-
Structural Heart : the Journal of the... May 2024The current clinical practice standard is 10% to 20% oversizing of self-expanding valves in transcatheter aortic valve replacement. We aimed to determine whether >20%...
BACKGROUND
The current clinical practice standard is 10% to 20% oversizing of self-expanding valves in transcatheter aortic valve replacement. We aimed to determine whether >20% oversizing of self-expanding valves (Medtronic Evolut) would lead to better valve performance with similar or better outcomes.
METHODS
From October 2011 to December 2016, we approached all transcatheter aortic valve replacement patients with a conscious attempt at large oversizing (>20%). The most common valve used, excluding those used in valve-in-valve patients, was the 29-mm Evolut R (29%). We used a retrospective chart review to compare moderate oversizing (group 1; 10% to 20%) with large oversizing (group 2; >20%).
RESULTS
Of 556 patients, 45% were male; the overall mean Society of Thoracic Surgeons risk score was 5.8 ± 3.8. Eighty-five (15%) patients needed a pacemaker, and 21 (3.8%) developed significant paravalvular leak. Mean oversizing was 20.3% ± 6.0%, with 41.4% of patients included in group 1 and 54.5% in group 2. Incidences of complications in group 2 vs. group 1 were as follows: a) paravalvular leak (2.0 vs. 6.1%; odds ratio = 0.31, = 0.01), b) pacemaker (15 vs. 14%), c) gastrointestinal bleed (n = 4 vs. 0; 1.3 vs. 0.0%; = 0.03), d) annular dissection (n = 1 vs. 0; 0.3 vs. 0%; = 0.29), e) mortality (n = 5 vs. 4; 1.6 vs. 1.7%). Incidence of paravalvular leak was higher in those who died than survivors (13 vs. 1.3%; ≤ 0.0001).
CONCLUSIONS
These data suggest that, in current self-expanding valves, >20% oversizing delivers a significantly lower prevalence of paravalvular leak without an increase in other complications. Since paravalvular leak is associated with increased mortality, >20% oversizing may represent a superior prosthesis choice.
PubMed: 38799807
DOI: 10.1016/j.shj.2023.100278 -
Structural Heart : the Journal of the... May 2024Bioprosthetic valve fracture (BVF) during valve-in-valve TAVR (transcatheter aortic valve replacement) is a procedural adjunct designed to optimize the expansion of the...
BACKGROUND
Bioprosthetic valve fracture (BVF) during valve-in-valve TAVR (transcatheter aortic valve replacement) is a procedural adjunct designed to optimize the expansion of the transcatheter heart valve and reduce patient-prosthesis mismatch by using a high-pressure balloon to intentionally fracture the surgical heart valve (SHV).
METHODS
We performed bench testing on 15 bioprosthetic SHV to examine the optimal balloon size and pressure for BVF. We assessed morphological changes and expansion of SHV by computed tomography angiography. Successful BVF was defined as balloon waist disappearance on fluoroscopy and/or sudden pressure drop during balloon inflation.
RESULTS
Nine valves met the definition of BVF, 3 of which were confirmed by disruption of the stent frame. We classified surgical valves into 3 subsets: 1) fracturable with metal stent frame (MSF), 2) fracturable with polymer stent frame (PSF) and 3) nonfracturable. In general, valves with MSF were fractured using a balloon size = true internal diameter plus 3-5 mm inflated at high pressure (16-20 ATM) whereas valves with PSF could be fractured with a balloon size = true internal diameter plus 3-5 mm and lower balloon pressure (6-14 ATM). Gains in computed tomography angiography derived inflow area after BVF were 12.3% for MSF and 3.6% for PSF SHV.
CONCLUSIONS
Gains in CT-determined valve area after BVF depend on the physical properties of the SHV, which in turn influences pressure thresholds and balloon sizing strategy for optimal BVF. Elastic recoil of PSF valves limits the gains in inflow area after BVF.
PubMed: 38799806
DOI: 10.1016/j.shj.2023.100276 -
Microorganisms Apr 2024Infective endocarditis (IE) is a pathological condition caused by various microbial agents that can lead to severe complications affecting the heart. Accurate diagnosis...
BACKGROUND
Infective endocarditis (IE) is a pathological condition caused by various microbial agents that can lead to severe complications affecting the heart. Accurate diagnosis is crucial for the effective management of patients with IE. Blood culture is the gold standard for identifying the primary infectious agents, which is a key factor in diagnosing IE using the modified Duke criteria.
OBJECTIVE
The main objective of this study was to investigate the distribution of the etiological agents of IE and the most common secondary diagnoses associated with it.
METHOD
A total of 152 patients aged 23-95 years with a diagnosis of IE and proven etiology (through blood cultures or serological tests) were included in this study.
