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1.
Scott Goldman Anson Cheung Joseph E. Bavaria Michael R. Petracek Mark A. Groh Hartzell V. Schaff 《The Journal of thoracic and cardiovascular surgery》2017,153(3):561-569.e2
Objective
To evaluate the midterm hemodynamic performance and clinical outcomes of the Trifecta aortic pericardial valve.Methods
In a multicenter, prospective, nonrandomized, follow-up study, 710 patients underwent surgical implantation of a pericardial stented aortic prosthesis (Trifecta valve; St Jude Medical, St. Paul, Minn). The valve is constructed from bovine pericardium mounted externally onto a titanium stent. Subjects were followed on an annual basis over 6 years.Results
Operations were performed from 2007 to 2009, and mean age was 72.4 ± 9.3 years; 471 of 710 (66.3%) were men. Preoperatively, 361 of 710 (50.8%) of patients were in New York Heart Association class III or IV, and at 6 years postoperatively, 92 of 96 (95.8%) were New York Heart Association class I or II. Six years postoperatively, average mean gradient across all valve sizes was 11.0 mm Hg, and the average effective orifice area index was 0.80 cm2/m2. The proportion of patients without moderate-to-severe valvular regurgitation at 6 years was 95.2% (80/84). Six years postoperatively, freedom from valve-related mortality, nonstructural dysfunction, and paravalvular leak were 98.3%, 98.6%, and 98.9%, respectively, and freedom from reoperation due to structural valve deterioration was 97.3% (95% confidence limits, 98.6-94.7).Conclusion
These midterm results demonstrate that the Trifecta valve is a safe and effective valve substitute with excellent hemodynamic performance and durability that is maintained through the 6-year follow-up period. 相似文献2.
Naoto Fukunaga Tadaaki Koyama Yasunobu Konishi Takashi Murashita Hideo Kanemitsu Yukikatsu Okada 《General thoracic and cardiovascular surgery》2014,62(4):215-220
Background
With the increasing use of biologic conduits or bioprosthetic valve, the number of patients who require redo operation on aortic root increased.Methods
In the past 22 years, 14 patients underwent redo operation on aortic root. The mean age was 61.9 ± 14.8 years. Previous operations were full root replacement with stentless valve (n = 4), aortic root replacement with subcoronary technique (n = 3) and Bentall operation (n = 7). The operation interval was 5.4 ± 6.4 years. Indication for redo operation included structural valve deterioration (n = 6), prosthetic valve endocarditis (n = 4), perivalvular leakage (n = 2), dilatation of sinus of Valsalva (n = 1) and dehiscence of proximal anastomosis line (n = 1). Mean follow-up period was 5.3 ± 5.2 years.Results
Present operations were full root replacement with stentless valve (n = 5) and Bentall operation (n = 9). There was one in-hospital death (7.1 %) caused by arrhythmia. Postoperative complications included implantation of permanent pacemaker (n = 3), arrhythmia (n = 2) and re-intubation (n = 1). The 5-year survival was 92.9 ± 6.9 %. Freedom from redo aortic operation at 5 years was 100 %.Conclusion
Redo operation on aortic root can be performed with acceptable in-hospital mortality and good late survival. 相似文献3.
Hiroyuki Nishi Taichi Sakaguchi Shigeru Miyagawa Yasushi Yoshikawa Satsuki Fukushima Daisuke Yoshioka Takayoshi Ueno Toru Kuratani Yoshiki Sawa 《Surgery today》2014,44(8):1483-1489
Purpose
Information regarding the appropriate management of patients with moderately dilated ascending aortas is limited. We investigated factors affecting ascending aortic dilatation in BAV patients, such as anatomy, body size and age.Methods
We evaluated 130 patients with BAV (age, 59.9 ± 16.1 years; body surface area (BSA), 1.58 ± 0.20 m2) who underwent aortic valve surgery. The cusp configuration was determined according to the presence and location of the raphe and the cusp direction. The ascending aortic diameter index (AADI) was calculated using computed tomography and the BSA.Results
Sixty-four patients had A-P-type BAV, while 66 had R-L-type BAV. The mean ascending aorta diameter was 42.6 ± 6.7 mm, and the mean AADI was 27.1 ± 5.6 mm/m2. Based on the AADI, cusp configuration (R-L-BAV: 28.3 ± 6.0 mm/m2 vs. A-P-BAV: 25.8 ± 4.9 mm/m2, P < 0.05), a female gender, age and the presence of aortic stenosis were found to be related to ascending aortic dilatation, while the mean ascending aortic diameter did not differ between the groups. Among the elderly patients, an AADI greater than 28 mm/m2 was more frequently observed in the R-L-BAV group than in the A-P-BAV group. Ascending aortic replacement was required after 10 years in two patients with R-L-BAV and no patients with A-P-BAV.Conclusions
The relative ascending aortic diameter helped to identify patients with BAV with a risk of dilatation, indicating that the use of ascending aortic replacement should be considered more frequently in patients with R-L-type BAV, while the procedure is avoidable in elderly patients with A-P-type BAV. 相似文献4.
