scholarly journals Right Anterior Minithoracotomy Is an Alternative, Less Invasive Approach to Median Sternotomy during Aortic Valve Replacement for Patients with Low Left Ventricular Ejection Fraction

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Zheng Qu ◽  
Bin You ◽  
Ping Li
Keyword(s):  
Cardiac Surgery ◽  
Left Ventricular Ejection Fraction ◽  
Aortic Valve ◽  
Ejection Fraction ◽  
Median Sternotomy ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Invasive Approach ◽  
Less Invasive Approach

The concept of minimally invasive cardiac surgery has been put forward for more than decades and continued to develop. Recently, minimally invasive aortic valve surgery is established as a safe and effective treatment for various aortic valvular heart diseases and ascending aorta disorders. This study is aimed at analyzing the safety and effectiveness of aortic valve replacement (AVR) through right anterior minithoracotomy for the treatment of patients with low left ventricular ejection fraction (LVEF). Retrospective analyses of 43 cases with low LVEF undergoing AVR through median sternotomy and 43 cases with low LVEF undergoing AVR through right anterior minithoracotomy were performed. Extracorporeal circulation time and aortic cross-clamping time were longer in patients undergoing AVR through right anterior minithoracotomy than those in patients undergoing AVR through median sternotomy ( P < 0.05 ). Patients undergoing AVR through right anterior minithoracotomy exhibited declines in the cardiac surgery intensive care unit (CSICU) stay, duration of mechanical ventilation, and the length of hospital stay than those undergoing AVR through median sternotomy ( P < 0.05 ). The volumes of 24 h chest drainage were reduced in patients undergoing AVR through right anterior minithoracotomy compared with those undergoing AVR through median sternotomy ( P < 0.05 ). The incidence rates of blood transfusion within 24 h and postoperative atrial fibrillation were lower in patients undergoing AVR through right anterior minithoracotomy than those in patients undergoing AVR through median sternotomy ( P < 0.05 ). As for cardiac function, patients with right anterior minithoracotomy had decreased left ventricular end diastolic diameter (LVEDD) but increased LVEF and left ventricular fractional shortening (LVFS) when compared to median sternotomy ( P < 0.05 ). With regard to inflammatory response, the serum levels of interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor-α (TNF-α) in patients with right anterior minithoracotomy were much lower than those in median sternotomy ( P < 0.05 ). All these results indicate that right anterior minithoracotomy is an alternative, less invasive approach to median sternotomy during AVR for patients with low LVEF.

scholarly journals P1348 Impact of left ventricular ejection fraction and aortic valve sclerosis on cardiovascular outcome in patients with acute ischemic stroke

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M Kim ◽  
H L Kim ◽  
K T Park ◽  
W H Lim ◽  
J B Seo ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Left Ventricular Ejection Fraction ◽  
Aortic Valve ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Echocardiographic Parameters ◽  
Composite Events

Abstract Background/Introduction Previous studies have focused on only 1 or 2 echocardiographic parameters as prognostic marker in patients with acute ischemic stroke (AIS). Purpose Various echocardiographic parameters in the same patient were systemically evaluated for their prognostic significance in AIS. Methods A total of 900 patients with AIS who underwent transthoracic echocardiography (TTE) (72.6 ± 12.0 years and 60% male) were retrospectively reviewed. Composite events including all-cause mortality, non-fatal stroke, non-fatal myocardial infarction, and coronary revascularization were assessed during clinical follow-up. Results During a median follow-up of 3.3 years (interquartile range, 0.6-5.1 years), there were 151 (16.8%) composite events. Univariable analyses showed that low left ventricular ejection fraction (LVEF) (&lt; 60%), increased peak tricuspid regurgitation (TR) velocity (&gt; 2.8 m/s) and aortic valve (AV) sclerosis were associated with composite events (P &lt; 0.05 for each). In the multivariable analyses after controlling for potential confounders, LVEF &lt; 60% (hazard ratio [HR], 1.90; 95% confidence interval [CI], 1.30-2.77; P = 0.001) and AV sclerosis (HR, 1.56; 95% CI, 1.10-2.21; P = 0.013) were independent prognostic factors associated with composite events. Multivariable analysis showed that HR for composite events gradually increased according to LVEF and AV sclerosis: HR was 2.8-fold higher in the highest-risk group than in the lowest group (P = 0.001). Conclusions In patients with AIS, LVEF &lt; 60% and the presence of AV sclerosis predicts the future vascular events. Patients with AIS exhibiting reduced LVEF and AV sclerosis may benefit from aggressive secondary prevention Abstract P1348 Figure. COX plot for composite event

scholarly journals Dimensionless Index in Patients With Low-Gradient Severe Aortic Stenosis and Preserved Ejection Fraction

2020 ◽  
Vol 13 (10) ◽  
Author(s):  
Alexandre Altes ◽  
Nicolas Thellier ◽  
Dan Rusinaru ◽  
Wassima Marsou ◽  
Yohann Bohbot ◽  
...  
Keyword(s):  
Left Ventricular Ejection Fraction ◽  
Aortic Valve ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Hazard Ratio ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Aortic Valve Area ◽  
Ventricular Ejection Fraction ◽  
Valve Area

Background Risk stratification of patients with low-gradient (LG) severe aortic stenosis (AS) despite preserved left ventricular ejection fraction remains challenging. We sought to evaluate the relationship between the dimensionless index (DI)—the ratio of the left ventricular outflow tract time-velocity integral to that of the aortic valve jet—and mortality in these patients. Methods Seven hundred fifty-five patients with LG severe AS (defined by aortic valve area ≤1 cm 2 or aortic valve area indexed to body surface area ≤0.6 cm 2 /m 2 and mean aortic pressure gradient <40 mm Hg) and preserved left ventricular ejection fraction ≥50% were studied. Flow status was defined according to stroke volume index <35 mL/m 2 (low flow, LF) or ≥35 mL/m 2 (normal flow, NF). Results After adjustment for age, sex, body mass index, Charlson comorbidity index, history of hypertension, history of atrial fibrillation, AS-related symptoms, left ventricular ejection fraction, indexed left ventricular ventricular mass, aortic valve area, and aortic valve replacement as a time-dependent covariate, patients with LG-LF and DI<0.25 exhibited a considerable increased risk of death compared with patients with LG-NF and DI≥0.25 (adjusted hazard ratio, 2.41 [95% CI, 1.61–3.62]; P <0.001), LG-NF and DI<0.25 (adjusted hazard ratio, 1.84 [95% CI, 1.24–2.73]; P =0.003), and LG-LF and D≥0.25 (adjusted hazard ratio, 2.27 [95% CI, 1.42–3.63]; P <0.001). In contrast, patients with LG-LF and DI≥0.25, LG-NF and DI<0.25, and LG-NF and DI≥0.25 had similar outcome. DI<0.25 showed incremental prognostic value in patients with LG-LF severe AS but not in patients with LG-NF severe AS. Conclusions Among patients with LG severe AS and preserved left ventricular ejection fraction, decreased DI<0.25 is a reliable parameter in patients with LF to identify a subgroup of patients at higher risk of death who may derive benefit from aortic valve replacement.

Sign in / Sign up

Export Citation Format

Share Document