Abstract 18424: Elective Cardiac Arrest in Isolated Aortic Valve Surgery: Comparison of Blood-cardioplegia versus HTK-Bretschneider Solution in 7005 Consecutive Patients

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Alexandro A Hoyer ◽  
Sven Lehmann ◽  
Andreas Oberbach ◽  
Denis A Merk ◽  
Stefan Feder ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Aortic Valve ◽  
Valve Surgery ◽  
Aortic Valve Surgery ◽  
Term Survival ◽  
Blood Cardioplegia ◽  
Cold Blood ◽  
Group B ◽  
Cold Blood Cardioplegia

Introduction: Assessing the impact of HTK-Bretschneider solution versus blood-cardioplegia on short- and long-term outcome after isolated aortic valve replacement (AVR). Hypothesis: HTK-Bretschneider is not inferior to Blood-cardioplegia for isolated aortic valve replacement. Methods: Screening of our institutional database revealed 7290 consecutive patients who underwent AVR between 11/1994 and 06/2015. In the majority of patients (n=5998; 83%) antegrade infusion of htk-bretschneider solution (custodiol®) was used for elective cardiac arrest (Group A). Intermittent cold blood-cardioplegia was chosen in 1007 patients (14%; Group B). All preoperative risk-factors were considered for risk-factor analysis influencing outcome. Results: Early mortality was equal between the subgroups (p=0.22). Postoperative complications like pacemaker implantation (p=0.01) or low cardiac output were more likely to occur in group B (p=0.02). Overall long term survival was inferior for patients receiving elective cardiac arrest with cold blood cardioplegia (p<0.001). Cox-regression identified age (HR: 1.063 ; p<0.001), end stage renal disease (ESDR; HR:4.8; p<0.001), history of PCI (HR: 1.3; p=0.03), active infective endocarditis (AIE; HR: 2.1; p<0.001), neurological dysfunction (HR: 1.4; p=0.02), low ejection fraction (EF<30%; HR: 2.5; p<0.001), prior cardiac surgery (HR:1,5; p=0.02) and emergent surgical intervention (HR: 2.5; p<0.001) being highly associated with long term survival and occurring more frequently in group B. Artificial low-risk and high-risk groups showed no differences in longevity depending on cardioplegic solutions (p=0.35). Conclusions: Blood-cardioplegia for elective cardiac arrest seems to be preferred when complex aortic valve surgery is expected. However, HTK-Bretschneider solution yields equivalent longevity to blood-cardioplegia, even after surgery demanding extended cross-clamp times.

scholarly journals PRE-OPERATIVE RENAL DISEASE PROGRESSIVELY IMPACTS LONG-TERM SURVIVAL FOLLOWING AORTIC VALVE SURGERY

2014 ◽  
Vol 63 (12) ◽  
pp. A1978
Author(s):  
Halit Yerebakan ◽  
Robert Sorabella ◽  
Marc Najjar ◽  
Julie van Hassel ◽  
Catherine Wang ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Renal Disease ◽  
Valve Surgery ◽  
Aortic Valve Surgery ◽  
Term Survival ◽  
Long Term Survival

scholarly journals Long-Term Survival of the Very Elderly Undergoing Aortic Valve Surgery

Circulation ◽  
2009 ◽  
Vol 120 (11_suppl_1) ◽  
pp. S127-S133 ◽  
Author(s):  
D. S. Likosky ◽  
M. J. Sorensen ◽  
L. J. Dacey ◽  
Y. R. Baribeau ◽  
B. J. Leavitt ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Valve Surgery ◽  
Aortic Valve Surgery ◽  
Very Elderly ◽  
Term Survival ◽  
Long Term Survival

scholarly journals Early Valve Replacement for Severe Aortic Valve Disease: Effect on Mortality and Clinical Ramifications

2020 ◽  
Vol 9 (9) ◽  
pp. 2694
Author(s):  
Jason P. Koerber ◽  
Jayme S. Bennetts ◽  
Peter J. Psaltis
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Survival Benefit ◽  
Observational Studies ◽  
Aortic Valve Disease ◽  
Valve Surgery ◽  
Aortic Valve Surgery ◽  
Term Survival ◽  
Chronic Aortic Regurgitation

