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Pardo González L, Ruiz-Ortiz M, Delgado M, Rodriguez S, Villalba R, Merino C, Casares J, Mesa D, Suárez de Lezo J, Pan M. Ross procedure: valve function, clinical outcomes and predictors after 25 years' follow-up. Curr Probl Cardiol 2024; 49:102410. [PMID: 38266692 DOI: 10.1016/j.cpcardiol.2024.102410] [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] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 01/14/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE To describe long-term outcomes of the Ross procedure in a single center and retrospective series after 25 years follow-up. METHODS From 1997-2019 we included all consecutive patients who underwent Ross procedure at our center. Clinical and echocardiographic evaluations were performed at least yearly. Echocardiographic valvular impairment was defined as at least moderate autograft or homograft dysfunction. Reintervention outcomes included surgical and percutaneous approach. RESULTS 151 Ross procedures were performed (mean age 28±12years, 21 %<16years, 70 %male). After 25 years follow-up (median 18 years, interquartile range 9-21, only 3 patients lost) 12 patients died (8 %); Autograft, homograft or any valve dysfunction were present in 38(26 %), 48(32 %) and 75(51 %), respectively; and reintervention in 22(15%), 17(11%) and 38(26 %) respectively. At 20 years of follow-up, probabilities of survival free from autograft, homograft or any valve dysfunction were 63 %, 60 % and 35 %; and from reintervention, 80 %, 85 % and 67 %, respectively. The learning curve period (first 12 cases) was independently associated to autograft dysfunction (HR 2.78, 95 %CI:1.18-6.53, p = 0.02) and reintervention (HR 3.76, 95 %CI: 1.46-9.70, p = 0.006). Larger native pulmonary diameter was also an independent predictor of autograft reintervention (HR 1.22, 95 %CI:1.03-1.45, p = 0.03). Homograft dysfunction was associated with younger age (HR 5.35, 95 %CI: 2.13-13.47, p<0.001) and homograft reintervention, with higher left ventricle ejection fraction (HR 1,10, 95 %CI:1.02-1.19, p<0.02). CONCLUSIONS In this 25 years' experience after the Ross procedure, global survival was high, although autograft and homograft dysfunction and reintervention rates were not negligible. Clinical and echocardiographic variables can identify patients with higher risk of events in follow up.
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Affiliation(s)
| | - Martín Ruiz-Ortiz
- Department of Cardiology, Reina Sofia University Hospital, Córdoba, Spain; Maimónides Institute for Biomedical Research of Córdoba (IMIBIC), Córdoba, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV). Spain.
| | - Mónica Delgado
- Department of Cardiology, Reina Sofia University Hospital, Córdoba, Spain; Maimónides Institute for Biomedical Research of Córdoba (IMIBIC), Córdoba, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV). Spain
| | - Sara Rodriguez
- Department of Cardiology, Reina Sofia University Hospital, Córdoba, Spain
| | - Rafael Villalba
- Regional Blood Transfusion Centre and Tissue Bank, Córdoba, Spain
| | - Carlos Merino
- Department of Cardiovascular Surgery, Reina Sofia University Hospital, Córdoba, Spain
| | - Jaime Casares
- Department of Cardiovascular Surgery, Reina Sofia University Hospital, Córdoba, Spain
| | - Dolores Mesa
- Department of Cardiology, Reina Sofia University Hospital, Córdoba, Spain; Maimónides Institute for Biomedical Research of Córdoba (IMIBIC), Córdoba, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV). Spain
| | | | - Manuel Pan
- Department of Cardiology, Reina Sofia University Hospital, Córdoba, Spain; Maimónides Institute for Biomedical Research of Córdoba (IMIBIC), Córdoba, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV). Spain
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Bolakale-Rufai IK, Shinnerl A, Knapp SM, Johnson AE, Mohammed S, Brewer L, Torabi A, Addison D, Mazimba S, Breathett K. Association between social vulnerability index and admission urgency for transcatheter aortic valve replacement. Am Heart J Plus 2024; 39:100370. [PMID: 38469116 PMCID: PMC10927260 DOI: 10.1016/j.ahjo.2024.100370] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 02/19/2024] [Indexed: 03/13/2024]
Abstract
Background Transcatheter aortic valve replacement (TAVR) are not offered equitably to vulnerable population groups. Adequate levels of insurance may narrow gaps among patients with higher social vulnerability index (SVI). Among a national population of individuals with commercial or Medicare insurance, we sought to determine whether SVI was associated with urgency of receipt of TAVR for aortic stenosis. Methods and results Using Optum's de-identified Clinformatics Data Mart Database (CDM), we identified admissions for TAVR with aortic stenosis between January 2018 and March 2022. Admission urgency was identified by CDM claims codes. SVI was cross-referenced to patient zip codes and grouped into quintiles. Generalized linear mixed effects models were used to predict the probability of a TAVR admission being urgent based on SVI quintiles, adjusting for patient and hospital-level covariates. Results Among 6680 admissions for TAVR [median age 80 years (interquartile range 75-85), 43.9 % female], 8.5 % (n = 567) were classified as urgent. After adjusting for patient and hospital-level variables, there were no significant differences in the odds of urgent admission for TAVR according to SVI quintiles [OR 5th (greatest social vulnerability) vs 1st quintile (least social vulnerability): 1.29 (95 % CI: 0.90-1.85)]. Conclusions Among commercial or Medicare beneficiaries with aortic stenosis, SVI was not associated with admission urgency for TAVR. To clarify whether cardiovascular care delivery is improved across SVI with higher paying beneficiaries, future investigation should identify whether relationships between SVI and TAVR urgency vary for Medicaid beneficiaries compared to commercial beneficiaries.
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Affiliation(s)
- Ikeoluwapo Kendra Bolakale-Rufai
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University, Indianapolis, IN, United States of America
| | - Alexander Shinnerl
- School of Medicine, Indiana University, Indianapolis, IN, United States of America
| | - Shannon M. Knapp
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University, Indianapolis, IN, United States of America
| | - Amber E. Johnson
- Division of Cardiovascular Medicine, University of Chicago, Chicago, IL, United States of America
| | - Selma Mohammed
- Division of Cardiovascular Medicine, Creighton University, Omaha, NE, United States of America
| | - LaPrincess Brewer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America
| | - Asad Torabi
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University, Indianapolis, IN, United States of America
| | - Daniel Addison
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, United States of America
| | - Sula Mazimba
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville and AdventHealth, Orlando, FL, United States of America
| | - Khadijah Breathett
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University, Indianapolis, IN, United States of America
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Bazire B, Para M, Raffoul R, Nataf P, Cachier A, Extramiana F, Iung B, Algalarrondo V. Prophylactic epicardial pacemaker implantation in tricuspid valve replacement. Eur J Cardiothorac Surg 2023; 64:ezad344. [PMID: 37843446 DOI: 10.1093/ejcts/ezad344] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 02/03/2023] [Revised: 09/25/2023] [Accepted: 10/15/2023] [Indexed: 10/17/2023] Open
Abstract
OBJECTIVES Patients undergoing surgical tricuspid valve replacement (TVR) are at high risk of atrioventricular conduction disorders. Because implanting a lead through the tricuspid bioprosthesis is discouraged, the patients who undergo TVR in our centre are usually given a prophylactic epicardial pacemaker. Our aim was to assess the benefits and risks of this strategy. METHODS Among the patients who underwent TVR with prophylactic epicardial pacemaker implantation, clinical evaluations and pacemaker reports were analysed retrospectively after surgery. The need for cardiac pacing were assessed by characterizing the atrioventricular conduction, while the risks were evaluated by listing and adjudicating post-operative events. RESULTS A total of 80 patients were analysed (mean age was 57 ± 16 years old, 30% males). TVR was isolated in 28 (35%) patients, but most often associated with another valve surgery. In the postoperative period, heart rhythm was analysed in 59/80 patients during a median follow-up of 35 months. Cardiac pacing was needed in 46% patients: 14% had complete pacing dependency, 17% had high degree AV block, while 15% had a high ventricular pacing rate (>80%). No pre- or per-operative variables could predict cardiac pacing requirement. Post-operatively, a spontaneous heart rate >70 bpm (P = 0.02) and the presence of narrow QRS (P = 0.03) were significantly associated with a lower risk of cardiac pacing requirement. Complications related to epicardial pacemaker were documented in 2 (2.5%) patients. CONCLUSIONS After TVR, cardiac pacing was needed in 46% of patients for post-operative atrioventricular conduction disorders. This high incidence associated with an acceptable safety profile supports a prophylactic epicardial pacing strategy for the patients undergoing TVR.
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Affiliation(s)
- Baptiste Bazire
- Service de Cardiologie, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
- Université de Paris Cité, Paris, France
| | - Marylou Para
- Université de Paris Cité, Paris, France
- Service de Chirurgie Cardiaque, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
| | - Richard Raffoul
- Service de Chirurgie Cardiaque, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
| | - Patrick Nataf
- Université de Paris Cité, Paris, France
- Service de Chirurgie Cardiaque, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
| | - Agnès Cachier
- Service de Cardiologie, Hôpital Beaujon, AP-HP, Clichy, France
| | - Fabrice Extramiana
- Service de Cardiologie, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
- Université de Paris Cité, Paris, France
| | - Bernard Iung
- Service de Cardiologie, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
- Université de Paris Cité, Paris, France
| | - Vincent Algalarrondo
- Service de Cardiologie, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
- Université de Paris Cité, Paris, France
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Lee KS, Kim HJ, Lee YS, Choi YJ, Yoon SM, Kim WY, Kim JH. Investigating preoperative myoglobin level as predictive factor for acute kidney injury following cardiac surgery with cardiopulmonary bypass: a retrospective observational study. Braz J Anesthesiol 2023; 73:775-781. [PMID: 34627830 PMCID: PMC10625156 DOI: 10.1016/j.bjane.2021.08.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 08/12/2021] [Accepted: 08/28/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Early identification of patients at risk of AKI after cardiac surgery is of critical importance for optimizing perioperative management and improving outcomes. This study aimed to identify the association between preoperative myoglobin levels and postoperative acute kidney injury (AKI) in patients undergoing valve surgery or coronary artery bypass graft surgery (CABG) with cardiopulmonary bypass. METHODS This retrospective study included 293 patients aged over 17 years who underwent valve surgery or CABG with cardiopulmonary bypass. We excluded 87 patients as they met the exclusion criteria. Therefore, 206 patients were included in the final analysis. The patients... demographics as well as intraoperative and postoperative data were collected from electronic medical records. AKI was defined according to the Acute Kidney Injury Network classification system. RESULTS Of the 206 patients included in this study, 77 developed AKI. The patients who developed AKI were older, had a history of hypertension, underwent valve surgery with concomitant CABG, had lower preoperative hemoglobin levels, and experienced prolonged extracorporeal circulation (ECC) times. Multivariate logistic regression analysis revealed that preoperative myoglobin levels and ECC time were correlated with the development of AKI. A higher preoperative myoglobin level was an independent risk factor for the development of cardiac surgery-associated AKI. CONCLUSIONS Higher preoperative myoglobin levels may enable physicians to identify patients at risk of developing AKI and optimize management accordingly.
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Affiliation(s)
- Kuen Su Lee
- Uijeongbu Eulji Medical Center, Eulji University School of Medicine
| | | | - Yoon Sook Lee
- Korea University Ansan Hospital, Ansan, South Korea.
| | - Yoon Ji Choi
- Korea University Ansan Hospital, Ansan, South Korea
| | | | | | - Jae Hwan Kim
- Korea University Ansan Hospital, Ansan, South Korea
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Bove T, Grootjans E, Naessens R, Martens T, De Wolf D, Vandekerckhove K, Panzer J, De Groote K, De Backer J, Demulier L, François K. Long-term follow-up of atrioventricular valve function in Fontan patients: effect of atrioventricular valve surgery. Eur J Cardiothorac Surg 2023; 64:ezad305. [PMID: 37682065 DOI: 10.1093/ejcts/ezad305] [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: 02/17/2023] [Revised: 08/23/2023] [Accepted: 09/06/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the relationship between atrioventricular valve and ventricular function in Fontan survivors, including the effect of atrioventricular valve surgery. METHODS Analysis focused on transplant-free survival and the need for atrioventricular valve surgery in single ventricle patients after Fontan completion. Longitudinal echocardiographic examination of long-term valve and ventricular function was performed. RESULTS Fontan completion was performed in 113 patients, having a right univentricular morphology in 33.6%, a left ventricle morphology in 62.8% and ambiguous in 3.6%. Perioperative mortality was 2.7% (n = 3). Within a median follow-up of 16.3 years (interquartile range 10.6-23.6), transplant-free survival was 96.1 ± 1.9% and 90.4 ± 5.8% at 10-25 years. Twenty AV valve procedures were performed in 14 (12.4%) children, respectively, pre-Fontan (n = 10), per-Fontan (n = 8) and post-Fontan (n = 2), resulting in a cumulative incidence of AV valve surgery is 5.7 ± 2.2% and 12.3 ± 3.2% at 1-5 years. Atrio-ventricular valve function deteriorated over time [hazard ratio (HR) 1.112, 95% confidence interval (CI) 1.089-1.138, P < 0.001], without difference for valve morphology (P = 0.736) or ventricular dominance (P = 0.484). AV valve dysfunction was greater in patients requiring AV valve surgery (HR 20.383, 95% CI 6.223-36.762, P < 0.001) but showed a comparable evolution since repair to those without valve surgery (HR 1.070, 95% CI 0.987-1.160, P = 0.099). Progressive time-related ventricular dysfunction was observed (HR 1.141, 95% CI 1.097-1.182, P < 0.001), significantly less in left ventricle-dominance (HR 0.927, 95% CI 0.860-0.999, P = 0.047) but more after AV valve surgery (HR 1.103, 95% CI 1.014-1.167, P = 0.022). CONCLUSIONS In a homogeneously treated Fontan population, 25-year transplant-free survival is encouraging. Atrio-ventricular valve surgery was necessary in 12.4%, resulting mostly in a durable valve function. However, a slow time-related decline of atrioventricular valve function as of ventricular function is worrisome, evoking a role for additional heart failure therapy.
