Logistic EuroSCORE Research Articles

Analyzing current German transcatheter and surgical aortic valve replacement practices in pure aortic regurgitation

Abstract Background In Germany, the use of transcatheter aortic valve replacement (TAVR) for treating pure aortic regurgitation is still not regular practice. Purpose Therefore, the current development of TAVR in aortic regurgitation is to be investigated. Methods In 2018–2020, 4,025 surgical aortic valve replacements (SAVR), 50 transapical, 329 balloon-expandable transfemoral, and 457 self-expanding transfemoral TAVR in pure aortic regurgitation were studied using multivariable logistic and linear regressions. Results The TAVR groups had a higher age than SAVR (76.0-77.3a vs 62.8a) and logistic EuroSCORE (17.7-19.1 vs 4.9%). Unadjusted in-hospital mortality was highest in transapical TAVR (6.0%), followed by SAVR (5.7%), and it was lowest in transfemoral TAVR, with self-expanding procedures (2.4%) showing significantly lower in-hospital mortality than balloon-expandable (5.2%; p=0.039). After risk adjustment, we saw a significant association with lower mortality rates for balloon-expandable as well as self-expanding transfemoral TAVR vs SAVR (balloon-expandable: OR=0.50, p=0.031; self-expanding: OR=0.20, p<0.001). In the same way, we found that other examined outcomes were significantly in favor of TAVR: stroke (balloon-expandable: OR=0.17, p<0.001; self-expanding: OR=0.17, p<0.001), major bleeding (balloon-expandable: OR=0.04, p<0.001; self-expanding: OR=0.03, p<0.001), delirium (balloon-expandable: OR=0.19, p<0.001; self-expanding: OR=0.16, p<0.001), mechanical ventilation >48h (balloon-expandable: OR=0.09, p<0.001; self-expanding: OR=0.06, p<0.001), and length of hospital stay (balloon-expandable: Coefficient=-6.88d, p<0.001; self-expanding: Coefficient=-7.22d, p<0.001). Conclusion Despite lower procedure volumes in TAVR vs SAVR for pure aortic regurgitation, we see lower rates of in-hospital mortality and complications, suggesting that TAVR can be used successfully in selected patients with aortic regurgitation.

Abstract 14768: Elevated Baseline Serum High Sensitivity Cardiac Troponin Levels and Mortality Post Transcatheter Aortic Valve Replacement: A Meta-Analysis

Introduction: High-sensitive cardiac troponins (hs-cTn) have been associated with worse prognosis and increased mortality post transcatheter aortic valve replacement (post-TAVR). However, limited data on the association prompted us to perform a meta-analysis for further understanding. Methods: PubMed, SCOPUS and Google Scholar were searched until May 2023 using relevant keywords. A random effects model was employed to estimate the odds of pooled pre-procedural hs-cTn levels and post-TAVR mortality. Inter-study heterogeneity was assessed using I2 statistics, and leave-one-out sensitivity analysis was performed with a significance level of p<0.05 Results: The final analysis included six studies (n=4672) with a mean age of 82.7±5.6 and 46% female participants. There are 2 retrospective and 3 prospective studies with median follow up of 1 year. The population exhibited a high prevalence of hypertension, hyperlipidemia, and diabetes. All individuals who underwent TAVR had aortic valve area measuring <1cm2. The combined mean logistic EuroSCORE was calculated as 20.91%±12.88. An increase in pre-procedural hs-cTn levels was associated with significantly higher unadjusted (OR 2.29, 95% CI 1.85-2.84, p<0.01, I2=61.34%) and adjusted odds (aOR 2.01, 95%CI 1.62-2.50, p<0.01, I2=52.81 %) of post-TAVR mortality (Fig. 1). Subgroup analysis revealed elevated mortality risk in both retrospective (OR 1.86, 95% CI: 1.33-2.60, p<0.01) and prospective (OR 2.21, 95% CI: 1.62-3.01, p<0.01) studies (Fig. 1). Furthermore, increased mortality risk persisted during both short-term (less than 2 years; OR 1.86, 95% CI: 1.33-2.60, p<0.01) and long-term (more than 2 years; OR 2.21, 95% CI: 1.62-3.01,p<0.01) follow-up (Fig. 1). Leave-one out sensitivity analysis confirmed the robustness of findings. Conclusion: This meta-analysis provides compelling evidence that elevated pre-procedural levels of hs-cTn serve as a significant predictor of post-TAVR 1-year mortality.

Implantation depth of balloon-expandable transcatheter heart valves and risks for permanent pacemaker implantation and midterm adverse events.

