1,720,996 research outputs found
A Surgeons-Only Transcatheter Aortic Valve Implantation Programme: What Did We Learn After 1000 Procedures
No full textRisk of stroke with "no-touch" - As compared to conventional off-pump coronary artery bypass grafting. An updated meta-analysis of observational studies.
No full textModes of failure of Trifecta aortic valve prosthesis
No full textObjectives: Several concerns have been recently raised regarding the durability of Trifecta prostheses. Different mechanisms of early failure were reported. Our aim was to study in a large population the modes of failure of Trifecta valves. Methods: We conducted a retrospective analysis of patients who underwent surgical aortic valve replacement with a Trifecta prosthesis during the period 2010-2018. Details regarding the mode of failure and haemodynamic dysfunction were collected for patients who underwent reintervention for structural valve failure. The Kaplan-Meier method was used to calculate survival. Competing risk analysis was performed to calculate the cumulative risk of reintervention for structural valve failure. Results: The overall population comprises 1228 patients (1084 TF model and 144 TFGT model). Forty-four patients-mean patients' age at the time of the first implant 69 (standard deviation: 12) years and 61% female-underwent reintervention for structural valve failure after a median time of 63 [44-74] months. The cumulative incidence of reintervention for structural valve failure was 0.16% (SE 0.11%), 1.77% (SE 0.38%) and 5.11% (SE 0.98%) at 1, 5 and 9 years, respectively. In 24/44 patients (55%), a leaflet tear with dehiscence at the commissure level was found intraoperatively or described by imaging assessment. The cumulative incidence of reintervention for failure due to leaflet(s) tear was 0.16% (SE 0.11%), 1.08% (SE 0.29%) and 3.03% (SE 0.88%) at 1, 5 and 9 years, respectively. Conclusions: Leaflet(s) tear with dehiscence along the stent post was the main mode of early failure, up to 5 years, after Trifecta valves' implantation
Durability of Mitral Valve Bioprostheses: A meta-analysis of long-term follow-up studies
No full textPorcine and pericardial valves exhibited similar freedom from structural valve deterioration after aortic valve replacement. Limited data exists regarding their durability at long-term follow-up in the mitral position
del Nido and Histidine-Tryptophan-Ketoglutarate cardioplegia in minimally invasive mitral valve surgery: A propensity-Match study
No full textIntroduction: In the last decade, del Nido cardioplegia has been embedded in adult cardiac surgery involving CABG and aortic valve surgical procedures. We reviewed our early experience with del Nido cardioplegia in the setting of minimally invasive mitral valve surgery. Methods: Data on 120 consecutive patients operated between 03/2021 and 06/2022 were retrieved from our internal database (infective endocarditis and urgent operations were excluded). Patients were divided into two groups according to the use of Histidine-Tryptophan-Ketoglutarate or del Nido cardioplegia. A propensity match analysis was performed using thirteen preoperative and intraoperative variables. Several intraoperative data and early postoperative outcomes were investigated, including cardiac enzymes (Troponin I HS and CK-MB) measured upon arrival in the Intensive Care Unit (ICU), after 12 hours and everyday thereafter. Results: There was no difference in preoperative characteristics and surgical techniques between both unmatched and matched Histidine-Tryptophan-Ketoglutarate and del Nido populations. Patients in the del Nido group received a lower volume of cardioplegia (p < 0.001) and ultrafiltration during CPB (p < 0.001). Histidine-Tryptophan-Ketoglutarate was associated with a lower rate of post cross-clamp spontaneous defibrillation (p < 0.001) and showed a lower level of blood sodium after CPB (p < 0.001). The release of cardiac enzymes was similar between the two groups (p = 0.72). There was no difference in terms of postoperative morbidity and 30 day mortality. Conclusions: del Nido cardioplegia in the setting of minimally invasive mitral valve surgery seemed safe with acceptable myocardial protection and excellent early outcomes
Surgical repair and replacement for native mitral valve infective endocarditis
No full textAims: The clinical benefits of mitral valve repair over replacement in the setting of mitral infective endocarditis are not clearly established. Methods: Data of patients who underwent cardiac surgery for infective endocarditis over a 20-year period (2001-2021) at two cardiac centres were reviewed. Among them, 282 patients underwent native mitral valve surgery and were included in the study. Nearest-neighbour propensity-score matching was performed to account for differences in patients' profile between the repair and replacement subgroups. Results: Mitral valve replacement was performed in 186 patients, while in 96 cases patients underwent mitral valve repair. Propensity match analysis provided 89 well matched pairs. Mean age was 60 ± 15 years; 75% of the patients were male. Mitral valve replacement was more commonly performed in patients with involvement of both mitral leaflets, commissure(s) and mitral annulus. Patients with lesion(s) limited to P2 segment formed the majority of the cases undergoing mitral valve repair. There was no difference in terms of microbiological findings. In-hospital mortality was 7% with no difference between the repair and the replacement cohorts. Survival probabilities at 1, 5 and 10 years were 88%, 72% and 68%, respectively after mitral repair, and 88%, 78% and 63%, respectively after mitral replacement (log-rank P = 0.94). Conclusions: Mitral valve repair was more commonly performed in patients with isolated single leaflet involvement and provided good early and 10-year outcomes. Patients with annular disruption, lesion(s) on both leaflets and commissure(s) were successfully served on early and mid-term course by mitral valve replacement
Surgical retrieval of a degenerated Sapien 3 valve after 29 months.
