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De Gaspari M, Ascione A, Baldovini C, Marzullo A, Pucci A, Rizzo S, Salzillo C, Angelini A, Basso C, d'Amati G, di Gioia CRT, van der Wal AC, Giordano C. Cardiovascular pathology in vasculitis. Pathologica 2024; 116:78-92. [PMID: 38767541 DOI: 10.32074/1591-951x-993] [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: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 05/22/2024] Open
Abstract
Vasculitides are diseases that can affect any vessel. When cardiac or aortic involvement is present, the prognosis can worsen significantly. Pathological assessment often plays a key role in reaching a definite diagnosis of cardiac or aortic vasculitis, particularly when the clinical evidence of a systemic inflammatory disease is missing. The following review will focus on the main histopathological findings of cardiac and aortic vasculitides.
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Affiliation(s)
- Monica De Gaspari
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Azienda Ospedaliera, Padova, Italy
| | - Andrea Ascione
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Chiara Baldovini
- Department of Pathology, Cardiovascular and Cardiac Transplant Pathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Marzullo
- Department of Precision and Regenerative Medicine and Ionian Area, Pathology Unit, University of Bari "Aldo Moro", Bari, Italy
| | - Angela Pucci
- Histopathology Department, University Hospital of Pisa, Pisa, Italy
| | - Stefania Rizzo
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Azienda Ospedaliera, Padova, Italy
| | - Cecilia Salzillo
- Department of Precision and Regenerative Medicine and Ionian Area, Pathology Unit, University of Bari "Aldo Moro", Bari, Italy
| | - Annalisa Angelini
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Azienda Ospedaliera, Padova, Italy
| | - Cristina Basso
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Azienda Ospedaliera, Padova, Italy
| | - Giulia d'Amati
- Department of Radiology, Oncology and Pathology, Sapienza University, Rome, Italy
| | | | - Allard C van der Wal
- Department of Pathology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Carla Giordano
- Department of Radiology, Oncology and Pathology, Sapienza University, Rome, Italy
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Monteiro S, Curate F, Garcia S, Cunha E. The Identification Potential of Atherosclerotic Calcifications in the Context of Forensic Anthropology. Biology (Basel) 2024; 13:66. [PMID: 38392285 PMCID: PMC10886313 DOI: 10.3390/biology13020066] [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] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/18/2024] [Accepted: 01/21/2024] [Indexed: 02/24/2024]
Abstract
Atherosclerosis is an inflammatory disease that, in its more developed stages, can lead to the calcification of fatty plaques on the walls of arteries, resulting in the appearance of new bone elements. It is a condition that has been studied and documented little in the context of paleopathology, especially in the framework of forensic anthropology. This article analyzed the skeletal remains of 71 individuals (35 females and 36 males) from the Luís Lopes Identified Collection of the National Museum of Natural History and Science in Lisbon, 31 of whom had an autopsy report. An attempt was made to ascertain whether these bone elements resulting from atherosclerotic calcification would resist cadaveric decomposition and whether they would be recoverable several years after burial, and a survey was carried out of their distribution according to sex and age, as well as their association with other pathologies, such as osteoporosis and cardiac and renal pathologies. An imaging analysis of an atherosclerotic plaque was also carried out to complement the macroscopic analysis and present other methods of identifying plaques. It was concluded that each atherosclerotic calcification has a unique profile, which can be useful for identification, especially in cases where the individual shows a severe condition. In terms of identification potential, the analysis of calcified atherosclerotic plaques can be useful, as they can corroborate or reject an identification. However, it always requires the existence of ante-mortem imaging exams and must always be used in addition to other identification methods. Regardless of the identification, these plaques are bone elements resulting from a pathology and should, therefore, be known and recognized by the scientific community.
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Affiliation(s)
- Sara Monteiro
- University of Coimbra, Centre for Functional Ecology, Department of Life Sciences, Calçada Martim de Freitas, 3000-456 Coimbra, Portugal
- National Institute of Legal Medicine and Forensic Sciences, 1150-334 Lisbon, Portugal
| | - Francisco Curate
- University of Coimbra, Research Centre for Anthropology and Health (CIAS), Department of Life Sciences, Faculty of Sciences and Technology, Calçada Martim de Freitas, 3000-456 Coimbra, Portugal
| | - Susana Garcia
- Centro de Administração e Políticas Públicas, Instituto Superior de Ciências Sociais e Políticas, Museu Nacional de História Natural e da Ciência, Universidade de Lisboa, Rua Almerindo Lessa, 1300-663 Lisbon, Portugal
| | - Eugénia Cunha
- University of Coimbra, Centre for Functional Ecology, Department of Life Sciences, Calçada Martim de Freitas, 3000-456 Coimbra, Portugal
- National Institute of Legal Medicine and Forensic Sciences, 1150-334 Lisbon, Portugal
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Seropian IM, Cassaglia P, Miksztowicz V, González GE. Unraveling the role of galectin-3 in cardiac pathology and physiology. Front Physiol 2023; 14:1304735. [PMID: 38170009 PMCID: PMC10759241 DOI: 10.3389/fphys.2023.1304735] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
Galectin-3 (Gal-3) is a carbohydrate-binding protein with multiple functions. Gal-3 regulates cell growth, proliferation, and apoptosis by orchestrating cell-cell and cell-matrix interactions. It is implicated in the development and progression of cardiovascular disease, and its expression is increased in patients with heart failure. In atherosclerosis, Gal-3 promotes monocyte recruitment to the arterial wall boosting inflammation and atheroma. In acute myocardial infarction (AMI), the expression of Gal-3 increases in infarcted and remote zones from the beginning of AMI, and plays a critical role in macrophage infiltration, differentiation to M1 phenotype, inflammation and interstitial fibrosis through collagen synthesis. Genetic deficiency of Gal-3 delays wound healing, impairs cardiac remodeling and function after AMI. On the contrary, Gal-3 deficiency shows opposite results with improved remodeling and function in other cardiomyopathies and in hypertension. Pharmacologic inhibition with non-selective inhibitors is also protective in cardiac disease. Finally, we recently showed that Gal-3 participates in normal aging. However, genetic absence of Gal-3 in aged mice exacerbates pathological hypertrophy and increases fibrosis, as opposed to reduced fibrosis shown in cardiac disease. Despite some gaps in understanding its precise mechanisms of action, Gal-3 represents a potential therapeutic target for the treatment of cardiovascular diseases and the management of cardiac aging. In this review, we summarize the current knowledge regarding the role of Gal-3 in the pathophysiology of heart failure, atherosclerosis, hypertension, myocarditis, and ischemic heart disease. Furthermore, we describe the physiological role of Gal-3 in cardiac aging.
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Affiliation(s)
- Ignacio M. Seropian
- Laboratorio de Patología Cardiovascular Experimental e Hipertensión Arterial, Instituto de Investigaciones Biomédicas (UCA-CONICET), Facultad de Ciencias Médicas Universidad Católica Argentina, Buenos Aires, Argentina
- Servicio de Hemodinamia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Pablo Cassaglia
- Departamento de Patología, Instituto de Salud Comunitaria, Universidad Nacional de Hurlingham, Buenos Aires, Argentina
| | - Verónica Miksztowicz
- Laboratorio de Patología Cardiovascular Experimental e Hipertensión Arterial, Instituto de Investigaciones Biomédicas (UCA-CONICET), Facultad de Ciencias Médicas Universidad Católica Argentina, Buenos Aires, Argentina
| | - Germán E. González
- Laboratorio de Patología Cardiovascular Experimental e Hipertensión Arterial, Instituto de Investigaciones Biomédicas (UCA-CONICET), Facultad de Ciencias Médicas Universidad Católica Argentina, Buenos Aires, Argentina
- Departamento de Patología, Instituto de Salud Comunitaria, Universidad Nacional de Hurlingham, Buenos Aires, Argentina
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Myagkova MA, Orlova EA, Petrochenko SN, Bobrova ZV, Bachurin SO. Analysis of Immunobiochemical Parameters in Overweight People in Assessing the Risk of Cardiovascular Diseases. Bull Exp Biol Med 2023; 174:446-450. [PMID: 36894812 DOI: 10.1007/s10517-023-05726-0] [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: 07/08/2022] [Indexed: 03/11/2023]
Abstract
A comparative analysis of specific immunobiochemical parameters, including natural antibodies (NAb) to endogenous regulators of the cardiovascular system, adrenal and gastrointestinal hormones, was performed in students aged 18-22 years with normal and increased body weight (the body mass index from 18.5 to 24.9 kg/m2 and from 25 to 29.9 kg/m2, respectively). The serum content of NAb and hormones was determined by ELISA. The level of the studied indicators depended on the body mass index value. In overweight subjects, the main immune indicators of the biogenic amine system, renin-angiotensin system, and kinin system exceeded the normal. The cortisol level was higher than in subjects with normal body weight. Aldosterone secretion was less dependent on the ACTH content and was lower than in students with normal body weight. The content of cholecystokinin and gastrin corresponded to the values for overweight. These trends in hormone contents are a predisposing factor for further weight gain. Practical significance of the combined assessment of disturbances in the immunological and biochemical homeostasis has been established. Analysis of the adrenal and gastrointestinal hormones can predict the risk of weight gain, but at the same time, changes in the level of immunological indicators in subjects with increased body weight characterizes the possibility of developing cardiovascular pathologies.
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Affiliation(s)
- M A Myagkova
- Laboratory of Immunochemistry, Chernogolovka, Moscow Region, Russia
| | - E A Orlova
- Laboratory of Immunochemistry, Chernogolovka, Moscow Region, Russia
| | - S N Petrochenko
- Laboratory of Immunochemistry, Chernogolovka, Moscow Region, Russia.
| | - Z V Bobrova
- Laboratory of Immunochemistry, Chernogolovka, Moscow Region, Russia
| | - S O Bachurin
- Department of Biochemical Research, Institute of Physiologically Active Substances, Russian Academy of Sciences, Chernogolovka, Moscow Region, Russia
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Khavinson V, Linkova N, Dyatlova A, Kantemirova R, Kozlov K. Senescence-Associated Secretory Phenotype of Cardiovascular System Cells and Inflammaging: Perspectives of Peptide Regulation. Cells 2022; 12. [PMID: 36611900 DOI: 10.3390/cells12010106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/23/2022] [Accepted: 12/24/2022] [Indexed: 12/28/2022] Open
Abstract
A senescence-associated secretory phenotype (SASP) and a mild inflammatory response characteristic of senescent cells (inflammaging) form the conditions for the development of cardiovascular diseases: atherosclerosis, coronary heart disease, and myocardial infarction. The purpose of the review is to analyze the pool of signaling molecules that form SASP and inflammaging in cells of the cardiovascular system and to search for targets for the action of vasoprotective peptides. The SASP of cells of the cardiovascular system is characterized by a change in the synthesis of anti-proliferative proteins (p16, p19, p21, p38, p53), cytokines characteristic of inflammaging (IL-1α,β, IL-4, IL-6, IL-8, IL-18, TNFα, TGFβ1, NF-κB, MCP), matrix metalloproteinases, adhesion molecules, and sirtuins. It has been established that peptides are physiological regulators of body functions. Vasoprotective polypeptides (liraglutide, atrial natriuretic peptide, mimetics of relaxin, Ucn1, and adropin), KED tripeptide, and AEDR tetrapeptide regulate the synthesis of molecules involved in inflammaging and SASP-forming cells of the cardiovascular system. This indicates the prospects for the development of drugs based on peptides for the treatment of age-associated cardiovascular pathology.
