Liyan Chen, Li Jiang, Mei Zou, Xuanlan Chen, Zhiyong Wu
Patients with bicuspid stenosis often have anatomical characteristics such as elliptical valve rings, high and asymmetric valve calcification, unequal valve leaflets, and concomitant widening of the ascending aorta and/or transverse heart. These unfavorable factors are more likely to cause poor placement of transcatheter aortic valve replacement (TAVR) valves, poor expansion of valve stents, which can lead to reduced valve durability, residual perivalve leakage, rupture of valve rings and surrounding structures, and serious surgical related complications such as ascending aortic dissection. In summary, TAVR treatment for mitral stenosis is receiving increasing attention. In this manuscript, we reviewed the research progress of transcatheter aortic valve replacement in aortic valve stenosis due to bicuspid aortic valve.
{"title":"Research Progress of Transcatheter Aortic Valve Replacement in Aortic Valve Stenosis due to Bicuspid Aortic Valve","authors":"Liyan Chen, Li Jiang, Mei Zou, Xuanlan Chen, Zhiyong Wu","doi":"10.59958/hsf.7005","DOIUrl":"https://doi.org/10.59958/hsf.7005","url":null,"abstract":"Patients with bicuspid stenosis often have anatomical characteristics such as elliptical valve rings, high and asymmetric valve calcification, unequal valve leaflets, and concomitant widening of the ascending aorta and/or transverse heart. These unfavorable factors are more likely to cause poor placement of transcatheter aortic valve replacement (TAVR) valves, poor expansion of valve stents, which can lead to reduced valve durability, residual perivalve leakage, rupture of valve rings and surrounding structures, and serious surgical related complications such as ascending aortic dissection. In summary, TAVR treatment for mitral stenosis is receiving increasing attention. In this manuscript, we reviewed the research progress of transcatheter aortic valve replacement in aortic valve stenosis due to bicuspid aortic valve.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":"111 28","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140678205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: To determine the contribution of serial cardiac magnetic resonance imaging (MRI) following coronary revascularization (CR) to the clinical management of patients with left ventricular insufficiency. Methods: The study objects comprised the clinical data of 145 patients with CR undergoing CR surgery for left ventricular insufficiency in our hospital from January 2021 to January 2023. The patients were divided into the case (n = 35, left ventricular ejection fraction (LVEF) <50%) and control (n = 110, LVEF ≥50%) groups based on the LVEF recorded in the medical record system 6 months after surgery. Preoperative LVEF left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume index (LVEDVI), left ventricular end-systolic volume index (LVESVI), cardiac index (CI), and other cardiac magnetic resonance detection parameters were compared. Logistic regression analysis was performed to analyze the prognostic factors of patients undergoing CR after CR surgery for left ventricular insufficiency. The receiver operating characteristic curve was drawn, the sensitivity, specificity, and area under curve (AUC) were calculated, and the best prediction threshold was determined. The prognostic value of cardiac MRI in CR surgery for left ventricular dysfunction was observed. Results: Cardiac MRI revealed that the case group had higher LVEDV, LVESV, LVEDVI, LVESVI, and CI than the control group. However, the LVEF index was lower than that in the control group (p < 0.05). Logistic regression analysis was conducted for indicators with differences, and the results indicate LVEF as a protective factor for the postoperative efficacy of the patients, with an odds ratio (OR) <1. LVEDV, LVESV, LVEDVI, LVESVI, and CI were all risk factors for the postoperative efficacy of the patients, with an OR >1. The AUC values of LVEF, LVEDV, LVESV, LVEDVI, LVESVI, and CI were 0.698, 0.674, 0.654, 0.700, 0.572, and 0.812, respectively. The optimal threshold values were 53.57%, 112.33 and 68.5 mL, and 205.51, 163.99, and 2.14 L/m2, and their corresponding sensitivities reached 0.618, 0.514, 0.654, 0.800, 0.371, and 0.829 for each index. The specificities were 0.800, 0.836, 0.771, 0.609, 0.836, and 0.645, which indicate that LVEF, LVEDV, LVESV, LVEDVI, LVESVI, and CI had a certain degree of predictive value for postoperative cardiac function recovery. Conclusion: LVEDV, LVESV, LVEDVI, LVESVI, CI, and LVEF are all factors affecting the clinical efficacy in patients undergoing CR after left ventricular insufficiency. In addition, cardiac MRI can effectively detect the above factors and effectively predict the postoperative efficacy among patients.
