RESUMEN
INTRODUCTION: The pre-operative planning and intra-operative navigation of the endovascular aneurysm repair (EVAR) procedure are currently challenged by the aortic deformations that occur due to the insertion of a stiff guidewire. Hence, a fast and accurate predictive tool may help clinicians in the decision-making process and during surgical navigation, potentially reducing the radiations and contrast dose. To this aim, we generated a reduced order model (ROM) trained on parametric finite element simulations of the aortic wall-guidewire interaction. METHOD: A Design of Experiments (DOE) consisting of 300 scenarios was created spanning over seven parameters. Radial basis functions were used to achieve a morphological parametrization of the aortic geometry. The ROM was built using 200 scenarios for training and the remaining 100 for validation. RESULTS: The developed ROM estimated the displacement of aortic nodes with a relative error below 5.5% for all the considered validation cases. From a preliminary analysis, the aortic elasticity, the stiffness of the guidewire and the tortuosity of the cannulated iliac artery proved to be the most influential parameters. CONCLUSIONS: Once built, the ROM provided almost real-time and accurate estimations of the guidewire-induced aortic displacement field, thus potentially being a promising pre- and intra-operative tool for clinicians.
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Procedimientos Endovasculares , Análisis de Elementos Finitos , Cirugía Asistida por Computador , Procedimientos Endovasculares/instrumentación , Cirugía Asistida por Computador/métodos , Humanos , Aorta/cirugía , Periodo IntraoperatorioRESUMEN
BACKGROUND (RATIONALE/PURPOSE/OBJECTIVE): Resuscitative endovascular balloon occlusion of the aorta (REBOA) is used to temporary control non-compressible truncal hemorrhage (NCTH) as bridge to definitive surgical treatment. The dependence on radiography for safe balloon positioning is one factor that limits the extended use of REBOA in civilian and military pre-hospital settings. We aimed to determine standardized sex and age-based variable-distance catheter insertion lengths for accurate REBOA placement without initial fluoroscopic confirmation. METHODS: Contrast enhanced CT-scans from a representative sample of a Dutch non-trauma population were retrospectively analyzed. Intravascular distances were measured from the bilateral common femoral artery access points (FAAP) to the middle of the aortic occlusion zones and accompanying boundaries. Means and 95% confidence intervals for the distances from the FAAPs to the boundaries and mid-zone III were calculated for all (combined) sex and age-based subgroups. Optimal insertion lengths and potentially safe regions were determined for these groups. Bootstrap analysis was performed in combination with a 40-mm long balloon introduction simulation to determine error-rates and REBOA placement accuracy for the general population. RESULTS: In total, 1354 non-trauma patients (694 females) were included. Vascular distances increased with age and were longer in males. The iliofemoral trajectory was 7 mm longer on the right side. The optimal zone I catheter insertion length would be 430 mm. Optimal zone III catheter insertion lengths showed up to 30 mm difference, ranging between 234 and 264 mm. Statistically significant and potentially clinically relevant differences were observed between the anatomical distances and necessary introduction depths for each subgroup. CONCLUSION: This is the first study to compare aortic morphology and intravascular distances between combined sex and age-based subgroups. As zone III length was consistent, length variability and elongation seem to mainly originate in the iliofemoral trajectory and zone II. The optimal zone I catheter insertion length would be 430 mm. Optimal zone III catheter insertion ranged between 234 and 264 mm. These standardized variable-distance insertion lengths could facilitate safer fluoroscopy-free REBOA in austere, pre-hospital settings.
