scholarly journals Predictors of Early Mortality After Aortic Valve Replacement in Middle-Aged Rheumatic Patients

2019 ◽  
Vol 1 (3) ◽  
pp. 105-111
Author(s):  
Essam Hassan ◽  
Sameh Sersar
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Median Sternotomy ◽  
Early Postoperative Period ◽  
Early Mortality ◽  
P Value ◽  
The Mean ◽  
Valve Prostheses ◽  
Rheumatic Patients

Background: Several risk factors, including emergency surgery, predicted early mortality after aortic valve replacement (AVR).  Euroscore II is used to predict the mortality after cardiac operations. We aimed to review our experience in AVR and determine the early mortality predictors Methods: We collected the data of 200 rheumatic patients who had standard AVR in two centers. Median sternotomy and cardiopulmonary bypass were used in all patients. Transcatheter and minimally invasive aortic valve replacement patients were excluded. We used 15 types of aortic valve prostheses, either mechanical or biological. Follow-up echocardiography was done in the intensive care unit, on discharge, and one month after discharge.     Results: 128 patients (64%) had mechanical AVR, and 130 patients (65%) were males. The mean age was 48.2 ± 19 years, and body mass index was 1.8 ± 0.2 Kg/m2. The mean preoperative ejection fraction was 54 ± 9.4 %, end-diastolic dimension was 5.3 ± 0.8 cm, and end-systolic dimension was 3.5 ± 0.9 cm. Nine patients (4.5%) died in the early postoperative period (6 months). Euroscore II was the only factor significantly associated with early mortality (P value= 0.031).  The mean Euroscore II was 1.3 ± 0.9 and 10.1 ± 10.7 for survivors and non-survivors, respectively.  Conclusion: Euroscore II score was significantly associated with early mortality after aortic valve replacement in rheumatic patients and can be used for risk stratification in those patients.

Aortic root enlargement to mitigate patient–prosthesis mismatch: do early adverse events justify reluctance?†

2019 ◽  
Vol 56 (2) ◽  
pp. 335-342 ◽  
Author(s):  
Josephina Haunschild ◽  
Sven Scharnowski ◽  
Meinhard Mende ◽  
Konstantin von Aspern ◽  
Martin Misfeld ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Aortic Root ◽  
Early Mortality ◽  
Surgical Aortic Valve Replacement ◽  
Patient Prosthesis Mismatch ◽  
The Mean ◽  
Aortic Root Enlargement

Abstract OBJECTIVES Concomitant aortic root enlargement (ARE) at the time of surgical aortic valve replacement can be performed to avoid patient–prosthesis mismatch, an important predictor of adverse long-term outcome. METHODS We performed a single-centre, retrospective analysis of 4120 patients receiving isolated aortic valve replacement, of whom 171 (4%) had concomitant ARE between January 2005 and December 2015. The analysis of postoperative outcome and early mortality was performed. Owing to inequality of the groups, patients were matched 1:1. RESULTS The mean age of all 4120 patients was 68.8 ± 10.5 years, and comorbidities were equally balanced after matching. The mean aortic cross-clamp time, cardiopulmonary bypass time and total operative time were prolonged by 19, 20 and 27 min in the ARE group, respectively. Early mortality was not statistically significantly different with 1.4% in the surgical aortic valve replacement and 1.8% in the ARE group. Postoperative complications were <5% in all matched 338 patients: bleeding (3% vs 3%), pericardial effusion (3.0% vs 4.2%), sternal instability (1.8% vs 0%) and sternal wound infection (3.0% vs 1.2%). A significant higher number of patients had respiratory failure after ARE (unmatched: 17.1% vs 9.9%, P < 0.001; matched: 18.3% vs 9.5%, P = 0.028). Factors independently associated with overall mortality were age [hazard ratio (HR) 1.71], chronic obstructive pulmonary disease (HR 1.47), diabetes (HR 1.82), atrial fibrillation (HR 2.14) and postoperative respiratory failure (HR 2.84). CONCLUSIONS ARE can be performed safely in experienced centres with no significant increase in the risk of early postoperative surgical complications and early mortality. However, the surgeon and the intensive care unit team should be aware of an increased risk for postoperative respiratory failure in ARE patients.

