Aortic Valve ; surgery ; Female ; Heart Valve Diseases ; surgery ; Heart Valve Prosthesis Implantation ; adverse effects ; mortality ; Humans ; Logistic Models ; Male ; Multivariate Analysis ; Risk Factors

BACKGROUND: It is unclear whether mitral valve (MV) repair for degenerative mitral regurgitation (MR) provides the same advantages in the elderly that it does in the general population. METHODS: From 1994 to 2016, 188 elderly patients (mean age, 68.3±5.50 years) underwent MV repair (n=153) or MV replacement (n=35) for primary degenerative MR. Early and long-term outcomes were compared before and after propensity score matching (PSM). RESULTS: Before PSM, there was a significant difference in operative mortality (p=0.011). Overall survival and freedom from cardiac-related death (CRD) at 5, 10, and 15 years were significantly higher in patients who underwent MV repair (p=0.039 and p=0.007, respectively). In the multivariable analysis, MV replacement was an independent risk factor of CRD. After PSM, operative mortality was not significantly lower in patients who underwent MV repair (p=0.125). Overall survival and freedom from CRD at 5, 10, and 15 years showed no significant difference between the 2 groups in the PSM cohort (p=0.207, p=0.47, respectively). There was no significant difference in freedom from reoperation before or after PSM (p=0.963 and p=0.575, respectively). CONCLUSION: MV repair for primary degenerative MR might be a valid option in the elderly population if successful repair is possible.
Aged* ; Cohort Studies ; Freedom ; Heart Valve Prosthesis Implantation ; Humans ; Mitral Valve Insufficiency* ; Mitral Valve* ; Mortality ; Propensity Score* ; Reoperation ; Risk Factors

BACKGROUND: In elderly high-risk surgical patients, sutureless aortic valve replacement (AVR) should be an alternative to standard AVR. The potential advantages of sutureless aortic prostheses include reducing cross-clamping and cardiopulmonary bypass (CPB) time and facilitating minimally invasive surgery and complex cardiac interventions, while maintaining satisfactory hemodynamic outcomes and low rates of paravalvular leakage. The current study reports our single-center experience regarding the early outcomes of sutureless aortic valve implantation. METHODS: Between October 2012 and June 2015, 65 patients scheduled for surgical valve replacement with symptomatic aortic valve disease and New York Heart Association function of class II or higher were included to this study. Perceval S (Sorin Biomedica Cardio Srl, Sallugia, Italy) and Edwards Intuity (Edwards Lifesciences, Irvine, CA, USA) valves were used. RESULTS: The mean age of the patients was 71.15±8.60 years. Forty-four patients (67.7%) were female. The average preoperative left ventricular ejection fraction was 56.9±9.93. The CPB time was 96.51±41.27 minutes and the cross-clamping time was 60.85±27.08 minutes. The intubation time was 8.95±4.19 hours, and the intensive care unit and hospital stays were 2.89±1.42 days and 7.86±1.42 days, respectively. The mean quantity of drainage from chest tubes was 407.69±149.28 mL. The hospital mortality rate was 3.1%. A total of five patients (7.69%) died during follow-up. The mean follow-up time was 687.24±24.76 days. The one-year survival rate was over 90%. CONCLUSION: In the last few years, several models of valvular sutureless bioprostheses have been developed. The present study evaluating the single-center early outcomes of sutureless aortic valve implantation presents the results of an innovative surgical technique, finding that it resulted in appropriate hemodynamic conditions with acceptable ischemic time.
Aged ; Aortic Valve* ; Bioprosthesis ; Cardiopulmonary Bypass ; Chest Tubes ; Drainage ; Female ; Follow-Up Studies ; Heart ; Heart Valve Prosthesis Implantation ; Hemodynamics ; Hospital Mortality ; Humans ; Intensive Care Units ; Intubation ; Length of Stay ; Minimally Invasive Surgical Procedures ; Prostheses and Implants ; Prosthesis Design ; Stroke Volume ; Surgical Instruments ; Survival Rate