{"title":"Continuous Cardiac Magnetic Resonance Imaging after Coronary Revascularization for Left Ventricular Dysfunction","authors":"Jie Ding, Wei Shu, Jiaojiao Chen","doi":"10.59958/hsf.7361","DOIUrl":"https://doi.org/10.59958/hsf.7361","url":null,"abstract":"Objective: To determine the contribution of serial cardiac magnetic resonance imaging (MRI) following coronary revascularization (CR) to the clinical management of patients with left ventricular insufficiency. Methods: The study objects comprised the clinical data of 145 patients with CR undergoing CR surgery for left ventricular insufficiency in our hospital from January 2021 to January 2023. The patients were divided into the case (n = 35, left ventricular ejection fraction (LVEF) <50%) and control (n = 110, LVEF ≥50%) groups based on the LVEF recorded in the medical record system 6 months after surgery. Preoperative LVEF left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume index (LVEDVI), left ventricular end-systolic volume index (LVESVI), cardiac index (CI), and other cardiac magnetic resonance detection parameters were compared. Logistic regression analysis was performed to analyze the prognostic factors of patients undergoing CR after CR surgery for left ventricular insufficiency. The receiver operating characteristic curve was drawn, the sensitivity, specificity, and area under curve (AUC) were calculated, and the best prediction threshold was determined. The prognostic value of cardiac MRI in CR surgery for left ventricular dysfunction was observed. Results: Cardiac MRI revealed that the case group had higher LVEDV, LVESV, LVEDVI, LVESVI, and CI than the control group. However, the LVEF index was lower than that in the control group (p < 0.05). Logistic regression analysis was conducted for indicators with differences, and the results indicate LVEF as a protective factor for the postoperative efficacy of the patients, with an odds ratio (OR) <1. LVEDV, LVESV, LVEDVI, LVESVI, and CI were all risk factors for the postoperative efficacy of the patients, with an OR >1. The AUC values of LVEF, LVEDV, LVESV, LVEDVI, LVESVI, and CI were 0.698, 0.674, 0.654, 0.700, 0.572, and 0.812, respectively. The optimal threshold values were 53.57%, 112.33 and 68.5 mL, and 205.51, 163.99, and 2.14 L/m2, and their corresponding sensitivities reached 0.618, 0.514, 0.654, 0.800, 0.371, and 0.829 for each index. The specificities were 0.800, 0.836, 0.771, 0.609, 0.836, and 0.645, which indicate that LVEF, LVEDV, LVESV, LVEDVI, LVESVI, and CI had a certain degree of predictive value for postoperative cardiac function recovery. Conclusion: LVEDV, LVESV, LVEDVI, LVESVI, CI, and LVEF are all factors affecting the clinical efficacy in patients undergoing CR after left ventricular insufficiency. In addition, cardiac MRI can effectively detect the above factors and effectively predict the postoperative efficacy among patients.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":"27 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140694258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Acute myocardial infarction (AMI) is related with poor outcomes in patients with diabetes mellitus (DM). Whether diabetic patients with AMI undergoing percutaneous coronary intervention (PCI) benefit from sodium–glucose cotransporter 2 inhibitors (SGLT2i) in terms of cardiovascular mortality, myocardial damage, and left ventricular function is unclear. Methods: Through a comprehensive search in PubMed, EMBASE, and Web of science databases from January 2018 to September 2023, randomized controlled trials were performed to compare SGLT2i with other oral antidiabetic medications in diabetic patients with AMI undergoing PCI. Cardiovascular mortality constituted the primary outcome. Secondary outcomes were high-sensitivity troponin I (hs-TnI) levels, left ventricular ejection fraction (LVEF), and contrast-induced acute kidney injury (CI-AKI). Results: SGLT2i significantly reduced cardiovascular mortality risk versus other antidiabetic agents (hazard ratio (HR): 0.35, 95% confidence interval (CI): 0.21–0.58, p < 0.0001). SGLT2i also lowered hs-TnI levels across all time points (mean difference: –2931 ng/L, p < 0.001). After adjustment for publication bias, this difference was no longer significant. However, peak hs-TnI levels remained significantly lower with SGLT2i (mean difference: –3836 ng/L, p < 0.001). Finally, SGLT2i improved LVEF versus comparators, with a mean difference of –5.00% (95% CI: –6.69 to –3.31, p < 0.001) at hospital discharge. SGLT2i was also associated with 60% lower odds of CI-AKI (odds ratio (OR): 0.40, 95% CI: 0.22–0.75, p = 0.004). Conclusions: Compared with other antidiabetic medications, SGLT2i may lower cardiovascular mortality, infarct size, and prevent left ventricle (LV) systolic dysfunction in diabetic patients with AMI undergoing PCI. The use of SGLT2i in this high-risk group is supported by these findings.
{"title":"Effect of SGLT2 Inhibitors on Post-PCI Outcomes after Acute Myocardial Infarction in Diabetic Patients: A Systematic Review and Meta-Analysis","authors":"Xiaoyu Liu, Weifen Wang, Xiaohan Xing","doi":"10.59958/hsf.7021","DOIUrl":"https://doi.org/10.59958/hsf.7021","url":null,"abstract":"Background: Acute myocardial infarction (AMI) is related with poor outcomes in patients with diabetes mellitus (DM). Whether diabetic patients with AMI undergoing percutaneous coronary intervention (PCI) benefit from sodium–glucose cotransporter 2 inhibitors (SGLT2i) in terms of cardiovascular mortality, myocardial damage, and left ventricular function is unclear. Methods: Through a comprehensive search in PubMed, EMBASE, and Web of science databases from January 2018 to September 2023, randomized controlled trials were performed to compare SGLT2i with other oral antidiabetic medications in diabetic patients with AMI undergoing PCI. Cardiovascular mortality constituted the primary outcome. Secondary outcomes were high-sensitivity troponin I (hs-TnI) levels, left ventricular ejection fraction (LVEF), and contrast-induced acute kidney injury (CI-AKI). Results: SGLT2i significantly reduced cardiovascular mortality risk versus other antidiabetic agents (hazard ratio (HR): 0.35, 95% confidence interval (CI): 0.21–0.58, p < 0.0001). SGLT2i also lowered hs-TnI levels across all time points (mean difference: –2931 ng/L, p < 0.001). After adjustment for publication bias, this difference was no longer significant. However, peak hs-TnI levels remained significantly lower with SGLT2i (mean difference: –3836 ng/L, p < 0.001). Finally, SGLT2i improved LVEF versus comparators, with a mean difference of –5.00% (95% CI: –6.69 to –3.31, p < 0.001) at hospital discharge. SGLT2i was also associated with 60% lower odds of CI-AKI (odds ratio (OR): 0.40, 95% CI: 0.22–0.75, p = 0.004). Conclusions: Compared with other antidiabetic medications, SGLT2i may lower cardiovascular mortality, infarct size, and prevent left ventricle (LV) systolic dysfunction in diabetic patients with AMI undergoing PCI. The use of SGLT2i in this high-risk group is supported by these findings.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":" 37","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140690514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yiyao Jiang, Ming Cheng, Wei Zhang, Xingxing Peng, Qijun Sun, Hang Lv, Junquan Li
Introduction: The objective of this cohort study was to analyze the long-term relative survival of degenerative valve disease (DVD) patients who underwent mitral valve repair (MVP) or replacement and aortic valve replacement (AVR). Methods: A total of 146 patients underwent double valve replacement (DVR) or MVP+AVR at four institutions between 2016 and 2022. Kaplan–Meier method was applied to analyze survival rate. The potential predictors of mortality were investigated by Cox regression. Results: Of 146 patients, 62 underwent MVP+AVR, and 84 underwent DVR. The thirty-day mortality rate was 4.76% in the DVR cohort and 1.61% in the MVP+AVR cohort. At baseline, there were differences in age (63.39 ± 8.01 vs. 58.46 ± 9.92, p = 0.012), proportions of male patients (51.61% vs. 72.62, p = 0.014), smoking history (45.16% vs. 28.57%, p = 0.039). More biological valves were applied in the MVP+AVR cohort (77.42% vs. 47.62%, p < 0.001). There was no significant difference in mortality between the cohorts (1339.5 [Interquartile range (IQR), 1021.25–1876.75] vs. 1026.00 [IQR, 679.50–1674.00], p = 0.252). The overall mortality rate was 16.67% for DVR and 6.45% for MVP+AVR. Mechanical valve replacement (hazard ratio (HR) = 3.7, 95% confidence interval (CI): 1.0–12.0, p = 0.029) was increased the risk of postoperative mortality. Conclusion: Although the superiority of MVP+AVR was not verified with statistical significance in our cohort, we believe that MVP+AVR should be the preferred strategy for treating most DVD patient because it is associated with higher survival rates during follow-up.
