Predictive Power and Implication of EuroSCORE,EuroSCORE II and STS Score for Isolated Repeated Aortic Valve Replacement

Objective: We evaluated the predictive power of the EuroSCORE, EuroSCORE II and Society of Thoracic Surgeons (STS) score for isolated redo aortic valve replacement.Materials and Methods: 78 consecutive patients underwent the aforementioned procedure mainly with a stentless valve prosthesis at our institution. Observed mortality was compared to the predicted mortality, Receiver Operating Characteristics (ROC) curves were calculated and the area under the curve (AUC) analyzed.Result: Observed mortality was 11.5%. EuroSCORE and EuroScore II predicted a mortality of 28.2 ± 21.6% (p <0.001) and 10.2 ± 11.8% (p = 0.75), respectively. AUC of the EuroSCORE was 0.74 (95% CI: 0.62–0.83), p = 0.009 and of the EuroSCORE II 0.86 (95% CI: 0.76–0.93), p <0.0001. Optimal Youden index of the EuroSCORE II was 0.59 refering to a predicted mortality of 9.9% (sensitivity: 77.8% and specificity: 81.2%). Predicted mortality of STS score was 17.8 ± 10.6% (p = 0.08) and AUC was 0.64 (95% CI: 0.53–0.75), p = 0.06.Conclusion: EuroSCORE II calculation was not only superior to EuroSCORE and STS score but led to a very realistic mortality prediction for this special procedure at our institution. A EuroSCORE II greater 10 should encourage to consider an alternative treatment.     

TRANSFORM (Multicenter Experience With Rapid Deployment Edwards INTUITY Valve System for Aortic Valve Replacement) US clinical trial: Performance of a rapid deployment aortic valve

Background

The TRANSFORM (Multicenter Experience With Rapid Deployment Edwards INTUITY Valve System for Aortic Valve Replacement) trial (NCT01700439) evaluated the performance of the INTUITY rapid deployment aortic valve replacement (RDAVR) system in patients with severe aortic stenosis.

非原位主动脉瓣置换术治疗主动脉瓣环严重毁损性病变的方法与疗效

目的总结非原位主动脉瓣置换术(AVR)的方法和疗效。方法 2008年3月至2010年12月第二军医大学长海医院收治5例主动脉瓣环严重毁损患者,男4例,女1例;平均年龄46.3(38～53)岁。AVR术后并发严重瓣周漏再次手术4例(白塞氏病2例、大动脉炎2例),严重主动脉瓣感染性心内膜炎1例。术中发现主动脉瓣环严重毁损,无法施行常规AVR,改行非原位AVR,即将人工主动脉瓣环固定的位置提高到毁损的主动脉瓣环以上,固定人工瓣环的缝线从主动脉腔外进针、腔内出针。必要时行冠状动脉旁路移植术(CABG)。结果 5例手术患者均顺利康复出院,无出血再次手术或其它并发症。术后5例患者均获得随访,生存良好,心功能分级(NYHA)Ⅰ～Ⅱ级;分别于术后6个月(4例)、1年(2例)和3年(1例)行主动脉心脏三维CT成像(CTA)检查,均未见有主动脉根部瘤或假性动脉瘤形成,显示左心室流出道延长,左、右冠状动脉形态良好。心脏超声心动图检查均未发现有瓣周漏。结论对主动脉瓣环毁损严重的患者采用非原位AVR,人工瓣膜固定可靠,可以防止术后并发瓣周漏或根部假性动脉瘤。     

Long Term Results and Predictors of Left Ventricular Function Recovery after Aortic Valve Replacement for Chronic Aortic Regurgitation

Objectives: In most patients with aortic regurgitation (AR), aortic valve replacement (AVR) improves left ventricular (LV) function, but some patients will not have favorable remodeling. Our objectives were to review long term clinical results of AVR for AR and to examine what factors affect the normalization of LV function after AVR for chronic AR.Methods: Between 1989 and 2010, 177 patients underwent isolated AVR for chronic pure AR. The patients were divided into 2 groups based on indexed end-systolic LV diameter (iESD): Group L (iESD) ≧25 mm/m²) (130 patients) and Group S (iESD <25 mm/m²) (47 patients).Results: There was no significant difference between groups in late mortality, freedom from cardiac-related death and rehospitalization for heart failure at late follow up after operation. At postoperative follow-up, 16% of patients had not recovered normal LV systolic function. By means of multivariate analysis, iESD and cardiac index (CI) were independent predictors of recovery of LV function and iESD >26.7 mm/m² and CI <2.71 l/min/m² were the best cut-off values.Conclusions: Early and late surgical results of AVR for chronic AR were good, but for the preservation of postoperative normal LV function, AVR for AR patients should be performed before iESD reaches 26.7 mm/m².