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Aorta , Oclusión con Balón , Procedimientos Endovasculares , Resucitación , Tomografía Computarizada por Rayos X , Humanos , Oclusión con Balón/métodos , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Adulto , Resucitación/métodos , Aorta/cirugía , Aorta/diagnóstico por imagen , Anciano , Procedimientos Endovasculares/métodos , Tomografía Computarizada por Rayos X/métodos , Países Bajos , Fluoroscopía/métodos , Hemorragia , Anciano de 80 o más Años , AdolescenteRESUMEN
OBJECTIVES: Mechanical composite valve grafts (MCVGs) are the first-line therapy for aortic root replacement in young adults. Decellularized aortic homografts (DAH) present a promising novel alternative due to their lower thrombogenicity. We aimed to compare both treatment options regarding survival and valve-related adverse events. METHODS: This study was designed as a single-centre retrospective cohort study including patients who underwent root replacement with MCVG or DAH between 2000 and 2022. Urgent or emergent procedures were excluded. RESULTS: The study cohort included 289 patients (MCVG n = 216, DAH n = 73) with a mean age of 48.5 ± 12 years (MCVG 49 ± 12 years vs DAH 47 ± 11 years; P = 0.23) and a median EuroScore II of 1.7% (1.2, 2.6). The 30-day mortality was 1% (n = 3). Cumulative survival at 3 years was 99% for DAH and 94% for MCVG, respectively (P = 0.15). Mean follow-up was 98.9 ± 72.7 months. Bleeding events (n = 14, 6.5%) and thromboembolism (n = 14, 6.5%) were only observed in the MCVG group (P = 0.19 and 0.09, respectively). Four cases (5%) of moderate structural valve deterioration occurred, all in the DAH group (P ≤ 0.001). The cumulative incidence of a composite end point of valve-related adverse events was significantly higher in the MCVG group (P = 0.0295). CONCLUSIONS: Aortic root replacement with MCVGs and decellularized aortic homografts showed low mortality in an elective setting. Patients in the homograft cohort demonstrated significantly higher freedom from valve-related adverse events. DAH present a promising treatment option for young patients requiring root replacement; however, data on long-term durability are needed.
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Válvula Aórtica , Prótesis Valvulares Cardíacas , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Femenino , Válvula Aórtica/cirugía , Adulto , Implantación de Prótesis de Válvulas Cardíacas/métodos , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/mortalidad , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Aorta/cirugía , Aloinjertos , Complicaciones Posoperatorias/epidemiología , Implantación de Prótesis Vascular/métodos , Implantación de Prótesis Vascular/efectos adversos , Resultado del Tratamiento , Bioprótesis/efectos adversos , Diseño de PrótesisRESUMEN
BACKGROUND: Transcatheter aortic valve implantation (TAVI) is indicated for elderly patients who often have severe comorbidities and high operative risk. Despite many advantages, it carries the potential for both early and late complications. The literature reports mainly periprocedural problems. This case report describes a rare instance of ascending aortic rupture as a late complication following TAVI. CASE PRESENTATION: An 81-year-old male with severe aortic stenosis (AS) was a non-surgical patient due to a high operative risk (EuroSCORE II 14.08%) and comorbidities, including cardiovascular problems, chronic obstructive pulmonary disease, myelodysplastic syndrome. During the TAVI procedure Medtronic CoreValve™ Evolut™ R-26 was implanted via the right femoral artery. Postoperative period elapsed without complications and the patient was discharged home. Six months later, the patient was re-admitted to the hospital on an emergency basis and transferred directly to the operating room due to ascending aortic rupture (EuroSCORE II 53.20%, GERAADA score 64.9%). Computed tomography angiography (CTA) showed aortic rupture with a multiple fresh blood reservoirs and thrombus around the ascending aorta originating from the spot where the nitinol frame of the TAVI valve was attached to the native aorta. Supracoronary excision of the ascending aorta with implantation of a vascular graft (Intergard Woven Graft 34 mm) was performed, preserving the earlier implanted TAVI valve. On the 9th day after surgery the patient's general condition deteriorated, he suffered from circulatory and respiratory insufficiency. Furthermore, a gastrointestinal bleeding with the need for gastro-, and colonoscopy and multiple blood transfusions occurred. Patient developed urosepsis and acute renal failure with the need for hemodiafiltration. Despite intensive treatment, further deterioration of the medical condition of the patient. and finally the multiple organ failure was observed. Patient died on the 50th postoperative day. CONCLUSIONS: TAVI is a safe method of treating severe AS, especially recommended for non-surgical candidates. Rupture of the ascending aorta is a rare but serious complication of TAVI that usually occur during or shortly after the procedure. This case report highlights the importance of post-procedural monitoring for such TAVI complications, even in the late period following TAVI, and if such complications occur, taking the risk to perform a life-saving operation.
