Natalie Glaser - Academia.edu (original) (raw)

Papers by Natalie Glaser

European Journal of Cardio-Thoracic Surgery, Mar 11, 2022

Journal of the American College of Cardiology, Jul 1, 2019

BACKGROUND Contemporary data on loss in life expectancy after aortic valve replacement (AVR) are ... more BACKGROUND Contemporary data on loss in life expectancy after aortic valve replacement (AVR) are scarce, particularly in younger patients. OBJECTIVES The purpose of this national, observational cohort study was to analyze long-term relative survival and estimated loss in life expectancy after AVR. METHODS The study included 23,528 patients who underwent primary surgical AVR with or without concomitant coronary artery bypass grafting in Sweden between 1995 and 2013 from the SWEDEHEART (Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies) register. Individual level linking with other national health-data registers was performed to obtain baseline characteristics and vital status. The expected survival from the general Swedish population matched by age, sex, and year of surgery was obtained from the Human Mortality Database. The relative survival was used as an estimate of cause-specific mortality. Flexible parametric models based on relative survival were used to estimate the loss in life expectancy. RESULTS The mean follow-up was 6.8 years. The 19-year observed, expected, and relative survival was 21%, 34%, and 63% (95% confidence interval [CI]: 59% to 67%), respectively. The loss in life expectancy was 1.9 years (95% CI: 1.2 to 2.6 years) in the total study population. The estimated loss in life expectancy increased with younger age: 0.4 years (95% CI: 0.3 to 0.5 years) versus 4.4 years (95% CI: 1.5 to 7.2 years) in patients $80 and <50 years of age, respectively. There was no difference in loss in life expectancy between men and women. CONCLUSIONS This study found a shorter life expectancy in patients after AVR compared with the general population. The estimated loss in life expectancy was substantial, and increased with younger age. These results provide important information to quantify disease burden after AVR, and are relevant for clinicians counseling patients before and after AVR.

Journal of the American College of Cardiology, Jun 1, 2022

Open heart, Oct 1, 2021

Background Small femoral arteries have been associated with a higher risk of vascular complicatio... more Background Small femoral arteries have been associated with a higher risk of vascular complications in transfemoral transcatheter aortic valve replacement (TAVR). We investigated the feasibility and safety of TAVR in patients with small femoral arteries. Methods In this observational study, we included 82 patients who underwent transfemoral TAVR with the ACURATE neo system using the expandable 14F iSleeve sheath between 2018 and 2019 at Karolinska University Hospital, Sweden. Of these, 41 patients had a minimal femoral artery diameter of ≥5.5 mm (mean 6.5, range 5.5-9.2), and 41 patients had a minimal femoral artery diameter <5.5 mm (mean 4.9, range 3.9-5.4). Results There was no significant difference in major vascular and bleeding complications between the small femoral artery group (7%) and the normal femoral artery group (2%) (p=0.62). The total of major and minor vascular complications did not differ significantly according to femoral artery size (17% vs 5%) (p=0.16). The iSleeve sheath was not correlated with any of the complications. The use of the iSleeve sheath was unsuccessful in four patients (5%), of which one patient had a small femoral artery diameter. Conclusion Transfemoral TAVR with the ACURATE neo system using the iSleeve sheath is a promising method for patients with small femoral arteries even though we found a trend towards higher rates of complications in these patients. The use of expandable sheaths may expand the spectrum of patients that can be treated with transfemoral TAVR, and thus may improve the prognosis in patients with severe aortic valve stenosis.

