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Lérault A, Villecourt A, Decottignies-Dienne T, Tassan-Mangina S, Heroguelle V, Di Cesare A, Rubin S, Ruggieri VG, Metz D, Faroux L. Catheter versus surgical approach for the management of concomitant aortic stenosis and coronary artery disease: An inverse probability treatment weighting analysis. Arch Cardiovasc Dis 2023; 116:117-125. [PMID: 36702719 DOI: 10.1016/j.acvd.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Two therapeutic strategies are available when aortic stenosis and coronary artery disease coexist: a transcatheter approach, with percutaneous coronary intervention followed by transcatheter aortic valve replacement; and a surgical approach, consisting of surgical aortic valve replacement combined with coronary artery bypass graft. AIM We sought to compare the outcomes of these two strategies. METHODS The study population consisted of 241 patients who benefited from aortic valve replacement and coronary revascularization (transcatheter, n=150; surgery, n=91). RESULTS Patients in the transcatheter population were older (83.5 vs. 71.8years; P<0.001) and had a higher Logistic EuroSCORE (11.1% vs. 5.7%; P<0.001). At 30days postprocedure, patients who had surgery exhibited more life-threatening bleedings (12.1% vs 4.5%; P=0.034), acute kidney injury (12.1% vs. 1.3%; P<0.001) and atrial fibrillation (55.6% vs. 8.7%; P<0.001). After a median follow-up of 27months, the risk of major adverse cardiovascular or cerebrovascular events did not differ significantly between the two strategies (hazard ratio [HR] 1.41, 95% confidence interval [CI] 0.97-2.04; P=0.07), whereas estimated glomerular filtration rate<60mL/min (HR 2.22, 95% CI 1.58-3.12; P<0.001), peripheral artery disease (HR 2.00, 95% CI 1.37-2.91; P<0.001) and left ventricular ejection fraction<50% (HR 1.69, 95% CI 1.12-2.55; P=0.012) were associated with a negative prognosis. CONCLUSIONS In our study, patients with aortic stenosis and coronary artery disease treated by catheter were older and had a higher co-morbidity burden than those treated by surgery. The surgical strategy was associated with a higher rate of 30-day complications, but long-term outcomes were similar between the two strategies.
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Affiliation(s)
- Adèle Lérault
- Department of Cardiology, Reims University Hospital, 51092 Reims, France
| | | | | | | | | | | | - Sylvain Rubin
- Cardiac Surgery Department, Reims University Hospital, 51092 Reims, France
| | | | - Damien Metz
- Department of Cardiology, Reims University Hospital, 51092 Reims, France
| | - Laurent Faroux
- Department of Cardiology, Reims University Hospital, 51092 Reims, France; EA3801 HERVI, SFR CAP Santé, University of Reims Champagne Ardenne, 51100 Reims, France.
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Perrotti A, Francica A, Monaco F, Quintana E, Sponga S, El-Dean Z, Salizzoni S, Loizzo T, Salsano A, Di Cesare A, Benassi F, Castella M, Rinaldi M, Chocron S, Vendramin I, Faggian G, Santini F, Nicolini F, Milano AD, Ruggieri VG, Onorati F. Post-operative Quality of Life after Full-sternotomy and Mini-sternotomy Aortic Valve Replacement. Ann Thorac Surg 2021; 115:1189-1196. [PMID: 34971595 DOI: 10.1016/j.athoracsur.2021.11.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 10/16/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Few longitudinal data exist comparing quality of life (QoL) after full sternotomy aortic valve replacement (fsAVR) vs mini-sternotomy AVR (msAVR) METHODS: 1844 consecutive AVR prospectively enrolled in a European multicentre Registry were dichotomized according to surgical access. A non-parsimonious propensity-score matching selected 187 pairs of fsAVR or msAVR with comparable baseline characteristics. Hospital outcome was compared in the two groups. QoL was assessed with Short Form-36, further detailed in its Physical Component Score (PCS) and Mental Component Score (MCS). QoL was investigated at hospital admission, discharge, 1 month, 6 months and 1 year thereafter. RESULTS There were 1654 fsAVR and 190 msAVR in the entire population. fsAVR showed a worse preoperative risk-profile, a longer ICU length of stay (59.7 hours vs 38.8, p=0.002), and a higher life-threatening/disabling bleeding (4.1% vs. 0%; p=0.011); msAVR reported a higher early reintervention for failed index intervention (2.1% vs. 0.5%, p=0.001). QoL showed better PCS and MCS at 1 month after fsAVR, but no temporal-trend differences (PCS group-time p=0.202; MCS group-time p=0.141). Propensity-matched pairs showed comparable baseline characteristics and hospital outcome (p=NS for all endpoints), and comparable improvements of PCS and MCS over time, but no between-group differences over time (PCS group-time p=0.834; MCS group-time p=0.737). CONCLUSIONS Patients with similar baseline profiles report comparable hospital outcome and comparable improvement of physical and mental health, up to 1 year after surgery, with both fsAVR and msAVR. As for QoL, mini-sternotomy does not seem to offer any advantage compared to the traditional approach.
