Aortic Valve Replacement Surgery Research Articles

COVID19 INFECTION IN CORONARY ARTERY DISEASE WITH DIABETES AND HYPERTENSION IN VALVULAR SURGERY PATIENTS IN TERTIARY HEART CENTRE

Objective: The patient was a 59-year-old man who was referred to the hospital due to shortness of breath due to increased activity, accompanied by cough, weakness, and lethargy. The patient also had a history of diabetes, hypertension, hyperlipidemia, and asthma. The patient also underwent cardiac stenting last year. LCX and LAD stenting Design and method: He had a continuous pan-systolic murmur on cardiac examination diagnosed with valvular dysfunction. Severe aortic regurgitation was reported on echo. The patient underwent a CT scan of the lungs and a PCR test to rule out Covid-19, which was negative. Finally, the patient was diagnosed with severe aortic regurgitation and underwent aortic valve replacement surgery. Echocardiography was performed before the operation, and the diagnosis was confirmed. Results: Echocardiography was performed postoperatively, which showed good valve function and no valve leakage. From the 5th day after the operation, the patient developed fever and increased leukocytosis. Suspected of having Covid19 and accordingly underwent PCR test, the test result was positive; the patient underwent a CT scan of the lungs. After that, he was transferred to the corona ICU. The patient was treated with Remdesivir, and after two weeks, his PCR was negative, and he was almost ready to be discharged. The patient had completed the entire course of treatment and developed pulmonary fibrosis due to Covid disease, but suddenly, after two weeks from the onset of the illness, she developed severe shortness of breath, which led to intubation. We find severe pulmonary fibrosis in the re-CT scan, especially in the left lung, where the entire left lung had fibrosis. Prednisolone was started at a dose of 50 mg three times a day. The patient was intubated for ten days, then gradually removed from the device. Now the patient is extubated and ready for discharge. Conclusions: Risk factors such as Past cardiac surgery and present cardiac intervention with diabetes mellitus increase the risk of developing lung failure in these Covid19 patients. Elective intubation is better than emergency intubation in patients with comorbidities. Corticosteroids can be effective in treating pulmonary insufficiency

Early and long-term outcomes of conventional and valve-sparing aortic root replacement

ObjectiveTo determine the early and long-term outcomes of conventional aortic root (ARR) and valve-sparing root replacement (VSRR) using a standard perioperative and operative approach.MethodsWe present prospectively collected data of 609...

Effect of Transcatheter Aortic Valve Implantation vs Surgical Aortic Valve Replacement on All-Cause Mortality in Patients With Aortic Stenosis