The Annals of Thoracic Surgery, Feb 1, 2021

BACKGROUND Previous studies have reported superior hemodynamic performance with bovine bioprosthe... more BACKGROUND Previous studies have reported superior hemodynamic performance with bovine bioprosthetic aortic valves compared with porcine valves. However, conflicting results mean the long-term effect on survival is not well known. The aim of this study was to examine long-term survival, rate of aortic valve reoperations, and heart failure hospitalizations after surgical aortic valve replacement (AVR) with porcine versus bovine bioprosthetic valves. METHODS This was a population-based cohort study including all patients who had undergone AVR in Sweden from 1995-2012, with or without concomitant coronary artery bypass grafting. Patients were identified through the SWEDEHEART registry. Baseline and outcome data were gathered from national registries. Propensity scores and inverse probability of treatment weighting were used to control for inter-group differences. Analyses accounted for competing risk of death when appropriate. RESULTS A total of 12845 patients underwent AVR with porcine (n=4198) or bovine (n=8647) prostheses. We found a small but significant difference in mortality favoring porcine prostheses; 78% vs. 76%, 47% vs. 43%, and 17% vs. 15% at 5, 10, and 15 years, respectively (hazard ratio (HR): 0.90, 95% confidence interval (CI): 0.85-0.96). Porcine prostheses were associated with an increased risk of reoperation (HR: 1.48, 95% CI: 1.11-1.98), but no difference in the risk of heart failure hospitalization. Results were similar in patients who underwent isolated AVR. CONCLUSIONS Consistent with previous reports, we found that patients receiving porcine prostheses had a higher rate of reoperation compared with bovine prostheses. However, porcine prostheses were associated with improved long-term survival compared with bovine prostheses.

Heart, Feb 23, 2021

Objectives The objective of this cohort study was to analyse long-term relative survival in patie... more Objectives The objective of this cohort study was to analyse long-term relative survival in patients with bicuspid aortic valve (BAV) who underwent aortic valve surgery. Methods We studied 865 patients with BAVs who participated in three prospective cohort studies of elective, open-heart, aortic valve surgery at the

JAMA network open, Apr 19, 2024

IMPORTANCE Aggregated data and long-term follow-up in national health data registers offer the op... more IMPORTANCE Aggregated data and long-term follow-up in national health data registers offer the opportunity to compare the performance of mechanical aortic prostheses within the same population. OBJECTIVE To investigate the clinical performance of mechanical aortic valve prostheses. DESIGN, SETTING, AND PARTICIPANTS This nationwide cohort study included all 5224 patients who underwent primary mechanical aortic valve replacement in Sweden between

Journal of the American Heart Association, 2024

Journal of the American College of Cardiology, Mar 1, 2023

BMJ Open, May 1, 2019

Objective Blood type A antigen on porcine aortic bioprostheses might initiate an immune reaction ... more Objective Blood type A antigen on porcine aortic bioprostheses might initiate an immune reaction leading to an increased frequency of structural valve deterioration in patients with blood type B or O. The aim was to analyse the association between ABO blood type and porcine bioprosthetic aortic valve degeneration. Design Observational nationwide cohort study. setting Swedish population-based study. Participants Adult patients (n=3417) who underwent surgical aortic valve replacement and received porcine bioprosthetic aortic valves between 1995 and 2012 from the Swedish Web system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies register. The study database was enriched with information from other national registers. Exposure The patients were categorised into type A/AB and type B/O blood groups. Primary and secondary outcome measures Primary outcome measure was aortic valve reoperation, and secondary outcomes were heart failure and all-cause mortality. We report risk estimates that account for the competing risk of death. results In total, 3417 patients were identified: 1724 (50.5%) with blood type A/AB and 1693 (49.5%) with blood type B/O. Both groups had similar baseline characteristics. The cumulative incidence of aortic valve reoperation was 3.4% (95% CI 2.5% to 4.4%) and 3.6% (95% CI 2.6% to 4.6%) in the type B/O and the A/AB group, respectively, at 15 years of follow-up (absolute risk difference: −0.2% (95% CI −1.5% to 1.2%)). There was no significantly increased risk for aortic valve reoperation in patients with blood type B/O compared with type A/AB (HR 0.95, 95% CI 0.62 to 1.45). There was no significant difference in absolute or relative risk of heart failure or death between the groups. Conclusions We found no significant association between patient blood type and clinical manifestations of structural valve deterioration following porcine aortic valve replacement. Our findings suggest that it is safe to use porcine bioprosthetic valves without consideration of ABO blood type in the recipient. trial registration number NCT02276950