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Mendoza CE, Rivera H. Structural changes in explanted TAVR valves: Digging to find the answer. J Card Surg 2022; 37:5443-5444. [PMID: 35870164 DOI: 10.1111/jocs.16788] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 01/06/2023]
Affiliation(s)
- Cesar E Mendoza
- Division of Cardiovascular Disease, Jackson Memorial Hospital, Miami, Florida, USA
| | - Hector Rivera
- Division of Cardiovascular Disease, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, Florida, USA
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Mashadi AH, Narasimhan SL, Said SM. Cor triatriatum sinister: Long-term surgical outcomes in children and a proposal for a new classification. J Card Surg 2022; 37:4526-4533. [PMID: 36321701 DOI: 10.1111/jocs.17032] [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: 08/12/2022] [Revised: 09/09/2022] [Accepted: 09/18/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Cor Triatriatum Sinister (CTS) is a rare congenital anomaly with an estimated incidence of 0.4%, resulting from abnormal left atrial septation. It may present in isolation or in association with other heart defects. High percentage of patients require surgery with low mortality and recurrence rates. CTS has been classified in the past however we aim to describe a case series with more comprehensive and inclusive classification. METHODS This was a single-center retrospective cohort study of 16 children with the diagnosis of CTS between 2000 and 2020. Medical records were reviewed for clinical presentations, hospital, and postoperative courses. RESULTS Sixteen patients (63% female), with a median age at diagnosis of 4.3 months, five (31%) were neonates. Six (38%) had isolated CTS, two (13%) with functional single ventricle (SV), and the remaining eight patients (50%) had other associated heart defects (septal defects in three, coarctation of the aorta in another three, and anomalous pulmonary venous connections in three). Eight patients (50%) presented with obstructed CTS. Twelve patients (75%) underwent surgical intervention. Mortality occurred in three patients (19%) with two surgical (one with total anomalous pulmonary venous connection and another with SV) and one nonsurgical (septal defect with Fanconi anemia). The surgical median follow up was 4.7 years. Recurrence of the membrane occurred in two patients (17%). CONCLUSIONS This study showed good long-term outcomes for patients with isolated and complex CTS. Complete and proper classification of CTS ensures appropriate diagnosis, surgical planning, and better family counseling which may correlate with outcomes.
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Affiliation(s)
- Ali H Mashadi
- Department of Integrative Biology and Physiology, Undergraduate Studies, University of Minnesota, Minneapolis, Minnesota, USA
| | - Shanti L Narasimhan
- Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sameh M Said
- Division of Pediatric Cardiovascular Surgery, Department of Surgery, Maria Fareri Children's Hospital, Westchester Medical Center, Valhalla, New York, USA.,Department of Cardiothoracic Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Khairallah S, Chow OS, Mick SL. Combined minimally invasive repair of pectus excavatum and robotically assisted mitral valve repair: A case report and considerations. J Card Surg 2022; 37:5571-5574. [PMID: 36316821 DOI: 10.1111/jocs.17070] [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: 06/13/2022] [Revised: 09/21/2022] [Accepted: 10/15/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Severe pectus excavatum (PE) is considered a relative contraindication to robotic cardiac surgery and information is lacking on surgical solutions to allow for a robotic approach in this setting. OBJECTIVE We present a case of concomitant minimally invasive treatment of severe PE with initial pectus correction with Nuss bar insertion followed by robotically assisted mitral valve repair. METHODS A multidisciplinary team planned and executed the operation. Thoracoscopic assessment at the onset of the case demonstrated mediastinal exposure was inadequate for robotic repar without PE correction. Forced sternal elevation demonstrated sternal laxity sufficient to provide adequate exposure. Nuss bars were placed and robotic repair proceeded uneventfully. RESULTS The patient underwent successful concomitant minimally invasive PE and robotically assisted mitral repair. CONCLUSION Successful combined minimally invasive pectus repair and robotic mitral valve can be achieved if sufficient chest wall laxity is present on forced sternal elevation and access sites are planned properly in a multidisciplinary approach.
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Affiliation(s)
- Sherif Khairallah
- Cardiothoracic Surgery Department, Weill Cornell Medicine New York Presbyterian Hospital (WCM), New York, New York, USA
| | - Oliver S Chow
- Cardiothoracic Surgery Department, Weill Cornell Medicine New York Presbyterian Hospital (WCM), New York, New York, USA
| | - Stephanie L Mick
- Cardiothoracic Surgery Department, Weill Cornell Medicine New York Presbyterian Hospital (WCM), New York, New York, USA
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Pujitha V, Pandey NN, Arvind B, Kumar S. Idiopathic focal fibrosing mediastinitis with unilateral pulmonary arterial and venous involvement. J Card Surg 2022; 37:5466-5467. [PMID: 36378938 DOI: 10.1111/jocs.17182] [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: 06/13/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022]
Abstract
We report a case of a 1-year-old girl where computed tomography (CT) angiography demonstrated presence of ill-defined heterogenous soft tissue thickening obliterating the mediastinal fat planes in right peri-hilar region and encasing the hilar right pulmonary artery and its segmental branches leading to marked narrowing with nonvisualization of the right-sided pulmonary veins. The case highlights the features of fibrosing mediastinitis as well as the role of CT angiography in the diagnosis and accurate depiction of the extent of involvement of the mediastinal vasculature and airways.
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Affiliation(s)
- Vidiyala Pujitha
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Niraj Nirmal Pandey
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Balaji Arvind
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
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Solari S, Navarra E, de Kerchove L, El Khoury G. Mitral valve repair for endocarditis. J Card Surg 2022; 37:4097-4102. [PMID: 34390270 DOI: 10.1111/jocs.15891] [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: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 01/06/2023]
Abstract
Many authors have reported their results of mitral valve (MV) repair (MVr) in acute and healed endocarditis. However, the results published by different authors highlight the fact that the reparability rate for this indication remains low. Over the last three decades, our group has adopted an early and repair-oriented approach to infective endocarditis with the objective to improve the repair rate and the long-term results. In this paper, we describe our institutional experience on mitral valve repair for infective endocarditis. Data for this paper were extracted from our institutional database on heart valve disease. From 1991 to 2015, 160 consecutive patients in our institution underwent MV surgery for active IE on native MV. The median follow-up was 122 months. This study was approved by the institutional ethics review board, and written informed consent was waived for this study given its retrospective design. Hospital mortality was 11.6% (n = 18). Early MV reoperation before hospital discharge was required in five (3.1%) patients. At 5, 10, and 15 years, overall survival in the MVr for endocarditis in the group was 79% ± 4%, 65% ± 5%, 57% ± 6%, respectively. Freedom from reoperation at 5, 10, and 15 years was 95% ± 2%, 88% ± 4%, and 81% ± 6%, respectively. Mitral infective endocarditis is an insidious pathology and his surgical approach can be challenging. An early and repair-oriented surgical approach can allow to improve reparability rates with good long-term durability and a low recurrence rate of endocarditis.
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Affiliation(s)
- Silvia Solari
- Cardiovascular and Thoracic Surgery Department, Saint Luc University Clinic, Brussels, Belgium
| | - Emiliano Navarra
- Cardiovascular and Thoracic Surgery Department, Saint Luc University Clinic, Brussels, Belgium
| | - Laurent de Kerchove
- Cardiovascular and Thoracic Surgery Department, Saint Luc University Clinic, Brussels, Belgium
| | - Gebrine El Khoury
- Cardiovascular and Thoracic Surgery Department, Saint Luc University Clinic, Brussels, Belgium
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Lehtinen ML, Harik L, Soletti G, Rahouma M, Dimagli A, Perezgrovas-Olaria R, Audisio K, Demetres M, Gaudino M. Sex differences in saphenous vein graft patency: A systematic review and meta-analysis. J Card Surg 2022; 37:4573-4578. [PMID: 36378892 PMCID: PMC9812911 DOI: 10.1111/jocs.17195] [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: 09/22/2022] [Accepted: 09/25/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Saphenous vein grafts (SVG) are the most commonly used conduits in coronary artery bypass grafting (CABG). Graft failure is observed in up to 50% of SVG at 10 years after surgery. Whether a difference in SVG patency rates exists between men and women remains unclear. METHODS We performed a study-level meta-analysis to evaluate sex-related differences in follow-up patency rates of SVG after CABG. A systematic literature search was conducted to identify studies on CABG that reported follow-up SVG patency rates in men and women. The primary outcome was SVG patency rates by sex at follow-up. RESULTS Seventeen studies totaling 8235 patients and 14,781 SVG grafts were included. There was no significant difference in follow-up SVG patency rates between men and women (incidence rate ratio 0.96, 95% confidence interval 0.90-1.03, p = .24), with mean angiographic follow-up of 33.5 months (standard deviation 29.2). Leave-one-out and cumulative analysis were consistent with the main analysis. We concluded that follow-up SVG patency rate is similar between men and women undergoing CABG.
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Affiliation(s)
- Miia L. Lehtinen
- Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Lamia Harik
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Giovanni Soletti
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Mohamed Rahouma
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Arnaldo Dimagli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | | | - Katia Audisio
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Michelle Demetres
- Samuel J. Wood Library and C.V. Starr Biomedical Information Centre, Weill Cornell, Medicine, New York, NY, USA
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
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12
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Gupta AK, Ovenden CD, Nathin K, Aujayeb N, Hewitt JN, Kovoor JG, Chan JCY, Wells A. Geographical distribution of authorship for leading cardiothoracic surgery journals. J Card Surg 2022; 37:4465-4473. [PMID: 36229966 PMCID: PMC10092000 DOI: 10.1111/jocs.17022] [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: 06/20/2022] [Revised: 08/28/2022] [Accepted: 09/10/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Evolution of surgical practice is influenced by publications in the leading journals of that field. If the authorship of a publication lacks geographical diversity, this could create bias and limit generalizability of the evidence. Accordingly, we conducted a geographical analysis of the leading Cardiothoracic Surgery journals worldwide. METHODS Using 2020 Impact Factor, we searched the leading Cardiothoracic Surgery journals over the past decade. Only original articles were included. Data regarding first, second and last authors were extracted from every article. From this, we analysed country of affiliation, highest academic degree obtained and author location by metropolitan or rural setting. RESULTS A total of 12,706 original articles were published in the top 5 ranked Cardiothoracic journals between 2011 and 2020. Authors originated from 69 countries, with the majority being from North America and Western Europe. The United States was the most common country of affiliation (42.8%) in all five journals, with New York City the most prominent city. A total of 63.7% of the authorship originated from large metropolitan areas (estimated as population greater than 500,000 residents), and the most common degrees obtained by authors were MD and PhD. CONCLUSION The prominent Cardiothoracic authorship is predominantly located in Western countries, most commonly large metropolitan centers in the United States. This raises questions as to whether the literature adequately reflects populations in other geographical areas such as the continents of South America and Africa and rural settings. Leading journals should consider policies which encourage publication by authors from geographical locations that are underrepresented globally.