Transcatheter aortic valve implantation (TAVI) is a less invasive alternative to surgical aortic valve replacement and is the treatment of choice for patients at high operative risk. The role of TAVI in patients at lower risk is unclear. To determine whether TAVI is noninferior to surgery in patients at moderately increased operative risk. In this randomized clinical trial conducted at 34 UK centers, 913 patients aged 70 years or older with severe, symptomatic aortic stenosis and moderately increased operative risk due to age or comorbidity were enrolled between April 2014 and April 2018 and followed up through April 2019. TAVI using any valve with a CE mark (indicating conformity of the valve with all legal and safety requirements for sale throughout the European Economic Area) and any access route (n = 458) or surgical aortic valve replacement (surgery; n = 455). The primary outcome was all-cause mortality at 1 year. The primary hypothesis was that TAVI was noninferior to surgery, with a noninferiority margin of 5% for the upper limit of the 1-sided 97.5% CI for the absolute between-group difference in mortality. There were 36 secondary outcomes (30 reported herein), including duration of hospital stay, major bleeding events, vascular complications, conduction disturbance requiring pacemaker implantation, and aortic regurgitation. Among 913 patients randomized (median age, 81 years [IQR, 78 to 84 years]; 424 [46%] were female; median Society of Thoracic Surgeons mortality risk score, 2.6% [IQR, 2.0% to 3.4%]), 912 (99.9%) completed follow-up and were included in the noninferiority analysis. At 1 year, there were 21 deaths (4.6%) in the TAVI group and 30 deaths (6.6%) in the surgery group, with an adjusted absolute risk difference of -2.0% (1-sided 97.5% CI, -∞ to 1.2%; P < .001 for noninferiority). Of 30 prespecified secondary outcomes reported herein, 24 showed no significant difference at 1 year. TAVI was associated with significantly shorter postprocedural hospitalization (median of 3 days [IQR, 2 to 5 days] vs 8 days [IQR, 6 to 13 days] in the surgery group). At 1 year, there were significantly fewer major bleeding events after TAVI compared with surgery (7.2% vs 20.2%, respectively; adjusted hazard ratio [HR], 0.33 [95% CI, 0.24 to 0.45]) but significantly more vascular complications (10.3% vs 2.4%; adjusted HR, 4.42 [95% CI, 2.54 to 7.71]), conduction disturbances requiring pacemaker implantation (14.2% vs 7.3%; adjusted HR, 2.05 [95% CI, 1.43 to 2.94]), and mild (38.3% vs 11.7%) or moderate (2.3% vs 0.6%) aortic regurgitation (adjusted odds ratio for mild, moderate, or severe [no instance of severe reported] aortic regurgitation combined vs none, 4.89 [95% CI, 3.08 to 7.75]). Among patients aged 70 years or older with severe, symptomatic aortic stenosis and moderately increased operative risk, TAVI was noninferior to surgery with respect to all-cause mortality at 1 year. isrctn.com Identifier: ISRCTN57819173.

Reduced of radiation exposure and iodine load at CT angiography of the aorta before aortic and aortic valve replacement surgery

Objective . The comparison of protocols of computed tomography (CT) angiography of the aorta and their modification in conditions of radiation and iodine load reducing on the patient. Methods . In 95 patients (57 men, 38 women, mean age 61.4 ± 15.6 years) CT angiography of the aorta was performed using two- and three-zone scanning protocols with the voltage value on the X-ray tube (80 and 100kV) depending on the anthropometric measure namely body mass index (BMI). We compared dose length product parameters (DLP), effective dose (E), time and duration of scanning, as well as counting the amount of injected contrast agent (CM) between groups examined using a two-zone and three-zone protocols at an X-ray tube voltage of 80 and 100kV. Results . Analysis of the data obtained showed that the DLP and E values were statistically significantly lower with the CT angiography of the aorta protocol, which consisted of three scanning zones (at 80kV p = 0.008; at 100kV p &lt; 0.001). At the same time, there was no significant difference in the length of the study area in groups with the same voltage on the X-ray tube (p = 0.55), in the group with a three-zone protocol, the scanning time was significantly lower (p &lt; 0.001) and amounted to 9.4 ± 0.5 sec/10.24 ± 0.9 sec (80/100kV), which made it possible to significantly reduce radiation exposure up to 40% and the amount of injected contrast agent by 20%. Conclusions . The use of a three-zone CT-angiography of the aorta protocol with individual selection of voltage of the X-ray tube is justified and allows a significant reduction of radiation and iodine exposure compared to twozone scanning while maintaining the high images quality.

3D printed mechanically representative aortic model made of gelatin fiber reinforced silicone composite

Additive manufacturing (AM) is a useful technology to produce artificial aortic models for the training of transcatheter aortic valve replacement (TAVR) surgery. With AM, the models can be tailored towards the individualized aortic anatomy of patients. Most of these reported models so far are manufactured using single rubber-like materials. However, such materials do not replicate the mechanical properties of natural aortic tissue, especially the stress–strain response in higher strain (>0.1) regions. This could be problematic for surgeons training for surgeries using a model which does not exhibit properties of the real aorta. To overcome this limitation, we developed a 3D-printed, mechanically representative aortic model comprising gelatin fibers and silicone. The model is promising as a realistic analog of aortic sinus for mock TAVR surgery. Computerized tomography data was analyzed beforehand using medical imaging to identify the anatomy of a specific patient’s aortic sinus and the surrounding blood vessels. A novel silicone matrix composite reinforced with gelatin fibers designed in this work was tested and compared with the stress–strain response of aortic tissue. Such a model comprising both patient-specific geometries as well as realistic material properties of aortic tissue can be helpful for the development of next-generation medical phantoms.