Minimally Invasive Transaortic Repair of the Mitral Valve

2011 ◽  
Vol 14 (4) ◽  
pp. 232 ◽  
Author(s):  
Orlando Santana ◽  
Joseph Lamelas
Keyword(s):  
Mitral Valve ◽  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Aortic Valve Replacement ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Operative Mortality ◽  
The Mean ◽  
Transaortic Approach

<p><b>Objective:</b> We retrospectively evaluated the results of an edge-to-edge repair (Alfieri stitch) of the mitral valve performed via a transaortic approach in patients who were undergoing minimally invasive aortic valve replacement.</p><p><b>Methods:</b> From January 2010 to September 2010, 6 patients underwent minimally invasive edge-to-edge repair of the mitral valve via a transaortic approach with concomitant aortic valve replacement. The patients were considered to be candidates for this procedure if they were deemed by the surgeon to be high-risk for a double valve procedure and if on preoperative transesophageal echocardiogram the mitral regurgitation jet originated from the middle portion (A2/P2 segments) of the mitral valve.</p><p><b>Results:</b> There was no operative mortality. Mean cardiopulmonary bypass time was 137 minutes, and mean cross-clamp time was 111 minutes. There was a significant improvement in the mean mitral regurgitation grade, with a mean of 3.8 preoperatively and 0.8 postoperatively. The ejection fraction remained stable, with mean preoperative and postoperative ejection fractions of 43.3% and 47.5%, respectively. Follow-up transthoracic echocardiograms obtained at a mean of 33 days postoperatively (range, 8-108 days) showed no significant worsening of mitral regurgitation.</p><p><b>Conclusion:</b> Transaortic repair of the mitral valve is feasible in patients undergoing minimally invasive aortic valve replacement.</p>

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 The International Society for Minimally Invasive Cardiothoracic Surgery Expert Consensus Statement on Transcatheter and Surgical Aortic Valve Replacement in Low- and Intermediate-Risk Patients: A Meta-Analysis of Randomized and Propensity-Matched Studies

2021 ◽  
pp. 155698452097831
Author(s):  
Vinod H. Thourani ◽  
J. James Edelman ◽  
Sari D. Holmes ◽  
Tom C. Nguyen ◽  
John Carroll ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Meta Analysis ◽  
Early Mortality ◽  
Low Risk ◽  
Perioperative Outcomes ◽  
Intermediate Risk ◽  
Surgical Aortic Valve Replacement ◽  
Risk Patients

Objective There is an increasing amount of evidence supporting use of transcatheter aortic valve replacement (TAVR) for treatment of aortic stenosis in patients at low or intermediate risk for surgical aortic valve replacement (SAVR). TAVR is now approved for use in all patient cohorts. Despite this, there remains debate about the relative efficacy of TAVR compared with SAVR in lower-risk cohorts and various subgroups of patients. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) and propensity-matched trials to guide a consensus among expert cardiologists and surgeons. Methods Studies comparing TAVR and SAVR in low- and intermediate-risk patients were identified by a thorough search of the major databases. Mortality, stroke, and other perioperative outcomes were assessed at 30 days and 1 year. Results Early mortality was lower in TAVR compared to SAVR in RCTs, but not propensity-matched studies in low-risk cohorts (0.66% vs 1.5%; odds ratio [OR] = 0.44, 95% confidence interval [CI] 0.20 to 0.98, I2 = 0%). No difference in mortality between TAVR and SAVR was identified in intermediate-risk patients at early or later time points. Incidence of perioperative stroke in 3 low-risk RCTs was significantly lower in TAVR (0.4%) than SAVR (1.4%; OR = 0.33, 95% CI 0.13 to 0.81, I2 = 0%). There was no difference in stroke for intermediate-risk patients between TAVR and SAVR. The expert panel of cardiologists and cardiac surgeons provided recommendations for TAVR and SAVR in various clinical scenarios. Conclusions In RCTs comparing TAVR and SAVR in low-risk patients, early mortality and stroke were lower in TAVR, but did not differ at 1 year. There was no difference in mortality and stroke in intermediate-risk patients. The Multidisciplinary Heart Team must consider individual patient characteristics and preferences when recommending TAVR or SAVR. The decision must consider the long-term management of each patient’s aortic valve disease.