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Rotura de la Aorta , Estenosis de la Válvula Aórtica , Reemplazo de la Válvula Aórtica Transcatéter , Anciano de 80 o más Años , Humanos , Masculino , Aorta/diagnóstico por imagen , Aorta/cirugía , Rotura de la Aorta/diagnóstico por imagen , Rotura de la Aorta/etiología , Rotura de la Aorta/cirugía , Estenosis de la Válvula Aórtica/cirugía , Angiografía por Tomografía Computarizada , Prótesis Valvulares Cardíacas/efectos adversos , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Reemplazo de la Válvula Aórtica Transcatéter/instrumentaciónRESUMEN
BACKGROUND: Perioperative stroke is a devastating complication of coronary artery and aortic surgery, resulting in significantly increased mortality and morbidity rates. As such, predicting rehabilitation outcomes after perioperative stroke would be valuable in establishing rehabilitation plans. OBJECTIVE: To identify prognostic factors of rehabilitation outcomes in perioperative stroke after surgery of the aorta and coronary arteries. METHODS: This study included patients who experienced perioperative stroke after coronary artery bypass grafting and aortic surgery, and underwent 3-weeks of rehabilitation. Demographic data included age, sex, diagnosis, brain lesions, and Charlson Comorbidity Index (CCI). To identify prognostic factors and the effectiveness of rehabilitation, the Modified Barthel Index (MBI), National Institutes of Health Stroke Scale (NIHSS), Medical Research Council (MRC) sum score, modified Rankin Scale (mRS) score, and Mini-Mental State Examination (MMSE) scores were investigated before and after a three-week rehabilitation period. Spearman rank correlation analyses were performed. RESULTS: Statistically significant improvements were observed in NIHSS, MBI, and MMSE scores after rehabilitation. Spearman rank correlation analysis revealed a significant correlation between sex, stroke type, and improvement in MRC sum score. CONCLUSION: The most crucial factors influencing the prognosis of perioperative stroke occurring after coronary artery or aortic surgery included sex and stroke type.
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Complicaciones Posoperatorias , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular , Humanos , Masculino , Femenino , Anciano , Proyectos Piloto , Persona de Mediana Edad , Pronóstico , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/rehabilitación , Resultado del Tratamiento , Aorta/cirugía , Anciano de 80 o más Años , Vasos Coronarios/cirugía , Periodo PerioperatorioRESUMEN
Case 1 was a 59-year-old man who underwent aortic valve replacement (AVR) at the age of 38, for aortic regurgitation. Case 2 was a 51-year-old man who underwent AVR at the age of 34, for aortic regurgitation. Both cases required surgery for ascending aortic aneurysms. These patients showed aneurysm at the site of the prior aortotomy. In both of the patients used felt-strip was used for closing aortotomy. Intraoperative findings showed enlargement of the aorta around the felt-strip, which was a finding of true aneurysm. Both cases underwent ascending aortic replacement. The mechanism of aortic aneurysm development was thought to include persistent mechanical stimulation by the felt-strip and ischemia of the vasa-vasorum due to compression of the felt-strip. The use of felt-strips for the aortotomy suture should be avoided, especially in young patients.