A bioprosthetic heart valve prepared by copolymerization of 2-isocyanatoethyl methacrylate modified pericardium and functional monomer

Bioprosthetic heart valves (BHVs), mostly fabricated from glutaraldehyde crosslinked porcine or bovine pericardium, have been increasingly used in clinic with the application of transcatheter aortic valve replacement surgery. However, several drawbacks of glutaraldehyde crosslinked BHVs including poor cytocompatibility, thrombosis and calcification might lead to dysfunction and structural valvular degeneration (SVD) of BHVs. Here, we developed a glutaraldehyde-free crosslinking method in which the porcine pericardium was treated with 2-isocyanatoethyl methacrylate (ICM) to introduce methacrylate groups and subsequently copolymerized with crosslinker, poly(ethylene glycol) dimethacrylate (PEGDA), to prepare a PEGDA polymer crosslinked porcine pericardium (PICM-PEGDA-PP). The PICM-PEGDA-PP exhibited improved cytocompatibility, stability, mechanical properties and anticalcification property compared with glutaraldehyde crosslinked porcine pericardium (GA-PP). Owing to the introduction of PEGDA polymers, PICM-PEGDA-PP exhibited lower adsorption of proteins, platelets and blood cells as well as significant antithrombotic performance. Furthermore, the hydrodynamic performance and durability of PICM-PEGDA-PP were proved to meet the requirements of ISO 5840–3 for BHVs. These results indicated that the component stabilization and antithrombic functionalization of BHVs can be achieved by the proposed glutaraldehyde-free crosslinking method and PICM-PEGDA-PP is expected to be developed into a potential alternative for glutaraldehyde crosslinked BHVs clinically in the future.

Mechanisms of Death in Low-Risk Patients After Transcatheter or Surgical Aortic Valve Replacement

BackgroundDeath in high- and intermediate-risk patients after self-expanding transcatheter (TAVR) and surgical aortic valve replacement (surgery) differed in mechanisms and timing. In both risk groups, 1-year all-cause mortality was lower in TAVR than in surgery patients. The differences in mechanism and timing of death in low-risk patients has not been studied. This report explores the mechanisms of death during 3 time periods; 0 to 30 days (early), 31 to 120 days (recovery), and 121 to 365 days (late). MethodsWe retrospectively examined the mechanisms and timing of death following TAVR or surgery in the randomized Evolut Low Risk Trial. Patients were enrolled between March 2016 and November 2018 from 86 designated TAVR centers. Mechanisms of death were categorized as due to technical reasons, failure to repair, complications linked to death, failure to recover or other. ResultsAll-cause mortality at 1 year was 2.2% for TAVR and 2.8% for surgery, p = 0.44. Early deaths included 3 TAVR patients, all due to technical reasons, and 8 surgery patients (1 technical, 5 complications and 2 failed to recover). Recovery period deaths included 6 TAVR patients (4 complications, 1 failed to recover and 1 other), and 1 surgery patient from complications of valve endocarditis. Late period deaths included 6 TAVR patients and 9 surgery patients, primarily due to complications.Conclusions: In this low-risk study cohort, no patient died from failure to repair the valve; reduction in procedural complications in the TAVR and surgery groups remain opportunities for further improvement in outcomes.Clinical Trial Registrations (clinicaltrials.gov): NCT02701283 (Evolut Low Risk).

Post-pneumonectomy patients undergoing cardiac surgery: A case series.