scholarly journals Isolated mechanical aortic valve replacement in rheumatic patients in a low- to middle-income country

2019 ◽  
Vol 157 (3) ◽  
pp. 886-893 ◽  
Author(s):  
Jacques Scherman ◽  
Rodgers Manganyi ◽  
Paul Human ◽  
Timothy Pennel ◽  
Andre Brooks ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Middle Income Country ◽  
Income Country ◽  
Middle Income ◽  
Mechanical Aortic Valve ◽  
Rheumatic Patients

Comparison of Risk Scores to Estimate Early Mortality in Aortic Valve Replacement for Aortic Stenosis

CHEST Journal ◽  
2012 ◽  
Vol 142 (4) ◽  
pp. 77A
Author(s):  
Kenji Kuwaki ◽  
Atsushi Amano ◽  
Hirotaka Inaba ◽  
Taira Yamamoto ◽  
Shizuyuki Dohi ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Early Mortality ◽  
Risk Scores

scholarly journals Mini-Stern Trial: A randomized trial comparing mini-sternotomy to full median sternotomy for aortic valve replacement

2018 ◽  
Vol 156 (6) ◽  
pp. 2124-2132.e31 ◽  
Author(s):  
Sukumaran K. Nair ◽  
Catherine D. Sudarshan ◽  
Benjamin S. Thorpe ◽  
Jeshika Singh ◽  
Thasee Pillay ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Randomized Trial ◽  
Valve Replacement ◽  
Median Sternotomy

Original method of posterior aortoplasty for aortic valve replacement in surgical treatment of combined mitral-aortic valve diseases

2020 ◽  
Vol 87 (9-10) ◽  
pp. 40-43
Author(s):  
V. V. Popov ◽  
R. M. Vitovskyi ◽  
Yu. V. Bakhovska ◽  
O. O. Bolshak ◽  
K. Ye. Vakulenko ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Left Ventricle ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Heart Diseases ◽  
Original Method ◽  
Early Postoperative Period ◽  
Ascending Aorta ◽  
Artificial Heart Valve ◽  
Class Iii

Objective. To research of possibilities of reconstruction of aorta`s ostium and ascending aorta during aortic valve replacement and simultaneous correction of mitral valve defects at patients with narrow aorta`s ostium. Materials and methods. The study group consisted of 46 patients with mitral-aortic heart diseases and combination with a narrow aortic mouth, who were operated on at the A Amosov National Institute of Cardiovascular surgery for the period from January 1, 2006 to January 1, 2020. All patients underwent reconstruction of the aortic root and ascending aorta according to the original method of posterior aortoplasty. There were 26 men (56.5%) and 20 women (43.5%). The age of patients ranged from 23 to 72 years (average - 58.4±7.3 years). 8 (17.4%) patients belonged to class III NYHA, 38 (82.6%) - to class IV. Results. Of the 46 operated patients at the hospital stage (30 days after surgery), 4 died (hospital mortality 8.7%). No fatalities were associated with surgical technique. The dynamics of echocardiographic parameters at the hospital stage was as follows: the systolic gradient on the aortic valve was before surgery 112.1 ± 15.2 mm Hg, on the aortic prosthesis at discharge - 23.2 ± 6.4 mm Hg; end-systolic index (ESI) of the left ventricle (ml/m²) - 59.1 ± 7.6 (before surgery) and 48.3 ± 5.9 (after surgery); left ventricle ejection fraction (EF) - 0.45 ± 0.04 (before surgery) and 0.53 ± 0.04 (after surgery). Conclusions. The proposed original technique of posterior aortoplasty allows to effectively expand the mouth of the aorta for further implantation of an artificial heart valve of larger diameter. The technique is quite safe. At the hospital stage there are no complications directly related to the technique of operations. At the early postoperative period, the morphometric parameters of the left ventricle (EF and ESI) improved. The technique can be successfully used for the correction of combined mitral-aortic valve defects.

scholarly journals Outcomes of the minimally invasive aortic valve replacement

2019 ◽  
Vol 178 (3) ◽  
pp. 16-20
Author(s):  
M. A. Snegirev ◽  
A. A. Paivin ◽  
D. O. Denisyuk ◽  
N. E. Khvan ◽  
L. B. Sichinava ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Early Postoperative Period ◽  
Red Blood Cell Transfusion ◽  
Postoperative Blood Loss ◽  
Transfusion Rate ◽  
Results Of Treatment ◽  
Risk Patients

