Aortic Annulus Enlargement: Early and Long-Terms Results

AIM: Patient-prosthesis mismatch (PPM) is a common occurrence in aortic valve surgery. Even the discussions about the impact of this phenomenon on the results of aortic valve surgery, the management of this problem remain one of the main topics in this kind of surgery. One of the ways of a solution is aortic annulus enlargement. The main topic of this study is to evaluate the early and longterm results of this technique in our country.METHODS: During the period January 2010 –January 2015, 641 patients performed aortic valve surgery. In ten patients we performed aortic annulus enlargement according to Manouguian technique to avoid severe patient-prothesis mismatch.Operative mortality and perioperative complications (low cardiac output, pulmonary complications, etc..) were considered the indicators of the early results. Survival, clinical presentation according to NYHA, quality of life were the indicators to evaluate long-term results. Preoperative and postoperative echocardiographic data were also used to evaluate our results. We collected the data from hospital registrations and periodical clinical visit and echographic examination after hospital discharge.RESULTS: In our group, 6 of 10 patients were diagnosed with stenotic aortic valve, two patients had aortic valve regurgitation and two mixed valve pathology. Four patients had concomitant cardiac surgery procedure, mitral or CABG. In all cases, aortic valve pathology was the primary diagnose.In the preoperative echocardiographic examination mean transvalvular gradient was 54.3 ± 6.42.We had no death during early or late postoperative period. Only one patient had pulmonary complications and long time of respiratory assistance because of his pulmonary pathology.The same patient had low cardiac output and wound infection. Early after surgery mean transprostethic gradient was 16.2 ± 3.44 and late postoperative was 15.9 ± 4.3. No patient had the severe patient-prothesis mismatch. Mean follow-up was 49 ± 20.26 months. During follow-up, we had no death, and all patients had very good quality of life.CONCLUSIONS: Aortic valve annulus enlargement can be used with very good early and late results with the final goal to increase the potential benefit of the patient from surgery of aortic valve.

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The impact of frailty in aortic valve surgery.

10.21203/rs.3.rs-19049/v4 ◽

2020 ◽

Author(s):

elisabet berastegui ◽

Maria Luisa CAmara ◽

Enrique Moret ◽

Irma Casas ◽

Sara Badia ◽

...

Keyword(s):

Quality Of Life ◽

Aortic Valve ◽

Valve Surgery ◽

Geriatric Syndrome ◽

Aortic Valve Surgery ◽

Surgical Risk ◽

Scale Scores ◽

The Impact

Abstract Background: Frailty is a geriatric syndrome that diminishes potential functional recovery after any surgical procedure. Preoperative surgical risk assessment is crucial to calibrate the risk and benefit of cardiac surgery. The aim of this study was to test usefulness of FRAIL Scale and other surgical-risk-scales and individual features of frailty in cardiac aortic valve surgery. Methods: Prospective study. From May-2014 to February-2016, we collected 200 patients who underwent aortic valve replacement, either surgically or transcatheter. At 1-year follow-up, quality of life measurements were recorded using the EQ-5D (EuroQol). Univariate and multivariate analyses correlated preoperative condition, features of frailty and predicted risk scores with mortality, morbidity and quality of life at 1 year of follow-up. Results: Mean age 78.2y, 56%male. Mean-preoperative-scores: FRAIL scale 1.5(SD 1.02), STS 2.9(SD 1.13), BI 93.8(SD 7.3), ESlog I 12.8(SD 8.5) and GS 7.3s (SD 1.9). Morbidity at discharge, 6 m and 1 year was 51%, 14% and 28%. Mortality 4%. Survival at 6m/ 1-y was 97% / 88%. Complication-rate was higher in TAVI group due to-vascular complications. Renal dysfunction, anemia, social dependence and GS slower than 7 seconds were associated with morbidity. On multivariate analysis adjusted STS, BI and GS speed were statistically significant. Quality of life at 1-year follow-up adjusted for age and prosthesis type showed a significant association with STS and FRAIL scale scores. Conclusions: Frailty increases surgical risk and is associated with higher morbidity. Preoperative GS slower 7 s, and STS and FRAIL scale scores seem to be reliable predictors of quality of life at 1-year follow-up.