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Affiliation(s)
- Thierry Bove
- Department of Cardiac Surgery, University Hospital of Ghent, Ghent, Belgium
| | - Eva Grootjans
- Department of Cardiac Surgery, University Hospital of Ghent, Ghent, Belgium
| | - Romanie Naessens
- Department of Cardiac Surgery, University Hospital of Ghent, Ghent, Belgium
| | - Thomas Martens
- Department of Cardiac Surgery, University Hospital of Ghent, Ghent, Belgium
| | - Daniel De Wolf
- Department of Pediatric Cardiology, University Hospital of Ghent, Ghent, Belgium
| | | | - Joseph Panzer
- Department of Pediatric Cardiology, University Hospital of Ghent, Ghent, Belgium
| | - Katya De Groote
- Department of Pediatric Cardiology, University Hospital of Ghent, Ghent, Belgium
| | - Julie De Backer
- Department of Adult Congenital Cardiology, University Hospital of Ghent, Ghent, Belgium
| | - Laurent Demulier
- Department of Adult Congenital Cardiology, University Hospital of Ghent, Ghent, Belgium
| | - Katrien François
- Department of Cardiac Surgery, University Hospital of Ghent, Ghent, Belgium
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Liao X, Li S, Yan X, Lin X, Chen L, Lin Y. Association of preoperative CA-125 levels with early POAF after heart valve surgery: a single-center, retrospective study. BMC Surg 2023; 23:225. [PMID: 37559016 PMCID: PMC10413594 DOI: 10.1186/s12893-023-02099-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 07/06/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVE Cancer antigen-125 (CA-125), a tumor marker, has received increasing attention in recent years for its role in the cardiovascular field. However, no study has reported the association of CA-125 with early postoperative atrial fibrillation (POAF) after heart valve surgery. Therefore, the aim of this study was to assess whether there is a correlation between CA-125 and early postoperative POAF after heart valve surgery. METHODS Patients who underwent valve surgery at Fujian Heart Medical Center from January 2020 to August 2022 were retrospectively analyzed and divided into postoperative atrial fibrillation group (POAF group) and postoperative non-atrial fibrillation group (NO-POAF), and the differences in clinical data between the two groups were compared, and the variables with statistical significance in the univariate analysis were included in the COX regression analysis, and finally the receivers' operating characteristics (ROC) curves were drawn. RESULTS From January 2020 to August 2022, a total of 1653 patients underwent valve surgery. A total of 344 patients were finally included, including 52 patients (15.1%) in the POAF group and 292 patients (84.9%) in the NO-POAF group. Univariate analysis showed higher CA-125 levels in patients in the POAF group than in those in the NO-POAF group [27.89 (13.64, 61.54), 14.48 (9.87, 24.08), P = 0.000]. Analysis of the incidence of POAF based on CA-125 quartiles showed an incidence of up to 29.2% in the highest quartile (> 27.88). Multivariate COX regression analysis showed that CA-125 [OR = 1.006, 95% CI (1.002, 1.010), P = 0.001] was an independent predictor of POAF. The final ROC curve plot showed that the area under the curve for CA-125 was 0.669, with an optimal cut-off value of 27.08 U/ml, and the difference in the area under the curve between the two groups was statistically significant (P = 0.000). CONCLUSION Elevated preoperative CA-125 levels can affect the incidence of POAF and have a predictive value for the occurrence of POAF in the early stage after valve surgery. However, due to the small sample size and single-center retrospective study, further validation of this result is needed.
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Affiliation(s)
- Xiaoqin Liao
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Sailan Li
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xin Yan
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xin Lin
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Liangwan Chen
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yanjuan Lin
- Department of Nursing, Fujian Medical University Union Hospital, Fuzhou, China
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Ali SKM. A letter to editor in response to the article on management of patients with sickle cell disease undergoing valve surgery in Sudan. Interdiscip Cardiovasc Thorac Surg 2023; 36:7036336. [PMID: 36856746 PMCID: PMC9976737 DOI: 10.1093/icvts/ivad033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 01/20/2023] [Accepted: 02/14/2023] [Indexed: 02/16/2023]
Affiliation(s)
- Sulafa K M Ali
- Corresponding author. Department of Pediatric Cardiology, Sudan Heart Center, University of Khartoum, Al Qasr Street, P O Box 102, Khartoum, Sudan. Tel: 0024991075694; e-mail: (S.K.M. Ali)
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MacKay EJ, Zhang B, Neuman MD, Augoustides JG, Desai ND, Groeneveld PW. Impact of Hospital Practice and Staffing Differences on Transesophageal Echocardiography Use in Cardiac Valve or Coronary Artery Bypass Graft Surgery. J Cardiothorac Vasc Anesth 2022; 36:4012-4021. [PMID: 35909042 DOI: 10.1053/j.jvca.2022.07.005] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 06/27/2022] [Accepted: 07/06/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To identify and quantify the predictors of intraoperative transesophageal echocardiography (TEE) use among the patients undergoing cardiac valve or isolated coronary artery bypass graft (CABG) surgery. DESIGN An observational cohort study. SETTING This study used the Centers for Medicare and Medicaid Services administrative claims dataset of the beneficiaries undergoing valve or isolated CABG surgery between 2013 to 2015. PARTICIPANTS Adults aged ≥65 years of age undergoing cardiac valve or isolated CABG surgery. INTERVENTIONS Generalized linear mixed-model (GLMM) analyses were used to examine the relationship between the TEE and patient characteristics, hospital factors, and staffing differences, while accounting for clustering within hospitals. The proportion of variation in TEE use attributable to patient-level characteristics was quantified using odds ratios. Hospital-level factors and staffing differences were quantified using the median odds ratios (MOR) and interval odds ratios (IOR). MEASUREMENTS AND MAIN RESULTS Among 261,860 patients (123,702 valve procedures and 138,158 isolated CABG), the GLMM analysis demonstrated that the strongest predictor for intraoperative TEE use was the hospital where the surgery occurred (MOR for TEE of 2.57 in valve and 4.16 in isolated CABG). The TEE staffing variable reduced the previously unexplained across-hospital variability by 9% in valve and 21% in isolated CABG, and hospitals with anesthesiologist TEE staffing (versus mixed) were more likely to use TEE in both valve and CABG (MOR for TEE of 1.21 in valve and 1.84 in isolated CABG). CONCLUSION Hospital practice was the strongest predictor for TEE use overall. In isolated CABG surgery, hospitals with anesthesiologist TEE staffing were a primary predictor for TEE use.
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Affiliation(s)
- Emily J MacKay
- Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Department of Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Penn Center for Perioperative Outcomes Research and Transformation (CPORT), University of Pennsylvania, 310 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104, USA; Penn's Cardiovascular Outcomes, Quality and Evaluative Research Center (CAVOQER), University of Pennsylvania, Philadelphia, PA, USA.
| | - Bo Zhang
- Department of Statistics and Data Science, The Wharton School, University of Pennsylvania, Philadelphia, PA, USA; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Mark D Neuman
- Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Department of Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Penn Center for Perioperative Outcomes Research and Transformation (CPORT), University of Pennsylvania, 310 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104, USA; Penn's Cardiovascular Outcomes, Quality and Evaluative Research Center (CAVOQER), University of Pennsylvania, Philadelphia, PA, USA
| | - John G Augoustides
- Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Penn Center for Perioperative Outcomes Research and Transformation (CPORT), University of Pennsylvania, 310 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104, USA; Penn's Cardiovascular Outcomes, Quality and Evaluative Research Center (CAVOQER), University of Pennsylvania, Philadelphia, PA, USA
| | - Peter W Groeneveld
- Department of Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; Penn's Cardiovascular Outcomes, Quality and Evaluative Research Center (CAVOQER), University of Pennsylvania, Philadelphia, PA, USA; Leonard Davis Institute of Health Economics (LDI), University of Pennsylvania, Philadelphia, PA, USA; Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA
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Bansal A, Jaber WA, Cremer P, Wassif H, Mentias A, Menon V. Impact of hospital volume of valve operations on the utilization and outcomes of surgery for patients with infective endocarditis. Eur Heart J Acute Cardiovasc Care 2022; 11:102-110. [PMID: 34871384 DOI: 10.1093/ehjacc/zuab116] [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] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 06/13/2023]
Abstract
AIMS Valve surgery is indicated and can be life-saving in patients with infective endocarditis (IE). We evaluated the impact of hospital valvular surgery volume on utilization and outcomes of surgery for IE. METHODS AND RESULTS National Inpatient Sample (NIS) database was used for IE hospitalizations from 2008 to 2015. Hospitals were divided into quartiles based on valve surgery volume with quartile 1 (Q1) indicating lowest volume and quartile 4 (Q4) highest volume. Primary outcome was utilization of valve surgery in patients hospitalized with IE and secondary outcomes were in-hospital mortality and length of stay for IE patients undergoing valve surgery. Volume-outcome relationship was analysed both as categorical (quartiles) and continuous variable (restricted cubic splines). A total of 36 471 hospitalizations for IE were identified using the NIS database from 2008 to 2015 of which 17.33% underwent any valve surgery. Utilization rates of valve surgery for IE were significantly higher in Q4 hospitals (Q1: 6.73%; Q2: 10.39%; Q3: 14.91%; Q4: 2321%). Amongst the admissions for IE endocarditis undergoing valve surgery, there was no significant difference in in-hospital mortality when analysed as a categorical variable (as quartiles). However, when analysed as a continuous variable we note significant variation in outcomes across the Q4 hospitals, with highest volume centres having reduced mortality rates and length of stay. CONCLUSION Hospital valvular surgery volume has direct impact on utilization and outcomes of surgery for IE. Given rising rates of IE and ongoing intravenous drug pandemic, there is need for regionalization of care for IE patients and development of 'endocarditis centres of excellence' for improved patient outcomes.
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Affiliation(s)
- Agam Bansal
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave Cleveland, OH 44195, USA
| | - Wael A Jaber
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave Cleveland, OH 44195, USA
| | - Paul Cremer
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave Cleveland, OH 44195, USA
| | - Heba Wassif
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave Cleveland, OH 44195, USA
| | - Amgad Mentias
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave Cleveland, OH 44195, USA
| | - Venu Menon
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave Cleveland, OH 44195, USA
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Chaitidis N, Kokkinidis DG, Papadopoulou Z, Hasemaki N, Attaran R, Bakoyiannis C. Management of Post-Thrombotic Syndrome: A Comprehensive Review. Curr Pharm Des 2022; 28:550-559. [PMID: 35100955 DOI: 10.2174/1381612828666220131094655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 12/29/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Post-thrombotic syndrome (PTS) is the most common long-term complication of acute Deep Venous Thrombosis (DVT). The cumulative incidence of PTS in the first two years after a first acute DVT diagnosis approximates 25%. OBJECTIVE This study aims to summarize the most recent updates and provide a comprehensive review of the current management of PTS Methods: We searched MEDLINE/PMC/NCBI Bookshelf (PubMed), Cochrane, Embase, Scopus, ClinicalTrials and OpenGrey databases for relevant articles in English published from the establishment of each separate database until February 9, 2021. CONCLUSION PTS constitutes the most frequent long-term complication of lower limb deep venous thrombosis (DVT). Lifestyle changes and compression treatment represent an integral part of PTS management and have a clear benefit to offer in PTS patients. Pharmacological treatment with phlebotonic and non-phlebotonic medications -such as micronized purified flavonoid fraction (MMPF) and sulodexide, respectively- may have a more central and significant role in PTS management than previously thought. The introduction of percutaneous transluminal venoplasty (PTV) and stenting has again raised our expectations with the field, along with new concerns and considerations. There is growing number of studies that report promising results on patient-oriented outcomes on PTS patients who were treated with PTV and stenting. Moreover, hybrid (endovascular / surgical) interventions may also represent a safe and efficacious treatment option for a subset of patients with PTS. Patient selection criteria for endovascular and hybrid interventional treatment should be carefully set and standardized. Post-operative care after venoplasty is an important field of future research with potential clinical impact. Management of deep and superficial reflux remains controversial. Hopefully, future prospective studies shall provide more robust evidence on the management of PTS.
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Affiliation(s)
| | - Damianos G Kokkinidis
- Section of Cardiovascular Medicine, Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT
| | - Zoi Papadopoulou
- 3rd Department of Pediatrics, Ippokrateio General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Natasha Hasemaki
- 1st Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Robert Attaran
- Section of Cardiovascular Medicine, Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT
| | - Christos Bakoyiannis
- 1st Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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11
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Hirokawa M, Daimon M, Nakanishi K, Mahara K, Miyazaki S, Miyake M, Izumi C, Nakao T, Takeda N, Yatomi Y, Komuro I. Longitudinal change in postoperative right ventricular systolic function in patients undergoing surgery for isolated tricuspid regurgitation. Am Heart J Plus 2021; 12:100073. [PMID: 38559596 PMCID: PMC10978170 DOI: 10.1016/j.ahjo.2021.100073] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/11/2021] [Accepted: 11/15/2021] [Indexed: 04/04/2024]
Abstract
Right ventricular (RV) dysfunction is an indication for tricuspid valve (TV) surgery in patients with severe isolated tricuspid regurgitation (TR). Postoperative RV dysfunction is associated with poor outcome; however, the longitudinal changes in RV function before and after surgery have not been established. We retrospectively analyzed 24 patients who underwent TV surgery for isolated severe TR. For assessing RV systolic function, we measured the RV fractional area change (RVFAC) at baseline, and 1 (immediate) and 4-20 (late) months after surgery. We divided patients into 2 groups according to the RVFAC late after surgery (<35%, post-op. reduced; and ≥35%, post-op. preserved). The mean RVFAC was significantly decreased immediately after surgery compared to baseline (41.5 ± 10.1% vs. 32.2 ± 9.6%; p < 0.001). The RVFAC reduction was still observed late after surgery (35.5 ± 7.4%; p = 0.002). Of 24 patients, 12 patients (50%) had preserved RV systolic function late after surgery. Although there was no significant difference in the preoperative RVFAC between the 2 groups, the preoperative RV end-systolic area (RVESA) /body surface area (BSA) was significantly less in the post-op. preserved RV systolic function group (13.8 ± 4.3 cm2/m2 vs. 8.6 ± 2.6 cm2/m2; p = 0.001). The optimal cut-off value for the preoperative RVESA/BSA in detecting postoperative preserved RV systolic function was 10.8 cm2/m2 (AUC, 0.85; sensitivity, 91.7%; and specificity, 75.0%). In patients undergoing surgery for isolated severe TR, the RVFAC was significantly decreased immediately after surgery and the reduction continued late after surgery. The preoperative RVESA/BSA might be helpful to predict preserved RV function after surgery.
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Affiliation(s)
- Megumi Hirokawa
- Department of Cardiovascular Medicine, the University of Tokyo Hospital, Tokyo, Japan
| | - Masao Daimon
- Department of Clinical Laboratory, the University of Tokyo Hospital, Tokyo, Japan
| | - Koki Nakanishi
- Department of Cardiovascular Medicine, the University of Tokyo Hospital, Tokyo, Japan
| | - Keitaro Mahara
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Sakiko Miyazaki
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Makoto Miyake
- Department of Cardiology, Tenri Hospital, Nara, Japan
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tomoko Nakao
- Department of Clinical Laboratory, the University of Tokyo Hospital, Tokyo, Japan
| | - Norifumi Takeda
- Department of Cardiovascular Medicine, the University of Tokyo Hospital, Tokyo, Japan
| | - Yutaka Yatomi
- Department of Clinical Laboratory, the University of Tokyo Hospital, Tokyo, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, the University of Tokyo Hospital, Tokyo, Japan
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12
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Tamura K, Sakurai S. Clinical efficacy of digital chest drainage system in cardiac valve surgery. Gen Thorac Cardiovasc Surg 2021; 70:619-623. [PMID: 34843072 DOI: 10.1007/s11748-021-01752-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/23/2021] [Indexed: 11/28/2022]
Abstract
OBJECTS The portable digitalized suction was used widely in thoracic surgery. The aim of the study was to access the early outcomes of using the portable digitalized suction system after cardiac surgery. METHODS We invested 80 patients including 30 women (mean age 72.7 ± 9.2 years) who underwent cardiac surgery at our hospital, excluded coronary artery bypass grafting only, with or only aortic surgery, emergency operation, and patients with hemodialysis. Patients were categorized as those treated with digital chest drainage system (DCS group, n = 38) or analog chest drainage system (ACS group, n = 42), and the following data were analyzed in two groups. The primary endpoint was the duration of chest drainage, and the secondary endpoints were the rate of drainage-related complications and the length of hospitalization. RESULTS The duration of drainage was significantly shorter in the DCS group (ACS vs. DCS = 94.8 ± 31.5 vs. 81.1 ± 20.6 h, p = 0.036). The duration needed for rehabilitation completion was significantly shorter in the DCS group (ACS vs. DCS = 10.7 ± 1.2 vs. 9.6 ± 1.5 days, p = 0.047), and the length of hospitalization was significantly shorter in the DCS group (ACS vs. DCS = 21.9 ± 5.3 vs. 18.8 ± 7.2 days, p = 0.031). CONCLUSIONS This study provided evidence that DCS might be effective for patients who underwent cardiac valve surgery.