Alberto Repossini Lorenzo Di Bacco Bruno Passaretti Herko Grubitzsch Christina Schäfer Benjamin Claus Laura Giroletti Thierry Folliguet Gianluigi Bisleri Theodor Fischlein Giuseppe Santarpino Roberto Di Bartolomeo François Laborde Claudio Muneretto 《The Journal of thoracic and cardiovascular surgery》2017,153(3):549-558.e3
Objective
Stentless aortic valves have been developed to overcome obstructive limitations associated with stented bioprostheses. The aim of the current multi-institutional study was to compare hemodynamics of transcatheter (TAVR) and the Freedom SOLO Stentless (FS) valve in an intermediate risk population undergoing surgical aortic valve replacement.Methods
From 2010 to 2014, 420 consecutive patients underwent isolated surgical aortic valve replacement with FS and 375 patients underwent TAVR. Only patients with intermediate operative risk (Society of Thoracic Surgeons score 4-10) and small aortic annulus (≤23 mm) were included. After a propensity matched analysis 142 patients in each group were selected. Thirty-day postoperative clinical and echocardiographic parameters were evaluated.Results
Mean prosthesis diameter was 22.2 ± 0.9 mm for FS and 22.4 ± 1.0 mm for TAVR. In-hospital mortality was 2.1% for FS and 6.3% for TAVR (P = .02). Postoperative FS peak gradients were 19.1 ± 9.6 mm Hg (mean 10.8 ± 5.9 mm Hg); TAVR peak gradients were 20.2 ± 9.5 mm Hg (mean 10.7 ± 6.9 mm Hg) P = .57 (P = .88). Postoperative effective orifice area was 1.93 ± 0.52 cm2 for FS and 1.83 ± 0.3 cm2 for TAVR (P = .65). There was no prostheses-patient mismatch in either group. Postoperative grade 2-3 paravalvular leak was present in 3.5% for TAVR and 0.7% for FS. Postoperative permanent pacemaker implant rate was 12% for TAVR and only 1 case (0.7%) in the FS group (P < .001).Conclusions
In patients with small aortic annulus and intermediate risk, both FS and TAVR demonstrated similar excellent hemodynamic performance. TAVR demonstrated greater mortality and rates of pacemaker insertion. Further studies are warranted to validate TAVR indications in this subset of patients. 相似文献5.
Yan Shan Jun Li Yongshi Wang Boting Wu Alex J. Barker Michael Markl Chunsheng Wang Xiaolin Wang Xianhong Shu 《The Journal of thoracic and cardiovascular surgery》2017,153(6):1263-1272.e1
Objectives
Bicuspid aortic valve, characterized by valve malformation and risk for aortopathy, displays profound alteration in systolic aortic outflow and wall shear stress distribution. The present study performed 4-dimensional flow magnetic resonance imaging in patients with bicuspid aortic valve with right-left cusp fusion, focusing on the impact of valve function on hemodynamic status within the ascending aorta.Methods
Four-dimensional flow magnetic resonance imaging was performed in 50 subjects with right-left bicuspid aortic valve and 15 age- and aortic size–matched controls with tricuspid aortic valve. Patients with bicuspid aortic valve were categorized into 3 groups according to their aortic valve function as follows: bicuspid aortic valve with no more than mild aortic valve dysfunction (bicuspid aortic valve control, n = 20), bicuspid aortic valve with severe aortic insufficiency (n = 15), and bicuspid aortic valve with severe aortic stenosis (n = 15).Results
All patients with right-left bicuspid aortic valve exhibited peak wall shear stress at the right-anterior position of the ascending aorta (bicuspid aortic valve vs trileaflet aortic valve at the right-anterior position: 0.91 ± 0.23 N/m2 vs 0.43 ± 0.12 N/m2, P < .001) with no distinct alteration between bicuspid aortic valve with severe aortic insufficiency and bicuspid aortic valve with severe aortic stenosis. The predominance of dilatation involving the tubular ascending aorta (82%, type 2 aortopathy) persisted, with or without valve dysfunction. Compared with bicuspid aortic valve control subjects, the bicuspid aortic valve with severe aortic insufficiency group displayed universally elevated wall shear stress (0.75 ± 0.12 N/m2 vs 0.57 ± 0.09 N/m2, P < .01) in the ascending aorta, which was associated with elevated cardiac stroke volume (P < .05). The bicuspid aortic valve with severe aortic stenosis group showed elevated flow eccentricity in the form of significantly increased standard deviation of circumferential wall shear stress, which correlated with markedly increased peak aortic valve velocity (P < .01).Conclusions
The location of peak aortic wall shear stress and type of aortopathy remained homogeneous among patients with right-left bicuspid aortic valve irrespective of valve dysfunction. Severe aortic insufficiency or stenosis resulted in further elevated aortic wall shear stress and exaggerated flow eccentricity. 相似文献6.
