Prosthetic Dysfunction Research Articles

P1716 Aorto-left atrial fistula with left atrium dissection

Abstract We report a 71 year-old female with a history of rheumatic valvulopathy, who underwent St. Jude 23 and St. Jude 21 in mitral and aortic position replacement. The patient was admitted to the ER for pulmonary edema with haemoglobin level of 7.7 g/dL .No evidence of gastrointestinal bleeding. She was assessed to exclude intravascular hemolysis: bilirrubin 3.1mg/d,L direct bilirrubin 1.0 mg/dL, reticulocytes 207.000/mcL 6.8%, LDH 1.213, free plasmatic haemoglobin 9.6mg/dL, haptoglobin < 1 mg/dL, negative direct and indirect Coombs. Upon suspicion of hemolytic anemia in relation to prosthetic dysfunction, TEE was performed revealing stenotic mechanical aortic prosthesis with abundant pannus and normofunctional mitral prosthesis, no leakages were observed. A coronary CT scan showed severe calcification of the aortic root and mitral annulus without evidence of redundant tissue than hindered the opening of the aortic or mitral valves. Cardiac catheterization revealed normal coronary arteries, cardiac output preserved and mild passive predominance of PAP. Heart Team decided on aortic prosthesis valve replacement. On March 22, 2019 surgery was performed. There was a heavily calcified ascending aorta and aortic root with abundant pannus at the ventricular aspect of the aortic prosthesis. Former aortic prosthesis was resected and the root reconstructed with a pericardial patch. 18-mmATS mechanical aortic prosthesis was implanted. After 127minutes of cross-clamping time, the patient was admitted to the ICU. She presented a torpid course in the postoperative period after cardiac surgery and cardiogenic shock ensued. TEE was repeated, showing pseudoaneurysm of the mitral–aortic intervalvular fibrosa, left atrium dissection and severe paraprosthetic aortic leakage. Coronary CT scan revealed a large cavity, 7x4x3.5 cm, extending posteriorly and displacing cranially the right pulmonary artery and subsequently rejecting the cavity of left atrium; with final diagnosis of aorto-left atrial fistula with left atrium dissection. Emergent surgery was decided. During the procedure, mitral–aortic intervalvular fibrosa pseudoaneurysm was confirmed, perforation from the subaortic left ventricle into the left atrium was also appreciated at the junction of the aortic root pericardial patch with the dissected left atrium wall. Surgery was complicated with hemorrhagic shock and massive uncontrolled bleeding with severe coagulopathy and thrombocytopenia. The patient went into cardiac arrest and passed away in the operating room. Conclusion Aorto atrial fistulas are rare but important complications of many disease processes of the aorta and aortic valve. Classical clinical signs of continuous murmurs may not be present and echocardiography forms the cornerstone of diagnosis. AAF should be suspected in patients with poorly controlled heart failure and prior aortic surgery. Prompt surgical repair is usually helpful in relieving symptoms and decreasing mortality. Abstract P1716 Figure. Aortoatrial fistula

