Surgery For Valvular Heart Disease Research Articles

Surgical results of heart valve disease because of bacteriological endocarditis in children at hanoi heart hospital

Objective: Review of some clinical and paraclinical characteristics and evaluation of outcomes after surgical treatment of valvular heart disease due to infective endocarditis in children at Hanoi Heart Hospital
 Methods: Analysis and evaluation based on data collected from patients undergoing surgery and from the results of follow-up examination.[1]
 Results: The total number of patients was 25. Average age of surgery: 6,56 ± 7.05 years (The lowest age is 1years, the highest is 15 years). Male: 14 patients (56%), female: 11 patients 44(%). Ultrasound before discharge and after 3 months, we found similar results: mean EF:57,25 ± 9,68 %; Mean pressure through mitral valve: 3,5 ± 1,5mmHg; through aortic valve: 12,5 ± 1,68mmHg. Complications: Death immediately after surgery: 0 cases (0%); Late death: there was 1 case of death (4%).
 Conclusion: Results of surgery for valvular heart disease due to infective endocarditis in children are positive. The rate of mortality and complications after surgery is low.

The Quality of Life in Patients With Valve Prosthesis After Undergoing Surgery for Valvular Heart Diseases.

Background and objective Surgery for valvular heart disease by valve replacement procedures has become one of the most frequently performed cardiac operations to improve the quality of life (QoL). Its long-term outcomes are assessed using the quality-of-life index (QLI). This study aimed to evaluate the QoL in patients whoreceived valve prostheses after surgery for valvular heart diseases at King Abdulaziz University inJeddah from 2010 to 2023. Methods This was adescriptive cross-sectional study of 59 patients aged 18 years or older who underwent surgical mitral and aortic valve replacement, involving either mechanical or tissue valves,from January 2010 to May 2023 They were selectedusing a non-probability convenient sampling technique. Their medical records were reviewed and the participants were interviewed via phone using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire, which was used to measure the QoL of patients (https://neurotoolkit.com/whoqol-bref/). Results The study found that the QoL of the participants varied across different domains. The psychological domain had the highest mean score of 79.76, while the physical domain had the lowest mean score of 61.5. The other domains, - social, environmental, and spiritual - had mean scores of 68.05, 69.9, and 73.25, respectively. There was a statistically significant association between the QoL and nationality and chronic diseases. However, the duration after surgery and the type of valve did not significantly correlate with the QoL in the different domains. Conclusion Based on our findings, heart valve replacement improves the QoL of patients. Healthcare organizations and providers should aim to improve the management of chronic diseases to optimize outcomes.

Correlation of NT-proBNP and left atrial pressure in patients with atypical atrial flutter after cardiac surgery and previous catheter ablation

Abstract Funding Acknowledgements Type of funding sources: None. Background Atypical atrial flutter (AFL) is often associated with cardiac surgery or extensive catheter ablation (CA) for the treatment of atrial fibrillation (AF). Therefore, the increase in the number of cardiac surgery procedures leads to the development of substrates for atypical AFL onset. Described several prognostic factors for the development of AF in the long-term period after cardiac interventions. To our knowledge, the prognostic factors of atypical AFL in patients after cardiac surgery are not described. Objective the aim of our study was to determine the relationship between increased left atrial pressure and the NT-proBNP biomarker in patients after cardiac surgery and catheter ablation. Methods Sixty-five adult patients with AFL after cardiac surgery and catheter ablation were included in a single-center prospective study. The patients' age varied from 18 to 76 years, and the mean age was 57.1±12.2 years. Of these, 36 patients were male (55.4%) and 29 women (49.3%), respectively. Patients were observed for NT-proBNP before index radiofrequency ablation (RFA). All patients underwent RFA of atypical AFL in the left atrium (LA) and measurement of LA pressure. The patients were discharged safely and were monitored for 12 months. Results According to basic characteristics of patients with atypical AFL cardiac surgery for valvular heart disease was performed in 30 (46.1%) cases, for ischemic and congenital heart diseases occurred with the same frequency, 8 (12.3%). Atypical AFL occurred in 20 (30.8%) cases after cryoballoon pulmonary veins isolation (PVI), after RFA of a typical AFL in 14 (21.3%) cases, and radiofrequency PVI in 13 (20%) cases. The mean invasive LA pressure before index RFA was 22.3±5 mm. Hg, mean LA size on transthoracic echocardiography was 42.3±6.9mm. The parameters of the left ventricle: mean EDV 93.3±26.1ml, mean ESV 41.7±16.9ml, and mean EF 56±7.6%. Mean NT-proBNP was 974.8±440.5 pg/ml. In our cohort of patients, we identified a positive correlation between NT-proBNP and LA pressure (p<0.001, r=0.761), as well as a positive relationship between NT-proBNP and LA diameter (r=0.512, p<0.001), between LA pressure and LA diameter (r=0.438, p<0.001). Additionally, a correlation was found between the pulmonary artery systolic pressure and LA diameter (r=0.314, p=0.011). Conclusions Our study demonstrates a strong direct linear relationship of NT-proBNP with an increase of LA pressure in patients with atypical AFL in patients previously undergone cardiac surgery and catheter ablation. Thus, these parameters can serve as possible prognostic criteria for the development of complex cardiac arrhythmias such as atypical AFL.