Data regarding post-pneumonectomy patient assessment for cardiac surgery is scarce. This retrospective study was conducted to define early and late outcomes in these patients, and to identify risk factors for poor outcomes. This study included patients with a previous history of pneumonectomy undergoing on-pump cardiac surgery with median sternotomy. The institutional database was reviewed from 1992 to 2018. Sixteen post-pneumonectomy patients (all lung cancer) were identified. The age rangewas 53-81 years. The mean FEV1/FVC was 69%. The mean EuroSCORE II was 11.6%. Four patients had heart failure symptoms in the 2 weeks before surgery. Seven patients had isolated coronary artery bypass grafting (CABG) and six patients had CABG + aortic valve replacement (AVR). The major perioperative events affecting the ease and outcomes of the surgical procedures were structural shifts (5), extensive adhesions on heart and vessels (5), and extensive calcification of heart components (5). Important postoperative complications were respiratory (7), infections (5), and acute kidney injury (5). The median hospital length of stay was 7 days. Five patients died in hospital (none with isolated CABG) with a preoperative New York Heart Association classification (NYHA) of III-IV, a cardiopulmonary bypass time of 175.2 min and an aortic cross-clamp time of 104.0 min. The long-term survival data were recorded with a mean follow-up of 7.3 ± 7.1 years (range from 0 to 19). The overall, 5-year survival, was 50% for all cardiac surgeries, 71% for isolated CABG surgeries, and 17% for CABG + AVR surgeries, respectively. Post-pneumonectomy patients have acceptable postoperative outcomes and survival. Simple and short surgeries with careful planning can yield favorable outcomes for this high-risk subgroup of patients.

Surgical dilemma - spare or replace regurgitant aortic valve: Late comparative outcomes of two strategies.

To evaluate different aortic root surgery techniques and their contemporary clinical outcomes in patients with regurgitant aortic valve and aortic root aneurysm. The study consisted of 141 adult patients who underwent aortic valve reimplantation (David group = 73) or aortic valve replacement surgery (Bentall group = 68) for aortic valve regurgitation (AR) and dilatation of the aortic root at our institution within the same period (April 2004-October 2016). Kaplan-Meier method was used to estimate survival and other clinically relevant outcomes between the groups. The completeness of clinical follow-up was 100%, with a mean time of 8.0 ± 3.8years. Thirty-day (in-hospital) mortality rates were equivalent between groups (1.3 and 1.5%, p = 1.0). The overall survival rates at 10years were significantly better for the David group patients comparing to Bentall group patients (95.3 ± 2.6% vs 79.7 ± 6.8%; p = 0.04) with similar freedom from AV related reoperation (94.4 ± 2.7% vs 98.5 ± 1.5%; p = 0.2). Freedom from bleeding events at 10years was 90.7 ± 3.6% for Bentall group patients and none were observed among David group patients (p = 0.01). Aortic valve and root surgery can be performed with equivalent safety and efficacy using either valve-sparing (David procedure) or valve-replacing (Bentall procedure) techniques in selected patients. Furthermore, patients after the David procedure demonstrated significantly improved survival and low risk of bleeding in comparison to the Bentall procedure with an acceptable risk of reoperation at 10years follow-up.

Ralstonia pickettii bacteremia in a cardiac surgery patient in Belgrade, Serbia.

Ralstonia pickettii is an opportunistic bacterium found in the water environment with an increasing incidence as a nosocomial pathogen. The objectives of this study were to describe R. pickettii bacteremia in a cardiac surgery patient and to evaluate its ability to grow in a saline solution and to form biofilm. The patient in this study underwent mitral and aortic valve replacement surgery with two aortocoronary bypasses. She developed signs of respiratory and renal failure, therefore hemodialysis was started. After 25 days in an intensive care unit, the patient had recurrent episodes of fever with signs of bacteremia. R. pickettii was identified from blood cultures by MALDI-TOF MS. Antimicrobial susceptibility testing was performed using disc diffusion and broth microdilution methods in accordance with EUCAST methodology and results were interpreted following clinical breakpoints for Pseudomonas spp. The isolate was susceptible to all tested antimicrobial agents except aminoglycosides and colistin. Survival of R. pickettii was analyzed in saline solution with four different starting concentrations at 25 °C and 37 °C for six days. Biofilm capacity was tested using the microtiter plate method. R. pickettii showed substantial growth in saline solution, with starting concentration of 2 CFU ml-1 reaching 107 CFU ml-1 after six days. There was no significant difference between growth at 25 °C and 37 °C. This indicates that storage of contaminated solutions at room temperature can enhance the count of R. pickettii. Our strain did not show the capacity to form biofilm. The patient responded well to adequate treatment with ceftazidime, and after 48 days in ICU she was discharged to convalesce.