P1753 Echocardiographic assessment of prosthetic aortic valve in children

Abstract Introduction Although the diagnostic utility of Doppler-derived hemodynamic parameters of prosthetic aortic valve (PAV) for detecting prosthetic dysfunction has been demonstrated in adults, interpreting these parameters in children is difficult, as the relative size of PAV varies more greatly in them than in adults. We aimed to elucidate how the Doppler-derived hemodynamic parameters change as the PAV size decreases relative to the somatic growth of children. Methods We reviewed 11 echocardiographic examinations of 9 mechanical PAVs in 8 children. The median age at echocardiographic examination was 10.2 (0.5-17.7) years. Underlying diagnoses leading to aortic valve replacement were aortic regurgitation due to dysplastic aortic valve in 3 children, Marfan syndrome in 1, persistent truncus arteriosus in 1, and aortic stenosis associated with interrupted aortic arch/coarctation of the aorta in 3. The PAV functioned normally in all examinations. PAV size was 19 mm in 8 examinations and 17 mm in 3 examination, which was standardized to body surface area at the examination by calculating z-scores based on previously published normative data of aortic valve diameter. We assessed the Doppler-derived hemodynamic parameters, namely peak velocity, mean pressure gradient, and accerelation time of the transprosthetic flow, the velocity-time integral (VTI) ratio of the left ventricular outflow to the transprosthetic flow, and effective orifice area (EOA) of the PAV calculated by using the continuity equation. The Pearson correlation coefficients between the PAV size z-score and Doppler-derived hemodynamic parameters of the normally functioning PAVs were evaluated. A p-value of <0.05 was considered statistically significant. Results All the Doppler-derived hemodynamic parameters except for EOA had a statistically significant correlation with PAV size z-score (Pearson correlation coefficients: peak velocity, -0.76; mean pressure gradient, -0.70; acceleration time, -0.66; and VTI ratio, 0.76). Multivariate analysis revealed that VTI ratio was the sole parameter that independently correlated with PAV size z-score. Conclusions VTI ratio, which is theoretically less dependent on cardiac preload than other hemodynamic parameters, strongly reflects BSA-indexed PAV size. Disproportionately decreased VTI ratio in relation to PAV size might indicate prosthetic obstruction in children with PAV. Abstract P1753 Figure. Correlation of PAV size and VTI ratio

Safety and effectiveness of a transaortic approach for TAVI: procedural and midterm outcomes of 265 consecutive patients in a single centre.

Transcatheter aortic valve implantation with a transaortic approach (TAo-TAVI) is an alternative to transapical or femoral access. We studied the procedural and midterm efficacy and safety of TAo-TAVI with Edwards Sapien XT and Medtronic CoreValve devices. Among 901 patients receiving TAVI since 2006, 265 consecutive patients underwent TAo-TAVI between January 2011 and September 2014. Procedural and midterm results were evaluated according to Valve Academic Research Consortium-2 criteria. The mean age was 83 ± 5 years. Sapien XT and CoreValve were used in 191 (72.1%) and 74 (27.9%) patients, respectively. Full sternotomy made elective concomitant off-pump coronary artery bypass grafting possible in 38 patients (14.3%) with severe coronary artery disease unsuitable for percutaneous coronary intervention. The device success rate was 95.5%. Postprocedural paravalvular leak ≥2/4 was observed in 16 patients (6.4%). Emergency open chest surgery was required in 10 patients (3.8%) (3 aortic dissections, 3 valve embolizations, 2 LMCA occlusions, 1 aortic annulus rupture and 1 aortic rupture). Cerebrovascular accidents occurred in 3 patients (1.1%). Transfusions ≥4 units were required in 36 patients (13.6%). New pacemakers were implanted in 26 patients (9.8%). Thirty-day and 1-year mortality were 8.7% and 16.2%, respectively. Mean follow-up duration was 24 ± 6 months. At 3 years, freedom from all-cause death was 80% ± 4%. New York Heart Association class <III included 81% (n = 172) of patients alive and without prosthetic echocardiographic dysfunction at follow-up (mean gradient 10.5 ± 5.6 mmHg). The TAo-TAVI approach confirms its safety and effectiveness with satisfactory procedural and midterm outcomes with both currently available devices.

