Early Outcomes of Sutureless Aortic Valves

Muhammet Onur Hanedan, M.D.,İlker Mataracı, M.D.,Mehmet Ali Yürük, M.D.,Tanıl Özer, M.D.,Ufuk Sayar, M.D.,Ali Kemal Arslan, M.D.,Uğur Ziyrek, M.D.,Murat Yücel, M.D. 대한흉부외과학회 2016 Journal of Chest Surgery (J Chest Surg) Vol.49 No.3

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.

Early Clinical Experience with Sutureless Aortic Valve Replacement for Severe Aortic Stenosis

김도정,김효현,이신영,이삭,장병철 대한흉부외과학회 2018 Journal of Chest Surgery (J Chest Surg) Vol.51 No.1

Background: Sutureless aortic valve replacement (SU-AVR) has been developed as an alternative surgical treatment f or p atients with s ymptomatic s evere aortic stenosis ( AS). The aim o f this s tudy w as t o evaluate the clinical outcomes of SU-AVR through an assessment of hemodynamic performance and safety. Methods: From December 2014 to June 2016, a total of 12 consecutive patients with severe AS underwent SU-AVR. The endpoints were overall survival and valve-related complications (paravalvular leakage, valve thrombosis, migration, endocarditis, and permanent pacemaker implantation). The mean follow-up duration was 18.1±8.6 months. Results: The mean age of the patients was 77.1±5.8 years and their mean Society of Thoracic Surgeons score was 9.2±17.7. The mean cardiopulmonary bypass and aortic cross-clamp times were 94.5±37.3 minutes and 54.9±12.5 minutes, respectively. Follow-up echocardiography showed good prosthesis function with low transvalvular pressure gradients (mean, 13.9±8.6 mm Hg and peak, 27.2±15.0 mm Hg) at a mean of 9.9±4.2 months. No cases of primary paravalvular leakage, valve thrombosis, migration, or endocarditis were reported. A new permanent pacemaker was implanted in 1 patient (8.3%). The 1-year overall survival rate was 83.3%±10.8%. Conclusion: Our initial experience with SU-AVR demonstrated excellent early clinical outcomes with good hemodynamic results. However, there was a high incidence of permanent pacemaker implantation compared to the rate for conventional AVR, which is a problem that should be solved.

급성 뇌경색이 합병된 Haemophilus parainfluenzae 심내막염의 조기판막치환술 1례

강명호,임경리,김태석,김세현,김경현,오원섭,이길수 대한감염학회 2011 Infection and Chemotherapy Vol.43 No.3

Haemophilus parainfluenzae , one of the member of the HACEK group of gram-negative oropharyngeal species, is a rare cause of subacute native valve endocarditis. Infective endocarditis caused by H. parainfluenzae appears to carry a high incidence rate of cerebral embolism, often making the timing of surgical intervention difficult. A 52-year-old male was diagnosed with acute endocarditis caused by H. parainfluenzae complicated with acute cerebral infarctions. After institution of antibiotic therapy, this patient was mechanically ventilated because of the sudden onset of dyspnea. Repeated two-dimensional echocardiography demonstrated rate-dependent mitral stenosis without interval change of vegetations on the mitral valve. Making a decision regarding the timing of surgical intervention was difficult because of a fear of clinical deterioration after early valve replacement.

Transcatheter Aortic Valve Implantation in a Patient with Previous Mitral Valve Replacement

문성우,고영국,홍그루,이삭,장병철,심재광,곽영란,홍명기 대한심장학회 2014 Korean Circulation Journal Vol.44 No.5

Transcatheter aortic valve implantation (TAVI) has shown favorable outcomes in patients with severe symptomatic aortic valve stenosiswho are at high surgical risk or are unsuitable candidates for open heart surgery. However, concerns exist over treating patients who havepreviously undergone mitral valve surgery due to the potential interference between the mitral prosthetic valve or ring and the TAVI device. In this case report, we present a patient with symptomatic severe aortic stenosis and previous mechanical mitral valve replacement whowas successfully treated with TAVI using a CoreValve.

