Long-term Results after Carpentier-Edwards Pericardial Aortic Valve Implantation, with Attention to the Impact of Age

2011 ◽  
Vol 14 (3) ◽  
pp. 160 ◽  
Author(s):  
Karl F. Welke ◽  
YingXing Wu ◽  
Gary L. Grunkemeier ◽  
Aftab Ahmad ◽  
Albert Starr
Keyword(s):  
Aortic Valve ◽  
Older Patients ◽  
Long Term Results ◽  
Rank Test ◽  
Term Survival ◽  
Younger Patients ◽  
Kaplan Meier ◽  
Valve Implantation ◽  
The Impact

<p><b>Background:</b> The purpose of this study was to determine long-term patient survival and valve durability for Carpentier-Edwards pericardial valves (Edwards Lifesciences) implanted in the aortic position, with specific attention to the impact of patient age.</p><p><b>Methods:</b> We performed a retrospective cohort study of 2168 patients who underwent implantation of a Carpentier-Edwards pericardial aortic valve between 1991 and 2008. The mean follow-up time was 4.5 years. Primary outcomes of interest were mortality and valve explantation. Survival curves and event-free curves were obtained with the Kaplan-Meier method and compared with the log-rank test.</p><p><b>Results:</b> Survival was 92% at 1 year, 73% at 5 years, 38% at 10 years, and 18% at 15 years. Although the mortality rate of younger patients was worse than in the general population, older patients had significantly better survival than their contemporaries. Age was the independent variable most significantly associated with explantation. There was an early hazard phase for patients between 21 and 49 years of age, such that the freedom from explantation was 89% at 3 years. By 10 years, the freedom from explantation was 58% for patients 21 to 49 years of age, compared with 68% for patients 50 to 64 years, 93% for patients 65 to 74 years, and 99% for patients 75 years of age and older.</p><p><b>Conclusion:</b> We found good long-term survival and durability. Older patients had excellent freedom from explantation, whereas younger patients fared worse. As our population ages, this information becomes increasingly important. Assessing the durability of this pericardial aortic valve may aid in predicting the durability of the transcatheter aortic valves that share the same leaflets.</p>

Transapical versus Conventional Aortic Valve Replacement�A Propensity-Matched Comparison

2012 ◽  
Vol 15 (1) ◽  
pp. 4 ◽  
Author(s):  
David M. Holzhey ◽  
William Shi ◽  
A. Rastan ◽  
Michael A. Borger ◽  
Martin H�nsig ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Survival Rates ◽  
Long Term Results ◽  
Term Survival ◽  
Kaplan Meier ◽  
Risk Patients ◽  
Short And Long Term ◽  
Good Treatment Option ◽  
Matched Comparison

<p><b>Introduction:</b> The goal of this study was to compare the short- and long-term outcomes after aortic valve (AV) surgery carried out via standard sternotomy/partial sternotomy versus transapical transcatheter AV implantation (taTAVI).</p><p><b>Patients and Methods:</b> All 336 patients who underwent taTAVI between 2006 and 2010 were compared with 4533 patients who underwent conventional AV replacement (AVR) operations between 2001 and 2010. Using propensity score matching, we identified and consecutively compared 2 very similar groups of 167 patients each. The focus was on periprocedural complications and long-term survival.</p><p><b>Results:</b> The 30-day mortality rate was 10.8% and 8.4% (<i>P</i> = .56) for the conventional AVR patients and the TAVI patients, respectively. The percentages of postoperative pacemaker implantations (15.0% versus 6.0%, <i>P</i> = .017) and cases of renal failure requiring dialysis (25.7% versus 12.6%, <i>P</i> = .004) were higher in the TAVI group. Kaplan-Meier curves diverged after half a year in favor of conventional surgery. The estimated 3-year survival rates were 53.5% � 5.7% (TAVI) and 66.7% � 0.2% (conventional AVR).</p><p><b>Conclusion:</b> Our study shows that even with all the latest successes in catheter-based AV implantation, the conventional surgical approach is still a very good treatment option with excellent long-term results, even for older, high-risk patients.</p>

scholarly journals The Impact of Age on Clinical Outcomes of Coronary Artery Bypass Grafting: Long-Term Results of a Real-World Registry