Timing of aortic valve intervention for chronic aortic regurgitation (AR) and/or aortic stenosis (AS) potentially affects long-term survival. The 2014 American Heart Association/American College of Cardiology (AHA/ACC) guidelines provide recommendations for the timing of intervention. Subsequent to the guidelines’ release, several studies have been published that suggest a survival benefit from earlier timing of surgery for severe AR and/or AS. The aim of this review was to determine whether patients who have chronic aortic regurgitation (AR) and/or aortic stenosis (AS) have a survival benefit from earlier timing of aortic valve surgery. Medical databases were systematically searched from January 2015 to April 2020 for randomized controlled trials (RCTs) and observational studies that examined the timing of aortic valve replacement surgery for chronic AR and/or AS. For chronic AR, four observational studies and no RCTs were identified. For chronic AS, five observational studies, one RCT and one meta-analysis were identified. One observational study examining mixed aortic valve disease (MAVD) was identified. All of these studies, for AR, AS, and MAVD, found long-term survival benefit from timing of aortic valve surgery earlier than the current guidelines. Larger prospective RCTs are required to evaluate the benefit of earlier surgical intervention.

scholarly journals Relative survival after aortic valve surgery in patients with bicuspid aortic valves

Heart ◽  
2021 ◽  
pp. heartjnl-2020-318733 ◽  
Author(s):  
Natalie Glaser ◽  
Veronica Jackson ◽  
Per Eriksson ◽  
Ulrik Sartipy ◽  
Anders Franco-Cereceda
Keyword(s):  
Aortic Valve ◽  
Survival Rates ◽  
Relative Survival ◽  
Valve Surgery ◽  
University Hospital ◽  
Aortic Valve Surgery ◽  
Swedish Population ◽  
Term Survival

ObjectivesThe objective of this cohort study was to analyse long-term relative survival in patients with bicuspid aortic valve (BAV) who underwent aortic valve surgery.MethodsWe studied 865 patients with BAVs who participated in three prospective cohort studies of elective, open-heart, aortic valve surgery at the Karolinska University Hospital, Stockholm, Sweden, between 2007 and 2020. The expected survival for the age, sex and calendar year-matched general Swedish population was obtained from the Human Mortality Database. The Ederer II method was used to calculate relative survival, which was used as an estimate of cause-specific survival.ResultsNo differences were found in the observed versus expected survival at 1, 5, 10 or 12 years: 99%, 94%, 83% and 76% vs 99%, 93%, 84% and 80%, respectively. The relative survival at 1, 5, 10 and 12 years was 100% (95% CI 99% to 100%), 101% (95% CI 99% to 103%), 99% (95% CI 95% to 103%) and 95% (95% CI 87% to 102%), respectively. The relative survival at the end of follow-up tended to be lower for women than men (86% vs 95%). The mean follow-up was 6.3 years (maximum 13.3 years).ConclusionsThe survival of patients with BAV following aortic valve surgery was excellent and similar to that of the general population. Our results suggest that the timing of surgery according to current guidelines is correct and provide robust long-term survival rates, as well as important information about the natural history of BAV in patients following aortic valve surgery.

Persistence of Reduced Left Ventricular Function after Aortic Valve Surgery for Aortic Valve Regurgitation: Bicuspid versus Tricuspid

2019 ◽  
Author(s):  
Johannes Petersen ◽  
Niklas Neumann ◽  
Shiho Naito ◽  
Tatiana Sequeira Gross ◽  
Robert Massel ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Strong Predictor ◽  
Left Ventricular ◽  
Valve Surgery ◽  
Left Ventricular Ejection ◽  
Aortic Valve Surgery ◽  
Term Survival ◽  
Lv Dysfunction

