Surgery For Aortic Valve Disease Research Articles

Early results of surgery for aortic valve disease in patients with severe left ventricular dysfunction

Aim. This study aimed to analyse the early results of aortic valve replacement in patients with severe left ventricular dysfunction: i.e. a left ventricle ejection fraction (LVEF) ≤30%.Methods. This retrospective study included 145 adult patients with isolated aortic valve disease and LVEF ≤30% who underwent aortic valve replacement from 2005 to 2019 at our institution. Patients who required any concomitant or redo surgery were excluded from the study.Results. There were three perioperative deaths (in-hospital mortality, 2.1%) due to multiple organ failure syndrome (two patients) or acute heart failure (one patient). Postoperative heart failure was the prevailing non-lethal complication (73% of cases). Other complications occurred less frequently: nine patients (6.2%) had acute kidney injury (four of whom required hemodiafiltration), one patient (0.7%) suffered a stroke, six patients (4%) required chest re-exploration for bleeding and two patients (1.4%) experienced sternal infection of the surgical wound. Patient LVEF improved significantly from 22.6% ± 5.3% to 35.8% ± 11.0% postoperatively (a 37% mean increase; p = 0.02), and most patients (73%) were classified as New York Heart Association class I–II by the time of discharge.Conclusion. Our study showed excellent results of surgery for aortic valve disease in patients with severe left ventricular dysfunction. Postoperatively, there was a marked increase in LVEF and significant clinical improvement. Received 1 May 2020. Revised 12 May 2020. Accepted 18 May 2020. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Author contributionsConception and design: S.S. Babeshko, K.O. Barbukhatti, V.A. PorkhanovData collection and analysis: S.S. Babeshko, D.I. ShumkovDrafting the article: S.S. Babeshko, Y.P. SamurganovStatistical analysis: S.S. Babeshko, D.I. ShumkovCritical revision of the article: S.S. Babeshko, Y.P. Samurganov, K.O. BarbukhattiFinal approval of the version to be published: S.S. Babeshko, Y.P. Samurganov, D.I. Shumkov, K.O. Barbukhatti, V.A. Porkhanov

Comparison of Frequency of Referral to Cardiothoracic Surgery for Aortic Valve Disease in Blacks, Hispanics, and Whites

Racial differences in prevalence and in intervention rate of those with severe aortic stenosis have been reported. Our objective was to evaluate health disparities in referral to cardiothoracic surgery (CTS) for aortic stenosis in black and Hispanic compared with white patients before the transcatheter aortic valve replacement program was started in our community. Using a retrospective cohort design, we identified all patients >40years, who had been captured with aortic valve disease from January 2011 to June 2016. Clinical and echocardiographic data were collected manually. Exposure was race/ethnicity; outcome was referral to CTS. Multivariable logistic regression analysis was conducted with variables that had significance of p <0.20 in univariate model. We included 952 patients in the final analysis (423 white, 376 black, and 153 Hispanic). Compared with whites, black subjects were significantly younger, had more advanced degrees of kidney disease, were more likely to have Medicaid as payer, and had more atherogenic co-morbidities. Black patients had significantly higher aortic valve area indexed for body surface area, more aortic regurgitation, lower peak velocities, lower transvalvular gradients, less calcified valves, and fewer patients in aortic stenosis stage D. The adjusted odds ratio for CTS referral was 0.48 for blacks (p <0.001) and 0.86 for Hispanics (p= 0.73) compared with whites. In conclusion, after adjusting for clinical and echocardiographic variables, black patients were less likely to be referred to CTS for treatment of aortic valve disease. We found no difference in the referral pattern of Hispanic compared with white patients.