Novel Transcatheter Mitral Valve Prosthesis for Patients With Severe Mitral Annular Calcification

BackgroundTreatment of mitral regurgitation (MR) in the setting of severe mitral annular calcification (MAC) is challenging due to the high risk for fatal atrioventricular groove disruption and significant paravalvular leak. ObjectivesThe objective of this study was to evaluate the potential for transcatheter mitral valve replacement in patients with severe MAC using an anatomically designed mitral prosthesis. MethodsNine patients (77 ± 6 years of age; 5 men) were treated with the valve, using transapical delivery performed under general anesthesia and with guidance from transesophageal echocardiography and fluoroscopy. ResultsDevice implantation was successful with relief of MR in all 9 patients. There were no procedural deaths. In 1 patient, left ventricular outflow tract obstruction occurred due to malrotation of the prosthesis, and successful alcohol septal ablation was performed. During a median follow-up of 12 months (range 1 to 28 months), there was 1 cardiac death, 1 noncardiac death, no other mortality, and no prosthetic dysfunction, and MR remained absent in all treated patients. Rehospitalization for heart failure occurred in 2 patients who did not die subsequently. Clinical improvement with mild or no symptoms occurred in all patients alive at the end of follow-up. ConclusionsTranscatheter mitral valve replacement in severe mitral annular calcification with a dedicated prosthesis is feasible and can result in MR relief with symptom improvement. Further evaluation of this approach for these high-risk patients is warranted.

TRANSFEMORAL MITRAL VALVE-IN-VALVE IMPLANTATION FOR SEVERE PROSTHETIC REGURGITATION SECONDARY TO A FLAIL CUSP

There are limited therapeutic options for patients with prosthetic mitral dysfunction and prohibitive surgical risk. 84-year-old male admitted to hospital with NYHA III-IV heart failure symptoms. His past medical history included rheumatic heart disease with mitral valve replacement with a St. Jude

LONG-TERM OUTCOMES AND COMPLICATIONS OF ANTICOAGULANT THERAPY FOR BIOPROSTHETIC VALVE THROMBOSIS IN A LARGE MATCHED-COHORT STUDY

Bioprosthetic valve thrombosis (BPVT) is a known cause of prosthetic dysfunction. Anticoagulation restores prosthesis function, but long-term outcomes are unknown. Retrospective cohort study of patients treated with warfarin for presumed BPVT at a single center (1999-2016). Controls (normal BPV by

Risk Factors for Starr-Edwards Prosthetic Valve Dysfunction: New Insights into an Old Prosthesis

Background: Starr-Edwards prosthetic valves were used for valve replacement, but due to their high thrombogenic risk, they were withdrawn from market. Nevertheless, there are some cases of Starr-Edwards prosthetic valve carriers that have shown long-term survival reaching up to 50 years. The objective of this study was to determine survival in 12 patients with mechanical Starr-Edwards prosthetic valve and risk factors for predicting valve dysfunction. Methods: Cross-sectional study of patients who had valve replacement with a Starr-Edwards prosthetic valve in a single center from 1968 to 1990. Socio-demographic data, valvular dysfunction variables and mortality were recorded. Logistic regression models to determine valvular dysfunction were constructed. Survival was analyzed with Cox regression and Kaplan-Meier survival curves. Results: A total of 12 patients were analyzed. The median age was 59 years (48.5 - 64). Eleven patients had normal right and left ventricular function. The most common cause of valve replacement was rheumatic valve disease (75%) and it was more frequently in mitral position (50%). Valvular dysfunction was detected in 3 patients (25%). Atrial fibrillation had the highest association with valvular dysfunction (P = 0.005). Stroke was seen in 25% of the population and the overall mortality was 33.3%. Conclusions: The survival of patients with Starr-Edwards prosthetic valve was 66.66% in the 50-year follow-up. Atrial fibrillation had the highest association with prosthetic valvular dysfunction.

