13 research outputs found
Aortic valve visualization and pressurization device: a novel device for intraoperative evaluation of aortic valve repair procedures
OBJECTIVESAortic valve repair procedures are technically challenging, and current intraoperative evaluation methods often fail to predict the final echocardiographic result. We have developed a novel intraoperative aortic valve visualization and pressurization (AVP) device, enabling valve inspection under physiological conditions, and measuring aortic valve insufficiency (AI) during cardioplegic arrest.METHODSThe AVP device is attached to the (neo)aorta, after any type of aortic valve repair, while the heart is arrested. The root is pressurized (60â80 mmHg) using a saline solution and an endoscope is introduced. The valve is inspected, and the amount of valvular leakage is measured. Postoperative âgold standardâ transesophageal echocardiogram measurements of AI are performed and compared against regurgitation volume measured.RESULTSIn 24 patients undergoing valve-sparing root replacement, the AVP device was used. In 22 patients, postoperative echocardiographic AI was †grade 1. The median leakage was 90âml/min, IQR 60â120âml/min. In 3 patients, additional adjustments after visual inspection was performed. In 2 patients, with complex anatomy, the valve was replaced. In one, after evaluation with the device, there was undesirable result visually and residual AI of 330âml/min, and in another, 260âml/min residual AI was measured and valve restriction on visual inspection.CONCLUSIONSThe novel AVP device enables intraoperative evaluation of the valve under physiological conditions, while still on arrested heart, and allows for targeted adjustments. The AVP device can be an important aid for intraoperative evaluation of the aortic valve, during valve repair and valve-sparing procedures, thereby making the operative result more predictable and the operation more efficient.Thoracic Surger
Prosthesisâpatient mismatch after mitral valve replacement: A pooled meta-analysis of KaplanâMeier-derived individual patient data
Objective: The hemodynamic effect and early and late survival impact of
prosthesisâpatient mismatch (PPM) after mitral valve replacement remains
insufficiently explored.
Methods: Pubmed, Embase, Web of Science, and Cochrane Library databases were
searched for English language original publications. The search yielded 791 potentially relevant studies. The final review and analysis included 19 studies compromising 11,675 patients.
Results: Prosthetic effective orifice area was calculated with the continuity equation
method in 7 (37%), pressure halfâtime method in 2 (10%), and partially or fully obtained
from referenced values in 10 (53%) studies. Risk factors for PPM included gender (male),
diabetes mellitus, chronic renal disease, and the use of bioprostheses. When pooling
unadjusted data, PPM was associated with higher perioperative (odds ratio [OR]: 1.66;
95% confidence interval [CI]: 1.32â2.10; p < .001) and late mortality (hazard ratio [HR]:
1.46; 95% CI: 1.21â1.77; p < .001). Moreover, PPM was associated with higher late
mortality when Cox proportionalâhazards regression (HR: 1.97; 95% CI: 1.57â2.47;
p < .001) and propensity score (HR: 1.99; 95% CI: 1.34â2.95; p < .001) adjusted data were
pooled. Contrarily, moderate (HR: 1.01; 95% CI: 0.84â1.22; p = .88) or severe (HR: 1.19;
95% CI: 0.89â1.58; p = .24) PPM were not related to higher late mortality when adjusted
data were pooled individually. PPM was associated with higher systolic pulmonary pressures (mean difference: 7.88 mmHg; 95% CI: 4.72â11.05; p < .001) and less pulmonary
hypertension regression (OR: 5.78; 95% CI: 3.33â10.05; p < .001) late after surgery.
Conclusions: Mitral valve PPM is associated with higher postoperative pulmonary
artery pressure and might impair perioperative and overall survival. The relation
should be further assessed in properly designed studie
Unexpected negative results for CytoSorb during left ventricular assist device implantation; interpret with caution
Thoracic Surger
The aortic root in acute type A dissection: repair or replace?
BACKGROUND The effect of an "aggressive" approach on the aortic root in acute type A aortic dissection (ATAAD) remains insufficiently explored. METHODS Retrospective analysis was conducted between 1992 and 2020 of a single-center, prospective cohort of consecutive patients aged double dagger 18 years diagnosed with ATAAD. Patients were divided into 2 groups: aortic root replacement (ARR; prosthetic or valve-sparing root replacement, n = 141) and conservative root approach (CRA; root sparing of partially dissected root, n = 90; and supracoronary ascending replacement in nondissected root, n = 68). Inverse probability weighting was used to compare patients with different preoperative characteristics. Mean follow-up was 5.1 (0-21) years in ARR and 7.1 (0-25) years in CRA. RESULTS The frequency of ARR increased over the years, with 19% and 78% of patients undergoing ARR in the earliest and most recent periods, respectively. Early mortality decreased over the years, despite a more aggressive approach, and remained lower in ARR. CRA was associated with a higher hazard of late mortality (hazard ratio, 1.38; 95% CI, 1.12-1.68; P = .001) and reintervention (hazard ratio, 2.08; 95% CI, 1.44-3.56; P = .001). After CRA, new-onset aortic valve insufficiency was a common cause of reintervention. CONCLUSIONS Over the years, there was a gradual increase in the root replacement approach in ATAAD. Root replacement was associated with better long-term survival and fewer reinterventions compared with the conservative approach, whereas the in-hospital mortality decreased during these years. Hence, aggressive root replacement is safe and may be applied in ATAAD with good long-term clinical results, without increased hospital mortality.(Ann Thorac Surg 2023;115:1396-402)(c) 2023 by The Society of Thoracic SurgeonsThoracic Surger
Outcome reporting for surgical treatment of degenerative mitral valve disease: a systematic review and critical appraisal
Thoracic Surger
Risk factors and clinical significance of elevated mitral valve gradient following valve repair for degenerative disease
OBJECTIVES The risk factors and clinical effect of elevated mitral valve (MV) gradients after valve repair for degenerative valve disease remain insufficiently understood.METHODS Between January 2004 and December 2015, a total of 484 patients underwent valve repair for degenerative disease. A true-sized full annuloplasty ring was implanted in all cases. We analysed the effect of preoperative and intraoperative factors on the postrepair gradient. Additionally, we explored the effect of postrepair gradients on long-term outcomes.RESULTS On linear regression analysis, postrepair MV gradients were associated with patient age (coefficient=-0.110, standard error=0.005, P=0.034), body surface area (coefficient=0.905, standard error=0.340, P=0.008), implanted annuloplasty ring size (coefficient=-0.181, standard error=0.018, P<0.001) and the use of Physio I ring (coefficient=0.414, standard error=0.122, P=0.001). On multivariable analysis, postrepair MV gradient was not associated with overall survival [hazard ratio (HR) 1.034, 95% confidence interval (CI) 0.889-1.203; P=0.66] or freedom from atrial fibrillation (HR 0.849, 95% CI 0.682-1.057; P=0.14), but did emerge as a risk factor for MV reintervention (HR 1.378, 95% CI 1.033-1.838; P=0.029). Two out of 11 reinterventions were performed due to MV stenosis and in both patients, high postrepair gradients were seen readily on predischarge echocardiography.CONCLUSIONS Following valve repair for degenerative MV disease, elevated gradients occur even when true-sized annuloplasty is performed. The late clinical results of valve repair with elevated postrepair gradient are impaired and further studies are needed to explore preventive measures aimed at resolving the issue.Cardiolog