Yi Dong, Zai-Rong Lin, Liang-Wan Chen, Zeng-Rong Luo
Objective. To establish risk factors for predicting preoperative ruptures in patients with acute type A aortic dissection (ATAAD) based on computed tomography angiography (CTA) imaging features alone. Methods. We retrospectively reviewed patients with ATAAD treated between January 2017 and December 2021 in Fujian Medical University Union Hospital, China. The primary outcome was preoperative rupture after admission. Multivariate logistic regression analysis was performed based on basic characteristics and CTA imaging variables selected by the application of the least absolute shrinkage and selection operator. Results. A total of 564 patients were enrolled. The rate of preoperative rupture was 14.2% (n = 80). Patients who experienced rupture were significantly older ( = 0.002) and had a higher rate of DeBakey II ( = 0.016), syncope ( = 0.003), ventilator-assisted ventilation ( = 0.008), preoperative shock ( = 0.040), hypotensive state ( = 0.009), hepatic insufficiency ( = 0.002), acute kidney injury ( = 0.045), and moderate or massive pericardial effusion ( = 0.007). Multivariate analysis identified the following independent risk factors for preoperative rupture based on CTA imaging features: DeBakey II (odds ratio (OR) = 1.988, 95% confidence interval (CI) 1.211–3.676, = 0.009), ascending aorta diameter (OR = 2.077, 95% CI 1.335–4.045, < 0.001), ascending aorta false lumen diameter (OR = 2.988, 95% CI 2.055–4.291, < 0.001), ascending aorta false lumen/true lumen diameter ratio >4 : 1 (OR = 3.129, 95% CI 2.031–6.225, < 0.001), and number of branch arteries involved in dissection >6 (OR = 1.154, 95% CI 1.036–2.006, = 0.036). Conclusions. CTA imaging features are one of the most convenient indicators for the early prediction of preoperative rupture in patients with ATAAD.
目标。目的:建立基于ct血管造影(CTA)影像学特征预测急性A型主动脉夹层(ATAAD)患者术前破裂的危险因素。方法。我们回顾性分析了2017年1月至2021年12月在中国福建医科大学协和医院治疗的ATAAD患者。主要结局是入院后术前破裂。应用最小绝对收缩算子和选择算子，根据基本特征和选择的CTA成像变量进行多元logistic回归分析。结果。共有564名患者入组。术前破裂率为14.2% (n = 80)。破裂的患者明显年龄较大(P = 0.002)， deakey II (P = 0.016)、晕厥(P = 0.003)、呼吸机辅助通气(P = 0.008)、术前休克(P = 0.040)、低血压(P = 0.009)、肝功能不全(P = 0.002)、急性肾损伤(P = 0.045)、中度或大量心包积液(P = 0.007)发生率较高。多因素分析根据CTA影像学特征确定了以下术前破裂的独立危险因素:DeBakey II(优势比(OR) = 1.988, 95%可信区间(CI) 1.211 ~ 3.676, P = 0.009)，升主动脉直径(OR = 2.077, 95% CI 1.335 ~ 4.045, P <0.001)，升主动脉假腔直径(OR = 2.988, 95% CI 2.055-4.291, P <0.001)，升主动脉假腔/真腔直径比> 4:1 (OR = 3.129, 95% CI 2.031-6.225, P <0.001)，以及分支动脉剥离数>6 (OR = 1.154, 95% CI 1.036-2.006, P = 0.036)。结论。CTA影像学特征是早期预测ATAAD患者术前破裂最方便的指标之一。
{"title":"Predicting Preoperative Rupture from Imaging Alone in Acute Type A Aortic Dissection","authors":"Yi Dong, Zai-Rong Lin, Liang-Wan Chen, Zeng-Rong Luo","doi":"10.1155/2023/1337373","DOIUrl":"https://doi.org/10.1155/2023/1337373","url":null,"abstract":"Objective. To establish risk factors for predicting preoperative ruptures in patients with acute type A aortic dissection (ATAAD) based on computed tomography angiography (CTA) imaging features alone. Methods. We retrospectively reviewed patients with ATAAD treated between January 2017 and December 2021 in Fujian Medical University Union Hospital, China. The primary outcome was preoperative rupture after admission. Multivariate logistic regression analysis was performed based on basic characteristics and CTA imaging variables selected by the application of the least absolute shrinkage and selection operator. Results. A total of 564 patients were enrolled. The rate of preoperative rupture was 14.2% (n = 80). Patients who experienced rupture were significantly older ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M1\"> <mi>P</mi> </math> = 0.002) and had a higher rate of DeBakey II ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M2\"> <mi>P</mi> </math> = 0.016), syncope ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M3\"> <mi>P</mi> </math> = 0.003), ventilator-assisted ventilation ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M4\"> <mi>P</mi> </math> = 0.008), preoperative shock ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M5\"> <mi>P</mi> </math> = 0.040), hypotensive state ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M6\"> <mi>P</mi> </math> = 0.009), hepatic insufficiency ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M7\"> <mi>P</mi> </math> = 0.002), acute kidney injury ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M8\"> <mi>P</mi> </math> = 0.045), and moderate