简介这项队列研究旨在分析接受二尖瓣修复术（MVP）或置换术以及主动脉瓣置换术（AVR）的退行性瓣膜病（DVD）患者的长期相对生存率。研究方法2016年至2022年期间，共有146名患者在四家机构接受了双瓣膜置换术（DVR）或MVP+AVR。采用 Kaplan-Meier 法分析存活率。采用 Cox 回归法研究死亡率的潜在预测因素。结果：146名患者中，62人接受了MVP+AVR，84人接受了DVR。DVR 组的 30 天死亡率为 4.76%，MVP+AVR 组为 1.61%。基线年龄（63.39 ± 8.01 vs. 58.46 ± 9.92，p = 0.012）、男性患者比例（51.61% vs. 72.62，p = 0.014）和吸烟史（45.16% vs. 28.57%，p = 0.039）存在差异。MVP+AVR队列中应用了更多生物瓣膜（77.42% vs. 47.62%，p < 0.001）。两组患者的死亡率无明显差异（1339.5 [四分位距（IQR），1021.25-1876.75] vs. 1026.00 [四分位距（IQR），679.50-1674.00]，P = 0.252）。DVR的总死亡率为16.67%，MVP+AVR的总死亡率为6.45%。机械瓣膜置换术（危险比 (HR) = 3.7，95% 置信区间 (CI)：1.0-12.0，P = 0.029）增加了术后死亡风险。结论虽然在我们的队列中 MVP+AVR 的优越性没有得到统计学意义上的验证，但我们认为 MVP+AVR 应该是治疗大多数 DVD 患者的首选策略，因为它与随访期间较高的存活率相关。
{"title":"Outcomes of Different Mitral Valve Approaches Combined with Aortic Valve Replacement in Patients with Degenerative Valve Disease","authors":"Yiyao Jiang, Ming Cheng, Wei Zhang, Xingxing Peng, Qijun Sun, Hang Lv, Junquan Li","doi":"10.59958/hsf.7405","DOIUrl":"https://doi.org/10.59958/hsf.7405","url":null,"abstract":"Introduction: The objective of this cohort study was to analyze the long-term relative survival of degenerative valve disease (DVD) patients who underwent mitral valve repair (MVP) or replacement and aortic valve replacement (AVR). Methods: A total of 146 patients underwent double valve replacement (DVR) or MVP+AVR at four institutions between 2016 and 2022. Kaplan–Meier method was applied to analyze survival rate. The potential predictors of mortality were investigated by Cox regression. Results: Of 146 patients, 62 underwent MVP+AVR, and 84 underwent DVR. The thirty-day mortality rate was 4.76% in the DVR cohort and 1.61% in the MVP+AVR cohort. At baseline, there were differences in age (63.39 ± 8.01 vs. 58.46 ± 9.92, p = 0.012), proportions of male patients (51.61% vs. 72.62, p = 0.014), smoking history (45.16% vs. 28.57%, p = 0.039). More biological valves were applied in the MVP+AVR cohort (77.42% vs. 47.62%, p < 0.001). There was no significant difference in mortality between the cohorts (1339.5 [Interquartile range (IQR), 1021.25–1876.75] vs. 1026.00 [IQR, 679.50–1674.00], p = 0.252). The overall mortality rate was 16.67% for DVR and 6.45% for MVP+AVR. Mechanical valve replacement (hazard ratio (HR) = 3.7, 95% confidence interval (CI): 1.0–12.0, p = 0.029) was increased the risk of postoperative mortality. Conclusion: Although the superiority of MVP+AVR was not verified with statistical significance in our cohort, we believe that MVP+AVR should be the preferred strategy for treating most DVD patient because it is associated with higher survival rates during follow-up.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":"73 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140699843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I. Ergui, Fatima Lakhani, Rahul Sheth, B. Ebner, M. Dangl, K. Inestroza, L. Vincent, Rosario A Colombo, George Marzouka, L. Grazette
Background: Many international governing bodies recommend against heart transplantation in patients with severe cognitive-behavioral disabilities, however no clear criteria are offered to define severity. Patients with neurodevelopmental disorders may face systematic discrimination when being evaluated for transplant. We set out to investigate whether children with neurodevelopmental disorders that undergo heart transplantation have poorer in-hospital outcomes compared to neurotypical children. Methods: A retrospective analysis of the National Inpatient Sample database was conducted to identify pediatric patients with neurodevelopmental disorders who underwent heart transplantation from 2011–2019. Baseline characteristics and in-hospital outcomes between patients were compared. Binary logistic regression was used to investigate the association between the documented presence of a neurodevelopmental disorder and in-hospital outcomes in children undergoing heart transplantation. Results: We identified a weighted sample of 3770 pediatric cardiac transplant patients, of whom 245 (6.5%) had a documented diagnosis of neurodevelopmental disorder. There was no significant difference in the odds of major adverse cardiovascular events (all-cause mortality, stroke complications or myocardial infarction), surgical complications, infection, venous thromboembolic events, delirium/restraint use, or cardiac dysrhythmia. Patients with neurodevelopmental disorders had lower overall length of stay (44.0 days interquartile range (IQR): 16.0–90.0 vs. 57.08 days IQR: 22.0–112.0, p < 0.050), and cost of stay ($956,031 IQR: 548,559.0–1,801,412.0 vs. $1,074,793 IQR: 599,089.8–2,129,086.0, p < 0.050). Patients with neurodevelopmental disorders had significantly lower odds of acute transplant complications (adjusted odds ratio (aOR): 0.39, 95% confidence interval (CI): 0.21–0.74, p < 0.050) vascular complications (aOR: 0.36, 95% CI: 0.19–0.66, p < 0.050) and acute kidney injury (AKI) (aOR: 0.52, 95% CI: 0.33–0.83, p < 0.050). Conclusions: These data suggest that patients with neurodevelopmental disorders have overall similar if not potentially improved post-transplant outcomes in the acute setting compared to neurotypical patients, possibly secondary to selection bias in the patient selection process.