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Affiliation(s)
- Kiyoshi Tamura
- Department of Cardiovascular Surgery, Soka Municipal Hospital, 2-21-1 Soka, Soka-shi, Saitama, 340-8560, Japan.
| | - Shogo Sakurai
- Department of Cardiovascular Surgery, Soka Municipal Hospital, 2-21-1 Soka, Soka-shi, Saitama, 340-8560, Japan
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13
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Máximo J, Pissarra D, Marinho B, Pinho P. Infective aortitis after self-expanding transcatheter valve implantation: a case report of a new reality for cardiac surgeons. Interact Cardiovasc Thorac Surg 2021; 34:694-696. [PMID: 34792160 PMCID: PMC9026202 DOI: 10.1093/icvts/ivab313] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 09/12/2021] [Accepted: 09/15/2021] [Indexed: 11/12/2022] Open
Abstract
A 62-year-old female patient was admitted to hospital care due to an ischaemic stroke and fever of unknown origin, 6 months after a transfemoral aortic valve implantation for symptomatic aortic stenosis. Further study resulted in the diagnosis of infective aortitis, and clinical course deemed prosthesis explantation necessary. In this case report, we describe the technique used to explant the partially endothelized aortic valve and review the alternatives found in literature for safe prosthesis removal.
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Affiliation(s)
- José Máximo
- Department of Cardiothoracic Surgery, Centro Hospitalar S. João, Porto, Portugal.,Department of Physiology and Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Diana Pissarra
- Department of Cardiothoracic Surgery, Centro Hospitalar S. João, Porto, Portugal.,Department of Physiology and Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Benjamim Marinho
- Department of Cardiothoracic Surgery, Centro Hospitalar S. João, Porto, Portugal.,Department of Physiology and Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Paulo Pinho
- Department of Cardiothoracic Surgery, Centro Hospitalar S. João, Porto, Portugal.,Department of Physiology and Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
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14
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Affiliation(s)
- Stuart W Grant
- Division of Cardiovascular Sciences, University of Manchester, ERC, Manchester University Hospitals Foundation Trust, Manchester, UK
| | - Maral Ouzounian
- Division of Cardiac Surgery, Department of Surgery, Peter Munk Cardiac Centre, University of Toronto, Toronto, ON, Canada
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15
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Lee JA, Yanagawa B, An KR, Arora RC, Verma S, Friedrich JO. Frailty and pre-frailty in cardiac surgery: a systematic review and meta-analysis of 66,448 patients. J Cardiothorac Surg 2021; 16:184. [PMID: 34172059 PMCID: PMC8229742 DOI: 10.1186/s13019-021-01541-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/13/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The burden of frailty on cardiac surgical outcomes is incompletely understood. Here we perform a systematic review and meta-analysis of studies comparing frail versus pre-frail versus non-frail patients following cardiac surgery. METHODS We searched MEDLINE and EMBASE databases until July 2018 for studies comparing cardiac surgery outcomes in "frail", "pre-frail" and "non-frail" patients. Data was extracted in duplicate. Primary outcome was operative mortality. RESULTS There were 19 observational studies with 66,448 patients. Frail patients were more likely female (risk ratio [RR]1.7; 95%CI:1.5-1.9), older (mean difference: 2.4; 95%CI:1.3-3.5 years older) with greater comorbidities and higher STS-PROM. Frailty (RR2.35; 95%CI:1.57-3.51; p < 0.0001) and pre-frailty (RR2.03; 95%CI:1.52-2.70; p < 0.00001) were associated with increased operative mortality compared with non-frail patients. Frailty was also associated with greater risk of prolonged hospital stay (RR1.83; 95%CI:1.61-2.08; p < 0.0001) and intermediate care facility discharge (RR2.71; 95%CI:1.45-5.05; p = 0.002). Frail (Hazard Ratio [HR]3.27; 95%CI:1.93-5.55; p < 0.0001) and pre-frail patients (HR2.30; 95%CI:1.29-4.09; p = 0.005) had worse mid-term mortality (median follow-up 1 years [range 0.5-4 years]). After adjustment for baseline imbalances, frailty was still associated with greater operative mortality (odds ratio [OR]1.97; 95%CI:1.51-2.57; p < 0.00001), intermediate care facility discharge (OR4.61; 95%CI:2.78-7.66; p < 0.00001) and midterm mortality (HR1.37; 95%CI:1.03-1.83; p = 0.03). CONCLUSION In patients undergoing cardiac surgery, frailty and pre-frailty were associated with 2-fold and 1.5-fold greater adjusted operative mortality, respectively, greater adjusted perioperative complications and frailty was associated with almost 5-fold risk of non-home discharge. Burden of frailty and pre-frailty on cardiac surgical outcomes.
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Affiliation(s)
- Jessica Avery Lee
- Division of Cardiac Surgery, University of Toronto, 30 Bond Street, 8th Floor, Bond Wing, Toronto, ON, M5B 1W8, Canada
| | - Bobby Yanagawa
- Division of Cardiac Surgery, University of Toronto, 30 Bond Street, 8th Floor, Bond Wing, Toronto, ON, M5B 1W8, Canada.
| | - Kevin R An
- Division of Cardiac Surgery, University of Toronto, 30 Bond Street, 8th Floor, Bond Wing, Toronto, ON, M5B 1W8, Canada
| | - Rakesh C Arora
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Subodh Verma
- Division of Cardiac Surgery, University of Toronto, 30 Bond Street, 8th Floor, Bond Wing, Toronto, ON, M5B 1W8, Canada
| | - Jan O Friedrich
- Critical Care, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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16
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Varela Barca L, Fernández-Felix BM, Navas Elorza E, Mestres CA, Muñoz P, Cuerpo-Caballero G, Rodríguez-Abella H, Montejo-Baranda M, Rodríguez-Álvarez R, Gutiérrez Díez F, Goenaga MA, Quintana E, Ojeda-Burgos G, de Alarcón A, Vidal-Bonet L, Centella Hernández T, López-Menéndez J. Prognostic assessment of valvular surgery in active infective endocarditis: multicentric nationwide validation of a new score developed from a meta-analysis. Eur J Cardiothorac Surg 2021; 57:724-731. [PMID: 31782783 DOI: 10.1093/ejcts/ezz328] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/24/2019] [Accepted: 10/27/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Several risk prediction models have been developed to estimate the risk of mortality after valve surgery for active infective endocarditis (IE), but few external validations have been conducted to assess their accuracy. We previously developed a systematic review and meta-analysis of the impact of IE-specific factors for the in-hospital mortality rate after IE valve surgery, whose obtained pooled estimations were the basis for the development of a new score (APORTEI). The aim of the present study was to assess its prognostic accuracy in a nationwide cohort. METHODS We analysed the prognostic utility of the APORTEI score using patient-level data from a multicentric national cohort. Patients who underwent surgery for active IE between 2008 and 2018 were included. Discrimination was evaluated using the area under the receiver operating characteristic curve, and the calibration was assessed using the calibration slope and the Hosmer-Lemeshow test. Agreement between the APORTEI and the EuroSCORE I was also analysed by Lin's concordance correlation coefficient (CCC), the Bland-Altman agreement analysis and a scatterplot graph. RESULTS The 11 variables that comprised the APORTEI score were analysed in the sample. The APORTEI score was calculated in 1338 patients. The overall observed surgical mortality rate was 25.56%. The score demonstrated adequate discrimination (area under the receiver operating characteristic curve = 0.75; 95% confidence interval 0.72-0.77) and calibration (calibration slope = 1.03; Hosmer-Lemeshow test P = 0.389). We found a lack of agreement between the APORTEI and EuroSCORE I (concordance correlation coefficient = 0.55). CONCLUSIONS The APORTEI score, developed from a systematic review and meta-analysis, showed an adequate estimation of the risk of mortality after IE valve surgery in a nationwide cohort.
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Affiliation(s)
- Laura Varela Barca
- Department of Cardiovascular Surgery, University Hospital Son Espases, Palma de Mallorca, Spain.,University of Alcalá de Henares, Madrid, Spain
| | - Borja M Fernández-Felix
- University of Alcalá de Henares, Madrid, Spain.,CIBER Epidemiology and Public Health (CIBERESP), Clinical Biostatistics Unit, Hospital Ramon y Cajal (IRYCIS), Madrid, Spain
| | | | - Carlos A Mestres
- Department of Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Patricia Muñoz
- CIBER Enfermedades Respiratorias-CIBERES, Instituto de Salud Carlos III, Madrid, Spain.,Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón-Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain.,Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Hugo Rodríguez-Abella
- Department of Cardiovascular Surgery, University Hospital Gregorio Marañón, Madrid, Spain
| | | | - Regino Rodríguez-Álvarez
- Department of Cardiovascular Surgery, University Hospital Marques de Valdecilla, Santander, Spain
| | | | | | - Eduard Quintana
- Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain
| | | | - Arístides de Alarcón
- Clinical Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville, CSIC, University Hospital Virgen del Rocío, Seville, Spain
| | - Laura Vidal-Bonet
- Department of Cardiovascular Surgery, University Hospital Son Espases, Palma de Mallorca, Spain
| | - Tomasa Centella Hernández
- University of Alcalá de Henares, Madrid, Spain.,Department of Cardiovascular Surgery, University Hospital Ramon y Cajal, Madrid, Spain
| | - Jose López-Menéndez
- University of Alcalá de Henares, Madrid, Spain.,Department of Cardiovascular Surgery, University Hospital Ramon y Cajal, Madrid, Spain
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17
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Meuris B, Vervoort D, De Praetere H, Rex S, Van De Bruaene A, Herijgers P, Rega F, Verbrugghe P. Starting an aortic valve repair program: is it worthwhile? Aortic valve repair compared to replacement. Eur J Cardiothorac Surg 2021; 60:1369-1377. [PMID: 34021336 DOI: 10.1093/ejcts/ezab200] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/12/2021] [Accepted: 03/20/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES Increasing evidence suggests that aortic valve (AV) repair may have better long-term outcomes than AV replacement for aortic insufficiency. However, most literature is limited to centres of excellence and has not sufficiently been replicated in nascent programs. This single-centre experience of a newly established AV repair program aims to compare short-term outcomes of AV sparing versus replacement surgery. METHODS A retrospective cohort study of patients who underwent elective surgery for aortic regurgitation or aortic root dilatation at the Leuven University Hospital between 2013 and 2018 was performed. Patients with a critically ill presentation, endocarditis, aortic stenosis or requiring redo surgery were excluded. Patients were assigned to repair versus replacement based on preoperative intention to preserve the AV. Nearest neighbour propensity score matching was performed to compare both groups. Safety (mortality, morbidity), efficiency (cross-clamp and bypass times) and efficacy end points (repair rate, postoperative echocardiography) were compared. RESULTS One hundred and seven patients underwent AV surgery (48 repair, 59 replacement), from which 2 groups of 23 matched patients were created. There were 1 death and 2 reoperations after repair and no death and 1 reoperation after replacement. Extracorporeal circulation and aortic cross-clamp time were significantly longer while ventilation and total hospital stay were significantly shorter after AV repair. Echocardiographic follow-up showed comparable aortic regurgitation but lower transvalvular gradients after repair. Freedom from major complications was comparable in both cohorts. CONCLUSIONS Early results suggest the feasibility of replicating experienced centres' perioperative and short-term outcomes in nascent programs.
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Affiliation(s)
- Bart Meuris
- Department of Cardiac Surgery, UZ Leuven, Leuven, Belgium
| | - Dominique Vervoort
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Steffen Rex
- Department of Anesthesiology, UZ Leuven, Leuven, Belgium
| | | | - Paul Herijgers
- Department of Cardiac Surgery, UZ Leuven, Leuven, Belgium
| | - Filip Rega
- Department of Cardiac Surgery, UZ Leuven, Leuven, Belgium
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18
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Chi MC, Hung KC, Chang SH, Wu VCC, Chou AH, Chan YH, Lin CP, Chang CH, Chu PH, Chen SW. Effect of Permanent Pacemaker Implantation After Valve Surgery on Long-Term Outcomes. Circ J 2021; 85:1027-1034. [PMID: 33746153 DOI: 10.1253/circj.cj-20-0905] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Patients are prone to permanent pacemaker implantation (PPM) after valve surgery, yet current data on the effects of postoperative PPM are scarce and large-scale studies are lacking. The aim of this study was to determine rates and long-term outcomes of PPM after cardiac valve surgery.Methods and Results:A total of 24,014 patients who received valve surgery from 2000 to 2013 were identified from the Taiwan National Health Insurance Research Database. The number of valve surgeries and the proportion of PPM implantations after valve surgery increased (P<0.001). After 1 : 5 propensity score matching, 602 and 3,010 patients were categorized to the PPM and non-PPM groups, respectively. Late outcomes included all-cause mortality, cardiovascular death, sepsis, and readmission due to any cause. The mean follow up was 4.3 years. PPM was associated with a higher all-cause mortality rate (33.6% vs. 29.8%; hazard ratio [HR], 1.14; 95% confidence interval [CI], 0.98-1.32), though not significant at the threshold of P<0.05. PPM was also associated with higher all-cause mortality rates in subgroups that received mitral valve (MV) replacement surgery, combined aortic valve replacement (AVR) with MV surgeries, and combined AVR with tricuspid valve surgeries. CONCLUSIONS The PPM rate after valve surgery is increasing, and is associated with short-term adverse effects. Patients with PPM may have a higher long-term mortality rate.
