were matched for age and mitral regurgitation, the analysis revealed that BMV were significantly associated with reoperations (p = 0.02) but not significantly associated with worse survival (p = 0.4) or worse NYHA (p = 0.4). Conclusion MMV replacement in mitral stenosis patients is associated with a lower reoperation rate, but there was no difference in survival compared with BMV replacement.
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Affiliation(s)
- Alqasem F. Al Mosa
- King Saud bin Abdulaziz University for Health Sciences, College of Medicine, Riyadh, aSaudi Arabia
| | - Aamir Omair
- King Saud bin Abdulaziz University for Health Sciences, Medical Education, Riyadh, bSaudi Arabia
| | - Ahmed A. Arifi
- Cardiac Clinical Research, Cardiac Surgery, Cardiac Sciences, King Abdulaziz Cardiac Center, Ministry of National Guard, Riyadh, cSaudi Arabia
| | - Hani K. Najm
- Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave/M41, Cleveland, Ohio, 44195, dUnited States
- Corresponding author at: Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave/M41, Cleveland, Ohio, 44195, United States.Heart and Vascular InstituteCleveland Clinic9500 Euclid Ave/M41ClevelandOhio44195United States
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Loor G, Schuster A, Cruz V, Rafael A, Stewart WJ, Diaz J, McCurry K. The Carpentier-Edwards Perimount Magna mitral valve bioprosthesis: intermediate-term efficacy and durability. J Cardiothorac Surg 2016; 11:20. [PMID: 26818795 PMCID: PMC4728780 DOI: 10.1186/s13019-016-0412-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 01/12/2016] [Indexed: 11/17/2022] Open
Abstract
Background The Carpentier-Edwards Perimount Magna mitral valve bioprosthesis (Edwards Lifesciences, Irvine, CA) is a low-profile version of the earlier Perimount valve that uses the ThermaFix process for enhanced calcium removal. The Magna valve has been in use since 2008, yet no publication, until now, has verified its intermediate-term safety and efficacy. Methods From 2008 through 2011 (our 4-year study period), 70 Magna valves were implanted in the mitral position at a single institution (the Cleveland Clinic). Echocardiograms were prospectively interpreted. For this study, we reviewed patients’ charts; endpoints included hemodynamic measurements, in-hospital morbidity and mortality, valve-related events, resource utilization, and 5-year survival rates. Results The mean patient age was 68 years; 43 % of the patients had New York Heart Association (NYHA) class III or IV disease, and 51.4 % had moderately severe, or worse, mitral regurgitation (MR). For 43 % of the patients, the Magna valve implantation was a reoperation. For 83 %, the Magna valve implantation also included a concomitant cardiac procedure. The median survival rate was 4.7 years and 90 % of patients were free from significant structural valve degeneration at 5 years. Preoperative atrial fibrillation, ischemic MR, intraaortic balloon pump placement, cardiogenic shock, cardiac arrest, and renal failure were associated with increased mortality. Right ventricular systolic pressure decreased from 50 mmHg preoperatively to 40 mmHg postoperatively, according to our matched-pair analysis (P = 0.003). Per their final echocardiogram during our study period, 98 % of surviving patients had trivial or no MR, one patient had mild MR, and one patient had severe MR. Conclusions Our 5-year experience indicates that the Magna valve offers excellent intermediate-term durability and substantial echocardiographic improvement; its low-profile design make it ideal for reoperations and for concomitant cardiac procedures, including valve replacement.
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Affiliation(s)
- Gabriel Loor
- Department of Cardiothoracic Surgery, University of Minnesota, 420 Delaware Street SE, MMC 207, Minneapolis, MN, 55455, USA.
