138 Can patient safety and outcomes be preserved during learning curve for an innovative surgical procedure? the early results of wolverhampton aortic valve repair programme (original) (raw)
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Contemporary Trends in Aortic Valve Surgery:. A Single Centre 10-Year Clinical Experience*
Journal of Cardiac Surgery, 2004
The purpose of this study is to present a comprehensive profile of the trends in aortic valve replacement at a single institution over the past decade. Prospectively collected data concerning 873 patients undergoing aortic valve replacement (AVR), with and without coronary artery bypass grafting (CABG), were analysed. The patients were divided into three time periods: period I, (1990 to 1993); period II, (1994 to 1996); and period III, (1997 to 2000). Actuarial survival of AVR patients with and without CABG at 7 years was 82.9 ± 2.4% and 79.1 ± 3.3% (p = 0.17), respectively. Actuarial survival at 7 years for stentless, mechanical, and stented valve patients were 89.5 ± 2.7%, 85.5 ± 2.8%, and 76.0 ± 3.2%, respectively. There was a significant difference in survival between the stentless and stented valve groups (p = 0.014). Age (63.8 ± 12.9 yrs, 66.2 ± 11.0 yrs, 67.9 ± 10.3 yrs; p = 0.01), the incidence of peripheral vascular disease (5.1%, 10.8%, 16.6%; p = 0.001), and the extent of coronary artery disease necessitating CABG (34.0%, 38.8%, 41.0%; p = 0.05) have increased significantly in the later time period. However, operative mortality has remained constant (4.7%, 4.8%, 4.5%; p = 0.9). Moreover, perioperative complications have decreased significantly (27.4%, 18.0, 16.0%; p = 0.001). Multivariate analysis identified more recent time period as independent protective factor for early mortality and morbidity (period I, RR 1.00; period II, RR 0.47; period III, RR 0.40from the analysis. Clinical, operative, and outcome data were collected in a computerized database.
The Journal of Thoracic and Cardiovascular Surgery, 2011
Objectives: Aortic valve replacement is accepted as a standard treatment for aortic stenosis and regurgitation. To help plan the national requirement for conventional and catheter-based procedures, we have analyzed the Society for Cardiothoracic Surgery in Great Britain and Ireland audit database to look at changes in practice over time. Methods: All patients undergoing conventional aortic valve replacement with or without coronary artery surgery from April 2004 to March 2009 were included. The main outcome measures were changes in the number, characteristics, operative details, and in-hospital mortality. We have looked particularly at trends and outcomes in elderly and high-risk patients (EuroSCORE of 10 or more) who may now be considered for percutaneous aortic valve insertion. Results: A total of 41,227 patients underwent aortic valve surgery over 5 years with an in-hospital mortality of 4.1%. The annual number increased from 7396 in 2004-2005 to 9333 in 2008-2009, with significant increases (P<.0005) in mean age (68.8-70.2 years), the proportion of patients with aortic stenosis (62.4%-65.1%), octogenarians (13.6%-18.4%), high-risk patients (24.6%-27.7%), and those receiving biological valves (65.4%-77.8%). The incidence of permanent cerebrovascular accident was 1.2% and 1.0% in patients having only an aortic valve replacement. The dialysis rate was 4.5% and the reoperation rate for bleeding was 6.6%. Overall mortality decreased from 4.4% in 2004-2005 to 3.7% in 2008-2009. Survival to a mean follow-up of 2.5 years was 89%. Conclusions: We have seen a large increase in annual volume of aortic valve replacements, with more patients undergoing surgery for aortic stenosis and an increase in surgery in the elderly and high-risk patients.
What the cardiac surgeon needs to know prior to aortic valve surgery: impact of echocardiography
European Journal of Cardio-Thoracic Surgery, 2009
Echocardiographic assessment prior to valve surgery is crucial for clinical decision making, timing of surgery, planning the adequate surgical therapy and predicting the patient's outcome. Description of transvalvular velocities is not enough for sending a patient to the operating room. There are specific functional and morphological characteristics of each valve dysfunction that have to be addressed by the echocardiographer prior to surgery. Evaluation of the aortic valve, annulus, root, ascending aorta, left ventricular outflow tract and left ventricular function are important. In knowing these characteristics the surgeon may choose the appropriate valve and operation techniques and assess the need for additional surgical procedures. A detailed evaluation of valve morphology and function in context with cardiac hemodynamics should be achieved during echocardiography. This step-by-step evaluation allows the correct diagnosis and classification of patient's outcome. In conclusion, an echohemodynamic approach enables the cardiac surgeon to plan and perform the adequate surgical procedure.
Can the results of contemporary aortic valve replacement be improved?
