To our knowledge, there have been no reports of right-sided infective endocarditis (RSIE) with ventricular free wall vegetation caused by Abiotrophia defectiva. We herein report a case of RSIE caused ...by A. defectiva with ventricular free wall vegetation in a 27-year-old man with ventricular septal defect (VSD). Computed tomography showed multiple bilateral pulmonary nodular shadows. Transesophageal echocardiography (TEE) demonstrated right ventricular free wall vegetation at the jet stream. Blood culture revealed A. defectiva. These findings are consistent with a diagnosis of infective endocarditis and septic pulmonary embolism. Treatment with ceftriaxone and gentamicin and subsequent surgical VSD closure improved the patient's condition without recurrence.
Background:This study retrospectively evaluated the long-term patient outcomes and durability of the Mosaic mitral porcine bioprosthesis in the Japan Mosaic valve long-term multicenter study.Methods ...and Results:The medical records of 390 patients who underwent mitral valve replacement with the Mosaic bioprosthesis at 10 centers in Japan (1999–2014) were reviewed. Patient data were collected using the Research Electronic Data Capture software. Patient survival was determined using the Kaplan-Meier method. Freedom from structural valve deterioration (SVD) and valve-related reoperation and death were determined using actuarial methods. The median (interquartile range IQR) age of the cohort was 73 (69–77) years. The median (IQR) follow-up period was 4.83 (1.84–8.26) years. The longest follow-up period was 15.8 years. The 30-day mortality rate was 5.4%. The 12-year actuarial survival rate was 54.1±4.5%, and the freedom from valve-related death was 85.3±3.4%. The freedom from reoperation at 12 years was 74.3±5.7%. The freedom from SVD at 12 years was 81.4±6.6% for patients aged ≥65 years and 71.6±11.1% for those aged <65 years. The median (IQR) mean pressure gradient was 4.1 (3.0–6.0) and 5.6 (4.0–6.7) mmHg at 1 and 10 years, respectively. The median (IQR) effective orifice area was 1.7 (1.4–2.0) and 1.4 (1.2–1.6) cm2at 1 and 10 years, respectively.Conclusions:The Mosaic porcine bioprosthesis offered satisfactory long-term outcomes for up to 12 years.
Purpose
The frozen elephant-trunk (FET) procedure is used widely in total aortic arch replacement (TAR) surgery; however, its safety, effectiveness, and long-term outcomes compared with those of the ...conventional elephant trunk (cET) procedure for degenerative aneurysms are unclear.
Methods
Between July, 2011 and August, 2019, 126 patients underwent elective total aortic arch replacement at our institution. We compared the short- and mid-term outcomes of 60 patients who underwent the FET procedure (FET group) with those of 66 patients who underwent cET (cET group).
Results
The in-hospital mortality rate tended to be lower in the FET group than in the cET group (
p
= 0.12). There were two cases of paraplegia (3.3%) in the FET group and in none in the cET group. The all-cause mortality at the 3-year follow-up did not differ significantly between the groups (
p
= 0.31). The FET group required more unexpected interventions at the surgical site in the mid-term period.
Conclusions
FET was associated with a shorter operative time and lower surgical mortality than cET. Although the mid-term total aortic arch replacement outcomes of FET were acceptable, careful imaging observation is necessary because reinterventions were required more frequently.
Purpose: Isolated tricuspid valve surgery (TVS) following valvular surgery has been still challenging. We reviewed our experience to determine early and late outcomes.Methods: We retrospectively ...analyzed 14 patients (mean age, 57.0 ± 17.8 years old) who underwent isolated TVS after valvular surgery between January 1990 and December 2010. The causes of isolated TVS were structural valve deterioration (SVD) (n = 5) and symptomatic severe tricuspid regurgitation (n = 9). The mean follow-up period was 6.4 ± 5.9 years.Results: At redo, seven patients underwent tricuspid valve replacement (TVR) using a bioprosthesis and the remaining underwent tricuspid valve repair (TVP). Early mortality rate was 7.1% (1/14). Survival rates at 5 and 10 years were 68.8% ± 13.1% and 68.8% ± 13.1%, respectively. Three deaths (two for heart failure and one for cerebral hemorrhage) were observed. Freedom from valve-related events was 58.3% ± 14.2% at 2 and 48.6% ± 14.8% at 5 years. Six events were observed (five for heart failure and one for cerebral hemorrhage). There was no statistically significant difference between TVP and TVR as to freedom from valve-related events (log-rank p = 0.3655).Conclusions: Early and late outcomes of isolated TVS after valvular surgery seem to be satisfactory. Special attention should be paid to heart failure following TVP.