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Affiliation(s)
- Mu-Chieh Chi
- Department of Medicine, Chang Gung University.,Chang Gung Memorial Hospital, Linkou Medical Center Shin Kong Wu Ho-Su Memorial Hospital.,Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University
| | - Kuo-Chun Hung
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memory Hospital, Linkou Branch, Chang Gung University College of Medicine
| | - Shang-Hung Chang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memory Hospital, Linkou Branch, Chang Gung University College of Medicine
| | - Victor Chien-Chia Wu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memory Hospital, Linkou Branch, Chang Gung University College of Medicine
| | - An-Hsun Chou
- Department of Anesthesiology, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University
| | - Yi-Hsin Chan
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memory Hospital, Linkou Branch, Chang Gung University College of Medicine
| | - Chia-Pin Lin
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memory Hospital, Linkou Branch, Chang Gung University College of Medicine
| | - Chih-Hsiang Chang
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center.,Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, College of Medicine, Chang Gung University
| | - Pao-Hsien Chu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memory Hospital, Linkou Branch, Chang Gung University College of Medicine
| | - Shao-Wei Chen
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University.,Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center.,Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, College of Medicine, Chang Gung University
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19
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Ibrahim KS, Kheirallah KA, Mayyas FA, Alwaqfi NR, Alawami MH, Aljarrah QM. Predictors of short-term mortality after rheumatic heart valve surgery: A single-center retrospective study. Ann Med Surg (Lond) 2021; 62:395-401. [PMID: 33552502 PMCID: PMC7851328 DOI: 10.1016/j.amsu.2021.01.077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/21/2021] [Accepted: 01/21/2021] [Indexed: 11/11/2022] Open
Abstract
Background Valve replacement surgeries holds risks of morbidity and mortality. Materials and methods The study cohort included 346 patients who underwent different types of valve surgery, excluding redo and Bentall operations. All operations were performed through a median sternotomy using cardiopulmonary bypass. Results Mean patient age was 51.6 ± 16.1 years, and 51% were male. Approximately 21% had diabetes, and 44.6% were hypertensive. Aortic valve replacement (AVR) was performed in 125 patients (37%), mitral valve replacement (MVR) in 95 (28%), combined AVR and MVR in 42 (13%), AVR plus coronary artery bypass grafting (CABG) in 19 (6%), and MVR plus CABG in 32 (10%). Operative mortality was 5.8% (n = 20). In the bivariate-level analysis, older age, operation type, hypertension, emergency surgery, use of a biological valve in the aortic or mitral position, pump time greater than 120 min, and aortic clamp time greater than 60 min were significant predictors of 30-day mortality. Use of medications stratified by duration (less than or more than a month) was also shown to be a predictor of mortality. Use of angiotensin-converting enzyme inhibitors, digoxin, beta-blockers, statins, and loop diuretics was associated with mortality. Older age, emergency/salvage surgery, use of beta-blockers for less than 1 month preoperatively, and use of a biological valve in the aortic position were significant and independent predictors of 30-day mortality. Conclusion Age, emergency valve surgery, use of a biological valve, use of beta-blockers for less than 1 month before surgery, type of surgery, EF<35%, pump time, and cross clamp time were all found to be independent predictors of mortality in patients undergoing valve surgery. Further prospective multicenter studies may be needed to provide a comprehensive assessment of mortality in patients undergoing valve surgery in Jordan. Rheumatic heart disease is still a health issue in developing countries. Developed countries are facing rheumatic patients due to forced immigrations. Early diagnosis and early referral to surgery is correlated with better outcomes. More than eight predictors were found to be independent predictors of mortality.
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Affiliation(s)
- Khalid S Ibrahim
- Division of Cardiac Surgery, Department of General Surgery and Urology, College of Medicine, Jordan University of Science and Technology and Princess Muna Center for Heart Diseases and Surgery, King Abdullah University Hospital, Jordan
| | - Khalid A Kheirallah
- Department of Public Health and Community Health, College of Medicine, Jordan University of Science and Technology, Jordan
| | - Fadia A Mayyas
- Department of Clinical Pharmacy, College of Pharmacy, Jordan University of Science and Technology, Jordan
| | - Nizar R Alwaqfi
- Division of Cardiac Surgery, Department of General Surgery and Urology, College of Medicine, Jordan University of Science and Technology and Princess Muna Center for Heart Diseases and Surgery, King Abdullah University Hospital, Jordan
| | | | - Qusai M Aljarrah
- Department of Surgery, Faculty of Medicine, Jordan University of Science and Technology, Jordan
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Tamulevičiūtė-Prascienė E, Beigienė A, Thompson MJ, Balnė K, Kubilius R, Bjarnason-Wehrens B. The impact of additional resistance and balance training in exercise-based cardiac rehabilitation in older patients after valve surgery or intervention: randomized control trial. BMC Geriatr 2021; 21:23. [PMID: 33413144 PMCID: PMC7792183 DOI: 10.1186/s12877-020-01964-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 12/15/2020] [Indexed: 01/14/2023] Open
Abstract
Background To evaluate the short- and mid-term effect of a specially tailored resistance and balance training provided in addition to usual cardiac rehabilitation (CR) care program in older patients after valve surgery/intervention. Methods Single-center (inpatient CR clinic in Lithuania) randomized controlled trial. Two hundred fifty-two patients were assessed for eligibility on the first day of admittance to CR early after (14.5 ± 5.9 days) valve surgery/intervention between January 2018 and November 2019. Participants were coded centrally in accordance with randomization 1:1 using a computerized list. Control group (CG) patients were provided with usual care phase-II-CR inpatient multidisciplinary CR program, while intervention group (IG) patients received additional resistance and balance training (3 d/wk). Patients participated in a 3-month follow-up. Main outcome measures were functional capacity (6 min walk test (6MWT, meters), cardiopulmonary exercise testing), physical performance (Short Physical Performance Battery (SPPB, score) and 5-m walk test (5MWT, meters/second)), strength (one repetition maximum test for leg press), physical frailty (SPPB, 5MWT). Results One hundred sixteen patients (76.1 ± 6.7 years, 50% male) who fulfilled the study inclusion criteria were randomized to IG (n = 60) or CG (n = 56) and participated in CR (18.6 ± 2.7 days). As a result, 6MWT (IG 247 ± 94.1 vs. 348 ± 100.1, CG 232 ± 102.8 vs. 333 ± 120.7), SPPB (IG 8.31 ± 2.21 vs. 9.51 ± 2.24, CG 7.95 ± 2.01 vs. 9.08 ± 2.35), 5MWT (IG 0.847 ± 0.31 vs. 0.965 ± 0.3, CG 0.765 ± 0.24 vs 0.879 ± 0.29) all other outcome variables and physical frailty level improved significantly (p < 0.05) in both groups with no significant difference between groups. Improvements were sustained over the 3-month follow-up for 6MWT (IG 348 ± 113 vs. CG 332 ± 147.4), SPPB (IG 10.37 ± 1.59 vs CG 9.44 ± 2.34), 5MWT (IG 1.086 ± 0. 307 vs CG 1.123 ± 0.539) and other variables. Improvement in physical frailty level was significantly more pronounced in IG (p < 0.05) after the 3-month follow-up. Conclusion Exercise-based CR improves functional and exercise capacity, physical performance, and muscular strength, and reduces physical frailty levels in patients after valve surgery/intervention in the short and medium terms. SPPB score and 5MWT were useful for physical frailty assessment, screening and evaluation of outcomes in a CR setting. Additional benefit from the resistance and balance training could not be confirmed. Trial registration NCT04234087, retrospectively registered 21 January 2020.
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Affiliation(s)
| | - Aurelija Beigienė
- Rehabilitation Department, Lithuanian University of Health Sciences, Eiveniu g. 2, LT-50161, Kaunas, Lithuania
| | | | - Kristina Balnė
- Faculty of Medicine, Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, LT-44307, Kaunas, Lithuania
| | - Raimondas Kubilius
- Rehabilitation Department, Lithuanian University of Health Sciences, Eiveniu g. 2, LT-50161, Kaunas, Lithuania
| | - Birna Bjarnason-Wehrens
- Institute of Cardiology and Sports Medicine, Department of Preventive and Rehabilitative Sport and Exercise Medicine, German Sport University Cologne, Am Sportpark Muengersdorf 6, 50933, Cologne, Germany
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21
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Abstract
Infective endocarditis (IE) is an infection primarily affecting the endocardium of heart valves that can embolize systemically and to the brain. Neurologic manifestations include strokes, intracerebral hemorrhages, mycotic aneurysms, meningitis, cerebral abscesses, and infections of the spine. Neurologic involvement is associated with worse mortality, though it does not always portend a poor functional prognosis. Neuroimaging is indicated in patients who have neurologic symptoms, including cerebral vessel imaging in patients who have subarachnoid hemorrhage. In the case of acute ischemic stroke (IS), IV thrombolysis is contraindicated but endovascular thrombectomy may be a consideration. Neurologic findings understandably raise concern about valve surgery when indicated due to the risk of hemorrhage with perioperative anticoagulation. However, most neurologic complications do not preclude valve surgery and valve surgery may in fact be indispensable in some cases to prevent further neurologic problems. Management decisions in patients with IE and neurologic complications should therefore be multidisciplinary with a major contribution from the neurologist.
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Affiliation(s)
- Tia Chakraborty
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | | | - Eelco Wijdicks
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
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22
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Watanabe T, Ishida N, Takaoka M, Tsujimoto K, Kondo K, Isoda R, Yukawa T, Tokunaga N, Ishida A, Fukazawa T, Morita I, Yoshida H, Kuinose M, Yamatsuji T. Bioelectrical impedance analysis for perioperative water management in adult cardiovascular valve disease surgery. Surg Today 2020; 51:1061-1067. [PMID: 33259014 PMCID: PMC8141485 DOI: 10.1007/s00595-020-02184-3] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 10/27/2020] [Indexed: 11/03/2022]
Abstract
PURPOSE Bioelectrical impedance analysis (BIA) has been used recently to measure the body water of patients with acute heart failure. We used BIA in this study to better understand, and possibly identify a predictive marker for, perioperative water behavior in cardiac surgery patients. METHODS We measured body water and studied its behavior in 44 patients undergoing surgery for cardiac valvular disease at our hospital. Measurements included the levels of extracellular water (ECW), intracellular water (ICW), and total body water, the edema index (EI), and the ratio of ECW to total body water. The first measured EI was defined as the "preoperative EI" and the maximum as the "peak EI". RESULTS A negative correlation was found between the preoperative EI and the preoperative estimated glomerular filtration rate (eGFR) (R = 0.644, p < 0.001). Positive correlations were found between the peak EI and the ICU stay (R = 0.625, p < 0.001), the peak EI and the ventilation time (R = 0.366, p < 0.01), and the preoperative EI and the ICU stay (R = 0.464, p = 0.026). CONCLUSION The EI is possibly a predictive marker for perioperative water management in cardiac surgery.
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Affiliation(s)
- Tatsuya Watanabe
- Department of General Surgery, Kawasaki Medical School General Medical Center, 2-6-1 Nakasange, Kita-Ku, Okayama-Shi, Okayama, Japan
| | - Naomasa Ishida
- Department of General Surgery, Kawasaki Medical School General Medical Center, 2-6-1 Nakasange, Kita-Ku, Okayama-Shi, Okayama, Japan
| | - Munenori Takaoka
- Department of General Surgery, Kawasaki Medical School General Medical Center, 2-6-1 Nakasange, Kita-Ku, Okayama-Shi, Okayama, Japan
| | - Kotone Tsujimoto
- Department of General Surgery, Kawasaki Medical School General Medical Center, 2-6-1 Nakasange, Kita-Ku, Okayama-Shi, Okayama, Japan
| | - Kensuke Kondo
- Department of General Surgery, Kawasaki Medical School General Medical Center, 2-6-1 Nakasange, Kita-Ku, Okayama-Shi, Okayama, Japan
| | - Ryutaro Isoda
- Department of General Surgery, Kawasaki Medical School General Medical Center, 2-6-1 Nakasange, Kita-Ku, Okayama-Shi, Okayama, Japan
| | - Takuro Yukawa
- Department of General Surgery, Kawasaki Medical School General Medical Center, 2-6-1 Nakasange, Kita-Ku, Okayama-Shi, Okayama, Japan
| | - Noriyuki Tokunaga
- Department of General Surgery, Kawasaki Medical School General Medical Center, 2-6-1 Nakasange, Kita-Ku, Okayama-Shi, Okayama, Japan
| | - Atsuhisa Ishida
- Department of General Surgery, Kawasaki Medical School General Medical Center, 2-6-1 Nakasange, Kita-Ku, Okayama-Shi, Okayama, Japan
| | - Takuya Fukazawa
- Department of General Surgery, Kawasaki Medical School General Medical Center, 2-6-1 Nakasange, Kita-Ku, Okayama-Shi, Okayama, Japan
| | - Ichiro Morita
- Department of General Surgery, Kawasaki Medical School General Medical Center, 2-6-1 Nakasange, Kita-Ku, Okayama-Shi, Okayama, Japan
| | - Hideo Yoshida
- Department of General Surgery, Kawasaki Medical School General Medical Center, 2-6-1 Nakasange, Kita-Ku, Okayama-Shi, Okayama, Japan
| | - Masahiko Kuinose
- Department of General Surgery, Kawasaki Medical School General Medical Center, 2-6-1 Nakasange, Kita-Ku, Okayama-Shi, Okayama, Japan
| | - Tomoki Yamatsuji
- Department of General Surgery, Kawasaki Medical School General Medical Center, 2-6-1 Nakasange, Kita-Ku, Okayama-Shi, Okayama, Japan.
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23
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Bradshaw PJ, Tohira H, Marangou J, Newman M, Reményi B, Wade V, Reid C, Katzenellenbogen JM. The use of cardiac valve procedures for rheumatic heart disease in Australia; a cross-sectional study 2002-2017. Ann Med Surg (Lond) 2020; 60:557-565. [PMID: 33299561 PMCID: PMC7704359 DOI: 10.1016/j.amsu.2020.11.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 11/18/2020] [Indexed: 11/28/2022] Open
Abstract
Background Australia, although a high income economy, carries a significant burden of rheumatic heart disease (RHD). Acute rheumatic fever (ARF) and RHD are endemic in the Indigenous population. Immigrants from low/lower-income countries (‘non-Indigenous high-risk’) are also at increased risk compared with ‘non-Indigenous low-risk’ Australians. This study describes the utilisation of surgical and percutaneous procedures for RHD-related valve disease among patients aged less than 50 years, from 2002 to 2017. Methods A descriptive study using data from the ‘End RHD in Australia: Study of Epidemiology (ERASE) Project’ linking RHD Registers and hospital inpatient data from five states/territories, and two surgical databases. Trends across three-year periods were determined and post-procedural all-cause 30-day mortality calculated. Results A total of 3900 valves interventions were undertaken in 3028 procedural episodes among 2487 patients. Over 50% of patients were in the 35–49 years group, and 64% were female. Over 60% of procedures for 3-24 year-olds were for Indigenous patients. There were few significant changes across the study period other than downward trends in the number and proportion of procedures for young Indigenous patients (3–24 years) and ‘non-Indigenous/low risk’ patients aged ≥35 years. Mitral valve procedures predominated, and multi-valve interventions increased, including on the tricuspid valve. The majority of replacement prostheses were mechanical, although bioprosthetic valve use increased overall, being highest among females <35 years and Indigenous Australians. All-cause mortality (n = 42) at 30-days was 1.4% overall (range 1.1–1.7), but 2.0% for Indigenous patients. Conclusions The frequency of cardiac valve procedures, and 30-day mortality remained steady across 15 years. Some changes in the distribution of procedures in population groups were evident. Replacement procedures, the use of bioprosthetic valves, and multiple-valve interventions increased. The challenge for Australian public health officials is to reduce the incidence, and improve the early detection and management of ARF/RHD in high-risk populations within Australia. Epidemic RHD in Indigenous Australians drives RHD-related cardiac valve procedures. 30-day mortality post-procedural is low in those under 50 years. Bioprosthetic valve replacements higher in young women, and increasing in older patients.