2017 ◽  
Vol 2017 ◽  
pp. 1-11 ◽  
Author(s):  
Francesco Nicolini ◽  
Daniela Fortuna ◽  
Giovanni Andrea Contini ◽  
Davide Pacini ◽  
Davide Gabbieri ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Older Patients ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Long Term Results ◽  
Left Ventricular Ejection ◽  
Term Survival ◽  
Ventricular Ejection Fraction ◽  
The Impact

The aim of this retrospective multicenter registry study was to investigate age-dependent trends in mortality, long-term survival, and comorbidity over time in patients who underwent isolated CABG from 2003 to 2015. The percentage of patients < 60 years of age was 18.9%. Female sex, chronic pulmonary disease, extracardiac arteriopathy, and neurologic dysfunction disease were significantly less frequent in this younger population. The prevalence of BMI ≥ 30, previous myocardial infarction, preoperative severe depressed left ventricular ejection fraction, and history of previous PCI were significantly higher in this population. After PS matching, at 5 years, patients < 60 years of age reported significantly lower overall mortality (p<0.0001), cardiac-related mortality (p<0.0001), incidence of acute myocardial infarction (p=0.01), and stroke rates (p<0.0001). Patients < 60 years required repeated revascularization more frequently than older patients (p=0.05). Patients < 60 who underwent CABG had a lower risk of adverse outcomes than older patients. Patients < 60 have a different clinical pattern of presentation of CAD in comparison with more elderly patients. These issues require focused attention in order to design and improve preventive strategies aiming to reduce the impact of specific cardiovascular risk factors for younger patients, such as diet, lifestyle, and weight control.

scholarly journals Long-term Survival after Aortic Valve Replacement with the Mitroflow Bioprosthesis: a Comparative Study

2019 ◽  
Vol 16 ◽  
Author(s):  
Alexander Manché ◽  
Liberato Camilleri
Keyword(s):  
Aortic Valve ◽  
Comparative Study ◽  
Patient Survival ◽  
Case Reports ◽  
Control Group ◽  
Term Survival ◽  
Younger Patients ◽  
Long Term Survival ◽  
Kaplan Meier

Background  Recent case reports of early structural degeneration of the Mitroflow valve have cast doubts on the suitability of this bioprosthesis, particularly in the smaller sizes, and in younger patients. We studied long-term patient survival, in a comparative study, as a marker of success after aortic valve replacement.Methods  Long-term survival in 142 consecutive patients implanted with the Mitroflow valve was compared, using the Kaplan-Meier method, with a control group of 149 patients receiving different bioprostheses. Ninety two percent of patients were over 70 and the Mitroflow was used preferentially in smaller sizes.Results Long-term survival in patients who received a Mitroflow valve was equivalent to controls. Four documented cases of premature structural valve degeneration (3 Mitroflow, 1 Perimount) required a second intervention.Conclusions The Mitroflow compared favourably with other valves in our practice. Although a few patients required further treatment this had no significant adverse impact on overall survival.

Pulmonary Homografts for Aortic Valve Replacement: Long-term Comparison with Aortic Grafts

2011 ◽  
Vol 14 (4) ◽  
pp. 237 ◽  
Author(s):  
Ferdinand Vogt ◽  
Anke Kowert ◽  
Andres Beiras-Fernandez ◽  
Martin Oberhoffer ◽  
Ingo Kaczmarek ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Survival Rates ◽  
Long Term Results ◽  
Rank Test ◽  
Aortic Graft ◽  
Valve Prostheses ◽  
Retrospective Comparative Study