or massive pericardial effusion ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M9\"> <mi>P</mi> </math> = 0.007). Multivariate analysis identified the following independent risk factors for preoperative rupture based on CTA imaging features: DeBakey II (odds ratio (OR) = 1.988, 95% confidence interval (CI) 1.211–3.676, <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M10\"> <mi>P</mi> </math> = 0.009), ascending aorta diameter (OR = 2.077, 95% CI 1.335–4.045, <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M11\"> <mi>P</mi> </math> < 0.001), ascending aorta false lumen diameter (OR = 2.988, 95% CI 2.055–4.291, <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M12\"> <mi>P</mi> </math> < 0.001), ascending aorta false lumen/true lumen diameter ratio >4 : 1 (OR = 3.129, 95% CI 2.031–6.225, <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M13\"> <mi>P</mi> </math> < 0.001), and number of branch arteries involved in dissection >6 (OR = 1.154, 95% CI 1.036–2.006, <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M14\"> <mi>P</mi> </math> = 0.036). Conclusions. CTA imaging features are one of the most convenient indicators for the early prediction of preoperative rupture in patients with ATAAD.","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135045095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andrea Amabile, Brandon Muncan, Arnar Geirsson, Andreas P. Kalogeropoulos, Markus Krane
Objective. We aimed to investigate outcomes in transcatheter versus surgical mitral valve repair in patients with secondary mitral regurgitation (MR) by leveraging a global, multi-institutional federated network database. Methods. Using validated ICD-10 and CPT codes, the TriNetX Analytics Research Data Network (a global federated database of electronic health records from 58 healthcare organizations) was queried to identify patients diagnosed with chronic, severe, ischemic MR and undergoing either transcatheter mitral valve repair (TMVr) or surgical mitral valve repair (SMVr) between January 1, 2015 and December 31, 2020. To adjust for baseline differences, 1 : 1 propensity score matching was performed via logistic regression using the nearest-neighbor approach and matching for 29 covariates including demographics, comorbidities, surgical history, preoperative medications, left ventricular function and heart failure status. We compared 1- and 3-year mortality rates and 1- and 3-year mitral valve reoperation rates in the matched cohorts using Kaplan-Meier estimates and adjusted Cox proportional hazards models. Results. A total of 2,352 patients met inclusion criteria (1,392 in the surgical mitral valve repair group and 960 in the TMVr group). After 1 : 1 propensity score matching, a total of 550 patients undergoing surgical mitral valve repair (SMVr) were compared to 550 patients undergoing TMVr. All characteristics were adequately matched between the cohorts (standardized mean difference <0.1). At 1- and 3-years respectively, mortality rate was 13.4% and 20.7% for surgical patients and 19.8% and 40.3% for TMVr patients. When compared to TMVr, patients undergoing SMVr were significantly less likely to face mortality at 3 years (HR: 0.42, 95% CI: 0.31–0.56, ). At 1- and 3-years respectively, mitral valve reoperation was 2.2%, and 2.4% for surgical patients and 6.6% and 7.8% for TMVr patients. When compared to TMVr, patients undergoing SMVr were significantly less likely to undergo mitral valve reintervention at 3 years (HR: 0.29, 95% CI: 0.14–0.58, p = 0.0002). Conclusion. In a real-world, propensity score matching analysis of a large cohort of patients with chronic ischemic MR, surgical mitral valve repair had significantly better survival rates and significantly lower reintervention rates at 1- and 3-years compared to TMVr.
目标。我们旨在通过利用全球多机构联合网络数据库，研究经导管与手术二尖瓣修复继发性二尖瓣反流(MR)患者的结果。方法。使用经过验证的ICD-10和CPT代码，查询TriNetX分析研究数据网络(来自58个医疗保健组织的电子健康记录的全球联邦数据库)，以确定2015年1月1日至2020年12月31日期间诊断为慢性，严重，缺血性MR并接受经导管二尖瓣修复(TMVr)或手术二尖瓣修复(SMVr)的患者。为了调整基线差异，采用最近邻方法，通过logistic回归进行1:1倾向评分匹配，并匹配29个协变量，包括人口统计学、合并症、手术史、术前用药、左心室功能和心力衰竭状态。我们使用Kaplan-Meier估计和调整的Cox比例风险模型比较了匹配队列中1年和3年死亡率以及1年和3年二尖瓣再手术率。结果。共有2352例患者符合纳入标准(手术二尖瓣修复组1392例，TMVr组960例)。1:1倾向评分匹配后，550例接受外科二尖瓣修复(SMVr)的患者与550例接受TMVr的患者进行比较。所有特征在队列之间充分匹配(标准化平均差<0.1)。手术患者1年和3年的死亡率分别为13.4%和20.7%，TMVr患者为19.8%和40.3%。与TMVr相比，接受SMVr的患者在3年时面临死亡率的可能性显著降低(HR: 0.42, 95% CI: 0.31-0.56, p <0.0001)。手术患者1年和3年二尖瓣再手术分别为2.2%和2.4%，TMVr患者为6.6%和7.8%。与TMVr相比，接受SMVr的患者在3年时进行二尖瓣再干预的可能性显著降低(HR: 0.29, 95% CI: 0.14-0.58, p = 0.0002)。结论。在现实世界中，对大量慢性缺血性MR患者进行倾向评分匹配分析，与TMVr相比，手术二尖瓣修复在1年和3年的生存率显著提高，再干预率显著降低。