Permanent pacemaker implantation (PPI) remains a relevant complication after transcatheter aortic valve implantation (TAVI) and its impact on outcome remains controversial. This study aimed to analyze the effects of implantation depth on PPI at 30 days and assess its impact on outcome with the balloon-expandable Sapien 3 (S3) prosthesis. Between 2014 and 2018, 849 patients without previous pacemaker undergoing transfemoral TAVI with the S3 were included. Prosthesis implantation depth was measured and divided into Quintiles. An ordinal logistic regression was used to assess its association with PPI, while a multivariate logistic regression was performed to identify predictors of PPI. Survival analyses were performed with the Kaplan-Meier method and a multivariable Cox regression was performed to ascertain the impact of PPI on mortality. Overall, incidence of PPI at 30 days was 9.7%. Implantation depth decreased consistently from a median of 6.7 mm [5.55-8.00] in 2014 to 2.7 mm [2.30-3.50] in 2018 (p < 0.001). When considering Quintiles of implantation depth, incidence of PPI was significantly higher in upper Quintiles and risk for PPI was significantly lower for the 1. Quintile compared to the 5. Quintile (OR: 0.34, 95% CI: [0.16-0.73]; p = 0.003). In the adjusted multivariable logistic regression implantation depth persisted ad independent predictor of PPI at 30 days. Patients requiring PPI at 30 days displayed significantly higher mortality at 4 years compared to patients without PPI (49.5% vs. 40.0%; log-rank = 0.022). In a multivariate analysis, increased logistic EuroScore, diabetes mellitus, and history of atrial fibrillation, were independent predictors of all-cause mortality at 2 years. Higher prosthesis implantation relative to the virtual aortic annulus was significantly associated with reduced risk for PPI at 30 days. Patients with PPI at 30 days exhibited higher mortality during follow-up, however, only logistic EuroScore, diabetes mellitus, and history of atrial fibrillation were identified as independent predictors of mortality at 2 years.

Preoperative Imaging Signs of Cerebral Malperfusion in Acute Type A Aortic Dissection: Influence on Outcomes and Prognostic Implications-A 20-Year Experience.

Acute type A aortic dissection (ATAAD) continues to be a subject of active research due to its high mortality rates and associated complications. Cerebral malperfusion in ATAAD can have a devastating impact on patients' neurological function and overall quality of life. We aimed to explore the risk profile and prognosis in ATAAD patients presenting with preoperative imaging signs of cerebral malperfusion (PSCM). We obtained patient data from our Aortic Dissection Registry, which included 480 consecutive ATAAD cases who underwent surgical repair between 2001 and 2021. Primary endpoint outcomes included the in-hospital and 30-day mortality, postoperative new neurological deficit, mechanical ventilation hours, and intensive care unit (ICU) length of stay. Of the total cohort, 82 patients (17.1%) had PSCM. Both groups had similar distributions in terms of age, sex, and body mass index. The patients in the PSCM group presented with a higher logistic EuroSCORE (47, IQR [31, 64] vs. 24, IQR [15, 39]; p < 0.001) and a higher portion of patients with a previous cardiac surgery (7.3% vs. 2.0%; p = 0.020). Intraoperatively, the bypass, cardioplegia, and aortic cross-clamp times were similar between both groups. However, the patients in the PSCM group received significantly more intraoperative packed red blood cells, fresh frozen plasma, and platelets transfusions (p < 0.05). Following the surgery, the patients who presented with PSCM had markedly longer ventilation hours (108.5 h, IQR [44, 277] vs. 43 h, IQR [16, 158], p < 0.001) and a significantly longer ICU length of stay (7 days, IQR [4, 13] vs. 5 days, IQR [2, 11]; p = 0.013). Additionally, the patients with PSCM had significantly higher rates of postoperative new neurological deficits (35.4% vs. 19.4%; p = 0.002). In the Cox regression analysis, PSCM was associated with significantly poorer long-term survival (hazard ratio (HR) 1.75, 95%CI [1.20-2.53], p = 0.003). Surprisingly, hypertension was shown as a protective factor against long-term mortality (HR: 0.59, 95%CI [0.43-0.82], p = 0.001). PSCM in ATAAD patients is linked to worse postoperative outcomes and poorer long-term survival, emphasizing the need for early recognition and tailored management.