Aortic Valve Replacement in Octogenarians

With improved life expectancy more octogenarians now present with aortic valve disease. Cardiac surgery in this group of patients has previously been considered high risk due to co-morbidities and challenges of rehabilitation. This study seeks to challenge the concept of octogenarian cardiac surgery "unsuitability" by analysing operative outcomes and long term survival following aortic valve replacement. Eighty-seven consecutive patients undergoing aortic valve replacement between 2000 and 2009 at St Vincent's Hospital were retrospectively identified. Statistical analysis was performed using SPSS (version 15 and 19). The average age was 82.7 ± 2.4 years. The mean logistic EuroSCORE was 18.86 ± 14.11. Post-operatively, four patients required insertion of a permanent pacemaker (4.6%) and five patients had a myocardial infarction (5.8%). In-hospital mortality was 3.4%. Follow-up was 93.1% complete. One-year survival was 92.9%, three-year survival was 86.7% and five-year survival was 75.0%. At follow-up 98.1% of patients were New York Heart Association (NYHA) Class I or II. Results were excellent despite reasonable co-morbidities and Euroscore risk. Survival was impressive and the NYHA class reflected the success of the surgery in relieving the pathological aortic valve process. Patient age should not be the primary exclusion for cardiac surgery for aortic valve disease.

Surgery for Aortic Valve Disease in Teenagers and Young Adults

Surgery for Aortic Valve Disease in Teenagers and Young Adults

Transapical vs. transfemoral aortic valve implantation: Which approach for which patient, from a surgeon's standpoint.

Transcatheter aortic valve implantation (TAVI) has gained increasing acceptance for treating patients with severe aortic stenosis (AS), especially in the presence of a higher risk profile. The procedure is performed a number of ways, however, the two main routes of access are the transfemoral (TF) retrograde approach and the transapical (TA) antegrade approach. At the present time TAVI is indicated in the presence of high risk according to current position statements from the European Society Cardiology and European Association Cardiothoracic Surgery (1). TAVI outcomes in intermediate risk patients, presenting with a logistic EuroSCORE lower than 20% or a Society of Thoracic Surgeons (STS) Score between 4% and 8% are currently being evaluated in prospective randomized trials such as the SURTAVI trial (TF CoreValve™ versus conventional surgery) and PARTNER 2 trial (Edwards SAPIEN-XT™ versus conventional surgery). Despite these advancements in endovascular approaches, conventional surgery remains the standard for many patients and is associated with excellent outcomes. For example, in 2011 a German registry reported an overall mortality to be as low as 3% in 11,500 patients undergoing conventional surgery for aortic valve disease (2). Our common goal is to perform the optimal therapy for an individual patient. This is fundamentally based on a low procedural risk together with immediate functional improvement and good longer term durability. Simplicity and safety will usually lead to good acceptance by the heart team of physicians, mostly cardiologists and cardiac surgeons, to use these approaches. For the individual patient, the overall balance of risks, which cannot be determined by incision length only but rather should prioritize hard endpoints such as mortality and morbidity such as stroke are extremely important. Thus, an objective pre-procedural informative discussion individualized to each patient’s unique risks and potential outcomes is mandatory before choosing between open versus percutaneous options. In this perspective, we highlight the different aspects of choosing the TF versus the TA approach using the best available current literature and propose future prospects for the care of aortic valve disease.

Midterm evaluation of aortic valve repair: results from a single center's aortic valve repair registry

Background: Aortic valve repair is a promising surgical option in patients undergoing cardiac surgery for aortic valve disease. Aim of this study is to investigate our midterm results after various types of aortic valve repair.

New fibrillin gene mutation - possible cause of ascending aortic dilation in patients with aortic valve disease: Preliminary results

Approximately 10% of patients who undergo surgery for aortic valve disease (stenosis or regurgitation) suffer from ascending aortic dilation (AAD). A possible genetic etiology of AAD associated with aortic valve disease has been repeatedly mentioned in the literature, but a specific responsible gene mutation has not been described. In the present study, two groups of patients were compared, all of whom underwent surgery for aortic valve disease. Group A was a cohort of 27 patients who suffered from aortic valve disease associated with AAD. Group B was a cohort of 29 patients with structural aortic valve disease, but without concomitant AAD (control group). Genomic DNA was extracted from the white blood cells of peripheral blood samples and was amplified using primers specific for chosen exons of the fibrillin-1 gene, including their intron/exon boundaries. Exons 26 and 27 were selected for analysis. Analysis of the intronic part situated close to exon 27 showed insertion of cytosine between nucleotide 37 682 and 37 683 of query sequence. This insertions was classified as IVS 37 682 and 37 683insC. This mutation was found in all 27 patients from group A (patients with structural aortic valve disease accompanied by significant AAD). The abovementioned mutation was not found in any of the 29 patients from group B. This finding has potential implications for risk stratification and therapeutic targeting not only for patients with existing disease, but also for the general population. Future studies are needed to determine the clinical utility of the finding; however, the present hypothesis needs to be verified by further molecular studies.

