Surgical aortic valve replacement in the era of transcatheter aortic valve implantation: a review of the UK national database

Objectives To date the reported outcomes of surgical aortic valve replacement (SAVR) are mainly in the settings of trials comparing it with evolving transcatheter aortic valve implantation. We set out to examine characteristics and outcomes in people who underwent SAVR reflecting a national cohort and therefore ‘real-world’ practice. Design Retrospective analysis of prospectively collected data of consecutive people who underwent SAVR with or without coronary artery bypass graft (CABG) surgery between April 2013 and March 2018 in the UK. This included elective, urgent and emergency operations. Participants’ demographics, preoperative risk factors, operative data, in-hospital mortality, postoperative complications and effect of the addition of CABG to SAVR were analysed. Setting 27 (90%) tertiary cardiac surgical centres in the UK submitted their data for analysis. Participants 31 277 people with AVR were identified. 19 670 (62.9%) had only SAVR and 11 607 (37.1%) had AVR+CABG. Results In-hospital mortality for isolated SAVR was 1.9% (95% CI 1.6% to 2.1%) and was 2.4% for AVR+CABG. Mortality by age category for SAVR only were: 75 years=2.2%. For SAVR+CABG these were; 2.2%, 1.8% and 3.1%. For different categories of EuroSCORE, mortality for SAVR in low risk people was 1.3%, in intermediate risk 1% and for high risk 3.9%. 74.3% of the operations were elective, 24% urgent and 1.7% emergency/salvage. The incidences of resternotomy for bleeding and stroke were 3.9% and 1.1%, respectively. Multivariable analyses provided no evidence that concomitant CABG influenced outcome. However, urgency of the operation, poor ventricular function, higher EuroSCORE and longer cross clamp and cardiopulmonary bypass times adversely affected outcomes. Conclusions Surgical SAVR±CABG has low mortality risk and a low level of complications in the UK in people of all ages and risk factors. These results should inform consideration of treatment options in people with aortic valve disease

Outcome following patent ductus arteriosus ligation in premature infants:A retrospective cohort analysis

BACKGROUND: The patent ductus arteriosus (PDA) is an important problem in premature infants. Surgical PDA ligation is usually only be considered when medical treatment has either failed or was contraindicated. The aims of our study were to determine the mortality and morbidity following patent ductus arteriosus ligation in premature infants, and whether prostaglandin synthetase inhibitor (PSI) use prior to ligation affects outcome. METHODS: A retrospective case note review study to determine the outcome of premature infants undergoing patent ductus arteriosus ligation in one tertiary neonatal intensive care unit and two paediatric cardiothoracic centres. RESULTS: We had follow-up data on 87 infants. Cumulative mortality rates at 7 days, 30 days and at hospital discharge were 2%, 8% and 20% respectively. The incidence of chronic lung disease, intraventricular haemorrhage, necrotising enterocolitis and retinopathy of prematurity were 77%, 39%, 26% and 28% respectively. There was no difference in mortality, incidence of chronic lung disease or duration of oxygen dependence between those who had and those who had not received a PSI prior to surgical ligation. In those who had received 2 or more courses of PSI prior to surgical ligation, there was a trend to increase in the duration of oxygen therapy and chronic lung disease, but no difference in mortality. CONCLUSION: This study shows that patent ductus arteriosus ligation is a relatively safe procedure (30 day survival 92%) but there is substantial late mortality and a high incidence of morbidity in the survivors. 2 or more courses of PSI prior to surgical ligation trends to increased oxygen dependence and chronic lung disease. This high risk population requires careful follow-up. A definitive prospective cohort study is lacking

Surgical aortic valve replacement in the era of transcatheter aortic valve implantation: a review of the UK national database.