Transaxillary versus transfemoral access as default access in TAVI: A propensity matched analysis

BackgroundTransfemoral (TF) access is default in transcatheter aortic valve implantation (TAVI). Transaxillary (TAx) access has been shown to be a safe alternative in case of prohibitive iliofemoral anatomy, but whether TAx as preferred access has similar safety and efficacy as TF access is unknown. The aim of this study was to compare outcomes between patients treated with self-expanding devices using TF or TAx route as preferred access in TAVI. MethodsA single center cohort of 354 patients treated using TAx as preferred access and a multi-center cohort of 5980 patients treated using TF access were compared. Propensity score matching was used to reduce selection bias and potential confounding. After propensity score matching, each group consisted of 322 patients. Clinical outcomes according to VARC-2 were compared using chi-square test. ResultsIn 6334 patients undergoing TAVI, mean age was 81.4 ± 7.0 years, 57% was female and median logistic EuroSCORE was 14.7% (IQR 9.5–22.6). In the matched population (age 79.3 ± 7.0, 50% female, logistic EuroSCORE 13.4%, IQR 9.0–21.5), primary outcomes 30-day and one-year all-cause mortality were similar between Tax and TF groups (30 days: 5% versus 6%, p = 0.90; 1 year: 20% versus 16%, p = 0.17). Myocardial infarction was more frequent in patients undergoing Tax TAVI compared with TF (4% versus 1%, p = 0.05), but new permanent pacemakers were less frequently implanted (12% versus 21%, p = 0.001). ConclusionTAx as preferred access is feasible and safe with outcomes that are comparable to TF access.

Postoperative delirium in 47379 individuals undergoing transcatheter aortic valve replacement: a systematic review and meta-analysis.

The study aims to discuss the assessment methods used for the incidence of in-hospital postoperative delirium (IHPOD) in transcatheter aortic valve replacement (TAVR) patients and explore possible strategies for preventing and reducing postoperative complications in the geriatric population. An electronic search of PubMed, Embase, BioMedCentral, Google Scholar, and the Cochrane Central Register of Controlled Trials was conducted up to August 2021, to identify studies on the IHPOD following TAVR in patients above 70 years. The primary objective of the study was to determine the incidence of delirium following TAVR and procedures like transfemoral (TF) and non-TF approaches. The secondary objectives were to determine the incidence of stroke and incidence according to the confusion assessment method (CAM) diagnostic tool. The authors only included studies published in English and excluded patients with comorbidities and studies with inaccessible full-text. Among the selected 42 studies with 47379 patients, the incidence of IHPOD following TAVR was 10.5% (95% CI: 9.2-11.9%, I2=95.82%, P<0.001). Incidence based on CAM was 15.6% (95% CI: 10.5-20.7%, I2=95.36%, P<0.001). The incidence of IHPOD after TF-TAVR was 9.3% (95% CI: 7.6-11.0%, I2=94.52%, P<0.001), and after non-TF TAVI was 25.3% (95% CI: 15.4-35.1%, I2=92.45%, P<0.001). The incidence of stroke was 3.7% (95% CI: 2.9-4.5%, I2=89.76%, P<0.001). Meta-regression analyses between mean age (P=0.146), logistic EuroSCORE (P=0.099), or percentage of participants treated using the TF approach (P=0.276) were nonsignificant while stroke (P=0.010) was significant. When considering these variables, the residual heterogeneity remained high indicating that other variables influence the heterogeneity. IHPOD following TAVR was observed in 10.5% of individuals and in 15.6% using CAM. Its incidence was found to be three times higher after non-TF TAVR (25.3%) compared to TF TAVR (9.3%). Stroke showed an incidence of 3.7% after TAVR and was found to be significantly associated with the risk of developing delirium following TAVR. Further studies are needed to evaluate possible causes and risk factors responsible for delirium and to assess the role of anesthesia and cerebral embolic protection in preventing delirium after TAVR.

Transcatheter Aortic Valve Implantation with the Portico Valve: 2-Year Outcomes of a Multicenter, Real-World Registry.

The self-expanding, resheathable, repositionable transcatheter aortic heart valve Portico is being used successfully for transcatheter aortic valve implantation procedures (TAVI) in patients with severe aortic stenosis. The aim of this study was to evaluate outcomes at 2 years after TAVI with the Portico valve. Multicenter registry of clinical, echocardiographic and survival data from consecutive patients treated with the Portico TAVI system (Abbott, Chicago, IL, USA) in three cath labs in Northern Greece and Epirus during 2017-2020. The primary end point was all-cause mortality at 24 months. Secondary end points included procedural outcomes (efficacy and safety) and echocardiographic measurements. A total of 90 patients (81 ± 6 years, 50% females, mean age 81 ± 6 years) were included in the registry. The indication for implantation was severe, symptomatic aortic stenosis (NYHA III, IV) in eighty-two (91.1%) and degeneration of a prosthetic aortic valve in eight (8.9%) patients. All patients were categorized as high surgical risk (mean Logistic Euroscore 25.9 ± 10, Euroscore II 7.7 ± 4.4 and STS score 10.8 ± 8.9). The procedure was performed transfemorally in all patients, under general anesthesia in 95.6%, under TOE guidance in 21.1%, with native valve predilatation in 46.7%, and the "resheath" option was used in 31.1% of the cases. The implantation was successful in 97.8% and there was a need for a second valve in 2.2% of the cases. Complications included permanent pacemaker implantation (16.7%), access cite complications (15.6%), arrythmias (23.3%), paravalvular leak (moderate 7.8%, severe 1.1%), acute kidney injury (7.8%), no strokes and one death during the procedure. Aortic valve peak velocity, peak and mean pressure gradients, were significantly reduced after the procedure. All-cause mortality at 1, 12 and 24 months was 4.4%, 6.7% and 7.8%, respectively. TAVI with the Portico system comprises an effective and safe solution for the management of severe, symptomatic aortic stenosis in high-risk surgical patients.