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Válvula Aórtica , Humanos , Masculino , Persona de Mediana Edad , Aorta/cirugía , Aneurisma de la Aorta/cirugía , Aneurisma de la Aorta/etiología , Aneurisma de la Aorta/diagnóstico por imagen , Válvula Aórtica/cirugía , Insuficiencia de la Válvula Aórtica/cirugía , Insuficiencia de la Válvula Aórtica/etiología , Implantación de Prótesis de Válvulas Cardíacas , Complicaciones PosoperatoriasRESUMEN
INTRODUCTION: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a temporizing hemorrhage control intervention, but its inevitable effect on time to operating room (OR) has not been assessed. The aim of our study is to assess the impact of undergoing REBOA before surgery (RBS) on time to definitive hemorrhage control surgery. METHODS: In this retrospective analysis of 2017-2021 ACS-TQIP database, all adult (≥18 years) patients who underwent emergency hemorrhage control laparotomy (≤4 hours of admission) and received early blood products (≤4 hours) were included, and patients with severe head injury (Head-abbreviated injury score > 2) were excluded. Patients were stratified into those who did (RBS) vs those who did not undergo REBOA before surgery (No-RBS). Primary outcome was time to laparotomy. Secondary outcomes were complications and mortality. Multivariable linear and binary logistic regression analyses were performed to identify the independent associations between RBS and outcomes. RESULTS: A total of 32,683 patients who underwent emergency laparotomy were identified (RBS: 342; No-RBS: 32,341). The mean age was 39 (16) years, 78% were male, mean SBP was 107 (34) mmHg, and the median injury severity score was 21 [14-29]. The median time to emergency hemorrhage control surgery was 50 [32-85] minutes. Overall complication rate was 16% and mortality was 19%. On univariate analysis, RBS group had longer time to surgery (RBS 56 [41-89] vs No-RBS 50 [32-85] minutes, P < 0.001). On multivariable analysis, RBS was independently associated with a longer time to hemorrhage control surgery (ß + 14.5 [95%CI 7.8-21.3], P < 0.001), higher odds of complications (aOR = 1.72, 95%CI = 1.27-2.34, P < 0.001), and mortality (aOR = 3.42, 95%CI = 2.57-4.55, P < 0.001). CONCLUSION: REBOA is independently associated with longer time to OR for hemorrhaging trauma patients with an average delay of 15 minutes. Further research evaluating center-specific REBOA volume and utilization practices, and other pertinent system factors, may help improve both time to REBOA as well as time to definitive hemorrhage control across US trauma centers. LEVEL OF EVIDENCE: III. STUDY TYPE: Epidemiologic.
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Oclusión con Balón , Hemorragia , Humanos , Masculino , Estudios Retrospectivos , Femenino , Adulto , Oclusión con Balón/métodos , Oclusión con Balón/normas , Oclusión con Balón/estadística & datos numéricos , Persona de Mediana Edad , Hemorragia/etiología , Hemorragia/epidemiología , Resucitación/métodos , Resucitación/estadística & datos numéricos , Resucitación/normas , Tiempo de Tratamiento/estadística & datos numéricos , Tiempo de Tratamiento/normas , Factores de Tiempo , Modelos Logísticos , Puntaje de Gravedad del Traumatismo , Aorta/cirugía , Laparotomía/métodos , Laparotomía/estadística & datos numéricos , Laparotomía/efectos adversosRESUMEN