Current Opinions on New-Onset Left Bundle Branch Block after Transcatheter Aortic Valve Replacement and the Search for Physiological Pacing.

Transcatheter aortic valve replacement possesses a high validity for patients with aortic stenosis who are considered high risk for aortic valve replacement surgery, nowadays it is also considered for patients with intermediate risk or even lower risk in certain situations. The incidence of new conduction abnormalities remains to be a tough problem, in particular, left bundle branch block. New-onset left bundle branch block is a major concern despite improvements in valve technology, and it may affect postoperative prognosis. Understanding the anatomical relationship between the conduction system and the aortic root, clarify factors related to the procedure, devices, and patients, might help to reduce the conduction abnormalities. Physiological pacing has emerged as a reasonable pacing strategy for patients with cardiac insufficiency post-valve replacement, especially combined with left bundle branch block. The purpose of this review is to summarize the current opinion on the incidence of new-onset left bundle branch block associated with transcatheter aortic valve replacement, to offer insights into its anatomical and procedural causes, clinical consequences, and more importantly, the prospect of applying physiological pacing as a therapeutic method for these patients.

Effects of transcutaneous electrical nerve stimulation on myocardial protection in patients undergoing aortic valve replacement: a randomized clinical trial

BackgroundCardiopulmonary bypass-related myocardial ischemia-reperfusion injury is a major contributor to postoperative morbidity. Although transcutaneous electrical nerve stimulation (TENS) has been found to have cardioprotective effects in animal studies and healthy volunteers, its effects on cardiac surgery under cardiopulmonary bypass patients have not been evaluated. We investigated the effects of TENS on myocardial protection in patients undergoing aortic valve replacement surgery using cardiopulmonary bypass.MethodsThirty patients were randomized to receive TENS or sham in three different anesthetic states – pre-anesthesia, sevoflurane, or propofol (each n = 5). TENS was applied with a pulse width of 385 μs and a frequency of 10 Hz using two surface electrodes at the upper arm for 30 min. Sham treatment was provided without stimulation. The primary outcome was the difference in myocardial infarct size following ischemia-reperfusion injury in rat hearts perfused with pre- and post-TENS plasma dialysate obtained from the patients using Langendorff perfusion system. The cardioprotective effects of TENS were determined by assessing reduction in infarct size following treatment.ResultsThere were no differences in myocardial infarct size between pre- and post-treatment in any group (41.4 ± 4.3% vs. 36.7 ± 5.3%, 39.8 ± 7.3% vs. 27.8 ± 12.0%, and 41.6 ± 2.2% vs. 37.8 ± 7.6%; p = 0.080, 0.152, and 0.353 in the pre-anesthesia, sevoflurane, and propofol groups, respectively).ConclusionsIn our study, TENS did not show a cardioprotective effect in patients undergoing aortic valve replacement surgery.Trial registrationThis study was registered at clinicaltrials.gov (NCT03859115, on March 1, 2019).

