Results of minimally invasive aortic valve replacement surgery through right thoracotomy at Hanoi Heart Hospital

Objectives: To evaluate results of minimally invasive aortic valve replacement surgery through right thoracotomy with some techinque improvements in Hanoi Heart Hospital. Methods: Surgery was performed via a small right thoracotomy in the second intercostal space. The third rib was detached by a wedge-shaped way using sternum saw. Cannulation approaches were central or peripheral depended on patients’ condition. Preoperative, perioperative, early results and follow-up data was collected and analysed. Results: There was 48 patients in the research. Mean age was 60,94 ± 11,53 (25-82), and 52,1% was male. 29,2% of patients had peripheral vascular disease. 22,9% underwent central arterial cannulation. 3 patients (6,3%) had pericardial adhesion. There was no early mortality, 2 patients had redo surgery due to excess bleeding. 1 patients had intestinal infarction. Mean follow-up time was 13,4 months. 91,3% of patients had NYHA I. 1 patients was dead due to intracerebral hemorrhage. Conclusions: With some improvements in techniques, minimally invasive aortic valve replacement surgery through right thoracotomy gave good early and midterm results in our center.

Evaluation of hemostasis parameters after mitral valve replacement surgery with mechanical prostheses in patients with different treatment adherence

The aim of the study. To analyze the indicators of hemostasis with adherence to treatment in patients operated on for mitral valve prosthetics with mechanical bicuspid prostheses in dynamics after 6, 12 and 60 months.Materials and methods. The study included 260 patients who underwent surgery for prosthetics with mechanical prostheses. Patients’ adherence to treatment was assessed using the Morisky – Green test. The following hemostasis parameters were analyzed: international normalized ratio (INR), activated partial thromboplastin time (APTT), D-dimer, fibrinogen and soluble fibrin-monomer complexes.Results of the study and conclusion. At all stages of the postoperative period, the hemostasis indicators of compliant patients corresponded to the reference values for people receiving anticoagulants, in non-compliant patients, these indicators did not reach the recommended values for patients on anticoagulant therapy. The presence of correlations between compliance and hemostasis indicators is evidenced by the results of correlation analysis. In most cases, the maximum strength of the relationship between compliance and hemostasis indicators was observed after 12 months of follow-up. A noticeable strength of interrelations was traced between compliance and levels of APTT, INR and fibrinogen.

Сardiac troponin I for assessment of myocardial damage and prediction of complications in cardiac surgery patients

The study analysed the level of troponin I (Tn) in the blood in patients with coronary artery disease after coronary artery bypass grafting in comparison with patients after aortic valve replacement surgery. The dynamics of troponin in the early postoperative period was studied, a parallelism was established between the occurrence of complications after surgery and the degree of myocardial damage. A new method has been developed for assessing the degree of intraoperative myocardial damage and the risk of complications using the «index of myocardial damage», the Tn level is determined twice after the operation, in the period up to 6 hours – Tn early and 12–24 hours later – Tn late, the index is calculated as the ratio of Tn late one to Tn early one. A correlation analysis of the «index» with other laboratory parameters was carried out, as a result of which no significant correlations were found, which indicates the absence of duplication and the significance of the developed indicator for assessing myocardial damage after cardiac surgery.

The Efficacy and Safety of Postoperative Tranexamic Acid, Hemocoagulase Agkistrodon, and their Combination in Patients Undergoing Heart Valve Replacement With Cardiopulmonary Bypass

Background Excessive bleeding is a major complication in patients undergoing cardiac surgery. We aimed to compare the efficacy and safety of postoperative tranexamic acid (TXA), hemocoagulase agkistrodon and their combination in patients undergoing heart valve replacement surgery with cardiopulmonary bypass (CPB). Methods This was a retrospective study. The enrolled patients were intravenously injected with TXA at a dose of 1.0 g during the intraoperative period. After surgery, the patients were assigned to four groups: the control group (Group C), the TXA group (Group T), the hemocoagulase agkistrodon group (Group H) and the combination group (Group TH). The primary efficacy outcomes were the total blood loss (TBL) from the time of the operation to postoperative Day 2, postoperative blood loss within 2 days, and transfusion of red blood cells and plasma from the operation to postoperative Day 3. The primary safety endpoint was the incidence of thromboembolic events. Results A total of 252 patients were recruited. There were no statistically significant differences in terms of the TBL, postoperative blood loss, volumes of red blood cells or plasma transfusion among the four groups. However, an increased total pericardial drainage volume and longer length of stay in the ICU were found in Group H compared with in Group T. In addition, increased volumes of total pericardial drainage were found in Group TH compared with Groups C and T. A similar result was also found in the number of days of pericardial drainage. Regarding safety outcomes, fibrinogen levels on postoperative Days 1 and 2 in Groups H and TH were significantly lower than those in Groups C and T, while the frequencies of human fibrinogen transfusion in Groups H and TH were higher, with the highest frequency in Group H. The transfusions of human fibrinogen among Groups C, T, H and TH were 1.45%, 2.78%, 64.71%, and 28.72%, respectively. No significant differences were found in the postoperative incidences of thromboembolic events and acute kidney injuries among all groups. Conclusions Bleeding events after cardiac valve replacement surgery with CPB were not improved by postoperative administration of TXA, hemocoagulase agkistrodon or their combination. Hemocoagulase agkistrodon is related to hypofibrinogenemia and increased transfusions of human fibrinogen.