OBJECTIVE: To study the structure and dynamics of anxiety-depressive disorders in patients with dissection/aneurysm of the ascending aorta and aortic arch before and in the long term after surgical treatment and to identify factors associated with disturbances in psycho-emotional status. MATERIAL AND METHODS: We examined 124 patients with dissection/aneurysm of the ascending aorta and arch before and in the long-term period after aortic replacement, assessing anxiety and depression using the Generalized Anxiety Disorder (GAD-7) and Beck Depression Questionnaires. Multivariate regression analysis was used to identify factors associated with clinically significant anxiety and depressive disorders. RESULTS: Average scores on the GAD and the depression scale before surgery decreased from 6.5 (4.0-9.0) and 12.0 (8.0-16.0) to 3.0 (2.0-5.0) and 6.0 (3.0-10.0) (p<0.05) respectively, in the long-term postoperative period. There was no significant decrease in the proportion of patients with clinically significant levels of GAD and depression (p>0.05). Before surgery, clinically significant anxiety and depressive disorders are associated with older age, chronic cerebrovascular insufficiency (CCI) and atrial fibrillation (AF) in the hospital period. After surgery, clinically significant GAD was associated with older age, CCI, and a history of stroke. Depressive disorders were associated with older age and a history of stroke. CONCLUSION: In all patients with aortic disease, GAD and depression of varying severity are recorded; clinically significant GAD and depression are recorded in 19.2 and 23.2% of cases. In the long-term postoperative period, there is no significant decrease in the proportion of patients with clinically significant levels of GAD and depression, which amounted to 10.1 and 13.1%. Clinically significant anxiety and depressive disorders before and after surgery are associated with older age and the history of cerebrovascular disorders. In addition, the baseline clinically significant anxiety and depressive disorders showed an association with the subsequent development of AF in the early postoperative period.
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Trastornos de Ansiedad , Trastorno Depresivo , Humanos , Femenino , Masculino , Persona de Mediana Edad , Trastornos de Ansiedad/epidemiología , Trastornos de Ansiedad/etiología , Trastorno Depresivo/epidemiología , Trastorno Depresivo/etiología , Anciano , Disección Aórtica/cirugía , Disección Aórtica/complicaciones , Disección Aórtica/psicología , Adulto , Aorta/cirugíaRESUMEN
BACKGROUND: Variations in the aortomitral positional anatomy, including aortic root rotation appear to be related to variations in the location of the conduction system, including the bundle of His. However, little is known about their clinical significance. METHODS AND RESULTS: This study included 147 patients with normal ECGs who underwent mitral valve surgery. The aortomitral anatomy was classified using preoperative 3-dimensional transesophageal echocardiography, and postoperative conduction disorders, including atrioventricular block and bundle branch block, were analyzed. Variations classified as aortomitral appearance were designated as having a center appearance (85.7%, n=126/147) or lateral appearance (14.3%, n=21/147) on the basis of whether the aortic root was located at the center or was shifted to the left fibrous trigone side. Subsequently, those with a center appearance, aortic root rotation was classified as having a center rotation (83.3% [n=105/126]), in which the commissure of the left and noncoronary aortic leaflet was located at the center, lateral rotation (14.3% [n=18/126]), rotated to the left trigone side, or medial rotation (2.4% [n=3/126]), rotated to the right. The incidence of 3-month persistent new-onset conduction disorder was higher in the lateral appearance than the center appearance group (21.1% versus 5.0%; P=0.031) and higher in the lateral rotation than in the center or medial rotation groups (29.4% versus 1.0% versus 0.0%, respectively; P<0.001). CONCLUSIONS: Aortomitral variations can be classified using 3-dimensional transesophageal echocardiography. Lateral appearance and lateral rotation are risk factors for conduction disorders in mitral valve surgery.