Repeated valve replacement: approaches and devices (literature review)

Bioprosthetic valve dysfunction represent a serious drawback that limits the wider clinical use of these medical devices for valvular heart disease surgery. Modern studies describe the view of pathophysiologists on this problem as a multifactorial multi-stage process that causes irreversible changes in bioprosthesis components, ultimately leading to its dysfunction. However, in addition to under- standing the causes and manifestations of prosthetic valve dys- function, an applied question arises about the treatment strategies — determining the most attenuated and accessible low-risk method/ device. The aim of this review was to analyze and systematize current literature data on methods and designs used in repeated surgical and transcatheter interventions on heart valves.

A Study of Fertility and Pregnancy Outcomes in Women after Surgery for Valvular Heart Disease

Objectives: Chronic Rheumatic Heart Disease (CRHD)is a common condition in India. CRHD accounts for a majority of heart valve surgery, including those in the younger age group. These young women almost traditionally get married in a country like India, and the social pressure to bear children is tremendous. Anticoagulation and the postoperative state of the patient itself can be a risk factor for maternal and fetal outcomes. There is very little data available for the same in India. Materials and Methods: In this study, 100 cases were studied retrospectively to study the fertility patterns after valvular heart surgery including fetal outcomes. This study was conducted at Nizam’s Institute of Medical Sciences, Hyderabad in which pregnancy, anticoagulation, maternal and fetal outcomes were studied. Results: A total of 63 patients conceived after surgery (pregnancy rate = 63%/ failure rate =37%) (p=0.001). Fetal loss occurred in 6 of the pregnancies, due to spontaneous abortion (n=3) and medical abortion (n=3). Parity, associated conditions and age did not affect the outcome. During pregnancy, 28 patients switched to UF heparin, 31 stayed on warfarin, 4 did not take any anticoagulation. Fetal loss was observed in 3 patients on Warfarin during pregnancy and 3 on UF heparin. Maternal loss was observed in 4 patients out of which 2 were on Warfarin, 1 on unfractionated UF heparin and 1 did not take any anticoagulation during pregnancy. In comparison, warfarin and UF heparin had similar fetal outcomes. Conclusion: The study recorded good outcomes irrespective of type of prosthesis and anticoagulation.

Validity of Preoperative Screening Before Open-Heart Surgery in Reduction of Perioperative Ischemic Stroke

ObjectivesCerebrovascular event after open-heart surgery is a critical complication and contributes to poor prognosis, including increased mortality. The purpose of this study is to investigate the appropriate preoperative risk assessment and monitoring for reducing the risk of ischemic stroke after open-heart surgery. Materials and methods184 patients who underwent surgery for valvular heart disease were included in this study. Near-infrared oxygen saturation monitoring (INVOS system) was performed during open-heart surgery. For the purpose of perioperative stroke risk assessment, we evaluated the clinical and radiological factors of the group that underwent preoperative consultation and the group that did not, and of the patients with and without postoperative ischemic stroke. ResultsPreoperative consultation was performed in 60 cases. Large vessel steno-occlusive disease was found in nine cases, of which three had undergone revascularization surgery. Cerebral infarction developed in four cases, all of which had no large vessel steno-occlusive disease. There was no significant association between the development of postoperative ischemic stroke and presence of large vessel steno-occlusive disease. Preoperative baseline INVOS value was significantly low in the ischemic stroke group (49.5 ± 12.5) compared to the non-ischemic stroke group (66.8 ± 10.0), (P = 0.012). ConclusionsIn open-heart surgery for valvular heart disease, low preoperative baseline INVOS values were associated with cerebral ischemic stroke after surgery. The combination of appropriate preoperative screening for large vessel steno-occlusive disease and measurement of INVOS could be used as a simple and useful method in screening for the risk of ischemic stroke after open-heart surgery.