Assessment of the Effectiveness of Zone 1-Landing Hybrid TEVAR by Comparing Its Outcomes with Those of Zone 2-Landing Hybrid TEVAR.

Background: Hybrid thoracic endovascular aortic repair (TEVAR) without median sternotomy is increasingly being performed in high-risk patients with aortic arch disease. The outcomes of hybrid TEVAR were reported to be worse with a more proximal landing zone. This study aims to clarify the effectiveness of zone 1-landing hybrid TEVAR by comparing the outcomes of zone 2-landing hybrid TEVAR. Methods: From April 2008 to October 2020, 213 patients (zone 1: zone 1-landing hybrid TEVAR, n = 82, 38.5%; zone 2: zone 2-landing hybrid TEVAR, n = 131, 61.5%) were enrolled (median age, 72 years; interquartile range [IQR], 65-78 years), with a median follow-up period of 6.0 years (IQR, 2.8-9.7 years). Results: The mean logistic EuroSCORE was 20.9 ± 14.8%: the logistic EuroSCORE of the zone 1 group (23.3 ± 16.1) was significantly higher than that of the zone 2 group (19.3 ± 12.4%, p = 0.045). The operative time and hospital stay of the zone 1 group were significantly longer than those of the zone 2 group. On the other hand, the in-hospital and late outcomes did not differ significantly between the two groups. There were no significant differences in cumulative survival (66.8% vs. 78.0% at 10 years, Log-rank p = 0.074), aorta-related death-free rates (97.6% vs. 99.2% at 10 years, Log-rank p = 0.312), and aortic event-free rates (81.4% vs. 87.9% at 10 years, Log-rank p = 0.257). Conclusions: Zone 1- and 2-landing hybrid TEVAR outcomes were satisfactory. Despite the high procedural difficulty and surgical risk, the outcomes of zone 1-landing hybrid TEVAR were equal to those of zone 2-landing hybrid TEVAR. If the surgical risk is high, zone 1-landing hybrid TEVAR should not be avoided.

10-year results of simultaneous combined procedures of coronary artery stenting and transcatheter aortic valve implantation: a clinical case

Introduction. In recent years, transcatheter aortic valve implantation (TAVI) has become routine clinical practice in treatment of severe aortic stenosis in patients with high surgical risk. Timing of endovascular procedures is a key issue in management of patients with severe aortic valve stenosis and concomitant coronary heart disease. To date, there is no consensus on the advisability and necessity of performing simultaneous procedures of TAVI and coronary artery stenting. The long-term (over 10 years) outcomes of combined percutaneous coronary interventions in patients with severe aortic stenosis and coronary heart disease are not fully studied. Results and Methods. We described a long-term outcome in a 75-year-old female patient with marked aortic stenosis (maximum gradient = 103 mm Hg, mean gradient = 62 mm Hg, AVA area = 0.37 cm2), NYHA class II and hemodynamically significant coronary lesions. Given the high surgical risk (logistic EuroScore = 27.72%, STS = 17.21%), the patient underwent the following simultaneous procedures upon vital indications: coronary artery stenting and transcatheter aortic valve implantation with 23-mm Edwards Sapien XT prosthesis. There were no major intra- and perioperative complications. At the control examination 7 months later, the patient had no complaints. She reported an improvement in general well-being and increased tolerance of physical activities. The transprosthetic aortic blood flow parameters were as follows: peak gradient = 13 mm Hg; mean gradient = 7 mm Hg; V max = 1.8 m/s; there were 2 paraprosthetic fistulas with Grade 1–2 regurgitation. A control angiogram showed no restenosis in the coronary artery stents. 10 years after simultaneous interventions, hemodynamic parameters of the functioning aortic valve prosthesis were within the normal ranges. Control coronary angiography revealed satisfactory outcomes of coronary artery stenting. Conclusions. Simultaneous procedure of transcatheter aortic valve implantation combined with coronary artery stenting is feasible, effective, and safe. This technique can be used to treat patients with extremely high risk for open heart surgery. Keywords: aortic stenosis, transcatheter aortic valve implantation, coronary heart disease, coronary arteries, single-stage endovascular procedures

The Impact of Gender and Age in Obese Patients on Sternal Instability and Deep-Sternal-Wound-Healing Disorders after Median Sternotomy.