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Affiliation(s)
- Aashray K Gupta
- Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia
| | | | - Kayla Nathin
- Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia
| | - Nidhi Aujayeb
- Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia
| | - Joseph N Hewitt
- Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia
| | - Joshua G Kovoor
- Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia
| | - Justin C Y Chan
- Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia.,Department of Cardiothoracic Surgery, New York University Langone Health, New York, USA
| | - Adam Wells
- Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia
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13
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Eisenga J, Monday K, Blough B, Vandervest K, Lingle K, Espinoza O, Schwartz G. Extracorporeal membrane oxygenation support in the setting of penetrating traumatic injuries. J Card Surg 2022; 37:4359-4361. [PMID: 36150148 DOI: 10.1111/jocs.16955] [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: 06/09/2022] [Revised: 08/07/2022] [Accepted: 08/26/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Currently, no absolute contraindications to the use of extracorporeal membrane oxygenation (ECMO) support exist. However, the presence of penetrating traumatic injuries is often considered a relative contraindication to ECMO support. In this study, we aim to assess whether penetrating traumatic injuries should be considered a contraindication to the use of ECMO support, and how to better select patients who may benefit from this therapy. MATERIALS AND METHODS In this paper, we present the findings of a retrospective review of all patients at a large, level 1 trauma center who received ECMO support following penetrating traumatic injuries. We describe the use of ECMO in these patients along with the complications associated with this therapy. CONCLUSION In this study we show penetrating traumatic injuries should not be considered a contraindication to ECMO support, and how ECMO can be a useful treatment strategy in selected patients with these injuries.
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Affiliation(s)
- John Eisenga
- Depratment of Surgery, Baylor University Medical Center, Dallas, Texas, USA
| | - Kara Monday
- Depratment of Surgery, Baylor University Medical Center, Dallas, Texas, USA
| | - Britton Blough
- Depratment of Surgery, Baylor University Medical Center, Dallas, Texas, USA
| | | | - Katy Lingle
- Depratment of Surgery, Baylor University Medical Center, Dallas, Texas, USA
| | - Otoniel Espinoza
- Depratment of Surgery, Baylor University Medical Center, Dallas, Texas, USA
| | - Gary Schwartz
- Depratment of Surgery, Baylor University Medical Center, Dallas, Texas, USA
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14
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Arslanhan G, Ak K, Öztürk F, Türker A, Bozkurtlar E, Arsan S, Yıldızeli B. Pulmonary artery sarcoma treated with pulmonary endarterectomy and leaflet reconstruction using Ozaki technique. J Card Surg 2022; 37:5630-5633. [PMID: 36378914 DOI: 10.1111/jocs.17172] [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: 04/11/2022] [Revised: 10/31/2022] [Accepted: 10/31/2022] [Indexed: 11/16/2022]
Abstract
Pulmonary arterial intimal sarcomas (PAIS) are rare malignancies with a poor prognosis. Sarcomas present with signs and symptoms mimicking pulmonary thromboembolic disease, delaying the diagnosis. We present a 29-year-old male patient diagnosed with PAIS in the right and main pulmonary arteries extending to the left pulmonary leaflet. The patient was treated with pulmonary endarterectomy and pulmonary leaflet reconstruction using the Ozaki technique.
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Affiliation(s)
- Gokhan Arslanhan
- Department of Cardiovascular Surgery, Marmara University School of Medicine Pendik Research and Training Hospital, Istanbul, Turkey
| | - Koray Ak
- Department of Cardiovascular Surgery, Marmara University School of Medicine Pendik Research and Training Hospital, Istanbul, Turkey
| | - Fatih Öztürk
- Department of Cardiovascular Surgery, Marmara University School of Medicine Pendik Research and Training Hospital, Istanbul, Turkey
| | - Alperen Türker
- Department of Cardiovascular Surgery, Marmara University School of Medicine Pendik Research and Training Hospital, Istanbul, Turkey
| | - Emine Bozkurtlar
- Department of Pathology, Marmara University School of Medicine Pendik Research and Training Hospital, Istanbul, Turkey
| | - Sinan Arsan
- Department of Cardiovascular Surgery, Marmara University School of Medicine Pendik Research and Training Hospital, Istanbul, Turkey
| | - Bedrettin Yıldızeli
- Department of Thoracic Surgery, Marmara University School of Medicine Pendik Research and Training Hospital, Istanbul, Turkey
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15
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Di Mauro M, Bonalumi G, Giambuzzi I, Messi P, Cargoni M, Paparella D, Lorusso R, Calafiore AM. Mitral valve repair with artificial chords: Tips and tricks. J Card Surg 2022; 37:4081-4087. [PMID: 36321669 PMCID: PMC10092434 DOI: 10.1111/jocs.17076] [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: 07/04/2022] [Revised: 09/22/2022] [Accepted: 09/29/2022] [Indexed: 11/07/2022]
Abstract
Mitral valve regurgitation (MR) is a common valvular disorder occurring in up to 10% of the general population. Mitral valve reconstructive strategies may address any of the components, annulus, leaflets, and chords, involved in the valvular competence. The classical repair technique involves the resection of the prolapsing tissue. Chordal replacement was introduced already in the '60, but in the mid '80, some surgeons started to use expanded polytetrafluoroethylene (ePTFE) Gore-Tex sutures. In the last years, artificial chords have been used also using transcatheter approach such as NeoChord DS 1000 (Neochord) and Harpoon TSD-5. The first step is to achieve a good exposure of the papillary muscles that before approaching the implant of the artificial chords. Then, the chords are attached to the papillary muscle, with or without the use of supportive pledgets. The techniques to correctly implant artificial chords are many and might vary considerably from one center to another, but they can be summarized into three big families of suturing techniques: single, running or loop. Regardless of how to anchor to the mitral leaflet, the real challenge that many surgeons have taken on, giving rise to some very creative solutions, has been to establish an adequate length of the chords. It can be established based on anatomically healthy chords, but it is important to bear in mind that surgeons work on the mitral valve when the heart is arrested in diastole, so this length could fail to replicate the required length in the full, beating heart. Hence, some surgeons suggested techniques to overcome this problem. Herein, we aimed to describe the current use of artificial chords in real-world surgery, summarizing all the tips and tricks.
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Affiliation(s)
- Michele Di Mauro
- Department of Cardio-Thoracic Surgery, Heart & Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Giorgia Bonalumi
- Department of Cardiac Surgery, IRCCS Monzino Cardiology Center, Milan, Italy.,DISCCO (Dipartimento di Scienze Cliniche e di Comunità), University of Milan, Milan, Italy
| | - Ilaria Giambuzzi
- Department of Cardiac Surgery, IRCCS Monzino Cardiology Center, Milan, Italy.,DISCCO (Dipartimento di Scienze Cliniche e di Comunità), University of Milan, Milan, Italy
| | - Pietro Messi
- DISCCO (Dipartimento di Scienze Cliniche e di Comunità), University of Milan, Milan, Italy.,Department of Cardiac Surgery, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Marco Cargoni
- Department of Cardiac Anesthesia, Mazzini Hospital, Teramo, Italy
| | - Domenico Paparella
- Department of Medical and Surgical Sciences, Division of Cardiac Surgery, University of Foggia, Foggia, Italy.,Division of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, Bari, Italy
| | - Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Heart & Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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16
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Dagher O, Ibrahim M, Cousin G, Dorval JF, Demers P, Dürrleman N. Hybrid off-pump debranching and thoracic endovascular arch repair in a high-risk surgical patient. J Card Surg 2022; 37:5567-5570. [PMID: 36378932 DOI: 10.1111/jocs.17174] [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: 06/08/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022]
Abstract
Management of aortic arch pathologies remains challenging. Open total arch replacements have been associated with significant morbidity and mortality owing to the need for cardiopulmonary bypass and circulatory arrest. On the other hand, aortic arch-branched stent grafts are not widely available. In this context, hybrid techniques combining open arch debranching with endovascular graft placement have been identified as an attractive option in select patients. However, there still is a paucity of literature on their application and outcomes. A case is presented of an elderly frail patient diagnosed with a pseudoaneurysm of the aortic arch and who was successfully treated by an off-pump arch debranching followed by endovascular arch repair. This case highlights (i) the feasibility of hybrid debranching techniques, (ii) their technical challenges, and (iii) the need for long-term follow-up data.
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Affiliation(s)
- Olina Dagher
- Libin Cardiovascular Institute, Calgary, Alberta, Canada.,Montreal Heart Institute, Montreal, Quebec, Canada
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17
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Bin Mahmood SU, Mori M, Amabile A, Prescher L, Forrest J, Kaple R, Geirsson A, Mangi AA. Risk factors and mortality associated with permanent pacemaker after surgical or transcatheter aortic valve replacement: Early versus late implantation. J Card Surg 2022; 37:4295-4300. [PMID: 36131523 DOI: 10.1111/jocs.16938] [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: 07/06/2022] [Revised: 08/10/2022] [Accepted: 08/17/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Inflation of transcatheter aortic valve replacement (TAVR) procedures compared to surgical aortic valve replacement (SAVR) has increased the number of patients requiring a postprocedure permanent pacemaker (PPM). We investigate the impact of PPM on mid-term mortality comparing SAVR versus TAVR procedures and risk factors for early and late (>14 days) need of PPM. METHODS We conducted a retrospective, single-center evaluation of 903 patients that underwent either SAVR or TAVR procedures at the Yale New Haven Hospital from 2012 to 2017. Patients were stratified into PPM and non-PPM groups. We performed Kaplan-Meier and Cox proportional hazard analysis to characterize mid-term mortality. Further subgroup analysis was performed to identify risk factors for early and late PPM implantation in the TAVR cohort. RESULTS There was no correlation between PPM implantation and mid-term mortality in both SAVR (hazard ratio [HR] = 0.69; confidence interval [CI] = 0.21-2.30; p = .56) and TAVR (HR = 0.70; CI = 0.42-1.17; p = .18) patients. The presence of the right bundle branch block (Odds ratio = 24.07; 95% CI = 2.34-247.64, p = .007) was associated with higher odds of early PPM requirement after TAVR procedures. CONCLUSION PPM placement after SAVR or TAVR procedures is not associated with increased mid-term mortality. In-depth characterization of risk factors for early and late PPM implantation will require further analysis in the growing TAVR patient population.