The Journal of Thoracic and Cardiovascular Surgery, 1986
Can the results of contemporary aortic valve replacement be improved? Although the results of contemporary aortic valve replacement are excellent, cardiac surgeons mest identify the factors that predictpostoperative morbidity and mortalityto develop alternative strategiesfor high-risk patients. Two hundred seventy-seven consecutive patients Undergoing isolated aortic valve replacement between 1982 and 1984 were evaluated. Thirty-seven c6nical and 13 preoperative hemodynamic variables were analyzed by univariate and multivariate statistics to determine the risk factors for postoperativ~morbidity and mortality. The operative mortality was 3 %, the incidence of a postoperative lowoutput syndrome was 12%, and the incidence of a perioperative myocardial infarction was 5%• A multivariate: logistic regression analysis found that age was the onlyindependent predictorof mortality. Three factors independently predicted postoperative lowoutput syndrome: age, the presence of coronary artery disease, and the peak systolic gradient in patients with aortic stenosis. Patients with aortic stenosis had a higher incidence of postoperative ventricular dysfunction (17%) than those with mixed valvular disease (9%) or aortic regurgitation (5%~Perioperative myocardial infarction was predicted by the extent of coronary artery disease. the incidence of perioperative myocardial infarction was higher in patients with triple-vessel coronary artery disease (13%) and those with left main stenosis (18 %) than in patientswithsingle-or double-vessel disease (4%) or those without coronaryartery disease (4 %~Because of the higherrisk of aortic valve replacement in older patients, the risk-benefit ratio of the operation must be carefully assessed in the elderly. Improved methods of myocardial protection may reduce the risks for patients with aortic stenosis and symptomatic triple-vessel coronary artery disease.
Aortic valve repair: a ten-year single-centre experience†
Interactive cardiovascular and thoracic surgery, 2014
Aortic valvuloplasty could represent an alternative to valve replacement resulting in optimal haemodynamic conditions, avoiding anticoagulation and allowing, in young people, normal aortic annulus growth. We analysed our results of aortic valve repair for incompetence due to leaflets and root pathology. From January 2003 to January 2013, 235 patients affected by aortic valve regurgitation, pure or associated with aortic dilatation, were treated with a combination of the principal leaflet repair techniques and, when necessary, sparing procedures. Of these patients, 218 were considered eligible in this study. All of them were submitted to pre- and postoperative transthoracic echocardiography and pre- and post-repair transoesophageal echocardiography. Follow-up was achieved with periodic echocardiograms and clinical evaluations. Eight patients (3.40%) died before discharge. Median clinical and echocardiographic follow-up for all patients was 2.94 (1.41-5.41) years. Mean cross-clamping ...
Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology, 2017
Aortic stenosis is the most prevalent type of valvular disease in Europe. Surgical aortic valve replacement (SAVR) is the standard therapy, while transcatheter aortic valve implantation (TAVI) is an alternative in patients at unacceptably high surgical risk. Assessment by a heart team is recommended by the guidelines but there is little published evidence on this subject. The purpose of this paper is to describe the experience of a multidisciplinary TAVI program that began in 2008. The heart team prospectively assessed 473 patients using a standardized approach. A total of 214 patients were selected for TAVI and 80 for SAVR. Demographic, clinical and procedural characteristics and long-term success rates were compared between the groups. TAVI patients were older than the SAVR group (median 83 vs. 81 years), and had higher surgical risk scores (median EuroSCORE II 5.3 vs. 3.6% and Society of Thoracic Surgeons score 5.1 vs. 3.1%), as did the patients under medical treatment only. Thes...
Initial Surgical Experience with Aortic Valve Repair - Clinical and Echocardiographic Results
Brazilian Journal of Cardiovascular Surgery, 2016
Introduction: Due to late complications associated with the use of conventional prosthetic heart valves, several centers have advocated aortic valve repair and/or valve sparing aortic root replacement for patients with aortic valve insufficiency, in order to enhance late survival and minimize adverse postoperative events. Methods: From March/2012 thru March 2015, 37 patients consecutively underwent conservative operations of the aortic valve and/or aortic root. Mean age was 48±16 years and 81% were males. The aortic valve was bicuspid in 54% and tricuspid in the remaining. All were operated with the aid of intraoperative transesophageal echocardiography. Surgical techniques consisted of replacing the aortic root with a Dacron graft whenever it was dilated or aneurysmatic, using either the remodeling or the reimplantation technique, besides correcting leaflet prolapse when present. Patients were sequentially evaluated with clinical and echocardiographic studies and mean follow-up time was 16±5 months. Results: Thirty-day mortality was 2.7%. In addition there were two late deaths, with late survival being 85% (CI 95%-68%-95%) at two years. Two patients were reoperated due to primary structural valve failure. Freedom from reoperation or from primary structural valve failure was 90% (CI 95%-66%-97%) and 91% (CI 95%-69%-97%) at 2 years, respectively. During clinical follow-up up to 3 years, there were no cases of thromboembolism, hemorrhage or endocarditis. Conclusions: Although this represents an initial series, these data demonstrates that aortic valve repair and/or valve sparing aortic root surgery can be performed with satisfactory immediate and short-term results.
BMJ Open, 2021
Objectives To date the reported outcomes of surgical aortic valve replacement (SAVR) are mainly in the settings of trials comparing it with evolving transcatheter aortic valve implantation. We set out to examine characteristics and outcomes in people who underwent SAVR reflecting a national cohort and therefore ‘real-world’ practice. Design Retrospective analysis of prospectively collected data of consecutive people who underwent SAVR with or without coronary artery bypass graft (CABG) surgery between April 2013 and March 2018 in the UK. This included elective, urgent and emergency operations. Participants’ demographics, preoperative risk factors, operative data, in-hospital mortality, postoperative complications and effect of the addition of CABG to SAVR were analysed. Setting 27 (90%) tertiary cardiac surgical centres in the UK submitted their data for analysis. Participants 31 277 people with AVR were identified. 19 670 (62.9%) had only SAVR and 11 607 (37.1%) had AVR+CABG. Resul...