135 research outputs found
Is a minimally invasive approach for re-operative aortic valve replacement superior to standard full resternotomy?
Abstract A best-evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'is a minimally invasive approach for re-operative aortic valve replacement (AVR) superior to standard full resternotomy?' A total of 193 papers were found using the reported search of which 13 represented the best evidence to answer the clinical question. The authors, country, journal and date of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that minimally invasive re-operative AVR can be performed with an operative morbidity and mortality at least similar to the standard full sternotomy approach. A shorter hospital length of stay and less blood product requirements are the main advantages of this technique. The incidence of prolonged ventilation, bleeding requiring re-operation, sternal wound infections and in-hospital mortality may be reduced with a minimally invasive approach. Prospective studies are required to confirm the potential benefits of minimally invasive surgery and, up to date, conventional full re-sternotomy is still the standard approach for re-operative AVR
Incidence of postoperative acute kidney injury in patients with chronic kidney disease undergoing minimally invasive valve surgery
BackgroundWe hypothesize that minimally invasive valve surgery in patients with chronic kidney disease (CKD) is superior to a conventional median sternotomy.MethodsWe retrospectively analyzed 1945 consecutive patients who underwent isolated valve surgery. Included were patients with CKD stages 2 to 5. In-hospital mortality, composite complication rates, and intensive care unit and total hospital lengths of stay of those who underwent a minimally invasive approach were compared with those who underwent a standard median sternotomy. Resource use was approximated based on intensive care unit and total hospital lengths of stay.ResultsThere were 688 patients identified; 510 (74%) underwent minimally invasive surgery, and 178 (26%) underwent a median sternotomy. There was no significant difference in mortality. Minimally invasive surgery was associated with fewer composite complications (33.1% vs 49.4%; odds ratio, 0.5; P ≤ .001), shorter intensive care unit (48 [interquartile range {IQR}, 33-74] hours vs 71 [IQR, 42-96] hours; P < .01), and hospital (8 [IQR, 6-9] days vs 10 [IQR, 8-15] days; P < .001) lengths of stay, and a lower incidence of acute kidney injury (8% vs 14.7%; odds ratio, 0.5; P = .01), compared with median sternotomy. In a multivariable analysis, minimally invasive surgery was associated with a 60% reduction in the risk of development of postoperative acute kidney injury.ConclusionsIn patients with CKD undergoing isolated valve surgery, minimally invasive valve surgery is associated with reduced postoperative complications and lower resource use
Cardiac surgery in the time of the novel coronavirus:Why we should think to a new normal
On 11 March 2020, the World Health Organization declared the SARS-CoV-2 outbreak a pandemic. At the time of writing, 24 May 2020 more than 5 million individuals have been tested positive and the death toll was over 330 000 deaths worldwide. The initial data pointed out the tight bond between cardiovascular diseases and worse health outcomes in COVID19-patients. Epidemiologically speaking, there is an overlap between the age-groups more affected by COVID-related death and the age-groups in which Cardiac Surgery has its usual base of patients. The Cardiac Surgery Departments have to think to anew normal: since the virus will remain endemic in the society, dedicated pathways or even dedicated Teams are pivotal to treat safely the patients, in respect of the safety of the health care workers. Moreover, we need a keen eye on deciding which pathologies have to be treated with priority: Coronary artery Disease showed a higher mortality rate in patients affected by COVID19, but it is, however, reasonable to think that all the cardiac pathologies affecting the lung circulation-such as symptomatic severe mitral diseases or aortic stenosis-might deserve a priority access to treatment, to increase the survival rate in case of an acquired-Coronavirus infection later on
In-Stent CTO Percutaneous Coronary Intervention: Individual Patient Data Pooled Analysis of 4 Multicenter Registries
OBJECTIVES: The authors sought to examine the outcomes of percutaneous coronary intervention (PCI) for in-stent restenosis (ISR) chronic total occlusions (CTOs).
BACKGROUND: The outcomes of PCI for ISR CTOs have received limited study.
METHODS: The authors examined the clinical and angiographic characteristics and procedural outcomes of 11,961 CTO PCIs performed in 11,728 patients at 107 centers in Europe, North America, Latin America, and Asia between 2012 and 2020, pooling patient-level data from 4 multicenter registries. In-hospital major adverse cardiovascular events (MACE) included death, myocardial infarction, stroke, and tamponade. Long-term MACE were defined as the composite of all-cause death, myocardial infarction, and target vessel revascularization.