{"title":"Surgical versus Interventional Mitral Valve Repair: Analysis of 1,100 Propensity Score-Matched Patients","authors":"Andrea Amabile, Brandon Muncan, Arnar Geirsson, Andreas P. Kalogeropoulos, Markus Krane","doi":"10.1155/2023/8838005","DOIUrl":"https://doi.org/10.1155/2023/8838005","url":null,"abstract":"Objective. We aimed to investigate outcomes in transcatheter versus surgical mitral valve repair in patients with secondary mitral regurgitation (MR) by leveraging a global, multi-institutional federated network database. Methods. Using validated ICD-10 and CPT codes, the TriNetX Analytics Research Data Network (a global federated database of electronic health records from 58 healthcare organizations) was queried to identify patients diagnosed with chronic, severe, ischemic MR and undergoing either transcatheter mitral valve repair (TMVr) or surgical mitral valve repair (SMVr) between January 1, 2015 and December 31, 2020. To adjust for baseline differences, 1 : 1 propensity score matching was performed via logistic regression using the nearest-neighbor approach and matching for 29 covariates including demographics, comorbidities, surgical history, preoperative medications, left ventricular function and heart failure status. We compared 1- and 3-year mortality rates and 1- and 3-year mitral valve reoperation rates in the matched cohorts using Kaplan-Meier estimates and adjusted Cox proportional hazards models. Results. A total of 2,352 patients met inclusion criteria (1,392 in the surgical mitral valve repair group and 960 in the TMVr group). After 1 : 1 propensity score matching, a total of 550 patients undergoing surgical mitral valve repair (SMVr) were compared to 550 patients undergoing TMVr. All characteristics were adequately matched between the cohorts (standardized mean difference <0.1). At 1- and 3-years respectively, mortality rate was 13.4% and 20.7% for surgical patients and 19.8% and 40.3% for TMVr patients. When compared to TMVr, patients undergoing SMVr were significantly less likely to face mortality at 3 years (HR: 0.42, 95% CI: 0.31–0.56, <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M1\"> <mi>p</mi> <mtext> </mtext> <mo><</mo> <mtext> </mtext> <mn>0.0001</mn> </math> ). At 1- and 3-years respectively, mitral valve reoperation was 2.2%, and 2.4% for surgical patients and 6.6% and 7.8% for TMVr patients. When compared to TMVr, patients undergoing SMVr were significantly less likely to undergo mitral valve reintervention at 3 years (HR: 0.29, 95% CI: 0.14–0.58, p = 0.0002). Conclusion. In a real-world, propensity score matching analysis of a large cohort of patients with chronic ischemic MR, surgical mitral valve repair had significantly better survival rates and significantly lower reintervention rates at 1- and 3-years compared to TMVr.","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135346113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective. The study evaluates the safety and efficacy of hypothermic cardiac arrest (HCA) at various temperatures in aortic arch surgeries. Methods. We conducted a literature search in PubMed, Google Scholar, and Embase databases. For single proportion assessments, we employed fixed-effect and random-effect models in the general linear mixture model and the inverse variance model for other computations. We analyzed factors such as age, sex, operation time, and postoperative complications, with subgroup and metaregression analyses. We used funnel plots to depict potential publication bias. Results. Our research incorporated 43 papers with 34,797 cases. HCA temperatures were divided into five groups (A: 30–32°C, B: 28–30°C, C: 26–28°C, D: 24–26°C, and E: <24°C). There is no statistically significant difference in myocardial ischemia time ( P = 0.90) and isolated cerebral perfusion (ICP) time ( P = 0.95). Groups A and C have the best performance in avoiding postoperative complications including transient nerve injury (TNI), permanent nerve injury (PNI), renal failure (RF), and mortality occurrence rate. Group A has the lowest occurrence rate in PNI (3%) and mortality (3%). Group C has the lowest RF incidence (5%). Conclusion. Maintaining temperatures of 30–32°C in en bloc anastomosis or 26–28°C during arch replacement with separate grafts can significantly reduce complications including PNI, RF, and in-hospital mortality.
