Mechanical Prosthesis Research Articles

Prognostic Factors for Morbidity and Mortality in Redux Valve Surgery

Objectives: Redux valve surgery is increasingly common in Algeria, and the aim of this study was to identify the risk factors for hospital morbidity and mortality in this type of surgery. Method :49 patients with a mean age of 51 years (20-67 years) and a sex ratio of 0.88 underwent redux valve surgery between January 2015 and december 2019. 79%), and in almost half of the cases (46%) the first operation was performed in our department; the most frequent reasons for repeat operations were mitral plasty dysfunction, expression of new valve damage and removal of mechanical prostheses due to infective endocarditis. The Euroscore was used to predict operative risk. Results: 80% of our patients were classified in the moderate risk group (score 3-5) with an expected mortality of between 2.90 and 2.94%. Our results show a mortality rate of 2.56% for these patients. The study of post-operative results revealed a number of cardiac complications (28.5% low output and 37% rhythm disorders), infectious complications (8% mediastinitis) and neurological complications (6%). The risk factors for operative mortality were multiple valve procedures (p=0.03), persistent atrial fibrillation or fibrillation that appeared postoperatively (p=0.05) and age over 70 (p=0.04). Conclusion: Valvular redux surgery with a single-valve procedure has an operative morbi-mortality, actuarial survival and post-operative functional benefit that are entirely comparable to those of a primary intervention; whereas in redux surgery with a multi-valvular procedure, the operative morbi-mortality is significantly higher, but the actuarial survival and functional benefit are comparable to those of a primary intervention

Approach To Pregnant Women with Mechanical Mitral Valve Prosthesis: A Case Report

Cardiovascular diseases are one of the leading causes of maternal mortality. The management of pregnant women with mechanical valve prosthesis is difficult. Fetal-maternal mortality and morbidity are high. Selection of the most appropriate anticoagulant that will minimize fetal, maternal mortality and avoid embryopathy risk should be tailored according to the needs of each individual patient. 
 In this paper, in the light of the literature, we aimed to discuss our patient, who delivered at 39th gestational week after a pregnancy before which she had not been provided with prepregnancy counseling and during which she did not attend follow-up visits.
 These patients prepregnancy counseling, follow-up visits, anticoagulant management during pregnancy, and prophylaxis and management of complications at the postpartum period are very important and require close follow-up.

Mechanical valve replacement for patients with rheumatic heart disease: the reality of INR control in Africa and beyond.

The majority of patients requiring heart valve replacement in low- to middle-income countries (LMICs) need it for rheumatic heart disease (RHD). While the young age of such patients largely prescribes replacement with mechanical prostheses, reliable anticoagulation management is often unattainable under the prevailing socioeconomic circumstances. Cases of patients with clotted valves presenting for emergency surgery as a consequence of poor adherence to anticoagulation control are frequent. The operative mortality rates of reoperations for thrombosed mechanical valves are several times higher than those for tissue valves, and long-term results are also disappointing. Under-anticoagulation prevails in these regions that has clearly been linked to poor international normalised ratio (INR) monitoring. In industrialised countries, safe anticoagulation is defined as >60%-70% of the time in the therapeutic range (TTR). In LMICs, the TTR has been found to be in the range of twenty to forty percent. In this study, we analysed >20,000 INR test results of 552 consecutive patients receiving a mechanical valve for RHD. Only 27% of these test results were in the therapeutic range, with the vast majority (61%) being sub-therapeutic. Interestingly, the post-operative frequency of INR tests of one every 3-4 weeks in year 1 had dropped to less than 1 per year by year 7. LMICs need to use clinical judgement and assess the probability of insufficient INR monitoring prior to uncritically applying Western guidelines predominantly based on chronological age. The process of identification of high-risk subgroups in terms of non-adherence to anticoagulation control should take into account both the adherence history of >50% of patients with RHD who were in chronic atrial fibrillation prior to surgery as well as geographic and socioeconomic circumstances.