The aim of this study was to investigate the relationship between age and sex in regard to the development of deep sternal wound infections and sternal instability following median sternotomy. A propensity-score-matching analysis was conducted on 4505 patients who underwent cardiac surgery between 2009 and 2021, all of whom had a BMI of ≥30 kg/m2. A total of 1297 matched pairs were determined in the sex group, and 1449 matched pairs we determined in the age group. The distributions of sex, age, diabetes mellitus, delirium, unstable sterna, wire refixation, wire removal, superficial vacuum-assisted wound closure, deep vacuum-assisted wound closure, clamp time, bypass time, logistic EuroSCORE, and BMI were determined. The 30-day in-hospital mortality was found to be similar in the older and younger groups (8.149% vs. 8.35%, p = 0.947), and diabetes mellitus was also equally distributed in both groups. However, postoperative delirium occurred significantly more often in the older group (29.81% vs. 17.46%, p < 0.001), and there was a significantly higher incidence in men compared with women (16.96% vs. 26.91%, p < 0.001). There were no differences found in the incidence of sternum instability, fractured sternum, superficial vacuum-assisted wound closure, and deep vacuum-assisted wound closure between the age and sex groups. In conclusion, this study found that sternal instability and deep-wound-healing problems occur with equal frequency in older and younger patients and in men and women following median sternotomy. However, the likelihood of postoperative delirium is significantly higher in older patients and in men. These findings suggest that a higher level of monitoring and care may be required for these high-risk patient groups to reduce the incidence of postoperative delirium and improve outcomes following median sternotomy.

Sutureless Aortic Valve Prosthesis in Redo Procedures: Single-Center Experience.

Background and Objectives: Sutureless aortic valve prostheses have presented favorable hemodynamic performance while facilitating minimally invasive access approaches. As the population ages, the number of patients at risk for aortic valve reoperation constantly increases. The aim of the present study is to present our single-center experience in sutureless aortic valve replacement (SU-AVR) in reoperations. Materials and Methods: The data of 18 consecutive patients who underwent SU-AVR in a reoperation between May 2020 and January 2023 were retrospectively analyzed. Results: The mean age of the patients was 67.9 ± 11.1 years; patients showed a moderate-risk profile with a median logistic EuroSCORE II of 7.8 (IQR of 3.8-32.0) %. The implantation of the Perceval S prosthesis was technically successful in all patients. The mean cardiopulmonary bypass time was 103.3 ± 50.0 min, and the cross-clamp time was 69.1 ± 38.8 min. No patients required a permanent pacemaker implantation. The postoperative gradient was 7.3 ± 2.4 mmHg, and no cases of paravalvular leakage were observed. There was one case of intraprocedural death, while the thirty-day mortality was 11%. Conclusions: Sutureless bioprosthetic valves tend to simplify the surgical procedure of a redo AVR. By maximizing the effective orifice area, sutureless valves may present an important advantage, being a safe and effective alternative not only to traditional surgical prostheses but also to transcatheter valve-in-valve approaches in select cases.

Validation of the TRI-SCORE in patients undergoing surgery for isolated tricuspid regurgitation

IntroductionEstimation of peri-procedural risk in patients with tricuspid regurgitation (TR) undergoing isolated tricuspid valve surgery (ITVS) is of paramount importance. The TRI-SCORE is a new surgical risk scale specifically developed...