44 Early and Long-Term Outcomes of Re-Sternotomy Aortic Valve Replacement (AVR) With Previous Coronary Artery Bypass Grafts (CABG)

Abstract Introduction With the wider use of biological prosthetic valves and increasing life expectancy, the number of patients requiring redo surgery for aortic valve replacement (AVR) is increasing. This carries its own risks particularly in those with previous cardiac surgery - from graft injury and myocardial jeopardy. Transcatheter valve replacement provides a safer option for high-risk patients that do not require any additional cardiac surgery. This project aims to evaluate the early and long-term outcomes of redo-sternotomy AVR after previous CABG. Method Retrospective study of patients that underwent redo sternotomy AVR with (Group 1) or without (Group 2) concomitant cardiac procedure(s) from 2000–2019. Pre-operative, operative and post-operative data collected for each patient. Statistical analysis done with significance p-value &amp;lt;0.15. Results 178 patients included during this time-period (Group 1 = 90 and Group 2 = 88). Mean age of 75 years and EuroSCORE of 17. In hospital-mortality was 7.8% with key contributing factors of heart failure (NYHA III-V), perioperative IABP insertion and cardiovascular injury - 12% of cases and most commonly effecting the left internal mammary artery (LIMA). Survival at 5 years in both groups is significantly worse for patients with post-operative complications and cardiovascular injury. However, long-term survival is better in Group 1 than in Group 2. Conclusions Risk of injury to LIMA increases operative mortality. Peripheral cannulation and pre-sternotomy cardiopulmonary bypass can help manage this - although numbers in this study too small. Alternatives to redo valve surgery are to be considered in high-risk patients and a multidisciplinary approach continued to be adopted for each case.

Use of a sutureless aortic valve in reoperative aortic valve replacement.

ObjectivesManagement of degenerated bioprosthetic aortic valves remains a challenge. Valve-in-valve transcatheter aortic valve replacement (AVR) has limited utility in the presence of small annuli/prosthetic valves. Sutureless valves may offer an advantage over traditional redo AVR by maximizing effective orifice area due to their unique design as well as ease of implant.MethodsTwenty-two patients undergoing redo AVR received a sutureless valve in our institution over the past 5 years. All patients were determined to be poor candidates for valve-in-valve transcatheter AVR due to a combination of small annulus size, low coronary heights, and/or underlying valve characteristics (ie, mechanical valves).ResultsMedian time from implant to redo AVR was 8 years. One patient died within 30 days. In the 13 patients who had a 21 mm or smaller valve explanted, 5 small, 7 medium, and 1 large Perceval valves were implanted (all with larger internal diameters than the explanted valve). The average postoperative gradient of the cohort valves was 14.8 mm Hg compared with 38.8 mm Hg preoperatively.ConclusionsIn addition to their ease of use and rapid deployment, sutureless bioprosthetic aortic valves offer significant physiological advantages in patients with degenerated prosthetic aortic valves and small anatomical annuli. It can also simplify the surgical approach to redo AVR following a Bentall procedure. If long-term durability is confirmed, sutureless valves should be considered in a broader population of patients for both redo and primary aortic valve replacement surgery.

Pericardial Fluid Annexin A1 Is a Marker of Atrial Fibrillation in Aortic Stenosis: A Proteomics Analysis.

Atrial fibrillation (AF) is the most common arrhythmia with adverse clinical outcomes. Pericardial fluid (PF) mirrors the heart’s pathophysiological status due to its proximity. This study aimed to characterise the PF proteome to identify new biomarkers of disease. Eighty-three patients submitted to aortic valve replacement surgery with severe aortic stenosis were selected, and their baseline echocardiographic and clinical variables were documented. Thirteen samples were selected blindly for proteome characterisation following a shotgun (GeLC–MS/MS) and a label-free quantification approach (LFQ). According to previous AF history, a partial least squares discriminant analysis (PLS-DA) was conducted, and the top 15 variables important in projection were identified. To inquire potential biomarkers, ROC curves were designed using LFQ data. Target proteins were further validated by ELISA, in both pericardial fluid and serum. Proteome analysis uncovered nine proteins up- and downregulated ≥2-fold. Annexin A1, annexin A2, and vimentin were among the top 15 most important variables for group discrimination in PLS-DA. Protein—protein interaction and gene ontology enrichment analysis presented functional interaction among identified proteins, which were all part of focal adhesion sites. Annexin A1 was increased in the pericardial fluid of AF patients but not in serum when quantified by ELISA. Annexin A1 is a novel pericardial fluid biomarker of AF in patients with severe aortic stenosis.

