Long-term follow-up of triple valve surgery: a single center analysis

Objectives: The aims of this study were to analyze early and late outcomes of TVS and identify predictors of poor prognosis . Methods: Single centre retrospective study with 108 patients who underwent TVS between 2007 and 2016. Most of the patients were female (74.1%), mean age of 65 years; 61,1% were in New York Heart Association class III/IV, with a EuroSCORE II of 7.5%. Univariable and Multivariable analyses were developed to identify predictors of perioperative mortality and morbidity and long-term mortality. Results: In-hospital mortality was 12%. Creatinine clearance was an independent predictor of decreased perioperative mortality. This group had 28.7% rate of major perioperative complications. Systolic pulmonary pressure and obesity were predictors of early morbidity. The 10-year mortality was 29.6%. The survival at 1, 5 and 10 years was 80%, 76% and 45%, respectively. Diabetes Mellitus was a risk factor for long-term mortality and creatinine clearance was a predictor of long-term survival. Need for re-operation was identified in 3.5% of the patients. Conclusions: Patients undergoing TVS have high surgical risk making TVS an operation associated with high mortality and morbidity. This research identifies Diabetes Mellitus, renal function, pulmonary hypertension and obesity as the future challenges in TVS.

Download Full-text

Long-term survival and frequency of reinterventions after proximal aortic surgery: a retrospective study†

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz073 ◽

2019 ◽

Vol 56 (4) ◽

pp. 722-730 ◽

Cited By ~ 1

Author(s):

Per Vikholm ◽

Rafael Astudillo ◽

Stefan Thelin

Keyword(s):

Survival Benefit ◽

Aortic Surgery ◽

Event Free Survival ◽

Perioperative Mortality ◽

Term Survival ◽

Free Survival ◽

Mortality And Morbidity ◽

Age And Sex ◽

Long Term Mortality

Abstract OBJECTIVES: We sought to analyse perioperative outcome, long-term mortality, frequency and causes of reintervention, and survival benefit in a contemporary cohort of patients undergoing proximal thoracic aortic surgery. METHODS: Participants comprised all patients undergoing open surgery for proximal thoracic aortic aneurysm (TAA) (n = 319) and thoracic aortic dissection type A (TAD) (n = 229) during 2005–2014 at the Department of Thoracic Surgery, Uppsala University Hospital. Long-term survival was compared to age- and sex-matched controls. Perioperative mortality and morbidity, event-free survival and causes of reoperation were also analysed. RESULTS: Long-term mortality was normalized in patients with TAA, and a survival benefit was seen as early as 20 months when corrected for time lost due to perioperative mortality. Long-term survivors undergoing surgery for TAD, on the other hand, had a 10-year mortality of 130% [95% confidence interval (95% CI) 120–140%] compared to age- and sex-matched controls. Moreover, their event-free survival was half that of patients with TAA (hazard ratio 2.3; 95% CI 1.7–3.2). Reintervention (i.e. reoperation or thoracic endovascular aortic repair) was also twice as common in the TAD patients (odds ratio 2.0; 95% CI 1.1–3.5). The dominant causes for reoperation among TAD patients were aortic insufficiency, aortic arch aneurysm and infection. CONCLUSIONS: Surgery for TAA is relatively safe, normalizes long-term mortality and confers an early survival benefit. However, TAD surgery carries a high risk of perioperative mortality and morbidity, as well as increased long-term mortality and risk of reintervention.

Download Full-text

Long-Term Mortality and Incidence of Renal Dialysis and Transplantation in Type 1 Diabetes Mellitus

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2006-1058 ◽

2006 ◽

Vol 91 (10) ◽

pp. 3814-3820 ◽

Cited By ~ 35

Author(s):

M. Stadler ◽

M. Auinger ◽

C. Anderwald ◽

T. Kästenbauer ◽

R. Kramar ◽

...

Keyword(s):