OBJECTIVES: To date the reported outcomes of surgical aortic valve replacement (SAVR) are mainly in the settings of trials comparing it with evolving transcatheter aortic valve implantation. We set out to examine characteristics and outcomes in people who underwent SAVR reflecting a national cohort and therefore 'real-world' practice. DESIGN: Retrospective analysis of prospectively collected data of consecutive people who underwent SAVR with or without coronary artery bypass graft (CABG) surgery between April 2013 and March 2018 in the UK. This included elective, urgent and emergency operations. Participants' demographics, preoperative risk factors, operative data, in-hospital mortality, postoperative complications and effect of the addition of CABG to SAVR were analysed. SETTING: 27 (90%) tertiary cardiac surgical centres in the UK submitted their data for analysis. PARTICIPANTS: 31 277 people with AVR were identified. 19 670 (62.9%) had only SAVR and 11 607 (37.1%) had AVR+CABG. RESULTS: In-hospital mortality for isolated SAVR was 1.9% (95% CI 1.6% to 2.1%) and was 2.4% for AVR+CABG. Mortality by age category for SAVR only were: 75 years=2.2%. For SAVR+CABG these were; 2.2%, 1.8% and 3.1%. For different categories of EuroSCORE, mortality for SAVR in low risk people was 1.3%, in intermediate risk 1% and for high risk 3.9%. 74.3% of the operations were elective, 24% urgent and 1.7% emergency/salvage. The incidences of resternotomy for bleeding and stroke were 3.9% and 1.1%, respectively. Multivariable analyses provided no evidence that concomitant CABG influenced outcome. However, urgency of the operation, poor ventricular function, higher EuroSCORE and longer cross clamp and cardiopulmonary bypass times adversely affected outcomes. CONCLUSIONS: Surgical SAVR±CABG has low mortality risk and a low level of complications in the UK in people of all ages and risk factors. These results should inform consideration of treatment options in people with aortic valve disease

Vertical and lateral organization of a carbonate deep-water slope marginal to a submarine fan system, Miocene, southern Turkey

Organization is recognized in the forereef-deep water slope-submarine fan system of the Burdigalian-Langhian Kaplankaya Formation. A basinwards transition from a prograding shelfal reef complex, through forereef talus, deep-water slope and laterally encroaching bypass deep-water clastic system is described, although the deep-water slope makes up the bulk of the succession. Considerable thickness variations occur between the reef and deep-water clastic complexes; these are controlled by sea-floor topography, carbonate foreslope gradient and degree of mass wasting off the platform and foreslope. The vertical and lateral heterogeneity of the Kaplankaya deep-water slope system is described from a number of localities along a 40-km-long and up to 3-km-wide exposed section of the northern margin of the Miocene Adana Basin, a foreland basin setting resulting from thrust sheet loading from the north during the Tauride Orogeny. Detailed field mapping is supplemented with vertical sedimentary logs, photomosaics, palaeontological and petrological data to investigate stratal variation, diagnostic architectural elements, controls on slope progradation, differential timing of basinward encroachment of the reefal complex and lateral onlap of the deep-water clastic system onto the slope. Three-dimensional models are presented showing the vertical and lateral facies associations in different parts of the deep-water slope system, and provide a basis for architectural prediction of geometry and relative position in such environments

Sand body geometry in a sand-rich, deep-water clastic system, Miocene Cingoz Formation of southern Turkey

Three types of sandstone bodies, canyon-fill, tongues and lobes are recognized, and their geometry and spatial organization described within an elongate, W-E trending deep-water clastic system. The canyon-fill comprises sheet-like, fining upward packages that pinch-out rapidly (over 20 m laterally) where they onlap against the basin margin slope to the north. To the south, bed packages pinch-out more gradually over 400-500 m where they are confined by basin floor topography that forms one margin to the canyon. Down-system from the canyon, tongues form narrow and elongate (0.5-1 km wide and 25 km long) sandstone bodies. They are non-erosive, and are thus not channels, but sedimentation is focused within palaeotopographic lows formed by basement structure and differential compaction. Lobes occur close to the mouth of the canyon, overlying the tongues. Packages of lobes (net sandstone ~80%) and interlobe deposits (net sandstone ~40%) are cut by distributary channels that allow sediment to bypass the lobes. The overall asymmetric geometry and elongate nature of this sand-rich deep-water clastic system, and consequently sandstone distribution and architecture, are controlled by the basin margin slope and basin floor palaeotopography. (C) 2000 Elsevier Science Ltd. All rights reserved.Three types of sandstone bodies, canyon-fill, tongues and lobes are recognized, and their geometry and spatial organization described within an elongate, W-E trending deep-water clastic system. The canyon-fill comprises sheet-like, fining upward packages that pinch-out rapidly (over 20 m laterally) where they onlap against the basin margin slope to the north. To the south, bed packages pinch-out more gradually over 400-500 m where they are confined by basin floor topography that forms one margin to the canyon. Down-system from the canyon, tongues form narrow and elongate (0.5-1 km wide and 25 km long) sandstone bodies. They are non-erosive, and are thus not channels, but sedimentation is focused within palaeotopographic lows formed by basement structure and differential compaction. Lobes occur close to the mouth of the canyon, overlying the tongues. Packages of lobes (net sandstone approx. 80%) and interlobe deposits (net sandstone approx. 40%) are cut by distributary channels that allow sediment to bypass the lobes. The overall asymmetric geometry and elongate nature of this sand-rich deep-water clastic system, and consequently sandstone distribution and architecture, are controlled by the basin margin slope and basin floor palaeotopography

