We present a case of spontaneous fracture and embolization of the distal part of a cannula into the left inferior lobar artery. The embolized fragment was captured with an angioplasty balloon and ...extracted through the right atrium appendage. No adverse event related to the embolization was observed and the patient was discharged with no sequelae.
Background
This study aims to determine the incidence and causes of structural valve deterioration (SVD) among all models of Mitroflow bioprostheses (A12/LX/DL), as well as to define their long‐term ...clinical and hemodynamic performance.
Methods and Results
We retrospectively reviewed a series of 1023 patients who underwent aortic valve replacement with Mitroflow bioprostheses between 2001 and 2014. A small aortic root was found in 22.4% of patients. There were two cases of severe patient‐prosthesis mismatch. Only 31 patients developed SVD. The rate of incidence was 8.1 cases per 1000 patient‐years. Cumulative incidence of SVD was 1.4% and 3% at five and 10 years, respectively. Freedom from SVD was 97.4% and 88.2% at five and 10 years, respectively. Anticalcification phospholipid reduction treatment (PRT) for model DL was a protective factor for SVD. Multivariable analysis confirmed age <70 years and use of 19 mm valve as independent predictors of SVD. Cumulative survival was 76.6% at five years and 42.3% at 10 years (mean follow‐up 3.8 ± 3.1 years). In multivariable analysis, neither the use of small aortic prosthesis (p = 0.18) nor the occurrence of SVD (p = 0.85) was found to be independent predictors of long‐term survival.
Conclusions
Mitroflow valves demonstrate an acceptable rate of SVD and satisfactory long‐term hemodynamic performance, particularly in patients with small aortic roots, age >70 years, and cases with severe left ventricular hypertrophy. PRT might contribute to improved long‐term durability. doi: 10.1111/jocs.12726 (J Card Surg 2016;31:264–273)
The main objective was to analyse the impact of the modification of the Perceval S implantation technique on the prevalence of postoperative atrioventricular block, which requires a permanent ...pacemaker, in our aortic valve replacement series. In addition, we attempted to identify those risk factors that are related to the appearance of this complication.
Five hundred and seventy-two valve replacements were carried out with PERCEVAL S in our centre up to July 2018. Use of modified technique (n=302). Minimally invasive approach (n=340). Associated coronary surgery (n=95). Patients with pacemakers prior to surgery (n=27) and associated mitral or tricuspid valve surgery (n=26) were excluded. We analysed variables of interest that could influence the increase in postoperative atrioventricular block. Technique performed, disorders of intraventricular conduction and pre/intraoperative characteristics. The influence of the modified technique was analysed.
Five hundred and nineteen aortic valve replacements with PERCEVAL S. Age (years) (median 77, interquartile range 8). Height (cm) (159, 13.5). Euroscore II (%) (2.25, 2.27). Postoperative atrioventricular block standard technique (n=23, 10.14%). Modified technique (n=14, 4.30%) (P=0.009). Multivariate regression analysis. Final model AUC =0.740, maximum model AUC =0.774 (P>0.05). Includes: Technique used (P=0.024), height (P=0.043) and disorders of interventricular conduction, right bundle branch block (P=0.005), trifascicular block (P=0.008).
In our experience, the modified technique significantly decreases the incidence of postoperative atrioventricular block that requires a permanent pacemaker in the aortic valve replacement with PERCEVAL S. The prior electrocardiographic presence of right bundle branch block, trifascicular block and the height of the patient are associated with an increased risk of blocking.
The CarboMedics supra-annular Top Hat valve improves long-term left ventricular mass regression Mosquera, Victor X., MD, PhD; Bouzas-Mosquera, Alberto, MD, PhD; Bautista-Hernandez, Victor, MD, PhD ...