Diabetes Mellitus ◽

Body Mass Index ◽

Type 1 Diabetes ◽

Confidence Interval ◽

Creatinine Clearance ◽

Type 1 Diabetes Mellitus ◽

Body Mass ◽

Long Term Mortality

Abstract Aims: We investigated long-term mortality and requirement of renal replacement therapy (RRT) in type 1 diabetes mellitus (T1DM) to study risk factors and late complication incidence of T1DM in a prospective cohort study at Lainz Hospital, Vienna, Austria. Methods: In 1983–1984, T1DM patients [n = 648; 47% females, 53% males; age, 30 ± 11 yr; T1DM duration, 15 ± 9 yr; body mass index, 24 ± 4 kg/m2; glycated hemoglobin (HbA1c), 7.6 ± 1.6%] were stratified into HbA1c quartiles [1st, 5.9 ± 0.5% (range, 4.2–6.5%); 2nd, 6.9 ± 0.3% (6.6–7.4%); 3rd, 7.9 ± 0.3% (7.5–8.4%); and 4th, 9.6 ± 1.3% (8.5–14.8%)]. Twenty years later, both endpoints (death and RRT) were investigated by record linkage with national registries. Results: At baseline, creatinine clearance, blood pressure, and body mass index were comparable among the HbA1c quartiles, whereas albuminuria was more frequent in the 4th quartile (+15%; P < 0.03). After the 20-yr follow-up, 13.0% of the patients had died [rate, 708 per 100,000 person-years (95% confidence interval, 557–859)], and 5.6% had received RRT [311 per 100,000 person-years (95% confidence interval, 210–412)]. Patients with the highest HbA1c values (4th quartile) had a higher mortality rate and a greater incidence of RRT (P < 0.04). In the Cox proportional hazards analysis, age, male gender, increased HbA1c, albuminuria, and reduced creatinine clearance were predictors of mortality (P < 0.05). Predictors of RRT were albuminuria (P < 0.001), reduced creatinine clearance (P < 0.001), and belonging to the 4th HbA1c quartile (P = 0.06). In Kaplan-Meier analysis, mortality was linearly associated with poor glycemia, whereas RRT incidence appeared to rise at a HbA1c threshold of approximately 8.5%. Conclusion/Interpretation: In the Lainz T1DM cohort, 13.0% mortality and 5.6% RRT were directly associated with and more frequently found in poor glycemia, showing that good glycemic control is essential for the longevity and quality of life in T1DM.

Download Full-text

Long-Term Survival With Tafamidis in Patients With Transthyretin Amyloid Cardiomyopathy

Circulation Heart Failure ◽

10.1161/circheartfailure.120.008193 ◽

2021 ◽

Author(s):

Perry Elliott ◽

Brian M. Drachman ◽

Stephen S. Gottlieb ◽

James E. Hoffman ◽

Scott L. Hummel ◽

...

Keyword(s):

New York ◽

Free Acid ◽

Heart Association ◽

Class Iii ◽

Unique Identifier ◽

Transthyretin Amyloidosis ◽

Term Survival ◽

New York Heart Association ◽

Amyloid Cardiomyopathy

Background: Tafamidis is approved in many countries for the treatment of transthyretin amyloid cardiomyopathy. This study reports data on the long-term efficacy of tafamidis from an ongoing long-term extension (LTE) to the pivotal ATTR-ACT (Tafamidis in Transthyretin Cardiomyopathy Clinical Trial). Methods: Patients with transthyretin amyloid cardiomyopathy who completed ATTR-ACT could enroll in an LTE, continuing with the same tafamidis dose or, if previously treated with placebo, randomized (2:1) to tafamidis meglumine 80 or 20 mg. All patients in the LTE transitioned to tafamidis free acid 61 mg (bioequivalent to tafamidis meglumine 80 mg) following a protocol amendment. In this interim analysis, all-cause mortality was assessed in patients treated with tafamidis meglumine 80 mg in ATTR-ACT continuing in the LTE, compared with those receiving placebo in ATTR-ACT transitioning to tafamidis in the LTE. Results: Median follow-up was 58.5 months in the continuous tafamidis group (n=176) and 57.1 months in the placebo to tafamidis group (n=177). There were 79 (44.9%) deaths with continuous tafamidis and 111 (62.7%) with placebo to tafamidis (hazard ratio, 0.59 [95% CI, 0.44–0.79]; P <0.001). Mortality was also reduced in the continuous tafamidis (versus placebo to tafamidis) subgroups of: variant transthyretin amyloidosis (0.57 [0.33–0.99]; P =0.05) and wild-type transthyretin amyloidosis (0.61 [0.43–0.87]; P =0.006); and baseline New York Heart Association class I and II (0.56 [0.38–0.82]; P =0.003) and class III (0.65 [0.41–1.01]; P =0.06). Conclusions: In the LTE, patients initially treated with tafamidis in ATTR-ACT had substantially better survival than those first treated with placebo, highlighting the importance of early diagnosis and treatment in transthyretin amyloid cardiomyopathy. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01994889 and NCT02791230.