Aymen S. Ramadan Anca Mitulescu Peggy Schmitt 《European journal of orthopaedic surgery & traumatology : orthopedie traumatologie》2007,17(6):513-520
Purpose
The purpose of the present study is to evaluate the early clinical and radiographic outcome in patients operated with Discocerv® Cervidisc Evolution semi-constrained cervical mobile prosthesis (Discocerv®), made of ceramic materials (Zirconia & Alumina).Study design
This is a monocentric prospective noncomparative study.Patient sample
Seventeen consecutive patients (8 men/9 women) were enrolled in the study so far. Mean age was 46.1 ± 7.9 years (33–62).Methods
Patients in this series underwent one or two level total cervical disc replacement (TCDR) with Discocerv for disc herniation (n = 13), stenosis (n = 2) or discopathy (n = 1). Mean follow up was 4.8 ± 1.8 months (0–7.2).Outcome measures
Clinical evaluation criteria included: VAS 1–100 mm self-reported cervical and radicular pain, neck disability index (NDI), symptoms evolution (ODOM score), work status, patient satisfaction index (PSI), mobility preservation. Prior to surgery VAS self-reported cervical and radicular pain were 62 mm (4–95) and 67 mm (2–96) respectively. NDI was 25/50 (9/50–37/50). Out of the active population (88%) 66% of patients were in sick leave for cervical symptoms. Radiographic criteria such as intervertebral mobility of the operated level were also assessed.Results
Sixteen patients had a one level total cervical disc replacement (C3C4 n = 1, C4C5 n = 3, C5C6 n = 9, C6C7 n = 3. One patient had C5C6 and C6C7 total cervical disc replacement. Surgery duration was 67.1 ± 20.2 min (35–120). Hospital stay was 3.6 ± 1.5 days (2–7). No pre-operative or post-operative complications were reported in this series, except for excessive bleeding in one patient without any further consequences. About 47% of active patients resumed their previous work within the first 3 months after surgery. The ODOM score showed 100% excellent and good results. Three months post-operatively, mean VAS self-reported cervical and radicular pain decreased to 13 mm (0–60) and 5 mm (0–20) respectively and NDI decreased to 11/50 (0–24). All patients were satisfied with the results so far. Quantitative radiographic analysis showed satisfactory restoration of cervical mobility at the operated levels, with mean intervertebral mobility of 4.9° ± 5.6° (0 to 19.0°) in flexion-extension and 8.4° ± 4.1° (2.7°–16.9°) in lateral bending.Conclusion
Early results with Discocerv® Cervidisc Evolution cervical prosthesis are encouraging. However, further follow-up on a larger group is necessary to confirm these findings. 相似文献7.
Subramanian Muthukkumaran Sachin Talwar Parag Gharde Sanjiv Sharma Sandeep Singh Shiv Kumar Choudhary 《Indian Journal of Thoracic and Cardiovascular Surgery》2014,30(1):17-21
Background
Role of Computed Tomography Angiography (CTA) in patients with Bicuspid Aortic Valve (BAV) undergoing Aortic Valve Replacement (AVR) needs assessment.Patients and Methods
After echocardiography, 54 patients with BAV were referred for AVR. CTA was performed routinely. Pre-operative characteristics, echocardiographic and CTA findings, and details of surgery were obtained.Results
The study population had 54 subjects (48 males). Median age was 35.5 years (range 7 to 78 years), and median weight was 57.5 Kg (range 14 to 83 kg). On echocardiography, aortic sinus diameter ranged from 13 to 38 mm (median 28 mm). In none of the patients, ascending aorta was reported to be dilated. On CT angiography, the sinus diameter ranged from 16 to 46 mm (median 35 mm). Sinus diameter was ≥40 mm in 13 patients. The sinus diameter on echocardiography was within the range of 0 to 2 mm of CT angiographic estimates in 31 patients, within 2.1 to 5 mm in 22 patients, and more than 5 mm in one patient. The ascending aortic diameter ranged from 19 to 70 mm (median 43 mm). In 26 patients, ascending aortic diameter was ≥45 mm. In 12 patients, the proximal arch diameter was ≥40 mm. In two patients, the distal ascending aorta and proximal arch were aneurysmally dilated (48 mm and 57 mm). In 12 patients, the ascending aorta was dilated (≥ 45 mm) without any sinus dilatation. In one patient, the distal ascending aorta and proximal arch were aneurysmally dilated (57 mm) without any proximal dilatation. Based on CT angiographic findings, 25 patients (46.3 %) underwent additional aortic replacement in the form of Bentall’s procedure (n?=?7), Bentall’s + Hemiarch replacement (n?=?6), aortoplasty (n?=?5), Wheat procedure (n?=?6) and Wheat procedure?+?Hemiarch replacement (n?=?1).Conclusion
CT angiography is justified as a routine pre-operative evaluation tool in all patients with BAV who are undergoing open heart surgery for significant aortic valve dysfunction. 相似文献8.