RESULTS
The most common etiological agent identified through blood tests was , which was detected in 39 patients (23.5%). was the second most common agent and was identified in 33 patients (19.9%), followed by Staphylococcus epidermidis, which was identified in 12 patients (13.1%). Nine patients (5.8%) had high levels of anti- IgG phase I and II antibodies.
CONCLUSIONS
IE is a leading cause of death in the Department of Infectious Diseases. Early and accurate diagnosis, along with interdisciplinary treatment, can significantly increase the chances of patient survival. Currently, and are the dominant etiological agents of IE, highlighting the need to revise protocols for prophylaxis, diagnosis, and initial treatment of this condition.
PubMed: 38792742
DOI: 10.3390/microorganisms12050910 -
Journal of Cardiothoracic Surgery May 2024Mitral valve failure is one of the most common valvular heart diseases worldwide. Valve replacement and repair have an impact on the quality of life of patients.... (Comparative Study)
Comparative Study
OBJECTIVE
Mitral valve failure is one of the most common valvular heart diseases worldwide. Valve replacement and repair have an impact on the quality of life of patients. Therefore, the present study was conducted to compare the quality of life in patients with mitral valve replacement and those who underwent mitral valve repair.
METHODS
In this cross-sectional study, we considered all cardiac patients with ischemic mitral insufficiency who underwent mitral valve repair and patients with a history of valve replacement in Imam Ali Hospital of Kermanshah between 2014 and 2020. Two Minnesota and general quality of life questionnaires along with a checklist for demographic variables were used for data collection. Data analysis was performed using SPSS version 21 software.
RESULTS
The mean quality of life score based on the general quality of life scale in the valve repair group was 32.33 (SD = 2.29) and in the valve replacement group 32.89(SD = 2.60), (p = 0.917). Also, mean quality of life, as measured by the Minnesota MLHFQ was 60.89(SD = 17.67) in the valve repair group and 63.42 (SD = 12.13) in the valve replacement group (p = 0.308). The results showed that the average general quality of life was different in study groups regarding education. Tukey's post hoc test showed that the average general quality of life in illiterate people is significantly lower than in people with academic degrees (P-value = 0.001).
CONCLUSION
The quality of life of the patients in both the valve repair and replacement groups was at an average level. There was no significant difference between the general quality of life and the Minnesota scales, suggesting that both tools can be effectively used to measure patients' quality of life. The study's findings can be valuable for monitoring patients, screening for conditions, and enhancing communication between doctors and patients.
Topics: Humans; Quality of Life; Cross-Sectional Studies; Male; Female; Heart Valve Prosthesis Implantation; Middle Aged; Mitral Valve Insufficiency; Mitral Valve; Iran; Aged; Surveys and Questionnaires; Adult
PubMed: 38789973
DOI: 10.1186/s13019-024-02780-1 -
Multimedia Manual of Cardiothoracic... May 2024Aortic root reconstruction during aortic root replacement for a patient with prosthetic valve endocarditis and aortic root abscess can be a difficult procedure with many...
Aortic root reconstruction during aortic root replacement for a patient with prosthetic valve endocarditis and aortic root abscess can be a difficult procedure with many possible complications. In this video case report, we describe our novel technique using a single bovine pericardial patch that avoids deep stitches or external sutures to support the friable annulus. Compared with more standard methods, this approach has shorter cross-clamp and cardiopulmonary bypass times and is less demanding technically.
Topics: Humans; Heart Valve Prosthesis; Aortic Valve; Heart Valve Prosthesis Implantation; Prosthesis-Related Infections; Male; Endocarditis; Endocarditis, Bacterial; Pericardium; Plastic Surgery Procedures; Middle Aged; Animals; Cattle
PubMed: 38787287
DOI: 10.1510/mmcts.2024.014 -
Journal of Cardiovascular Development... Apr 2024Surgical aortic valve replacement (SAVR) with a biological heart valve prosthesis (BHV) is often used as a treatment in elderly patients with symptomatic aortic valve...
Surgical aortic valve replacement (SAVR) with a biological heart valve prosthesis (BHV) is often used as a treatment in elderly patients with symptomatic aortic valve disease. This age group is also at risk for the development of dementia in the years following SAVR. The research question is "what are the predictors for the development of dementia?". In 1500 patients undergoing SAVR with or without an associated procedure, preoperative (demographic, cardiac and non-cardiac comorbid conditions), perioperative (associated procedures, cross-clamp and cardiopulmonary bypass time) and postoperative 30-day adverse events (bleeding, thromboembolism, heart failure, conduction defects, arrhythmias, delirium, renal and pulmonary complications) were investigated for their effect on the occurrence of dementia by univariate analyses. Significant factors were entered in a multivariate analysis. The sum of the individual follow-up of the patients was 10,182 patient-years, with a mean follow-up of 6.8 years. Data for the development of dementia could be obtained in 1233 of the 1406 patients who left the hospital alive. Dementia during long-term follow-up developed in 216/1233 (17.2%) of the patients at 70 ± 37 months. Development of dementia reduced the mean survival from 123 (119-128) to 109 (102-116) months ( < 0.001). Postoperative delirium was the dominant predictor (OR = 3.55 with a 95%CI of 2.41-4.93; < 0.00), followed by age > 80 years (2.38; 1.78-3.18; < 0.001); preoperative atrial fibrillation (1.47; 1.07-2.01; = 0.018); cardiopulmonary bypass time > 120 min (1.34; 1.02-1.78; = 0.039) and postoperative thromboembolism (1.94; 1.02-3.70; = 0.044). Postoperative delirium, as a marker for poor condition, and an age of 80 or more were the dominant predictors.