Machine learning predicts all-cause mortality in patients with severe aortic regurgitation

Abstract Funding Acknowledgements Type of funding sources: None. Background Aortic regurgitation (AR) is a common valvular lesion associated with left ventricular (LV) enlargement and dysfunction and increased risk of death with onset of symptoms, significant LV enlargement, or systolic dysfunction. The current guidelines are based on symptoms, LV size and LV function to evaluate the candidacy for surgery in patients with severe AR. Purpose We propose a machine-learning (ML) based algorithm to identify patients at risk for death from AR independent of aortic valve replacement (AVR) surgery (patients were censored at AVR event unless the operation occurred within 100 days of the first visit, in which case baseline AVR is included as a predictor). Methods The model was trained with 5-fold cross-validation on a dataset of 1035 patients. Model performance is reported on an independent dataset of 207 patients. Optimal predictive performance was observed with a Conditional Random Survival Forest model. A subset of 19 / 41 variables were selected for inclusion in the final model. Variable selection was performed with 10-fold cross validation using Random Survival Forest model; variables that were on an average selected by less than 6/10 splits were excluded. Results The mean age of patients was 60 ± 17 years and 198 (18%) were females. The variables included in the models were age, end-diastolic volume, end systolic dimension, body surface area, ejection fraction, NYHA class, body mass index, diastolic blood pressure, bicuspid valve, regurgitant volume, filling pressure, mid ascending aorta diameter, mitral tissue early relaxation velocity, pulmonary artery systolic pressure, and comorbidities, and the relative variable importances averaged across five splits of cross validation in each repeat were evaluated (Figure). The predictive AUC for predicting survival of the best-performing model was 0.84 at 1 year, 0.86 at 2 years, and 0.87 overall, respectively. Conclusion Using commonly observed echo parameters and patient characteristics we successfully trained a ML model to predict survival in patients with severe AR. This technique could identify high-risk patients who would benefit from early intervention, thereby improving patient outcomes. Abstract Figure.

Послеоперационная мозговая дисфункция при протезировании аортального клапана сердца

Study Objective: To study the incidence and the structure of the postoperative cerebral dysfunction after open and endovascular aortic valve replacement surgery, and to identify the risk factors and the methods of prevention of postoperative cerebral dysfunction after the open aortic valve replacement surgery. Study Design: Prospective cohort study. Materials and Methods. The study involved 114 patients (92 men and 22 women) aged 67 [58; 76] years, who undergone elective aortic valve replacement surgery. All patients were divided into three groups: “open surgery” (n = 82), “cerebroprotection” (n = 16) and “X-ray surgery” (n = 16). In the “open surgery” and “cerebroprotection” groups, patients undergo open aortic valve replacement surgery with cardiopulmonary bypass, in the “X-ray surgery” group transcatheter aortic valve implantation is performed. In the “cerebroprotection” group patients additionally received the 1.5% solution of meglumine sodium succinate in the early postoperative period. Study Results. The postoperative cerebral dysfunction was diagnosed in 41.2% of patients, the incidence of the postoperative cerebral dysfunction did not differ in the study groups. In the group “cerebroprotection” there was a shorter duration of symptomatic delirium of the early postoperative period (p = 0.0441) compared with the group “open surgery”. We identified 18 risk factors for postoperative cerebral dysfunction and its clinical types and two cerebroprotective factors — a body mass index more than 25 kg/m2 and the use of the meglumine sodium succinate in the early postoperative period. Conclusion. Aortic valve replacement surgery is characterized by the high incidence of the postoperative cerebral dysfunction, further improvement of the methods of the perioperative cerebroprotection is required. Keywords: postoperative cerebral dysfunction, perioperative stroke, symptomatic delirium of the early postoperative period, postoperative cognitive dysfunction, perioperative cerebroprotection, aortic valve replacement.