P346 MINIMALLY INVASIVE APPROACH FOR THE SURGICAL TREATMENT OF COMBINED MITRAL AND AORTIC VALVE DISEASE

Abstract Background Minimally invasive approaches are more and more used for isolated aortic or mitral valve procedures. However, minimally invasive combined mitral and aortic valve surgery is still uncommon. We report our experience performing multiple valve procedures through a right–sided mini–thoracotomy. Methods From November 2013 to July 2022, 32 patients underwent aortic and mitral valve surgery through right anterior thoracotomy. Results Median (Q1–Q3) age of our population was 71 years (59,5–76) and 59% were females. Median (Q1–Q3) logistic Euroscore was 3.99 (2.52–6.76) and median (Q1–Q3) EuroSCORE II was 2.28 (1.81–5.42). Three patients (9%) were redo operations. Median cardiopulmonary bypass and cross–clamp times were 95 (83–118) minutes and 83 (71–104) minutes, respectively. No conversion to full sternotomy was necessary. In–hospital mortality was 3.1% (1 patient) who died for septic shock and consequent multi–organ failure. 62% of patients required transfusions with packed blood cells. Post–operative atrial fibrillation was observed in 8 patients (25%) and 2 patient (6%) required Pace–maker implantation due to third degree AV block. Also, 1 (3%) re–thoracotomy for bleeding was observed. Median (Q1–Q3) intensive care unit and in–hospital length of stay were 2 (2–3) days and 9 (8–11) days respectively. Median follow up period was 5.5 years (1.4–6.3) with 87.5% survival rate (incidence rate of death: 2.8 per 100 patient–years). Re–operation rate was 9.4%. Conclusions In our experience, a minimally invasive approach for combined aortic and mitral valve surgery is safe and feasible, with acceptable cardiopulmonary bypass and cross–clamp times and good outcomes. Therefore, it can be an attractive option for patients with double valve diseases. Further studies are needed with a bigger population and a comparison to full sternotomy results.

Preoperative hypoalbuminemia and postoperative acute kidney injury in adult patients after elective on-pump cardiac surgery

Abstract Funding Acknowledgements Type of funding sources: None. Background An earlier published prospective cohort study evaluating the impact of malnutrition on cardiac surgery outcomes showed serum albumin ≤42 g/dL to be associated with a poor prognosis [1]. However, the association with kidney outcomes was not studied. The adverse effect of preoperative hypoalbuminemia on postoperative kidney injury and its cut-off value in on-pump cardiac surgery patients is still controversial [2]. Methods A retrospective matched case-control study based on the secondary analysis of the open-access dataset [3] was conducted. The research hypothesis was that preoperative hypoalbuminemia is independently associated with a higher risk of acute kidney injury (AKI) requiring postoperative new-onset dialysis. We defined cases as patients treated with new-onset dialysis for AKI and controls as those who did not. Hypoalbuminemia was defined as serum albumin of ≤42 g/L based on findings from the original study. The dataset counted 1178 adults from multiple centers who underwent elective cardiopulmonary bypass (CPB) cardiac surgery in 2011. We excluded patients with missing data and compared key demographic and medical history characteristics. Following the hypothesis, subjects were matched on the type of surgery they received (coronary, valvular, or combined) in a multiple conditional logistic regression model that included the hypoalbuminemia status, diabetes history, CPB time, and logistic EuroScore. Additionally, univariate regression with and without conditional matching was performed. Results In total, 831 (39 cases and 792 controls) subjects were included. Subjects shared similar demographics and medical history. Expectedly, cases had prolonged CPB and aortic cross-clamp time. The median CPB time in cases and controls was 120 and 79 min, respectively (p=0.001). The median aortic cross-clamp time was 79 in cases and 54 in controls (p=0.001). Hypoalbuminemia was observed in 18 cases (46%) in cases compared to 241 (30%) in controls (p=0.038). Multiple conditional regression demonstrated that the risk of postoperative AKI requiring dialysis was not associated with preoperative hypoalbuminemia (OR 1.43, [0.70, 2.89]). Similarly, univariate conditional regression showed no association (OR 1.84 [0.95, 3.53]). Only univariate unmatched regression resulted in statistical significance(OR 1.96 [1.03, 3.74]). The higher logistic EuroScore (OR 1.11, [1.06, 1.15]) and the longer cardiopulmonary bypass time (OR 1.01, [1.01, 1.02]), but not the history of diabetes (OR 0.61, [0.19, 1.88]), increased the odds of renal replacement therapy requirement. Conclusion In our study, preoperative hypoalbuminemia was not independently associated with a higher risk of postoperative AKI requiring new-onset dialysis after elective on-pump cardiac surgery. Patients who required dialysis had lower preoperative albumin levels, but the association between hypoalbuminemia ≤ 42 g/L and kidney outcomes could be confounded.

Treatment of pure aortic regurgitation using surgical or transcatheter aortic valve replacement between 2018 and 2020 in Germany.