Amedeo Anselmi Vito Giovanni Ruggieri Bernard Lelong Erwan Flecher Hervé Corbineau Thierry Langanay Jean-Philippe Verhoye Alain Leguerrier 《The Journal of thoracic and cardiovascular surgery》2017,153(1):21-28.e1
Objective
To clarify the mid-term durability of the Trifecta bioprosthesis for aortic valve replacement (AVR).Methods
We retrospectively analyzed the prospectively collected data of 824 consecutive implants of the Trifecta valve at a single institution. A 100% complete follow-up was available (average duration, 2.2 ± 1.3 years; range, 0.03-6.9 years; 1747.6 patient-years). Echocardiography data at discharge were recorded prospectively.Results
Operative mortality was 3.8%; 2.7% in patients receiving isolated AVR. There were 5 valve-related early reoperations, including 1 for infective prosthetic endocarditis and 4 for nonstructural valve dysfunction. The global rate of severe patient–prosthesis mismatch was 1.26%. Overall 5-year survival was 74.9%, and freedom from valve-related death was 97.8%. The majority of deaths attributed to the valve were due to unknown causes. We observed 6 SVD events at 3.4 ± 1.6 years after surgery. At 5 years, the actuarial freedom from SVD was 98% ± 0.9% (n = 6), freedom from reintervention for SVD was 98% ± 0.9% (n = 5, including 2 transcatheter valve-in-valve), and freedom from open reoperation for SVD was 98.9% ± 0.6%. The 5-year freedom from prosthetic endocarditis was 97.7% ± 0.7% (n = 12, 6 requiring reoperation). There was 1 case of late NSVD (5-year freedom, 99.8% ± 0.2%). Freedom from hemorrhagic events was 98.6% ± 0.5% (86% occurring in patients on anticoagulants); there were no thromboembolic events at follow-up.Conclusions
The Trifecta bioprosthesis is a reliable device for AVR. We confirm excellent immediate hemodynamic properties and a very low rate of patient–prosthesis mismatch. The absolute number of SVD cases observed remains limited; nevertheless, their timing, pathological characteristics, and clinical presentation mandate continued follow-up. 相似文献9.
Terumasa Koyama Hiroyuki Okura Teruyoshi Kume Kenzo Fukuhara Koichiro Imai Akihiro Hayashida Yoji Neishi Takahiro Kawamoto Kazuo Tanemoto Kiyoshi Yoshida 《Journal of Echocardiography》2014,12(2):51-58
Background
Recently, the energy loss index (ELI) has been proposed as a new functional index to assess the severity of aortic stenosis (AS). The aim of this study was to investigate the impact of the ELI on left ventricular mass (LVM) regression in patients after aortic valve replacement (AVR) with mechanical valves.Methods
A total of 30 patients with severe AS who underwent AVR with mechanical valves was studied. Echocardiography was performed to measure the LVM before AVR (pre-LVM) (n = 30) and repeated 12 months later (post-LVM) (n = 19). The ELI was calculated as [effective orifice area (EOA) × aortic cross sectional area]/(aortic cross sectional area ? EOA) divided by the body surface area. The LVM regression rate (%) was calculated as 100 × (post-LVM ? pre-LVM)/(pre-LVM). A cardiac event was defined as a composite of cardiac death and heart failure requiring hospitalization.Results
LVM regressed significantly (245.1 ± 84.3 to 173.4 ± 62.6 g, P < 0.01) at 12 months after AVR. The LVM regression rate negatively correlated with the ELI (R = ?0.67, P < 0.01). By receiver operating characteristic (ROC) curve analysis, ELI <1.12 cm2/m2 predicted smaller (<?30.0 %) LVM regression rates (area under the curve = 0.825; P = 0.030). Patients with ELI <1.12 cm2/m2 had significantly lower cardiac event-free survival.Conclusion
The ELI as well as the EOA index (EOAI) could predict LVM regression after AVR with mechanical valves. Whether the ELI is a stronger predictor of clinical events than EOAI is still unclear, and further large-scale study is necessary to elucidate the clinical impact of the ELI in patients with AVR. 相似文献10.