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Affiliation(s)
- Pamela J Bradshaw
- The School of Population and Global Health, The University of Western Australia, Australia
| | - Hideo Tohira
- The School of Population and Global Health, The University of Western Australia, Australia
| | - James Marangou
- Fiona Stanley Hospital, 11 Robin Warren Drive Murdoch, WA, 6150, Australia
| | - Mark Newman
- Sir Charles Gairdner Hospital, Hospital Ave. Nedlands, WA, 6009, Australia
| | - Bo Reményi
- Menzies School of Health Research, PO Box, 41096, Casuarina, NT, Australia
| | - Vicki Wade
- Menzies School of Health Research, PO Box, 41096, Casuarina, NT, Australia
| | - Christopher Reid
- The Centre for Research Excellence Centre of Clinical Research and Education, Curtin University, Hayman Rd. Bentley, WA, Australia
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Samura T, Yoshioka D, Toda K, Sakaniwa R, Yokoyama J, Suzuki K, Miyagawa S, Yoshikawa Y, Hata H, Takano H, Matsumiya G, Monta O, Sakaguchi T, Fukuda H, Sawa Y. Emergency valve surgery improves clinical results in patients with infective endocarditis complicated with acute cerebral infarction: analysis using propensity score matching†. Eur J Cardiothorac Surg 2020; 56:942-949. [PMID: 31502643 DOI: 10.1093/ejcts/ezz100] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 03/01/2019] [Accepted: 03/04/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To date, the optimal timing for patients with infective endocarditis (IE) with acute cerebral infarction (CI) to undergo valve surgery is unknown. Although some previous studies have reported that early valve surgery for IE patients within 1 or 2 weeks after CI could be performed safely, an initial strategy has not been identified because of the unmatched cohorts in previous studies. This study aimed to assess the feasibility and safety of early surgery within a few days after cerebral infarction by using propensity score matching. METHODS Between 2009 and 2017, 585 patients underwent valve surgery for patients with active IE at 14 institutions. Among these, 152 had preoperative acute CI. Early surgery was defined as surgery within 3 days after the diagnosis of CI. Of these 152 patients, 67 underwent early valve surgery (early group), whereas 85 underwent delayed valve surgery (delayed group). Of the patients, 45 in each group were analysed using propensity score matching. The primary outcome was in-hospital death after valve surgery, and secondary outcomes included neurological complications. We compared the clinical results of these matched patients. RESULTS Hospital mortality was lower in the early group (2% vs 16%, P = 0.058). The rate of postoperative intracranial haemorrhage in the early and delayed groups was 4% in both groups. The postoperative modified Rankin scale was not significantly different [early group: 0 (0-2); delayed group: 0 (0-2)]. Incidence of neurological deterioration did not differ significantly between the groups. The survival rates after the first discharge at 1, 3 and 5 years after valve operation were 100%, 97% and 97% in the early group and 91%, 83% and 80% in the delayed group, respectively (P = 0.029). CONCLUSIONS Early valve surgery for patients with IE within 3 days after a CI measuring <2 cm in size improved clinical results without increasing the incidence of postoperative neurological complications.
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Affiliation(s)
- Takaaki Samura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Daisuke Yoshioka
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ryoto Sakaniwa
- Department of Public Health, Osaka University Graduate School of Medicine, Osaka, Japan.,Department of Advanced Clinical Advanced Clinical Epidemiology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Junya Yokoyama
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kota Suzuki
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasushi Yoshikawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroki Hata
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroshi Takano
- Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | | | | | | | | | | | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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25
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Suzuki K, Yoshioka D, Toda K, Yokoyama JY, Samura T, Miyagawa S, Yoshikawa Y, Hata H, Takano H, Matsumiya G, Sakaguchi T, Fukuda H, Sawa Y. Results of surgical management of infective endocarditis associated with Staphylococcus aureus. Eur J Cardiothorac Surg 2020; 56:30-37. [PMID: 30689791 DOI: 10.1093/ejcts/ezy470] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 12/03/2018] [Accepted: 12/13/2018] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Staphylococcus aureus (SA) is a leading cause of infective endocarditis (IE), and such cases are on the rise. Our objective was to evaluate the clinical outcomes of surgical intervention in patients with SA-associated IE and to identify the factors associated with outcomes. METHODS Between 2009 and 2017, 585 patients underwent valve surgery for definitive left-sided IE at 14 affiliated hospitals. Their medical records were retrospectively reviewed, and the preoperative variables and clinical results of patients with (n = 117) or without SA infection (n = 468) were compared. RESULTS The SA group had a more critical preoperative condition with higher rates of chronic haemodialysis, preoperative embolic events and preoperative inflammation levels, as well as worse renal function. In-hospital mortality was 20% and 7% in the patients with or without SA infection, respectively. The overall survival rate at 1 year and 5 years was 72% and 62% in the SA group, and 88% and 81% in the non-SA group, respectively (P < 0.001). The Cox hazard analysis revealed that methicillin-resistant SA infection was an independent risk factor for overall mortality in the SA group. The rate of freedom from recurrence of endocarditis at 1 year and 5 years was 95% and 90% in the SA group and 96% and 92% in the non-SA group, respectively (P = 0.43). CONCLUSIONS The short- and mid-term outcomes after valve surgery for active IE in patients with SA are still challenging. Methicillin-resistant SA infection is an independent predictor of mid-term mortality.
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Affiliation(s)
- Kota Suzuki
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Daisuke Yoshioka
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Jun-Ya Yokoyama
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takaaki Samura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasushi Yoshikawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroki Hata
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hiroshi Takano
- Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | | | | | | | | | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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26
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Laskawski G, Abdelbar A, Zacharias J. An endoscopic repair of residual post-myocardial infarction ventricular septal defect. Interact Cardiovasc Thorac Surg 2020; 31:580-582. [PMID: 33091930 DOI: 10.1093/icvts/ivaa127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/08/2020] [Accepted: 06/16/2020] [Indexed: 11/12/2022] Open
Abstract
Post-myocardial infarction (MI) ventricular septal defect (VSD) is a serious condition that is, fortunately, less diagnosed nowadays due to the advances in early diagnosis and treatment of ischaemic heart disease (incidence 1-2%). Despite the lower mortality of both surgical and interventional closure of the defect (25%) as compared to medical therapy (40-50%), there are still risks of residual leak in both approaches. Herein, we describe a case of a successful endoscopic-assisted repair of a delayed residual leak post-MI VSD after surgical repair. An attempt for interventional closure of the leaking point had failed; an endoscopic-assisted minimal access closure was successfully performed.
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Affiliation(s)
- Grzegorz Laskawski
- Department of Cardiothoracic Surgery, Lancashire Cardiac Centre, Blackpool Teaching Hospitals, Blackpool, UK.,Department of Cardiothoracic Surgery, Medical University of Gdansk, Gdansk, Poland
| | - Abdelrahman Abdelbar
- Department of Cardiothoracic Surgery, Lancashire Cardiac Centre, Blackpool Teaching Hospitals, Blackpool, UK
| | - Joseph Zacharias
- Department of Cardiothoracic Surgery, Lancashire Cardiac Centre, Blackpool Teaching Hospitals, Blackpool, UK
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27
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Hartrumpf M, Sterner J, Schroeter F, Kuehnel RU, Laux ML, Braun C, Albes JM. Tourniquet fixing prior to knot tying reduces forces during aortic valve replacement: experimental results from 18 surgeons. Interact Cardiovasc Thorac Surg 2020; 31:446-453. [PMID: 32810214 DOI: 10.1093/icvts/ivaa135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 06/11/2020] [Accepted: 06/18/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To increase the safety of aortic valve replacement, we developed the 'Caput medusae' method, where the prosthesis is prefixed with circumferential tourniquets prior to knot tying. We assumed that an even distribution of forces may help reduce tissue damage. To confirm this theoretically, we compared forces between knots and tourniquets. METHODS The experimental set-up included a device with movable acrylic plates, a mounted valve and a set of sutures. Traction forces were measured with a luggage scale. Two different tourniquets were compared individually and as bundles of 15. Force-path curves were generated. Knotting and tourniquet forces of 18 staff surgeons were then compared. Both modalities were measured 10 times on 2 days, resulting in 40 observations per surgeon, or 360 observations per modality. RESULTS Polyvinyl chloride tourniquets were stiffer than silicone, expressed by a 1.5- to 1.7-fold higher regression-line slope. Fifteen simultaneous tubes produced force increments 7.9-8.9 times higher than their single counterparts. Overall knotting force was 13.64 ± 5.76 vs tourniquet 1.08 ± 0.48 N. Male surgeons' knotting forces were higher compared to female staff (14.76 ± 6.01 vs 10.73 ± 3.74 N; P < 0.001) while tourniquet forces did not differ (1.09 ± 0.47 vs 1.05 ± 0.49 N; P = 0.459). Dedicated valve surgeons (n = 10) tightened the tourniquets more strongly than inexperienced surgeons (1.20 ± 0.52 vs 0.94 ± 0.37 N; P < 0.001); knotting was similar. Multivariable analysis confirmed only valve experience as a predictor of tourniquet strength (experienced surgeons exerted higher force). CONCLUSIONS Tourniquets exert less force on the tissue than knots. When distributed over the circumference, they can reduce local tension and avoid potential paravalvular leakage. Complete or partial use of tourniquets may thus be an additional option to enhance surgical safety.
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Affiliation(s)
- Martin Hartrumpf
- Department of Cardiovascular Surgery, Heart Center Brandenburg, Brandenburg Medical School, Bernau bei Berlin, Germany
| | - Josephine Sterner
- Department of Cardiovascular Surgery, Heart Center Brandenburg, Brandenburg Medical School, Bernau bei Berlin, Germany
| | - Filip Schroeter
- Department of Cardiovascular Surgery, Heart Center Brandenburg, Brandenburg Medical School, Bernau bei Berlin, Germany
| | - Ralf-Uwe Kuehnel
- Department of Cardiovascular Surgery, Heart Center Brandenburg, Brandenburg Medical School, Bernau bei Berlin, Germany
| | - Magdalena L Laux
- Department of Cardiovascular Surgery, Heart Center Brandenburg, Brandenburg Medical School, Bernau bei Berlin, Germany
| | - Christian Braun
- Department of Cardiovascular Surgery, Heart Center Brandenburg, Brandenburg Medical School, Bernau bei Berlin, Germany
| | - Johannes M Albes
- Department of Cardiovascular Surgery, Heart Center Brandenburg, Brandenburg Medical School, Bernau bei Berlin, Germany
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28
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Suzuki K, Yoshioka D, Toda K, Miyagawa S, Yoshikawa Y, Sakaniwa R, Sawa Y. The Effect of Adjunctive Antibiotic Oral Therapy on the Recurrence of Infective Endocarditis After Valve Surgeries. Semin Thorac Cardiovasc Surg 2020; 33:691-698. [PMID: 32979481 DOI: 10.1053/j.semtcvs.2020.09.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 09/19/2020] [Indexed: 11/11/2022]
Abstract
Adjunctive oral antibiotics following intravenous antibiotics are administered after valve surgery in some patients with active infective endocarditis (IE); however, little is known about their efficacy. Therefore, we evaluated the effect of adjunctive antibiotic oral therapy after IE surgeries. Between 2009 and 2017, 585 patients underwent valve surgery for left-sided active IE at 14 hospitals. Patients who died during hospitalization or transferred with intravenous antibiotics were excluded. Of the remaining 460 patients, 239 were treated with oral antibiotics at discharge (group O) and 221 did not take the oral antibiotic (group N). The primary outcome was all-cause mortality. Secondary outcomes were the recurrence of IE and a subset analysis of it. The 2 groups had similar background, postoperative inflammatory responses, and an almost similar duration of postoperative intravenous antibiotics. The overall survival rates at 1 and 5 years were 96% and 88% in group O and 92% and 84% in group N, respectively (P = 0.425). The rates of freedom from the recurrence of endocarditis at 1 and 5 years were 98% and 94% in group O and 97% and 93% in group N, respectively (P = 0.309). In chronic hemodialysis patients, the rates of freedom from the recurrence were significantly higher in group O than in group N (1 year: 100% vs 87.5%; 5 years: 95% vs 69%, P = 0.022). Adjunctive oral antibiotics following intravenous antibiotics in patients with active IE after valve surgery did not affect the overall survival and recurrence of IE, except in chronic hemodialysis patients.
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Affiliation(s)
- Kota Suzuki
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Daisuke Yoshioka
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasushi Yoshikawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ryoto Sakaniwa
- Department of Public Health, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan..
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29
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Fleissner F, Frank P, Haverich A, Ismail I. Echocardiographic guided, transatrial closure of a patent foramen ovale. J Cardiothorac Surg 2020; 15:255. [PMID: 32928262 PMCID: PMC7491112 DOI: 10.1186/s13019-020-01289-7] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/03/2020] [Indexed: 11/23/2022] Open
Abstract
Background The management of an incidental patent foramen ovale found during planned cardiac surgery remains a challenge, and current guidelines are not helpful. Although evidence is accumulating, that closure of an incidental found patent foramen ovale might be beneficial, especially in planned off-pump procedures, the diagnosis of a formerly unknown patent foramen ovale with the patient on the operation table has vast consequences by making it necessary to switch to on pump, bi-caval cannulation for patent foramen ovale closure. We therefore developed a technique for transatrial closure of a patent foramen ovale, guided by transesophageal echocardiography. Results We have performed this surgery in 9 patients. None of them had a previously diagnosed patent foramen ovale. Mean age was 74 (±5) years, Operation time was 175 min (± 34 min), Clamp time 35 min (± 16 min) and Cardiopulmonary bypass time 80 (±17 min). Mortality was 0%. Periprocedural transesophageal echocardiography revealed closure of the patent foramen ovale in all cases. Conclusion We report a new surgical method for transoesophageal echocardiography controlled closure of a patent foramen ovale without the need for an atriotomy. This new technique is especially useful for the closure of patent foramen ovale in the setting of on-pump and off-pump coronary artery bypass graft surgeries alike.