Abstract 16833: Long-Term Outcomes and Complications of Anticoagulant Therapy for Bioprosthetic Valve Thrombosis in a Large Matched-Cohort Study

Introduction: Bioprosthetic valve thrombosis (BPVT) is a well-recognized cause of prosthetic dysfunction. Anticoagulation restores prosthetic valve gradients, but long term outcomes and complications from therapy are unknown. Objectives: To define the complications and long-term outcomes of anticoagulant therapy for BPVT. Methods: Retrospective matched cohort study of patients treated with warfarin for presumed BPVT at a single center from 1999 to 2016. Controls with normal bioprostheses by echocardiography were matched 2:1 for age at implantation, gender, prosthetic valve position, and type of prosthesis (porcine / pericardial). Results: A total of 83 presumed BPVT patients (40 aortic, 21 mitral, 18 tricuspid, and 4 pulmonary) and 166 controls were included. Age at BPVT diagnosis was 60±19 yrs (41±41 months post implantation); 45 (54%) were male. Transvalvular gradients returned to baseline in 63 (76%) of the patients, after 5±4 months of warfarin; 60 (72%) patients were maintained on warfarin indefinitely. Recurrent BPVT was seen in 13 (16%) patients, 33±31 months after initial therapy. When compared to controls, warfarin-treated BPVT patients had similar incidence of stroke [4(5%) vs 5 (3%), p=0.49], peripheral embolic events [4(5%) vs 10 (6%), p=0.78)], and death [12 (14%) vs 28 (17%), p= 0.72] (Figure, left panel), but more bleeding requiring transfusion [18 (22%) vs 3 (2%), p&lt;0.0001]. Presumed BPVT patients more often required surgical or percutaneous valve re-replacement (Figure, center panel); this difference persisted even when comparing only patients with confirmed BPVT (those who responded to anticoagulant therapy) vs. their matched controls (Figure, right panel). Conclusion: Warfarin anticoagulation for presumed BPVT is successful in the majority of patients, without increase in stroke, peripheral embolism or death, but at the cost of excess bleeding. Recurrent BPVT occured in 16% of patients. Importantly, patients with BPVT required more often valve re-replacement. This finding suggests that anticoagulant therapy does not fully restore prosthetic valve durability, and that BPVT patients should be closely monitored.

IS 10 YEARS THE APPROPRIATE TIME TO HAVE A FOLLOW UP ECHOCARDIOGRAM AFTER AN IMPLANTED VALVE PROSTHESIS?

The 2014 ACC/AHA Valve Guidelines give a class IIA (level of evidence C) recommendation for performing annual transthoracic echocardiograms (TTE) beginning ten years after bioprosthetic valve implantation, earlier if clinically indicated. However, the scientific evidence for this remains limited. The purpose of this study was to determine if this ten year recommendation is valid by reviewing TTEs done at least ten years after valve implantation. The echo database at Vancouver General Hospital was searched for all TTEs involving bioprosthetic or mechanical valves in the aortic or mitral position. We only included those patients who had a TTE at least ten years after implantation, as evidenced by the date of the intraoperative TEE. The first TTE greater than ten years post-implantation was reviewed and included if there were no obvious structural abnormalities to the prosthesis. Prosthetic valvular dysfunction was defined as a mean gradient greater than 5 mmHg across the mitral valve or 25 mmHg across the aortic valve, or more than moderate regurgitation. The prosthetic valve function at least ten years after implantation are shown in Table 1. 82% had normal function, with the predominant abnormality being stenosis. Abnormal bioprosthetic function was significantly increased compared to mechanical valves (26% vs 9% p < 0.04), as shown in Table 2. Normal prosthetic valve function were found in the majority (82%) of the echocardiograms done ten year post valve implantation, supporting the ACC/AHA guidelines. Furthermore, as there was an increased chance of bioprosthetic dysfunction at this point, annual surveillance beyond this seems reasonable. The recommendations for mechanical valves surveillance can be more lax, owing to the robustness of its echocardiographic findings.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Usefulness of Mitral Valve Prosthetic or Bioprosthetic Time Velocity Index Ratio to Detect Prosthetic or Bioprosthetic Mitral Valve Dysfunction