In pure aortic regurgitation, transcatheter aortic valve replacement (TAVR) is not yet used on a regular base. Due to constant development of TAVR, it is necessary to analyze current data. By use of health records, we analyzed all isolated TAVR or surgical aortic valve replacements (SAVR) for pure aortic regurgitation between 2018 and 2020 in Germany. 4,861 procedures-4,025 SAVR and 836 TAVR-for aortic regurgitation were identified. Patients treated with TAVR were older, showed a higher logistic EuroSCORE, and had more pre-existing diseases. While results indicate a slightly higher unadjusted in-hospital mortality for transapical TAVR (6.00%) vs. SAVR (5.71%), transfemoral TAVR showed better outcomes, with self-expanding compared to balloon-expandable transfemoral TAVR having significantly lower in-hospital mortality (2.41% vs. 5.17%; p = 0.039). After risk adjustment, balloon-expandable as well as self-expanding transfemoral TAVR were associated with a significantly lower mortality vs. SAVR (balloon-expandable: risk adjusted OR = 0.50 [95% CI 0.27; 0.94], p = 0.031; self-expanding: OR = 0.20 [0.10; 0.41], p < 0.001). Furthermore, the observed in-hospital outcomes of stroke, major bleeding, delirium, and mechanical ventilation >48 h were significantly in favor of TAVR. In addition, TAVR showed a significantly shorter length of hospital stay compared to SAVR (transapical: risk adjusted Coefficient = -4.75d [-7.05d; -2.46d], p < 0.001; balloon-expandable: Coefficient = -6.88d [-9.06d; -4.69d], p < 0.001; self-expanding: Coefficient = -7.22 [-8.95; -5.49], p < 0.001). TAVR is a viable alternative to SAVR in the treatment of pure aortic regurgitation for selected patients, showing overall low in-hospital mortality and complication rates, especially with regard to self-expanding transfemoral TAVR.

Comorbidities may offset expected improved survival after transcatheter aortic valve replacement

After transcatheter aortic valve replacement (TAVR), cardiovascular and non-cardiovascular comorbidities may offset the survival benefit from the procedure. We aimed to describe the relationships between that benefit and patient comorbidities. The study pooled two European cohorts of patients with severe aortic stenosis (AS-pooled): one with patients who underwent (cohort of AS patients treated by TAVR, n = 233) and another with patients who did not undergo TAVR (cohort of AS patients treated medically; n = 291). The investigators collected the following: calcification prognostic impact (CAPRI) and Charlson scores for cardiovascular and non-cardiovascular comorbidities, activities of daily living (ADL)/instrumental activities of daily living (IADL) scores for frailty as well as routine Society of Thoracic Surgeons (STS) score and Logistic Euroscore. Unlike ADL/IADL scores, CAPRI and Charlson scores were found to be independent predictors of 1-year all-cause death in the AS-pooled cohort, with and without adjustment for STS score or Logistic Euroscore; they were thus retained to define a three-level prognostic scale (good, intermediate, and poor). The survival benefit from TAVR—vs. no TAVR—was stratified according to these three prognosis categories. The beneficial effect of TAVR on 1-year all-cause death was significant in patients with good and intermediate prognosis, hazard ratio (95% confidence interval): 0.36 (0.18; 0.72) and 0.32 (0.15; 0.67). That effect was reduced and not statistically significant in patient with poor prognosis [0.65 (0.22; 1.88)]. The study showed that, beyond a given comorbidity burden (as assessed by CAPRI and Charlson scores), the probability of death within a year was high and poorly reduced by TAVR. This indicates the futility of TAVR in patients in the poor prognosis category.

Treatment of Anomalous Coronary Arteries—Surgical Revascularisation Using the Pure Internal Thoracic Artery Technique

To evaluate the use of CABG utilising an isolated pedicled Right Internal Thoracic Artery (RITA) or Left Internal Thoracic Artery (LITA) or the Pure Internal Thoracic Artery (PITA) technique to treat anomalous aortic origin of coronary artery (AAOCA). A retrospective review of all patients at our institution over an 8-year period (2013-2021) who underwent surgery for AAOCA was performed. Data assessed included patient demographics, initial presentation, morphology of coronary anomaly, surgical procedure, cross-clamp time, cardiopulmonary bypass time, and long-term outcome. A total of 14 patients underwent surgery, including 11 males (78.5%) with a median logistic EuroSCORE of 1.605 (IQR 1.34). The median age was 62.5 years (IQR 48.75). Presentation was angina (7 patients), acute coronary syndrome (5 patients), incidental findings in aortic valve pathology (2 patients). AAOCA morphology varied: RCA from left coronary sinus (6), RCA from left main stem (3), left coronary artery from the right coronary sinus (1), left main stem arising from right coronary sinus (2) and circumflex artery arising from the right coronary sinus (2). Overall, 7 patients had co-existing flow-limiting coronary artery disease. CABG was performed using either a pedicled skeletonized RITA, LITA or PITA technique. There was no perioperative mortality. Overall median follow-up time was 43 months. One patient presented with recurrent angina secondary to graft failure at 2 years and there were two non-cardiac-related deaths at 4 and 35 months. The use of internal thoracic artery grafts can provide a durable treatment option in patients with anomalous coronary arteries. The potential risk of graft failure in patients with no flow-limiting disease should be very carefully considered. However, a proposed benefit of this technique is the use of a pedicle flow to increase the long-term patency. More consistent results are obtained when ischaemia can be demonstrated preoperatively.