Sedimentary architecture of a canyon-style fairway feeding a deep-water clastic system, the Miocene Cingoz Formation, southern Turkey: significance for reservoir characterisation and modelling

WOS: 000226841800004The sedimentary architecture of a submarine canyon-fill supplying sediment to a deep-water fan system in the Adana Basin, southern Turkey is described and quantified. The canyon is at least 9-km long, 3-4-km wide, asymmetric in cross-section and has :m exposed fill, 360-m thick consisting of sands and gravels deposited in sheets across the entire width of the canyon. Normal graded and nongraded pebbly sandstones reflecting deposition from both waning and waxing high-density turbidity currents dominate these deposits. Facies are identified and correlated between closely spaced sedimentary logs. A hierarchy of bedding scales is recognised, ranging from individual beds and their sedimentary structures through 3-21-m-thick packages of beds to 100+m thick major units. This hierarchy provides the framework for computer-generated 3D models where sandstone bodies and facies are stochastically modelled to provide a better understanding of the internal sedimentary architecture within similar types of canyons in subsurface or in areas of poor exposure. (C) 2004 Elsevier B.V. All rights reserved

Down-channel variations in stratal patterns within a conglomeratic, deepwater fan feeder system (Miocene, Adana Basin, Southern Turkey

The proximal, channelized section of a deepwater fan in the Adana Basin, southern Turkey, provides an opportunity to study down-channel changes in stratal patterns. This is a multisourced, bypass fan with at least four feeder channels. The downdip changes within one of these channels are described along a 10 km transect. Down-channel changes in grading and organization of clasts are observed for non-grading disorganized facies in the most proximal locations to more organized, inverse-normal and normal graded conglomerates midway down the transect. Bedding style changes from scoured and more sheet-like beds updip into a pattern of small channels and bars midway along the transect, and into thick-bedded and structureless conglomerates in the more distal locations within the channel. These changes in stratal patterns coincide with observed changes in depositional gradient of the channel. The gradient changes are interpreted to be a contributing factor in controlling hydrodynamics within the gravity flows and thus the depositional stratal patterns. © The Geological Society of London 2004

Sedimentary architecture of a canyon-style fairway feeding a deep-water clastic system, the Miocene Cingöz Formation, southern Turkey: Significance for reservoir characterisation and modelling

The sedimentary architecture of a submarine canyon-fill supplying sediment to a deep-water fan system in the Adana Basin, southern Turkey is described and quantified. The canyon is at least 9-km long, 3-4-km wide, asymmetric in cross-section and has an exposed fill, 360-m thick consisting of sands and gravels deposited in sheets across the entire width of the canyon. Normal graded and nongraded pebbly sandstones reflecting deposition from both waning and waxing high-density turbidity currents dominate these deposits. Facies are identified and correlated between closely spaced sedimentary logs. A hierarchy of bedding scales is recognised, ranging from individual beds and their sedimentary structures through 3-21-m-thick packages of beds to 100+m thick major units. This hierarchy provides the framework for computer-generated 3D models where sandstone bodies and facies are stochastically modelled to provide a better understanding of the internal sedimentary architecture within similar types of canyons in subsurface or in areas of poor exposure. © 2004 Elsevier B.V. All rights reserved.EnterpriseThe authors warmly acknowledge financial support from the Mesostratigraphy of Deep-water Sandstones Consortium (Amerada Hess, BP-Amoco, Conoco, TotalFinaElf and Enterprise). Drs. U. Ünlügenç and A Nazik (Çukurova University) provided logistical support while Y. Topak, O. Çelik and I. Naz from Çukurova University are thanked for their assistance in the field. Constructive comments on an early draft of this paper by Prof. John Collinson and Dr. Sami Derman are gratefully acknowledged