{"title":"The Effect of Neurodevelopmental Disorders on the Prognosis of Children Undergoing Heart Transplantation: A Retrospective Analysis of the National Inpatient Sample 2011–2019","authors":"I. Ergui, Fatima Lakhani, Rahul Sheth, B. Ebner, M. Dangl, K. Inestroza, L. Vincent, Rosario A Colombo, George Marzouka, L. Grazette","doi":"10.59958/hsf.7289","DOIUrl":"https://doi.org/10.59958/hsf.7289","url":null,"abstract":"Background: Many international governing bodies recommend against heart transplantation in patients with severe cognitive-behavioral disabilities, however no clear criteria are offered to define severity. Patients with neurodevelopmental disorders may face systematic discrimination when being evaluated for transplant. We set out to investigate whether children with neurodevelopmental disorders that undergo heart transplantation have poorer in-hospital outcomes compared to neurotypical children. Methods: A retrospective analysis of the National Inpatient Sample database was conducted to identify pediatric patients with neurodevelopmental disorders who underwent heart transplantation from 2011–2019. Baseline characteristics and in-hospital outcomes between patients were compared. Binary logistic regression was used to investigate the association between the documented presence of a neurodevelopmental disorder and in-hospital outcomes in children undergoing heart transplantation. Results: We identified a weighted sample of 3770 pediatric cardiac transplant patients, of whom 245 (6.5%) had a documented diagnosis of neurodevelopmental disorder. There was no significant difference in the odds of major adverse cardiovascular events (all-cause mortality, stroke complications or myocardial infarction), surgical complications, infection, venous thromboembolic events, delirium/restraint use, or cardiac dysrhythmia. Patients with neurodevelopmental disorders had lower overall length of stay (44.0 days interquartile range (IQR): 16.0–90.0 vs. 57.08 days IQR: 22.0–112.0, p < 0.050), and cost of stay ($956,031 IQR: 548,559.0–1,801,412.0 vs. $1,074,793 IQR: 599,089.8–2,129,086.0, p < 0.050). Patients with neurodevelopmental disorders had significantly lower odds of acute transplant complications (adjusted odds ratio (aOR): 0.39, 95% confidence interval (CI): 0.21–0.74, p < 0.050) vascular complications (aOR: 0.36, 95% CI: 0.19–0.66, p < 0.050) and acute kidney injury (AKI) (aOR: 0.52, 95% CI: 0.33–0.83, p < 0.050). Conclusions: These data suggest that patients with neurodevelopmental disorders have overall similar if not potentially improved post-transplant outcomes in the acute setting compared to neurotypical patients, possibly secondary to selection bias in the patient selection process.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":"11 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140699941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: This study analyzed three-dimensional echocardiography (3DE) combined with the triglyceride–glucose (TYG) index to evaluate the long-term prognosis of patients after percutaneous coronary intervention (PCI). Methods: The clinical data of 102 patients who were treated with PCI after admission to our hospital from January 2020 to December 2020 were retrospectively analyzed. All the patients were followed up for 24 months to evaluate their long-term prognosis. The occurrence of cardiovascular and cerebrovascular events in all the patients was recorded. Cardiovascular and cerebrovascular events refer to a series of diseases or conditions of the heart and the cerebrovascular system, including sudden cardiac death. Patients with cardiovascular events were assigned to the exposed group, while those without cardiovascular events were included in the nonexposed group. The left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular mass index (LVMI), left ventricular remodeling index (LVRI), left ventricular ejection fraction (LVEF), standard deviation of time to peak of left ventricular 16 segments (Tmsv16-SD), maximum time difference (Tmsv16-Dif), and difference between the 3DE index and the TYG index were collected. Logistic regression analysis was performed on the indicators with differences to analyze the influencing factors of the long-term prognosis of patients after PCI. The receiver operating characteristic (ROC) curve was drawn. The sensitivity, specificity, area under the curve (AUC), and Youden index were calculated. The best predictive cutoff value was determined. The predictive value of the 3DE index and the TYG index, either alone or in combination, was observed for long-term prognosis after PCI. The relationship between the 3DE index and the TYG index was explored. Result: The 2-year follow-up results showed that 22 patients experienced cardiovascular events, and they were included in the exposed group, accounting for 21.57%. The remaining 80 patients without cardiovascular events were included in the nonexposed group, accounting for 78.43%. A significant difference was found in creatinine (Cr), high-density lipoprotein cholesterol (HDL-C), LVEDV, LVESV, LVMI, LVRI, LVEF, Tmsv16-SD, Tmsv16-Dif, and the TYG index between the exposed group and nonexposed group (p < 0.05). Cr, HDL-C, LVEDV, LVESV, LVMI, Tmsv16-SD, Tmsv16-Dif, and the TYG index in the exposed group were higher than those in the nonexposed group (p < 0.05). The exposed group also had lower LVRI and LVEF than the nonexposed group (p < 0.05). Logistic regression analysis of the indicators with differences showed that Cr, HDL-C, LVEDV, LVESV, LVMI, LVRI, LVEF, Tmsv16-SD, Tmsv16-Dif, and the TYG index were the major factors that affect the long-term prognosis of patients after PCI, with odds ratio values >1. Correlation analysis showed that the TYG index was positively correlated with LVEDV, LVESV, LVMI, Tmsv16-SD, Tmsv16-