Effect of Patient-Prosthesis Mismatch in Aortic Position on Late-Onset Tricuspid Regurgitation and Clinical Outcomes after Double Valve Replacement

이승현,이삭,윤영남,장병철,주현철,유경종 연세대학교의과대학 2017 Yonsei medical journal Vol.58 No.5

Purpose: Significant late-onset tricuspid regurgitation (TR) is unfortunately common after double valve replacement (DVR); however, its underlying factors remain undefined. We evaluated the effect of aortic patient-prosthesis mismatch (PPM) on late-onset TR and clinical outcomes after DVR. Materials and Methods: Of the 2392 consecutive patients who underwent aortic valve replacement between January 1990 and May 2014 at our institution, we retrospectively studied 462 patients who underwent DVR (excluding concomitant tricuspid valvularannuloplasty or replacement). Survival and freedom from grade >3 TR were compared between PPM (n=152) and non-PPM (n=310) groups using the Kaplan-Meier method. Results: Although the overall survival rates were similar between the two groups at 5 and 10 years (95%, 91% vs. 96%, 93%, p=0.412), grade >3 TR-free survival was significantly lower in the PPM group (98%, 91% vs. 99%, 95%, p=0.014). Small body-surfacearea, atrial fibrillation, PPM, and subaortic pannus were risk factors for TR progression. However, aortic prosthesis size and trans-valvular pressure gradient were not significant factors for either TR progression or overall survival. Conclusion: Aortic PPM in DVR, regardless of mitral prosthesis size, was associated with late TR progression, but was not significantlycorrelated with overall survival. Therefore, we recommend careful echocardiographic follow-up for the early detection of TR progression in patients with aortic PPM in DVR.

Aortic Valve Replacement after Previous Coronary Artery Bypass Grafting with Patent Internal Mammary Artery

Jin, Moo-Nyun,Kim, Sun Wook,Kim, Young Ju,Kim, Hyun Ju,Lee, Jung-Hee,Hong, Myeong-Ki,Chang, Byung-Chul Ewha Womans University School of Medicine 2014 EMJ (Ewha medical journal) Vol.37 No.1

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.

Surgical Treatment of Degenerative Mitral Valve Regurgitation in the Elderly: Comparison of Early and Long-Term Outcomes Using Propensity Score Matching Analysis

이준석,김경환,최재웅,황호영,김기봉 대한흉부외과학회 2018 Journal of Chest Surgery (J Chest Surg) Vol.51 No.6

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.

Successful Treatment of Severe Aortic Stenosis With Transcatheter Aortic Valve Implantation in a Centenarian Patient

이용준,김영주,이중희,고영국,신상훈,홍그루,이삭,장병철,심재광,곽영란,홍명기 대한노인병학회 2014 Annals of geriatric medicine and research Vol.18 No.1

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.

The First Case of Successful Transcatheter Aortic Valve Implantation Using CoreValve in Korea

김인수,고영국,신상훈,심지영,이삭,장병철,심재광,곽영란,홍명기 대한심장학회 2012 Korean Circulation Journal Vol.42 No.11

Surgical replacement of the aortic valve is the standard therapy for severe aortic valve stenosis. However, it is generally associated with increased mortality and morbidities in older individuals. Transcatheter aortic valve implantation (TAVI) is a less invasive procedure and has shown similar clinical outcomes as surgical treatment in elderly patients at high risk for conventional surgery. In this report, we describe the first case of TAVI using a CoreValve in Korea. An 84-year-old man with symptomatic severe aortic valve stenosis was successfully treated by transfemoral TAVI. The patient was discharged without any significant complications and remained free of adverse clinical event for a follow-up duration of 6 months.

Successful emergency transcatheter aortic valve implantation

Jung-Hee Lee,Ah-Young Ji,Young Ju Kim,Changho Song,Moo-Nyun Jin,Sun Wook Kim,Myeong-Ki Hong,Geu-Ru Hong 영남대학교 의과대학 2014 Yeungnam University Journal of Medicine Vol.31 No.2

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.