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Affiliation(s)
- Felix Fleissner
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg- Strasse 1, 30625, Hannover, Germany.
| | - Paul Frank
- Clinic for Anesthesia and Critical Care Medicine, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg- Strasse 1, 30625, Hannover, Germany
| | - Issam Ismail
- Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg- Strasse 1, 30625, Hannover, Germany
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Stanger O, Grabherr M, Göber V, Gahl B, Reineke S, Stahel HT, Carrel TP. Reduced Permanent Pacemaker Implantation in Patients With Stentless Freedom SOLO Compared With Stented Perimount Magna Aortic Bioprostheses: A Propensity Score Weighted Analysis. Heart Lung Circ 2021; 30:423-30. [PMID: 32800443 DOI: 10.1016/j.hlc.2020.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/26/2020] [Accepted: 06/04/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Postoperative permanent pacemaker implantation (PPI) after conventional aortic valve replacement (AVR), due to new-onset severe conduction system disorders, is required in approximately 7% of patients. This study investigated the need for PPI after AVR with conventional stented Perimount Magna compared with the Freedom SOLO (FS) stentless valve (Sorin Group, Saluggia, Italy), now LivaNova plc (London, UK) that uses a strictly supra-annular, subcoronary running suture implantation technique, sparing the vulnerable interleaflet triangles in the region of the septum membranaceum. METHODS A total of 413 consecutive patients (71.4±9.2 yrs, 178 [43.1%] female) underwent isolated AVR using the stented Perimount Magna (n=264) or the stentless FS (n=149) bioprosthesis. Propensity score weighted analysis was used to account for patient-specific and procedural-specific variables, and to identify the prosthesis-specific need for early postoperative PPI within 30 days of AVR. RESULTS Twenty (20) patients required PPI, which was associated with longer intensive care unit (2.1±1.7 vs 1.5±3.0 days, p<0.001) and overall hospital stays (13.8±5.2 vs 10.7±5.3 days, p<0.001) compared with no PPI. Propensity weighted logistic regression including cross-clamp times identified that use of the stented Perimount Magna was associated with increased need for PPI, as compared with the FS, with an odds ratio 5.8 (95% CI, 1.09-30.76; p=0.039). CONCLUSIONS After corrections for all plausible confounders, AVR with the stented Perimount valve was associated with an odds ratio of almost 6 for an increased early postoperative need for pacemaker implantation compared with the FS stentless valve. This finding can be explained by the conventional implantation technique, which is potentially associated with mechanical trauma to the conducting system.
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Allen N, O'Sullivan K, Jones JM. The most influential papers in mitral valve surgery; a bibliometric analysis. J Cardiothorac Surg 2020; 15:175. [PMID: 32690042 PMCID: PMC7370429 DOI: 10.1186/s13019-020-01214-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 07/01/2020] [Indexed: 12/02/2022] Open
Abstract
This study is an analysis of the 100 most cited articles in mitral valve surgery. A bibliometric analysis is a tool to evaluate research performance in a given field. It uses the number of times a publication is cited by others as a proxy marker of its impact. The most cited paper Carpentier et al. discusses mitral valve repair in terms of restoring the geometry of the entire valve rather than simply narrowing the annulus (Carpentier, J Thorac Cardiovasc Surg 86:23–37, 1983). The first successful mitral valve repair was performed by Elliot Cutler at Brigham and Women’s Hospital in 1923 (Cohn et al., Ann Cardiothorac Surg 4:315, 2015). More recently percutaneous and minimally invasive techniques that were originally designed as an option for high risk patients are being trialled in other patient groups (Hajar, Heart Views 19:160–3, 2018). Comparison of percutaneous method with open repair represents an expanding area of research (Hajar, Heart Views 19:160–3, 2018). This study will analyse the top 100 cited papers relevant to mitral valve surgery, identifying the most influential papers that guide current management, the institutions that produce them and the authors involved.
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Affiliation(s)
- N Allen
- Department of Cardiothoracic Surgery, Royal Victoria Hospital, 274 Grosvenor Road, Belfast, BT12 6BA, UK.
| | - K O'Sullivan
- Department of Cardiothoracic Surgery, Royal Victoria Hospital, 274 Grosvenor Road, Belfast, BT12 6BA, UK
| | - J M Jones
- Department of Cardiothoracic Surgery, Royal Victoria Hospital, 274 Grosvenor Road, Belfast, BT12 6BA, UK
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32
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Ullah W, Khan MS, Gowda SN, Alraies MC, Fischman DL. Prosthetic Valve Endocarditis in Patients Undergoing TAVR Compared to SAVR: A Systematic Review and Meta-Analysis. Cardiovasc Revasc Med 2020; 21:1567-72. [PMID: 32553850 DOI: 10.1016/j.carrev.2020.05.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 05/21/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND The risk of prosthetic valve endocarditis (PVE) in patients who underwent transcatheter aortic valve replacement (TAVR) is presumed to be high. METHODS Electronic databases were searched to identify articles comparing the rate of PVE in post-TAVR and post-surgical aortic valve replacement (SAVR) patients. Pooled adjusted odds ratio (OR) was computed using a random-effects model. RESULTS A total of 19 studies consisting of 84,288 patients, were identified. There was no significant difference in the odds of PVE between patients undergoing TAVR and SAVR, at 30-day (OR 0.62, 95% confidence interval (CI) 0.20-1.92, p = 0.41), 1-year (OR 0.99 95% CI 0.89-1.11, p = 0.84), 2-year (OR 1.02 95% CI 0.68-1.54, p = 0.92) and 5-year (OR 1.03 95% CI 0.80-1.33, p = 0.81). A subgroup sensitivity analysis also showed no significant inter-group differences in the rate of PVE at all time points, when stratified by the study design (clinical trial vs. observational), type of TAVR valves used (self-expanding bioprosthetic valves vs. balloon expanded bioprosthetic valves) and surgical risk of patients (high vs. intermediate vs. low). There was no heterogeneity (I2 = 0%) in the outcomes of the included studies at 30-day, 1-year and 2-year, while the heterogeneity in studies at 5-year was minimal (I2 = 22%). CONCLUSIONS In comparison to SAVR, both short and long-term risk of prosthetic valve endocarditis appears to be identical in patients undergoing TAVR. This risk is unaffected by the type of valve, duration of follow-up, study design and surgical risk of the patients.
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33
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Ullah W, Sattar Y, Mukhtar M, Abdullah HM, Figueredo VM, Haas DC, Fischman DL, Chadi Alraies M. Outcomes of open mitral valve replacement versus Transcatheter mitral valve repair; insight from the National Inpatient Sample Database. Int J Cardiol Heart Vasc 2020; 28:100540. [PMID: 32490147 PMCID: PMC7262433 DOI: 10.1016/j.ijcha.2020.100540] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/14/2020] [Accepted: 05/17/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Transcatheter mitral valve repair and replacement (TMVR) is a minimally invasive alternative to conventional open-heart mitral valve replacement (OMVR). The present study aims to compare the burden, demographics, cost, and complications of TMVR and OMVR. METHODS The United States National Inpatient Sample (US-NIS) for the year 2017 was queried to identify all cases of TMVR and OMVR. Categorical and continuous data were analyzed using Pearson chi-square and independent t-test analysis, respectively. An adjusted odds ratio (aOR) based on the ordinal logistic regression (OLR) model was calculated to determine the association between outcome variables. RESULTS Of 19,580 patients, 18,460 (94%) underwent OMVR and 1120 (6%) TMVR. Mean ages of patients were 63 ± 14 years (OMVR) and 67 ± 13 years (TMVR). Both cohorts were predominantly Caucasian (73% OMVR vs. 74.0% TMVR). The patients who underwent TMVR were more likely to belong to a household with an income in the highest quartile (26.1% vs. 22.0% for OMVR) versus the lowest quartile (22.1% vs. 27.8%). The average number of days from admission to TMVR was less compared to OMVR (2.63 days vs. 3.02 days, p = 0.015). In-hospital length of stay (LOS) was significantly lower for TMVR compared to OMVR (11.56 vs. 14.01 days, p=<0.0001). Adjusted in-hospital mortality taking into account comorbidities showed no significant difference between the two groups (OR 1.2, 0.93-1.68, p = 0.15). CONCLUSION Patients undergoing TMVR were older and more financially affluent. TMVR was more costly but was associated with a shorter hospital stay and similar mortality to OMVR.
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Affiliation(s)
| | - Yasar Sattar
- Icahn school of medicine at Mount Sinai Elmhurst Hospital New York, USA
| | - Maryam Mukhtar
- Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
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Handa K, Yoshioka D, Toda K, Yokoyama JY, Samura T, Suzuki K, Miyagawa S, Matsumiya G, Sakaguchi T, Fukuda H, Sawa Y. Surgical Results for Infective Endocarditis Complicated With Cardiogenic Shock. Circ J 2020; 84:926-934. [PMID: 32295976 DOI: 10.1253/circj.cj-19-0583] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Infective endocarditis remains associated with substantial mortality and morbidity rates, and the presence of acute heart failure (AHF) compromises clinical results after valve surgery; however, little is known in cardiogenic shock (CGS) patients. This study evaluated the clinical results and risk of mortality in CGS patients after valve surgery.Methods and Results:This study enrolled 585 patients who underwent valve surgery for active endocarditis at 14 institutions between 2009 and 2017. Of these patients, 69 (12%) were in CGS, which was defined as systolic blood pressure <80 mmHg and severe pulmonary congestion, requiring mechanical ventilation and/or mechanical circulatory support, preoperatively. The predictors of CGS were analyzed, and clinical results of patients with non-CGS AHF (n=215) were evaluated and compared.Staphylococcus aureusinfection (odds ratio [OR] 2.19; P=0.044), double valve involvement (OR 3.37; P=0.003), and larger vegetation (OR 1.05; P=0.036) were risk factors for CGS. Hospital mortality occurred in 27 (13%) non-CGS AHF patients and in 15 (22%) CGS patients (P=0.079). Overall survival at 1 and 5 years in CGS patients was 76% and 69%, respectively, and there were no significant differences in overall survival compared with non-CGS AHF patients (P=1.000). CONCLUSIONS Clinical results after valve surgery in CGS patients remain challenging; however, mid-term results were equivalent to those of non-CGS AHF patients.
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Affiliation(s)
- Kazuma Handa
- Department of Cardiovascular Surgery, Osaka University Hospital
| | - Daisuke Yoshioka
- Department of Cardiovascular Surgery, Osaka University Hospital.,Department of Cardiovascular Surgery, Chiba University Hospital
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Hospital
| | - Jun-Ya Yokoyama
- Department of Cardiovascular Surgery, Osaka University Hospital
| | - Takaaki Samura
- Department of Cardiovascular Surgery, Osaka University Hospital
| | - Kota Suzuki
- Department of Cardiovascular Surgery, Osaka University Hospital
| | | | - Goro Matsumiya
- Department of Cardiovascular Surgery, Chiba University Hospital
| | | | - Hirotsugu Fukuda
- Department of Cardiovascular Surgery, Dokkyo University Medical School Hospital
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Hospital
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Wang CT, Zhang L, Qin T, Xi ZL, Sun L, Wu HW, Li DM. Cox-maze III procedure for atrial fibrillation during valve surgery: a single institution experience. J Cardiothorac Surg 2020; 15:111. [PMID: 32448312 PMCID: PMC7247260 DOI: 10.1186/s13019-020-01165-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/18/2020] [Indexed: 01/04/2023] Open
Abstract
Objectives Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in patients with heart valve disease. Our aim was to summarize our experience and evaluate the efficacy and safety of the Cox maze III procedure combined with valve surgery in patients with AF. Methods A retrospective, observational analysis was performed for all consecutive patients underwent maze III procedure combined with valve surgery between October 2015 and June 2019. In this trial, we used a monopolar radiofrequency (RF) ablation in addition to cut and sew technique to treat AF. Results 66 patients (37 female, 56.1%) with persistent or long-lasting persistent AF associated with valve disease were identified. The mean age was 54.2 ± 8.4 years (range, 30 to 73 years). Overall hospital mortality was 3.0%. The duration of cardiopulmonary bypass and aortic cross clamping was 175.4 ± 32.9 and 115.6 ± 22.8 min respectively. The first 24 h drainage was 488.6 ± 293.3 ml. The postoperative hospital stay was 14.8 ± 8.3 days. The postoperative incidence of permanent pacemaker implantation, reoperation for bleeding, renal failure required hemodialysis, and stroke was 4.5, 1.5, 4.5% and 0 respectively. The frequency of sinus rhythm was 91.7, 93.1, 94.7, 93.3 and 89.5% at 1, 3, 6, 12, and 24 months respectively. Conclusions The Cox-Maze III procedure is safe in the surgical treatment of AF associated with valve disease, and efficacious for sinus rhythm maintenance, with low morbidity and mortality.
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Affiliation(s)
- Chang-Tian Wang
- Department of Cardiovascular Surgery. Jinling Hospital, Nanjing University, School Medicine, 305 East Zhongshan Road, Nanjing, 210002, PR China.
| | - Lei Zhang
- Department of Cardiovascular Surgery. Jinling Hospital, Nanjing University, School Medicine, 305 East Zhongshan Road, Nanjing, 210002, PR China
| | - Tao Qin
- Department of Cardiovascular Surgery. Jinling Hospital, Nanjing University, School Medicine, 305 East Zhongshan Road, Nanjing, 210002, PR China
| | - Zhi-Long Xi
- Department of Cardiovascular Surgery. Jinling Hospital, Nanjing University, School Medicine, 305 East Zhongshan Road, Nanjing, 210002, PR China
| | - Lei Sun
- Department of Cardiovascular Surgery. Jinling Hospital, Nanjing University, School Medicine, 305 East Zhongshan Road, Nanjing, 210002, PR China
| | - Hai-Wei Wu
- Department of Cardiovascular Surgery. Jinling Hospital, Nanjing University, School Medicine, 305 East Zhongshan Road, Nanjing, 210002, PR China
| | - De-Min Li
- Department of Cardiovascular Surgery. Jinling Hospital, Nanjing University, School Medicine, 305 East Zhongshan Road, Nanjing, 210002, PR China
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Spiliopoulos K, Skoularigis J, Triposkiadis F. Surgery for infective endocarditis: old problem-still unanswered questions? Eur J Cardiothorac Surg 2020; 57:1016. [PMID: 31930306 DOI: 10.1093/ejcts/ezz362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/06/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- Kyriakos Spiliopoulos
- Department of Thoracic and Cardiovascular Surgery, Larissa University Hospital, Larissa, Greece
| | - John Skoularigis
- Cardiology Department, Larissa University Hospital, Larissa, Greece
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Gumus F, Hasde AI, Bermede O, Kilickap M, Durdu MS. Multiple Valve Implantation Through a Minimally Invasive Approach: Comparison of Standard Median Sternotomy and Right Anterior Thoracotomy. Heart Lung Circ 2020; 29:1418-1423. [PMID: 32249168 DOI: 10.1016/j.hlc.2020.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 12/09/2019] [Accepted: 01/16/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Following developments in the area of minimally invasive surgery and good, recently published surgical results, the areas in which minimally invasive surgery can be used are beginning to expand. This study aimed to describe experience and show the feasibility and safety of minimally invasive multiple valve implantation with right anterior minithoracotomy (RAT) and compare the outcomes with cases that underwent multiple valve surgery via a standard median sternotomy. METHODS The study cohort comprised 52 patients with combined valvular disease who underwent aortic valve replacement and mitral valve replacement or repair, and/or tricuspid valve ring annuloplasty through median sternotomy (control group n=32) or minimally invasive surgery through a RAT (study group n=20) between January 2012 and December 2018 at the current centre. Preoperative evaluation included coronary catheterisation and multisliced computerised tomography in all patients. Postoperative clinical outcomes and haemodynamic performance of heart valves were reviewed. RESULTS The mean age of patients was 72.6±7.1 years, and 50% were male. Seventeen (17) patients (32.6%) were in New York Heart Association functional class III or IV. Three (3) patients (7.6%) had third-degree atrioventricular block requiring permanent pacemaker implantation. Mean follow-up was 21±3.9 months (maximum 26 months). No major paravalvular leakage occurred, and there was no postoperative valve migration in either group. Non-valve-related deaths occurred in five patients during follow-up. CONCLUSION This study showed that minimally invasive multiple valve implantation is a technically feasible and safe procedure with acceptable surgical outcomes and similar postoperative quality when compared with median sternotomy.