PubMed: 38786959
DOI: 10.3390/jcdd11050136 -
Healthcare (Basel, Switzerland) May 2024Diagnosing intracardiac masses poses a complex, multimodal challenge. We present the case of a 72-year-old woman with a history of rheumatic fever leading to mitral...
Diagnosing intracardiac masses poses a complex, multimodal challenge. We present the case of a 72-year-old woman with a history of rheumatic fever leading to mitral stenosis and a previous mitral valve commissurotomy who reported fatigue, weakness, and palpitations over the past three months. Echocardiography revealed a tumor (53 × 40 mm) in the enlarged left atrium, attached by a wide base to the left atrium wall, exhibiting variable densities. Computerized tomography identified a heterodense mass (53 × 46 × 37 mm) with similar attachments. Angiography showed two branches from the circumflex artery intricately associated with the mass. Despite unsuccessful embolization of the mass' blood supply, surgical intervention including mitral valve replacement, tricuspid valve annuloplasty, and tumor removal was pursued. Pathohistological analysis confirmed the mass as a thrombus. During the postoperative follow-up, the patient presented with no complaints. Follow-up echocardiography indicated the normal function of the mechanical mitral valve prosthesis and the absence of intracardiac masses. While it remains unknown whether this neovascularization is specific to patients with severe mitral valve disease, this case highlights the diagnostic challenges of differentiating between thrombi and tumors in the context of mitral valve disease. It illustrates the critical role of multimodal imaging in elucidating the anatomical and functional relationships within the heart, thereby guiding accurate diagnosis and effective treatment.
PubMed: 38786423
DOI: 10.3390/healthcare12101009 -
Scientific Reports May 2024There is limited data on the effect of socioeconomic status (SES) on transcatheter (TAVR) and surgical aortic valve replacement (SAVR) outcomes for aortic stenosis (AS)....
There is limited data on the effect of socioeconomic status (SES) on transcatheter (TAVR) and surgical aortic valve replacement (SAVR) outcomes for aortic stenosis (AS). This study conducted a population-based analysis to assess the influence of SES on valve replacement outcomes. Patients with AS undergoing TAVR or SAVR were identified in National Inpatient Sample from Q4 2015-2020. Multivariable logistic regressions were used to compare in-hospital outcomes between patients living in neighborhoods of income at the lowest and highest quartiles. Of 613,785 AS patients, 9.77% underwent TAVR and 10.13% had SAVR. These rates decline with lower neighborhood income levels, with TAVR/SAVR ratio also declining in lower-income areas. Excluding concomitant procedures, 58,064 patients received isolated TAVR (12,355 low-income and 15,212 high-income) and 43,694 underwent isolated SAVR (10,029 low-income and 10,811 high-income). Low-income patients, in both TAVR and SAVR, were younger but had more comorbid burden. For isolated TAVR, outcomes were similar across income groups. However, for isolated SAVR, low-income patients experienced higher in-hospital mortality (aOR = 1.44, p < 0.01), pulmonary (aOR = 1.13, p = 0.01), and renal complications (aOR = 1.14, p < 0.01). They also had more transfers, longer waits for operations, and extended hospital stays. Lower-income communities had reduced access to TAVR and SAVR, with TAVR accessibility being particularly limited. When given access to TAVR, patients from lower-income neighborhoods had mostly comparable outcomes. However, patients from low-income communities faced worse outcomes in SAVR, possibly due to delays in treatment. Ensuring equitable specialized healthcare resources including expanding TAVR access in economically disadvantaged communities is crucial.
Topics: Humans; Female; Male; Transcatheter Aortic Valve Replacement; Aged; Aortic Valve Stenosis; Aged, 80 and over; Healthcare Disparities; Inpatients; Heart Valve Prosthesis Implantation; United States; Hospital Mortality; Middle Aged; Socioeconomic Factors; Social Class; Aortic Valve; Treatment Outcome; Socioeconomic Disparities in Health
PubMed: 38783030
DOI: 10.1038/s41598-024-62797-3 -
European Journal of Cardio-thoracic... Jun 2024Barlow's disease is a specific sub-form of mitral valve (MV) disease, characterized by diffuse excessive tissue and multi segment prolapse. The anterolateral...