{"title":"Efficiency and Safety of Temperatures Management in Aortic Arch Surgery: A System Review and Meta-Analysis","authors":"Yang Yu, Zheng Ding, E. Shi, T. Gu","doi":"10.1155/2023/8887221","DOIUrl":"https://doi.org/10.1155/2023/8887221","url":null,"abstract":"Objective. The study evaluates the safety and efficacy of hypothermic cardiac arrest (HCA) at various temperatures in aortic arch surgeries. Methods. We conducted a literature search in PubMed, Google Scholar, and Embase databases. For single proportion assessments, we employed fixed-effect and random-effect models in the general linear mixture model and the inverse variance model for other computations. We analyzed factors such as age, sex, operation time, and postoperative complications, with subgroup and metaregression analyses. We used funnel plots to depict potential publication bias. Results. Our research incorporated 43 papers with 34,797 cases. HCA temperatures were divided into five groups (A: 30–32°C, B: 28–30°C, C: 26–28°C, D: 24–26°C, and E: <24°C). There is no statistically significant difference in myocardial ischemia time (\u0000 \u0000 P\u0000 \u0000 = 0.90) and isolated cerebral perfusion (ICP) time (\u0000 \u0000 P\u0000 \u0000 = 0.95). Groups A and C have the best performance in avoiding postoperative complications including transient nerve injury (TNI), permanent nerve injury (PNI), renal failure (RF), and mortality occurrence rate. Group A has the lowest occurrence rate in PNI (3%) and mortality (3%). Group C has the lowest RF incidence (5%). Conclusion. Maintaining temperatures of 30–32°C in en bloc anastomosis or 26–28°C during arch replacement with separate grafts can significantly reduce complications including PNI, RF, and in-hospital mortality.","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47417624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Caterina Campanella, K. Vitanova, M. Burri, H. Ruge, R. Lange, S. Voss
Background. Current data reveal a predominace of left as opposed to right-sided cerebral strokes after transcatether aortic valve replacement (TAVR). Aortic arch variations might raise the likelihood of cardioembolic particles entering predominantly the left cerebral circulation during catheter tracking and manipulation. Aim. We sought to analyse the impact of aortic arch anatomy on stroke laterality (right vs. left) in patients undergoing TAVR. Methods. All patients who developed a symptomatic, periprocedural left- or right-sided ischemic stroke after TAVR between June 2007 and August 2022 were included in this study. Multislice computed tomography (MSCT) analysis was used to assess aortic arch anatomy, arch configuration (types I–III), arch tortuosity, and the determination of the take-off angles of the supraaortic arteries. Results. The final study cohort comprised 77 patients. Periprocedural ischemic stroke was left-sided in 66.2% of the patients (n = 51) and right-sided in 33.8% (n = 26) (p = 0.006). MSCT analysis revealed a standard aortic arch branching pattern in 70.1% (n = 54) and a common origin of the brachiocephalic and left common arteries (bovine arch anatomy) in 29.9% (n = 23) of the patients. There was no association between the anatomical variations of the aortic arch and stroke laterality p = 0.601 . Frequency of arch configuration types was 15.6% (type I), 74.0% (type II), and 10.4% (type III). There was no correlation between the different types of configuration and the laterality of periprocedural stroke (type I: p = 0.526 , type II: p = 0.585 , and type III: p = 1.000 ). Aortic arch tortuosity and angulation of the supraaortic arteries did also not differ between right- and left-sided strokes. Conclusion. Our data add evidence that there is a significant propensity for left-hemispheric strokes in patients undergoing TAVR. However, MSCT analysis in our cohort did not reveal an association between aortic arch geometry and laterality of stroke.
{"title":"Does Aortic Arch Anatomy Affect Stroke Laterality in Transcatheter Aortic Valve Implantation?","authors":"Caterina Campanella, K. Vitanova, M. Burri, H. Ruge, R. Lange, S. Voss","doi":"10.1155/2023/5563121","DOIUrl":"https://doi.org/10.1155/2023/5563121","url":null,"abstract":"Background. Current data reveal a predominace of left as opposed to right-sided cerebral strokes after transcatether aortic valve replacement (TAVR). Aortic arch variations might raise the likelihood of cardioembolic particles entering predominantly the left cerebral circulation during catheter tracking and manipulation. Aim. We sought to analyse the impact of aortic arch anatomy on stroke laterality (right vs. left) in patients undergoing TAVR. Methods. All patients who developed a symptomatic, periprocedural left- or right-sided ischemic stroke after TAVR between June 2007 and August 2022 were included in this study. Multislice computed tomography (MSCT) analysis was used to assess aortic arch anatomy, arch configuration (types I–III), arch tortuosity, and the determination of the take-off angles of the supraaortic arteries. Results. The final study cohort comprised 77 patients. Periprocedural ischemic stroke was left-sided in 66.2% of the patients (n = 51) and right-sided in 33.8% (n = 26) (p = 0.006). MSCT analysis revealed a standard aortic arch branching pattern in 70.1% (n = 54) and a common origin of the brachiocephalic and left common arteries (bovine arch anatomy) in 29.9% (n = 23) of the patients. There was no association between the anatomical variations of the aortic arch and stroke laterality \u0000 \u0000 \u0000 \u0000 p\u0000 =\u0000 0.601\u0000 \u0000 \u0000 \u0000 . Frequency of arch configuration types was 15.6% (type I), 74.0% (type II), and 10.4% (type III). There was no correlation between the different types of configuration and the laterality of periprocedural stroke (type I: \u0000 \u0000 p\u0000 =\u0000 0.526\u0000 \u0000 , type II: \u0000 \u0000 p\u0000 =\u0000 0.585\u0000 \u0000 , and type III: \u0000 \u0000 p\u0000 =\u0000 1.000\u0000 \u0000 ). Aortic arch tortuosity and angulation of the supraaortic arteries did also not differ between right- and left-sided strokes. Conclusion. Our data add evidence that there is a significant propensity for left-hemispheric strokes in patients undergoing TAVR. However, MSCT analysis in our cohort did not reveal an association between aortic arch geometry and laterality of stroke.","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47334725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Yamazaki, Kazunari Okawa, K. Shunto, K. Oka, Koki Ikemoto, Akiyuki Takahashi
Background and Aim of Study.To evaluate predictors of residual left ventricular hypertrophy (LVH) one year after surgical aortic valve replacement (SAVR) in patients with aortic stenosis and clarify the relationship between long-term outcomes and predictors. Methods. We retrospectively reviewed 141 patients who underwent SAVR with a bioprosthetic valve. Left ventricular dimensions and mass index were assessed using serial transthoracic echocardiography. The difference in time course and the pattern of left ventricular mass index (LVMI) regression between patients with and without residual LVH one year after surgery were evaluated. The factors associated with LVMI one year after SAVR and the prognostic impact of these predictors on long-term outcomes were analyzed. Results. Although LVMI one year after surgery showed a significant decrease in patients with and without LVH, greater preoperative LVMI and lesser extent of LVMI decrease resulted in high residual LVMI at one year after SAVR in patients with LVH. The preoperative left ventricular end-diastolic dimension index ( p = 0.027 ) and preoperative left atrial dimension ( p = 0.001 ) were significant determinants of LVMI at one year after SAVR. A cut-off value of 30 mm/m2 or greater for the left ventricular end-diastolic dimension index was optimal for predicting high LVMI one year after SAVR. Overall survival was significantly lower with a left ventricular end-diastolic dimension index ≥30 mm/m2 ( p = 0.017 , Log rank). Conclusions. High preoperative left ventricular end-diastolic dimension index and large left atrial dimension were associated with high LVMI one year after surgical aortic valve replacement. Preoperative left ventricular end-diastolic dimension index of >30 mm/m2 could predict adverse outcomes after surgical aortic valve replacement.