This study aimed to investigate the utility of transthoracic echocardiographic (TTE) Doppler-derived parameters in detection of mitral prosthetic dysfunction and to define optimal cut-off values for identification of such dysfunction by valve type. In total, 971 TTE studies (647 mechanical prostheses; 324 bioprostheses) were compared with transesophageal echocardiography for evaluation of mitral prosthesis function. Among all prostheses, mitral valve prosthesis (MVP) ratio (ratio of time velocity integral of MVP to that of left ventricular outflow tract; odds ratio [OR] 10.34, 95% confidence interval [95% CI] 6.43 to 16.61, p<0.001), E velocity (OR 3.23, 95% CI 1.61 to 6.47, p<0.001), and mean gradient (OR 1.13, 95% CI 1.02 to 1.25, p=0.02) provided good discrimination of clinically normal and clinically abnormal prostheses. Optimal cut-off values by receiver operating characteristic analysis for differentiating clinically normal and abnormal prostheses varied by prosthesis type. Combining MVP ratio and E velocity improved specificity (92%) and positive predictive value (65%) compared with either parameter alone, with minimal decline in negative predictive value (92%). Pressure halftime (OR 0.99, 95% CI 0.98 to 1.00, p=0.04) did not differentiate between clinically normal and clinically abnormal prostheses but was useful in discriminating obstructed from normal and regurgitant prostheses. In conclusion, cut-off values for TTE-derived Doppler parameters of MVP function were specific to prosthesis type and carried high sensitivity and specificity for identifying prosthetic valve dysfunction. MVP ratio was the best predictor of prosthetic dysfunction and, combined with E velocity, provided a useful parameter for determining likelihood of dysfunction and need for further assessment.

Prótesis pulmonar porcina versus yugular bovina para reparar el tracto de salida del ventrículo derecho en menores con cardiopatía congénita

IntroductionIn some patients, in childhood, it may be necessary to recover the valve function of the right ventricular outflow tract, a sequel of the primary repair of their congenital heart disease. ObjectiveTo compare the outcomes of bovine jugular (YB) -Contegra® versus porcine prosthesis (PPP), implanted in patients under 18 years old. MethodsThe study included all patients under 18 years old and re-operated on between January 2003 and June 2015 after primary surgery right ventricle outflow tract, and in whom a YB/PPP was implanted. Prosthetic valve dysfunction criteria were, surgical/percutaneous re-intervention, and a gradient>50mmHg or severe prosthetic regurgitation. Statistical analysis was performed using SPSS 20.0. ResultsThere were 21 PPP implanted in 20 patients, and 15 YB in 15 patients. The study included 60% males. The most common primary congenital heart disease was Fallot. The groups were not exactly homogeneous. Of the 24 preoperative variables, 11 of them showed statistically significant differences (P<.05). These included a higher percentage of transannular surgery, indication of pulmonary regurgitation surgery, ventricular dilation, and dysfunction in the PPP group.Of the 15 perioperative variables, there were significant differences in, the mean age at implantation: 8.8±4.4 years YB versus 11.8±4 PPP (P=.044); valve diameter (P<.001) lower in YB. Need of aortic cross clamping (P=.015) however, higher in YB.There was no in-hospital or late mortality. Follow-up: 4.8 years YB versus 2.4 PPP (P=.046). Other postoperative variables with significant differences: transprosthetic gradient, residual prosthetic regurgitation, prosthetic dysfunction, all higher in YB group. ConclusionsWith prudence imposed by differences in follow-up time and type of previous surgery in both cohorts, it seems reasonable to choose a PPP to recover functionality of the right ventricle outflow tract.The YB could be used when a conduit is essential.