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Affiliation(s)
- Syed Usman Bin Mahmood
- Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Makoto Mori
- Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Andrea Amabile
- Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Lindsey Prescher
- Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - John Forrest
- Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Ryan Kaple
- Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Arnar Geirsson
- Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Abeel A Mangi
- Section of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
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18
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Gupta AK, Sabab A, Goh R, Ovenden CD, Kovoor JG, Ramponi F, Chan JCY, Reddi BAJ, Bennetts JS, Maddern GJ, Kleinig TJ. Endovascular thrombectomy for large vessel occlusion acute ischemic stroke after cardiac surgery. J Card Surg 2022; 37:4562-4570. [PMID: 36335602 PMCID: PMC10100038 DOI: 10.1111/jocs.17082] [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: 06/19/2022] [Revised: 08/28/2022] [Accepted: 09/24/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Acute ischemic stroke (AIS) can be a catastrophic complication of cardiac surgery previously without effective treatment. Endovascular thrombectomy (EVT) is a potentially life-saving intervention. We examined patients at our institution who had EVT to treat AIS post cardiac surgery. METHODS We retrospectively reviewed a stroke database from January 1, 2016 to October 31, 2021 to identify patients who had undergone EVT to treat AIS following cardiac surgery. Demographic data, operation type, stroke severity, imaging features, management and outcomes (mortality and modified Rankin Score (mRS)) were assessed. RESULTS Of 5022 consecutive patients with AIS, 870 underwent EVT. Seven patients (0.8%) had EVT following cardiac surgery. Operations varied: two coronary artery bypass grafting (CABG), two transcatheter AVR, one redo surgical aortic valve replacement (AVR), one mitral valve repair and one patient with combined aortic and mitral valve replacements and CABG. Meantime postsurgery to stroke symptoms onset was 3 days (range 0-9 days). Median NIHSS was 26 (range 10-32). Five patients had middle cerebral artery occlusion and two internal carotid artery (n = 2). Median time between onset of symptoms and recanalization was 157 min (range 97-263). Two patients received Intra-arterial Thrombolysis. All patients survived and were discharged to another hospital (n = 3), home (n = 2), or rehabilitation facility (n = 2). Median 3-month mRS was 3 (range 0-6). CONCLUSION We report the largest case series of EVT after cardiac surgery. EVT can be associated with excellent outcomes in these patients. Close neurological monitoring postoperatively to identify patients who may benefit from intervention is key.
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Affiliation(s)
- Aashray K. Gupta
- Discipline of Surgery, Royal Adelaide HospitalUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Ahad Sabab
- Discipline of Surgery, Royal Adelaide HospitalUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Rudy Goh
- Stroke UnitRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Christopher D. Ovenden
- Discipline of Surgery, Royal Adelaide HospitalUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Joshua G. Kovoor
- Discipline of Surgery, Royal Adelaide HospitalUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Australian Safety and Efficacy Register of New Interventional Procedures–SurgicalRoyal Australasian College of SurgeonsAdelaideSouth AustraliaAustralia
| | - Fabio Ramponi
- Department of Cardiothoracic SurgeryRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Justin C. Y. Chan
- Discipline of Surgery, Royal Adelaide HospitalUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | | | - Jayme S. Bennetts
- Cardiothoracic Surgical UnitFlinders Medical CentreAdelaideSouth AustraliaAustralia
| | - Guy J. Maddern
- Discipline of Surgery, Royal Adelaide HospitalUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Australian Safety and Efficacy Register of New Interventional Procedures–SurgicalRoyal Australasian College of SurgeonsAdelaideSouth AustraliaAustralia
- Research, Audit and Academic SurgeryRoyal Australasian College of SurgeonsAdelaideSouth AustraliaAustralia
| | - Timothy J. Kleinig
- Stroke UnitRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
- Discipline of Medicine, Royal Adelaide HospitalUniversity of AdelaideAdelaideSouth AustraliaAustralia
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19
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Fattouch K, Calafiore AM. Mitral valve repair: Regulatory or ethical problem? J Card Surg 2022; 37:4094-4096. [PMID: 35916157 DOI: 10.1111/jocs.16823] [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: 07/16/2022] [Accepted: 07/20/2022] [Indexed: 01/06/2023]
Abstract
The long-term outcome of patients undergoing mitral valve repair (MVr) is based on what happens during the more or less 60 min of aortic cross-clamping necessary to transform a leaking valve into a well-functioning one. As a consequence, the experience of the surgeon performing the procedure is the only determinant of the success rate that deserves to be taken into account. It is clear from the literature that the number of cases/year is inversely related to the number of early and late deaths, repair failures, and reoperations. However, there is no agreement on the minimum caseload/year that represents the threshold to identify surgeons that can perform or not MVr. This problem then cannot be regulated by specific guidelines of Scientific Societies, but only by the ethical perception, we have of our profession.
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Affiliation(s)
- Khalil Fattouch
- Department of Surgical, Oncologic and Stomatological Disciplines, GVM Care and Research, Maria Eleonora Hospital, University of Palermo, Palermo, Italy
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20
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Calafiore AM, Prapas S, Totaro A, Guarracini S, Cargoni M, Katsavrias K, Fattouch K, Di Mauro M. Cutting the second order chords during mitral valve repair. J Card Surg 2022; 37:4072-4078. [PMID: 36378871 DOI: 10.1111/jocs.17194] [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: 07/04/2022] [Revised: 08/15/2022] [Accepted: 09/04/2022] [Indexed: 11/16/2022]
Abstract
The chordae tendinae connect the papillary muscles (PMs) to the mitral valve. While the first-order chordae serve to secure the leaflets to maintain valve closure and prevent mitral valve prolapse, the second-order chordae are believed to play a role in maintaining normal left ventricle size and geometry. The PMs, from where the chordae tendinae originate, function as shock absorbers that compensate for the geometric changes of the left ventricular wall. The second-order chordae connect the PMs to both trigons under tension. The tension distributed towards the second-order chordae has been demonstrate to be more than threefold that in their first-order counterpart. Cutting the second-order chordae puts all the tension on the first-order chordae, which are then closer to their rupture point. However, it has been experimentally demonstrated that the tension at which the first-order chordae break is 6.8 newtons (N), by far higher than the maximal tension reached, that is 0.4 N. Even if the clinical reports have been favorable, the importance of cutting the second-order chordae to recover curvature of the anterior leaflet and increase the coaptation length between the mitral valve leaflets has been slowly absorbed by the surgical world. Nevertheless, there are progressive demonstrations that chordal tethering affects the anterior leaflet not only in secondary, but also in primary mitral regurgitation, having a not negligible role in the long-term outcome of mitral repair.
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Affiliation(s)
| | - Sotirios Prapas
- Division of Cardiac Surgery A, Henry Dunant Hospital, Athens, Greece
| | - Antonio Totaro
- Department of Cardiovascular Diseases, Gemelli Molise, Campobasso, Italy
| | | | - Marco Cargoni
- Department of Surgical, Oncologic and Stomatological Disciplines, GVM Care & Research, Maria Eleonora Hospital, University of Palermo, Palermo, Italy
| | - Kostas Katsavrias
- Division of Cardiac Surgery A, Henry Dunant Hospital, Athens, Greece
| | - Khalil Fattouch
- Department of Cardiac Anesthesia, Mazzini Hospital, Teramo, Italy
| | - Michele Di Mauro
- Departmente of Cardio-Thoracic and Vascular Surgery, Heart and Vascular Center, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC), Maastricht, The Netherlands
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21
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Vidiyala P, Ojha V, Ramakrishnan S, Jagia P. Origin of the left common carotid artery from ascending aorta in association with tetralogy of Fallot and hypoplastic right cervical aortic arch. J Card Surg 2022; 37:5457-5458. [PMID: 36335633 DOI: 10.1111/jocs.17136] [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: 08/29/2022] [Revised: 10/12/2022] [Accepted: 10/22/2022] [Indexed: 11/08/2022]
Abstract
We present a case of a 6-year-old girl with tetralogy of Fallot (TOF) and hypoplastic aortic arch with anomalous origin of left common carotid artery from the ascending aorta. The case highlights the importance of screening for abnormalities of aortic arch and arch vessels in TOF patients for accurate presurgical planning and to predict the postoperative outcomes.
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Affiliation(s)
- Pujitha Vidiyala
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Vineeta Ojha
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | | | - Priya Jagia
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
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22
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Paparella D, Squiccimarro E, Di Mauro M, Katsavrias K, Calafiore AM. Acute iatrogenic complications after mitral valve repair. J Card Surg 2022; 37:4088-4093. [PMID: 36273407 DOI: 10.1111/jocs.17055] [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: 07/04/2022] [Accepted: 10/04/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Mitral valve repair is the procedure of choice to correct mitral regurgitation. However, some dangerous iatrogenic complications can occur at the end of the procedure. Therefore, we sought to review the most frequent and clinically relevant acute iatrogenic complication following mitral valve repair. METHODS A thorough review of the literature has been performed. Criteria for considering studies for this non-systematic review were as follows: observational and interventional studies investigating the acute iatrogenic complications following mitral valve repair, and essential review studies pertinent to the topic. RESULTS The most frequent is the systolic anterior motion. Due to a systolic dislocation of the anterior leaflet toward the outflow tract, it causes both obstruction of the outflow tract and mitral regurgitation. Often it is due to excess of catecholamines or to reduced filling of the left ventricle but sometimes needs further surgical maneuvers, focused on moving posteriorly the coaptation line. It can be obtained by shortening the posterior leaflet or increasing the size of the ring or applying an Alfieri stitch to limit the movements of the anterior leaflet. Another complication, often underdiagnosed and potentially lethal, is the injury of the circumflex artery that happens at the level of the anterolateral commissure or P1 zone. Two mechanisms are involved. The first one is the direct injury of the artery by a stitch (roughly 25% of the patients present a distance artery-annulus <3 mm. The second one is the distortion of the artery, attracted toward the annulus by a misplaced stitch. The attraction causes kinking with stenosis of different degrees till functional occlusion. However, the artery has to be far from the annulus and the atrial tissue has to be stiff and resistant, as after an infective process, to move the circumflex artery toward the annulus without tearing. Positioning the stitches very close to the mitral leaflets in the dangerous area is the only prevention to the complication. The treatment in the operating theater is partial or total removal/reimplantation of the annular sutures or coronary artery bypass grafting to the circumflex area. If the injury is demonstrated only after coronary angiography, percutaneous revascularization can be attempted before further surgical treatment. CONCLUSIONS Acute iatrogenic complication after mitral repair exists and may compromize patient outcome. Raising awareness about these issues, the precautions to prevent them, and the manners of resolution is therefore mandatory.
