Transcaval Valve-in-Valve-in-Valve Aortic Valve Replacement for Bioprosthetic Valve Degeneration
A 74-year-old man presented with progressive dyspnea on exertion. History included peripheral arterial disease and coronary artery bypass grafting with aortic valve replacement 12 years ago. Subsequently, the surgical valve developed severe stenosis and moderate insufficiency. He underwent a transapical valve-in-valve transcatheter aortic valve replacement 5 years before presentation. This second valve developed a mean gradient of 66 mm Hg with mild insufficiency. The patient was treated with a third aortic valve using an alternative transcaval approach, significantly alleviating his symptoms.
Authors: Dickinson TA, Wu X, Sturmer DL, Goldberg J, Fitzgerald DC, Paone G, Likosky DS, on Behalf of the PERForm Registry and the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative Abstract Hemodilutional anemia has been cited as a contributing factor to red blood cell (RBC) transfusions in cardiac surgery patients. Accordingly, efforts have been made to minimize hemodilution by reducing cardiopulmonary bypass (CPB) prime volume. We sought to assess the impact of these efforts on intraoperative RBC transfusions. We evaluated 21,360 patients undergoing coronary artery bypass with or with...
ConclusionsIn our propensity score-matched analysis on 2720 patients undergoing elective isolated aortic valve replacement or combined aortic valve replacement and coronary artery bypass grafting, time of day variation had no significant impact on clinical outcomes. Thus, our study refutes the need for taking timing of elective aortic valve surgery into consideration to improve clinical outcomes.Graphical abstract
CONCLUSIONS: In our propensity score-matched analysis on 2720 patients undergoing elective isolated aortic valve replacement or combined aortic valve replacement and coronary artery bypass grafting, time of day variation had no significant impact on clinical outcomes. Thus, our study refutes the need for taking timing of elective aortic valve surgery into consideration to improve clinical outcomes. PMID: 31926160 [PubMed - as supplied by publisher]
ConclusionImage intensification may decrease malposition rates and mechanical complications associated with difficult central venous catheterisation. Further research comparing the safety and efficiency of ultrasound-guided and fluoroscopy-guided CVC insertion should be contemplated.
CONCLUSION: The high PH probability as evaluated by the ESC PH echocardiographic probability model, is associated with increased short- and mid-term mortality and morbidity and reduced right ventricular systolic function after cardiac surgery, Thus, additional echocardiographic parameters assessing PH probability are valuable tools to stratify risk in patients undergoing cardiac surgery. PMID: 31904543 [PubMed - as supplied by publisher]
Coronary artery disease is a common comorbidity of aortic stenosis. When needed, adding coronary artery bypass grafting (CABG) to surgical aortic valve replacement (SAVR) is the standard treatment method, but the impact of concomitant CABG on long-term outcomes is uncertain. We compared long-term outcomes of SAVR patients with and without CABG. Hospital survivors aged ≥50 years discharged after SAVR ± CABG in Finland between 2004-2014 (n=6870) were retrospectively studied using nationwide registries.
We examined the impact of AM vs. PM operative time on surgical outcomes of CABG and AVR in a diverse, multi-institutional cardiac surgery network between January 2008 and September 2018.
ConclusionsThe risk estimation model is a useful tool to identify the patients at risk and to create patient risk groups for postoperative AKI defined by KDIGO after heart valve replacement surgery.
CONCLUSION: Baseline characteristics and epidemiology were different between MUV and single-valve procedures. The in-hospital mortality and postoperative complications for MUV procedures remained considerably higher and determinants of mortality were relatively different across procedures types. These findings serve as a benchmark for further studies, as well as suggest a continued search for explanations of MUV outcomes. PMID: 31895035 [PubMed - in process]
ConclusionsDespite a trend towards higher risk of MR recurrence, patients undergoing MVr have similar rates of survival and mitral valve reoperation, with lower rates of readmission at 5 ‐years. This, combined with lower operative mortality rates, makes MVr a reasonable choice particularly in sicker patients with higher operative risk and more limited life expectancy.