{"title":"Predictors of Left Ventricular Mass Index One Year after Bioprosthetic Aortic Valve Replacement for Aortic Stenosis","authors":"S. Yamazaki, Kazunari Okawa, K. Shunto, K. Oka, Koki Ikemoto, Akiyuki Takahashi","doi":"10.1155/2023/2906311","DOIUrl":"https://doi.org/10.1155/2023/2906311","url":null,"abstract":"Background and Aim of Study.To evaluate predictors of residual left ventricular hypertrophy (LVH) one year after surgical aortic valve replacement (SAVR) in patients with aortic stenosis and clarify the relationship between long-term outcomes and predictors. Methods. We retrospectively reviewed 141 patients who underwent SAVR with a bioprosthetic valve. Left ventricular dimensions and mass index were assessed using serial transthoracic echocardiography. The difference in time course and the pattern of left ventricular mass index (LVMI) regression between patients with and without residual LVH one year after surgery were evaluated. The factors associated with LVMI one year after SAVR and the prognostic impact of these predictors on long-term outcomes were analyzed. Results. Although LVMI one year after surgery showed a significant decrease in patients with and without LVH, greater preoperative LVMI and lesser extent of LVMI decrease resulted in high residual LVMI at one year after SAVR in patients with LVH. The preoperative left ventricular end-diastolic dimension index (\u0000 \u0000 p\u0000 =\u0000 0.027\u0000 \u0000 ) and preoperative left atrial dimension (\u0000 \u0000 p\u0000 =\u0000 0.001\u0000 \u0000 ) were significant determinants of LVMI at one year after SAVR. A cut-off value of 30 mm/m2 or greater for the left ventricular end-diastolic dimension index was optimal for predicting high LVMI one year after SAVR. Overall survival was significantly lower with a left ventricular end-diastolic dimension index ≥30 mm/m2 (\u0000 \u0000 p\u0000 =\u0000 0.017\u0000 \u0000 , Log rank). Conclusions. High preoperative left ventricular end-diastolic dimension index and large left atrial dimension were associated with high LVMI one year after surgical aortic valve replacement. Preoperative left ventricular end-diastolic dimension index of >30 mm/m2 could predict adverse outcomes after surgical aortic valve replacement.","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41383443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Monteagudo-Vela, Emilio Monguió-Santín, N. de Antonio Antón, Fernanda Aguirre, Begoña Bernal Gallego, Guillermo Reyes-Copa, V. Panoulas
Background. Total sternotomy for aortic valve replacement has been superseded by less invasive approaches such as mini-sternotomy or transcatheter procedures. There has been an exponential uptake in transcatheter aortic valve implantation (TAVI) in younger and lower risk patients following recent randomized trials. This study aims to compare the outcomes of patients with aortic stenosis treated with minimally invasive approaches: mini-sternotomy for aortic valve replacement (mini-AVR) and TAVI implantation. Methods. Between January 2015 and December 2021, a total of 1437 TAVI and 176 mini-AVR patients from 2 tertiary centers fulfilled the criteria and were included in the propensity matching model. Results. A total of 256 TAVIs and 146 mini-AVR were included in the matched cohort. There was no significant difference in 30-day mortality in the two groups (TAVI vs. mini-AVR 2.7% vs. 2.8%, p = 0.935 ). TAVI confers slightly lower gradients in the follow-up echo when compared with mini-AVR (peak gradient 20 ± 8.7 mmHg vs. 24.5 ± 10 mmHg, p < 0.001 ; mean gradient 10.9 ± 5.6 mmHg vs. 13.2 ± 5.7 mmHg, p < 0.001 ). On the other hand, mini-AVR exhibits remarkably lower rates of paravalvular leak (mild leak 8% vs. 41.5%, p < 0.001 ; moderate leak 2.8% vs. 0%, p < 0.001 ) and of need for permanent pacemaker implantation (2% vs. 12.2%, p < 0.001 ). Unsurprisingly, TAVI has lower in-hospital stay 3 (2 to 6) days vs. 10 (8 to 13) days, p < 0.001 ). Conclusions. For eligible aortic stenosis patients in the 7th decade of life, mini-AVR remains an excellent therapeutic option.