Clinical and Evolutionary Profile of Patients with Rheumatic Valvulopathy Operated Versus Not Operated in Chad

Introduction: The aim of this study was to describe the clinical and evolutionary profile of patients with rheumatic valvulopathy, operated versus non-operated in Chad. Patient and methods: This was a prospective, multicenter cohort study carried out in the cardiology departments of the National Reference University Hospital Centre, cardiology Department, Renaissance University Hospital Center, and Bon Samaritain University Hospital, of N’Djamena city. It was spread over a six-year period, from January 1, 2015, to December 31, 2020. Were included in the study, all patients who had been seen on an outpatient basis and/or hospitalized for rheumatic valvular disease in the aforementioned in the aforementioned during the study period. The clinical and evolutionary characteristics of operated patients were compared with those of non-operated patients using, as required, Pearson’s chi2 test, Fisher’s exact test or Student’s t-test. The threshold of statistical significance was p<0.05. Results: A total of 80 patients (22%) had undergone surgery out of the 364 included. Valve replacement by mechanical prosthesis accounted for 77% of procedures, and valve plasty for 45%. The mean age of operated patients was 33 vs. 31 for non-operated patients (p=not significant NS). Female gender was found in 57% of operated patients vs. 52% of non-operated patients (p=NS). Dyspnea on exertion was present on admission in 65% of operated patients vs. 82% of non-operated patients (p<0.001). LVEF in operated patients was 61% vs 59% in non-operated patients (p=NS), mean LV end-diastolic diameter was 53.2 mm vs. 54.7 mm (p=NS) and PAPs were 43 mmHg vs 54 mmHg (p=0.0001). During follow-up, 36% of operated patients vs. 47% of non-operated patients had a hemodynamic complication (p=0.07), 12% of operated patients had a thromboembolic complication vs. 5% of non-operated patients (p=0.01), 13% of operated patients had atrial fibrillation vs. 15% of non-operated patients (p=0.12). Ten (10) deaths (12%) were recorded among operated patient’s vs 28 deaths (10%) among non-operated patients (p=NS). Conclusion: Morbidity and mortality in patients with rheumatic valvular disease remain high, even in patients undergoing surgery. even in patients who have undergone surgery. While there is a need to make surgery accessible to as many patients as possible, good therapeutic education and improvement of the patient's care pathway are essential. Those are the keys to effective, safe care.

Reverse-U Aortotomy (Kırali Incision) for Aortic Valvular Interventions.

Surgical incisional approach to the ascending aorta is the main strategic step during valvular and/or subvalvular aortic interventions. Classic aortotomy incisions (transverse or oblique) can be challenging and can cause suboptimal exposure of the aortic root especially for the patients with small aortic annulus or for redo coronary artery bypass patients with patent proximal grafts interposed to the ascending aorta. The Kırali incision was used in 91 patients (including 13 reoperations) who underwent an aortic intervention for valvular and subvalvular pathologies. Aortic root was exposed by forming inverted "U" shape incision starting from approximately 3 cm above the right coronary ostium toward the center of the noncoronary annulus and the top of the left-right commissure like a tongue. The aortic valve was replaced with a mechanical prosthesis in 45 patients and with a bioprosthesis in 39 patients including 14 sutureless and 16 stentless prostheses. A total of 29 patients received a concomitant procedure per the following: coronary artery bypass grafting on 8 patients and left ventricular assist device on 7 patients. There was no any problem related to aortotomy incision technique such as bleeding, rupture, dehiscence, or laceration perioperatively. There was no complication related to the procedure during 5-year follow-up. This new aortotomy incision technique is a safe procedure that provides good exposure for all kinds of aortic valve interventions and protects grafts and can facilitate aortic root enlargement or aortoplasty easily. This incision has the potential to be an alternative to traditional techniques.

The effectiveness of David procedure for aneurysm of the root and ascending part of the aorta

The aim – comparison of the results of David and Bentall operations in patients with aneurysms of the root and ascending aorta. Materials and methods. The one-centre study included 85 patients who underwent planned and urgent surgical treatment from 2019 to 2022. The patients were divided into two groups depending on the type of surgical intervention: the Bentall procedure was performed in the I group, while the David procedure was performed in the II group. Results. The study did not determine statistically significant differences in such indicators as the duration of artificial blood circulation and the time of aortic clamping. No significant differences were found in the duration of artificial lung ventilation and stay in the intensive care unit. However, the total length of hospital stay in the group of patients with David procedure was statistically lower and was 17.3 (8–35) days, while in the group with Bentall operation it was 23.7 (10–40) days (p = 0.01). The results of our analysis show that the early postoperative clinical results of the David and Bentall procedures are good and there are no significant differences. During David procedure, a statistically significant positive result of surgical treatment was revealed by such an indicator as the degree of insufficiency on the aortic valve (before and after the operation, 2.7 ± 1.3 and 0.8 ± 0.6, respectively, p < 0.05). In addition to the above indicator, significant results were found in the indicators: left ventricular end-diastolic size and left ventricular end-diastolic volume. Conclusions. The good immediate results of Bentall and David operations suggest that surgical repair of ascending and aortic root aneurysms using these operations can be equally safe when performed according to absolute anatomical indications and by an experienced surgical team. If both operations might be used in a particular patient, the valve-sparing operation should be preferred, given the lower risk of postoperative complications associated with the presence of a mechanical or biological prosthesis (such as thromboembolism, bleeding associated with anticoagulants, and structural deterioration of the bioprosthesis).