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Affiliation(s)
- Domenico Paparella
- Department of Medical and Surgical Sciences, Division of Cardiac Surgery, University of Foggia, Foggia, Italy.,Division of Cardiac Surgery, Santa Maria Hospital, GVM Care & Research, Bari, Italy
| | - Enrico Squiccimarro
- Department of Medical and Surgical Sciences, Division of Cardiac Surgery, University of Foggia, Foggia, Italy.,Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Michele Di Mauro
- Cardio-Thoracic Surgery Department, Heart & Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Kostas Katsavrias
- Division of Cardiac Surgery A, Henry Dunant Hospital, Athens, Greece
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23
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Alenezi F, Alajmi H, Agarwal R, Zwischenberger BA. Role of cardiac magnetic resonance (CMR) in planning ventricular septal myomectomy in patients with hypertrophic obstructive cardiomyopathy (HOCM). J Card Surg 2022; 37:4186-4189. [PMID: 36434805 DOI: 10.1111/jocs.17090] [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: 10/08/2022] [Accepted: 10/11/2022] [Indexed: 11/23/2022]
Abstract
Septal myectomy is currently the gold standard treatment for symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM). The procedure needs to be tailored and performed in a personalized fashion, taking into consideration the anatomic and physiologic heterogeneity of this disease. The extent and location of surgical myectomy will depend on the location of the hypertrophy, with the goal of widening the outflow tract and improve the function of the mitral valve. CMR helps to identify hypertrophy not well visualized by TTE, providing more accurate wall thickness measurements and differentiating HOCM from other causes of LV hypertrophy. CMR also helps identify an abnormal attachment of papillary muscle to the MV or to the septal myocardium and mitral valve pathology. A collaborative approach with cardiac surgeons, radiologists and cardiologists will optimize preoperative planning to improve the success for surgical myectomy.
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Affiliation(s)
- Fawaz Alenezi
- Division of Cardiology, Duke University, Durham, North Carolina, USA.,Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Hasan Alajmi
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Richa Agarwal
- Division of Cardiology, Duke University, Durham, North Carolina, USA.,Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
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24
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Ng Yin Ling C, Avci Demir F, Bleetman D, Eskandari M, Khan H, Baghai M, Deshpande R, Monaghan MJ, Wendler O. The impact of complete versus partial preservation of the sub-valvular apparatus on left ventricular function in mitral valve replacement. J Card Surg 2022; 37:4598-4605. [PMID: 36284463 PMCID: PMC10092726 DOI: 10.1111/jocs.17049] [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: 06/19/2022] [Revised: 09/07/2022] [Accepted: 10/02/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION In mitral valve replacement (MVR), sudden increases in afterload and disruption of the annular-chordal-papillary-left-ventricular wall causes left ventricular (LV) dysfunction in the early postoperative period. Preservation of the posterior mitral leaflet apparatus (MVR-P) has a favorable outcome on LV function. However, there is paucity of data on the impact of complete preservation of the sub-valvular apparatus (MVR-C). OBJECTIVE We investigated the impact of MVR-P and MVR-C on baseline and 3-months postoperative LV ejection fraction (EF) and global longitudinal strain (GLS). METHODS We retrospectively analyzed a cohort of 29 MVR-P and 19 MVR-C patients with complete echocardiography data at our unit, who were operated between 2008 and 2017. Between-group changes in LVEF and GLS were compared using independent sample T-test. RESULTS Median age was 59 years (IQR 50-69 years). Baseline LVEF was 58% (51%- 60%). Baseline GLS was -18.4 (-21.2 to -15.5). There were no significant between-group differences between all baseline demographics and echocardiographic markers. There was significantly higher absolute postoperative LVEF in MVR-C patients (p = 0.029). There was also significant worsening in LVEF (p = 0.0121) and GLS (p < 0.0001) after MVR-P and not MVR-C, suggesting no reduction in LV function post-MVR-C but a reduction post-MVR-P. There was significantly less postoperative worsening of GLS per patient in MVR-C group as compared to the MVR-P group (p = 0.023), indicating better preservation of LV function. There was also a smaller decline in LVEF per patient in the MVR-C as compared to the MVR-P group, although not statistically significant (p = 0.23). CONCLUSION MVR with complete preservation of the sub-valvular apparatus shows a favorable impact on the longitudinal function of the heart at 3 months. Further studies with larger patient numbers are indicated to investigate the long-term results of this surgical approach.
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Affiliation(s)
| | | | - David Bleetman
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Mehdi Eskandari
- Department of Cardiology, King's College Hospital, London, UK
| | - Habib Khan
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Max Baghai
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Ranjit Deshpande
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
| | - Mark J Monaghan
- Department of Cardiology, King's College Hospital, London, UK
| | - Olaf Wendler
- Department of Cardiothoracic Surgery, King's College Hospital, London, UK
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25
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Vendramin I, Milano AD, Pucci A, Lechiancole A, Sponga S, Bortolotti U, Livi U. Artificial chordae for mitral valve repair. J Card Surg 2022; 37:3722-3728. [PMID: 36116053 PMCID: PMC9826337 DOI: 10.1111/jocs.16937] [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: 07/19/2022] [Revised: 08/24/2022] [Accepted: 09/03/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Mitral valve repair using expanded polytetrafluoroethylene sutures to replace mitral chordae tendineae is a well-established procedure. However, the incidence of neo-chordae failure causing recurrent mitral regurgitation is not well defined. METHODS We have reviewed the reported cases of complications after mitral valve repair related to the use of neo-chordae. This study was mainly carried out through PubMed, Medline, and Google Chrome websites. RESULTS We have identified a total of 26 patients presenting with rupture of polytetrafluoroethylene neo-chordae, mostly being described as isolated cases. Few other cases of recurrent mitral regurgitation with hemolysis were found, where reoperation was not caused by neo-chordal failure but most likely by technical errors. At pathological investigation the findings were substantially similar in all reported cases. The neo-chordae retained their length and pliability, became covered with host tissue and rupture was mainly related to suture size. Mild calcification was observed not interfering with chordal function; chordal infection did never occur. CONCLUSIONS The use of artificial neo-chordae provides excellent late results with durable mitral valve repair stability. Chordal rupture may occur late postoperatively leading to reoperation because of recurrent mitral regurgitation. Despite its rarity, this potential complication should not be overlooked during follow-up of patients after mitral valve repair using artificial neo-chordae.
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Affiliation(s)
| | | | - Angela Pucci
- Division of PathologyUniversity HospitalPisaItaly
| | | | - Sandro Sponga
- Cardiothoracic DepartmentUniversity HospitalUdineItaly
| | | | - Ugolino Livi
- Cardiothoracic DepartmentUniversity HospitalUdineItaly
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George TJ, Schaffer JM, Harrington KB, Meidan TG, Michael DiMaio J, Kabra N, Rawitscher DA, Afzal A. Impact of preoperative Impella support on destination left ventricular assist device outcomes. J Card Surg 2022; 37:3576-3583. [PMID: 36124428 DOI: 10.1111/jocs.16942] [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: 03/16/2022] [Revised: 08/06/2022] [Accepted: 08/17/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Although left ventricular assist device (LVAD) implantation is associated with improved heart failure survival, the impact of pre-implantation Impella support on outcomes is unknown. We undertook this study to evaluate the impact of preoperative Impella support on LVAD outcomes. METHODS We conducted a retrospective review of all Heartmate 3 LVAD implants. Primary stratification was by the need for preoperative Impella support with the 5.0/5.5 device. Longitudinal survival was assessed by the Kaplan-Meier method. Multivariable Cox proportional hazards regression models were developed to evaluate mortality. Secondary outcomes included changes in laboratory values during Impella support. RESULTS From 2017 to 2021, 87 patients underwent LVAD implantation. Sixteen were supported with a single inotrope, 36 with dual inotropes, 27 with Impella, and 3 with extracorporeal membrane oxygenation (ECMO). When stratified by the need for Impella, there was no difference in survival at 30-days (98.3 [88.2-99.8]% vs. 96.3 [76.5-99.5]%, p = .59), 1-year (91.0 [79.8-96.2] vs. 74.9 [51.7-88.2], p = .10), or at 2 years (87.9 [74.3-94.5] vs. 74.9 [51.7-88.2], p = .15). On multivariable modeling, the need for preoperative Impella was not associated with an increased hazard of 1-year (1.24 [0.23-6.73], p = .81) or 2-year mortality (1.05 [0.21-5.19], p = .95). After 7 (5-10) days of Impella support, recipient creatinine (p < .01), creatinine clearance (p = .02), and total bilirubin (p = .053) improved and lactic acidosis resolved (p < .01). CONCLUSIONS Preoperative Impella support is not associated with increased short or long-term mortality but is associated with improved renal and hepatic function as well as total body perfusion before LVAD implantation.
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Affiliation(s)
- Timothy J George
- Department of Advanced Heart Failure and MCS, Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | - Justin M Schaffer
- Department of Advanced Heart Failure and MCS, Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | - Katherine B Harrington
- Department of Advanced Heart Failure and MCS, Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | - Talia G Meidan
- Department of Advanced Heart Failure and MCS, Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | - John Michael DiMaio
- Department of Advanced Heart Failure and MCS, Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | - Nitin Kabra
- Department of Advanced Heart Failure and MCS, Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | - David A Rawitscher
- Department of Advanced Heart Failure and MCS, Baylor Scott & White The Heart Hospital, Plano, Texas, USA
| | - Aasim Afzal
- Department of Advanced Heart Failure and MCS, Baylor Scott & White The Heart Hospital, Plano, Texas, USA
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27
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Zhou X, Liu H, He J, Cheng Y, Lu J. Primary cardiac composite hemangioendothelioma with calcification mimicking a right atrial myxoma: A rare entity. J Card Surg 2022; 37:3867-3869. [PMID: 36073116 DOI: 10.1111/jocs.16915] [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: 06/30/2022] [Revised: 08/12/2022] [Accepted: 08/22/2022] [Indexed: 11/30/2022]
Abstract
Composite hemangioendothelioma (CHE) is a rare vascular tumor which shows varying combination of benign, low-grade, and malignant vascular components on pathology. CHE is usually located on the surface of the dermis and subcutaneous tissue of the extremities. We report an unusual case of CHE in the heart.
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Affiliation(s)
- Xiang Zhou
- Department of Cardiac Surgery, Wuhan Asia Heart Hospital, Wuhan, China
| | - Hongyan Liu
- Department of Cardiac Surgery, Wuhan Asia Heart Hospital, Wuhan, China
| | - Jiahui He
- Department of Echocardiography, Wuhan Asia Heart Hospital, Wuhan, China
| | - Youping Cheng
- Department of Pathology, Wuhan Asia General Hospital, Wuhan, China
| | - Jiajia Lu
- Department of Cardiac Surgery, Wuhan Asia Heart Hospital, Wuhan, China
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28
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Sharma A, Naganur SH, Barwad P, Singhal M. Aortopulmonary window with anomalous ascending aortic origin of left pulmonary artery: Hitherto unreported pattern. J Card Surg 2022; 37:3870-3871. [PMID: 36066047 DOI: 10.1111/jocs.16900] [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: 08/04/2022] [Revised: 08/08/2022] [Accepted: 08/16/2022] [Indexed: 11/26/2022]
Abstract
Anomalous ascending aortic origin of left pulmonary artery in association with aortopulmonary window has not been reported so far in literature and is the main highlight of the present case.
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Affiliation(s)
- Arun Sharma
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjeev Hanumantacharya Naganur
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Parag Barwad
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manphool Singhal
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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29
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Zhou X, Song L, Liu H, Cheng Y, Han X. Giant primary cardiac alveolar rhabdomyosarcoma of the right atrium. J Card Surg 2022; 37:3878-3879. [PMID: 35979697 DOI: 10.1111/jocs.16862] [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: 06/23/2022] [Revised: 07/23/2022] [Accepted: 08/02/2022] [Indexed: 11/28/2022]
Abstract
Primary cardiac alveolar rhabdomyosarcoma (ARMS) is an extremely rare malignant tumor with dismal prognosis. We herein report a case of right atrial ARMS in a 63-year-old female with intermittent dizziness. Complete surgical resection of the mass was performed and the postoperative histopathologic examination confirmed ARMS. The patient received adjuvant therapy after surgery and was doing well at 1-year follow-up.