{"title":"Appraised Value of 3D Echocardiography Combined with the Triglyceride–Glucose Index to Evaluate the Long-Term Prognosis of Patients after Percutaneous Coronary Intervention","authors":"Xuan Luo, Yaoyao Deng, Lijuan Gu","doi":"10.59958/hsf.6881","DOIUrl":"https://doi.org/10.59958/hsf.6881","url":null,"abstract":"Objective: This study analyzed three-dimensional echocardiography (3DE) combined with the triglyceride–glucose (TYG) index to evaluate the long-term prognosis of patients after percutaneous coronary intervention (PCI). Methods: The clinical data of 102 patients who were treated with PCI after admission to our hospital from January 2020 to December 2020 were retrospectively analyzed. All the patients were followed up for 24 months to evaluate their long-term prognosis. The occurrence of cardiovascular and cerebrovascular events in all the patients was recorded. Cardiovascular and cerebrovascular events refer to a series of diseases or conditions of the heart and the cerebrovascular system, including sudden cardiac death. Patients with cardiovascular events were assigned to the exposed group, while those without cardiovascular events were included in the nonexposed group. The left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular mass index (LVMI), left ventricular remodeling index (LVRI), left ventricular ejection fraction (LVEF), standard deviation of time to peak of left ventricular 16 segments (Tmsv16-SD), maximum time difference (Tmsv16-Dif), and difference between the 3DE index and the TYG index were collected. Logistic regression analysis was performed on the indicators with differences to analyze the influencing factors of the long-term prognosis of patients after PCI. The receiver operating characteristic (ROC) curve was drawn. The sensitivity, specificity, area under the curve (AUC), and Youden index were calculated. The best predictive cutoff value was determined. The predictive value of the 3DE index and the TYG index, either alone or in combination, was observed for long-term prognosis after PCI. The relationship between the 3DE index and the TYG index was explored. Result: The 2-year follow-up results showed that 22 patients experienced cardiovascular events, and they were included in the exposed group, accounting for 21.57%. The remaining 80 patients without cardiovascular events were included in the nonexposed group, accounting for 78.43%. A significant difference was found in creatinine (Cr), high-density lipoprotein cholesterol (HDL-C), LVEDV, LVESV, LVMI, LVRI, LVEF, Tmsv16-SD, Tmsv16-Dif, and the TYG index between the exposed group and nonexposed group (p < 0.05). Cr, HDL-C, LVEDV, LVESV, LVMI, Tmsv16-SD, Tmsv16-Dif, and the TYG index in the exposed group were higher than those in the nonexposed group (p < 0.05). The exposed group also had lower LVRI and LVEF than the nonexposed group (p < 0.05). Logistic regression analysis of the indicators with differences showed that Cr, HDL-C, LVEDV, LVESV, LVMI, LVRI, LVEF, Tmsv16-SD, Tmsv16-Dif, and the TYG index were the major factors that affect the long-term prognosis of patients after PCI, with odds ratio values >1. Correlation analysis showed that the TYG index was positively correlated with LVEDV, LVESV, LVMI, Tmsv16-SD, Tmsv16-","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140718138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Li-Yun Liu, Fang Ren, Y. Xing, Qing-Rong Liu, Qin-Yan Wu, Ge Ren, Qin-Wen Liao, Lu Wang, Feng Gan
Introduction: Percutaneous coronary intervention (PCI) is an important treatment for acute coronary syndrome. The main puncture paths of PCI include radial artery, brachial artery, and femoral artery. The aim of this study was to investigate the safety and efficacy of transbrachial intervention in elderly patients. Methods: According to intraoperative and postoperative nursing records, a retrospective analysis was performed for 70 elderly patients who underwent coronary intervention were divided into brachial artery A group (33 cases) and brachial artery B group (37 cases) according to immediate postoperative extubation compression dressing and 6 hours postoperative extubation compression dressing, and matched elderly patients who had successful transradial artery puncture in the same period as radial artery group (35 cases). The success rate of puncture and catheterization, arterial puncture time, total operation time, length of hospital stay, patient comfort score, incidence of arterial spasm and occlusion, subcutaneous ecchymosis and hematoma, epidermal blister occurrence, vagal reflex, pseudoaneurysm development, arteriovenous fistula formation, nerve damage risk assessment and osteofascial compartment syndrome were compared. Results: Compared with the radial artery group, the brachial artery group (group A and group B) had a higher success rate of puncture and catheterization (97.0% vs. 97.3% vs. 80.0%, p = 0.013), shorter arterial puncture time (2.45 ± 0.38 vs. 2.40 ± 0.35 vs. 3.40 ± 0.37, p = 0.000), and lower incidence of arterial spasm (0.0% vs. 0.0% vs. 34.3%, p = 0.000), arterial occlusion (0.0% vs. 0.0% vs. 14.3%, p = 0.005) and puncture site bleeding (12.1% vs. 5.6% vs. 40.0%, p = 0.001). The incidence of epidermal blister was higher in brachial artery A group than in brachial artery B group (24.2% vs. 2.7%, p = 0.003) or radial artery group (24.2% vs. 0%, p = 0.001), and the incidence of epidermal blister in brachial artery B group and radial artery group was not much different. There was no difference between the three groups in total operation time, length of hospital stay, comfort score, subcutaneous ecchymosis and hematoma, vagal reflex, pseudoaneurysm, arteriovenous fistula, nerve damage and osteofascial compartment syndrome. Conclusion: In elderly patients, coronary intervention through brachial artery is not inferior to radial artery.