Circulation, Jul 18, 2017

CORRESPONDENCE P rosthetic valve endocarditis (PVE) is the most severe form of infective endocard... more CORRESPONDENCE P rosthetic valve endocarditis (PVE) is the most severe form of infective endocarditis and accounts for 20% of all cases of infective endocarditis. 1,2 However, studies reporting the incidence of PVE after surgical aortic valve replacement (AVR) are scarce and based mainly on noncontemporary patient cohorts. Whether PVE affects biological and mechanical aortic valves to the same extent remains unknown. Therefore, we investigated the incidence and risk of PVE after surgical AVR in patients with biological and mechanical valves. This observational, nationwide, population-based cohort study was approved by the regional Human Research Ethics Committee in Stockholm, Sweden (Dnr. 2016/1241-32) and is registered at ClinicalTrials.gov (Unique identifier: NCT02276950). No informed consent from patients was required. The SWEDE-HEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) register was used to obtain the study population. The unique personal identity number was used for cross-linking patient-level data from other national healthcare registers as described previously. 3 All patients who underwent AVR with a biological or mechanical valve prosthesis in Sweden from January 1, 1995, to December 31, 2012, were included in the study. Patients with multiple valve surgeries were excluded. Person-time in days was counted from the date of surgery until the date of diagnosis of PVE, death, or end of follow-up (December 31, 2012, for PVE and March 24, 2014, for death). Cox regression was used to estimate the relative risk of PVE. Data management and statistical analyses were performed with Stata version 14.2 (StataCorp LP, College Station, TX). We included 26 580 patients; 16 426 (62%) received a bioprosthesis and 10 154 (38%) received a mechanical valve. Patients with bioprostheses were older (mean age, 74.1 versus 61.0 years) and had more comorbidities than patients with mechanical valves. During a mean follow-up of 6.2 years (maximum, 18.0 years), 940 patients (3.5%) were hospitalized for infective endocarditis. The event rates and crude and adjusted risks for PVE are shown in the Table. The incidence rate of PVE was 0.57% (95% confidence interval [CI], 0.54-0.61) per person-year. The incidence rates of PVE in biological and mechanical valves at 0 to 1, 1 to 5, 5 to 10, and 10 to 15 years' follow-up are shown in the Table. The risk of PVE was higher in patients with bioprostheses, both in the unadjusted analysis (hazard ratio [HR], 1.51; 95% CI, 1.31-1.74) and in the multivariable-adjusted analysis (HR, 1.54; 95% CI, 1.29-1.83). The results were consistent in age-stratified and agematched analyses. The adjusted risk of both early (within 1 year) endocarditis (HR, 1.65; 95% CI, 1.16-2.37) and late endocarditis (HR, 1.53; 95% CI, 1.25-1.86) was higher in patients with bioprostheses. In this nationwide, population-based cohort study, the incidence of PVE after AVR was 0.57% per person-year. The risk of PVE was highest during the first year after AVR; thereafter, the yearly rate of PVE was halved and remained stable during