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Bloqueo Atrioventricular , Ecocardiografía Tridimensional , Ecocardiografía Transesofágica , Válvula Mitral , Humanos , Masculino , Femenino , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/cirugía , Válvula Mitral/fisiopatología , Persona de Mediana Edad , Bloqueo Atrioventricular/etiología , Bloqueo Atrioventricular/fisiopatología , Bloqueo Atrioventricular/diagnóstico , Anciano , Estudios Retrospectivos , Electrocardiografía , Bloqueo de Rama/fisiopatología , Bloqueo de Rama/etiología , Factores de Riesgo , Aorta/diagnóstico por imagen , Aorta/cirugía , Aorta/fisiopatología , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Adulto , Resultado del Tratamiento , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/diagnóstico por imagenRESUMEN
BACKGROUND: The objective of this study is to investigate whether the use of antegrade perfusion with terminal non-cardioplegic warm blood (TNWB) before aortic unclamping in single-clamp technique coronary artery bypass has a positive impact on intraoperative heartbeat recovery. METHODS: Between December 2022 and May 2023, 40 consecutive patients undergoing coronary artery bypass using single-clamp technique were randomized into one of two groups: the TNWB group received an antegrade perfusion with TNWB before removing the aortic cross-clamp (n = 20), while the control group did not receive (n = 20). The time intervals between coronary perfusion and the onset of the first heartbeats and sinus rhythms, occurrences of spontaneous sinus rhythm, intraoperative defibrillation requirements, as well as postoperative CK-MB and troponin T levels were recorded and subjected to analysis. RESULTS: In the TNWB group, the median onset of the first heartbeats after the initiation of coronary perfusion was 34 s (4-100), while in the control group, it was 90 s (15-340) (p < 0.001). The median onset of the sinus rhythms was 100 s (28-290) in the TNWB group and was 132 s (45-350) in the control group (p = 0.023). The occurrence of intraoperative arrhythmias was 15% in the TNWB group compared to 50% in the control group (p = 0.018), and the incidence for internal defibrillation was 5% in the TNWB group and was 30% in the control group (p = 0.037). The TNWB group showed the median CK-MB levels at 6 h postoperative was 14.10 ng/mL (9.78-19.26), compared to 18.31 ng/mL (13.98-23.80) in the control group (p = 0.045). CONCLUSIONS: During single clamp coronary artery bypass, administration TNWB into the aortic root before aortic unclamping has the potential to enhance heartbeat recovery, as evidenced by the shortened time to the initial heartbeat and the establishment of sinus beats following coronary perfusion. TRIAL REGISTRATION: Trial registration number (Study ID): TCTR20231002003.
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Puente de Arteria Coronaria , Frecuencia Cardíaca , Humanos , Masculino , Femenino , Puente de Arteria Coronaria/métodos , Persona de Mediana Edad , Anciano , Frecuencia Cardíaca/fisiología , Perfusión/métodos , Aorta/cirugíaRESUMEN
An increasing number of patients have required cardiac reoperations in recent decades, and this trend is expected to continue. Hence, re-sternotomy is and will be a common practice in high-volume centres. Re-sternotomy in complex aortic reinterventions carries a high risk of injuring major vascular and heart structures. To avoid catastrophic injuries, preoperative planning and case individualization are essential to minimize complications. Designing a safe and tailored strategy for each patient is believed to have an impact on postoperative outcomes. The arterial cannulation site, the need for hypothermia, left ventricle decompression and the use of an aortic occlusion balloon catheter are some of the preoperative decisions that must be made on a case-by-case basis to ensure adequate brain and visceral perfusion and to minimize major bleeding and circulatory interruption in case of re-entry injury.
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Reoperación , Esternotomía , Humanos , Esternotomía/métodos , Reoperación/métodos , Complicaciones Posoperatorias/prevención & control , Masculino , Femenino , Anciano , Aorta/cirugíaRESUMEN
An orthotopic heart transplant and an aortic operation can be done concomitantly at centres that are experienced in both aortic operations and heart transplants with meticulous surgical strategy.
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Trasplante de Corazón , Humanos , Trasplante de Corazón/métodos , Masculino , Esternón/cirugía , Aneurisma de la Aorta/cirugía , Persona de Mediana Edad , Aneurisma de la Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/diagnóstico , Implantación de Prótesis Vascular/métodos , Aorta/cirugía , Aneurisma de la Aorta AscendenteRESUMEN
ABSTRACT: Intraoperative aortic dissection is a life-threatening emergency. The prognosis of patients with aortic dissection has markedly improved in recent years due to prompt diagnosis and the institution of effective medical and surgical therapy. Transesophageal echocardiography (TEE) is helpful in the evaluation of this life-threatening disorder.