No full textA 70-year-old man developed heart failure due to severe mixed disease of a degenerated transcatheter aortic valve prosthesis. The patient underwent retrieval of the transcatheter aortic valve and implantation of a 25-mm bioprosthesis through a redo sternotomy
Full sternotomy and minimal access approaches for surgical aortic valve replacement: a multicentre propensity-matched study
No full textSurgical aortic valve replacement (AVR) can be performed via a full sternotomy or a minimal access approach (mini-AVR). Despite long-term experience with the procedure, mini-AVR is not routinely adopted. Our goal was to compare contemporary outcomes of mini-AVR and conventional AVR in a large multi-institutional national cohort
The association between cerebral blood flow variations during on-pump coronary artery bypass grafting surgery and postoperative delirium
No full textIntroduction: Postoperative delirium (POD) has a major impact on patient recovery after cardiac surgery. Although its pathophysiology remains unclear, there could be a correlation between cerebral blood flow (CBF) variations during cardio-pulmonary bypass (CPB) and POD. Our study aimed to evaluate whether variations in on-pump CBF, compared to pre-anesthesia and pre-CPB values, are associated with POD following coronary artery bypass grafting (CABG) surgery. Methods: This prospective observational cohort study included 95 adult patients undergoing elective on-pump CABG surgery. Right middle cerebral artery blood flow velocity (MCAV) was assessed using Transcranial Doppler before anesthesia induction, before CPB and every fifteen minutes during CPB. Pre-anesthesia and pre-CPB values were chosen as baselines. Individual values, measured during CPB, were converted as percentage changes relative to these baselines and named as %MCAV0 and %MCAV1, respectively. POD was assessed using the Confusion Assessment Method for ICU (CAM-ICU) during the first 48 post-operative hours and with the 3-Minute Diagnostic Interview for Confusion Assessment Method (3D-CAM) on the fifth post-surgical day. Results: Overall POD incidence was 17.9%. At 30 minutes of CPB, %MCAV0 was higher in POD group than in no-POD group (p = .05). %MCAV0 at 45 minutes of CPB was significantly higher in POD group (87 (±17) %) than in no-POD group (68 (±24) %), p = .04. %MCAV1 at 30 and 45 minutes of CPB were higher in POD group than in no-POD group, at the limit of statistical significance. We found %MCAV1 > 100% in POD group, but not in no-POD group. Conclusions: Significant differences in %MCAV0 became evident after 30 minutes of CPB, whereas differences in %MCAV1 at 45 minutes of CPB were at limit of statistical significance. In POD group %MCAV1 was higher than 100% at 30 and 45 minutes of CPB, which is supposed to be a sign of cerebral hyperperfusion. Monitoring CBF during CPB could have prognostic value for POD
Transaxillary approach enhances postoperative recovery after mitral valve surgery
Full text linkObjectives: Several thoracic incisions have been described and different techniques used for cardiopulmonary bypass, myocardial protection, and valve exposure in minimally invasive mitral valve surgery (MIMVS). Aim of this study is to compare the early outcomes of patients operated using a simplified minimally invasive approach through a right trans-axillary (TAxA) access with those achieved with conventional full sternotomy (FS) operations. Methods: Prospectively collected data of patients who underwent mitral valve surgery between 2017 and 2022 at two academic centres were reviewed. Among them, 454 patients were operated through MIMVS TAxA access and 667 patients through FS; associated aortic and CABG procedures, infective endocarditis, redo and urgent operations were excluded. A propensity match analysis was performed using seventeen preoperative variables. Results: Two well balanced cohorts including a total of 804 patients were analysed. The rate of mitral valve repair was similar in both groups. Operative times were shorter in FS group, nevertheless in patients operated with a minimally invasive approach there was a trend towards decreasing crossclamp time over the study period (p = 0.07). In TAxA group 30-day mortality was 0.25%, postoperative cerebral stroke rate was 0.7%. TAxA mitral surgery was associated with shorter intubation time (p < 0.001) and ICU stay (p < 0.001). After a median hospital stay of 8 days, 30% of patients who had TAxA surgery were discharged home vs. 5% in the FS group (p < 0.001). Conclusions: When compared with FS access, TAxA approach provides at least similar excellent early outcomes in terms of perioperative morbidity and mortality and allows shorter mechanical ventilation time, ICU and postoperative hospital stay with a higher rate of patients able to be discharged home without any further period of cardiopulmonary rehabilitation
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