RESULTS: ISR represented 15% of the CTOs (n = 1,755). Patients with ISR CTOs had higher prevalence of diabetes (44% vs. 38%; p \u3c 0.0001) and prior coronary artery bypass graft surgery (27% vs. 24%; p = 0.03). Mean J-CTO (Multicenter CTO Registry in Japan) score was 2.32 ± 1.27 in the ISR group and 2.22 ± 1.27 in the de novo group (p = 0.01). Technical (85% vs. 85%; p = 0.75) and procedural (84% vs. 84%; p = 0.82) success was similar for ISR and de novo CTOs, as was the incidence of in-hospital MACE (1.7% vs. 2.2%; p = 0.25). Antegrade wiring was the most common successful strategy, in 70% of ISR and 60% of de novo CTOs, followed by retrograde crossing (16% vs. 23%) and antegrade dissection and re-entry (15% vs. 16%; p \u3c 0.0001). At 12 months, patients with ISR CTOs had a higher incidence of MACE (hazard ratio: 1.31; 95% confidence intervals: 1.01 to 1.70; p = 0.04).
CONCLUSIONS: ISR CTOs represent 15% of all CTO PCIs and can be recanalized with similar success and in-hospital MACE as de novo CTOs
Surgical Techniques for Functional Mitral Regurgitation
Joseph Lamelas of the Texas Heart Institute in Houston discusses different surgical techniques to address ventricular dysfunction in functional mitral regurgitation. He presents video of his prefered technique, termed "Ring & Sling," in which a graft draws the papillary muscles together.<div>This presentation was originally given during the SCTS Ionescu University program at the 2017 Annual Meeting of the Society for Cardiothoracic Surgery in Great Britain and Ireland. This content is published with the permission of <a href="https://scts.org/">SCTS</a>. Please <a href="https://sctsed.org/">click here</a> for more information on SCTS educational programs.<br></div
Surgical options of ischemic mitral regurgitation
Mitral regurgitation after a myocardial infarction is common. It can occur acutely or chronically, and its presence portends a poor prognosis. The focus of this article will be on chronic ischemic mitral regurgitation. We will discuss the current concepts of its pathophysiology, the benefits of revascularization, along with the surgical, and percutaneous therapeutic options
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Early Outcomes for Surgical Minimally Invasive SAPIEN 3 Transcatheter Mitral Valve Replacement
Background. Limited surgical options are available for patients with extensive mitral annular calcification. Several reports have shown the feasibility of surgical mitral valve replacement (MVR) using a transcatheter aortic valve in the mitral position (MVR-TAVR). This study reviewed 30-day and 1-year outcomes of a minimally invasive approach for MVR-TAVR.
Methods. Between 2017 and 2019, 16 patients underwent MVR-TAVR under direct vision. Primary end points included overall survival, technical success, and effectiveness. Secondary end points included valve and cardiac hemodynamics postoperatively and during follow up.
Results. The 16 patients (69% female) were 53 to 88 years of age (average, 77 +/- 9 years). Comorbidities on presentation were as follows: 31% (5 of 16) were reoperative procedures; 13% (3 of 16) of patients had right ventricular dysfunction, 31% (5 of 16) had severe pulmonary hypertension, and 20% (3 of 16) had chronic kidney disease. Isolated MVR-TAVR was performed on 69% (11 of 16) of patients, with a cross-clamp (58%; 7 of 12) or on a fibrillating heart (42%; 5 of 12), whereas concomitant MVR-TAVR was performed in 31% (5 of 16) of patients with a cross-clamp. At follow-up, the estimated 30-day mortality rate was 12.5%, and the 1-year mortality rate was 36.2%. A moderate postoperative paravalvular leak (PVL) was evident immediately in 1 patient, and a severe PVL was noted after 30-day follow-up in another. In addition, 1 patient had mild left ventricular outflow tract obstruction, and another had moderate mitral valve stenosis. At 1-year follow-up, there were no changes in the mild PVL and moderate stenosis identified postoperatively.
Conclusions. Minithoracotomy MVR-TAVR is an acceptable alternative to conventional and transcatheter MVR in patients with mitral valve disease and extensive mitral annular calcification. (C) 2021 by The Society of Thoracic Surgeon
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