Journal of thoracic and cardiovascular surgery/The Journal of thoracic and cardiovascular surgery/The journal of thoracic and cardiovascular surgery,
12/2014, Letnik:
148, Številka:
6
Journal Article
Recenzirano
Odprti dostop
Objective The present study aimed to identify potential differences in hemodynamic performance between the supra-annular CarboMedics Top Hat valve and the intra-annular CarboMedics standard valve in ...terms of the long-term left ventricular mass reduction and transvalvular gradients. Methods We retrospectively reviewed a series of 186 consecutive patients who had undergone aortic valve replacement with a small size mechanical prosthesis at our institution from 2003 to 2013, receiving either a CarboMedics Top Hat valve (53 patients, valve size, 21 mm in 52.8% and 23 mm in 47.2%) or a CarboMedics standard prosthesis (133 patients, valve size, 19 mm in 14.3% and 21 mm in 85.7%). Results The in-hospital mortality was 9.4% and 11.3% in the Top Hat and standard groups, respectively ( P = .71). The mean percentage of left ventricular mass reduction was greater in the Top Hat group (33% ± 15.8% vs 20.1% ± 16.6%, P < .001). The mean postoperative peak aortic gradient was lower in the Top Hat group (19.9 ± 8.9 vs 29.6 ± 8.6 mm Hg; P < .001). Spearman analysis showed a positive correlation between the indexed effective orifice area and the percentage of left ventricular mass reduction (Rho = +0.65, P = .02). The survival in the Top Hat group was 79.7% and 71.7% at 5 and 10 years, respectively. In the standard group, survival was 66.8% and 61.5% at 5 and 10 years, respectively (log-rank test, 0.19). Cox regression demonstrated severe myocardial hypertrophy (hazard ratio, 2.559; 95% confidence interval, 1.095-5.981) as one of the independent predictors of survival. Conclusions The Top Hat valve surpasses hemodynamically the intra-annular valve. We suggest the supra-annular Top Hat prosthesis can be especially recommended for patients with a small aortic root and severe myocardial hypertrophy.
Abstract Introduction and Objectives Circulating galectin-3 (Gal-3) is elevated and significantly correlates with all-cause and cardiovascular mortality in patients with heart failure. However, the ...relationship between serum Gal-3 and heart transplant (HT) outcomes is unclear. The aim of this study was to describe the longitudinal trend and prognostic value of Gal-3 levels after HT. Methods Banked serum samples were available from 122 HT recipients, collected before transplant and at 1, 3, 6, and 12 months posttransplant. Gal-3 levels in these serum samples were measured by enzyme immune assay. Multivariable Cox regression was performed to determine the prognostic value of 12-month posttransplant Gal-3 serum levels. The primary endpoint was the composite variable all-cause death or graft failure over long-term posttransplant follow-up. Results Circulating Gal-3 concentration steadily decreased during the first year after HT (median values: pretransplant, 19.1 ng/mL; 1-year posttransplant, 14.6 ng/mL; P < .001). Circulating Gal-3 levels 1-year posttransplant were associated with an increased risk of all-cause death or graft failure (adjusted HR per 1 ng/mL, 1.04; 95%CI, 1.01-1.08; P = .008). The predictive accuracy of this biomarker was moderate (area under the receiver-operator curve 0.72 (95%CI, 0.60-0.82; P < .001). Conclusions Circulating Gal-3 steadily decreased during the first year after HT. However, 1-year posttransplant Gal-3 serum levels that remained elevated were associated with increased long-term risk of death and graft failure.
Resumen Introducción y objetivos La insuficiencia mitral (IM) isquémica crónica es una patología frecuente y compleja, consecuencia del remodelado ventricular y anular mitral asimétrico que acontece ...tras el infarto de miocardio. El anillo protésico Carpentier-McCarthy-Adams IMR ETlogix® (Edwards Lifesciences Corporation) actúa específicamente sobre esta deformación geométrica. Analizamos nuestros resultados tras 10 años realizando esta técnica. Métodos Noventa pacientes con IM isquémica crónica grado ≥ 2 fueron sometidos consecutivamente a anuloplastia mitral con anillo IMR ETlogix® desde 2005 hasta 2015; 75 (83,3%) presentaban clase funcional NYHA III-IV. Sesenta y seis (73,3%) fueron intervenidos con carácter urgente. En 73 (81,1%) asociamos otro procedimiento cardíaco. Obtuvimos seguimiento clínico y ecocardiográfico periódico de todos los pacientes que superaron la cirugía. Resultados Mediana de seguimiento 62 meses (12-129). Mortalidad hospitalaria de 1 paciente (1,1%); 16 pacientes fallecidos en el seguimiento (7 de causa cardíaca). El ecocardiograma de control tardío objetivó recidiva significativa (IM grado ≥ 2) en 6 pacientes (2 de ellos IM grado > 2), con una reintervención por dehiscencia anular. No hubo incremento significativo en el gradiente medio transmitral. El análisis univariado objetivó la altura de tenting preoperatoria como mejor predictor de recidiva de la IM en nuestra serie, con un punto de corte en 10,65 mm (sensibilidad 100%, especificidad 93%, área bajo la curva ROC 0,97). Conclusiones La anuloplastia con anillo IMR ETlogix® es una técnica segura y eficaz para corregir la IM isquémica crónica, fundamentalmente en pacientes con una altura de tenting preoperatoria inferior a 10,65 mm.