Journal of the American Heart Association, Dec 19, 2016

Background-The influence of moderately reduced kidney function on late survival after surgical ao... more Background-The influence of moderately reduced kidney function on late survival after surgical aortic valve replacement (AVR) is unknown. We analyzed survival after AVR in patients with moderately reduced kidney function. Methods and Results-All patients who underwent primary AVR in Sweden 1997-2013 were identified from the Swedish Web system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies register. Patients were categorized according to estimated glomerular filtration rate (eGFR). Of 13 102 patients, 9836 (75%) had normal kidney function (eGFR >60 mL/min per 1.73 m 2) and 3266 (25%) had moderately reduced kidney function (eGFR 30-60 mL/min per 1.73 m 2). Mean follow-up time was 6.2 years. Mortality was higher in patients with moderately reduced kidney function; 5-, 10-, and 15-year survival was 76%, 48%, and 25% versus 89%, 73%, and 55% (adjusted hazard ratio [HR], 1.28; 95% CI, 1.18-1.38; P<0.001). Patients with moderately reduced kidney function had a nonsignificantly higher risk of major bleeding (HR, 1.18; 95% CI, 1.00-1.39; P=0.051) and a lower risk for aortic valve reoperation (HR, 0.54; 95% CI, 0.38-0.79; P=0.001) compared to those with normal kidney function. In patients with moderately reduced kidney function, survival was similar in those who received bioprostheses compared to those who received mechanical valves (HR, 0.85; 95% CI, 0.70-1.03; P=0.094). Conclusions-Moderately reduced kidney function was strongly associated with increased mortality after AVR. These results have important implications for preoperative risk stratification, and suggest that patients with eGFR 30 to 60 mL/min per 1.73 m 2 warrant careful observation after AVR.

Seminars in Thoracic and Cardiovascular Surgery, 2022

Background Aortic valve replacement (AVR) can be performed with different types of valve prosthes... more Background Aortic valve replacement (AVR) can be performed with different types of valve prostheses. There is no perfect aortic valve prosthesis, and the prosthetic choice for each patient requires careful consideration. This thesis evaluates mortality, morbidity, and prosthetic valve function after AVR with different aortic valve prostheses. Methods and Results Study I We studied all-cause mortality and postoperative outcomes in all 1219 patients who underwent AVR at Karolinska University Hospital between 2002 and 2010 and received either Perimount (n=864; Edwards Lifesciences, Irvine, CA) or Mosaic (n=355; Medtronic, Inc., Minneapolis, MN) bioprostheses. There was no difference in all-cause mortality (adjusted hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.65-1.11) or rate of aortic valve reoperation between the two groups. Severe prosthesis-patient mismatch (PPM) was more common in the Mosaic group than in the Perimount group (15% vs. 6%, p<0.001). Study II We studied hemodynamic function and postoperative outcomes in all 355 patients who underwent AVR at Karolinska University Hospital between 2002 and 2008 and received a Mosaic bioprosthesis. The mean pressure gradient was 21.2 mmHg and 22.5 mmHg during early and late echocardiography, respectively. Moderate or severe PPM was found in 299 (84%) patients, and 46 patients had moderate or severe aortic stenosis at late echocardiography, but neither was associated with increased mortality. Study III We studied all-cause mortality and postoperative outcomes in all 4545 patients aged 50-69 years who underwent primary, isolated AVR with biological (n=1832) or mechanical (n=2713) prostheses in Sweden between 1997 and 2013. The study population was obtained from the SWEDEHEART register. In a propensity score-matched analysis, patients with mechanical valve prostheses had better survival than patients with bioprostheses (HR 1.34, 95% CI 1.09-1.66, p=0.006). There was no difference in the rate of stroke, but patients with mechanical valves had a higher risk of major bleeding events and a lower risk of aortic valve reoperation than patients with bioprostheses. Study IV We studied all-cause mortality and postoperative outcomes in all 13 102 patients with moderately reduced (n=3266), or normal (n=9836) kidney function who underwent primary AVR in Sweden between 1997 and 2013. The study population was obtained from the SWEDEHEART register. Patients with normal kidney function had better survival than patients with moderately reduced kidney function (adjusted HR 1.28, 95% CI 1.18-1.38). Patients with moderately reduced kidney function had a slightly higher risk of major bleeding events and a lower risk of aortic valve reoperation than patients with normal kidney function. Study V We studied the incidence of prosthetic valve endocarditis (PVE) in all 26 580 patients who underwent AVR with biological (n=16 426) or mechanical (n=10 154) prostheses in Sweden between 1995 and 2012. The study population was obtained from the SWEDEHEART register. The incidence rate of PVE was 0.57% (95% CI 0.54-0.61) per person-year. The incidence of PVE was highest during the first year after surgery and remained stable thereafter for up to 18 years of follow-up. The risk of PVE was higher in patients with bioprostheses than in patients with mechanical valve prostheses (adjusted HR 1.54, 95% CI 1.29-1.83, p<0.001). Study VI We performed a systematic review and meta-analysis evaluating all-cause mortality after AVR in 49 190 patients who received bovine (n=32 235) versus porcine (n=16 955) bioprostheses. In total, seven articles met the inclusion criteria. The random-effects model was used to obtain pooled HR and 95% CI. The metaanalysis revealed no difference in survival between the groups (pooled HR 1.00, 95% CI 0.92-1.09). Conclusions [1] Both the Perimount and Mosaic bioprostheses are acceptable valve alternatives for AVR. [2] In patients aged 50-69 years, survival after AVR was better for those who received mechanical valve prostheses rather than bioprostheses. [3] After AVR, patients with moderately reduced kidney function have higher mortality than patients with normal kidney function. [4] After AVR, the yearly rate of PVE was 0.57%. Patients with bioprostheses had a higher risk of PVE than that of patients with mechanical valves. [5] Both bovine and porcine bioprostheses are acceptable valve choices for AVR. LIST OF SCIENTIFIC PAPERS I. Glaser N, Franco-Cereceda A, Sartipy U. Late survival after aortic valve replacement with the Perimount versus the Mosaic bioprosthesis.