Brainstem stroke in a Nigerian male with prosthetic heart valves—A case report

Stroke following cardiac surgery particularly valvular implantation is an anticipated complication. This is due to the prosthetic valve as well as possible associated comorbid conditions. There is dearth of published data on stroke post valve replacement surgery in Nigeria. There is no general consensus on the role of antiplatelet agents in combination with anticoagulant therapy in at-risk patients. Our paper documents the case of a 46-year-old male hypertensive, who in 2016 had mitral and aortic valve replacement surgery in a Tertiary Teaching Hospital and presented in May 2020 with sudden onset abnormal tongue sensation and double vision. A left internuclear ophthalmoplegia with bilateral torsional nystagmus was evident. Brain magnetic resonance imaging confirmed pontine lacunar infarction. There were no intracardiac clots on echocardiography. He had full resolution of deficits following treatment with anticoagulants. This case report demonstrates that ischemic stroke can occur in people with prosthetic heart valve and that other comorbid risk factors may be contributory. Anticoagulation therapy is important, though there is no consensus on time of starting therapy and the role of adjunctive antiplatelet combination therapy in such patients. Individualized therapy should be based on the type of implant, numbers, and location of valve replaced, comorbid clinical conditions, and the risk of hemorrhagic transformation.

Tuberculous Aortic Aneurysm - A Review.

IntroductionTuberculous aortic aneurysm (TBAA) is an exceedingly rare but severe manifestation of tuberculosis, with a high risk of sudden rupture of the aorta in absence of medical or surgical intervention. This review aimed to provide a detailed understanding of TBAA, including its associated complications, affected population, treatment measures, and outcomes.MethodsCase studies and relevant research articles were analyzed to understand the recent advances in medical scientific knowledge on TBAA. Recent clinical case reports on TBAA were searched from the year 2010 to 2020.ResultsCase reports indicated a higher prevalence of TBAA in the male population. The most affected age group was 15 to 79 years. The most common treatment for TBAA included surgery followed by antituberculous medication. The case reports discussed in this review reflected open surgery, endovascular repair, coil embolization, laparotomy, aortic valve and root replacement as some of the surgical procedures used depending on the complication and type of aneurysm. The treatment outcome was considered effective in most cases.ConclusionPostoperative chemotherapy and medications reduce the risk of severity. Early diagnosis of TBAA is imperative, followed by surgical resection and postoperative antituberculous medication with careful follow-up to prevent relapse.

A comparative study between mini versus full sternotomy aortic valve replacement

BackgroundAortic valve replacement for treatment of aortic valve diseases is quite common. Minimally invasive procedures have gained a lot of popularity in recent years with the claimed better early postoperative outcomes in comparison with conventional techniques.ObjectiveThe aim was to compare early postoperative outcomes after ministernotomy versus conventional median sternotomy aortic valve replacement.Patients and methodsThe authors prospectively studied 60 patients who underwent aortic valve replacement surgery at the National Heart Institute between the period of May 2020 and July 2021. A total of 30 patients had aortic valve replacement via upper ministernotomy approach, whereas the other 30 patients had aortic valve replacement using conventional median sternotomy. Early postoperative results were compared with each other.ResultsThere was no morality throughout the study. The mean age was 45.8 ± 15.13 years in the conventional group and 51.13 ± 17.8 in the ministernotomy group. Perioperative data showed no significant difference between the two groups, except for aortic orifice (root) diameter, which was wider in the ministernotomy group. The cross-clamp time was 60.33 ± 8.27 in the conventional group and 70.66 ± 6.91 in the ministernotomy group, and the total bypass time was 77.0 ± 8.46 and 88.1 ± 9.55, respectively, with significant difference between the two groups. Postoperative pain levels showed a statistically significant difference and were less severe in the ministernotomy group, and the total hospital stay was shorter in the ministernotomy group, with significant difference between the two groups.ConclusionThe use of upper ministernotomy approach to replace a diseased aortic valve is safe and can be compared with the conventional median sternotomy approach.