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Affiliation(s)
- Xiang Zhou
- Department of Cardiac Surgery, Wuhan Asia Heart Hospital, Wuhan, China
| | - Laichun Song
- Department of Cardiac Surgery, Wuhan Asia Heart Hospital, Wuhan, China
| | - Hongyan Liu
- Department of Cardiac Surgery, Wuhan Asia Heart Hospital, Wuhan, China
| | - Youping Cheng
- Department of Pathology, Wuhan Asia General Hospital, Wuhan, China
| | - Xiao Han
- Department of Cardiac Surgery, Wuhan Asia Heart Hospital, Wuhan, China
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30
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Khituova L, Khabizhanova V, Musayev A, Akhmetova G, Almukhambetova E, Indershiyev V. Risk Factors of Cardiovascular Pathology in Patients with Gout. Curr Rheumatol Rev 2022; 19:72-75. [PMID: 35927914 DOI: 10.2174/1573397118666220802141420] [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: 10/15/2021] [Revised: 03/04/2022] [Accepted: 04/05/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To determine the frequency and assess the risk of cardiovascular disease in patients suffering from gout. BACKGROUND Gout is a sign of disturbed metabolism, which is associated with cardiovascular diseases (CVD). Soaring mortality is associated with a lot of risk factors and comorbid conditions, which have to be dealt with the help of scientists and practitioners. METHODS The following retrospective study included 218 patients suffering from gout according to the criteria of S.L. Wallace. The risk of major coronary events was calculated via the SCORE scale. RESULTS Arterial hypertension and BMI > 25 kg / m2 (90.8%) have prevailed among the respondents. Increased level of total cholesterol (TC) was detected in 63.8% cases, decreased level of highdensity lipoproteins - in 71.6%, and hypertriglyceridemia - in 60.5% relevantly. 175 patients (80.3%) had high cardiovascular risk (estimated more than 5%). 43 (19.7%) of them had a low and medium risk of developing fatal CVD (1-4%). The high share of patients suffering from gout was endangered with cardiovascular pathology. CONCLUSION The most frequently matched risk factors among patients suffering from gout are an increase in BMI> 25 kg/m2 (90.8%) and dyslipidemia.
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Affiliation(s)
- Lidiya Khituova
- Department of Child Diseases, Kazakh National Medical University Named after S. Asfendiyarov, Kazakhstan
| | - Venera Khabizhanova
- Department of General Medical Practice, Kazakh National Medical University, Kazakhstan
| | - Abdugani Musayev
- Department of Ambulance and Emergency Care, Kazakh National Medical University, Kazakhstan
| | - Gulsim Akhmetova
- Department of Ambulance and Emergency Care, Kazakh National Medical University, Kazakhstan
| | - Elmira Almukhambetova
- Department of Ambulance and Emergency Care, Kazakh National Medical University, Kazakhstan
| | - Vildan Indershiyev
- Department of Family Medicine, Kazakh National Medical University, Kazakhstan
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31
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Irqsusi M, Schenk Zu Schweinsberg T, Johnson FA, Dielmann K, Ramzan R, Vogt S, Mirow N, Rastan AJ. Prediction of stroke reconvalescence after coronary bypass surgery indicated by CT scan parameters. J Card Surg 2022; 37:3133-3147. [PMID: 35904236 DOI: 10.1111/jocs.16797] [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: 02/02/2022] [Revised: 05/22/2022] [Accepted: 06/09/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Stroke in the postoperative time course after heart surgery remains a serious risk. Cranial computer tomography (CCT) is the first line option to detect severe intracranial damage. However, only few data are available to predict neurological outcome. Using visual rating scales (VRSs), this study addresses reliability and effectivity to indicate neurological status and likelyhood of improvement. METHODS In a single-center retrospective evaluation, 3719 patients underwent coronary bypass surgery. Because of a delayed recovery phase and neurologic deficits after cardiac surgery 109 patients had a cranial CT scan in the early postoperative period. The incidence of clinically relevant findings within the imaging was rated by an experienced neuroradiologist using two VRS, that is, the age-related white matter changes (ARWMCs) and the Mendes-Ribeiro visual rating scale (MRVRS). Both are computer-assisted measurement schemes to detect stroke-related intracranial damage. Follow-up was investigated with regard to clinical outcome and patient-related risk profiles. RESULTS Of 109 patients with postoperative cranial CT scans due to prolonged recovery phases or proven neurological damage 44.5% had one cerebral defect in CCT imaging scans only. The others showed multiple defects. During hospital stay, 92.3% experienced neurological improvement exposing reduced ARWMC, while 7.1% had no improvement and correlating high scores. Of both scales, the ARWMC-VRS demonstrated superior accuracy and discrimination. The preoperative ejection fraction (EF), arteriosclerotic degeneration of carotid arteries, and reduced glomerular filtration rate were found to have a high correlation (r = 0.0005) with the latter group. In-hospital mortality of this cohort was 8.18%. CONCLUSION Both the ARWMC and MRVRS were found to be appropriate. They reliably discriminate the groups of stroke patients after coronary artery bypass grafting (CABG) in the analysis of CCT images. When applied at the onset of neurological symptoms both scales are able to predict neurological reconvalescence upon hospital dismission. The ARWMC scale appeared superior as it demonstrated better accuracy and discrimination. The use of both VRS in patients with suspected stroke after CABG surgery can give insightful information toward a progression of neurological dysfunction or postoperative improvement.
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Affiliation(s)
- Marc Irqsusi
- Department of Cardiothoracic Surgery, University Hospital Marburg, Philipps University, Marburg, Germany
| | - Titus Schenk Zu Schweinsberg
- Department of Diagnostic and Interventional Radiology, University Hospital Marburg, Philipps University, Marburg, Germany
| | - Felix Allendorff Johnson
- Department of Cardiothoracic Surgery, University Hospital Marburg, Philipps University, Marburg, Germany
| | - Kai Dielmann
- Department of Anesthesiology and Intensive Care, University Hospital Marburg, Philipps University, Marburg, Germany
| | - Rabia Ramzan
- Department of Cardiothoracic Surgery, University Hospital Marburg, Philipps University, Marburg, Germany
| | - Sebastian Vogt
- Department of Cardiothoracic Surgery, University Hospital Marburg, Philipps University, Marburg, Germany
| | - Nikolas Mirow
- Department of Cardiothoracic Surgery, University Hospital Marburg, Philipps University, Marburg, Germany
| | - Ardawan J Rastan
- Department of Cardiothoracic Surgery, University Hospital Marburg, Philipps University, Marburg, Germany
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32
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Perez SA, Ebner B, Kall CMY, Mitrani R, de Marchena EJ. A novel temporary atrioventricular sequential pacing catheter-Characteristics and first-in-human application. J Card Surg 2022; 37:2991-2996. [PMID: 35900290 DOI: 10.1111/jocs.16796] [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: 03/09/2022] [Revised: 04/21/2022] [Accepted: 04/26/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sequential synchronized atrioventricular (AV) pacing provides enhanced electrophysiologic parameters which contribute to improved hemodynamic parameters and increased cardiac performance to subsequently confer a clinical advantage over traditional ventricular pacing. Current temporary transvenous pacemaker catheters are limited to only one electrode which paces solely the right ventricle, thus lacking the capability to provide the optimal pacing mode. A new multilead pacemaker device was developed in response to the need for improved temporary pacing through the utilization of sequential synchronized atrioventricular pacing (TAVSP). It consists of seven preformed, preshaped nitinol wires electrodes, of which four are for intra-atrial and three for intraventricular positioning and endocardial contact, respectively. Each wire carries a ball tip designed to minimize tissue trauma and provide a high current density for adequate myocardial capture. The device is not yet Food and Drug Administration approved. OBJECTIVE To present the unique structural components and mechanical properties of a novel sequential synchronized AV pacing device for temporary insertion and to report its first-in-human application with an analysis of the early clinical experience. METHODS Following a process of development and proof of concept of the novel pacing modality in an animal model which demonstrated feasibility and safety, a series of patients who were candidates for the device application was identified. During left and right heart catheterization, the novel temporary pacing catheter was inserted transvenously and delivered in most patients under fluoroscopy or echocardiography. The catheter was deployed to its target right heart anatomic sites and then activated in an AV sequential mode. The technical aspects, the corresponding clinical utilization, and device performance were documented and analyzed. RESULTS The series included 10 enrolled subjects. During planned left and right heart catheterization, the novel TAVSP device was inserted transvenously and then delivered and deployed successfully in a timely fashion in all patients. The pacing catheter achieved proper threshold and impedance in all (100%) patients. The performance of all ventricular leads was adequate; however, in 1 (10%) patient poor performance of the atrial leads was detected. The device was successfully retrieved in all patients. No adverse arrhythmia, impaired hemodynamics, or clinical adverse events occurred. No technical difficulties, component failure, or wires thrombosis were detected. All patients sustained the device application without sequala and were discharged home. CONCLUSION Initial clinical experience with the utilization of a novel TAVSP demonstrates feasibility and safety in humans. The TAVSP modality potentially offers improved pacing capability and subsequent hemodynamic benefits over the current temporary pacing catheters. Further experience with the clinical application of this pacing catheter is warranted.
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Affiliation(s)
- Sergio A Perez
- Baptist Health Medical Center, Cardiovascular Services, Montgomery, Alabama, USA
| | - Bertrand Ebner
- Division of Cardiovascular Medicine, University of Miami Miller School of Medicine, University of Miami Hospital, Miami, Florida, USA
| | - Christian M Y Kall
- Division of Cardiovascular Medicine, University of Miami Miller School of Medicine, University of Miami Hospital, Miami, Florida, USA
| | - Raul Mitrani
- Division of Cardiovascular Medicine, University of Miami Miller School of Medicine, University of Miami Hospital, Miami, Florida, USA
| | - Eduardo J de Marchena
- Division of Cardiovascular Medicine, University of Miami Miller School of Medicine, University of Miami Hospital, Miami, Florida, USA
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Shou BL, Halub ME, Zhou AL, Thompkins BA, Choi CW. Massive left atrial thrombus evades multimodality imaging as a myxoma in a bicaval heart transplant recipient. J Card Surg 2022; 37:2884-2887. [PMID: 35789119 DOI: 10.1111/jocs.16708] [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: 02/09/2022] [Revised: 06/07/2022] [Accepted: 06/13/2022] [Indexed: 11/30/2022]
Abstract
Intracardiac masses are an extremely rare and poorly described complication following a bicaval heart transplantation. We describe the case of an asymptomatic 62-year-old male with a large left atrial mass found incidentally on transthoracic echocardiography 6 years post-transplant. A battery of additional imaging tests was ordered including transesophageal echocardiography, 18 F-fluorodeoxyglucose positron emission tomography/computed tomography, and T1 and T2 magnetic resonance imaging. Although imaging biomarkers were generally nonspecific, the mass was most consistent with a cardiac myxoma. However, intraoperative findings confirmed by pathology revealed a massive organizing thrombus. The patient had an uneventful recovery after surgical removal of the mass. Our case highlights a very rare phenomenon in heart transplant recipients which remains a unique diagnostic challenge even with current advances in imaging.