In 2011, the Japanese Registry of Acute Aortic Dissection (JRAD) was started in accordance with the model of the International Registration of Acute Aortic Dissection. The aim of this study was to ...report actual clinical early and midterm outcomes of treatment for acute type A aortic dissection in Japan.
Between 2011 and 2016, 1217 patients (67.9 years-old, 584 male, 241 >80 years old) who had acute type A aortic dissection within 14 days after the onset of symptoms were enrolled.
Among 75% patients managed surgically, 68% underwent surgical procedure with cardiopulmonary bypass. Surgery was not indicated in 25% patients. Overall, 12% died in the hospital, 10.8% after surgical treatment and 16.6% after medical treatment. Multivariable analysis of in-hospital mortality revealed the following risk factors: age older than 80 years (odds ratio, 2.37; P < .01); shock vital status on arrival (odds ratio, 1.89; P = .01); disturbance of consciousness, including coma (odds ratio, 3.32; P < .01); and cardiac arrest, for which resuscitation was needed on arrival (odds ratio, 4.86; P < .01).
JRAD data revealed the actual clinical setting for the treatment of acute type A dissection in Japan. Early surgical results were favorable, with a low in-hospital morality rate, and midterm outcomes in selected medically treated patients were equivalent. Preoperative severe conditions, including shock, need for preoperative cardiopulmonary resuscitation, and disturbance of consciousness, as well as advanced age, were risk factors for in-hospital mortality even though the referral interval was brief.
Background:The long-term outcomes of mitral valve (MV) repair for active infective endocarditis (AE) are not well known, so the present study examined results from >5 years.Methods and Results:We ...retrospectively reviewed 43 patients who underwent primary MV repair for AE at a single center between 1991 and 2009. Patients’ mean age was 50.9 years, and 39% were female. The mean follow-up was 7.4 years, and 90.7% of the patients had serial echocardiographic studies over the years. We examined the data for mortality, mitral reoperation, and recurrent significant mitral regurgitation (MR). There were no early deaths but 6 late deaths. Survival was 92.6±4.1% for 5 years, and 83.5±7.3% for 10 years. The respective 5- and 10-year rates of freedom from MV reoperation were 90.5±4.5% and 86.6±5.8%, and for freedom from moderate or severe MR were 95.0±3.5 and 86.1±6.7%. Recurrence of endocarditis was observed in 2 patients (4.7%). Most (86%) of the survivors were in New York Heart Association class I.Conclusions:MV repair for AE is durable and offers acceptable long-term outcomes with low rates of recurrence and reoperation. (Circ J 2016; 80: 1148–1152)
Background:This study retrospectively evaluated the long-term patient outcomes and durability of the Mosaic aortic porcine bioprosthesis in the Japan Mosaic valve long-term multicenter study.Methods ...and Results:We reviewed the records of 1,202 patients who underwent aortic valve replacement with the Mosaic bioprosthesis at 10 centers in Japan (1999–2014). Patient data were collected using Research Electronic Data Capture. Patient survival was determined by Kaplan-Meier methodology. Freedom from structural valve deterioration (SVD) and valve-related reoperation and death were determined by actuarial methods. The median (interquartile range IQR) age of the cohort was 76 (70–80) years. The median (IQR) follow-up period was 3.52 (1.71–5.35) years. The longest follow-up was 15.8 years. The 30-day mortality rate was 2.3%. The 12-year actuarial survival rate was 59.9±7.5%, and the freedom from valve-related death was 81.1±7.9%. The freedom from reoperation was 86.4±2.6% at 12 years. The freedom from SVD at 12 years was 93.5±2.9% for patients aged ≥65 years and 98.2±1.8% for those aged <65 years. The median (IQR) systolic pressure gradient was 17 (12–23) and 19 (12–25) mmHg at 1 and 10 years, respectively. The median (IQR) effective orifice area was 1.2 (1.1–1.5) and 1.1 (1–1.5) cm2at 1 and 10 years, respectively.Conclusions:The Mosaic porcine bioprosthesis showed satisfactory long-term outcomes over 12 years.