{"title":"Mini-Aortic Valve Replacement versus Transcatheter Aortic Valve Implantation: A Propensity-Matched Study","authors":"M. Monteagudo-Vela, Emilio Monguió-Santín, N. de Antonio Antón, Fernanda Aguirre, Begoña Bernal Gallego, Guillermo Reyes-Copa, V. Panoulas","doi":"10.1155/2023/9501508","DOIUrl":"https://doi.org/10.1155/2023/9501508","url":null,"abstract":"Background. Total sternotomy for aortic valve replacement has been superseded by less invasive approaches such as mini-sternotomy or transcatheter procedures. There has been an exponential uptake in transcatheter aortic valve implantation (TAVI) in younger and lower risk patients following recent randomized trials. This study aims to compare the outcomes of patients with aortic stenosis treated with minimally invasive approaches: mini-sternotomy for aortic valve replacement (mini-AVR) and TAVI implantation. Methods. Between January 2015 and December 2021, a total of 1437 TAVI and 176 mini-AVR patients from 2 tertiary centers fulfilled the criteria and were included in the propensity matching model. Results. A total of 256 TAVIs and 146 mini-AVR were included in the matched cohort. There was no significant difference in 30-day mortality in the two groups (TAVI vs. mini-AVR 2.7% vs. 2.8%, \u0000 \u0000 p\u0000 =\u0000 0.935\u0000 \u0000 ). TAVI confers slightly lower gradients in the follow-up echo when compared with mini-AVR (peak gradient 20 ± 8.7 mmHg vs. 24.5 ± 10 mmHg, \u0000 \u0000 p\u0000 \u0000 <\u0000 0.001\u0000 \u0000 ; mean gradient 10.9 ± 5.6 mmHg vs. 13.2 ± 5.7 mmHg, \u0000 \u0000 p\u0000 <\u0000 0.001\u0000 \u0000 ). On the other hand, mini-AVR exhibits remarkably lower rates of paravalvular leak (mild leak 8% vs. 41.5%, \u0000 \u0000 p\u0000 <\u0000 0.001\u0000 \u0000 ; moderate leak 2.8% vs. 0%, \u0000 \u0000 p\u0000 <\u0000 0.001\u0000 \u0000 ) and of need for permanent pacemaker implantation (2% vs. 12.2%, \u0000 \u0000 p\u0000 <\u0000 0.001\u0000 \u0000 ). Unsurprisingly, TAVI has lower in-hospital stay 3 (2 to 6) days vs. 10 (8 to 13) days, \u0000 \u0000 p\u0000 <\u0000 0.001\u0000 \u0000 ). Conclusions. For eligible aortic stenosis patients in the 7th decade of life, mini-AVR remains an excellent therapeutic option.","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42512634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Robich, K. Ohlrich, Catherine Raymer, D. Robaczewski, J. Rabb, D. Radziszewski, A. Iribarne, S. Seshasayee, C. Ross, R. Quinn, R. Kramer
Background. The Perceval S is a sutureless, bovine pericardial aortic prosthesis on a nitinol stent, which has limited data on outcomes, as well as cost, from the United States. Methods. We performed a retrospective review of Perceval S implantation at a single center between 2015 and 2018. After exclusion criteria, we compared 234 patients who underwent sutureless aortic valve (SLV) implantation with 370 patients who underwent standard sutured aortic valves (SAVR). Hospital cost data were reviewed, and risk adjustment, done by propensity score and inverse probability weighting, was used to compare outcomes. Results. Compared to those undergoing SAVR, the SLV group was older and had a higher proportion of multicomponent operations, higher preoperative white blood cell count, higher rate of previous percutaneous coronary interventions, more comorbid conditions (diabetes, renal insufficiency, and dialysis), and more three-vessel coronary disease. For isolated AVR, partial upper hemisternotomy was more frequent in SLV. The mean cardiopulmonary bypass and cross-clamp times for isolated SLV were significantly lower than SAVR. After adjustment, the cohort was balanced. Operative differences for SLV were lower cross-clamp and pump time, larger valve size, more minimally invasive approaches, and shorter operating room times. There were no differences in other postoperative complications (postoperative atrial fibrillation, stroke, renal failure, prolonged ventilation, and in-hospital mortality; p > 0.05 for all). Mean and median hospital costs were higher in the SLV group, largely due to the cost of the implant. Conclusion. Sutureless tissue aortic valves can be used safely with lower cardiopulmonary bypass and clamp times than sutured prostheses and facilitate use of minimally invasive approaches. This valve may be advantageous in older, higher risk patients requiring more complex operations.