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Aorta , Disección Aórtica , Ecocardiografía Transesofágica , Complicaciones Intraoperatorias , Humanos , Disección Aórtica/cirugía , Disección Aórtica/diagnóstico por imagen , Ecocardiografía Transesofágica/métodos , Aorta/cirugía , Aorta/diagnóstico por imagen , Complicaciones Intraoperatorias/diagnóstico por imagen , Aneurisma de la Aorta/cirugía , Aneurisma de la Aorta/diagnóstico por imagen , Masculino , Femenino , Persona de Mediana EdadRESUMEN
This article reviews the recent and relevant literature to the field of aortic surgery. Specific areas highlighted include outcomes of Stanford type A dissection, management of acute aortic syndromes, management of aortic aneurysms, and traumatic aortic injury. Although the focus was on articles from 2023, literature from prior years also was included, given that this article is the first of a series. Notably, the pertinent sections from the 2022 American College of Cardiology/American Heart Association Guidelines for the Diagnosis and Management Aortic Disease are discussed.
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Procedimientos Quirúrgicos Vasculares , Humanos , Procedimientos Quirúrgicos Vasculares/métodos , Procedimientos Quirúrgicos Vasculares/tendencias , Enfermedades de la Aorta/cirugía , Aorta/cirugía , Disección Aórtica/cirugíaRESUMEN
INTRODUCTION: The Charlson Comorbidity Index (CCI) is widely utilized for risk stratification for non-cardiac surgical patients, yet it has not been broadly validated in patients undergoing cardiac surgery. We aim to assess its ability to predict early and late outcomes of concomitant mitral valve intervention with ascending aortic surgery. METHODS: Patients who underwent surgery between 1997 and 2022 were reviewed. Age-adjusted CCI scores were calculated based on clinical status at a time of index operation. The primary endpoint was all causes mortality while secondary outcomes were major adverse events (MAE) that included combined perioperative mortality, dialysis, myocardial infarction, and stroke in addition to the individual outcomes and take back for bleeding and tracheostomy. Chi-square test, Logistic and Cox regression analysis, and Kaplan-Meier curves were used. Maximally selected rank statistics were used to identify best cutoff of CCI for late mortality. RESULTS: 186 patients (median age 65 [interquartile range (IQR): 54-76] and 69% males) were included with a median CCI of 4 [IQR: 3-6]. Five and ten-years overall survival were 95.9% and 67.1% vs 59.7%, and 19.9% in CCI ≤ 5 vs >5 (P < 0.001). On multivariate Cox regression analysis, higher CCI (HR 1.60 [1.17;2.18], P = 0.00), and lower EF (HR 0.89 [0.83;0.96], P = 0.002) were associated with late mortality. There was a trend to lower mortality in recent surgery years (HR 0.91 [0.83;1.01], P = 0.070)). Perioperative MAE was higher in CCI >5 (11.0% vs 2.1%, P = 0.017), and postoperative need for tracheostomy and CVA had a trend to be higher in CCI > 5 (P = 0.055). Logistic regression revealed that higher CCI, as a continuous variable, was associated with significantly higher odds of MAE, postoperative dialysis, and need for tracheostomy. CONCLUSIONS: The CCI can be a helpful tool in predicting outcomes of patients undergoing concomitant mitral valve intervention with ascending aortic surgery.