The Contribution of Echocardiography in the Dysfunctions of Mechanical Prosthesis: Report of 11 Cases

Introduction: The echocardiography has an essential place in the surveillance of prostheses. The aim of our study was to describe the echocardiography aspects of dysfunction of valvular prostheses. Materials and methods: This is a retrospective study, which collected all patients admitted for dysfunction of mechanical prosthesis bileaflet in the cardiology department of Marrakech during a period of 2 years. Results: We included 11 patients. The mean age was 43 years. Seven cases were carrying a mitral prosthesis, 3 patients with aortic prosthesis and one case a double valve. The average age of prostheses was 3.7years. All prosthesis was an ON-X type. The prosthesis dysfunction was revealed by an infectious syndrome (27%), acute heart failure (18%), ischemic stroke (18%), while 36% were asymptomatic. The Transthoracic Echocardiography (TTE) was pathological in 10 cases: a reduction in the functional surface prostheses with increased transprosthetic gradient (54%) significant par prosthetic leak (45%), a thrombus in one case, an anomaly of the movements of leaflet (18%). The Echo-Transesophageal (TEE) made in 8 patients, objectified images of thrombi (3 cases), Para prosthetic leaks (6 patients), abnormal of the movements of leaflet (4 cases). Conclusion: Echocardiography is the gold standard for the diagnosis of prosthetic dysfunction with superiority of TEE over TTE. Keywords: Dysfunction; Mechanical prosthesis bileaflet; Echocardiography; Valvular prosthesis; Mitral prosthesis. Abbreviation: DVI : Doppler Velocity Index EOA : Effective Orifice Area EROA : Effective Regurgitantorifice Area LV : Left Ventricular LVOT : Left Ventricular Outflow Tract MPG : Mean Pressure Gradient PHT : Pression Half Time PHV : Prosthetic Heart Valves R Vol : Regurgitant Volume TEE : Transesophageal Echocardiography TTE : Transthoracic Echocardiography TVI : Time velocity Integral VC : Vennacontracta

0369: Surgical valvular reoperations: indications and reoperations time – A series of 45 cases

Valvular heart disease still common despite improved health conditions that have reduced the incidence of rheumatic fever. Surgical and interventional indications have expanded and today we operate at early stages, sometimes even an asymptomatic stage. Valvular reoperation is required in about 15% of cases during the evolution of an operated valve disease. We report in this study the results of surgical valvular reoperations to identify the indications for these reoperations. This is a retrospective study of 45 patients aged between 18 and 70 years, admitted to the cardiology department from January 2011 to July 2013, and having a valve disease already operated and requiring reoperation. Our series consisted of 45 patients; the average age is 41 years. 73% of patients are women and 27% of men (sex ratio of 3). The mitral valve reoperations are motivated in most cases by a restenosis after a surgical commissurotomy (84%) and in 7% of cases by a prosthetic dysfunction, while aortic valve reoperations are represented primarily by the dysfunction of pros-thesis (44%) and aortic regurgitation neglected (56%). Finally, the reoperation on the tricuspid valve is dominated essentially by regurgitation neglected during the first intervention (62%). The average time between the two interventions, any kind confused, is 21 years, but this “timing” is variable if we take into consideration the repair technique. Cardiac reoperations may occur during the evolution of a valvulopathy. The patient should be warned of this and the possibility of reoperation should be considered at the first cardiac surgery. Good initial cardiac evaluation is needed to overcome the risk of reoperation for valve disease neglected.

Surgical Outcome in Hemodialysis Patients with Active-Phase Infective Endocarditis.

The aim of this study was to elucidate the characteristics of chronic hemodialysis (HD) patients requiring surgery during the active phase of infective endocarditis (IE). From December 2004 to July 2015, 58 patients underwent surgery in our institute for active IE. Seven patients had been on HD for 1-15 years. Their preoperative profiles and surgical outcomes were compared to those of the other 51 patients (non-HD group). The predominant causative microorganisms in the HD group were Staphylococcus spp, particularly methicillin-resistant Staphylococcus aureus (MRSA), whereas Streptococcus spp were predominant in the non-HD group. Prosthetic dysfunction (stuck valve after mechanical and structural valve dysfunction following bioprosthetic valve replacement), complete atrioventricular (AV) block, and annular abscess formation were more frequent in the HD group. In-hospital mortality was higher in the HD group (29% vs. 6%, p = 0.044). Actuarial survival in the HD and non-HD groups was 43% vs. 87% at 5 years and 43% vs. 76% at 10 years (p = 0.007). Early and long term outcomes in patients with chronic HD were poor. Compared to other patients, chronic HD patients undergoing valve surgery during active IE had higher incidences of MRSA infection, annular abscess formation, postoperative valve dysfunction, and postoperative complete AV block.