Download Full-text

Risk Factors Predicting the Postoperative Outcome in 134 Patients with Active Endocarditis

The Heart Surgery Forum ◽

10.1532/hsf98.2013270 ◽

2014 ◽

Vol 17 (1) ◽

pp. 35 ◽

Cited By ~ 2

Author(s):

Siyamek Neragi-Miandoab ◽

Edvard Skripochnik ◽

Robert Michler ◽

David D'Alessandro

Keyword(s):

Risk Factors ◽

Multivariate Analysis ◽

Artery Bypass ◽

Bypass Graft ◽

Postoperative Outcome ◽

Chronic Obstructive ◽

Perioperative Mortality ◽

Term Survival ◽

Long Term Mortality

Background: Surgery remains the cornerstone in management of endocarditis.Methods: In this retrospective cohort we evaluated the operative outcome of patients with infective endocarditis. The SPSS program was used to analyze the data.Results: A total of 134 predominantly male patients (60%) with a mean age of 55 � 12.4 years were examined. The procedures included single valve (n = 88; 66%), double/multiple valves (n = 29; 22%), and valve-coronary artery bypass graft (CABG) (n = 16; 12%). Perioperative mortality was 11.9% (n = 16). In the multivariate analysis, dialysis (odds ratio [OR] = 7.88; 95% confidence interval [CI] [1.78-34.77]; P = .006), sepsis (OR = 19.5; 95% CI [2.76-137.9]; P = .002), and perfusion time (95% CI [1.00-1.02]; P = .003) were independent predictors of perioperative mortality. The overall long-term survival at 28 months was 69.2% � 4%. Dialysis (P = .0001) was a predictor of mortality, whereas elevated creatinine in nondialysis patients (P = .0002) was not. In the multivariate analysis, dialysis (hazard ratio [HR] 4.06%; 95% CI [0.936-8.526]; P = .0002), CABG (HR 2.32; 95% CI [1.086-4.978]; P = .0299), chronic obstructive pulmonary disease (HR 2.20; 95% CI [1.027-4.739]; P = .0426), and double/multiple valve procedure (HR 3.0; 95% CI [1.467-6.206]; P = .0027) were risk factors for long-term mortality.Conclusion: Renal failure but not renal insufficiency is a risk factor for short and long-term mortality.

Download Full-text

Fifteen-year experience with pericardiectomy at a tertiary referral center

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01561-4 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Zainab Faiza ◽

Anjali Prakash ◽

Niharika Namburi ◽

Bailey Johnson ◽

Lava Timsina ◽

...

Keyword(s):

New York ◽

Heart Association ◽

Underlying Disease ◽

Term Survival ◽

Disease Etiology ◽

Mortality And Morbidity ◽

Tertiary Referral Center ◽

New York Heart Association ◽

Overall Mortality

Abstract Purpose Pericardiectomy has traditionally carried relatively high perioperative mortality and morbidity, with few published reports of intermediate- and long- term outcomes. We investigated our 15-year experience performing pericardiectomy at our institution. Methods Retrospective study of all patients who underwent pericardiectomy at our institution between 2005 and 2019. Baseline demographics, intraoperative details, and postoperative outcomes including long-term survival were analyzed. Results Sixty-three patients were included in the study. 66.7% of subjects underwent isolated pericardiectomy while 33.3% underwent pericardiectomy concomitantly with another cardiac surgical procedure. The most common indications for pericardiectomy were constrictive (79.4%) and hemorrhagic (9.5%) pericarditis. Preoperatively, 76.2% of patients were New York Heart Association class II and III, while postoperatively, 71.4% were class I and II. One-, three-, five-, and ten- year overall mortality was 9.5, 14.3, 20.6, and 25.4%, respectively. Overall pericarditis recurrence rate was 4.8%. Conclusion Pericardiectomy carries relatively high overall mortality rates, which likely reflects underlying disease etiology and comorbidities. Patients with prior cardiac intervention, history of dialysis, and immunocompromised state are associated with worse outcomes.

Download Full-text

Surgical reconstruction for unilateral iliac artery lesions in patients younger than 50 years

VASA ◽

10.1024/0301-1526/a000151 ◽

2011 ◽

Vol 40 (6) ◽

pp. 474-481 ◽

Cited By ~ 1

Author(s):

Radak ◽

Babic ◽

Ilijevski ◽

Jocic ◽

Aleksic ◽

...

Keyword(s):