简介：经皮冠状动脉介入治疗（PCI经皮冠状动脉介入治疗（PCI）是治疗急性冠状动脉综合征的重要方法。PCI 的主要穿刺路径包括桡动脉、肱动脉和股动脉。本研究旨在探讨老年患者经肱动脉介入治疗的安全性和有效性。方法：根据术中和术后护理记录，对 70 例接受冠状动脉介入治疗的老年患者进行回顾性分析，按术后立即拔管加压包扎和术后 6 小时拔管加压包扎分为肱动脉 A 组（33 例）和肱动脉 B 组（37 例），并将同期经桡动脉穿刺成功的老年患者与桡动脉组（35 例）进行配对。比较穿刺和导管插入成功率、动脉穿刺时间、手术总时间、住院时间、患者舒适度评分、动脉痉挛和闭塞发生率、皮下瘀斑和血肿、表皮水泡发生率、迷走神经反射、假性动脉瘤发生率、动静脉瘘形成率、神经损伤风险评估和骨筋膜室综合征。结果与桡动脉组相比，肱动脉组（A 组和 B 组）穿刺和导管插入成功率更高（97.0% vs. 97.3% vs. 80.0%，P = 0.013），动脉穿刺时间更短（2.45 ± 0.38 vs. 2.40 ± 0.35 vs. 3.40 ± 0.37，p = 0.000），动脉痉挛（0.0% vs. 0.0% vs. 34.3%，p = 0.000）、动脉闭塞（0.0% vs. 0.0% vs. 14.3%，p = 0.005）和穿刺部位出血（12.1% vs. 5.6% vs. 40.0%，p = 0.001）的发生率较低。肱动脉A组表皮水泡的发生率高于肱动脉B组（24.2% vs. 2.7%，p = 0.003）或桡动脉组（24.2% vs. 0%，p = 0.001），而肱动脉B组和桡动脉组表皮水泡的发生率差异不大。三组在手术总时间、住院时间、舒适度评分、皮下瘀斑和血肿、迷走神经反射、假性动脉瘤、动静脉瘘、神经损伤和骨筋膜室综合征方面没有差异。结论在老年患者中，通过肱动脉进行冠状动脉介入治疗并不比桡动脉差。
{"title":"Evaluation of the Safety and Efficacy of Coronary Intervention through the Brachial Artery Compared to the Radial Artery in Elderly Patients with Different Extubation Times","authors":"Li-Yun Liu, Fang Ren, Y. Xing, Qing-Rong Liu, Qin-Yan Wu, Ge Ren, Qin-Wen Liao, Lu Wang, Feng Gan","doi":"10.59958/hsf.7329","DOIUrl":"https://doi.org/10.59958/hsf.7329","url":null,"abstract":"Introduction: Percutaneous coronary intervention (PCI) is an important treatment for acute coronary syndrome. The main puncture paths of PCI include radial artery, brachial artery, and femoral artery. The aim of this study was to investigate the safety and efficacy of transbrachial intervention in elderly patients. Methods: According to intraoperative and postoperative nursing records, a retrospective analysis was performed for 70 elderly patients who underwent coronary intervention were divided into brachial artery A group (33 cases) and brachial artery B group (37 cases) according to immediate postoperative extubation compression dressing and 6 hours postoperative extubation compression dressing, and matched elderly patients who had successful transradial artery puncture in the same period as radial artery group (35 cases). The success rate of puncture and catheterization, arterial puncture time, total operation time, length of hospital stay, patient comfort score, incidence of arterial spasm and occlusion, subcutaneous ecchymosis and hematoma, epidermal blister occurrence, vagal reflex, pseudoaneurysm development, arteriovenous fistula formation, nerve damage risk assessment and osteofascial compartment syndrome were compared. Results: Compared with the radial artery group, the brachial artery group (group A and group B) had a higher success rate of puncture and catheterization (97.0% vs. 97.3% vs. 80.0%, p = 0.013), shorter arterial puncture time (2.45 ± 0.38 vs. 2.40 ± 0.35 vs. 3.40 ± 0.37, p = 0.000), and lower incidence of arterial spasm (0.0% vs. 0.0% vs. 34.3%, p = 0.000), arterial occlusion (0.0% vs. 0.0% vs. 14.3%, p = 0.005) and puncture site bleeding (12.1% vs. 5.6% vs. 40.0%, p = 0.001). The incidence of epidermal blister was higher in brachial artery A group than in brachial artery B group (24.2% vs. 2.7%, p = 0.003) or radial artery group (24.2% vs. 0%, p = 0.001), and the incidence of epidermal blister in brachial artery B group and radial artery group was not much different. There was no difference between the three groups in total operation time, length of hospital stay, comfort score, subcutaneous ecchymosis and hematoma, vagal reflex, pseudoaneurysm, arteriovenous fistula, nerve damage and osteofascial compartment syndrome. Conclusion: In elderly patients, coronary intervention through brachial artery is not inferior to radial artery.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140733163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mehmet Yılmaz, Vildan Kilic Yilmaz, Emine Ozer Yurt, Ahmet Yuksek, Alper Gorur, Huseyin Saskin, A. Saraçoğlu, K. Saraçoğlu
Background: The primary objective of this study was to compare sevoflurane inhalation anesthesia with total intravenous anesthesia (TIVA) in terms of its effectiveness in maintaining adequate depth of anesthesia during all open heart surgery procedures, including cardiopulmonary bypass. The study's secondary objective was to compare sevoflurane inhalation anesthesia with TIVA regarding the impact on the time of tracheal extubation and the incidence of postoperative acute kidney injury during open heart surgeries. Methods: A total of 58 patients undergoing open heart surgery were included, with 30 receiving sevoflurane inhalation anesthesia and 28 receiving TIVA. Demographic characteristics, intraoperative parameters, and postoperative outcomes were recorded and analyzed. Statistical analysis revealed no significant differences in Bispectral Index (BIS) monitor values, mean arterial pressure, body temperature, or other intraoperative parameters between the two groups. Notably, the time to tracheal extubation was significantly shorter in the Sevoflurane group compared to the TIVA group, although both groups exhibited similar rates of postoperative acute kidney injury (AKI). Results: None of the patients had complaints of intraoperative awareness. The mean arterial pressure, body temperature, and bispectral index values during and before cardiopulmonary bypass were similar between the groups. Postoperative variables such as intensive care unit stay duration, incidence of acute kidney injury, and immediate and 24-hour post-extubation visual analog scale values were similar between the groups. The tracheal extubation time was found to be statistically shorter in the sevoflurane group. Conclusion: We believe that sevoflurane inhalation anesthesia can achieve adequate depth of anesthesia during the intraoperative period in open heart surgery without increasing the rate of postoperative complications.