Effect of cardiac rehabilitation on intensity of physical activity according to type of surgery and Eurscore II after open heart surgery

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Patients after open heart surgery require cardiac rehabilitation (CR), as reconstructive surgery reduces the quality of life. A perioperative EuroSCORE II score is used for assessment of risk of worse outcomes after surgery. Few is known whether CR is feasible in patients undergoing open heart surgery with moderate and high risk Euroscore II and whether the intensity of physical activity (PA) varies according to the type of heart surgery. Objective To evaluate effect of CR on perceived intensity of PA and target heart rate in patients who underwent open heart surgery and different EurSCORE II scale. Methods The retrospective cohort study included 104 patients who underwent open heart surgery and stage 2 CR: group 1- 64 patients with coronary artery bypass surgery (CABG), group 2 - 40 patients with valvular heart disease (VHD) surgery. We evaluated following parameters: subjective assessment of PA intensity on the Borg scale and objective assessment on the achievement of the training heart rate before and after CR. The perioperative risk of worse outcomes was assessed using EuroSCORE II scale. Results According to the EuroSCORE II scale: 1st group patients were at: -low risk -21%, moderate risk -68%, high risk -11% and 2nd group - low risk 29%, moderate risk 54%, and high risk 17%. None of patients had adverse effects of CR. In the first group, the subjective assessment on the Borg scale before CR was slightly higher than in the second group: -2.43 ± 0.09 points vs. 2.22 ± 0.11 points before CR. At the end of the CR, there was a significant increase (p<0.05) in perception of intensity of PA in both groups - the 1st group –4.37 ± 0.06 points and in 2nd group - 4.35 ± 0.07 points. Target heart rate before CR did not differ between groups: group 1 - 75 ± 5.7 beats per minute and group 2 - 89 ± 7.7 beats per minute (p=0.552): after CR there was a significant decrease in heart rate: group 1 - 55 ± 2.2 bpm, group 2 - 61 ± 3.2 bpm (p =.0012). Conclusion 1. CR increases significantly intensity of physical activity in pts after open heart surgery 2. Though the VHD surgery pts might have lower intensity of PA before CR, the intensity of PA after CR did not differ between CABG and VHD surgeries, increasing in both groups. 3. Patients with moderate and high EurSCORE II risk comprised 80 and 69% of patients in our cohort, none of them experienced adverse effect of CR and had improvement of PA and achieved target heart rate.

Prediction of Recurrent Atrial Tachyarrhythmia After Receiving Atrial Flutter Ablation in Patients With Prior Cardiac Surgery for Valvular Heart Disease.

Background: Surgical scars cause an intra-atrial conduction delay and anatomical obstacles that facilitate the perpetuation of atrial flutter (AFL). This study aimed to investigate the outcome and predictor of recurrent atrial tachyarrhythmia after catheter ablation in patients with prior cardiac surgery for valvular heart disease (VHD) who presented with AFL.Methods: Seventy-two patients with prior cardiac surgery for VHD who underwent AFL ablation were included. The patients were categorized into a typical AFL group (n = 45) and an atypical AFL group (n = 27). The endpoint was the recurrence of atrial tachyarrhythmia during follow-up. A multivariate analysis was performed to determine the predictor of recurrence.Results: No significant difference was found in the recurrence rate of atrial tachyarrhythmia between the two groups. Patients with concomitant atrial fibrillation (AF) had a higher recurrence of typical AFL compared with those without AF (13 vs. 0%, P = 0.012). In subgroup analysis, typical AFL patients with concomitant AF had a higher incidence of recurrent atrial tachyarrhythmia than those without it (53 vs. 14%, P = 0.006). Regarding patients without AF, the typical AFL group had a lower recurrence rate of atrial tachyarrhythmia than the atypical AFL group (14 vs. 40%, P = 0.043). Multivariate analysis showed that chronic kidney disease (CKD) and left atrial diameter (LAD) were independent predictors of recurrence.Conclusions: In our study cohort, concomitant AF was associated with recurrence of atrial tachyarrhythmia. CKD and LAD independently predicted recurrence after AFL ablation in patients who have undergone cardiac surgery for VHD.