The OBJECTIVE was to demonstrate clinical outcomes of minimally invasive aortic valve replacement (MIAVR).MATERIAL AND METHODS. We retrospectively analyzed surgical results of treatment of patients underwent isolated AVR in our Institution between 2006 and 2018. Overall number of operations was 122; 56 of patient were operated via upper ministernotomy approach. Preoperative characteristics were similar in both groups.RESULTS. In our series MIAVR procedures had prolonged CPB and aortic cross clamping time, what significantly contributed to the increase in manifestations of heart failure in the early postoperative period, but didn’t affect the perioperative mortality and major morbidity rates. MIAVR led to reduction in postoperative blood loss and perioperative red blood cell transfusion rate. Most severe complications occurred in frail patients older than 75 years, and in those with extensive aortic annular calcification.CONCLUSION. MIAVR was the safe and reproducible surgical intervention and rarely led to significant complications in low-risk patients. Prolonged CPB time adversely affected the frequency of significant complications, especially in elderly patients. Although, selected high risk patients might benefit with MIAVR.

Ministernotomy for Aortic Valve Replacement Versus Conventional Sternotomy, a Choice for a Better outcome

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ahmed Refaat Mohamed Refaat ◽  
Gamal Samy ◽  
Faisal Morad ◽  
Nabil Abd Gawad
Keyword(s):  
Aortic Valve ◽  
Blood Loss ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Statistical Difference ◽  
Statistical Significance ◽  
P Value ◽  
Safe Procedure ◽  
Transfusion Requirements ◽  
Renal Complication

Abstract Background ​ In the era of minimal invasive cardiac surgery, Ministernotomy Aortic valve .replacement have been proposed as an alternative to conventional full sternotomy approach Aim of the Work ​: ​​To evaluate the safety and efficacy of AVR through ministernotomy in comparison to full sternotomy AVR in terms of Cardiac cause mortality, Neurological and .Renal complication​s Patients and Methods ​After gaining the institutional ethical committee approval, the study included all patients who underwent isolated, DE novo, open aortic valve replacement during the period from June 2017 till June 2019 performed by multiple surgeons at cardiothoracic .academy Ain Shams University Results ​ The study included 60 patients; 32 patients performed through full sternotomy (53.3%) and 28 patients through ministernotomy (46.6%).​ ​Post-operative arrhythmias occurred in full sternotomy in 6 cases (18.8%) where in mini-sternotomy, only 3 cases (12%) developed arrhythmias with no significant statistical difference (p value = ​0.558)​. Cerebrovascular stroke was recorded 1 patient (3%) versus 4 cases (14.3%) in the full sternotomy versus the ministernotomy groups respectively with no Statistical difference between the 2 groups (p value = 0.119).​ Postoperative acute renal impairment was recorded​ in 3 cases (9.4%) vs 2 patients (7.1%) in the full sternotomy vs the ministernotomy groups respectively (p value = 0.755). There was no​ mortality in either groups. Mean post-operative Ventilation hours were 17.21hrs with SD ± 11.026 versus 14.97hrs with SD ​± ​6.473 (p value is 0.35) for the full sternotomy versus the ministernotomy groups respectively. Mean blood loss was 305.51ml with SD ± 282.662 versus 230.36ml with SD ​± ​247.708 (p value is 0.277) for the full versus the ministernotomy groups respectively. Mean units of blood transfused was 2.31Units with SD ​± ​0.926 versus 1.14Units with SD ​±​ 0.591 in the full sternotomy versus the ministernotomy groups with high statistical significance between both groups (p value less than 0.01). Mean ICU stay was 2.66 days with SD ​±​ 0.915 and was 3.1days with SD ​±​ 2.743 (p .value is 0.424) for the full sternotomy versus the ministernotomy groups respectively Conclusion ​ Ministernotomy Aortic valve replacement was found to be a safe procedure​ compared to full sternotomy approach. Patients who had their surgery through the mini approach had less amount of blood loss, blood transfusion requirements, ventilation time which all led to less duration of ICU and hospital stay, resulting in a better outcome for the .patients

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