{"title":"Comparison of the Effects of Inhalational Anesthesia with Sevoflurane and Total Intravenous Anesthesia in Open Heart Surgery","authors":"Mehmet Yılmaz, Vildan Kilic Yilmaz, Emine Ozer Yurt, Ahmet Yuksek, Alper Gorur, Huseyin Saskin, A. Saraçoğlu, K. Saraçoğlu","doi":"10.59958/hsf.7277","DOIUrl":"https://doi.org/10.59958/hsf.7277","url":null,"abstract":"Background: The primary objective of this study was to compare sevoflurane inhalation anesthesia with total intravenous anesthesia (TIVA) in terms of its effectiveness in maintaining adequate depth of anesthesia during all open heart surgery procedures, including cardiopulmonary bypass. The study's secondary objective was to compare sevoflurane inhalation anesthesia with TIVA regarding the impact on the time of tracheal extubation and the incidence of postoperative acute kidney injury during open heart surgeries. Methods: A total of 58 patients undergoing open heart surgery were included, with 30 receiving sevoflurane inhalation anesthesia and 28 receiving TIVA. Demographic characteristics, intraoperative parameters, and postoperative outcomes were recorded and analyzed. Statistical analysis revealed no significant differences in Bispectral Index (BIS) monitor values, mean arterial pressure, body temperature, or other intraoperative parameters between the two groups. Notably, the time to tracheal extubation was significantly shorter in the Sevoflurane group compared to the TIVA group, although both groups exhibited similar rates of postoperative acute kidney injury (AKI). Results: None of the patients had complaints of intraoperative awareness. The mean arterial pressure, body temperature, and bispectral index values during and before cardiopulmonary bypass were similar between the groups. Postoperative variables such as intensive care unit stay duration, incidence of acute kidney injury, and immediate and 24-hour post-extubation visual analog scale values were similar between the groups. The tracheal extubation time was found to be statistically shorter in the sevoflurane group. Conclusion: We believe that sevoflurane inhalation anesthesia can achieve adequate depth of anesthesia during the intraoperative period in open heart surgery without increasing the rate of postoperative complications.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":"53 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140733532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: To analyze the reliability and validity of the Johns Hopkins Fall Risk Assessment Scale (JHFRAS) for out-of-bed fall risk in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). Methods: This study adopted continuity inclusion with the Chinese version of JHFRAS to test patients with AMI after PCI who were admitted to our hospital from January 2021 to December 2022. The occurrence of falls during out-of-bed activities was counted through follow-up, and the predictive value of the scale was assessed by using the area under the curve (AUC) of the receiver operator characteristic curve and determining sensitivity, specificity, Jordon's index, and critical value. The internal consistency reliability (Cronbach's α coefficient), interrater reliability (Spearman correlation analysis was conducted to analyze the scores obtained through the independent and simultaneous assessment of two reviewers who were unaware of the content and results of the scale), content validity (expert evaluation involving four experts), and criterion-related validity (the score of the Morse fall assessment scale [rMFS] was used as an indicator of criterion-related validity) were determined. Results: Through follow-up, this study found that 11 cases experienced falls during out-of-bed activities and 69 cases did not experience falls. The JHFRAS scores of the nonfall and fall groups were significantly different (p < 0.05). JHFRAS, which was designed to predict the risk of falls during out-of-bed activities in post-PCI patients with AMI, had an AUC of 0.880, a sensitivity of 0.937, a specificity of 0.824, a Jordon's index of 0.760, and a critical value of 9 points. Its Cronbach's α coefficient was 0.803. The assessment data from two reviewers were analyzed via intragroup coefficient analysis and yielded a Spearman's rank correlation coefficient of 0.948. The overall content validity of the scale was 0.968. The content validity indices of age, fall history, urine and defecation excretion amount, high-risk drug use, stent number, action capability, and cognitive ability were 0.915, 0.924, 0.938, 0.920, 0.954, 0.960 and 0.972, respectively. All correlation coefficients were significant at the 0.01 level. The scores of each dimension of rMFS and JHFRAS showed positive correlations. Conclusions: JHFRAS has good reliability and validity and can be used to assess the fall risk of out-of-bed activities in patients with AMI after PCI.