Diabetes Mellitus ◽

Limb Salvage ◽

Iliac Artery ◽

Graft Patency ◽

Long Term Results ◽

Surgical Reconstruction ◽

Safe Procedure ◽

Term Survival

Background: To evaluate safety, short and long-term graft patency, clinical success rates, and factors associated with patency, limb salvage and mortality after surgical reconstruction in patients younger than 50 years of age who had undergone unilateral iliac artery bypass surgery. Patients and methods: From January 2000 to January 2010, 65 consecutive reconstructive vascular operations were performed in 22 women and 43 men of age < 50 years with unilateral iliac atherosclerotic lesions and claudication or chronic limb ischemia. All patients were followed at 1, 3, 6, and 12 months after surgery and every 6 months thereafter. Results: There was in-hospital vascular graft thrombosis in four (6.1 %) patients. No in-hospital deaths occurred. Median follow-up was 49.6 ± 33 months. Primary patency rates at 1-, 3-, 5-, and 10-year were 92.2 %, 85.6 %, 73.6 %, and 56.5 %, respectively. Seven patients passed away during follow-up of which four patients due to coronary artery disease, two patients due to cerebrovascular disease and one patient due to malignancy. Limb salvage rate after 1-, 3-, 5-, and 10-year follow-up was 100 %, 100 %, 96.3 %, and 91.2 %, respectively. Cox regression analysis including age, sex, risk factors for vascular disease, indication for treatment, preoperative ABI, lesion length, graft diameter and type of pre-procedural lesion (stenosis/occlusion), showed that only age (beta - 0.281, expected beta 0.755, p = 0.007) and presence of diabetes mellitus during index surgery (beta - 1.292, expected beta 0.275, p = 0.026) were found to be significant predictors of diminishing graft patency during the follow-up. Presence of diabetes mellitus during index surgery (beta - 1.246, expected beta 0.291, p = 0.034) was the only variable predicting mortality. Conclusions: Surgical treatment for unilateral iliac lesions in patients with premature atherosclerosis is a safe procedure with a low operative risk and acceptable long-term results. Diabetes mellitus and age at index surgery are predictive for low graft patency. Presence of diabetes is associated with decreased long-term survival.

Download Full-text

P3267 Impact of diabetes mellitus prior to heart transplantation on long-term survival

European Heart Journal ◽

10.1016/s0195-668x(03)95893-3 ◽

2003 ◽

Vol 24 (5) ◽

pp. 618

Author(s):

R VAZQUEZ

Keyword(s):

Diabetes Mellitus ◽

Heart Transplantation ◽

Term Survival ◽

Long Term Survival

Download Full-text

Improved but still high short- and long-term mortality rates after myocardial infarction in patients with diabetes mellitus: a time-trend report from the Swedish Register of Information and Knowledge about Swedish Heart Intensive Care Admission

Heart ◽

10.1136/hrt.2006.097956 ◽

2006 ◽

Vol 93 (12) ◽

pp. 1577-1583 ◽

Cited By ~ 95

Author(s):

A. Norhammar ◽

J. Lindback ◽

L. Ryden ◽

L. Wallentin ◽

U. Stenestrand ◽

...

Keyword(s):

Diabetes Mellitus ◽

Myocardial Infarction ◽

Intensive Care ◽

Time Trend ◽

Mortality Rates ◽

Intensive Care Admission ◽

Patients With Diabetes ◽

Short And Long Term ◽

Long Term Mortality

Download Full-text

Surgery Combined With Peritonectomy Procedures and Intraperitoneal Chemohyperthermia in Abdominal Cancers With Peritoneal Carcinomatosis: A Phase II Study

Journal of Clinical Oncology ◽

10.1200/jco.2003.06.139 ◽

2003 ◽

Vol 21 (5) ◽

pp. 799-806 ◽

Cited By ~ 183

Author(s):

O. Glehen ◽

F. Mithieux ◽

D. Osinsky ◽

A.C. Beaujard ◽

G. Freyer ◽

...

Keyword(s):

Peritoneal Carcinomatosis ◽

Phase Ii ◽

Phase Ii Study ◽

Complete Resection ◽

Morbidity Rate ◽

Term Survival ◽

Mortality And Morbidity ◽

Peritonectomy Procedures ◽

Experienced Team

Purpose: To evaluate the tolerance of peritonectomy procedures (PP) combined with intraperitoneal chemohyperthermia (IPCH) in patients with peritoneal carcinomatosis (PC), a phase II study was carried out from January 1998 to September 2001. Patients and Methods: Fifty-six patients (35 females, mean age 49.3) were included for PC from colorectal cancer (26 patients), ovarian cancer (seven patients), gastric cancer (six patients), peritoneal mesothelioma (five patients), pseudomyxoma peritonei (seven patients), and miscellaneous reasons (five patients). Surgeries were performed mainly on advanced patients (40 patients stages 3 and 4 and 16 patients stages 2 and 1) and were synchronous in 36 patients. All patients underwent surgical resection of their primary tumor with PP and IPCH (with mitomycin C, cisplatinum, or both) with a closed sterile circuit and inflow temperatures ranging from 46° to 48°C. Three patients were included twice. Results: A macroscopic complete resection was performed in 27 cases. The mortality and morbidity rates were one of 56 and 16 of 56, respectively. The 2-year survival rate was 79.0% for patients with macroscopic complete resection and 44.7% for patients without macroscopic complete resection (P = .001). For the patients included twice, two are alive without evidence of disease, 54 and 47 months after the first procedure. Conclusion: IPCH and PP are able to achieve unexpected long-term survival in patients with bulky PC. However, one must be careful when selecting the patients for such an aggressive treatment, as morbidity rate remains high even for an experienced team.

Download Full-text