<p><b>Objective:</b> The use of homografts for aortic valve replacement (AVR) is an alternative to mechanical or biological valve prostheses, especially in younger patients. This retrospective comparative study evaluated our single-center long-term results, with a focus on the different origins of the homografts.</p><p><b>Methods:</b> Since 1992, 366 adult patients have undergone AVR with homografts at our center. We compared 320 homografts of aortic origin and 46 homografts of pulmonary origin. The grafts were implanted via either a subcoronary technique or the root replacement technique. We performed a multivariate analysis to identify independent factors that influence survival. Freedom from reintervention and survival rates were calculated as cumulative events according to the Kaplan-Meier method, and differences were tested with the log-rank test.</p><p><b>Results:</b> Overall mortality within 1 year was 6.5% (21/320) in the aortic graft group and 17.4% (8/46) in the pulmonary graft group. In the pulmonary graft group, 4 patients died from valve-related complications, 1 patient died after additional heterotopic heart transplantation, and 1 patient who entered with a primary higher risk died from a prosthesis infection. Two patients died from non-valve-related causes. During the long-term follow-up, the 15-year survival rate was 79.9% for patients in the aortic graft group and 68.7% for patients in the pulmonary graft group (<i>P</i> = .049). The rate of freedom from reoperation was 77.7% in the aortic graft group and 57.4% in the pulmonary graft group (<i>P</i> < .001). The reasons for homograft explantation were graft infections (aortic graft group, 5.0%; pulmonary graft group, 6.5%) and degeneration (aortic graft group, 7.5%; pulmonary graft group, 32.6%).</p><p><b>Conclusion:</b> Our study demonstrated superior rates of survival and freedom from reintervention after AVR with aortic homografts. Implantation with a pulmonary graft was associated with a higher risk of redo surgery, owing to earlier degenerative alterations.</p>

scholarly journals Improved Long-Term Survival with Edaravone Therapy in Patients with Amyotrophic Lateral Sclerosis: A Retrospective Single-Center Study in Japan

2021 ◽  
Vol 14 (8) ◽  
pp. 705
Author(s):  
Hideki Houzen ◽  
Takahiro Kano ◽  
Kazuhiro Horiuchi ◽  
Masahiro Wakita ◽  
Azusa Nagai ◽  
...  
Keyword(s):  
Amyotrophic Lateral Sclerosis ◽  
Rank Test ◽  
Positive Pressure ◽  
Control Group ◽  
Single Center ◽  
Term Survival ◽  
Long Term Survival ◽  
Kaplan Meier ◽  
Lateral Sclerosis

Reports on the long-term survival effect of edaravone, which was approved for the treatment of amyotrophic lateral sclerosis (ALS) in 2015 in Japan, are rare. Herein, we report our retrospective analysis of 45 consecutive patients with ALS who initially visited our hospital between 2013 and 2018. Of these, 22 patients were treated with edaravone for an average duration of 26.6 (range, 2–64) months, whereas the remaining patients were not treated with edaravone and comprised the control group. There were no differences in baseline demographics between the two groups. The primary endpoint was tracheostomy positive-pressure ventilation (TPPV) or death, and the follow-up period ended in December 2020. The survival rate was significantly better in the edaravone group than in the control group based on the Kaplan–Meier analysis, which revealed that the median survival durations were 49 (9–88) and 25 (8–41) months in the edaravone and control groups, respectively (p = 0.001, log-rank test). There were no serious edaravone-associated adverse effects during the study period. Overall, the findings of this single-center retrospective study suggest that edaravone might prolong survival in patients with ALS.

scholarly journals Clinical results of the Metha short hip stem: a perspective for younger patients?

2013 ◽  
Vol 5 (4) ◽  
pp. 34 ◽  
Author(s):  
Fritz Thorey ◽  
Claudia Hoefer ◽  
Nima Abdi-Tabari ◽  
Matthias Lerch ◽  
Stefan Budde ◽  
...  
Keyword(s):  
Bone Ingrowth ◽  
Long Term Results ◽  
Harris Hip Score ◽  
Femoral Revision ◽  
Term Survival ◽  
Younger Patients ◽  
The Mean ◽  
Short Stems