Design, manufacturing and testing of a green non-isocyanate polyurethane prosthetic heart valve.

The sole effective treatment for most patients with heart valve disease is valve replacement by implantation of mechanical or biological prostheses. However, mechanical valves represent high risk of thromboembolism, and biological prostheses are prone to early degeneration. In this work, we aim to determine the potential of novel environmentally-friendly non-isocyanate polyurethanes (NIPUs) for manufacturing synthetic prosthetic heart valves. Polyhydroxyurethane (PHU) NIPUs are synthesized via an isocyanate-free route, tested in vitro, and used to produce aortic valves. PHU elastomers reinforced with a polyester mesh show mechanical properties similar to native valve leaflets. These NIPUs do not cause hemolysis. Interestingly, both platelet adhesion and contact activation-induced coagulation are strongly reduced on NIPU surfaces, indicating low thrombogenicity. Fibroblasts and endothelial cells maintain normal growth and shape after indirect contact with NIPUs. Fluid-structure interaction (FSI) allows modeling of the ideal valve design, with minimal shear stress on the leaflets. Injection-molded valves are tested in a pulse duplicator and show ISO-compliant hydrodynamic performance, comparable to clinically-used bioprostheses. Poly(tetrahydrofuran) (PTHF)-NIPU patches do not show any evidence of calcification over a period of 8 weeks. NIPUs are promising sustainable biomaterials for the manufacturing of improved prosthetic valves with low thrombogenicity.

Comprehensive Management of Anticoagulants Induced Decompensated Severe Anemia in Postmitral Valve Replacement

Abstract Mechanical prosthetic valve needs consideration for anticoagulation. The objective of this case report was to know how maintenance of oral anticoagulant therapy is very important in patients, especially with mechanical heart valve replacement. It is the holistic management of mitral valve replacement (MVR) patients with high international normalized ratio (INR) (>100), which led bleeding into the peritoneal cavity and causes decompensated severe anemia. Although it is a rare presentation for a patient of MVR with high INR level but which is most commonly presented for cerebrovascular accident. Anemia is a thoughtful worldwide problem that disturbs the quality of life in persons of all ages. A 28-year-old Indian woman with follow-up case of post-MVR came to the hospital with complaints of breathing difficulty, altered sensorium, pulse rate of 150–170 bpm (beats/min) irregularly irregular, blood pressure (80/50 mmHg), palpitation, and abdominal pain. Blood test report revealed her hemoglobin (Hb) was 3.2 g%, suggestive of severe anemia, INR was >100 s. Hence, patient diagnosed as follow-up case of MVR (#27 mm mechanical bileaflet mitral valve prosthesis) with peritoneal bleeding, an oral anticoagulant with decompensated severe anemia managment should be done. Ended the progression of her hospitalization, she received four units of packed red blood cell transfusions; Vitamin K was given intravenous once daily for 2 days and no anticoagulant was given, so far, INR was high with serial monitoring of INR and Hb. Her symptoms of breathing difficulty, pain in abdomen, weakness and giddiness resolute by the finish of her hospital stay, and she recompensed to her oral anticoagulant therapy with improved Hb and hemodynamics. Disapprovingly high INR levels are classically related with bleeding disorders revealed on imperative indicators and hemodynamic variability. To our understanding, one of the lowermost noted Hb is because of bleeding due to very high INR, so monitoring of therapeutic INR level with anticoagulants is very-very important.