Objective Long-term prognosis of patients with aortic regurgitation (AR) and reduced left ventricular ejection fraction (LVEF) who undergo aortic valve surgery (AVS) is unknown. Due to the congenital origin, bicuspid aortic valve (BAV) morphotype might be associated with a more severe cardiomyopathy. We aimed to evaluate the LVEF recovery after aortic valve replacement (AVR) surgery in patients with AR and reduced preoperative LVEF. Methods This retrospective analysis included 1,170 consecutive patients with moderate to severe AR who underwent AVS at our institution between January 2005 and April 2016. Preoperative echocardiography revealed 154 (13%) patients with predominant AR and baseline LVEF < 50%. A total of 60 (39%) patients had a BAV (BAV group), while the remaining 94 (61%) patients had a tricuspid morphotype (tricuspid aortic valve [TAV] group). Follow-up protocol included clinical interview using a structured questionnaire and echocardiographic follow-up. Results A total of 154 patients (mean age 63.5 ± 12.4 years, 71% male) underwent AVS for AR in the context of reduced LVEF (mean LVEF 42 ± 8%). Fifteen (10%) patients had a severely reduced preoperative LVEF ≤ 30%. Mean STS (Society of Thoracic Surgeons) score was 1.36 ± 1.09%. Mean follow-up was comparable between both the study groups (BAV: 50 ± 40 months vs. TAV: 40 ± 38 months, p = 0.140). A total of 25 (17%) patients died during follow-up. Follow-up echocardiography demonstrated similar rate of postoperatively reduced LVEF in both groups (i.e., 39% BAV patients vs. 43% TAV patients; p = 0.638). Cox's regression analysis showed no significant impact of BAV morphotype (i.e., as compared with TAV) on the postoperative LVEF recovery (odds ratio [OR]: 1.065; p = 0.859). Severe left ventricular (LV) dysfunction at baseline (i.e., LVEF ≤ 30%) was a strong predictor for persistence of reduced LVEF during follow-up (OR: 3.174; 95% confidence interval: 1.517–6.640; p = 0.002). Survival was significantly reduced in patients with persisting LV dysfunction versus those in whom LVEF recovered (log rank: p < 0.001). Conclusion Our study demonstrates that reduced LVEF persists postoperatively in 40 to 45% patients who present with relevant AR and reduced LVEF at baseline. Postoperative LVEF recovery is independent of aortic valve morphotype (i.e., BAV vs. TAV). Severe LV dysfunction (LVEF ≤ 30%) at baseline is a strong predictor for persistence of reduced LVEF in patients with AR and results in significantly reduced long-term survival.

The impact of del Nido cardioplegia solution on blood morphology parameters

Perfusion ◽  
2021 ◽  
pp. 026765912110490
Author(s):  
Krzysztof Sanetra ◽  
Wojciech Domaradzki ◽  
Marek Cisowski ◽  
Rajesh Shrestha ◽  
Krzysztof Białek ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Blood Cell ◽  
Valve Replacement ◽  
Transfusion Rate ◽  
Blood Cardioplegia ◽  
Blood Morphology ◽  
Cold Blood ◽  
Cold Blood Cardioplegia ◽  
Morphology Parameters

Background: Crystalloid cardioplegic solutions are believed to reduce hemoglobin significantly and increase the transfusion rate. However, recent reports indicate that the del Nido cardioplegia may preserve blood morphology parameters. Methods: In “The del Nido versus cold blood cardioplegia in aortic valve Replacement” trial patients undergoing aortic valve replacement were randomized into the del Nido (DN) or cold blood cardioplegia (CB) group. For the subanalysis, patients who underwent blood transfusions were excluded from the study. Red blood cell (RBC) count, hemoglobin, white blood cell (WBC) count and platelet (PLT) count were measured before the surgery, 24-, 48-, and 96 hours postoperatively. Furthermore, percental variation in first-last measure was compared in groups. In addition, indexed normalized ratio (INR) and activated partial thromboplastin time (aPTT) were compared preoperatively and 24 hours after the surgery. Results: Eighteen (24%) patients from the del Nido group and 22 (29.3%) patients from the CB group received blood product transfusions (p = 0.560) and were excluded from further analysis. As such, 57 patients remained in DN group and 53 patients remained in CB group. No difference was found in RBC, hemoglobin, WBC, and platelet count in time intervals. Percental variation in first-last measure revealed higher fall in RBC (p = 0.0024) and hemoglobin (p = 0.0028) in the CB group. No difference was shown in preoperative and 24-hour postoperative INR and aPTT. Conclusions: The del Nido cardioplegia does not decrease blood morphology parameters when compared to cold blood cardioplegia and may be used alternatively regardless of bleeding and coagulopathy risk.

scholarly journals Aortic valve surgery in octogenarians: predictive factors for operative and long-term results

2007 ◽  
Vol 31 (4) ◽  
pp. 600-606 ◽  
Author(s):  
Philippe Kolh ◽  
Arnaud Kerzmann ◽  
Charles Honore ◽  
Laetitia Comte ◽  
Raymond Limet
Keyword(s):  
Aortic Valve ◽  
Predictive Factors ◽  
Valve Surgery ◽  
Long Term Results ◽  
Aortic Valve Surgery ◽  
Surgery In Octogenarians
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