Miniesternotomía para cirugía valvular aórtica: Experiencia inicial en un centro cardiovascular en Chile

Aortic valve surgery can be performed through a reduced mid sternotomy with excellent long term results.To report the initial results obtained with this technique.Descriptive study of 20 patients aged 48+/-11 years, subjected to valve replacement surgery for aortic valve disease between 2004 and 2007. Arterial and venous cannulation were performed with the usual method and extracorporeal circulation was performed with a mean perfusion of 4.5 L/min. Hypothermia and cardioplegia were performed infusing the hematic cardioplegic solution at 4 degrees C in the aortic root or coronary ostia.Sixteen patients were in functional class (FC) III. Fourteen patients had aortic insufficiency and six had predominant stenosis. There was no operative mortality One patient had a left hemothorax and was reoperated. All patients were discharged between 4 and 6 days after surgery. Mean follow-up was 21 +/- 4 months. All patients are in FC I and free from cardiac events. Echocardiographic assessment was done in 16 patients, showing a good motility of valve disks. Actuarial survival probability was 100% and probability of freedom from cardiac events was 100% at 42 months of follow-up.Ministernotomy is an excellent approach for aortic valve surgery providing good visualization of the ascending aorta, simplifying the surgical technique.

Clinical Characteristics of Bicuspid Aortic Valves in Surgical Patients

Of 413 patients undergoing surgery for aortic valve disease, 42 were confirmed to have congenital bicuspid aortic valve. There were 24 males and 18 females, with a mean age of 54.9 +/- 14.6 years. The etiology of the surgical indications in patients with bicuspid valves were degeneration, rheumatic disease, and infectious endocarditis. Thirty-two patients had aortic stenosis and 10 had aortic regurgitation. Infective endocarditis was seen mainly in patients < or =50 years of age at the time of surgery, while degenerative aortic stenosis occurred more often in older patients. The annular diameter measured during surgery was significantly narrower in the 42 patients with bicuspid valves compared to 371 patients with tricuspid valves who underwent aortic valve replacement during the same period. It is important to prevent infectious endocarditis in younger patients diagnosed with bicuspid aortic valve, whereas careful attention should be paid to decalcification during surgery in older patients because the vast majority suffer from degenerative aortic stenosis.

Reconstructive surgery for aortic valve disease.

CECORP-Centro Especializado do Coracao e Pulmao de Ribeirao Preto, Hospitaldo Coracao de Ribeirao Preto/Fundacao Waldemar B. Pessoa, Faculdade deMedicina de Ribeirao Preto-USP e Faculdade de Medicina da UNAERPMailing adress: Paulo J. F. Ribeiro - Rua Quintino Bocaiuva, 171 - 14015-160 -Ribeirao Preto, SP

Present Status of Reconstructive Surgery for Aortic Valve Disease

Most surgical techniques for reconstruction of the aortic valve, although described a long time ago, are now feasible with satisfactory results. The general surgical principles for successful reconstruction, and the operative techniques of annuloplasty, commissurotomy, free edge resuspension, unrolling and thinning, and cusp extension are described. Methods for intraoperative evaluation of the repaired valve are also described. Between August 1988 and April 1992, 166 patients underwent aortic valve reconstruction with a 3.2% hospital and 1.2% late mortality. There were no thromboembolic events in the patients with isolated aortic valve repair. The reoperation rate was 6.5%. Echocardiographic study at last follow-up showed stable results at 4 years maximum follow-up.