Сравнительная оценка эффективности механических и биологических протезов в процессе обратного ремоделирования левого желудочка после коррекции стеноза аортального клапана (Propensity score matching анализ и клинико-экспериментальное сопоставление)

Сравнительная оценка эффективности механических и биологических протезов в процессе обратного ремоделирования левого желудочка после коррекции стеноза аортального клапана (Propensity score matching анализ и клинико-экспериментальное сопоставление)

Concomitant Valve Replacement and Coronary Artery Bypass Grafting Surgery: Lessons from the Past, Guidance for the Future? A Mortality Analysis in 294 Patients.

The aims of this study were to analyze parameters influencing early and late mortality after concomitant valve replacement and coronary artery bypass grafting surgery, using early and long-term information from an institutionally available data registry, and to discuss the results in relation to the current treatment strategies and perspectives. The study population consisted of 294 patients after combined valve replacement with mechanical prosthesis and CABG surgery. There were 201 men (68.4%) and 93 women (31.6%). Concurrent to the coronary artery bypass grafting, 238 patients (80.9%) underwent aortic-, 46 patients (15.6%) mitral- and 10 patients (3.4%) doublevalve replacement. Cumulative duration of follow up was 1007 patient-years (py) with a maximum of 94 months and was completed in 92.2% (271 cases). Overall hospital mortality (30 days) rate was 6.5% (n = 19). It was significantly higher in patients of female gender, older than 70 y, in those suffering preoperative myocardial infarction, presenting with an additive EuroScore > 8 and being hemodynamically unstable after the operation. Cumulative survival rate at 7.6 y was 78.6%. Determinants of prolonged survival were male gender, age at operation < 70 y, preoperative sinus rhythm, normal renal function, additive EuroScore < 8 and the use of internal thoracic artery for grafting. Subsequent multivariate analysis revealed preoperative atrial fibrillation (HR: 2.1, 95% CI: 0.82-5.44, p: 0.01) and risk group of ES > 8 (HR: 3.63, 95% CI: 1.45-9.07, p < 0.01) as independent predictors for lower long-term survival. Hospital mortality (30 d) was nearly 2.5-fold higher in female and/or older than 70 y patients. Preoperative atrial fibrillation and/ or a calculated ES > 8 were independent predisposing factors of late mortality for combined VR and CABG surgery. Tailoring the approach, with the employment of the newest techniques and hybrid procedures, to the individual patient clinical profile enables favorable outcomes for concomitant valvular disease and CAD, especially in high-risk patients.

Prosthetic Valve Endocarditis After Aortic Valve Replacement: Differences Between Biological and Mechanical Prostheses

Prosthetic valve endocarditis (PVE) is the most severe form of infective endocarditis associated with a high mortality rate. Whether PVE affects biological and mechanical aortic valves to the same extent remains controversial. This study aimed to compare the incidence of re-intervention because of PVE between bioprosthetic and mechanical valves. Patients undergoing isolated surgical aortic valve replacement (AVR) or combined AVR in a single cardiac surgery centre between January 1998 and December 2019 were analysed. All patients who underwent re-intervention because of PVE were identified. The primary endpoint was the rate of explants. Freedom from re-intervention and variables associated with re-intervention were analysed using Cox regression analysis including correction for competing risk. During the study period, 5,983 aortic valve prostheses were implanted, including 3,620 biological (60.5%) and 2,363 mechanical (39.5%) prostheses. The overall mean follow-up period was 7.3±5.3 years (median, 6.5; IQR 2.9-11.2 years). The rate of re-intervention for PVE in the biological group was 1.5% (n=54) compared with 1.7% (n=40) in the mechanical group (p=0.541). Cox regression analysis revealed that younger age (HR 0.960, 95% CI 0.942-0.979; p<0.001), male sex (HR 2.362, 95% CI 1.384-4.033; p=0.002), higher creatinine (HR 1.002, 95% CI 0.999-1.004; p=0.057), and biological valve prosthesis (HR 2.073, 95% CI 1.258-3.414; p=0.004) were associated with re-intervention for PVE. After correction for competing risk of death, biological valve prosthesis was significantly associated with a higher rate of re-intervention for PVE (HR 2.011, 95% CI 1.177-3.437; p=0.011). According to this single-centre, observational, retrospective cohort study, AVR using biological prosthesis is associated with re-intervention for PVE compared to mechanical prosthesis. Further investigations are needed to verify these findings.