Is it possible to expect left ventricular ejection fraction improvement in patients with known advanced heart diseases in the case of right atrial flutter treated by ablation?

Atrial flutter (AFL)-related tachycardia-induced cardiomyopathy (TICM) is a treatable cause of heart failure (HF). This study aims to explore the effect of AFL ablation on left ventricular (LV) function in right AFL patients with or without advanced heart diseases. Between January 2013 and December 2019, 149 patients underwent ablation for persistent AFL. Among them, 60 patients with persistent right atrial (RA) flutter had symptomatic HF and elevated natriuretic peptide levels. Group 1 consisted of 35 patients without advanced heart diseases, and group 2 consisted of 25 patients with prior history of ischemic cardiomyopathy (ICM), dilated cardiomyopathy (DCM) or surgery for valvular heart disease (VHD). Follow-up echocardiography was performed 6months later. Improvement of LV performance was defined as LV ejection fraction (EF) increase ≥50% of baseline EF without clinical HF symptoms or LVEF recovery to ≥60%. Group 2 had larger LV end-diastolic volume (LVEDV) and LV end-systolic volume than group 1. At follow-up, group 2 had larger LV end-systolic volume than group 1. Group 1 had more increase in LVEF than group 2 (21.7±15.2% vs 4.1±13.2%; P<.001). A receiver operating characteristic curve was constructed to determine the discrimination threshold of baseline LVEDV (137mL) in the overall study group for improvement of LV performance after ablation (P=.005). Successful ablation for right AFL could achieve more reversal of LV dysfunction in patients without advanced heart diseases. Pre-ablation LVEDV≥137mL was associated with no improvement of LV performance after ablation.

Frequency of obstructive coronary artery disease in patients undergoing valvular heart disease surgery.

Objectives: To determine the frequency of obstructive coronary artery disease in patients undergoing valvular heart disease surgery. Study Design: Cross-sectional study. Setting: Department of Cardiology, Faisalabad Institute of Cardiology, Faisalabad. Period: Six months, from 02 February, 2017 to 01 August, 2017. Material &amp; Methods: After taking approval from hospital ethical committee, patients coming through outpatient department who fulfilled the inclusion criteria were enrolled and informed consent was taken from them. History of smoking, diabetes mellitus, renal dysfunction, dyslipidemia, hypertension and family history of coronary artery disease was assessed. Coronary angiography was performed by senior consultant interventional cardiologist for assessing obstructive coronary artery disease as per operational definition. All the information was collected on prespecified Performa. Results: In this study, out of 140 cases of valvular heart disease (VHD), 47.14%(n=66) were between 30-50 years of age whereas 52.86%(n=74) were between 51-70 years of age, mean ±sd was calculated as 51.71+9.09 years, 57.14%(n=80) were male while 42.86%(n=60) were female, frequency of obstructive coronary artery disease in patients undergoing valvular heart surgery was recorded as 29.3% (n=41) whereas 70.7% (n=99) had no such finding. Conclusion: The frequency of obstructive coronary artery disease was (29.3%) in patients undergoing valvular heart disease surgery. However, coronary artery disease was less frequent in rheumatic as compared to degenerative heart valve disease.

46 Classic or new echocardiographic parameters in the evaluation of the right ventricular function after tricuspid valve surgery?