In recent years, various uncemented proximal metaphyseal hip stems were introduced for younger patients as a bone preserving strategy. Initial osteodensitometric analyses of the surrounding bone of short stems indicate an increase of bone mass with secondary bone ingrowth fixation as a predictor of long-term survival of these types of implants. We report the outcome of 151 modular Metha short hip stem implants in 148 patients between March 2005 and October 2007. The mean follow-up was 5.8±0.7 years and the mean age of the patients was 55.7±9.8 years. Along with demographic data and co-morbidities, the Harris Hip Score (HHS), the Hip dysfunction and Osteoarthritis Outcome Score (HOOS), and also the results of a patient-administered questionnaire were recorded pre-operatively and at follow-up. The mean HHS increased from 46±17 pre-operatively to 90±5 the HOOS improved from 55±16 pre-operatively to 89±10 at the final follow-up. A total of three patients have been revised, two for subsidence with femoral revision and one for infection without femoral revision (Kaplan Meier survival estimate 98%). The radiological findings showed no radiolucent lines in any of the patients. The modular Metha short hip stem was implanted in younger patients, who reported an overall high level of satisfaction. The clinical and radiographic results give support to the principle of using short stems with metaphyseal anchorage. However, long-term results are necessary to confirm the success of this concept in the years to come.

scholarly journals Lymphadenectomy in the Treatment of Colon Cancer: A Survival Nalysis

2019 ◽  
Vol 4 (12) ◽  
Author(s):  
Romualdo Silva Corrêa ◽  
Luciana Ayres de Oliveira Lima ◽  
Isa Maryana Araújo Bezerra de Macedo ◽  
Amália Cinhtia Meneses Rêgo ◽  
Irami Araújo-Filho
Keyword(s):  
Colon Cancer ◽  
Lymph Nodes ◽  
Medical Records ◽  
Survival Rates ◽  
Primary Treatment ◽  
Term Survival ◽  
Kaplan Meier ◽  
The Impact ◽  
Radiotherapy Treatment

Colon cancer is a curable disease when restricted to the bowel and colectomy, the primary treatment. However, the presence and number of resected lymph nodes influence the therapeutic approach and prognosis of the patient. To evaluate the impact of the number of resected lymph nodes on the overall survival of patients treated for colon cancer at the League of Cancer Hospital - Natal - State of Rio Grande do Norte (RN) - Northeast Brazil. A retrospective observational study of 80 patients with colon cancer from Dr. Luiz Antônio Hospital (Natal-RN / Brazil), considering the period 2007-2014. Data were collected through medical records review. Survival rates were calculated and compared using the non-parametric Kaplan-Meier and Wilcoxon tests, respectively. All patients underwent radical surgical treatment associated or not with chemotherapy and/or radiotherapy treatment. The median survival time for the group of patients who had 12 or more resected lymph nodes was 9.4 years, in contrast to the 3.3 years of those who had less than 12 lymph nodes. Conclusion: It was concluded that a total of 12 or more resected lymph nodes confirmed by histopathology is associated with increased long-term survival in patients with colon cancer undergoing radical colectomy with or without chemotherapy and radiotherapy.

Abstract 3172: Impact of Prosthesis-Patient Mismatch on Long-Term Survival After Aortic Valve Replacement

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Dania Mohty ◽  
Jean G. Dumesnil ◽  
Najmeddine Echahidi ◽  
Patrick Mathieu ◽  
François Dagenais ◽  
...  
Keyword(s):  
Survival Rate ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Operative Mortality ◽  
Independent Predictor ◽  
Term Survival ◽  
Time Of Operation ◽  
The Impact