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Affiliation(s)
- Fatih Gumus
- Department of Cardiovascular Surgery, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Ankara, Turkey
| | - Ali Ihsan Hasde
- Department of Cardiovascular Surgery, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Ankara, Turkey
| | - Onat Bermede
- Department of Anesthesiology and Reanimation, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Ankara, Turkey
| | - Mustafa Kilickap
- Department of Cardiology, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Ankara, Turkey
| | - Mustafa Serkan Durdu
- Department of Cardiovascular Surgery, Heart Center, Cebeci Hospitals, Ankara University School of Medicine, Ankara, Turkey.
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Liu X, Xie L, Zhu W, Zhou Y. Association of body mass index and all-cause mortality in patients after cardiac surgery: A dose-response meta-analysis. Nutrition 2019; 72:110696. [PMID: 32007807 DOI: 10.1016/j.nut.2019.110696] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/18/2019] [Accepted: 12/01/2019] [Indexed: 12/26/2022]
Abstract
Ample studies have reported the effect of body mass index (BMI) on the prognosis of patients undergoing cardiac surgery, but the results remain inconsistent. Therefore, we aimed to conduct a dose-response meta-analysis to clarify the relationship between BMI and all-cause mortality in this population. A systematic search was performed in the PubMed and Embase databases through April 2019 for studies that reported the impact of BMI on all-cause mortality in patients after cardiac surgery. Pooled risk ratios (RRs) were calculated using a random-effects model. Non-linear associations were explored with restricted cubic spline models. Forty-one studies with a total of 54,300 cases/1,774,387 patients were included. The pooled RR for all-cause mortality was 0.93 (95% CI 0.89-0.97) for every 5-unit increment in BMI, indicating that higher BMI did not increase the risk of all-cause mortality in patients after cardiac surgery. A U-shaped association with the nadir of risk at a BMI of 25-27.5 kg/m2 was observed, as well as a higher mortality risk for the underweight and the extremely obese patients. The subgroup analysis revealed that this phenomenon remained regardless of mean age, surgery type, geographic location and number of cases. Overall, for patients after cardiac surgery, a slightly higher BMI may be instrumental in survival, whereas underweight and extreme obesity is associated with a worse prognosis.
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Affiliation(s)
- Xin Liu
- Department of Critial Care Medicine, The First Affiliated Hosptial of Gannan Medical University, Ganzhou of Jiangxi, China
| | - Lixia Xie
- Department of Respiratory Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wengen Zhu
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yue Zhou
- Department of Pediatric Ophthalmology, The Second Affiliated Hospital of Nanchang University, Jiangxi, China.
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Abstract
The term "UFO" is not a medical term, but helps emphasize the extremely high degree of complexity of a surgical repair that is akin to someone observing an unidentified flying object. It involves replacement of the mitral and aortic valves with reconstruction of the intervalvular fibrous body (IVFB). Specific pathologies that render this operation necessary usually involve the IVFB, which is located between the aortic and mitral valves and constitutes a major portion of the fibrous skeleton of the heart. Patients that most often require such an operation are those with extensive aortic and mitral valve endocarditis with perivalvular extension into the IVFB. Other infrequent situations such as severe aortic and mitral annular calcification involving the IVFB, double valve replacement in patients with extremely small aortic and mitral annuli or double valve reoperations in which no IVFB is available following excision of both valves, necessitating the UFO procedure. The basic surgical principle has been first described as early as 1980. Depending on the extent of excised tissue due to the underlying disease, modifications and additional complex repair techniques have to be adopted. It is of utmost importance to have adequate visibility and exposure. There are certain important structures, which are at a risk of either injury or neglect, that can result in development of life-threatening complications during this operation, which a surgeon should be aware of. A step by step description of the "UFO" procedure can help guide the surgeon to perform this operation safely and efficiently. Although clinical complications are high, they are often related to the underlying disease and not specifically to the procedure itself, if performed perfectly.
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Affiliation(s)
- Martin Misfeld
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.,Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | - Piroze M Davierwala
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Michael A Borger
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Farhad Bakhtiary
- Department for Cardiac and Thoracic Surgery, Helios Clinic Siegburg, Siegburg, Germany
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Yokoyama J, Yoshioka D, Toda K, Matsuura R, Suzuki K, Samura T, Miyagawa S, Yoshikawa Y, Takano H, Matsumiya G, Sakaguchi T, Fukuda H, Takahashi T, Izutani H, Funatsu T, Nishi H, Sawa Y. Surgery-first treatment improves clinical results in infective endocarditis complicated with disseminated intravascular coagulation†. Eur J Cardiothorac Surg 2019; 56:785-792. [PMID: 30932157 DOI: 10.1093/ejcts/ezz068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 09/27/2018] [Revised: 02/02/2019] [Accepted: 02/12/2019] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES Infective endocarditis (IE) is a critical infection with a high mortality rate, and it usually causes sepsis. Though disseminated intravascular coagulation (DIC) sometimes occurs in IE patients, no definitive treatment strategy for IE patients with DIC as a complication exists. Therefore, we evaluated the prevalence, surgical results and treatment strategy for IE complicated with DIC. METHODS Between 2009 and 2017, a total of 585 patients undergoing valve surgery for active IE were enrolled at 14 institutions, of whom 116 (20%) had DIC as a complication. For further evaluation, we divided DIC patients into medical treatment-first (n = 45, group M) and valve surgery-first (n = 51, group S) groups after excluding 20 patients with intracranial haemorrhage. RESULTS The overall survival rates at 1 and 5 years were 91% and 85% in the non-DIC group and 65% and 55% in the DIC group, respectively (P < 0.001). Recurrence-free survival rates at 1 and 5 years were 99% and 95% in the non-DIC group and 94% and 74% in the DIC group, respectively (P < 0.001). The overall survival rates at 1 and 5 years were 77% and 64% in group S and 51% and 46% in group M, respectively (P = 0.032). Multivariable analysis revealed that 'medical treatment first' was an exclusive independent risk factor [hazards ratio 2.26 (1.13-4.75), P = 0.024] for overall mortality. CONCLUSIONS Mortality and IE recurrence were statistically significantly higher in DIC patients. Valve surgery should not be delayed because most patients proceeding with medical treatment eventually require emergency surgery and their clinical outcomes are worse than those of patients undergoing early surgery.
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Affiliation(s)
- Junya Yokoyama
- Department of Cardiovascular Surgery, Osaka University Hospital, Osaka, Japan
| | - Daisuke Yoshioka
- Department of Cardiovascular Surgery, Osaka University Hospital, Osaka, Japan
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Hospital, Osaka, Japan
| | - Ryohei Matsuura
- Department of Cardiovascular Surgery, Osaka University Hospital, Osaka, Japan
| | - Kota Suzuki
- Department of Cardiovascular Surgery, Osaka University Hospital, Osaka, Japan
| | - Takaaki Samura
- Department of Cardiovascular Surgery, Osaka University Hospital, Osaka, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Hospital, Osaka, Japan
| | - Yasushi Yoshikawa
- Department of Cardiovascular Surgery, Osaka University Hospital, Osaka, Japan
| | - Hiroshi Takano
- Department of Cardiovascular Surgery, Dokkyo Koshigaya Medical Center, Saitama, Japan
| | - Goro Matsumiya
- Department of Cardiovascular Surgery, Chiba University Hospital, Chiba, Japan
| | - Taichi Sakaguchi
- Department of Cardiovascular Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Hirotsugu Fukuda
- Department of Cardiovascular Surgery, Dokkyo University Medical School Hospital, Tochigi, Japan
| | - Toshiki Takahashi
- Department of Cardiovascular Surgery, Osaka Police Hospital, Osaka, Japan
| | - Hironori Izutani
- Department of Cardiovascular Surgery, Ehime University Hospital, Matsuyama, Japan
| | - Toshihiro Funatsu
- Department of Cardiovascular Surgery, Rinku General Medical Center, Osaka, Japan
| | - Hiroyuki Nishi
- Department of Cardiovascular Surgery, Osaka Police Hospital, Osaka, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Hospital, Osaka, Japan
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Elsherbiny M, Abdelwahab Y, Nagy K, Mannaa A, Hassabelnaby Y. Role of Intraoperative Transesophageal Echocardiography in Cardiac Surgery: an Observational Study. Open Access Maced J Med Sci 2019; 7:2480-2483. [PMID: 31666851 PMCID: PMC6814460 DOI: 10.3889/oamjms.2019.712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 08/01/2019] [Accepted: 08/08/2019] [Indexed: 12/19/2022] Open
Abstract
AIM: This study is based on the hypothesis that the routine use of transesophageal echocardiography in cardiac surgery will influence the surgical decision taken by the surgeon intra-operatively in Kasr-Alainy hospitals. METHODS: Patients were examined with intraoperative transesophageal echocardiography (TEE) before and after cardiopulmonary bypass. Complete and comprehensive intraoperative TEE examinations will be performed by TEE certified cardiac anesthesiologists. Data that will be collected from the intraoperative examination and will be compared with preoperative transthoracic echocardiography, and the surgical decision that was taken preoperatively will be revised again with the cardiothoracic surgeon before the start of surgery. Also, TEE will be used again after weaning from bypass for revision and assessment of our decision. RESULTS: We examined the utility of TEE in 100 patients undergoing different types of cardiac procedures in Kasr Al-Ainy hospital. This prospective clinical investigation found that the pre- and post-CPB TEE examinations influenced surgical decision making in 10% of all evaluated patients. CONCLUSION: Intraoperative TEE has the potential to influence clinical decision making for cardiac surgical patients significantly. It is useful in surgical planning, guiding various hemodynamic interventions, and assessing the immediate results of surgery. Thus, IOTEE should be used routinely in all patients undergoing all types of cardiac surgeries.
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Affiliation(s)
- Mona Elsherbiny
- Anesthesia Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Yaser Abdelwahab
- Anesthesia Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Kareem Nagy
- Anesthesia Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Asser Mannaa
- Anesthesia Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Olds A, Saadat S, Azzolini A, Dombrovskiy V, Odroniec K, Lemaire A, Ghaly A, Lee LY. Improved operative and recovery times with mini-thoracotomy aortic valve replacement. J Cardiothorac Surg 2019; 14:91. [PMID: 31072356 PMCID: PMC6509756 DOI: 10.1186/s13019-019-0912-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 04/23/2019] [Indexed: 11/25/2022] Open
Abstract
Background The small incisions of minimally invasive surgery have the proposed benefit of less surgical trauma, less pain, and faster recovery. This study was done to compare minimally invasive techniques for aortic valve replacement, including right anterior mini-thoracotomy and mini-sternotomy, to conventional sternotomy. Methods We retrospectively reviewed 503 patients who underwent isolated aortic valve replacement at our institution from 2012 to 2015 using one of three techniques: 1) Mini-thoracotomy, 2) Mini-sternotomy, 3) Conventional sternotomy. Demographics, operative morbidity, mortality, and postoperative complications were compared. Results Of the 503 cases, 267 (53.1%) were mini-thoracotomy, 120 (23.8%) were mini-sternotomy, and 116 (23.1%) were conventional sternotomy. Mini-thoracotomy patients, compared to mini-sternotomy and conventional sternotomy, had significantly shorter bypass times [82 (IQ 67–113) minutes; vs. 117 (93.5–139.5); vs. 102.5 (85.5–132.5), respectively (p < 0.0001)], a lower incidence of prolonged ventilator support [3.75% vs. 9.17 and 12.9%, respectively (p = 0.0034)], and required significantly shorter ICU and postoperative stays, resulting in an overall shorter hospitalization [6 (IQ 5–9) days; vs. 7 (5–14.5); vs 9 (6–15.5), respectively (p < 0.05)]. Incidence of other postoperative complications were lower in the mini-thoracotomy group compared to mini-sternotomy and conventional sternotomy, without significance. Minimally invasive techniques trended towards better survival [mini-thoracotomy 1.5%, mini-sternotomy 1.67%, and conventional sternotomy 5.17% (p = 0.13)]. Conclusions Minimally invasive aortic valve replacement approaches are safe, effective alternatives to conventional sternotomy. The mini-thoracotomy approach showed decreased operative times, decreased lengths of stay, decreased incidence of prolonged ventilator time, and a trend towards lower mortality when compared to mini-sternotomy and conventional sternotomy.
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Affiliation(s)
- Anna Olds
- Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Siavash Saadat
- Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA. .,, Boston, USA.
| | - Anthony Azzolini
- Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Viktor Dombrovskiy
- Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Karen Odroniec
- Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Anthony Lemaire
- Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Aziz Ghaly
- Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Leonard Y Lee
- Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Isoda S, Izubuchi R, Yamazaki I, Nakayama Y, Yano Y, Masuda M. Priming and replenishment in cardiopulmonary bypass with hydroxyethyl starch 130/0.4 decreases fluid overbalance without renal dysfunction or bleeding in adult valve surgery. Gen Thorac Cardiovasc Surg 2019; 67:374-6. [PMID: 30805825 DOI: 10.1007/s11748-019-01091-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 02/18/2019] [Indexed: 10/27/2022]
Abstract
The best priming and replenishment solution in cardiopulmonary bypass remains unknown, and the efficacy and drawbacks of artificial colloid are controversial. We retrospectively compared consecutive patients undergoing elective adult valve surgery in cases wherein cardiopulmonary bypass was primed and replenished with hydroxyethyl starch 130/0.4 (n = 12) or crystalloid solution (n = 11). The fluid overbalance during cardiopulmonary bypass was much lower in the hydroxyethyl starch 130/0.4 group (mean ± standard deviation, + 95 ± 1241 mL) than in the crystalloid solution group (+ 2921 ± 1984 mL) (P < 0.001). Renal function, intraoperative and postoperative bleeding, and blood products did not deteriorate with the use of hydroxyethyl starch 130/0.4. The postoperative intubation time was shorter in the hydroxyethyl starch 130/0.4 group (16.0 ± 2.6 h) than in the crystalloid solution group (18.7 ± 2.6 h) (P = 0.018). Although prospective randomized trials are needed to verify our findings, the impact of fluid balance differences requires serious consideration.
