Long-Term Outcomes of Patients With Mediastinal Radiation-Associated Severe Aortic Stenosis and Subsequent Surgical Aortic Valve Replacement: A Matched Cohort Study Valvular Heart Disease

BackgroundCardiac disease after mediastinal radiotherapy for thoracic malignancy (chest radiotherapy [XRT]) often manifests as progressive aortic stenosis. In patients with XRT‐induced severe aortic stenosis undergoing surgical aortic valve replacement (SAVR), we sought to: (1) study long‐term survival and compare these patients with a matched cohort undergoing SAVR during the same time frame; and (2) identify potential predictors of long‐term mortality.Methods and ResultsWe studied patients with symptomatic severe aortic stenosis undergoing SAVR at our institution, of which there were 172 mediastinal XRT patients (63±13 years, 62% women) matched in a 1:1 fashion (based on age, sex, time of surgery, and aortic valve area) with 172 non‐XRT patients (comparison group). Baseline clinical and postoperative data were obtained. Society of Thoracic Surgeons score was calculated and mortality was recorded. In the XRT group, the median Society of Thoracic Surgeons score was 4% (interquartile range 2–13), while mean left ventricular ejection fraction, left ventricular stroke volume index, and mean aortic valve gradient were 54±11%, 38±14 mL/m2, and 39±11 mm Hg, respectively. In the entire cohort, 27% and 34% of patients underwent concomitant coronary artery bypass grafting and aortic surgery at the time of SAVR, respectively. Thirty‐day/in‐hospital deaths occurred in 4 (2%) patients in the XRT group and 0 patients in the...
Source: JAHA:Journal of the American Heart Association - Category: Cardiology Authors: Tags: Valvular Heart Disease Original Research Source Type: research

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Conclusion Among patients with severe degenerative aortic stenosis, vitamin D deficiency is common. We found a significant association between left ventricular wall thickness and vitamin D levels, suggesting a potential role of this hormone in modulating hypertrophic remodelling in these patients. However, future larger studies are certainly needed to confirm our findings and to define their prognostic implications.
Source: Journal of Cardiovascular Medicine - Category: Cardiology Tags: Research articles: Valvular heart disease Source Type: research
Discussion Congenital heart diseases (CHD) are malformations of the heart and great vessels. It occurs in about 5-8/1000 live births. Cyanotic congenital heart disease is often noted perinatally because of cyanosis, respiratory distress and/or poor feeding or other distress type problems. A review can be found here. Acyanotic congenital heart disease (ACHD) can present at birth but often is seen in older children or adults unless the lesions are severe, especially obstructive lesions. Severe lesions may also cause cyanosis and distress type problems in patients also. Shunting lesions cause problems by diverting blood flo...
Source: PediatricEducation.org - Category: Pediatrics Authors: Tags: Uncategorized Source Type: news
AbstractLipoprotein(a) (Lp(a)) is a highly proatherogenic lipid fraction that is genetically determined and minimally responsive to lifestyle or behavior changes. Mendelian randomization studies have suggested a causal link between elevated Lp(a) and heart disease, stroke, and aortic stenosis. There is substantial inter-ethnic variation in Lp(a) levels, with persons of African descent having the highest median values. Monitoring of Lp(a) has historically been limited by lack of standardization of assays. With the advent of novel therapeutic modalities to lower Lp(a) levels including proprotein convertase subtilisin/kexin 9...
