Number Of Aortic Valve Replacements Research Articles

Status of cardiovascular surgery in Japan between 2017 and 2018: A report based on the Japan Cardiovascular Surgery Database. 3. Valvular heart surgery.

We aimed to present data regarding the current status and trends of valvular heart surgeries in Japan from the Japan Cardiovascular Surgery Database for the 2017-2018. We extracted data on cardiac valve surgeries performed in 2017 and 2018 from the Japan Cardiovascular Surgery Database. We determined the trend in the number of aortic valve replacement procedures from 2013 to 2018. The operative mortality rates were calculated for representative valve procedures stratified by age group. Data regarding minimally invasive procedures and transcatheter aortic valve replacement in the Japan Cardiovascular Surgery Database are also presented. In conjunction with the dramatic increase in the number of transcatheter aortic valve replacements in 2017 and 2018, surgical aortic valve replacement also increased from 26,054 to 28,202. The operative mortality rate in first-time valve procedures was 1.8% in isolated aortic valve replacement, 0.9% in isolated mitral valve repair, and 8.2% and 4.6% in mitral valve replacement with biological prostheses and with mechanical prostheses, respectively. Regarding minimally invasive procedures, 30.8% of first-time isolated mitral valve plasty procedures were performed by a right thoracotomy. Although patients who underwent surgery by a right thoracotomy had better clinical outcomes, it was also apparent that patients who underwent surgery by a right thoracotomy had lower operative risk profiles. The overall mortality rates after transcatheter aortic valve replacement and surgical aortic valve replacement were 1.5% and 1.8%, respectively. We have reported benchmark data on heart valve surgery in 2017 and 2018 from the Japan Cardiovascular Surgery Database.

Implementation of Transcatheter Aortic Valve Replacement in France

BackgroundTranscatheter aortic valve replacement (TAVR) has emerged as an alternative to surgical aortic valve replacement (SAVR), but unbiased data regarding evolution of the treatment of patients with aortic stenosis at the nationwide level are scarce. ObjectivesThis study sought to evaluate the number of aortic valve replacements (AVRs) performed in France, changes over time, and the effect of the adoption of TAVR. MethodsBased on a French administrative hospital-discharge database, the study collected all consecutive AVRs performed in France between 2007 and 2015. ResultsA total of 131,251 interventions were performed: 109,317 (83%) SAVR and 21,934 (17%) TAVR. AVR linearly increased (from 10,892 to 18,704; p for trend <0.0001) mainly due to a marked increase in TAVR (from 244 to 6,722; p for trend = 0.0004), whereas SAVR remained stable (from 10,892 to 11,982; p for trend = 0.18). Parallel to a decrease in the Charlson index (p for trend <0.05), SAVR and TAVR in-hospital mortality rates significantly declined (both p for trend <0.01). The number of TAVRs significantly increased in all age categories (<75, 75 to 79, 80 to 84, and ≥85 years of age; all p for trend = 0.003), but reached or even exceeded SAVR in the 2 oldest categories. Although mortality rates declined for both isolated SAVR and TAVR, it became similar or slightly lower for TAVR than for isolated SAVR in 2015 in the 3 oldest age categories even if it did not reach statistical significance (p = 0.66, p = 0.47, and p = 0.06, respectively). ConclusionsThe number of AVRs markedly increased in France between 2007 and 2015 due to the wide adoption of TAVR, which represented one-third of all AVRs in 2015. Patients’ profile improved, suggesting that patients are referred earlier, and in-hospital mortality declined in all AVR subsets. Despite a worse clinical profile, the immediate outcome of TAVR compared favorably to isolated SAVR in patients >75 years of age. The results may have major implications for clinical practice and policymakers.

Rapid Deployment Valves: Therapy of Choice in Elderly Patients?

Objective: Over the past few years the number of aortic valve replacements (AVR) has increased with outcomes that have been improved despite increasing age of patients and increasing burden of comorbidities. Rapid deployment (RD) AVR is an emerging alternative to standard AVR in elderly high-risk surgical patients. It has been even shown that for patients with severe aortic stenosis, RD-AVR may achieve better perioperative survival than TAVI.

Simplified closure of ministernotomy using thermoreactive sternal clips

An increasing number of aortic valve replacements are performed through a ministernotomy. Due to the small incision and partial fixation of the caudal sternum, the traditional wire closure can be complicated and even harmful to the surrounding tissue. In such cases, we recommend the use of nitinol clips for sternal closure. This technique, which we have used in 48 patients, is simple, safe, and fast, and results in excellent outcomes.

Discussion: Session 1—Ascending Aorta

Discussion: Session 1—Ascending Aorta

Four-year clinical experience with the gelatin-resorcine-formol biological glue in acute aortic dissection

From January, 1977, to September, 1980, the gelatin-resorcine-formol (GRF) biological glue was used for tissue reinforcement in 25 patients operated upon for acute dissection involving the ascending aorta. The results in these patients (GRF group) were compared to the results in 25 patients operated upon between 1970 and 1976 with “classical techniques” (CT group). There were no significant differences between the two groups regarding age, sex, and preoperative clinical and anatomic data. The ascending aorta was replaced in all patients. The aortic valve was replaced in three cases (12%) in the GRF group and in 12 cases (48%) of the CT group. The coronary arteries were bypassed or reimplanted in 20% of the patients in each group. Average volume of intraoperative blood transfusion was 5,800 ml in the CT group and 2,100 in the GRF group (p < 0.01). Four (16%) intraoperative deaths were registered in the CT group and none in the GRF group. Postoperative renal failure, cerebral ischemia, persisting peripheral ischemia, and infection were more frequent in the CT group, being responsible for eight hospital deaths in this group and for two in the GRF group (p < 0.01). Hospital mortality was therefore reduced from 48% (CT group) to 8% (GRF group) (p < 0.01). Two late deaths occurred in the CT group and none in the GRF group, all survivors being in good clinical condition. Sixteen patients in the GRF group underwent 19 control angiograms 2 to 36 months following the operation. Two of the angiograms documented moderate aortic incompetence (8%) and three showed persisting dissections of the descending aorta, but good and stable repair was apparent in the other patients. In conclusion, the use of the GRF glue significantly reduces the number of aortic valve replacements, the amount of intraoperative and postoperative bleeding, and the frequency and severity of postoperative complications. Long-term (4 years) survival rate has been raised from 40% to 91%.