Sex Differences in the Utilization and Outcomes of Cardiac Valve Replacement Surgery for Infective Endocarditis: Insights From the National Inpatient Sample

Background The data on the differential impact of sex on the utilization and outcomes of valve replacement surgery for infective endocarditis are limited to single‐center and small sample size patient population. Methods and Results We utilized the National Inpatient Sample database to identify patients with a discharge diagnosis of infective endocarditis from 2004 to 2015 to assess differences in the characteristics and clinical outcomes of patients hospitalized with infective endocarditis stratified by sex. We also evaluated trends in utilization of cardiac valve replacement and individual valve replacement surgeries in women versus men over a 12‐year period, and compared in‐hospital mortality after surgical treatment in women versus men. A total of 81 942 patients were hospitalized with a primary diagnosis of infective endocarditis from January 2004 to September 2015, of whom 44.31% were women. Women were less likely to undergo overall cardiac valve replacement (6.92% versus 12.12%), aortic valve replacement (3.32% versus 8.46%), mitral valve replacement (4.60% versus 5.57%), and combined aortic and mitral valve replacement (0.85% versus 1.81%) but had similar in‐hospital mortality rates. From 2004 to 2015, the overall rates of cardiac valve replacement increased from 11.76% to 13.96% in men and 6.34% to 9.26% in women and in‐hospital mortality declined in both men and women. Among the patients undergoing valve replacement surgery, in‐hospital mortality was higher in women (9.94% versus 6.99%, P <0.001). Conclusions Despite increased utilization of valve surgery for infective endocarditis in both men and women and improving trends in mortality, we showed that there exists a treatment bias with underutilization of valve surgeries for infective endocarditis in women and demonstrated that in‐hospital mortality was higher in women undergoing valve surgery in comparison to men.

Valve Abnormalities, Risk Factors for Heart Valve Disease and Valve Replacement Surgery in Spondyloarthritis. A Systematic Review of the Literature

Objective: Evaluate the evidence on the abnormalities of the aortic root and heart valves, risk and prognostic factors for heart valve disease and valve replacement surgery in spondyloarthritis.Methods: A systematic literature review was performed using Medline, EMBASE and Cochrane databases until July 2021. Prevalence, incidence, risk and prognostic factors for heart valve disease; dimension, morphology, and pathological abnormalities of the valves were analyzed. Patient characteristics (younger age, history of cardiac disease or longer disease duration) and period of realization were considered for the analysis. The SIGN Approach was used for rating the quality of the evidence of the studies.Results: In total, 37 out of 555 studies were included. Overall, the level of evidence was low. The incidence of aortic insufficiency was 2.5–3.9‰. Hazard Ratio for aortic insufficiency was 1.8–2.0. Relative risk for aortic valve replacement surgery in ankylosing spondylitis patients was 1.22–1.46. Odds ratio for aortic insufficiency was 1.07 for age and 1.05 for disease duration. Mitral valve abnormalities described were mitral valve prolapse, calcification, and thickening. Aortic valve abnormalities described were calcification, thickening and an echocardiographic “subaortic bump.” Abnormalities of the aorta described were thickening of the wall and aortic root dilatation. The most common microscopic findings were scarring of the adventitia, lymphocytic infiltration, and intimal proliferation.Conclusions: A higher prevalence and risk of aortic valve disease is observed in patients with ankylosing spondylitis. Studies were heterogeneous and analysis was not adjusted by potential confounders. Most studies did not define accurate outcomes and may have detected small effects as being statistically significant.