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Halavaara M, Martelius T, Järvinen A, Antikainen J, Kuusela P, Salminen US, Anttila VJ. Impact of pre-operative antimicrobial treatment on microbiological findings from endocardial specimens in infective endocarditis. Eur J Clin Microbiol Infect Dis 2019; 38:497-503. [PMID: 30680557 PMCID: PMC6394703 DOI: 10.1007/s10096-018-03451-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 12/05/2018] [Indexed: 01/13/2023]
Abstract
Treatment of infective endocarditis (IE) should be initiated promptly. This might hamper the chances to identify the causative organism in blood cultures. Microbiological sampling of infected valve in patients undergoing surgery might identify the causative organism. The impact of pre-operative antimicrobial treatment on the yield of valve samples is not known. This study evaluated the impact of the duration of the pre-operative antibiotic treatment on valve culture and 16S rRNA PCR findings from resected endocardial samples. Patients meeting the modified Duke criteria of definite or possible IE and undergoing valve surgery due to IE during 2011–2016 were included from Southern Finland. Eighty-seven patients were included. In patients with shorter than 2 weeks of pre-operative antimicrobial treatment, PCR was positive in 91% (n = 42/46) and valve culture in 41% (n = 19/46) of cases. However, in patients who had 2 weeks or longer therapy before operation, PCR was positive in 53% (n = 18/34) and all valve cultures were negative. In 14% of patients, PCR had a diagnostic impact. In blood-culture negative cases (n = 13), PCR could detect the causative organism in ten patients (77%). These included five cases of Bartonella quintana, one Tropheryma whipplei, and one Coxiella burnetii. Long pre-operative antimicrobial treatment was shown to have a negative impact on microbiological tests done on resected endocardial material. After 2 weeks of therapy, all valve cultures were negative, but PCR was positive in half of the cases. PCR aided in diagnostic work-up, especially in blood culture negative cases.
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Affiliation(s)
- Mika Halavaara
- Department of Infectious Diseases, Inflammation Center, Helsinki University Hospital (HUH) and University of Helsinki, Meilahti Triangle Hospital, open-plan office, 1st floor, P.O. BOX 372, 00029, Helsinki, Finland.
| | - Timi Martelius
- Department of Infectious Diseases, Inflammation Center, Helsinki University Hospital (HUH) and University of Helsinki, Meilahti Triangle Hospital, open-plan office, 1st floor, P.O. BOX 372, 00029, Helsinki, Finland
| | - Asko Järvinen
- Department of Infectious Diseases, Inflammation Center, Helsinki University Hospital (HUH) and University of Helsinki, Meilahti Triangle Hospital, open-plan office, 1st floor, P.O. BOX 372, 00029, Helsinki, Finland
| | - Jenni Antikainen
- Division of Clinical Microbiology, HUSLAB, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Pentti Kuusela
- Division of Clinical Microbiology, HUSLAB, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ulla-Stina Salminen
- Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Veli-Jukka Anttila
- Department of Infectious Diseases, Inflammation Center, Helsinki University Hospital (HUH) and University of Helsinki, Meilahti Triangle Hospital, open-plan office, 1st floor, P.O. BOX 372, 00029, Helsinki, Finland
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Duchnowski P, Hryniewiecki T, Kuśmierczyk M, Szymanski P. Red cell distribution width as a predictor of multiple organ dysfunction syndrome in patients undergoing heart valve surgery. Biol Open 2018; 7:bio.036251. [PMID: 30127093 PMCID: PMC6215413 DOI: 10.1242/bio.036251] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The aim of the study was to evaluate the prognostic value of red cell distribution width (RDW) for multiple organ dysfunction syndrome (MODS) in the early postoperative period in patients undergoing valve replacement or repair surgery. A prospective study was conducted on a group of 713 patients with haemodynamically significant valvular heart disease who underwent elective valvular surgery. The primary end-point at the 30-day follow-up was postoperative MODS. The secondary end-point was death from all causes in patients with MODS. The postoperative MODS occurred in 72 patients. At multivariate analysis: RDW (OR 1.267; 95% CI 1.113-1.441; P=0.0003), creatinine (OR 1.007; 95% CI 1.001-1.013; P=0.02) and age (OR 1.047; 95% CI 1.019-1.077; P=0.001) remained independent predictors of the primary end-point. Receiver operator characteristics analysis determined a cut-off value of RDW for the prediction of the occurrence of the perioperative MODS at 14.3%. RDW (OR 1.448; 95% CI 1.057-1.984; P=0.02) and age (OR 1.057; 95% CI 1.007-1.117; P=0.04) were associated with an increased risk of death in patients with perioperative MODS. Elevated RDW is associated with a higher risk of MODS and death in patients with MODS following heart valve surgery.
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Affiliation(s)
- Piotr Duchnowski
- Institute of Cardiology, Department of Acquired Cardiac Defects, 04-628 Warsaw, Poland
| | - Tomasz Hryniewiecki
- Institute of Cardiology, Department of Acquired Cardiac Defects, 04-628 Warsaw, Poland
| | - Mariusz Kuśmierczyk
- Institute of Cardiology, Department of Cardiosurgery and Transplantology, 04-628 Warsaw, Poland
| | - Piotr Szymanski
- Institute of Cardiology, Department of Acquired Cardiac Defects, 04-628 Warsaw, Poland
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Di Mauro M, Barili F; GIROC (Gruppo Italiano Ricerca sugli Outcome in Cardiochirurgia). Validation of Endoscore. Reply to Dr Barca. Int J Cardiol 2018; 267:197. [PMID: 29957258 DOI: 10.1016/j.ijcard.2018.05.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 05/17/2018] [Accepted: 05/29/2018] [Indexed: 11/21/2022]
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Abstract
Infective endocarditis (IE) is associated with significant serious adverse outcomes including death. IE usually presents with diverse clinical picture and syndromic diagnoses including heart failure, stroke, and peripheral embolization. Given variable, vague, and syndromic presentations, the diagnosis of IE may be delayed for days to weeks. Maintaining a high index of suspicion among clinicians is the key to early recognition of the disease and prompt initiation of antimicrobial therapy to prevent IE-associated mortality and morbidity. Blood culture and echocardiography remain essential tools in the diagnosis of infective endocarditis. However, advances in molecular techniques, serology testing, computed tomography scan, and nuclear medicine have led to growth in the available tools that may aid in early diagnosis of infective endocarditis. Antimicrobial agents are the mainstay of IE therapy; however, as many as 50% of endocarditis cases will undergo valve surgery, even on an urgent or emergent basis.
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Affiliation(s)
- Aref A Bin Abdulhak
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, 52242, USA
| | - Abdul H Qazi
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, 52242, USA
| | - Imad M Tleyjeh
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA. .,Division of Epidemiology, Mayo Clinic, Rochester, MN, USA. .,Department of Medicine, Infectious Diseases Section, King Fahad Medical City, PO Box 59046, Riyadh, 11525, Saudi Arabia. .,College of Medicine, Al Faisal University, Riyadh, Saudi Arabia.
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Mahía P, Aguilar R, De Agustín JA, Marcos-Alberca P, Islas F, Tirado G, Nogales MT, Gómez de Diego JJ, Luaces M, Rodrigo JL, Cobos MÁ, Macaya C, Pérez de Isla L. Three-dimensional Tricuspid Area. A New Criterion to Improve Patient Selection for Annuloplasty in Tricuspid Regurgitation. ACTA ACUST UNITED AC 2018; 72:732-739. [PMID: 30042008 DOI: 10.1016/j.rec.2018.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/22/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION AND OBJECTIVES Late functional tricuspid regurgitation after rheumatic left-sided valve surgery is an important predictor of poor prognosis. This study investigated the usefulness and accuracy of 3-dimensional transthoracic echocardiography tricuspid area compared with conventional 2-dimensional diameter (2DD) for assessing significant tricuspid annulus dilatation, providing cutoff values that could be used in clinical practice to improve patient selection for surgery. METHODS We prospectively included 109 patients with rheumatic heart disease in the absence of previous valve replacement. Tricuspid regurgitation was divided into 3 groups: mild, moderate, and severe. Optimal 3-dimensional area (3DA) and 2DD cutoff points for identification of significant tricuspid annulus dilatation were obtained and compared with current guideline thresholds. Predictive factors for 3DA dilatation were also assessed. RESULTS Optimal cutoff points for both absolute and adjusted to body surface area (BSA) tricuspid annulus dilatation were identified (3DA: 10.4 cm2, 6.5 cm2/m2; 2DD: 35 mm, 21 mm/m2); 3DA/BSA had the best diagnostic performance (AUC=0.83). Three-dimensional transthoracic echocardiography tricuspid area helped to reclassify surgical indication in 14% of patients with mild tricuspid regurgitation (95%CI, 1%-15%; P=.03) and 37% with moderate tricuspid regurgitation (95%CI, 22%-37%; P<.0001), whereas 3DA/BSA changed surgery criteria in cases of mild tricuspid regurgitation (17%; 95%CI, 3%-17%; P=.01) compared with 2DD/BSA. On multivariable analysis, right and left atrial volumes and basal right ventricle diameter were independently correlated with 3DA. CONCLUSIONS The current 40 mm threshold underestimates tricuspid annulus dilatation. Although 21 mm/m2 seems to be a reasonable criterion, the combination with 3DA assessment improves patient selection for surgery.
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Affiliation(s)
- Patricia Mahía
- Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain.
| | - Río Aguilar
- Departamento de Cardiología, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Pedro Marcos-Alberca
- Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Fabián Islas
- Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Gabriela Tirado
- Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - María Teresa Nogales
- Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | - María Luaces
- Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - José Luis Rodrigo
- Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Miguel Ángel Cobos
- Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Carlos Macaya
- Instituto Cardiovascular, Hospital Universitario Clínico San Carlos, Madrid, Spain
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Elgalad A, Arafat A, Elshazly T, Elkahwagy M, Fawzy H, Wahby E, Taha AH, Sampaio L, Herregods MC, Peetermans W, Herijgers P. Surgery for Active Infective Endocarditis of the Aortic Valve With Infection Extending Beyond the Leaflets. Heart Lung Circ 2018; 28:1112-1120. [PMID: 30181036 DOI: 10.1016/j.hlc.2018.05.200] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 05/28/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The optimal aortic substitute in extensive aortic valve active infective endocarditis (AIE) continues to be debated. To determine the surgical approach in aortic valve AIE with infection extension beyond the leaflets, we evaluated the outcome of reconstructive surgery with various valve substitutes in those patients. METHODS During 2000-2013, 168 patients had surgery for extensive aortic valve AIE. Patients were categorised based on aortic valve substitute: Group A: Stented aortic valve replacement (AVR), Group B: Stented AVR with patch support, Group C: Stentless valve, Group D: Aortic allograft, and Group E: Composite valve graft. Outcome parameters were mortality, postoperative cardiogenic or septic shock, stroke, or reinfection. RESULTS Stented valves with patch support were more frequently utilised in cases of native valve endocarditis (p<0.001). Postoperative complications were comparable among groups. Concomitant preoperative extension of infection in the mitral valve predicted reinfection (OR 3.6; confidence interval 1.46-8.66; p=0.005). Survival was not affected by operative group (log rank=0.6). Univariable preoperative predictors of mortality were: septic shock (hazard ratio 8.3; 95% confidence interval 3.6-19.2; p<0.001), ejection fraction (hazard ratio 0.96; 95% confidence interval 0.93-0.99; p=0.006), preoperative cardiogenic shock (hazard ratio 1.9; 95%CI 1.1-3.6, p=0.02) and concomitant mitral valve surgery (hazard ratio 1.8; 95% confidence interval 1.2-2.5; p=0.002). CONCLUSIONS Surgical treatment of extensive aortic valve infective endocarditis remains a challenge. Outcomes were not affected by the surgical complexity of aortic reconstruction procedure or valve substitute. Surgical approach should be tailored to individual patient's characteristics.
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Affiliation(s)
- Abdelmotagaly Elgalad
- Cardiothoracic Surgery Department, Tanta University, Tanta, Gharbeya, Egypt; Cullen Cardiovascular Surgery Research, Texas Heart Institute, Houston, TX, USA
| | - Amr Arafat
- Cardiothoracic Surgery Department, Tanta University, Tanta, Gharbeya, Egypt
| | - Tarek Elshazly
- Cardiothoracic Surgery Department, Tanta University, Tanta, Gharbeya, Egypt
| | - Mohamed Elkahwagy
- Cardiothoracic Surgery Department, Tanta University, Tanta, Gharbeya, Egypt
| | - Hossam Fawzy
- Cardiothoracic Surgery Department, Tanta University, Tanta, Gharbeya, Egypt
| | - Ehab Wahby
- Cardiothoracic Surgery Department, Tanta University, Tanta, Gharbeya, Egypt
| | - Abdel-Hady Taha
- Cardiothoracic Surgery Department, Tanta University, Tanta, Gharbeya, Egypt
| | - Luiz Sampaio
- Cullen Cardiovascular Surgery Research, Texas Heart Institute, Houston, TX, USA
| | | | - Willy Peetermans
- Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Paul Herijgers
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.
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Rogers CA, Capoun R, Scott LJ, Taylor J, Jain A, Angelini GD, Narayan P, Suleiman MS, Sarkar K, Ascione R. Shortening cardioplegic arrest time in patients undergoing combined coronary and valve surgery: results from a multicentre randomized controlled trial: the SCAT trial. Eur J Cardiothorac Surg 2018; 52:288-296. [PMID: 28444178 PMCID: PMC5848808 DOI: 10.1093/ejcts/ezx087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 02/26/2017] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Combined coronary artery bypass grafting and valve surgery requires a prolonged period of cardioplegic arrest (CA) predisposing to myocardial injury and postoperative cardiac-specific complications. The aim of this trial was to reduce the CA time in patients undergoing combined coronary artery bypass grafting and valve surgery and assess if this was associated with less myocardial injury and related complications. METHODS Participants were randomized to (i) coronary artery bypass grafting performed on the beating heart with cardiopulmonary bypass support followed by CA for the valve procedure (hybrid) or (ii) both procedures under CA (conventional). To assess complications related to myocardial injury, we used the composite of death, myocardial infarction, arrhythmia, need for pacing or inotropes for >12 h. To assess myocardial injury, we used serial plasma troponin T and markers of metabolic stress in myocardial biopsies. RESULTS Hundred and sixty patients (80 hybrid and 80 conventional) were randomized. Mean age was 66.5 years and 74% were male. Valve procedures included aortic (61.8%) and mitral (33.1%) alone or in combination (5.1%). CA time was 16% lower in the hybrid group [median 98 vs 89 min, geometric mean ratio (GMR) 0.84, 95% confidence interval (CI) 0.77-0.93, P = 0.0004]. Complications related to myocardial injury occurred in 131/160 patients (64/80 conventional, 67/80 hybrid), odds ratio 1.24, 95% CI 0.54-2.86, P = 0.61. Release of troponin T was similar between groups (GMR 1.04, 95% CI 0.87-1.24, P = 0.68). Adenosine monophosphate was 28% lower in the hybrid group (GMR 0.72, 95% CI 0.51-1.02, P = 0.056). CONCLUSIONS The hybrid procedure reduced the CA time but myocardial injury outcomes were not superior to conventional approach. TRIAL REGISTRATION ISRCTN65770930.
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Affiliation(s)
- Chris A Rogers
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Radek Capoun
- Bristol Heart Institute, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Lauren J Scott
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Jodi Taylor
- Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Anil Jain
- SAL Hospital and Medical Institute, Ahmedabad, India
| | - Gianni D Angelini
- Bristol Heart Institute, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Pradeep Narayan
- Rabindranath Tagore International Institute of Cardiac Sciences (RTIICS), Kolkata, India
| | - M-Saadeh Suleiman
- Bristol Heart Institute, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Kunal Sarkar
- Rabindranath Tagore International Institute of Cardiac Sciences (RTIICS), Kolkata, India
| | - Raimondo Ascione
- Bristol Heart Institute, School of Clinical Sciences, University of Bristol, Bristol, UK
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