Search

Objectives: The clinical implications of finding immobile leaflet(s) at the time of bioprosthetic valve implantation but with acceptable prosthetic haemodynamics are uncertain. We sought to determine the characteristics of such patients and their impact on outcome., Methods: Patients with immobile leaflet at the time of surgical bioprosthetic valve implantation were identified retrospectively by a systematic search of an institutional echocardiography database (2010-2020). Intraoperative echocardiograms were reviewed de-novo to confirm immobile leaflet(s) at the time of implantation. Cases were matched 1:2 to controls with normal bioprosthetic leaflets motion for age, sex, prosthesis position, prosthesis model, size, year of implantation, and pre-implantation left ventricular ejection fraction. Proportional hazards method was used to analyse the composite endpoint of stroke, valve thrombosis or re-intervention., Results: Immobile leaflet at the time of bioprosthetic valve implantation were found in 26 patients (median age 71 ys 39% males) following tricuspid (n=13), mitral (n=11) and aortic (n=2) valve replacements; 96% received porcine prostheses; prosthesis size was 27 mm or larger in 92%. Immobile leaflet were recorded on intraoperative reports in 16 (62%) cases. It resulted in elevated gradient or mild-moderate prosthetic regurgitation in three (12%), but none led to immediate corrective action intraoperatively. At median follow-up of 21 (4-50) months, presence of immobile leaflet was associated with composite clinical endpoint of stroke, valve thrombosis or re-intervention (hazard ratio 6.8, 95% CI 1.8-25.2, p<0.01) compared to controls., Conclusion: Immobile leaflet immediately post-bioprosthetic valve implantation is frequently under-recognised intraoperatively and appears to be associated with early bioprosthetic dysfunction and worse clinical outcome., (Copyright © 2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.)

Background: This study sought to determine the outcome effect of concomitant tricuspid valve operation for regurgitation during pericardiectomy for constrictive pericarditis., Methods: This cohort study included 310 patients with mild or greater tricuspid valve regurgitation who underwent pericardiectomy for constrictive pericarditis from 2000 to 2016 at the Mayo Clinic in Rochester, Minnesota. Patients were divided into 2 treatment groups: tricuspid valve operation (n = 68) and no tricuspid operation (n = 242). Survival analysis, proportional odds models, and landmark analysis were carried out to estimate the treatment effects of tricuspid valve operation., Results: Tricuspid valve regurgitation was graded mild in 203 (65%) patients, moderate in 69 (22%), and severe in 38 (12%). Tricuspid valve operation included repair in 54 patients (17%) and replacement in 14 (5%). Mechanical circulatory support was used more commonly in the intervention group (15% vs 5%; P = .009), but rates of stroke (3% vs 2%; P = .210) and mortality (9% vs 6%; P = .422) were similar. Tricuspid valve intervention resulted in a reduced risk of long-term mortality (hazard ratio, 0.68; 95% confidence interval [CI], 0.38 to 1.21; P = .192), less than moderate tricuspid valve regurgitation at follow-up (odds ratio vs moderate or severe, 0.093; 95% CI, 0.04 to 0.19), and less than moderate right ventricular enlargement at follow-up (odds ratio vs moderate or severe, 0.67; 95% CI, 0.35 to 1.24). Remnant severe right ventricular dysfunction resulted in increased risk of mortality (hazard ratio vs none or trivial, 4.87; 95% CI, 1.10 to 21.65; P = .037)., Conclusions: Concomitant tricuspid valve operation for regurgitation can be performed without increased operative mortality during pericardiectomy for constrictive pericarditis. Operation appears protective against long-term mortality, residual tricuspid regurgitation, and right ventricular enlargement., (Copyright © 2021 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: Symptoms and survival of patients with carcinoid syndrome have improved, but development of carcinoid heart disease (CaHD) continues to decrease survival., Objectives: This study aimed to analyze patient outcomes after valve surgery for CaHD during a 27-year period at 1 institution to determine early and late outcomes and opportunities for improved patient care., Methods: We retrospectively studied the short-term and long-term outcomes of all consecutive patients with CaHD who underwent valve replacement at our institution between 1985 and 2012., Results: The records of 195 patients with CaHD were analyzed. Pre-operative New York Heart Association class was III or IV in 125 of 178 patients (70%). All had tricuspid valve replacement (159 bioprostheses, 36 mechanical), and 157 underwent a pulmonary valve operation. Other concomitant operations included mitral valve procedure (11%), aortic valve procedure (9%), patent foramen ovale or atrial septal defect closure (23%), cardiac metastasectomies or biopsy (4%), and simultaneous coronary artery bypass (11%). There were 20 perioperative deaths (10%); after 2000, perioperative mortality was 6%. Survival rates (95% confidence intervals) at 1, 5, and 10 years were 69% (63% to 76%), 35% (28% to 43%), and 24% (18% to 32%), respectively. Overall mortality was associated with older age, cytotoxic chemotherapy, and tobacco use; 75% of survivors had symptomatic improvement at follow-up. Presymptomatic valve operation was not associated with late survival benefit., Conclusions: Operative mortality associated with valve replacement surgery for CaHD has decreased. Symptomatic and survival benefit is noted in most patients when CaHD is managed by an experienced multidisciplinary team., (Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Transcatheter aortic valve replacements lower mortality in patients not suitable for surgical valve replacement compared to conservative treatment. Transcatheter valve-in-valve implants have been shown to be feasible in failed bioprostheses in aortic, mitral, pulmonary and tricuspid positions. We report the first Australasian experience of a transapical mitral valve-in-valve placement with an Edwards Sapien(®) transcatheter valve for a failed mitral bioprosthesis, focussing on the technical aspects of this novel procedure. Whilst the evidence for this niche indication is limited currently to case reports and case series, further evaluation of its long term outcomes may justify its use in this particularly high risk group of re-do sternotomy patients., (Crown Copyright © 2012. Published by Elsevier B.V. All rights reserved.)