Abstract
Background
Several studies have reported high rates of structural valve deterioration (SVD) in the Trifecta valves. Herein, we analyzed the midterm results of the Trifecta valve and risk ...factors for early SVD.
Methods
We retrospectively reviewed the records of 110 patients who had undergone Trifecta implantation between January 2012 and December 2017.
Results
We encountered seven cases of Trifecta valve failure. We performed a redo aortic valve replacement in five patients and a transcatheter aortic valve replacement in two patients. The SVD rate was 4.8% at 5 years and 6.6% at 7 years. The mean pressure gradient and peak velocity on the first postoperative echocardiogram in patients with SVD were higher than those in patients without SVD. The SVD rates with and without patient-prosthesis mismatch (PPM) were 2.8% and 12.6% at 5 years and 2.8% and 20.0% at 7 years. PPM is a risk factor for SVD. Noncoronary cusp tears were observed in all patients who had undergone redo surgery.
Conclusions
The most common cause of SVD was noncoronary cusp tear. Patients with PPM are at high risk of developing SVD.
Objectives
Surgery for acute type A aortic dissection with mesenteric malperfusion is challenging. Although the peripheral-reperfusion-first strategy has shown good results, more discussion regarding ...indicated patients is needed. This study aimed to describe the imaging features and surgical outcomes of mesenteric malperfusion and to clarify which cases should be considered for the peripheral-reperfusion-first strategy.
Methods
A total of 200 patients underwent emergent aortic repair for acute type A aortic dissection at our institution between October 2011 and July 2019. Superior mesenteric artery occlusion on preoperative contrast-enhanced computed tomography was detected in 12 patients, who were categorized into two groups based on enhancement (
n
= 7) or non-enhancement (
n
= 5) of the superior mesenteric artery peripheral branches. Operative outcomes after central repair were compared between groups.
Results
Four patients in the enhanced group had no postoperative abdominal complications, and three patients required superior mesenteric artery bypass grafting with the central-repair-first strategy. However, all patients in the enhanced group survived and did not require intestinal resection. In contrast, four patients (80%) in the non-enhanced group had intestinal necrosis, three patients required intestinal resection, and one patient died from multiple organ failure.
Conclusion
The presence or absence of an enhancement of the peripheral superior mesenteric artery by the collateral network could be helpful for decision-making. The central-repair-first strategy may be permitted in patients with enhanced peripheral branches. Conversely, in patients with non-enhanced peripheral branches, a more invasive assessment should be considered before central aortic repair, and peripheral-reperfusion-first strategy may be required.
Abstract
Using existing prognostic models, including the Graded Prognostic Assessment (GPA), it is difficult to identify patients with brain metastases (BMs) who are not likely to survive 2 months ...after whole-brain radiotherapy (WBRT). The purpose of this study was to identify a subgroup of patients who would not benefit clinically from WBRT. We retrospectively reviewed the records of 111 patients with BMs who were ineligible for surgery or stereotactic irradiation and who underwent WBRT between March 2013 and April 2016. Most patients were scheduled to receive a total dose of 30 Gy in 10 fractions. Non–small cell lung cancer represented the most common primary cancer type (67%), followed by breast cancer (12%). Median survival time (MST) was 109 days (range, 4–883). Univariate analysis identified five factors significantly associated with poor prognosis: performance status (PS) 2–4, perilesional edema, elevated serum lactate dehydrogenase (LDH), using steroids during WBRT, and presence of hepatic metastases. Multivariate analysis confirmed elevated LDH (>300 IU/l) as an independent predictor. MST for LDH >300 IU/l (n = 30) and LDH ≤300 IU/L (n = 87) cohorts were 47 days and 148 days, respectively (P < 0.001). MSTs for GPA 0–1 patients (n = 85) with and without elevated LDH were 37 days and 123 days, respectively (P < 0.001). More than half of the patients with GPA 0–1 and elevated LDH died within two months. Adding elevated LDH to the GPA will permit identification of patients with BMs who have extremely unfavorable prognoses.
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