{"title":"Single-Center, Multisurgeon Experience with a Sutureless Rapid Deployment Aortic Valve Prosthesis: A Clinical Analysis in the United States","authors":"M. Robich, K. Ohlrich, Catherine Raymer, D. Robaczewski, J. Rabb, D. Radziszewski, A. Iribarne, S. Seshasayee, C. Ross, R. Quinn, R. Kramer","doi":"10.1155/2023/4827516","DOIUrl":"https://doi.org/10.1155/2023/4827516","url":null,"abstract":"Background. The Perceval S is a sutureless, bovine pericardial aortic prosthesis on a nitinol stent, which has limited data on outcomes, as well as cost, from the United States. Methods. We performed a retrospective review of Perceval S implantation at a single center between 2015 and 2018. After exclusion criteria, we compared 234 patients who underwent sutureless aortic valve (SLV) implantation with 370 patients who underwent standard sutured aortic valves (SAVR). Hospital cost data were reviewed, and risk adjustment, done by propensity score and inverse probability weighting, was used to compare outcomes. Results. Compared to those undergoing SAVR, the SLV group was older and had a higher proportion of multicomponent operations, higher preoperative white blood cell count, higher rate of previous percutaneous coronary interventions, more comorbid conditions (diabetes, renal insufficiency, and dialysis), and more three-vessel coronary disease. For isolated AVR, partial upper hemisternotomy was more frequent in SLV. The mean cardiopulmonary bypass and cross-clamp times for isolated SLV were significantly lower than SAVR. After adjustment, the cohort was balanced. Operative differences for SLV were lower cross-clamp and pump time, larger valve size, more minimally invasive approaches, and shorter operating room times. There were no differences in other postoperative complications (postoperative atrial fibrillation, stroke, renal failure, prolonged ventilation, and in-hospital mortality; \u0000 \u0000 p\u0000 >\u0000 0.05\u0000 \u0000 for all). Mean and median hospital costs were higher in the SLV group, largely due to the cost of the implant. Conclusion. Sutureless tissue aortic valves can be used safely with lower cardiopulmonary bypass and clamp times than sutured prostheses and facilitate use of minimally invasive approaches. This valve may be advantageous in older, higher risk patients requiring more complex operations.","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45743126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Hattori, K. Noguchi, Y. Gunji, Motoki Nagatsuka, T. Yamabe, H. Kagaya, I. Katayama, T. Asai
We introduce a unique perfusion method for open descending aortic repair through a left thoracotomy. Perfusion from femoral artery cannulation is generally adopted in descending aortic replacement surgery. However, in cases with shaggy or partially thrombosed chronic aortic dissection, retrograde perfusion alone has a high risk of embolization and alternative perfusion methods should be considered. Our perfusion method from the third part of the left axillary artery graft is safe, simple, and useful for avoiding postoperative cerebral complications. In the present study, we report the advantages and challenges of this graft-interposed perfusion via the distal left axillary artery for descending aortic replacement.
{"title":"Descending Aortic Replacement with Third-Part Left Axillary Artery Graft Perfusion","authors":"S. Hattori, K. Noguchi, Y. Gunji, Motoki Nagatsuka, T. Yamabe, H. Kagaya, I. Katayama, T. Asai","doi":"10.1155/2023/2767859","DOIUrl":"https://doi.org/10.1155/2023/2767859","url":null,"abstract":"We introduce a unique perfusion method for open descending aortic repair through a left thoracotomy. Perfusion from femoral artery cannulation is generally adopted in descending aortic replacement surgery. However, in cases with shaggy or partially thrombosed chronic aortic dissection, retrograde perfusion alone has a high risk of embolization and alternative perfusion methods should be considered. Our perfusion method from the third part of the left axillary artery graft is safe, simple, and useful for avoiding postoperative cerebral complications. In the present study, we report the advantages and challenges of this graft-interposed perfusion via the distal left axillary artery for descending aortic replacement.","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45699175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Bloom, D. Paneitz, S. Wolfe, David L. Convissar, T. Sundt, D. D’Alessandro, A. Dalia
Background. Intraoperative team turnover is necessary given the duration of many cardiac surgical procedures, despite being an established risk factor for harm. We sought to determine if there was an association between intraoperative anesthesia handoff (AH) and patient morbidity and/or mortality after cardiac surgery. Methods. All adult cardiac surgery procedures from November 2016 through November 2021 were retrospectively interrogated for AH. These results were merged with postoperative patient outcomes data and analyzed for morbidity and mortality. Results. A single AH occurred in 1,087/5,937 (18.3%) procedures, and two or more AHs occurred in 224 (3.8%) procedures. Baseline characteristics show that AH is more frequently associated with higher complexity patients and operations. The primary outcome of operative mortality occurred in 113 (2.4%), 54 (5.0%), and 7 (3.1%) patients in the no AH, single AH, and multiple AH cohorts. After multivariable adjustment, the odds ratio for mortality was 1.15 (95% CI 0.79–1.67 and P = 0.46 ) for a single AH and 0.83 (95% CI 0.36–1.90 and P = 0.66 ) for multiple AH. There were no significant differences in readmission, length of stay, or a composite complication outcome between the cohorts after adjustment. Conclusions. In a large single-center experience, intraoperative anesthesia handoffs were not associated with adverse outcomes after cardiac surgery.