Source: Cardiology and Therapy - Category: Cardiology Source Type: research
Publication date: Available online 21 November 2019Source: Canadian Journal of CardiologyAuthor(s): Gabriele Crimi, Claudio Montalto, Luca Angelo Ferri, Luigi Piatti, Irene Bossi, Nuccia Morici, Alessandro Mandurino-Mirizzi, Daniele Grosseto, Giovanni Tortorella, Stefano Savonitto, Stefano De Servi, Elderly-ACS 2 InvestigatorsABSTRACTBackgroundElderlies are underrepresented in clinical trials and registries and a gap of evidence exists for clinical decision making in the setting of acute coronary syndromes (ACS). We aimed to assess the prevalence and independent prognostic impact of valvular heart disease (VHD) diagnosed d...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research
AbstractBackgroundUntreated symptomatic high-grade aortic stenosis remains a lethal disease requiring individually adapted valve replacement. High-risk surgical patients benefit from transcatheter aortic valve replacement (TAVR), but there is no uniform standard for patient selection and valve sizing and it is still unclear whether transthoracic (TTE) or transesophageal (TEE) echocardiography is superior in preprocedural aortic annulus sizing. As preprocedural sizing of the native aortic annulus diameter is crucial to outcome and survival, we report the results of a direct comparison between preprocedural sizing with TTE a...
Source: Journal of Echocardiography - Category: Cardiology Source Type: research
Abstract Valvular heart diseases are one of the most frequent causes for heart failure. Degenerative diseases of the aortic and mitral valve as well as a dysfunctional tricuspid valve disease result in a worse clinical outcome if severe. Minimal-invasive, surgical and/or catheter-based structural heart disease (SHD) interventions have recently seen a dramatic increase. Transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) is a disruptive technology, and next generation devices and careful patient selection will minimize limitations of TAVI such as paravalvular leak, conductance disturbance...
Source: Journal of Cardiology - Category: Cardiology Authors: Tags: J Cardiol Source Type: research
Purpose of review Transcatheter aortic valve replacement (TAVR) has become the cornerstone for aortic valve intervention since the first implantation in 2002. Recent advances with novel devices and introduction into lower risk cohorts have been successful. In this review, we discuss the ongoing limitations to transcatheter aortic valve therapy and whether it will replace surgical aortic valve replacement in the foreseeable future. Recent findings A better understanding of valve durability, high-grade heart block, and stroke post TAVR has led to practice changes that improve patient outcome. Summary Although there h...
Source: Current Opinion in Cardiology - Category: Cardiology Tags: VALVULAR HEART DISEASE: Edited by Subodh Verma and Bobby Yanagawa Source Type: research
This study investigated the relationship between VO2, SVi and AS severity in patients with AS to examine the association between reduced VO2 and PLFLPG AS. In 59 patients (24 men, mean age 78±7 years) with severe AS, SVi, AS severity and type were evaluated by echocardiography, and VO2 was measured by the fraction of O2 in expired gases. The SVi and VO2 were significantly decreased in 20 patients with PLFLPG AS compared to those in 39 patients with non-PLFLPG AS (30±4 vs 41±7 ml/m2 and 2.4±0.5 vs 3.0±0.5 ml/min/kg, p
Source: American Journal of Physiology. Heart and Circulatory Physiology - Category: Physiology Authors: Tags: Am J Physiol Heart Circ Physiol Source Type: research
BOSTON (CBS) – There aren’t many people who run their age in miles every year. Dave McGillivray does. From the time he was a boy, he’s celebrated his good health and love of running with a personal challenge that obviously gets more challenging with age. His last “full” birthday run was last year: 63 miles. This year, by necessity, he split the effort into 32 miles of running and 32 miles of biking. A feat, to be sure. But this year, he is facing a challenge for which there is no training. McGillivray, arguably one of the most fit people on the planet, has coronary artery disease and is prepa...
Source: WBZ-TV - Breaking News, Weather and Sports for Boston, Worcester and New Hampshire - Category: Consumer Health News Authors: Tags: Boston News Health Seen On WBZ-TV Syndicated Local Watch Listen Dave McGillivray Lisa Hughes Mass General Hospital Source Type: news
ConclusionsECMO can be used as a bridge to heart valve or septal defect surgery in severely decompensated patients. Through recovery of end-organ function, ECMO may allow surgical correction of structural heart disease in patients considered inoperable or convert a salvage situation to an elective operation.
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
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