Gender-Related Outcomes after Surgical Resection and Level of Satisfaction in Patients with Left Atrial Tumors

Cardiac tumors are rare, with a low incidence of between 0.0017 and 0.19%. The majority of cardiac tumors are benign and predominantly occur in females. The aim of our study was to examine how outcomes differ between men and women. From 2015 to 2022, 80 patients diagnosed with suspected myxoma were operated on. In all patients, preoperative, perioperative, and postoperative data were recorded. Such patients were identified and included in a retrospective analysis focused on gender-related differences. Patients were predominantly female (n = 64; 80%). The mean age was 62.76 ± 13.42 years in female patients and 59.65 ± 15.84 years in male patients (p = 0.438). The body mass index (BMI) was comparable in both groups: between 27.36 ± 6.16 in male and 27.09 ± 5.75 (p = 0.945) in female patients. Logistic EuroSCORE (LogES) (female: 5.89 ± 4.6; male: 3.95 ± 3.06; p = 0.017) and EuroSCORE II (ES II) (female: 2.07 ± 2.1; male: 0.94 ± 0.45; p = 0.043), both scores to predict the mortality in cardiac surgery, were significantly higher in female patients. Two patients died early, within 30 days after surgery: one male and one female patient. Late mortality was defined as the 5-year survival rate, which was 94.8%, and 15-year survival rate, which was 85.3% in our cohort. Causes of death were not related to the primary tumor operation. The follow up showed that satisfaction with surgery and long-term outcome was high. Predominately female patients presented with left atrial tumors over a 17-year period. Relevant gender differences aside from that were not evident. Surgery could be performed with excellent early (within 30 days after surgery) and late results (follow up after discharge).

Predictive value of the TRI-SCORE for in-hospital mortality after redo isolated tricuspid valve surgery

ObjectivesThe TRI-SCORE reliably predicts in-hospital mortality after isolated tricuspid valve surgery (ITVS) on native valve but has not been tested in the setting of redo interventions. We aimed to evaluate...

AKI3-Risk Predictors and Scores in Radical Nephrectomy with High Thrombectomy under Extracorporeal Circulation for Renal Cell Carcinoma with Supradiaphragmatic Inferior Vena Cava/Right Atrial Thrombus: A Single-Centre Retrospective Study.

Background and Objectives: The recommended therapeutic management in renal cell carcinoma (RCC) with supradiaphragmatic inferior vena cava/right atrial thrombus (IVC/RA) is surgery. Extracorporeal circulation is required. Acute kidney injury (AKI), a frequent complication after nephrectomy and cardiac surgery is associated with long-term kidney disease. This study aims to identify the risk factors involved in the occurrence of the severe postoperative AKI (AKI3) and to analyse various preoperative validated risk scores from cardiac and noncardiac surgery in predicting this endpoint. Materials and Methods: The medical data of all patients with RCC with supradiaphragmatic IVC/RA thrombus who underwent radical nephrectomy with high thrombectomy, using extracorporeal circulation, between 2004-2018 in the Prof. C. C. Iliescu Emergency Institute for Cardiovascular Diseases, Bucharest, were retrospectively analysed. The patients who died intraoperatively were excluded from the study. The predefined study endpoint was the postoperative AKI3. Preoperative, intraoperative and postoperative data were collected according to the stratification of study population in two subgroups: AKI3-present and AKI3- absent patients. EuroSCORE, EuroSCORE II, Logistic EuroSCORE, NSQIP any-complications and NSQIP serious-complications were analysed. Results: We reviewed 30 patients who underwent this complex surgery between 2004-2018 in our institute. Two patients died intraoperatively. Nine patients (32.14%) presented postoperative AKI3. Age (OR 1.151, CI 95%: 1.009-1.312), preoperative creatinine clearance (OR 1.066, CI 95%: 1.010-1.123) and intraoperative arterial hypotension (OR 13.125, CI 95%: 1.924-89.515) were risk factors for AKI3 (univariable analysis). Intraoperative arterial hypotension emerged as the only independent risk factor in multivariable analysis (OR 11.66, CI 95%: 1.400-97.190). Logistic EuroSCORE (ROC analysis: AUC = 0.813, p = 0.008, CI 95%: 0.633-0.993) best predicted the endpoint. Conclusions: An integrated team effort is essential to avoid intraoperative arterial hypotension, the only independent risk factor of AKI3 in this highly complex surgery. Some risk scores can predict this complication. Further studies are needed.