| | | | - Vincent Cruz
- Lerner College of Medicine, Cleveland Clinic, Cleveland, USA
| | - Aldo Rafael
- Department of Cardiac Surgery, Baylor University Medical Center, Dallas, USA
| | | | - James Diaz
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, USA
| | - Kenneth McCurry
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, USA
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Multidetector computed tomography sizing of bioprosthetic valves: guidelines for measurement and implications for valve-in-valve therapies. Clin Radiol 2016; 71:e41-8. [DOI: 10.1016/j.crad.2015.10.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 06/30/2015] [Accepted: 10/14/2015] [Indexed: 11/20/2022]
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Etnel JR, Elmont LC, Ertekin E, Mokhles MM, Heuvelman HJ, Roos-Hesselink JW, de Jong PL, Helbing WA, Bogers AJ, Takkenberg JJ. Outcome after aortic valve replacement in children: A systematic review and meta-analysis. J Thorac Cardiovasc Surg 2016; 151:143-52.e1-3. [DOI: 10.1016/j.jtcvs.2015.09.083] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 08/18/2015] [Accepted: 09/15/2015] [Indexed: 10/23/2022]
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Tada N, Enta Y, Sakurai M, Ootomo T, Hata M. Transcatheter valve-in-valve implantation for failed mitral prosthesis: the first experience in Japan. Cardiovasc Interv Ther 2015; 32:82-86. [PMID: 26711631 DOI: 10.1007/s12928-015-0374-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 12/13/2015] [Indexed: 11/27/2022]
Abstract
An 82-year-old woman had a history of mitral valve replacement with a 25-mm MOSAIC (Medtronic, USA) for severe mitral regurgitation (MR) 8 years previously. Recently, she developed heart failure due to MR secondary to prosthetic valve failure. She underwent transcatheter valve-in-valve implantation with a 23-mm SAPIEN XT (Edwards Lifesciences, USA) to the prosthetic mitral valve by transapical approach. To our knowledge, this is the first reported case of transcatheter valve implantation for failed mitral prosthetic valve using valve-in-valve technique in Japan.
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Affiliation(s)
- Norio Tada
- Department of Cardiology, Sendai Kousei Hospital, 4-15 Hirosemachi, Aoba, Sendai, Miyagi, 980-0873, Japan.
| | - Yusuke Enta
- Department of Cardiology, Sendai Kousei Hospital, 4-15 Hirosemachi, Aoba, Sendai, Miyagi, 980-0873, Japan
| | - Mie Sakurai
- Department of Cardiology, Sendai Kousei Hospital, 4-15 Hirosemachi, Aoba, Sendai, Miyagi, 980-0873, Japan
| | - Tatsushi Ootomo
- Department of Cardiology, Sendai Kousei Hospital, 4-15 Hirosemachi, Aoba, Sendai, Miyagi, 980-0873, Japan
| | - Masaki Hata
- Department of Cardiovascular Surgery, Sendai Kousei Hospital, 4-15 Hirosemachi, Aoba, Sendai, Miyagi, 980-0873, Japan
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Wang Y, Chen S, Shi J, Li G, Dong N. Mid- to long-term outcome comparison of the Medtronic Hancock II and bi-leaflet mechanical aortic valve replacement in patients younger than 60 years of age: a propensity-matched analysis. Interact Cardiovasc Thorac Surg 2015; 22:280-6. [PMID: 26675564 DOI: 10.1093/icvts/ivv347] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 11/06/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study aims to compare mid-long-term clinical outcomes between patients younger than 60 years of age undergoing bioprosthetic and mechanical aortic valve replacement. METHODS From January 2002 to December 2009, patients younger than 60 years of age who received Medtronic Hancock II porcine bioprostheses were selected and compared with those who received mechanical bi-leaflet valves in the aortic position. A stepwise logistic regression propensity score identified a subset of 112 evenly matched patient-pairs. Mid-long-term outcomes of survival, valve-related reoperations, thromboembolic events and bleeding events were assessed. RESULTS The follow-up was only 95.1% complete. Fourteen measurable variables were statistically similar for the matched cohort. Postoperative in-hospital mortality was 3.6% (bioprosthetic valves) and 2.7% (mechanical valves) (P = 0.700). Survival at 5 and 10 years was 96.3 and 88.7% for patients receiving bioprosthetic valve replacement versus 96.3 and 87.9% for patients receiving mechanical valve replacement (P = 0.860), respectively. At 5 and 10 years after operations, freedom from valve-related reoperation was 97.2 and 94.8% for patients receiving mechanical valve replacement, and 96.3 and 90.2% for patients receiving bioprosthetic valve replacement (P = 0.296), respectively. There was no difference between freedom from thromboembolic events (P = 0.528) and bleeding events (P = 0.128) between the matched groups during the postoperative 10 years. CONCLUSIONS In patients younger than 60 years of age undergoing aortic valve replacement, mid-long-term survival rate was similar for patients receiving bioprosthetic versus mechanical valve replacement. Bioprosthetic valves were associated with a trend for a lower risk of anticoagulation treatment and did not have significantly greater likelihood of a reoperation. These findings suggest that a bioprosthetic valve may be a reasonable choice for AVR in patients younger than 60 years of age.