El recambio valvular aórtico con prótesis sin sutura PercevalS se asocia a un aumento en la tasa de bloqueo auriculoventricular postoperatorio que precisa implante de marcapasos definitivo, comparado ...con las bioprótesis convencionales. En nuestra serie hemos modificado la técnica de implante (mínimo baloneo <5 segundos, decalcificación anular rigurosa, avance de prótesis plegada al tracto de salida del ventrículo izquierdo y reposicionamiento mediante tracción de puntos guía).
Analizar el impacto de la modificación de la técnica de implante de Perceval en el número de bloqueo auriculoventricular postoperatorio que precisa implante de marcapasos definitivo.
De 438 pacientes sometidos a recambio valvular aórtico con prótesis Perceval, se excluyeron los correspondientes a la fase inicial del programa (6meses, n=14), cirugía concomitante mitral (n=18) o tricuspídea (n=11) y portadores de marcapasos prequirúrgico (n=11). Se establecieron dos grupos de comparación: grupo estándar (octubre 2013-noviembre 2016, n=209) con técnica de implante estándar, y grupo modificado (diciembre 2016-noviembre 2017, n=184) con técnica de implante modificada. Se analizaron las tasas de implante de marcapasos definitivo (6meses de seguimiento) y variables de interés entre grupos.
Tasa implante de marcapasos definitivo grupo estándar y modificado: 10,05% vs. 4,35%, p=0,031, respectivamente. Edad (años) grupo estándar y modificado: media 78,15±0,34 vs. media 74,90±0,47, p<0,01, respectivamente. EuroscoreII grupo estándar y modificado: media 3,76±0,24 vs. media 3,00±0,25, p=0,03, respectivamente. No existieron otras diferencias significativas entre variables de interés.
La modificación de la técnica de implante de Perceval se ha asociado a una reducción estadísticamente significativa de la tasa de bloqueo auriculoventricular postoperatorio que precisa implante de marcapasos definitivo.
Aortic valve replacement with sutureless prosthesis PercevalS is associated with an increase in the rate of postoperative atrioventricular block that requires permanent pacemaker implantation compared to conventional bioprostheses. In our series, we modified the implant technique (minimum ballooning <5seconds, rigorous annular decalcification, advancement of the folded prosthesis to the left ventricle outflow tract and repositioning by traction of guide sutures).
To analyze the impact of the modification in the Perceval implant technique on the postoperative atrioventricular block rate which requires permanent pacemaker implantation.
438 patients underwent aortic valve replacement with Perceval prosthesis, excluding those corresponding to the initial phase of the program (6months, n=14), concomitant mitral surgery (n=18) or tricuspid (n=11) and pre-surgical pacemaker carriers (n=11). Two comparison groups were established; standard group (October 2013-November 2016, n=209) with standard implant technique. Modified group (December 2016-November 2017, n=184) with modified implant technique. We analyzed permanent pacemaker implantation rates (6months follow-up) and variables of interest between groups.
Implantation rate of permanent pacemaker, standard and modified group (10.05% vs. 4.35%, P=.031, respectively). Age, standard and modified group (mean 78.15±0.34 vs. mean 74.90±0.47, P<.01, respectively). EuroscoreII, standard and modified group (mean 3.76±0.24 vs. mean 3.00±0.25, P=.03, respectively). There were no other significant differences between variables of interest.
Modification of the Perceval implant technique has been associated with a statistically significant reduction in the postoperative atrioventricular block rate requiring implantation of permanent pacemaker.
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