Background: We recently reported that Prosthesis-Patient Mismatch (PPM) is an independent predictor of operative mortality in patients undergoing aortic valve replacement (AVR). The objective of this study was to evaluate the impact of PPM on late postoperative survival. Methods and Results: Between 1992 and 2005, 2653 patients (age: 68±10 years; 61% of males) underwent AVR in our institution. Patients who died at the time of operation or within 30 days were excluded from this study. The projected indexed effective orifice area (EOAi) was derived from the published normal in vivo EOA values for each model and size of prosthesis and PPM was classified as severe if the EOAi was ≤0.65 cm 2 /m 2 , moderate if it was > 0.65 cm 2 /m 2 and ≤ 0.85 cm 2 /m 2 , or not clinically significant if >0.85 cm 2 /m 2 . PPM was severe in 40 patients (2%), moderate in 797 (31%), and not significant in 1739 (67%). Patients with severe PPM had higher proportion of female gender (67% vs. 38%; P=0.0002) and hypertension (68% vs. 55%, p=0.02) and larger body surface (1.86±0.25 vs. 1.77±0.20, p=0.02). For patients with severe PPM, 5-year survival rate (74±8%) and 10-year survival rate (40±10%) were significantly (p=0.008) less than for patients with moderate PPM (5-yr: 81±2% and 10-yr: 57±3%) or no significant PPM (5-yr: 84±1% and 10-yr: 61±2%). On multivariate analysis after adjustment for other predictors of outcome, severe PPM was associated with increased overall mortality (Hazard ratio 1.38, [95% Confidence Interval 1.04 –1.75]; (p=0.02) Conclusion: In our previous study, we reported that severe PPM is a powerful risk factor for operative mortality. The results of the present study now suggest that severe PPM is also an independent predictor of long-term mortality. Hence, for the patients who are identified to be at risk of severe PPM at the time of operation, every effort should be made to implant a prosthesis with a larger EOA. Funded by: Canadian Institutes of Health Research

4069From first in man transcatheter aortic valve implantation, a 15-year experience

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G Avinee ◽  
E Durand ◽  
T Levesque ◽  
P Y Litzler ◽  
J N Dacher ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Transcatheter Aortic Valve ◽  
Kaplan Meier ◽  
Transcatheter Heart Valve ◽  
Structural Valve Deterioration ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Background Since the first-in-man transcatheter aortic valve implantation (TAVI) performed in 2002, the number of procedures has dramatically increased. However, long-term data regarding outcome and valve durability remain poor. Purpose We aimed to evaluate the evolution of 30-day outcomes over years and long-term mortality and valve durability after TAVI. Methods All consecutive patients presenting with severe symptomatic aortic stenosis treated by TAVI in our center were included prospectively. Clinical and echocardiographic follow-up was performed at 30 days and annually thereafter. Survival curves were constructed using Kaplan-Meier analysis. We also evaluated valve durability according to the European standardized definition of structural valve deterioration. Results Between 2002 and 2018, 1530 consecutive patients underwent TAVI including 1285 (84.0%) patients via a femoral approach. A balloon-expandable transcatheter heart valve was predominantly used (1421 patients; 92.9%). The annual transfemoral approach rate increased progressively to reach 93.3%. Age of patients remained stable over time with a global mean age of 83.7±6.5 years old. Logistic EuroSCORE decreased from 49.2±8.2% to 14.3±8.6% (p<0.0001). Thirty-day mortality dramatically decreased below 3% since 2015 and was 0% in 2018. Similarly, major vascular complications decreased from 50.0% in the first year to less than 1% since 2017 (p=0.001). The length of hospital-stay progressively shortened up to a median of 2 days in 2018. The Kaplan-Meier survival estimation was 82.3%, 60.3%, 33.0%; 11.7% and 8.9% respectively at 1, 3, 5, 8 and 10 years. On long-term follow-up the mean aortic gradient remained unchanged (Figure), and only five patients presented a severe prosthetic valve deterioration. Among them, four patients successfully benefited from a valve in valve TAVI procedure. The competing risk analysis at 10 years estimates risk for severe and moderate-or-severe valve deterioration of 1.9±0.9% and 4.3±1.3% respectively. TEE mean transaortic gradient Conclusions Long-term (up to 10 years) follow-up of our large pioneer series of patients treated by TAVI shows a dramatic improvement of outcomes and no warning signs of valve deterioration suggesting very encouraging valve durability, using predominantly, a balloon expandable prosthesis. Further studies are warranted to study valve durability after TAVI before extension to lower risk patients.

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