The Annals of Thoracic Surgery, Aug 1, 2013

Modern extracorporeal membrane oxygenation support has revolutionized the survival outcome of cri... more Modern extracorporeal membrane oxygenation support has revolutionized the survival outcome of critically ill patients with refractory cardiac failure. Mitral valve replacement in patients treated with extracorporeal membrane oxygenation poses a surgical challenge regarding the choice of appropriate prosthesis. We present two cases of mitral valve bioprosthetic failure within days to weeks after valve replacement. Both patients were supported with extracorporeal membrane oxygenation postoperatively, and the bioprosthetic failure was caused by fusion of the cusps. This mechanism of mitral valve bioprosthetic failure in combination with extracorporeal membrane oxygenation treatment has not previously been described.

Interactive Cardiovascular and Thoracic Surgery, Jul 12, 2014

OBJECTIVES: The objective was to evaluate the long-term haemodynamic performance of the Mosaic ao... more OBJECTIVES: The objective was to evaluate the long-term haemodynamic performance of the Mosaic aortic bioprosthesis. Secondary objectives were to investigate the long-term survival, the rate of aortic valve reoperations, and the rate of prosthesis-patient mismatch and its effect on long-term survival. METHODS: We included all patients who underwent aortic valve replacement with a Mosaic bioprosthesis at our institution between 2002 and 2008. Valve haemodynamics were assessed by transthoracic echocardiography as mean and peak pressure gradients. Patient characteristics and outcomes were collected from charts and national registers. RESULTS: We included 355 patients and echocardiographic evaluation was performed at early follow-up in 340 patients (96%) and at late follow-up in 161 patients (45%). The mean follow-up time was 7.1 (maximum 11.7) years. The unadjusted survival at 1, 5 and 10 years was 92, 79 and 42%, respectively. At the early postoperative echocardiography, the peak pressure gradient was 39.9 mmHg (SD 14.4) and the mean pressure gradient was 21.1 mmHg (SD 7.7) and, on late echocardiography, the peak pressure gradient was 38.6 mmHg (SD 15.6) and the mean pressure gradient was 22.5 mmHg (SD 10.1). Moderate or severe prosthesis-patient mismatch was found in 250 (70%) and 49 patients (14%), respectively, but was not significantly associated with mortality in multivariable analyses. CONCLUSIONS: We found that the Mosaic aortic bioprosthesis had acceptable clinical performance at late follow-up. However, a substantial proportion of patients had high transvalvular gradients or moderate or severe prosthesis-patient mismatch, although neither were significantly associated with long-term survival in our population.