Naoto Morimoto Syunsuke Matsushima Masaya Aoki Soichiro Henmi Naritomo Nishioka Hirohisa Murakami Tasuku Honda Keitaro Nakagiri Masato Yoshida Nobuhiko Mukohara 《General thoracic and cardiovascular surgery》2013,61(3):133-138
Background
Current knowledge in long-term results of tricuspid valve replacement is limited. Present study reviews our experience from a consecutive series.Methods
We retrospectively studied the early and late results of 32 consecutive patients (7 male and 25 female; mean age 60.2 ± 18.1 years) undergoing bioprosthetic tricuspid valve replacement between 1985 and 2010. The etiology is rheumatic in 38 %, congenital in 3 %, endocarditis in 9 %, and functional in 50 %. Patients underwent isolated valve replacement. The remaining underwent combined aortic and tricuspid (n = 5, 16 %), mitral tricuspid (n = 15, 47 %), and aortic, mitral, and tricuspid (n = 1, 3 %) valve replacement. Preoperative liver dysfunction was evaluated using Model for End-stage Liver Disease (MELD) score. Mean follow-up was 5.6 ± 6.8 years (ranging from 0 to 25.0 years).Results
Hospital mortality was 19 %. On univariate logistic regression analysis, NYHA class IV (p = 0.039, odds ratio 11.3, 95 % confidence interval 1.2–112.5), MELD score (>10) (p = 0.011, odds ratio 21.0, 95 % confidence interval 12.0–222.0) and congestive liver (p = 0.05, odds ratio 9.4, 95 % confidence interval 1.0–93.5) were incremental risk factors for hospital death. The 15- and 25-year actuarial survival were 56.5 ± 10.3 % and 45 ± 13.0 %, respectively. Multivariate analysis using Cox proportional hazard model showed MELD score (p = 0.024, hazard ratio 7.0, 95 % confidence interval 2.1–23.9) and postoperative pulmonary hypertension (p = 0.012, hazard ratio 4.4, 95 % confidence interval 1.4–14.1) were significantly associated with decreased survival. At 15 years, freedom rates from tricuspid valve reoperation, anticoagulation-related bleeding, and valve related events were 85.7 ± 13.2 %,95.7 ± 4.3 % and 81.8 ± 13.2 %, respectively. The linearized incidence of structural valve deterioration was 0.50 %/patient-year, anticoagulation-related bleeding was 0.94 %/patient-year, and valve-related events were 1.52 %/patient-year.Conclusion
Preoperative hepatic congestion and liver dysfunction which were indicated by the MELD score >10 were associated with poor outcome for patients undergoing tricuspid valve replacement. The MELD score is useful to predict the morality among these patients. 相似文献11.
Gananjay Gopalrao Salve Shilpa Suresh Mavanoor Varadaraju Rajanna Dhanya Prakash Kumsi Sreedhar 《Indian Journal of Thoracic and Cardiovascular Surgery》2013,29(3):184-187
Aims
Modified Bentall Procedure is a treatment of choice for aneurysms of ascending aorta associated with aortic valve disease. Bleeding from proximal anastomosis is one of the major concerns in this procedure. We report our modification of Bentall procedure to avoid bleeding from proximal anastomosis.Settings and design
Between May 2006 to July 2012, 15 patients underwent modified Bentall procedure by a single surgeon at our institute. There were 10 male and 5 female patients; the mean age was 39.4?±?12.3 years (range, 12–60 years). The disease pathology of these patients included Marfans syndrome, syphilitic aneurysm and atherosclerotic aneurysm of the ascending aorta. All had severe aortic regurgitation (grade III & IV) with thinned, non-calcified aortic valve cusps.Methods and material
In our modification of Bentall procedure, we completely preserved the aortic cusps and 5 to 10 mm of native aortic wall collar at the aortic annulus. Pledgeted sutures were passed to buttress the native aortic cusps between the aortic annulus and the sewing ring of the graft. Then aortic wall collar was sutured to the sewing ring by continuous suture just distal to the pledgeted suture line.Results
The mean 24 hours post-operative bleeding was 232.14?±?105.84 ml; with a hospital mortality rate of 6.66 % (one patient).Conclusions
In the new proposed technique incorporated for Bentall procedure, we conclude that it is simple, reproducible and effective in controlling bleeding. 相似文献12.
Mitsumasa Hata Motomi Shiono Hiroaki Hata Akira Sezai Kenji Akiyama Yukihiko Orime Shinji Wakui 《Surgery today》2014,44(9):1669-1673
Purpose
We assessed the incidence of coronary artery disease (CAD) during hospitalization after emergency surgery for a type A acute aortic dissection.Methods
A total of 123 patients underwent multi-slice computed tomography (MSCT) scans during an early stage after surgery. The patients were divided into two groups: group I consisted of 14 patients (11.4 %) who had coronary artery stenosis of more than 75 % on MSCT, and group II consisted of 109 patients (88.6 %) who had no coronary lesions.Results
The prevalence of diabetes, dyslipidemia and a smoking history was significantly higher in group I. Although the serum low-density lipoprotein cholesterol levels were similar, the high-density lipoprotein cholesterol (HDL) level was significantly lower in group I (36.4 ± 7.9 mg/dl) than in group II (49.6 ± 13.5 mg/dl, P = 0.0005). The maximum carotid intima-media thickness (IMT) was significantly thicker in group I (1.17 ± 0.37 mm) compared to group II (0.96 ± 0.33 mm, P = 0.0297). The logistic regression analysis detected that a carotid IMT over 1.1 mm (odds ratio 4.35, P = 0.0371) and HDL less than 40 mg/dl (odds ratio 3.90, P = 0.0482) were predictors for CAD.Conclusions
CAD screening should be recommended for patients with aortic dissection who have several atherosclerosis risk factors, even after emergency surgery. 相似文献13.