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Affiliation(s)
- Andrea Perrotti
- Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, Besancon, France
| | - Alessandra Francica
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
| | - Francesco Monaco
- Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, Besancon, France
| | - Edward Quintana
- Division of Cardiac Surgery, Hospital Clinic, University of Barcelona Medical School, Barcelona, Spain
| | - Sandro Sponga
- Division of Cardiac Surgery, Azienda Ospedaliero Universitaria di Udine, Udine, Italy
| | - Zein El-Dean
- Department of Cardiac Surgery, Glenfield Hospital, University Hospitals of Leicester, Leicester, United Kingdom
| | - Stefano Salizzoni
- Department of Cardiac Surgery, Città della Salute e della Scienza, University of Turin Medical School, Turin, Italy
| | - Tommaso Loizzo
- Cardiac Surgery Unit, Department of Emergency and Organ Transplants, Bari, Italy
| | - Antonio Salsano
- Division of Cardiac Surgery, IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Alessandro Di Cesare
- Cardiovascular and Thoracic Surgery Unit, Robert Debre University Hospital, Reims, France; Université de Reims Champagne-Ardennes, Reims, France
| | - Filippo Benassi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Manuel Castella
- Division of Cardiac Surgery, Hospital Clinic, University of Barcelona Medical School, Barcelona, Spain
| | - Mauro Rinaldi
- Department of Cardiac Surgery, Città della Salute e della Scienza, University of Turin Medical School, Turin, Italy
| | - Sidney Chocron
- Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, Besancon, France
| | - Igor Vendramin
- Division of Cardiac Surgery, Azienda Ospedaliero Universitaria di Udine, Udine, Italy
| | - Giuseppe Faggian
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy
| | - Francesco Santini
- Division of Cardiac Surgery, IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | | | - Aldo Domenico Milano
- Cardiac Surgery Unit, Department of Emergency and Organ Transplants, Bari, Italy
| | - Vito Giovanni Ruggieri
- Cardiovascular and Thoracic Surgery Unit, Robert Debre University Hospital, Reims, France; Université de Reims Champagne-Ardennes, Reims, France
| | - Francesco Onorati
- Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy.
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Onorati F, Quintana E, El-Dean Z, Perrotti A, Sponga S, Ruggieri VG, Rinaldi M, Milano AD, Santini F, Chocron S, Livi U, Salizzoni S, Loizzo T, Salsano A, Di Cesare A, Faggian G, Castella M, Nicolini F. Aortic Valve Replacement for Aortic Stenosis in Low-, Intermediate-, and High-Risk Patients: Preliminary Results From a Prospective Multicenter Registry. J Cardiothorac Vasc Anesth 2020; 34:2091-2099. [DOI: 10.1053/j.jvca.2020.02.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/20/2020] [Accepted: 02/24/2020] [Indexed: 12/15/2022]
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Overtchouk P, Folliguet T, Pinaud F, Fouquet O, Pernot M, Bonnet G, Hubert M, Lapeze J, Claudel JP, Ghostine S, Azmoun A, Caussin C, Zannis K, Harmouche M, Verhoye JP, Lafont A, Chamandi C, Ruggieri VG, Di Cesare A, Leclercq F, Gandet T, Modine T. Transcarotid Approach for Transcatheter Aortic Valve Replacement With the Sapien 3 Prosthesis. JACC Cardiovasc Interv 2019; 12:413-419. [DOI: 10.1016/j.jcin.2018.11.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 11/09/2018] [Accepted: 11/13/2018] [Indexed: 10/27/2022]
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Bruno P, Di Cesare A, Nesta M, Cammertoni F, Mazza A, Paraggio L, Rosenhek R, Burzotta F, Crea F, Trani C, Massetti M. Rapid-deployment or transcatheter aortic valves in intermediate-risk patients? Asian Cardiovasc Thorac Ann 2017; 25:264-270. [PMID: 28361580 DOI: 10.1177/0218492317704773] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background Transcatheter aortic valve implantation and rapid-deployment aortic valve replacement represent two emerging therapies for patients with intermediate surgical risk and severe aortic stenosis. However, head-to-head comparisons between such novel therapies are lacking. Methods Severe aortic stenosis patients with intermediate surgical risk treated with rapid-deployment valve replacement at our institution were identified and compared with a propensity-matched population of patients who underwent transcatheter aortic valve replacement. Postoperative echocardiographic findings, in-hospital and midterm clinical outcomes were compared. Results We identified 60 patients who received transcatheter ( n = 30) or rapid-deployment ( n = 30) valve replacement. On postoperative echocardiography, freedom from paravalvular regurgitation was higher in the rapid-deployment valve group ( p < 0.001), while postoperative mean transprosthetic gradient was lower in the transcatheter valve group ( p = 0.03). Permanent pacemaker implantation was required more frequently in transcatheter valve patients ( p = 0.01). Postoperative atrial fibrillation was more common in the rapid-deployment valve group ( p = 0.03). Hospital mortality was similarly low in both groups ( p = 0.33). At midterm follow-up, mortality was comparable ( p = 0.42) but the rapid-deployment valve group still had a lower degree of paravalvular regurgitation. Conclusions Transcatheter and rapid-deployment valve replacement are promising treatment options for patients with intermediate surgical risk. These two techniques are associated with specific patterns of prosthesis function and postoperative complications. Further evaluation of the clinical impact of these therapies in this patient population is needed.