Survival and Recurrence of Endocarditis following Mechanical vs. Biological Aortic Valve Replacement for Endocarditis in Patients Aged 40 to 65 Years: Data from the INFECT-Registry.

Infective endocarditis (IE) is a serious disease, and in many cases, surgery is necessary. Whether the type of prosthesis implanted for aortic valve replacement (AVR) for IE impacts patient survival is a matter of debate. The aim of the present study is to quantify differences in long-term survival and recurrence of endocarditis AVR for IE according to prosthesis type among patients aged 40 to 65 years. This was an analysis of the INFECT-REGISTRY. Trends in proportion to the use of mechanical prostheses versus biological ones over time were tested by applying the sieve bootstrapped t-test. Confounders were adjusted using the optimal full-matching propensity score. The difference in overall survival was compared using the Cox model, whereas the differences in recurrence of endocarditis were evaluated using the Gray test. Overall, 4365 patients were diagnosed and operated on for IE from 2000 to 2021. Of these, 549, aged between 40 and 65 years, underwent AVR. A total of 268 (48.8%) received mechanical prostheses, and 281 (51.2%) received biological ones. A significant trend in the reduction of implantation of mechanical vs. biological prostheses was observed during the study period (p < 0.0001). Long-term survival was significantly higher among patients receiving a mechanical prosthesis than those receiving a biological prosthesis (hazard ratio [HR] 0.546, 95% CI: 0.322-0.926, p = 0.025). Mechanical prostheses were associated with significantly less recurrent endocarditis after AVR than biological prostheses (HR 0.268, 95%CI: 0.077-0.933, p = 0.039). The present analysis of the INFECT-REGISTRY shows increased survival and reduced recurrence of endocarditis after a mechanical aortic valve prosthesis implant for IE in middle-aged patients.

Current Usefulness of Transesophageal Echocardiography in Patients Undergoing Transcatheter Aortic Valve Replacement.

This review article describes in depth the current usefulness of transesophageal echocardiography in patients who undergo transcatheter aortic valve replacement. Pre-intervention, 3D-transesophageal echocardiography allows us to accurately evaluate the aortic valve morphology and to measure the valve annulus, helping us to choose the appropriate size of the prosthesis, especially useful in cases where the computed tomography is not of adequate quality. Although it is not currently used routinely during the intervention, it remains essential in those cases of greater complexity, such as for patients with greater calcification and bicuspid valve, mechanical mitral prosthesis, and "valve in valve" procedures. Three-dimensional transesophageal echocardiography is the best technique to detect and quantify paravalvular regurgitation, a fundamental aspect to decide whether immediate valve postdilation is needed. It also allows to detect early any immediate complications such as cardiac tamponade, aortic hematoma or dissection, migration of the prosthesis, malfunction of the prosthetic leaflets, or the appearance of segmental contractility disorders due to compromise of the coronary arteries ostium. Transesophageal echocardiography is also very useful in follow-up, to check the proper functioning of the prosthesis and to rule out complications such as thrombosis of the leaflets, endocarditis, or prosthetic degeneration.

Systemic Atrioventricular Valve Surgery in Patients With Congenitally Corrected Transposition of the Great Vessels.

Limited data exist regarding the long-term outcomes of systemic atrioventricular valve (SAVV) intervention (morphologic tricuspid valve) in congenitally corrected transposition (ccTGA). The goal of this study was to evaluate the mid- and long-term outcomes of SAVV surgery in ccTGA. We performed a retrospective review of 108 ccTGA patients undergoing SAVV surgery from 1979 to 2022. The primary outcome was a composite endpoint of mortality, cardiac transplantation, or ventricular assist device implantation. The secondary outcome was long-term systemic right ventricular ejection fraction (SVEF). Cox proportional hazard and linear regression models were used to analyze survival and late SVEF data. The median age at surgery was 39.5 years (Q1-Q3: 28.8-51.0 years), and the median preoperative SVEF was 39% (Q1-Q3: 33.2%-45.0%). Intrinsic valve abnormality was the most common mechanism of SAVV regurgitation (76.9%). There was 1 early postoperative mortality (0.9%). Postoperative complete heart block occurred in 20 patients (18.5%). The actuarial 5-, 10-, and 20-year freedom from death or transplantation was 92.4%, 79.1%, and 62.9%. The 10- and 20-year freedom from valve reoperation was 100% and 93% for mechanical prosthesis compared with 56.6% and 15.7% for bioprosthesis (P< 0.0001). Predictors of postoperative mortality were age at operation (P=0.01) and preoperative SVEF (P=0.04). Preoperative SVEF (P< 0.001), complex ccTGA (P=0.02), severe SAVV regurgitation (P=0.04), and preoperative creatinine (P=0.003) were predictors of late postoperative SVEF. SAVV surgery remains a valuable option for the treatment of patients with ccTGA, with low early mortality and satisfactory long-term outcomes, particularly in those with SVEF≥40%. Timely referral and accurate patient selection are the keys to better long-term outcomes.