Sina Stock Michael Scharfschwerdt Roza Meyer-Saraei Doreen Richardt Efstratios I. Charitos Hans-Hinrich Sievers Thorsten Hanke 《The Journal of thoracic and cardiovascular surgery》2017,153(2):255-263.e1
Background
Transcatheter aortic valve-in-valve implantation (TAVI-ViV) is an evolving treatment strategy for degenerated surgical aortic valve bioprostheses (SAVBs). However, there is some concern regarding coronary obstruction, especially after TAVI-ViV in calcified SAVBs with externally mounted leaflets. We investigated in vitro coronary flow and hydrodynamics after TAVI-ViV using 2 modern SAVBs with externally and internally mounted leaflets.Methods
Aortic root models including known risk factors for coronary obstruction served for the implantation of SAVBs with either externally mounted leaflets (St Jude Trifecta, size 25) or internally mounted leaflets (Edwards Perimount Magna Ease, size 25). Left and right coronary flow, as well as hydrodynamic parameters, were measured before and after TAVI-ViV with an Edwards Sapien XT transcatheter heart valve, size 23. After the first experimental run, the SAVB leaflets were artificially “calcified,” and the measurements were repeated.Results
In both models, noncalcified and calcified, there was no significant reduction in coronary flow with either the Trifecta or the Perimount Magna Ease SAVB. After TAVI-ViV, in the noncalcified model, the mean pressure gradient was increased (Trifecta, P = .0001; Perimount Magna Ease, P = .006) and the geometric orifice area was decreased (P < .001 for both), whereas in the calcified model, the mean pressure gradient was decreased (P < .001 for both) and the geometric orifice area was increased (P < .001 for both).Conclusions
In our specific model, in noncalcified as well as calcified conditions, TAVI-ViV is feasible with either SAVB (Trifecta or Perimount Magna Ease) without an increased risk of coronary obstruction. Nevertheless, before clinical application of these results, thorough preoperative assessment, considering the different limitations of this model, is mandatory. 相似文献14.
Konigstein Maayan Biner Simon Topilsky Yan Abramowitz Yigal Havakuk Ofer Ben-Assa Eyal Leshem-Rubinow Eran Arbel Yaron Keren Gad Banai Shmuel Finkelstein Ariel 《Journal of Echocardiography》2014,12(1):17-23
Background
Aortic stenosis is associated with concentric left ventricle (LV) hypertrophy or remodeling resulting in impaired diastolic function and elevated left-sided filling pressure. We investigated the changes in LV geometry and LV filling hemodynamics, giving emphasis to parameters associated with changes in diastolic function after transcatheter aortic valve implantation (TAVI).Methods
Comprehensive diastolic assessment was performed before and six months after TAVI in 70 patients with severe aortic stenosis. Patients with any degree of mitral stenosis or >mild left-sided valvular regurgitation were excluded.Results
In the entire cohort six months after TAVI, LV end-diastolic diameter increased (44.1 ± 6 versus 45 ± 6 mm, P = 0.02), whereas LV mass and relative wall thickness (RWT) decreased (270.1 ± 76 versus 245.1 ± 75 g and 0.53 ± 0.15 versus 0.46 ± 0.1, respectively; P < 0.0001 for both). Lateral e′ increased (5.8 ± 2 versus 6.6 ± 3 cm/s, P = 0.03) and left atrium (LA) volume, E/e′ ratio, and systolic pulmonary pressure decreased (88.1 ± 30 versus 80 ± 28 cc, 18 ± 7.8 versus 16.3 ± 5.5, and 42.7 ± 14.9 versus 38.7 ± 12 mmHg, respectively; P < 0.05 for all), suggesting reduction in LA pressure. The improvement in LA volume and E/e′ was almost exclusively seen in patients with LV hypertrophy before TAVI (P < 0.05 both), as opposed to patients with concentric remodeling.Conclusions
In our preliminary study, TAVI resulted in LV and LA reverse remodeling, and improved LV relaxation and LA filling pressure in patients with severe aortic stenosis and concentric hypertrophy. Patients with concentric remodeling at baseline seem to have limited improvement in LV diastolic function and filling pressure following TAVI, but larger clinical trials would be required to conclude if they have no improvement at all. 相似文献15.