Despite the necessity of surgical aortic valve replacement, many patients with symptomatic severe aortic stenosis (AS) cannot undergo surgery because of their severe comorbidities. In these high-risk patients, percutaneous transcatheter aortic valve implantation (TAVI) can be safely accomplished. However, no study has shown that TAVI can be performed for patients with severe AS accompanied by acute decompensated heart failure. In this case report, 1 patient presented a case of severe pulmonary hypertension with decompensated heart failure after diagnosis with severe AS, and was successfully treated via emergency TAVI. Without any invasive treatment, acute decompensated heart failure with severe pulmonary hypertension is common in patients with severe AS, and it can increase mortality rates. In conclusion, TAVI can be considered one of the treatment options for severe as presented as acute decompensated heart failure patients with pulmonary hypertension.
Aortic Valve Stenosis ; Aortic Valve* ; Comorbidity ; Diagnosis ; Emergencies* ; Emergency Treatment ; Heart Failure ; Heart Valve Prosthesis Implantation ; Humans ; Hypertension, Pulmonary ; Mortality

OBJECTIVETo investigate the role of left atrial appendage (LAA) closure for cerebral ischemic stroke prevention following mitral valve replacement.

METHODSRetrospective data on 860 consecutive adult patients undergoing mitral valve replacement between January 2008 and January 2013 were analyzed. There were 414 male and 446 female patients, with a mean age of (53 ± 12) years. The patients were divided into two groups according to whether the left atrial appendage was closed during operation: LAA closure group (n = 521) and non-LAA closure group (n = 339).Early mortality, postoperative cerebral ischemic stroke and the risk factors for cerebral ischemic stroke were assessed. Multivariate analysis was performed using logistic regression analysis.

RESULTSCompared with non-LAA closure group, LAA closure group had higher proportion of female gender, higher percentage of patients with cardiac insufficiency, pulmonary hypertension and left atrial thrombus, higher incidence of mechanical valve implantation and concurrent tricuspid surgery, and larger preoperative diameter of left atrium, but lower proportion of hypertension and patients undergoing coronary artery bypass surgery, and shorter aorta cross clamping time (χ² = 6.807 to 122.576, t = -2.818 and 3.756, all P < 0.05). There were no differences in exploratory thoracotomy for bleeding and in-hospital mortality between the two groups. Postoperative cerebral ischemic stroke occurred in 12 patients (1.4%). The incidence of cerebral ischemic stroke in LAA closure group was significantly lower than in non-LAA closure group (0.6% vs.2.7%, χ² = 6.452, P = 0.011).Logistic regression analysis showed that LAA closure was a significant protective factor for postoperative cerebral ischemic stroke (OR = 0.189, 95% CI: 0.039 to 0.902, P = 0.037) while history of cerebrovascular disease (OR = 4.326, 95% CI:1.074 to 17.418, P = 0.039) and preoperative diameter of left atrium (OR = 1.509, 95% CI: 1.022 to 1.098, P = 0.002) being the independent risk factors for postoperative cerebral ischemic stroke. The subgroup analysis showed that, for atrial fibrillation patients, LAA closure was a strong protective factor (OR = 0.064, 95% CI: 0.006 to 0.705, P = 0.025), but LAA closure was not a significant predictive factor (OR = 1.902, 95% CI: 0.171 to 21.191, P = 0.601) in non-atrial fibrillation patients.

CONCLUSIONConcurrent LAA closure during mitral valve replacement is safe and effective to reduce the early postoperative risk of cerebral ischemic stroke in atrial fibrillation patients.