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Affiliation(s)
- Benjamin L Shou
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Meghan E Halub
- Division of Cardiac Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Alice L Zhou
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Bryon A Thompkins
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Chun W Choi
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Cardiothoracic Surgery, Virtua Health, Virtua Our Lady of Lourdes Hospital, Camden, New Jersey, USA
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Zhou X, Song L, Cheng Y, He C, He J, Han X. Unusual case of a right atrial inflammatory myofibroblastic tumor presenting with an episodic cyanosis in an infant. J Card Surg 2022; 37:2859-2861. [PMID: 35726650 DOI: 10.1111/jocs.16698] [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: 05/29/2022] [Accepted: 06/10/2022] [Indexed: 11/26/2022]
Abstract
Cardiac inflammatory myofibroblastic tumor (IMT) is a rare benign tumor that occurs mainly in infants and children. We report a case of right atrial IMT in a 1-month-old girl with episodic cyanosis. Both echocardiography and cardiac computed tomography revealed a right atrial mass. The patient underwent a complete surgical resection of the mass and the postoperative histological examination confirmed the diagnosis of cardiac IMT. The patient recovered well after the operation and further follow-up evaluation was uneventful.
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Affiliation(s)
- Xiang Zhou
- Department of Cardiac Surgery, Wuhan Asia Heart Hospital, Wuhan, China
| | - Laichun Song
- Department of Cardiac Surgery, Wuhan Asia Heart Hospital, Wuhan, China
| | - Youping Cheng
- Department of Pathology, Wuhan Asia General Hospital, Wuhan, China
| | - Chunli He
- Department of Radiology, Wuhan Asia Heart Hospital, Wuhan, China
| | - Jiahui He
- Department of Echocardiography, Wuhan Asia Heart Hospital, Wuhan, China
| | - Xiao Han
- Department of Cardiac Surgery, Wuhan Asia Heart Hospital, Wuhan, China
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35
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Chowdhury UK, Anderson RH, Spicer DE, George N, Sankhyan LK, Pandey NN, Goja S, Chandhirasekar B. Transposition physiology in the setting of concordant ventriculo-arterial connections. J Card Surg 2022; 37:2823-2834. [PMID: 35717625 DOI: 10.1111/jocs.16688] [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: 03/20/2022] [Revised: 04/23/2022] [Accepted: 05/09/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIM To review the anatomical details, diagnostic challenges, associated cardiovascular anomalies, and techniques and outcomes of management, including re-interventions, for the rare instances of transposition physiology with concordant ventriculo-arterial connections. METHODS We reviewed clinical and necropsy studies on diagnosis and surgical treatment of individuals with transposition physiology and concordant ventriculo-arterial connections, analyzing also individuals with comparable flow patterns in the setting of isomerism. RESULTS Among reported cases, just over two-thirds were diagnosed during surgery, after initial palliation, or after necropsy. Of the patients, four-fifths presented in infancy with either cyanosis or congestive cardiac failure, with complex associated cardiac malformations. Nearly half had ventricular septal defects, and one-fifth had abnormalities of the tricuspid valve, including hypoplasia of the morphologically right ventricle. A small minority had common atrioventricular junctions We included cases reported with isomerism when the flow patterns were comparable, although the atrioventricular connections are mixed in this setting. Management mostly involved construction of intraatrial baffles, along with correction of coexisting anomalies, either together or multistaged. Overall mortality was 25%, with one-fifth of patients requiring pacemakers for surgically-induced heart block. The majority of survivors were in good functional state. CONCLUSIONS The flow patterns produced by discordant atrioventricular and concordant ventriculo-arterial connections remain an important, albeit rare, indication for atrial redirection or hemi-Mustard's procedure with bidirectional Glenn. The procedure recruits the morphologically left ventricle in the systemic circuit, producing good long-term functional results. The approach can also be used for those with isomeric atrial appendages and comparable hemodynamic circuits.
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Affiliation(s)
- Ujjwal Kumar Chowdhury
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Robert H Anderson
- Institute of Biomedical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - Diane E Spicer
- Department of Pediatric Cardiology, Heart Institute, Johns Hopkins All Children's Hospital, University of Florida, Gainesville, Florida, USA
| | - Niwin George
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Lakshmi Kumari Sankhyan
- Department of Cardiothoracic Surgery, All India Institute of Medical Sciences, Bilaspur, India
| | | | - Shikha Goja
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Balaji Chandhirasekar
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
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Bertolone DT, Bermpeis K, Gallinoro E, Esposito G, Paolisso P, De Colle C, Sonck J, Collet C, De Bruyne B, Barbato E, Van Praet F, Wyffels E. First report of totally robotically assisted hybrid coronary artery revascularization combining RE-MIDCAB and R-PCI: Case report. J Card Surg 2022; 37:2907-2911. [PMID: 35690894 DOI: 10.1111/jocs.16674] [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: 03/22/2022] [Revised: 05/10/2022] [Accepted: 05/19/2022] [Indexed: 11/30/2022]
Abstract
A 62-year-old man presents to the Cardiology Department with a history of angina on exertion. Invasive coronary angiography revealed a severe three vessels coronary artery disease. The "Hybrid Heart Team" successfully performed a fully robotically assisted hybrid revascularization combining robotically enhanced-minimally invasive direct coronary artery bypass on the left anterior descending (LAD) and robotically assisted percutaneous coronary intervention on non-LAD lesions.
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Affiliation(s)
- Dario T Bertolone
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Esposito
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Cristina De Colle
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Frank Van Praet
- Cardiovascular and Thoracic Surgery, OLV-Clinic, Aalst, Belgium
| | - Eric Wyffels
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
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Ikonomidis JS. The recurring theme of gender difference in cardiac surgical outcomes. J Card Surg 2022; 37:2661-2662. [PMID: 35652890 DOI: 10.1111/jocs.16657] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 05/18/2022] [Indexed: 11/30/2022]
Affiliation(s)
- John S Ikonomidis
- Division of Cardiothoracic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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38
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Copeland H, Westfall S, Morton J, Mohammed A. Successful recovery with venovenous ECMO for ARDS after LVAD HeartMate 3 implantation: A case report. J Card Surg 2022; 37:2450-2452. [PMID: 35650659 DOI: 10.1111/jocs.16624] [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: 03/15/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 11/28/2022]
Abstract
Acute respiratory distress syndrome (ARDS) following left ventricular assist device (LVAD) implantation is a rare complication. Venovenous (VV) extracorporeal membrane oxygenation (ECMO) is used as a treatment for severe ARDS and pneumonia. We report the successful use of VV ECMO for ARDS Klebsiella pneumonia following urgent LVAD HeartMate 3 implantation.
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Affiliation(s)
- Hannah Copeland
- Department of Cardiovascular and Thoracic Surgery, Lutheran Hospital, Fort Wayne, Indiana, USA.,Indiana University School of Medicine, Fort Wayne, Indiana, USA
| | - S Westfall
- Department of Cardiology, Advanced Heart Failure, Heart Transplant and Ventricular Assist Devices, Lutheran Hospital, Fort Wayne, Indiana, USA
| | - John Morton
- Department of Perfusion, Lutheran Hospital, Fort Wayne, Indiana, USA
| | - Asim Mohammed
- Department of Cardiology, Advanced Heart Failure, Heart Transplant and Ventricular Assist Devices, Lutheran Hospital, Fort Wayne, Indiana, USA
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39
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Khatri M. Aortic valve repair in patients with ventricular septal defect. J Card Surg 2022; 37:2508. [PMID: 35582753 DOI: 10.1111/jocs.16600] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Mahima Khatri
- Dow University of Health Sciences, Karachi, Pakistan
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40
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Aranda-Domene R, Minano-Frutos C, Arribas-Leal JM, Pérez-Andreu J, Taboada-Martín R, Alfonso-Colomer L, Moreno-Moreno J, Canovas S. Accessory left atrial cords: A case report and literature review. J Card Surg 2022; 37:2437-2439. [PMID: 35578332 DOI: 10.1111/jocs.16608] [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: 02/19/2022] [Revised: 05/01/2022] [Accepted: 05/02/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Accessory left atrial cords are fibroelastic structures found in the left atrium. Left atrial cords may be associated with mitral valve disease, atrial fibrillation, stroke, and other congenital left-side anomalies. METHODS We presented the case of a man with severe Mitral Regurgitation and two accessories left atrial cords attached to P2 scallop by a single tendon and performed a literature review using PUBMED/MEDLINE, Web of Science, and EMBASE databases on December 4, 2021. RESULTS According to our review, accessory left atrial cords were found more frequently in women (36 patients, 62%), more frequently attached to the mitral valve (66% of reports) and mitral regurgitation was the most frequently reported pattern of mitral valve disease (64.2%). No other cases of double left atrial cords attached to P2 segment were found. CONCLUSION Accessory left atrial chords may be related to mitral valve disease and other left-side congenital abnormalities. These structures were found more frequently in females and A2 insertion was the most frequently observed pattern in the review.
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Affiliation(s)
- Ramón Aranda-Domene
- Cardiovascular Surgery Department, Arrixaca University Hospital, IMIB Arrixaca, Murcia, Spain
| | - Celia Minano-Frutos
- Anesthesiology and Reanimation Department, Arrixaca University Hospital, IMIB Arrixaca, Murcia, Spain
| | - José M Arribas-Leal
- Cardiovascular Surgery Department, Arrixaca University Hospital, IMIB Arrixaca, Murcia, Spain
| | - Joaquín Pérez-Andreu
- Cardiovascular Surgery Department, Arrixaca University Hospital, IMIB Arrixaca, Murcia, Spain
| | - Rubén Taboada-Martín
- Cardiovascular Surgery Department, Arrixaca University Hospital, IMIB Arrixaca, Murcia, Spain
| | - Laura Alfonso-Colomer
- Cardiovascular Surgery Department, Arrixaca University Hospital, IMIB Arrixaca, Murcia, Spain
| | - José Moreno-Moreno
- Cardiovascular Surgery Department, Arrixaca University Hospital, IMIB Arrixaca, Murcia, Spain
| | - Sergio Canovas
- Cardiovascular Surgery Department, Arrixaca University Hospital, IMIB Arrixaca, Murcia, Spain
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41
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Minatoya K. Is this the final answer for the aortopathy with bicuspid aortic valve. J Card Surg 2022; 37:2336-2337. [PMID: 35526124 DOI: 10.1111/jocs.16589] [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: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/28/2022]
Abstract
There have been changes in the guidelines for surgical indications for aortopathy associated with bicuspid aortic valves over the last 10 years. Although the results of the last 3 years adhering to the latest guidelines have been shown to be good, careful follow-up and accumulation of new research findings are still required.