Abstract Background Tricuspid valve regurgitation(TR) is frequent in patients undergoing to valvular heart disease surgery, particularly joined to mitral valve surgery. Classically, it was considered that left valve disease surgery would regress the TR without requiring any surgery on it, which has not been confirmed during follow-up. There is no consensus about which tricuspid lesions need to be operated neither which is the best surgical technique. Purpose In this study, we have evaluated the right ventricle(RV) function by advanced transthoracic echocardiography before to surgery and three months later. Methods Prospective cohort including 43 patients with valve surgical indication and some degree of tricuspid insufficiency. An advanced echocardiographic study was performed to determine the RV function measured by the following variables: basal diameter, Tricuspid Annular Plane Systolic Excursion(TAPSE), end-systolic RV area, fractional area change(FAC), systolic tricuspid valve lateral annular velocities by tissue Doppler(s’) and global longitudinal strain(GLS). Variables were tested to normality with Kolmogorov-Smirnoff test. Wilcoxon test was performed in order to compare measures previous and after surgery. Results 43 patients were analysed. Mean age 64.7 ± 8.3 years, 31(72.1%) were female, 36 patients(83.7%) with functional TR which was associated to a left valvulopathy in 31(72.4%)cases. 17 patients(39.5%) had severe TR, 19 patients(44.2%) had moderate TR and 7 patients(16.3%) had mild TR. Twelve patients(27.9%) had isolated tricuspid surgery. The most frequent TR surgery was simple annuloplasty with 27 patients (62.8%). The classic RV echocardiographic parameters at initial evaluation and three months after surgery showed the following values respectively:Mean RV basal diameter was 48.3 ± 8.0mm vs. 41.7 ± 4.7 mm(p &amp;lt; 0.001), TAPSE was 19.0 ± 4.4mm vs. 15.7 ± 3.4mm (p &amp;lt; 0.001), peak systolic lateral annular velocity (s") was 0.12 ± 0.11cm/s vs. 0.11± 0.14cm/s(p = 0.001), FAC was 39.2 ± 13.2% vs. 38.2 ± 11.8%(p = Not significant), end-systolic RV area was 15.8 ± 10.2cm² vs. 14.4 ± 4.0cm²(p = Not significant). Nonetheless, there had not worsening in RV function based on myocardial deformation, with no significant differences between RV GLS(-20.0 ± 5.4% vs. -19.6 ± 4.9%; p = Not significant). Conclusions In our sample, 3 months post-surgery, the classic echocardiographic parameters based on the translational motion of the heart showed worsening of RV function. The parameters based on myocardial deformation do not show changes in RV function post-surgery, being better indicators of RV function in recently operated patients. These differences could be explain because tricuspid surgery is focus on the annulus that affects its motion while it does not affect to the global RV myocardial function evaluated by GLS.

Heart failure requiring hospitalization in patients after cardiac surgery for valvular heart disease

The aim – to determine the factors associated with the frequency of hospitalizations for decompensation of heart failure (HF) after cardiac surgery in patients with valvular heart disease.Materials and methods. 235 patients who underwent cardiac surgery for valvular heart disease were examined. During the period from 2014 to 2017, a part of patients (129 people) had no hospitalizations, while 106 people were on inpatient treatment from 1 to 10 times, on average 2.78±1.95. The complex of examination of patients along with physical examination included electrocardiography, echocardiography.Results and discussion. During dynamic observation for 2 years in the group of patients without hospitalization, a progressive statistically significant decrease in the size of the left atrium (LA) and left ventricle (LV) as well as an increase in LV contractility were noted, while in the group of patients after hospitalization such changes were not observed. The dimensions of the chambers of the heart remained practically unchanged for 2 years. Thus, it can be concluded that the more severe course of heart failure after prosthetics of heart valves is accompanied by the absence of reverse remodeling of the heart chambers. Predictors of hospitalizations for HF are the presence of diabetes mellitus, hypertension and permanent form of atrial fibrillation.Conclusions. The probability of progression of heart failure in patients after cardiosurgical intervention for valvular heart pathology is not affected by sex, age, type of lesion of the valve, etiology of valve damage, indicators of echocardiography. Predictors of hospitalizations for heart faiure in the long-term postoperative period are the presence of diabetes, AF, and AH. The more severe course of heart failure after prosthetics of heart valves is accompanied by the absence of reverse remodeling of the heart chambers.

Surgical treatment of acquired valvular heart disease in elderly patients

This article provides an overview of studies on indications, surgery and outcomes of valvular heart disease surgery in elderly patients.

Mid-Term Results of Surgical Treatment of Atrial Fibrillation in Valvular Heart Disease Assesed by Speckle Tracking Echocardiography.