Adult ; Aged ; Atrial Appendage ; surgery ; Atrial Fibrillation ; Brain Ischemia ; complications ; prevention & control ; Coronary Artery Bypass ; Female ; Heart Valve Prosthesis Implantation ; Hospital Mortality ; Humans ; Incidence ; Male ; Middle Aged ; Mitral Valve ; Mitral Valve Insufficiency ; surgery ; Nervous System Diseases ; Retrospective Studies ; Risk Factors ; Stroke ; prevention & control ; Thrombosis

With the aging population, more patients who have undergone previous coronary artery bypass grafting (CABG) are surviving long enough to require subsequent aortic valve replacement (AVR). Conventional redo AVR after prior CABG involves resternotomy, dissection and clamping of the patent bypass graft vessel. Favorable results have been reported for AVR following previous CABG; however, the problems of this procedure includes that injury to the patent bypass grafts can result in catastrophic complications. Increasing patient age and comorbidities may increase operative mortality, less invasive percutaneous aortic valve intervention has advanced. However, because there are no sufficient data comparing transcatheter aortic valve intervention with surgical AVR, currently, the surgical approach should still be consider as the standard of treatment for AVR following previous CABG. We report a patient in whom successful conventional AVR was underwent after previous CABG with patent left internal mammary artery.
Aging ; Aortic Valve Stenosis ; Aortic Valve* ; Comorbidity ; Constriction ; Coronary Artery Bypass* ; Coronary Vessels* ; Heart Valve Prosthesis Implantation ; Humans ; Mammary Arteries* ; Mortality ; Transplants

PURPOSE: This study was conducted to evaluate the surgical outcomes of active infective endocarditis with aortic root abscess formation. MATERIALS AND METHODS: Between February 1999 and June 2012, 49 patients underwent surgery for active endocarditis with aortic root abscess. The infected valve was native in 29 patients and prosthetic in 20 patients. The patients' mean age was 50+/-14 years, and 36 patients were male. Surgery was urgent/emergent in 15 patients (31%). The abscess involved the aortic annulus (11), left ventricular outflow tract (18), fibrous trigone (16), and mitral annulus (4). In all patients, wide debridement of abscess and aortic valve replacement with or without patch reconstruction of aortic root or annulus was performed. RESULTS: There were 6 (12%) operative deaths. Causes of early mortality were sepsis (2) and multi-organ failure (4). On postoperative echocardiogram, there was significant improvement of left ventricular dimension (LVEDD, from 58.8+/-11.8 mm to 52.6+/-8.2 mm, p<0.001); however, LV ejection fraction was significantly decreased (from 61.4+/-12.0% to 49.8+/-16.5%, p<0.001). The mean follow-up duration was 68.7+/-40.4 months. There was no late death or recurrent endocarditis during follow up. New York Heart Association functional class significantly improved from 3.2+/-0.7 to 1.2+/-0.4 (p<0.001). Kaplan-Meier estimated survival at 10 years was 87.2%. CONCLUSION: Surgical treatment for active endocarditis with aortic root abscess is still challenging, and was associated with high operative mortality. Nevertheless, long-term survival was excellent with good functional capacity after recovery from the early postoperative period.
Abscess/*surgery ; Adult ; Aortic Valve/microbiology/*surgery ; Debridement ; Endocarditis/*surgery ; Female ; Follow-Up Studies ; Heart Valve Prosthesis/*microbiology ; Heart Valve Prosthesis Implantation/*adverse effects/mortality ; Humans ; Intraoperative Complications/epidemiology ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Postoperative Complications/epidemiology ; Retrospective Studies

Transcatheter aortic valve implantation (TAVI) is a less invasive procedure to treat severe aortic valve stenosis than conventional surgical aortic valve replacement. Furthermore, TAVI has shown similar clinical outcomes as surgical treatment with less mortality and morbidities in elderly patients at high risk for conventional surgery. In this report, we describe case of successful TAVI using a CoreValve in a 103-year-old patient with symptomatic severe aortic valve stenosis.
Aged ; Aged, 80 and over* ; Aortic Valve Stenosis* ; Aortic Valve* ; Catheters ; Heart Valve Prosthesis ; Humans ; Mortality ; Prosthesis Implantation

OBJECTIVETo determine whether the prosthesis-patient mismatch has a deleterious impact on survival after mitral valve replacement.