Valve selection in aortic valve endocarditis.

Aortic prosthetic valve endocarditis (PVE) is a potentially life-threatening disease. Mortality and incidence of infective endocarditis have been reduced in the past 30 years. Medical treatment of aortic PVE may be successful in patients who have a prompt response after antibiotic treatment and who do not have prosthetic dysfunction. In advanced stages, antibiotic therapy alone is insufficient to control the disease, and surgical intervention is necessary. Surgical treatment may be lifesaving, but it is still associated with considerable morbidity and mortality. The aim of surgery is to perform a radical excision of all infected and necrotic tissue, reconstruction of the left ventricle outflow tract, and replacement of the aortic valve. There is no unanimous consensus on which is the optimal prosthesis to implant in this context, and several surgical techniques have been suggested. We aim to analyze the efficacy of the surgical treatment and discuss the issue of valve selection in patients with aortic valve endocarditis.

STENTED BIOPROSTHESIS IN AORTIC POSITION: ANALYSIS OF THE EARLY RESULTS BASED ON A RETROSPECTIVE STUDY

Purpose. Retrospective analysis of the immediate results of the treatment of these patients will form an idea of the need for a prospective randomized study. Materials and methods. Are analyzed the results of 411 operations performed in patients with aortic stenosis. The first group – 227 patients with implanted bioprosthesis in the aortic position UniLine, the second group – 184 patients with implanted stented bioprosthesis Biolab. Results. Postoperative mortality in group I was 1.8 % (4 patients), in group II – 2.7 % (5 patients) (p=0.8). To determine the factors that have a connection to the pressure gradient in the aortic prosthesis, regression analysis was performed. In group I, the relationship between the peak pressure gradient and body mass index (p = 0.001). In group II, the relationship peak pressure gradient and stroke volume of the left ventricle, body mass index and diameter of the prosthesis. In group I in the perioperative period required reimplantation valve 1 (0.4 %) patient. Reason dysfunction – iatrogenic damage to the prosthesis. In group II all recorded 3 (1.6 %) early prosthetic dysfunction, including 1 (0.5 %) – iatrogenic and 2 (1 %) – due to the prosthesis itself. Conclusion . A prospective randomized controlled study conducted over a long period of time, a few clinics at the same time, allow more objectively assess the advantages and disadvantages of dentures and to define prospects of development of this direction in Russia.

Early and long-term outcomes of minimally invasive mitral valve surgery through right minithoracotomy: a 10-year experience in 1604 patients.

BackgroundTo report early and long-term outcomes of patients undergoing minimally invasive mitral valve surgery (MIMVS) through right mini-thoracotomy (RT) over a 10-year period.MethodsFrom September 2003 to December 2013, a total of 1604 consecutive patients underwent MIMVS through RT.ResultsThe mean age was 63 ± 13 years, 770 (48 %) patients were female and 218 (13.6 %) had previous cardiac operations. The most predominant pathology was degenerative disease (70 %), followed by functional mitral valve regurgitation (12 %), rheumatic disease (9.4 %), endocarditis (5 %) and prosthetic dysfunction (3.2 %). Mitral valve repair was performed in 1137 (71 %) patients and 476 (29 %) had mitral valve replacement. Direct aortic cannulation was achieved in 1325 (83 %) patients. Among patients with degenerative disease candidate for repair (n = 958), rate of mitral valve repair was 95 %. Repair techniques included annuloplasty (95 %), leafleat resection (63 %), neochordae implantation (16 %) and sliding plasty (11 %). Concomitant procedures included tricuspid valve repair (14.6 %), atrial fibrillation ablation (9.5 %) and atrial septal defect closure (3.2 %). Overall in-hospital mortality was 1.1 %. Thirty-four patients (2.1 %) had conversion to sternotomy. Incidence of stroke was 2 %. Overall survival at 10 years was 88 ± 2 %. Freedom from reoperation at 10 years was 94 ± 2 % for repair and 80 ± 6 % for replacement. Freedom from recurrent mitral regurgitation >3+ at 10 years was 90 ± 3 %.ConclusionsMinimally invasive mitral valve surgery is a safe and reproducible approach associated with low mortality and morbidity, high rate of mitral valve repair and excellent late results.