JAMA network open, Mar 7, 2022

IMPORTANCE The performance of bioprosthetic aortic valves is usually assessed in single valve mod... more IMPORTANCE The performance of bioprosthetic aortic valves is usually assessed in single valve models or head-to-head comparisons. National databases or registries offer the opportunity to investigate all available valve models in the population and allows for a comparative assessment of their performance. OBJECTIVE To analyze the long-term rates of reintervention, all-cause mortality, and heart failure hospitalization associated with commonly used bioprosthetic aortic valves and to identify valve model groups with deviation in clinical performance. DESIGN, SETTING, AND PARTICIPANTS This population-based, nationwide cohort study included all adult patients who underwent surgical aortic valve replacement (with or without concomitant coronary artery bypass surgery or ascending aortic surgery) in Sweden between January 1, 2003, and December 31, 2018. Patients were identified from the SWEDEHEART (Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) registry. Patients with concomitant valve surgery, previous cardiac surgery, and previous transcatheter valve replacement were excluded. Follow-up was complete for all participants. Data were analyzed from March 9, 2020, to October 12, 2021. EXPOSURES Primary surgical aortic valve replacement with the Perimount, Mosaic/Hancock, Biocor/Epic, Mitroflow/Crown, Soprano, and Trifecta valve models. MAIN OUTCOMES AND MEASURES The primary outcome was cumulative incidence of reintervention, defined as a subsequent aortic valve operation or transcatheter valve replacement. Secondary outcomes were all-cause mortality and heart failure hospitalization. Regression standardization and flexible parametric survival models were used to account for intergroup differences. Mean follow-up time was 7.1 years, and maximum follow-up time was 16.0 years. RESULTS A total of 16 983 patients (mean [SD] age, 72.6 [8.5] years; 10 685 men [62.9%]) were included in the analysis. The Perimount valve model group had the lowest and the Mitroflow/Crown valve model group had the highest cumulative incidence of reintervention. The estimated cumulative incidence of reintervention at 10 years was 3.6% (95% CI, 3.1%-4.2%) in the Perimount valve model group and 12.2% (95% CI, 9.8%-15.1%) in the Mitroflow/Crown valve model group. The estimated incidence of reintervention at 10 years was 9.3% (95% CI, 7.3%-11.3%) in the Soprano valve model group. CONCLUSIONS AND RELEVANCE Results of this study showed that the Perimount valve was the most commonly used and had the lowest incidence of reintervention, all-cause mortality, and heart failure hospitalization, whereas the Mitroflow/Crown valve had the highest rates. These findings (continued) Key Points Question Are the rates of reintervention, all-cause mortality, and heart failure hospitalization different between commonly used bioprosthetic aortic valves? Findings In this cohort study of 16 983 patients who underwent primary surgical aortic valve replacement in Sweden between 2003 and 2018, the Perimount valve model group had a significantly lower cumulative incidence of reintervention, all-cause mortality, and heart failure hospitalization, whereas the Mitroflow/Crown valve model group had significantly higher rates; the Soprano valve model group also had an increased incidence of reintervention.

The Journal of Thoracic and Cardiovascular Surgery

Objectives: Our objective was to examine intermediate-term survival and reinterventions in unsele... more Objectives: Our objective was to examine intermediate-term survival and reinterventions in unselected patients, stratified according to indication, who received a Freestyle (Medtronic Inc, Minneapolis, Minn) bioprosthesis as a full aortic root replacement. Methods: Data from medical records were retrospectively collected for patients who had aortic root replacement using Freestyle bioprostheses between 1999 and 2018 at 6 North-Atlantic centers. Survival status was extracted from national registries and results stratified according to indication for surgery. PERSPECTIVE This study provides support for the use of the Freestyle (Medtronic Inc, Minneapolis, Minn) bioprosthesis in the diverse indications in the realworld setting of often high-risk aortic root replacement. Our data corroborate the notion that indication influences outcome greatly and show that prosthesis characteristics are compatible with intermediate-term survival in low-risk cases corresponding to the general population.