DATA SOURCESA comprehensive literature search of PubMed, Embase, and ScienceDirect was carried out. References and cited papers of relevant articles were also checked.

STUDY SELECTIONAll articles published after January 1980 was initially considered. Non-English and non-human studies, case reports, and reviews were excluded from the initial search. References and cited papers of relevant articles were also checked.

RESULTSA total of 8 retrospective cohort studies were identified for this review. The overall incidence of prosthesis-patient mismatch (<1.3 to <1.2 cm(2)/m(2)) after mitral valve replacement ranged from 3.7% to 85.9% (moderate prosthesis-patient mismatch (0.9 to 1.2 cm(2)/m(2)) in 37.4% to 69.5%, severe prosthesis-patient mismatch (<0.9 cm(2)/m(2)) in 8.7% to 16.4%). Four studies demonstrated an association of prosthesis-patient mismatch with reduced long-term survival, but the other four studies found no significant deleterious impact of prosthesis-patient mismatch after mitral valve replacement. No definite conclusion could be derived from these conflicting results.

CONCLUSIONSCurrent evidence is insufficient to derive a definite conclusion whether mitral prosthesis-patient mismatch affects long-term survival because of the biases and confounding factors that interfere with late clinical outcomes. Goodquality prospective studies are warranted to evaluate the impact of mitral prosthesis-patient mismatch after mitral valve replacement in the future.

Heart Valve Prosthesis ; adverse effects ; Heart Valve Prosthesis Implantation ; mortality ; Humans ; Mitral Valve ; surgery

OBJECTIVETo summarize the clinical characteristics, surgical management and postoperative complications in patients with congenital bicuspid aortic valve (CBAV) over 50 years of age.

METHODSFrom January 2009 to September 2011, 73 CBAV patients aged 51-76 years (mean 61.8∓0.73 years) were treated in our center. Except for 1 patient who underwent Bentall surgery and another having Wheat surgery, all the patients received aortic valve replacement (AVR), including 7 with double (mitral and aortic) valve replacement (DVR), 6 with mitral valvular plasty, 11 with tricuspid valvular plasty, 8 with coronary artery bypass graft implantation, 1 with aortic-left ventricular tunnel repair, 1 with atrial maze ablation, and 1 with left atrial thrombosis removal.

RESULTSTwo patients died after the surgery, with a perioperative mortality rate of 2.7%. The cardiopulmonary bypass time was 78-217 min (mean 131.9 ∓6.0 min) with an aortic blocking time of 56-158 min (mean 88.2 ∓4.8 min) and total postoperative ICU time of 23.0-647.4 h (mean 97.9∓10.5 h). The postoperative complications included low heart output syndrome in 5 cases, bleeding in 4 cases, wound debridement in 4 cases, and hemodialysis due to acute renal failure in 1 case. The left ventricular end diastolic diameter reduced significantly after the surgery (52.6∓1.7 vs 43.2∓1.0, P=0.001). No significant changes were detected in the left ventricular ejection fraction (62.3∓2.5 vs 65.5∓1.3, P=0.257).

CONCLUSIONThorough preoperative examination, preoperative risk factor assessment, timely perioperative interventions, careful evaluation of patients' tolerance of surgery, and prevention of surgical complications are essential to decrease the perioperative mortality in elderly patients with CBAV.

Aged ; Aortic Valve ; abnormalities ; surgery ; Coronary Artery Bypass ; Female ; Heart Valve Diseases ; mortality ; surgery ; Heart Valve Prosthesis Implantation ; methods ; Humans ; Male ; Middle Aged ; Mitral Valve ; surgery ; Postoperative Complications ; prevention & control ; Retrospective Studies