Permanent pacemaker implantation after aortic valve replacement: Long-term dependency or rhythm recovery?

IntroductionConduction disturbances requiring permanent pacemaker (PM) implantation occur in 3–12% of patients after aortic valve replacement (AVR). Our aim was to assess long-term PM dependency and its predictors in these patients. MethodsWe conducted a retrospective study of all consecutive patients undergoing permanent PM implantation after AVR between January 2004 and December 2010. Absence of sinus rhythm or atrial fibrillation with appropriate ventricular response at a pacing rate of 30 bpm for 10 s was defined as pacemaker dependency. ResultsNinety-one patients underwent permanent PM implantation and during follow-up (1026.6±732.0 days) 64% of them did not recover rhythm. Age, conduction disorders on the preoperative ECG, negative chronotropic medication before surgery, cardiopulmonary bypass and aortic cross-clamp times did not influence rhythm recovery. In multivariate analysis, valvular disease etiology related to endocarditis, prosthetic dysfunction and bicuspid valve were associated with long-term PM dependency (OR 5.05; CI: 1.43–17.75). ConclusionsThe majority of patients undergoing permanent PM implantation after AVR did not recover from conduction disorders during follow-up. The etiology of valvular disease was an independent predictor of late PM dependence.

Permanent pacemaker implantation after aortic valve replacement: Long-term dependency or rhythm recovery?

IntroductionConduction disturbances requiring permanent pacemaker (PM) implantation occur in 3–12% of patients after aortic valve replacement (AVR). Our aim was to assess long-term PM dependency and its predictors in these patients. MethodsWe conducted a retrospective study of all consecutive patients undergoing permanent PM implantation after AVR between January 2004 and December 2010. Absence of sinus rhythm or atrial fibrillation with appropriate ventricular response at a pacing rate of 30 bpm for 10 s was defined as pacemaker dependency. ResultsNinety-one patients underwent permanent PM implantation and during follow-up (1026.6±732.0 days) 64% of them did not recover rhythm. Age, conduction disorders on the preoperative ECG, negative chronotropic medication before surgery, cardiopulmonary bypass and aortic cross-clamp times did not influence rhythm recovery. In multivariate analysis, valvular disease etiology related to endocarditis, prosthetic dysfunction and bicuspid valve were associated with long-term PM dependency (OR 5.05; CI: 1.43–17.75). ConclusionsThe majority of patients undergoing permanent PM implantation after AVR did not recover from conduction disorders during follow-up. The etiology of valvular disease was an independent predictor of late PM dependence.

Experiencia inicial en implantación de electrodos endocavitarios en pacientes portadores de bioprótesis tricúspides

IntroductionTricuspid valve disease is frequently associated with disorders of rhythm and conduction. Endocardial electrode implantation in patients with tricuspid bioprosthesis was traditionally avoided. MethodsFour cases of endocardial electrode implantation in patients with tricuspid bioprosthesis are reviewed. ResultsNo prosthetic dysfunction was observed in monitoring, being similar to the outcome of patients without pacemakers. There were no deaths. ConclusionsInitial results suggest continuing this type of procedure.