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The impact of frailty in aortic valve surgery

BMC Geriatrics ◽

10.1186/s12877-020-01716-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Elisabet Berastegui Garcia ◽

Maria Luisa Camara Rosell ◽

Enrique Moret Ruiz ◽

Irma Casas Garcia ◽

Sara Badia Gamarra ◽

...

Keyword(s):

Quality Of Life ◽

Aortic Valve ◽

Valve Surgery ◽

Geriatric Syndrome ◽

Aortic Valve Surgery ◽

Surgical Risk ◽

Scale Scores ◽

The Impact

Abstract Background Frailty is a geriatric syndrome that diminishes potential functional recovery after any surgical procedure. Preoperative surgical risk assessment is crucial to calibrate the risk and benefit of cardiac surgery. The aim of this study was to test usefulness of FRAIL Scale and other surgical-risk-scales and individual features of frailty in cardiac aortic valve surgery. Methods Prospective study. From May-2014 to February-2016, we collected 200 patients who underwent aortic valve replacement, either surgically or transcatheter. At 1-year follow-up, quality of life measurements were recorded using the EQ-5D (EuroQol). Univariate and multivariate analyses correlated preoperative condition, features of frailty and predicted risk scores with mortality, morbidity and quality of life at 1 year of follow-up. Results Mean age 78.2y, 56%male. Mean-preoperative-scores: FRAIL scale 1.5(SD 1.02), STS 2.9(SD 1.13), BI 93.8(SD 7.3), ESlog I 12.8(SD 8.5) and GS 7.3 s (SD 1.9). Morbidity at discharge, 6 m and 1 year was 51, 14 and 28%. Mortality 4%. Survival at 6 m/ 1-y was 97% / 88%. Complication-rate was higher in TAVI group due to-vascular complications. Renal dysfunction, anemia, social dependence and GS slower than 7 s were associated with morbidity. On multivariate analysis adjusted STS, BI and GS speed were statistically significant. Quality of life at 1-year follow-up adjusted for age and prosthesis type showed a significant association with STS and FRAIL scale scores. Conclusions Frailty increases surgical risk and is associated with higher morbidity. Preoperative GS slower 7 s, and STS and FRAIL scale scores seem to be reliable predictors of quality of life at 1-year follow-up.

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Incidence and Impact of Patient-Prosthesis Mismatch in Isolated Aortic Valve Surgery

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2015.108 ◽

2014 ◽

Vol 3 (4) ◽

pp. 624-629

Author(s):

Selman Dumani ◽

Ermal Likaj ◽

Andi Kacani ◽

Laureta Dibra ◽

Elizana Petrela ◽

...

Keyword(s):

Aortic Valve ◽

Perioperative Complications ◽

Pulmonary Complications ◽

Valve Surgery ◽

Effective Orifice Area ◽

Aortic Valve Surgery ◽

Low Cardiac Output ◽

Early Results ◽

Patient Prosthesis Mismatch ◽

Study Population

AIM: The mains topics of this work are the incidence of patient-prosthesis mismatch and the influence in the early results of isolated aortic valve surgery.METHODS: In 193 patients isolated aortic valve surgery was performed. The study population was divided in three subgroups: 20 patients with severe, 131 patients with moderate and 42 patients without patient-prosthesis mismatch. The indexed effective orifice area was used to define the subgroups. Operative mortality and perioperative complications were considered the indicators of the early results of aortic valve surgery.RESULTS: The incidence of severe and moderate patient-prosthesis mismatch was respectively 10.3% and 67.8%. Hospital mortality and perioperative complications were: mortality 5% vs. 3.1% vs. 2.4% (p = 0.855), low cardiac output 5% vs. 6.9% vs. 4.8% (p = 0.861); pulmonary complications 5% vs. 3.1 vs. 0.0% (p = 0.430); exploration for bleeding 5% vs. 0.8% vs. 2.4% (p = 0.319); atrial fibrillation 30% vs. 19.8% vs. 11.9% (p = 0.225); wound infection 5% vs. 0.8% vs. 0.00% (p = 0.165), respectively for the group with severe, moderate and without patient-prosthesis mismatch.CONCLUSIONS: Patient-prosthesis mismatch is a common occurrence in aortic valve surgery. This phenomenon does not affect the early results of aortic valve surgery.