{"title":"Intraoperative Anesthesia Handoff Does Not Affect Patient Outcomes after Cardiac Surgery: A Single-Center Experience","authors":"J. Bloom, D. Paneitz, S. Wolfe, David L. Convissar, T. Sundt, D. D’Alessandro, A. Dalia","doi":"10.1155/2023/1793257","DOIUrl":"https://doi.org/10.1155/2023/1793257","url":null,"abstract":"Background. Intraoperative team turnover is necessary given the duration of many cardiac surgical procedures, despite being an established risk factor for harm. We sought to determine if there was an association between intraoperative anesthesia handoff (AH) and patient morbidity and/or mortality after cardiac surgery. Methods. All adult cardiac surgery procedures from November 2016 through November 2021 were retrospectively interrogated for AH. These results were merged with postoperative patient outcomes data and analyzed for morbidity and mortality. Results. A single AH occurred in 1,087/5,937 (18.3%) procedures, and two or more AHs occurred in 224 (3.8%) procedures. Baseline characteristics show that AH is more frequently associated with higher complexity patients and operations. The primary outcome of operative mortality occurred in 113 (2.4%), 54 (5.0%), and 7 (3.1%) patients in the no AH, single AH, and multiple AH cohorts. After multivariable adjustment, the odds ratio for mortality was 1.15 (95% CI 0.79–1.67 and \u0000 \u0000 P\u0000 =\u0000 0.46\u0000 \u0000 ) for a single AH and 0.83 (95% CI 0.36–1.90 and \u0000 \u0000 P\u0000 =\u0000 0.66\u0000 \u0000 ) for multiple AH. There were no significant differences in readmission, length of stay, or a composite complication outcome between the cohorts after adjustment. Conclusions. In a large single-center experience, intraoperative anesthesia handoffs were not associated with adverse outcomes after cardiac surgery.","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45631301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Shafiee, Aryan Ayati, E. Salimi, M. Sahebjam, A. Salehi Omran, Alireza Hadizadeh, Arezou Zoroufian
Background. Bioprosthetic mitral valves (MV) have limited durability. Dysfunction and degeneration of these valves can lead to reoperation and progressive heart failure. We investigated the frequency and predictors of MV bioprosthesis early degeneration within three years following MV replacement surgery. Methods. In this retrospective cohort study, we retrieved the data of consecutive patients who underwent bioprosthetic MV replacement through midsternotomy at Tehran Heart Center between 2013 and 2019. Based on the reviewed parameters of the bioprosthetic MV in the follow-up echocardiography, the patients were divided into two groups to compare the variables respecting early degeneration. Finally, the predictors of early degeneration were recognized using the Cox regression hazards model. Results. We reviewed and analyzed data of 177 patients from our hospital database. The mean age of the patients was 63.9 ± 11.7 years and 100 (56.5%) were women. 39 (22.0%) patients had experienced early degeneration and two (1.1% of the total) had died during the follow-up period. Patients in the degeneration group tended to have a history of stroke and renal failure, although not statistically significant. The sole independent predictor of early degeneration of bioprosthetic MV was a high MV mean gradient in the first postoperative echocardiography study (HR = 11.01, 95% CI: 4.80–25.24; P < 0.001 ). Conclusion. About 22.0% of our patients had echocardiographic criteria for early degeneration, and according to our results, increased MV gradients (without considering the reason) in the first postoperative echocardiography were the sole independent predictor for it. Careful valve selection can be essential in reducing early degeneration.
{"title":"Prevalence and Predictive Factors of Early Degeneration of Bioprosthetic Mitral Valves: A Single-Center Cohort Study","authors":"A. Shafiee, Aryan Ayati, E. Salimi, M. Sahebjam, A. Salehi Omran, Alireza Hadizadeh, Arezou Zoroufian","doi":"10.1155/2023/2901632","DOIUrl":"https://doi.org/10.1155/2023/2901632","url":null,"abstract":"Background. Bioprosthetic mitral valves (MV) have limited durability. Dysfunction and degeneration of these valves can lead to reoperation and progressive heart failure. We investigated the frequency and predictors of MV bioprosthesis early degeneration within three years following MV replacement surgery. Methods. In this retrospective cohort study, we retrieved the data of consecutive patients who underwent bioprosthetic MV replacement through midsternotomy at Tehran Heart Center between 2013 and 2019. Based on the reviewed parameters of the bioprosthetic MV in the follow-up echocardiography, the patients were divided into two groups to compare the variables respecting early degeneration. Finally, the predictors of early degeneration were recognized using the Cox regression hazards model. Results. We reviewed and analyzed data of 177 patients from our hospital database. The mean age of the patients was 63.9 ± 11.7 years and 100 (56.5%) were women. 39 (22.0%) patients had experienced early degeneration and two (1.1% of the total) had died during the follow-up period. Patients in the degeneration group tended to have a history of stroke and renal failure, although not statistically significant. The sole independent predictor of early degeneration of bioprosthetic MV was a high MV mean gradient in the first postoperative echocardiography study (HR = 11.01, 95% CI: 4.80–25.24; \u0000 \u0000 P\u0000 <\u0000 0.001\u0000 \u0000 ). Conclusion. About 22.0% of our patients had echocardiographic criteria for early degeneration, and according to our results, increased MV gradients (without considering the reason) in the first postoperative echocardiography were the sole independent predictor for it. Careful valve selection can be essential in reducing early degeneration.","PeriodicalId":15367,"journal":{"name":"Journal of Cardiac Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45040441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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