Mechanical heart valves and oral anticoagulation: a survey of the Italian Society of Cardiac Surgery.

In the latest European guidelines for the management of valvular heart disease, mechanical valve prostheses maintain a strategic role, particularly for certain patient subsets and age groups. Despite the high number of devices implanted in clinical practice, particularly in non-European and North American regions, current scientific literature and debate seem to suggest a limited use of mechanical heart valves. The cardiac surgery community seems to be highly interested in biological and transcatheter valve prostheses but less interested in mechanical heart valves, including possible strategies for self-management of anticoagulation therapy. In this respect, the Italian Society of Cardiac Surgery (SICCH), in particular the Italian Group of Research for Outcome in Cardiac Surgery (GIROC), has promoted a survey among its members to stimulate the interest in this topic and express their opinion on this issue that, due to the prevalence of the affected population and the new treatment options for improving patients' quality of life, should be more appraised and debated in the cardiac surgery community. The recorded results, obtained on the answers to 111 questionnaires, seem to divide the specialists into 'pros' and 'contras' on a useful tool for the entire cardiac surgery community. For this reason, SICCH proposes in conclusion to declare its unified and institutional opinion on this topic.

Trend in mitral valve prostheses of choice and early outcomes in the United Kingdom

ObjectiveDespite the superiority of mitral valve repair, surgical mitral valve replacement (SMVR) remains an important intervention for patients with valve stenosis, infective endocarditis and complex mitral valve degeneration.There has been an increasing popularity in the worldwide use of biological valves due to the avoidance of long-term anti-coagulation and recent advancements in transcatheter techniques. We aim to evaluate the trend, early clinical outcomes and the choice of prostheses use in isolated SMVR over a 23 years period in the United Kingdom. MethodsAll patients (n = 13,147) who underwent elective or urgent isolated SMVR from March 1996 to April 2019 were identified from the National Adult Cardiac Surgery Audit database.Trends in clinical outcomes, predicted/observed mortality of patients and the utilization of biological prostheses across 5 different age groups: <50, 50–59, 60–69, 70–79 and ≥80 years old were investigated. Early clinical outcomes associated with the use of mechanical and biological mitral valve prostheses in patients between the age of 60–70 years old were analysed. ResultsThe number of isolated SMVR performed has remained stable with approximately 600 cases annually since 2010. The in-hospital/30-day mortality rate has decreased from 7.41% (1996) to 3.92% (2018), despite the EuroScore II increasing from 1.42% in 1996 to 2.43% in 2018.Biological prostheses usage increased across all age group, and particularly in the 60–69 and 70–79 group, from 17.86% and 53.85% in 1996 to 48.85% and 82.38% in 2018, respectively. The use of mechanical prostheses was reduced in patients between the age of 50–59 from 100% in 1996 to 80.65% in 2018. There were no differences in short term outcomes among patients aged 60–70 years who received either a biological or mechanical prostheses. ConclusionThere has been a significant reduction in surgical mitral valve replacement early in-hospital mortality, despite an observed increase in the risk profile of patients over 23 years. A shifting trend in valve replacement choices was observed with a rise in the use of biological prostheses, particularly within the 60–69 and 70–79 age group. Early in hospital outcomes for patients aged 60–70 were not determined by the implanted valve type.