Ken-ichi Imasaka Eiki Tayama Yukihiro Tomita 《Indian Journal of Thoracic and Cardiovascular Surgery》2014,30(3):189-195
Background
We evaluated the effects of three implantation techniques (everting mattress, non-everting mattress, and simple interrupt techniques) for aortic valve replacement in severe aortic stenosis with small aortic annulus on left ventricular performance and function.Methods
Eighty-five patients who underwent aortic valve replacement for severe aortic valve stenosis were retrospectively examined. Left ventricular mechanics (Ees, end-systolic elastance; Ea, effective arterial elastance and efficiency), left ventricular ejection fraction, effective orifice area index, peak aortic valve velocity, and the left ventricular mass index were measured before and up to 1 month after surgery. Two-way repeated measure analysis of variance was used to compare parameters among the three valve replacement techniques.Results
Echocardiography after aortic valve replacement showed similar significant increases in the effective orifice area index (p?0.001) and significant decreases in the peak aortic valve velocity (p?0.001) and left ventricular mass index (p?0.05) for each technique. With regard to left ventricular mechanics, Ees did not change significantly across the techniques (p?=?0.80), and Ea decreased significantly and similarly in each group after surgery (p?0.001). Consequently, left ventricular efficiency (Ea/Ees and the stroke work to pressure/volume area ratio) improved significantly (p?0.001 and p?0.001 respectively) and similarly after surgery in each group.Conclusions
The three implantation techniques for aortic valve replacement gave equally satisfactory hemodynamic results and any would be reliable for patients with severe aortic valve stenosis and small aortic annuli. 相似文献16.
Fuad Al-Azzam Kevin L. Greason Chayakrit Krittanawong Eric E. Williamson Christopher J. McLeod Katherine S. King Verghese Mathew 《The Journal of thoracic and cardiovascular surgery》2017,153(5):1056-1062.e1
Objective
Native aortic valve calcium and transcatheter aortic valve oversize have been reported to predict pacemaker implantation after transcatheter aortic valve insertion. We reviewed our experience to better understand the association.Methods
We retrospectively reviewed the records of 300 patients with no prior permanent pacemaker implantation who underwent transcatheter aortic valve insertion from November 2008 to February 2015. Valve oversize was calculated using area. The end point of the study was 30-day postoperative pacemaker implantation.Results
Patient data included age of 81.1 ± 8.4 years, female sex in 135 patients (45%), atrial fibrillation in 74 patients (24.7%), Society of Thoracic Surgeons predicted risk of mortality of 7.6% (interquartile range [IQR], 5.3-10.6), aortic valve calcium score of 2568 (IQR, 1775-3526) Agatston units, and annulus area of 471 ± 82 mm2. Balloon-expandable valves were inserted in 244 patients (81.3%). Transcatheter aortic valve oversize was 12.8% (IQR, 3.9-23.3). Pacemaker implantation was performed in 59 patients (19.7%). Aortic valve calcium score (adjusted P = .275) and transcatheter valve oversize (adjusted P = .833) were not independent risk factors for pacemaker implantation when controlling for preoperative right bundle branch block (adjusted odds ratio, 3.49; 95% confidence interval, 1.61-8.55; P = .002), implantation of self-expanding valve (adjusted odds ratio, 4.09; 95% confidence interval, 1.53-10.96; P = .005), left bundle branch block (adjusted P = .331), previous percutaneous coronary intervention (adjusted P = .053), or valve surgery (adjusted P = .111), and PR interval (adjusted P = .350).Conclusions
Right bundle branch block and implantation of a self-expanding prosthesis were predictive of pacemaker implantation, but not native aortic valve score or transcatheter valve oversize. 相似文献17.
Volker Eichhorn Alexander Maerz Georg Salomon Irmgard F. Blanc Daniel A. Reuter Alwin E. Goetz 《World journal of urology》2013,31(2):371-376
Purpose
We investigated hemodynamics in patients receiving delta-Aminolevulinic acid (delta-ALA) to visualize tumor margins prior to radical retro pubic prostatectomy.Patients
Twenty patients undergoing elective open radical retro pubic prostatectomy (RRP).Methods
Cohort observational study. Ten patients receiving 20 mg/kg of delta-ALA orally prior to surgery (delta-ALA) and 10 patients undergoing RRP without the application of delta-ALA served as a retrospectively matched cohort (CONTROL).Measurements
Changes in heart rate (HR), mean arterial blood pressure (MAP), and functional hemodynamic parameters were assessed by electrocardiogram, non-invasive and invasive blood pressure monitoring plus transcardiopulmonary thermodilution.Results
Patients of both groups did not differ in means of age, body mass index, or ASA classification. During surgery, HR and MAP did not differ significantly between both groups. Also, the amount of IV crystalloids and colloids did not differ significantly. In contrast, the amount of vasopressor necessary to maintain MAP within the target range of 70–90 mmHg was significantly higher in delta-ALA when compared to CONTROL (0.08 ± 0.04 μg/kg/min (delta-ALA) vs. 0.03 ± 0.02 μg/kg/min (CONTROL); P < 0.01). Immediately after surgery, patients of delta-ALA showed a significantly higher heart rate (82 ± 18 min?1 vs. 67 ± 9 min?1; P < 0.05) compared to patients of CONTROL. Cardiac index, global end-diastolic volume index, and extravascular lung water index were significantly higher after surgery, when compared to baseline values (P < 0.05).Conclusions
Orally administered delta-ALA prior to open radical prostatectomy induces hemodynamic instability in the perioperative period requiring vasopressor support. Further, an increase of extravascular lung water points toward an increased vascular permeability induced by delta-ALA. 相似文献18.