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Affiliation(s)
- Yin Wang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Si Chen
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiawei Shi
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Geng Li
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Glaser N, Jackson V, Holzmann MJ, Franco-Cereceda A, Sartipy U. Aortic valve replacement with mechanical vs. biological prostheses in patients aged 50–69 years. Eur Heart J 2015; 37:2658-67. [DOI: 10.1093/eurheartj/ehv580] [Citation(s) in RCA: 158] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 10/07/2015] [Indexed: 11/13/2022] Open
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Transcatheter Valve Implantation in Failed Surgically Inserted Bioprosthesis. JACC Cardiovasc Imaging 2015; 8:960-79. [DOI: 10.1016/j.jcmg.2015.01.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 01/29/2015] [Accepted: 01/29/2015] [Indexed: 12/15/2022]
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Korteland NM, Bras FJ, van Hout FMA, Kluin J, Klautz RJM, Bogers AJJC, Takkenberg JJM. Prosthetic aortic valve selection: current patient experience, preferences and knowledge. Open Heart 2015; 2:e000237. [PMID: 25893105 PMCID: PMC4395830 DOI: 10.1136/openhrt-2015-000237] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 03/10/2015] [Accepted: 03/17/2015] [Indexed: 11/30/2022] Open
Abstract
Objective Current clinical practice guidelines advocate shared decision-making (SDM) in prosthetic valve selection. This study assesses among adult patients accepted for aortic valve replacement (AVR): (1) experience with current clinical decision-making regarding prosthetic valve selection, (2) preferences for SDM and risk presentation and (3) prosthetic valve knowledge and numeracy. Methods In a prospective multicentre cohort study, AVR patients were surveyed preoperatively and 3 months postoperatively. Results 132 patients (89 males/43 females; mean age 67 years (range 23–86)) responded preoperatively. Decisional conflict was observed in 56% of patients, and in 25% to such an extent that it made them feel unsure about the decision. 68% wanted to be involved in decision-making, whereas 53% agreed that they actually were. 69% were able to answer three basic knowledge questions concerning prosthetic valves correctly. 56% were able to answer three basic numeracy questions correctly. Three months postsurgery, 90% (n=110) were satisfied with their aortic valve prosthesis, with no difference between mechanical and bioprosthetic valve recipients. Conclusions In current clinical practice, many AVR patients experience decisional conflict and suboptimal involvement in prosthetic valve selection, and exhibit impaired knowledge concerning prosthetic valves and numeracy. Given the broad support for SDM among AVR patients and the obvious need for understandable information, to-be-developed tools to support SDM in the setting of prosthetic valve selection will help to improve quality of decision-making, better inform and actively involve patients, and reduce decisional conflict. Trial registration number NTR3618.
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Affiliation(s)
- Nelleke M Korteland
- Department of Cardio-Thoracic Surgery , Erasmus MC , Rotterdam , The Netherlands
| | - Frans J Bras
- Department of Cardio-Thoracic Surgery , UMC Utrecht , Utrecht , The Netherlands
| | | | - Jolanda Kluin
- Department of Cardio-Thoracic Surgery , UMC Utrecht , Utrecht , The Netherlands
| | - Robert J M Klautz
- Department of Cardio-Thoracic Surgery , LUMC , Leiden , The Netherlands
| | - Ad J J C Bogers
- Department of Cardio-Thoracic Surgery , Erasmus MC , Rotterdam , The Netherlands
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