BackgroundAtrial fibrillation frequently affects patients with valvular heart disease. Ablation of atrial fibrillation during valvular surgery is an alternative for restoring sinus rhythm.ObjectivesThis study aimed to evaluate mid-term results of successful atrial fibrillation surgical ablation during valvular heart disease surgery, to explore left atrium post-ablation mechanics and to identify predictors of recurrence.MethodsFifty-three consecutive candidates were included. Eligibility criteria for ablation included persistent atrial fibrillation <10 years and left atrium diameter < 6.0 cm. Three months after surgery, echocardiogram, 24-hour Holter monitoring and electrocardiograms were performed in all candidates who maintained sinus rhythm (44 patients). Echo-study included left atrial deformation parameters (strain and strain rate), using 2-dimensional speckle-tracking echocardiography. Simultaneously, 30 healthy individuals (controls) were analyzed with the same protocol for left atrial performance. Significance was considered with a P value of < 0.05.ResultsAfter a mean follow up of 17 ± 2 months, 13 new post-operative cases of recurrent atrial fibrillation were identified. A total of 1,245 left atrial segments were analysed. Left atrium was severely dilated in the post-surgery group and, mechanical properties of left atrium did not recover after surgery when compared with normal values. Left atrial volume (≥ 64 mL/m2) was the only independent predictor of atrial fibrillation recurrence (p = 0.03).ConclusionsLeft atrial volume was larger in patients with atrial fibrillation recurrence and emerges as the main predictor of recurrences, thereby improving the selection of candidates for this therapy; however, no differences were found regarding myocardial deformation parameters. Despite electrical maintenance of sinus rhythm, left atrium mechanics did not recover after atrial fibrillation ablation performed during valvular heart disease surgery.

A prediction score for significant coronary artery disease in Chinese patients ≥50 years old referred for rheumatic valvular heart disease surgery.

Our goal was to establish a prediction score and protocol for the preoperative prediction of significant coronary artery disease (CAD) in patients with rheumatic valvular heart disease. Using multivariate logistic regression analysis, we validated the model based on 490 patients without a history of myocardial infarction and who underwent preoperative screening coronary angiography. Significant CAD was defined as ≥50% narrowing of the diameter of the lumen of the left main coronary artery or ≥70% narrowing of the diameter of the lumen of the left anterior descending coronary artery, left circumflex artery or right coronary artery. Significant CAD was present in 9.8% of patients. Age, smoking, diabetes mellitus, diastolic blood pressure, low-density lipoprotein cholesterol and ischaemia evident on an electrocardiogram were independently associated with significant CAD and were entered into the multivariate model. According to the logistic regression predictive risk score, preoperative coronary angiography is recommended in (i) postmenopausal women between 50 and 59 years of age with ≥9.1% logistic regression predictive risk score; (ii) postmenopausal women who are ≥60 years old with a logistic regression predictive risk score ≥6.6% and (iii) men ≥50 years old whose logistic regression predictive risk score was ≥2.8%. Based on this predictive model, 246 (50.2%) preoperative coronary angiograms could be safely avoided. The negative predictive value of the model was 98.8% (246 of 249). This model was accurate for the preoperative prediction of significant CAD in patients with rheumatic valvular heart disease. This model must be validated in larger cohorts and various populations.

Simultaneous or staged surgery in patients with kidney tumors and concomitant cardiac disease.

IntroductionTo evaluate outcomes of simultaneous and staged surgery in patients with kidney tumors and concomitant cardiac disease.Material and methodsBetween October 2001 and October 2015, fifteen patients (Group 1) underwent simultaneous surgery and fourteen patients (Group 2) underwent staged surgery. 89.7% were males (26/29), and the mean age was 60.8 ±1.16 years. Locally advanced cancers (Stage III) were registered in the two groups in 11 vs. 3 patients (p = 0.016) and localized (Stage I) disease in 2 vs. 10 (p = 0.007), respectively. 18 patients (62%) were operated for coronary heart disease, while 10 patients (35%) underwent surgery for valvular heart disease. Nephrectomy was performed in 14rs 5 patients respectively (p = 0.003) while partial nephrectomy in 1rs 7 patients (p = 0.005).ResultsIn the two groups, the 30-day mortality was 13% (2 cases) and 7% (1 case), p = 1.0, and major hospital complications were observed in 3 (20%) and 2 (14%) cases, respectively, p = 0.53. The median follow-up in Group 1 and Group 2 was 87 months (range, 23.3 to 146.8 months) and 39 months (range, 3.9 to 98 months), respectively, p = 0.001. Three-year overall survival was 73.3 ±11.4% (95% CI 50.5–96.1) and 77.9 ±11.3%, respectively, p = 0.70, and three-year disease-free survival was 83.9 ±10.4% and 75.0 ±21.7%, respectively, p = 0.91.ConclusionsSimultaneous and staged surgery for kidney tumors and concomitant cardiac disease are feasible procedures. Patients with advanced tumors and complicated disease course can benefit from early intervention and consequently a simultaneous approach can be a preferred option for them. For localized renal tumors, staged surgery should be used.