Ayumu Abe Taisei Mikami Sanae Kaga Kanako Tsuji Kazunori Okada Shinobu Yokoyama Hisao Nishino Masahiro Nakabachi Mutsumi Nishida Chikara Shimizu Hiroyuki Iwano Satoshi Yamada Hiroyuki Tsutsui 《Journal of Echocardiography》2013,11(2):41-49
Background
Assessing left ventricular (LV) hypertrophy (LVH) is an important step in the echocardiographic diagnosis of aortic stenosis (AS). We aimed to investigate the causes of discrepancies between the degrees of AS and LVH.Methods
The study subjects consisted of 149 consecutive patients with AS having aortic valve area <2.0 cm2 (mean age 72.5 ± 11.9 years, 67 men and 82 women). Coexisting cardiac diseases were determined based on echocardiographic findings and comprehensive clinical judgment. Echocardiographic measurements included LV mass index (LVMI), aortic valve area index (AVAI), transaortic mean pressure gradient (MPG), valvulo-arterial impedance (Zva), energy loss coefficient (ELCo), and energy loss index (ELI).Results
LVMI was not significantly correlated with AVAI and Zva, and had a weak correlation with MPG (r = 0.305, p = 0.0001). There were 55 patients in group A (non-severe AS without significant LVH), 58 in group B (non-severe AS with significant LVH), 7 in group C (severe AS without significant LVH), and 29 in group D (severe AS with significant LVH). Coexisting cardiac diseases were more frequently observed (p = 0.0003) in group B (50 %) than in group A (18 %). In group C, ELCo and (ELI ? AVAI)/ELI were significantly greater than in group D (p = 0.043 and 0.007, respectively).Conclusion
Significant LVH seen in less than moderate AS is often due to coexisting cardiac diseases, and there may be an overestimation of AS severity due to pressure recovery among patients with apparently severe AS who do not have significant LVH. 相似文献19.
Yasuyuki Sasaki Hidekazu Hirai Mitsuharu Hosono Yasuyuki Bito Atsushi Nakahira Yasuo Suehiro Daisuke Kaku Yuko Okada Shigefumi Suehiro 《General thoracic and cardiovascular surgery》2013,61(11):626-631
Objective
This retrospective study aimed to determine the effect of simultaneous aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) on operative outcomes and long-term survival in elderly patients with a high prevalence of comorbidity.Methods
One hundred and fifty-seven elderly patients (70 years old or older) undergoing isolated AVR (n = 120) or combined AVR/CABG (n = 37) were evaluated. Operative outcomes were compared between the two surgical groups. Long-term survival was also compared between the groups using the Kaplan–Meier method and long-rank (Mantel–Cox) test.Results
Operative mortality was 0.8 % for the isolated AVR group and 5.4 % for the combined AVR/CABG group (p = 0.076). The length of the intensive care unit stay for the combined AVR/CABG group was significantly longer than that for the isolated AVR group (median: 40 vs. 21 h, p = 0.008). However, the occurrence rate of hospital complications, such as reoperation for bleeding, deep sternal infection, supra-ventricular arrhythmia, and neurological complications, was similar between the two groups. Actuarial survival at 3 and 5 years was 82.3 and 80.9 % for the isolated AVR group, and 88.3 and 73.0 % for the combined AVR/CABG group, respectively (p = 0.637).Conclusions
The satisfactory operative and long-term results in our study support a more aggressive simultaneous coronary revascularization combined with AVR for aortic valve stenosis in elderly patients. 相似文献20.
Glenn R. Barnhart Kevin D. Accola Eugene A. Grossi Y. Joseph Woo Mubashir A. Mumtaz Joseph F. Sabik Frank N. Slachman Himanshu J. Patel Michael A. Borger H. Edward Garrett Evelio Rodriguez Patrick M. McCarthy William H. Ryan Francis G. Duhay Michael J. Mack W. Randolph Chitwood 《The Journal of thoracic and cardiovascular surgery》2017,153(2):241-251.e2