Surgical Treatment Methods for Tricuspid Valve Infective Endocarditis

Introduction: In recent years, there has been a significant increase in the incidence of tricuspid valve infective endocarditis (IE), which is associated with both the increased number of invasive examinations and procedures and the high rates of intravenous drug use. The initial treatment for tricuspid valve IE was surgical removal of the focus of infection and restoration of intracardiac hemodynamics.Reconstructive surgery aimed at preserving the valve is the preferred method of surgical treatment. If a valve-­preserving operation is not possible due to significant valvular apparatus destruction, implantation of artificial heart valves (both mechanical and biological) is the method of choice.Objective: To analyze the results of reconstructive valve-­preserving surgery and tricuspid valve replacement for tricuspid valve IE treatment.Materials and methods: In the Scientific Research Institute – Specialized Cardiac Surgery Clinical Hospital named after Academician B.A. Korolev (Nizhny Novgorod, Russian Federation) 110 patients underwent surgery for tricuspid valve IE. Primary surgery was performed in 97 patients, and 13 patients underwent repeated surgery. The patients were divided into 2 groups based on the chosen surgical method for correcting tricuspid valve disease. Group 1 included 62 patients who successfully underwent tricuspid valve replacement: mechanical prostheses in 10 patients and biological prostheses in 52 patients. Group 2 included 38 patients who underwent reconstructive valve­preserving surgery. All patients underwent De Vega annuloplasty. In 10 patients it was directly associated with bicuspidalization of the tricuspid valve and plastic surgery of intact leaflets. Two patients had suture annuloplasty of the tricuspid valve based on the modified technique. In 2 of 3 patients, an infected right atrial thrombus was removed. Three patients underwent removal of the left ventricular wall abscess and aortic valve replacement for critical stenosis. After translocation of the chords, triangular resection of the anterior leaflet was performed to separate the chord of the left side of the chest and the myxoma of the right and left chest.Results: In the early postoperative period, no valve­related complications were observed in group 1. The most common nonlethal complication was a third­-degree atrioventricular block. Multiple organ dysfunction syndrome occurred in 3 patients; cardiac tamponade was reported in 2 patients, and 1 patient had postoperative bleeding that required resternotomy for serous mediastinitis in the mid­term period and reosteosynthesis. At the hospital stage, 1 patient from group 1 died, whereas there were no deaths in group 2. In­-hospital mortality in the groups of operated patients was 0.9%.Functional ultrasound imaging findings in the postoperative period show that patients from group 1 had the peak gradient across the prosthetic tricuspid valve of 9.4 ± 1.8 mm Hg, while the mean gradient was 5.8 ± 1.75 mm Hg. There was a significant decrease in the estimated right ventricle pressure from 54.0 ± 16.2 to 35.0 ± 5.5 mm Hg. In group 2 tricuspid valve regurgitation was not observed in 27 patients, while mild and moderate regurgitation was reported in 8 and 3 patients, respectively. The peak gradient during the tricuspid valve reconstruction was 6.2 ± 1.7 mm Hg, while the mean gradient was 2.8 ± 0.75 mm Hg. The annulus fibrosus size during tricuspid valve annuloplasty averaged 30.8 ± 2.5 (28­33) mm. There was a decrease in the right ventricle pressure from 44.0 ± 18.4 to 32.0 ± 7.3 mm Hg. In the mid-­term follow­up, surviving patients were classified as NYHA classes I­-II. Of 110 patients discharged from the clinic, we were able to trace the fate of 69 patients, which accounted for 62.7%. In the long-­term period, 3 patients from group 1 died. Thus, long­term mortality in the general group was 2.72%.Conclusions: Reconstructive surgery has significant advantages over tricuspid valve replacement using various artificial heart valve models: lower rates of in-­hospital and long­-term mortality and specific complications, higher quality of life. Compliance with principles and methods of pathogenetic treatment of electrode­induced IE guarantees a success in the cohort of severe patients. The technique of reconstruction and restoration of tricuspid valve structures and functions in case of active tricuspid valve IE with detachment of the chords and destruction of the leaflets demonstrated high surgical efficiency.

Clinical Profile and Outcomes of Rheumatic Heart Disease Patients Undergoing Surgical Valve Procedures in Uganda.