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Affiliation(s)
- Piergiorgio Bruno
- 1 Department of Cardiovascular Sciences, A. Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy
| | - Alessandro Di Cesare
- 1 Department of Cardiovascular Sciences, A. Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy
| | - Marialisa Nesta
- 1 Department of Cardiovascular Sciences, A. Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy
| | - Federico Cammertoni
- 1 Department of Cardiovascular Sciences, A. Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy
| | - Andrea Mazza
- 1 Department of Cardiovascular Sciences, A. Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy
| | - Lazzaro Paraggio
- 1 Department of Cardiovascular Sciences, A. Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy
| | - Raphael Rosenhek
- 2 Department of Cardiology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Francesco Burzotta
- 1 Department of Cardiovascular Sciences, A. Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy
| | - Filippo Crea
- 1 Department of Cardiovascular Sciences, A. Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy
| | - Carlo Trani
- 1 Department of Cardiovascular Sciences, A. Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy
| | - Massimo Massetti
- 1 Department of Cardiovascular Sciences, A. Gemelli Hospital, Catholic University of Sacred Heart, Rome, Italy
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Bruno P, Farina P, Cammertoni F, Biondi R, Perri G, Di Cesare A, Crea F, Massetti M. Mini-aortic surgery with percutaneous cannulation and rapid-deployment valve. Asian Cardiovasc Thorac Ann 2016; 24:535-40. [DOI: 10.1177/0218492316654774] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background We aimed to evaluate the results of the combined use of rapid-deployment valves, percutaneous cardioplegia delivery and left heart venting during minimally invasive aortic valve replacement surgery. Methods We identified 2 propensity-matched cohorts of patients who underwent primary elective isolated minimally invasive aortic valve surgery at our center over a 3-years period: 30 patients in group A had a conventional valve prosthesis and 30 patients in group B received a rapid-deployment valve using percutaneous cardioplegia delivery and percutaneous left heart venting. Skin incision length, intraoperative times, postoperative hospital outcomes, and 30-day echocardiographic results were compared between the 2 groups. Results Patients in group B had significantly shorter operative times and shorter skin incisions compared to group A (total operative time 196.0 ± 40.6 vs. 225.1 ± 30.8 min, respectively, p < 0.003; cardiopulmonary bypass time 79.9 ± 10.6 vs. 92.9 ± 17.2 min respectively, p < 0.001; crossclamp time 52.3 ± 9.6 vs. 74.9 ± 10.2 min, respectively, p < 0.001; incision length 3.6 ± 0.5 vs. 6.0 ± 0.6 cm, respectively, p < 0.001). Postoperative hospital outcomes and echocardiographic evaluation showed no significant differences. Conclusions The combined use of rapid-deployment valves, percutaneous cardioplegia, and left heart venting is safe and effective and allows a significant reduction of the skin incision together with a significant reduction of intraoperative times without affecting hospital outcomes or hemodynamic performance of the prosthetic valves.
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Affiliation(s)
- Piergiorgio Bruno
- Department of Cardiovascular Sciences, Catholic University, Rome, Italy
| | - Piero Farina
- Department of Cardiovascular Sciences, Catholic University, Rome, Italy
| | | | - Raoul Biondi
- Department of Cardiovascular Sciences, Catholic University, Rome, Italy
| | - Gianluigi Perri
- Department of Cardiovascular Sciences, Catholic University, Rome, Italy
| | | | - Filippo Crea
- Department of Cardiovascular Sciences, Catholic University, Rome, Italy
| | - Massimo Massetti
- Department of Cardiovascular Sciences, Catholic University, Rome, Italy
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