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Comorbilidad , Válvula Mitral , Humanos , Masculino , Femenino , Anciano , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Válvula Mitral/cirugía , Implantación de Prótesis de Válvulas Cardíacas/métodos , Aorta/cirugía , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/mortalidadRESUMEN
OBJECTIVE: Tricuspid valve surgery can be performed on a beating heart or on an arrested heart. We aimed to compare the outcomes of tricuspid valve surgery using these two different approaches. METHODS: Between January 2015 and February 2020, 204 patients who underwent tricuspid valve surgery along with concomitant cardiac surgical procedures were included in the study. Techniques of cross-clamping and beating-heart tricuspid surgery were applied to 103 and 101 patients, respectively. Concomitant valvular and/or coronary interventions were performed under cross clamping in both groups. Results from the preoperative period, immediate postoperative period, and six-month postoperative interval were compared between the groups. RESULTS: There were no differences in demographic characteristics or preoperative grades of tricuspid valve regurgitation between the groups. Duration of mechanical ventilation, and stays in the intensive care unit and hospital were significantly shorter in patients operated on using the beating-heart technique. Additionally, re-exploration surgery and mortality rates were significantly lower in the beating-heart group. Postoperative six-month echocardiography findings related to tricuspid valve regurgitation, maximum and minimum gradients of the tricuspid valve, and pulmonary arterial pressure were also lower in the beating-heart group. CONCLUSION: Beating-heart tricuspid valve surgery may be preferable to the cross-clamping technique to avoid clamp-induced ischemia, which can lead to worsened postoperative outcomes.
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Insuficiencia de la Válvula Tricúspide , Válvula Tricúspide , Humanos , Masculino , Femenino , Persona de Mediana Edad , Válvula Tricúspide/cirugía , Insuficiencia de la Válvula Tricúspide/cirugía , Anciano , Procedimientos Quirúrgicos Cardíacos/métodos , Aorta/cirugía , Resultado del Tratamiento , Constricción , Ecocardiografía , Estudios Retrospectivos , Tiempo de Internación/estadística & datos numéricosAsunto(s)
Aloinjertos , Tráquea , Humanos , Tráquea/cirugía , Tráquea/trasplante , Regeneración/fisiología , Aorta/cirugía , Cartílago/trasplanteAsunto(s)
Estenosis de la Válvula Aórtica , Arteria Femoral , Reemplazo de la Válvula Aórtica Transcatéter , Humanos , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Arteria Femoral/diagnóstico por imagen , Estenosis de la Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Masculino , Femenino , Anciano de 80 o más Años , Válvula Aórtica/cirugía , Válvula Aórtica/diagnóstico por imagen , Anciano , Resultado del Tratamiento , Aorta/diagnóstico por imagen , Aorta/cirugía , Pronóstico , Factores de Riesgo , Estudios RetrospectivosRESUMEN
OBJECTIVES: The aims of the present study were to compare the long-term outcomes for ascending aortic dilatation and adverse aortic events after isolated aortic valve replacement between patients with bicuspid aortic valve (BAV) and tricuspid aortic valve ( TAV). METHODS: This retrospective study included 310 patients who had undergone isolated aortic valve replacement with an ascending aorta diameter ≤ 45 mm between January 2010 and September 2021. The patients were divided into BAV group (n=90) and TAV group (n=220). The differences in the dilation rate of the ascending aorta and long-term outcomes were analyzed. RESULTS: Overall survival was 89 ± 4% in the BAV group vs. 75 ± 6% in the TAV group at 10 years postoperatively (P=0.007), yet this difference disappeared after adjusting exclusively for age (P=0.343). The mean annual growth rate of the ascending aorta was similar between the two groups during follow-up (0.5 ± 0.6 mm/year vs. 0.4 ± 0.5 mm/year; P=0.498). Ten-year freedom from adverse aortic events was 98.1% in the BAV group vs. 95.0% in the TAV group (P=0.636). Multivariable analysis revealed preoperative ascending aorta diameter to be a significant predictor of adverse aortic events (hazard ratio: 1.76; 95% confidence interval: 1.33 to 2.38; P<0.001). CONCLUSION: Our study revealed that the long-term survival and the risks of adverse aortic events between BAV and TAV patients were similar after isolated aortic valve replacement. BAV was not a risk factor of adverse aortic events.