{"title":"Analysis of the Reliability and Validity of the Johns Hopkins Fall Risk Assessment Scale in Patients with Acute Myocardial Infarction after Percutaneous Coronary Intervention","authors":"Jihe Yang, Jianguo Zhou","doi":"10.59958/hsf.7101","DOIUrl":"https://doi.org/10.59958/hsf.7101","url":null,"abstract":"Objective: To analyze the reliability and validity of the Johns Hopkins Fall Risk Assessment Scale (JHFRAS) for out-of-bed fall risk in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). Methods: This study adopted continuity inclusion with the Chinese version of JHFRAS to test patients with AMI after PCI who were admitted to our hospital from January 2021 to December 2022. The occurrence of falls during out-of-bed activities was counted through follow-up, and the predictive value of the scale was assessed by using the area under the curve (AUC) of the receiver operator characteristic curve and determining sensitivity, specificity, Jordon's index, and critical value. The internal consistency reliability (Cronbach's α coefficient), interrater reliability (Spearman correlation analysis was conducted to analyze the scores obtained through the independent and simultaneous assessment of two reviewers who were unaware of the content and results of the scale), content validity (expert evaluation involving four experts), and criterion-related validity (the score of the Morse fall assessment scale [rMFS] was used as an indicator of criterion-related validity) were determined. Results: Through follow-up, this study found that 11 cases experienced falls during out-of-bed activities and 69 cases did not experience falls. The JHFRAS scores of the nonfall and fall groups were significantly different (p < 0.05). JHFRAS, which was designed to predict the risk of falls during out-of-bed activities in post-PCI patients with AMI, had an AUC of 0.880, a sensitivity of 0.937, a specificity of 0.824, a Jordon's index of 0.760, and a critical value of 9 points. Its Cronbach's α coefficient was 0.803. The assessment data from two reviewers were analyzed via intragroup coefficient analysis and yielded a Spearman's rank correlation coefficient of 0.948. The overall content validity of the scale was 0.968. The content validity indices of age, fall history, urine and defecation excretion amount, high-risk drug use, stent number, action capability, and cognitive ability were 0.915, 0.924, 0.938, 0.920, 0.954, 0.960 and 0.972, respectively. All correlation coefficients were significant at the 0.01 level. The scores of each dimension of rMFS and JHFRAS showed positive correlations. Conclusions: JHFRAS has good reliability and validity and can be used to assess the fall risk of out-of-bed activities in patients with AMI after PCI.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":"27 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140735381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sarah Yousef, Valentino Bianco, James A Brown, Nandini Doshi, Derek Serna-Gallegos, Yisi Wang, David J. Kaczorowski, Johannes Bonatti, P. Yoon, Danny Chu, Ibrahim Sultan
Objective: To compare outcomes of pledgeted versus nonplegdeted suture techniques for aortic valve replacement (AVR). Methods: This was a retrospective study utilizing an institutional database of AVRs performed at our center between 2010 and 2020. All patients who underwent isolated surgical AVR were included, while those who underwent concomitant procedures were excluded. Patients were dichotomized into those who underwent pledgeted vs. nonpledgeted AVR, and 1:1 propensity score matching (PSM) was employed. Clinical and echocardiographic outcomes were compared. Kaplan-Meier survival estimation and Cox regression were performed. Cumulative incidence functions were generated for all-cause readmissions and for heart-failure readmissions. Freedom from major adverse cardiac and cerebrovascular events (MACCE) were also analyzed and compared using Kaplan-Meier methods. Results: A total of 2240 patients were identified. PSM yielded 892 matched pairs. Mean gradient was significantly higher in the pledgeted group (p < 0.001), but patients in this group had a smaller median valve size implanted. There were no significant differences in paravalvular leak rates. Kaplan-Meier survival estimates, cumulative incidence of readmissions, and freedom from MACCE were not significantly different between groups. Conclusion: Long-term survival, readmission rates, and freedom from MACCE are comparable after pledgeted and nonpledgeted AVR. There were no differences in paravalvular leak rates between the two techniques.
{"title":"Outcomes of Pledgeted versus Nonpledgeted Suture Technique for Isolated Aortic Valve Replacement","authors":"Sarah Yousef, Valentino Bianco, James A Brown, Nandini Doshi, Derek Serna-Gallegos, Yisi Wang, David J. Kaczorowski, Johannes Bonatti, P. Yoon, Danny Chu, Ibrahim Sultan","doi":"10.59958/hsf.6793","DOIUrl":"https://doi.org/10.59958/hsf.6793","url":null,"abstract":"Objective: To compare outcomes of pledgeted versus nonplegdeted suture techniques for aortic valve replacement (AVR). Methods: This was a retrospective study utilizing an institutional database of AVRs performed at our center between 2010 and 2020. All patients who underwent isolated surgical AVR were included, while those who underwent concomitant procedures were excluded. Patients were dichotomized into those who underwent pledgeted vs. nonpledgeted AVR, and 1:1 propensity score matching (PSM) was employed. Clinical and echocardiographic outcomes were compared. Kaplan-Meier survival estimation and Cox regression were performed. Cumulative incidence functions were generated for all-cause readmissions and for heart-failure readmissions. Freedom from major adverse cardiac and cerebrovascular events (MACCE) were also analyzed and compared using Kaplan-Meier methods. Results: A total of 2240 patients were identified. PSM yielded 892 matched pairs. Mean gradient was significantly higher in the pledgeted group (p < 0.001), but patients in this group had a smaller median valve size implanted. There were no significant differences in paravalvular leak rates. Kaplan-Meier survival estimates, cumulative incidence of readmissions, and freedom from MACCE were not significantly different between groups. Conclusion: Long-term survival, readmission rates, and freedom from MACCE are comparable after pledgeted and nonpledgeted AVR. There were no differences in paravalvular leak rates between the two techniques.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":"39 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140735329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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