OBJECTIVES
Barlow's disease is a specific sub-form of mitral valve (MV) disease, characterized by diffuse excessive tissue and multi segment prolapse. The anterolateral mini-thoracotomy represents the standard access for MV regurgitation in many centres. It still remains unclear which surgical technique provides the best results. Therefore, the aim of this study was to compare operative safety and mid-term outcomes after (i) isolated annuloplasty, (ii) use of additional artificial chordae or (iii) leaflet resection in patients suffering from Barlow's disease undergoing minimally invasive MV repair.
METHODS
A consecutive series of patients suffering from Barlow's disease undergoing minimally invasive MV surgery between 2001 and 2020 were analysed (n = 246). Patients were grouped and analysed according to the used surgical technique. The primary outcome was a modified Mitral Valve Academic Research Consortium combined end-point of mortality, reoperation due to repair failure or reoccurrence of severe mitral regurgitation within 5 years. The secondary outcome included operative success and safety up to 30 days.
RESULTS
No significant difference was found between the 3 surgical techniques with regard to operative safety (P = 0.774). The primary outcome did not differ between groups (P = 0.244). Operative success was achieved in 93.5% and was lowest in the isolated annuloplasty group (77.1%). Conversion to MV replacement was increased in patients undergoing isolated annuloplasty (P < 0.001).
CONCLUSIONS
Isolated annuloplasty, use of additional artificial chordae and leaflet resection represent feasible techniques in Barlow patients undergoing minimally invasive MV surgery with comparable 5-year results. In view of the increased conversion rate in the annuloplasty group, the pathology should not be oversimplified.
Topics: Humans; Female; Male; Mitral Valve Prolapse; Minimally Invasive Surgical Procedures; Middle Aged; Mitral Valve; Mitral Valve Annuloplasty; Treatment Outcome; Retrospective Studies; Mitral Valve Insufficiency; Aged; Adult; Heart Valve Prosthesis Implantation
PubMed: 38781502
DOI: 10.1093/ejcts/ezae213 -
PloS One 2024Transcatheter mitral valve replacement (TMVR) has garnered interest as a viable alternative to the traditional surgical mitral valve replacement (SMVR) for high-risk... (Comparative Study)
Comparative Study
BACKGROUND
Transcatheter mitral valve replacement (TMVR) has garnered interest as a viable alternative to the traditional surgical mitral valve replacement (SMVR) for high-risk patients requiring redo operations. This study aims to evaluate the association of TMVR with selected clinical and financial outcomes.
METHODS
Adults undergoing isolated redo mitral valve replacement were identified in the 2016-2020 Nationwide Readmissions Database and categorized into TMVR or SMVR cohorts. Various regression models were developed to assess the association between TMVR and in-hospital mortality, as well as additional secondary outcomes. Transseptal and transapical catheter-based approaches were also compared in relation to study endpoints.
RESULTS
Of an estimated 7,725 patients, 2,941 (38.1%) underwent TMVR. During the study period, the proportion of TMVR for redo operations increased from 17.8% to 46.7% (nptrend<0.001). Following adjustment, TMVR was associated with similar odds of in-hospital mortality (AOR 0.82, p = 0.48), but lower odds of stroke (AOR 0.44, p = 0.001), prolonged ventilation (AOR 0.43, p<0.001), acute kidney injury (AOR 0.61, p<0.001), and reoperation (AOR 0.29, p = 0.02). TMVR was additionally correlated with shorter postoperative length of stay (pLOS; β -0.98, p<0.001) and reduced costs (β -$10,100, p = 0.002). Additional analysis demonstrated that the transseptal approach had lower adjusted mortality (AOR 0.44, p = 0.02), shorter adjusted pLOS (β -0.43, p<0.001), but higher overall costs (β $5,200, p = 0.04), compared to transapical.
CONCLUSIONS
In this retrospective cohort study, we noted TMVR to yield similar odds of in-hospital mortality as SMVR, but fewer complications and reduced healthcare expenditures. Moreover, transseptal approaches were associated with lower adjusted mortality, shorter pLOS, but higher cost, relative to the transapical. Our findings suggest that TMVR represent a cost-effective and safe treatment modality for patients requiring redo mitral valve procedures. Nevertheless, future studies examining long-term outcomes associated with SMVR and TMVR in redo mitral valve operations, are needed.
Topics: Humans; Male; Female; Heart Valve Prosthesis Implantation; Aged; Mitral Valve; Hospital Mortality; Middle Aged; Reoperation; Cardiac Catheterization; Retrospective Studies; Length of Stay; Postoperative Complications; Aged, 80 and over; United States
PubMed: 38781278
DOI: 10.1371/journal.pone.0301939