Coronary risk stratification of patients undergoing surgery for valvular heart disease

BackgroundMultislice computed tomography (MSCT) is a non-invasive, less expensive, low-radiation alternative to coronary angiography (CAG) prior to valvular heart surgery. MSCT has a high negative predictive value for coronary artery disease (CAD) but previous studies of patients with valvular disease have shown that MSCT, as the primary evaluation technique, lead to re-evaluation with CAG in about a third of cases and it is therefore not recommended. If a subgroup of patients with low- to intermediate risk of CAD could be identified and examined with MSCT, it could be cost-effective, reduce radiation and the risk of complications associated with CAG. MethodsThe study cohort was derived from a national registry of patients undergoing CAG prior to valvular heart surgery. Using logistic regression, we identified significant risk factors for CAD and developed a risk score (CT-valve score). The score was validated on a similar cohort of patients from another registry. ResultsThe study cohort consisted of 2221 patients, 521 (23.5%) had CAD. The validation cohort consisted of 2575 patients, 771 (29.9%) had CAD. The identified risk factors were male sex, age, smoking, hyperlipidemia, hypertension, aortic valve disease, extracardiac arteriopathy, ejection fraction <30% and diabetes mellitus. CT-valve score could identify a third of the population with a risk about 10%. ConclusionA score based on risk factors of CAD can identify patients that might benefit from using MSCT as a gatekeeper to CAG prior to heart valve surgery.

Functional and Anatomic Responses of the Left Atrium to Change in Estimated Left Ventricular Filling Pressure.

Left atrial (LA) remodeling and dysfunction reflect chronic exposure to elevated left ventricular (LV) filling pressures. The aim of this longitudinal cohort study was to define the effect of reducing LV filling pressures on reverse remodeling of LA volume (LAV) and function. This retrospective cohort included 195 patients (52% men; mean age, 64 ± 14 years) in sinus rhythm with LA dilatation and sequential echocardiograms (median interval, 1 year; interquartile range, 0.5-2.0 years). One hundred seventy-four patients underwent medical therapy (82 with reduced E/e' ratios), and 21 underwent surgery for valvular heart disease. Biplane LAV (normal value, ≤ 68 mL for men, ≤ 62 mL for women), LA strain (ε) (normal value, >32%) and LV filling pressures (assessed as E/e' ratio; normal value, <13) were measured. Although LAV at baseline and follow-up were 88 ± 27 and 81 ± 24 mL, LA ε and E/e' ratio remained stable at 26 ± 11% and 14 ± 7, respectively. Changes in E/e' ratio were associated with changes in LAV (r = 0.37, P < .001) and LA ε (r = -0.51 P < .001). Although reduced E/e' ratio or improved LA ε at follow-up occurred in about 50% of the patients, only 26% (51 of 195) had normalized LAV. Compared with surgery, successful reduction of E/e' with medical therapy was less effective in reducing LAV (P < .001) but produced similar improvement in LA ε. Having normal or improved E/e' ratio at follow-up was not associated with normalization of LAV (relative risk, 1.29 [P = .326] and 1.22 [P = .421], respectively) but was associated with normalized LA ε (relative risk, 2.04 [P = .011] and 1.86 [P = .017], respectively) independently of LAV. Reduction in LV filling pressures reduces but rarely normalizes LAV. The strong association of reduced LV filling pressure with improved LA function indicated by LA longitudinal ε supports the increasing interest of LA ε measurement.

PT113 Prognostic factors for in-hospital death after valvular heart disease surgery in Brazil

PT113 Prognostic factors for in-hospital death after valvular heart disease surgery in Brazil

PT114 Prognostic factors for in-hospital death of Rheumatic Heart Disease Patients after valvular heart disease surgery in Brazil

PT114 Prognostic factors for in-hospital death of Rheumatic Heart Disease Patients after valvular heart disease surgery in Brazil