Chronic valvular heart disease is a well-known, long-term complication of acute rheumatic fever (ARF), which remains a major public health problem in low- and middle-income countries. Access to surgical management remains limited. Outcomes of the minority proportion of patients that access surgery have not been described in Uganda. To describe the volume and type of rheumatic heart disease (RHD) valvular interventions and the outcomes of operated patients in the Uganda RHD registry. We performed a retrospective cohort study of all valve surgery procedures identified in the Uganda RHD registry through December 2021. Three hundred and sixty-seven surgical procedures were performed among 359 patients. More than half were among young (55.9% were ≤20 years of age), female (59.9%) patients. All patients were censored at 15 years. The median (IQR) follow up period was 43 (22,79) months. Nearly half of surgeries (46.9%) included interventions on multiple valves, and most valvular operations were replacements with mechanical prostheses (96.6%). Over 70% of the procedures were sponsored by charity organizations. The overall mortality of patients who underwent surgery was 13% (47/359), with over half of the mortalities occurring within the first year following surgery (27/47; 57.4%). Fifteen-year survival or freedom from re-operation was not significantly different between those receiving valve replacements and those receiving valve repair (log-rank p = 0.76). There has been increasing access to valve surgery among Ugandan patients with RHD. Post-operative survival is similar to regionally reported rates. The growing cohort of patients living with prosthetic valves necessitates national expansion and decentralization of post-operative care services. Major reliance on charity funding of surgery is unsustainable, thus calling for locally generated and controlled support mechanisms such as a national health insurance scheme. The central illustration (Figure 1) provides a summary of our findings and recommendations.

Valvular and ascending aortic hemodynamics of the On-X aortic valved conduit by same-day echocardiography and 4D flow MRI.

This study aims to assess whether the On-X aortic valved conduit better restores normal valvular and ascending aortic hemodynamics than other commonly used bileaflet mechanical valved conduit prostheses from St. Jude Medical and Carbomedics by using same-day transthoracic echocardiography (TTE) and 4D flow magnetic resonance imaging (MRI) examinations. TTE and 4D flow MRI were performed back-to-back in 10 patients with On-X, six patients with St. Jude (two) and Carbomedics (four) prostheses, and 36 healthy volunteers. TTE evaluated valvular hemodynamic parameters: transvalvular peak velocity (TPV), mean and peak transvalvular pressure gradient (TPG), and effective orifice area (EOA). 4D flow MRI evaluated the peak systolic 3D viscous energy loss rate (VELR) density and mean vorticity magnitude in the ascending aorta (AAo). While higher TPV and mean and peak TPG were recorded in all patients compared to healthy subjects, the values in On-X patients were closer to those in healthy subjects (TPV 1.9 ± 0.3 vs. 2.2 ± 0.3 vs. 1.2 ± 0.2 m/s, mean TPG 7.4 ± 1.9 vs. 9.2 ± 2.3 vs. 3.1 ± 0.9 mmHg, peak TPG 15.3 ± 5.2 vs. 18.9 ± 5.2 vs. 6.1 ± 1.8 mmHg, p < 0.001). Likewise, while higher VELR density and mean vorticity magnitude were recorded in all patients than in healthy subjects, the values in On-X patients were closer to those in healthy subjects (VELR: 50.6 ± 20.1 vs. 89.8 ± 35.2 vs. 21.4 ± 9.2 W/m3, p < 0.001) and vorticity (147.6 ± 30.0 vs. 191.2 ± 26.0 vs. 84.6 ± 20.5 s-1, p < 0.001). This study demonstrates that the On-X aortic valved conduit may produce less aberrant hemodynamics in the AAo while maintaining similar valvular hemodynamics to St. Jude Medical and Carbomedics alternatives.

The impact of open native aortic valve replacement procedure on survival and costs in two hospitals: A multivariate analysis

ABSTRACT Objective To compare the survival and costs of native aortic valve replacement by open approach in two hospitals. Methods We analyzed 1,472 hospital discharges from two hospitals between 2017 and 2021. We followed mean post-operative length of stay and survival at 30 days, one year and five years. The variables under study were sex, age, type of prosthesis, complexity, hospital, cost of the valve, date of intervention, discharge and exitus if present. A bivariate and a multivariate analysis were performed. Results The two hospitals have baseline characteristics with no significant differences. One of the hospitals had a higher mean unit price, in both biological (96%) and mechanical prostheses (11%) (p1); this higher mortality did not reach statistical significance in the multivariate analysis. In both hospitals, older age was associated with lower survival at one year (HR = 1.299 CI = 1.035–1.630) and at five years (HR = 1.228, 95%CI = 1.023–1.476). Greater complexity is associated with lower survival in all three periods. Conclusions Higher costs for open aortic heart valves does not lead to better survival outcomes. There is room for improvement in hospital management of these resources.