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Affiliation(s)
- Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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42
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Kumar A, Satija S. The choice of palliative arterial switch operation as an alternative for selected cases in a single center: Experience and midterm results. J Card Surg 2022; 37:2502. [PMID: 35488782 DOI: 10.1111/jocs.16566] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Arun Kumar
- Ghulam Muhammad Mahar Medical College, Sukkur, Pakistan
| | - Sapna Satija
- Ghulam Muhammad Mahar Medical College, Sukkur, Pakistan
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43
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Serna-Gallegos D, Brown JA, Ridgley J, Aranda-Michel E, Navid F, Wang Y, Thoma FW, Sultan I. Long-term outcomes of patients undergoing mechanical versus bioprosthetic aortic root replacement. J Card Surg 2022; 37:1861-1867. [PMID: 35488772 DOI: 10.1111/jocs.16544] [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: 10/27/2021] [Revised: 03/02/2022] [Accepted: 03/23/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND We evaluated the impact of valve type (mechanical vs. bioprosthetic) on survival after aortic root replacement (ARR). METHODS In a propensity-matched analysis, we evaluated consecutive operations from 2010 to 2018. Patients were identified using a prospectively maintained institutional database. Patients with infective endocarditis were excluded. Kaplan-Meier survival estimation and multivariable Cox regression analysis were performed. Cox regression adjusted for age, sex, baseline comorbidities, and operative variables. Propensity score matching yielded 153 pairs of patients. RESULTS A total of 893 patients were identified. We excluded 192 patients with endocarditis and evaluated 701 patients. Of these patients, 455 (64.9%) received a bioprosthetic valve, 246 (35.1%) received a mechanical valve. Median follow-up was 4.06 years. The proportion of aortic dissections and circulatory arrest as well as cardiopulmonary bypass and ischemic times were similar across groups (p = .207, p = .086, p = .668, p = .454, respectively). Operative mortality was significantly higher in the bioprosthetic valve group (7.9% vs. 2.4%, p = .004). Total length of hospital stay was longer (11.4 ± 11.0 vs. 9.5 ± 10.1, p < .001) and there was a higher proportion of prolonged postoperative ventilation >24 h (21.3% vs. 13.0%, p = .007) in the bioprosthetic group. Postoperative outcomes were similar, regarding stroke (p = .077), re-exploration for bleeding (p = .211), new dialysis requirement (p = .077), long-term bleeding complications (p = .561), and reoperations (p = .755). Mechanical valve replacement was associated with improved long-term survival (adjusted HR 0.42, 95% CI: 0.23-0.77, p = .005). CONCLUSIONS These findings suggest that mechanical valves for ARRs may confer a survival benefit over bioprosthetic valves. Surgeon bias was likely to account for this survival advantage.
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Affiliation(s)
- Derek Serna-Gallegos
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - James A Brown
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jacqueline Ridgley
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Edgar Aranda-Michel
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Forozan Navid
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Yisi Wang
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Floyd W Thoma
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ibrahim Sultan
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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44
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Satija S, Kumar A. Association between time to therapeutic INR and length of stay following mechanical heart valve surgery. J Card Surg 2022; 37:2501. [PMID: 35488788 DOI: 10.1111/jocs.16562] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 04/18/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Sapna Satija
- Ghulam Muhammad Mahar Medical College, Sukkur, Pakistan
| | - Arun Kumar
- Ghulam Muhammad Mahar Medical College, Sukkur, Pakistan
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45
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Nadeem B. Letter to the Editor: Minimally invasive aortic valve repair using geometric ring annuloplasty. J Card Surg 2022; 37:2504. [PMID: 35485724 DOI: 10.1111/jocs.16571] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 04/18/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Bilawal Nadeem
- Department of Medicine, King Edward Medical University, Lahore, Punjab, Pakistan
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46
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Usman M, Azhar M. Letter to the Editor: Long-term results of percutaneous closure of patent ductus arteriosus associated with unilateral lack of a pulmonary artery. J Card Surg 2022; 37:2500. [PMID: 35485641 DOI: 10.1111/jocs.16560] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 04/18/2022] [Indexed: 11/27/2022]
Affiliation(s)
| | - Masood Azhar
- King Edward Medical University, Mayo Hospital, Lahore, Pakistan
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47
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Anumolu AR, Panakala S, Kumar S. Letter to the Editor: Outcomes of minimally invasive aortic valve replacement in patients with obese body mass indices. J Card Surg 2022; 37:2503. [PMID: 35471585 DOI: 10.1111/jocs.16568] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Akhil R Anumolu
- Andhra Medical College, Visakhapatnam, Andhra Pradesh, India
| | | | - Satesh Kumar
- Shaheed Mohtarma Benazir Bhutto Medical College Liyari, Karachi, Pakistan
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48
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Hiltner E, Erinne I, Singh A, Chen C, Kassotis J, Russo M, Sethi A. Contemporary trends and in-hospital outcomes of mechanical and bioprosthetic surgical aortic valve replacement in the United States. J Card Surg 2022; 37:1980-1988. [PMID: 35419890 DOI: 10.1111/jocs.16499] [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: 12/07/2021] [Revised: 02/03/2022] [Accepted: 02/18/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The choice between a mechanical versus a bioprosthetic valve in aortic valve replacement (AVR) is based on life expectancy, bleeding risk and comorbidities, since bioprosthetic AVR (bAVR) are associated with a more rapid structural deterioration compared to mechanical AVR (mAVR). The impact of widespread transcatheter valve replacements, on the decision to use bAVR versus mAVR, in the contemporary era and subsequent outcomes remain to be determined. METHODS The National Inpatient database (2009-2018) was used to study trends in admissions for bAVR and mAVR and in-hospital mortality and outcomes over time. Survey estimation commands were used to determine weighted national estimates. RESULTS There were 700,896 ± 18,285 inpatient visits for AVR with 70.1% (95% CI 69.2%-71.1%) and 29.9% (95% CI 28.9%-30.8%) visits for bAVR and mAVR, respectively. Those undergoing bAVR were significantly older (bAVR [69.8 years] vs. mAVR [62.7 years] p < .001]. The rates of mAVR decreased across all age groups during the study period (ptrend < .001), including patients ≤50 years (ptrend < .001). In-hospital mortality for mAVR recipients was higher, both after multivariable adjustment (OR 1.35 95% CI 1.26-1.45 p < .001) and propensity matching (mean difference 0.846% ± 0.19%). CONCLUSION In the contemporary era, the utilization of mAVR has decreased across all age groups, including those younger than 50 years old. Although mAVR recipients were healthier with less comorbidities, inpatient mortality was higher after mAVR compared to bAVR. In addition to understanding causes for higher in-hospital mortality after mAVR, future research should focus on developing transcatheter valve replacement friendly bAVR.
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Affiliation(s)
- Emily Hiltner
- Department of Medicine, Division of Cardiology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Ikenna Erinne
- Department of Medicine, Division of Cardiology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Anjuli Singh
- Department of Family Medicine, Robert Wood Johnson University Hospital Somerset, New Brunswick, New Jersey, USA
| | - Chunguang Chen
- Department of Medicine, Division of Cardiology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - John Kassotis
- Department of Medicine, Division of Cardiology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Mark Russo
- Department of Surgery, Division of Cardiothoracic Surgery, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Ankur Sethi
- Department of Medicine, Division of Cardiology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
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49
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Sharma A, Naganur SH, Baranwal AK, Singhal M. Congenitally corrected transposition with absent pulmonary valve: Hitherto unreported association. J Card Surg 2022; 37:2100-2102. [PMID: 35415859 DOI: 10.1111/jocs.16502] [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: 01/20/2022] [Revised: 03/19/2022] [Accepted: 03/21/2022] [Indexed: 11/30/2022]
Abstract
Absent pulmonary valve has usually been described in association with tetralogy of Fallot. Present case highlights its association with congenitally corrected transposition which has not been reported so far in literature.
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Affiliation(s)
- Arun Sharma
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjeev Hanumantacharya Naganur
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arun Kumar Baranwal
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manphool Singhal
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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50
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Bansal A, Akhtar F, Desai S, Velasco-Gonzalez C, Bansal A, Teagle A, Shridhar A, Webre K, Ostrow S, Fary D, Parrino PE. Six-month outcomes in postapproval HeartMate3 patients: A single-center US experience. J Card Surg 2022; 37:1907-1914. [PMID: 35385586 PMCID: PMC9320844 DOI: 10.1111/jocs.16452] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The European CE Mark approval study and the MOMENTUM 3 trial demonstrated safety and a reduction in hemocompatibility-related adverse events with the use of HeartMate 3 (HM3) device. This single-center study investigated the real-world experience in HM3 patients since FDA approval. METHODS This retrospective, observational study included patients implanted with the HM3 LVAD as a primary implant between October 2017 and March 2020. Patients were divided into trial group and postapproval group. The primary endpoint was survival at 6 months. Secondary endpoints were adverse events including pump thrombosis (requiring pump exchange), stroke, renal failure, acute limb ischemia, re-exploratory for bleeding, gastrointestinal bleeding, right ventricular failure, and driveline infection. RESULTS A total of 189 patients were implanted with HM3 device during the study period. 174 patients met the inclusion criteria: 82 patients in the trial group and 92 patients in the postapproval group. The postapproval group had younger patients, higher preoperative mean international normalized ratio, and greater numbers of patients with bridge to transplant (BTT) indications, IINTERMACS profile 1, and use of mechanical assist devices (other than IABP) than the trial group. Other characteristics between the two groups were comparable. Overall survival at 6 months in the postapproval group was 93.3% versus 93.8% (p = .88). The postapproval group demonstrated a statistically significant lower incidence of re-explorative surgery for bleeding (10.9% vs. 46.3, p = .01) than the trial group. CONCLUSION In this single-center study, the real-world 6-month survival in the postapproval group was comparable to the trial results. Further studies are needed to monitor long-term outcomes.
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Affiliation(s)
- Aditya Bansal
- Section of Cardiothoracic Surgery, Department of Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA.,Faculty of Medicine, Ochsner Clinical School, The University of Queensland, New Orleans, Louisiana, USA
| | - Faisal Akhtar
- Section of Cardiothoracic Surgery, Department of Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Sapna Desai
- Department of Cardiology, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Cruz Velasco-Gonzalez
- Center for Applied Health Services Research, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Anirudh Bansal
- Section of Cardiothoracic Surgery, Department of Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Angie Teagle
- Section of Cardiothoracic Surgery, Department of Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Avni Shridhar
- Section of Cardiothoracic Surgery, Department of Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Karen Webre
- Section of Cardiothoracic Surgery, Department of Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Sheila Ostrow
- Section of Cardiothoracic Surgery, Department of Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - David Fary
- Section of Cardiothoracic Surgery, Department of Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Patrick Eugene Parrino
- Section of Cardiothoracic Surgery, Department of Surgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA.,Faculty of Medicine, Ochsner Clinical School, The University of Queensland, New Orleans, Louisiana, USA
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