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Outcomes and quality of life after aortic valve surgery in octogenarians

Journal of Cardiac Surgery ◽

10.1111/jocs.14377 ◽

2019 ◽

Vol 35 (2) ◽

pp. 341-344

Author(s):

Aikaterini Gavalaki ◽

Antonios Roussakis ◽

Panagiotis Zoubourlis ◽

Constantinos Contrafouris ◽

Dimitrios Zarkalis ◽

...

Keyword(s):

Quality Of Life ◽

Aortic Valve ◽

Valve Surgery ◽

Aortic Valve Surgery ◽

Surgery In Octogenarians

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Mitral and aortic valve surgery-related acute kidney injury: affecting factors and its one year follow-up

Turkish Journal of Thoracic and Cardiovascular Surgery ◽

10.5606/tgkdc.dergisi.2017.13185 ◽

2017 ◽

Vol 25 (1) ◽

pp. 29-35

Author(s):

Şahin İşcan

Keyword(s):

Acute Kidney Injury ◽

Aortic Valve ◽

Kidney Injury ◽

Valve Surgery ◽

Aortic Valve Surgery ◽

Affecting Factors ◽

One Year

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Predicting the need of aortic valve surgery in patients with chronic aortic regurgitation: a comparison between cardiovascular magnetic resonance imaging and transthoracic echocardiography

The International Journal of Cardiovascular Imaging ◽

10.1007/s10554-021-02255-7 ◽

2021 ◽

Author(s):

M. Faber ◽

C. Sonne ◽

S. Rosner ◽

H. Persch ◽

W. Reinhard ◽

...

Keyword(s):

Magnetic Resonance ◽

Aortic Valve ◽

Aortic Regurgitation ◽

Transthoracic Echocardiography ◽

Magnetic Resonance Tomography ◽

Valve Surgery ◽

Aortic Valve Surgery ◽

Cardiac Magnetic Resonance Tomography ◽

Chronic Aortic Regurgitation

AbstractTo compare the ability of cardiac magnetic resonance tomography (CMR) and transthoracic echocardiography (TTE) to predict the need for valve surgery in patients with chronic aortic regurgitation on a mid-term basis. 66 individuals underwent assessment of aortic regurgitation (AR) both in CMR and TTE between August 2012 and April 2017. The follow-up rate was 76% with a median of 5.1 years. Cox proportional hazards method was used to assess the association of the time-to-aortic-valve-surgery, including valve replacement and reconstruction, and imaging parameters. A direct comparison of most predictive CMR and echocardiographic parameters was performed by using nested-factor-models. Sixteen patients (32%) were treated with aortic valve surgery during follow-up. Aortic valve insufficiency parameters, both of echocardiography and CMR, showed good discriminative and predictive power regarding the need of valve surgery. Within all examined parameters AR gradation derived by CMR correlated best with outcome [χ2 = 27.1; HR 12.2 (95% CI: 4.56, 36.8); (p < 0.0001)]. In direct comparison of both modalities, CMR assessment provided additive prognostic power beyond echocardiographic assessment of AR but not vice versa (improvement of χ2 from 21.4 to 28.4; p = 0.008). Nested model analysis demonstrated an overall better correlation with outcome by using both modalities compared with using echo alone with the best improvement in the moderate to severe AR range with an echo grade II out of III and a regurgitation fraction of 32% in CMR. This study corroborates the capability of CMR in direct quantification of AR and its role for guiding further treatment decisions particularly in patients with moderate AR in echocardiography.

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