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Objective: To evaluate the long-term outcomes of heart valve replacement with mechanical prosthesis (MP) versus bioprosthesis (BP) in patients on dialysis., Methods: A retrospective review was performed at 7 hospitals. Patients on dialysis who underwent valve replacement were included. Survival, reoperation, bleeding, and embolic events were compared across the MP and BP groups., Results: Between April 2000 and April 2016, 312 patients on dialysis were enrolled in our study (MP: 94 patients [30.1%], BP: 218 patients [69.9%]). Mean follow-up was 3.4 ± 3.6 years. Five-year and 10-year survival rates were similar in both groups (MP: 57.4 ± 5.5% at 5 years and 46.3 ± 6.4% at 10 years, BP: 50.2 ± 4.1% at 5 years and 38.8 ± 4.5% at 10 years, P = .305). Multivariate Cox hazard analysis demonstrated that diabetic nephropathy (hazard ratio [HR], 1.90; 95% confidence interval [CI], 1.31-2.73, P < .001), New York Heart Association functional classification ≥III (HR, 2.16; 95% CI, 1.37-3.35, P = .001), and mitral valve replacement (HR, 2.36; 95% CI, 1.58-3.49, P < .001) were significant risk factors for late death. Valve selection was not a significant risk factor. Freedom from valve-related embolic event at 5 years was significantly lower in the MP group (MP: 88.3 ± 4.3% at 5 years, BP: 97.2 ± 1.6% at 5 years, P = .007). Freedom from valve-related reoperation or hemorrhagic events was similar across both groups., Conclusions: Valve selection was not associated with late survival outcomes in patients on dialysis. However, BP may have an advantage in preventing embolic events without increasing the incidence of valve-related reoperation when compared with MP., (Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

Objectives: To improve the clinical outcome of patients with severe functional mitral regurgitation (FMR) associated with ischemic cardiomyopathy (ICM), we compared the therapeutic efficacy of mitral annuloplasty (MAP) with that of mitral valve replacement (MVR)., Methods: In a retrospective observation 63 consecutive patients underwent mitral valve surgery for severe ICM-FMR from November 1999 to March 2012. All patients had severe FMR (regurgitant volume >60 ml/beat) with Carpentier type I and type IIIb disease. Mean RV was 74.0 ± 35.0 ml/beat and coaptation depth was 12.7 ± 3.0 mm. Twenty-six patients (41.3 %) were treated by MVR with sparing of the subvalvular apparatus and 37 (58.7 %) by MAP., Results: Total in-hospital mortality was 6.3 %. Kaplan-Meier survival estimates at 1 and 5 years were 84.2 and 78.6 % in the MVR group and 82.6 and 71.6 % in the MAP group, with no significant difference between groups (p = 0.758). Freedom from major adverse cardiac and cerebrovascular events (MACCE) at 5 years was 66.9 % for patients treated by MVR and 64.1 % for those treated by MAP (p = 0.866). At the last follow-up visit, >grade II MR had recurred in 4 annuloplasty patients (10.8 %). In multivariate analysis, independent predictors of increased late death and MACCE were significantly associated with residual pulmonary hypertension (late death: odds ratio = 25.0, p = 0.0009; MACCE: odds ratio = 31.3, p = 0.0001)., Conclusions: Mitral valve replacement with sparing of the subvalvular apparatus is a safe and effective surgical alternative for patients with severe FMR.

Background: The purpose of this study is to compare mitral valve replacement (MVR) to anuloplasty (MAP) in patients with severe functional mitral regurgitation (FMR)., Methods: Data of 43 patients with significant chronic FMR who underwent mitral valve operations from November 1999 through May 2011 were retrospectively analyzed. This reference group included patients who underwent MVR (n = 18) and MAP (undersized restrictive annuloplasty, n = 25). The mitral valve is replaced sparing the continuity between mitral valve and subvalvular apparatus. All patients had severe FMR, and 71.4% had New York Heart Association (NYHA) III or IV symptoms of heart failure, and 20% had preoperative intraaortic balloon pumping (IABP) insertion. The MVR group had significantly higher risk patients with complex jet and advanced coaptation depth (13.3 +/- 2.1 versus 11.1 +/- 2.3 mm, p = 0.04)., Results: Hospital mortality was 9.3%. No statistical difference was found between the 2 groups in term of intraoperative data. Kaplan-Meier survival estimates at 1, 5 years was 82.6, 72.3% in MVR group, and 77.8, 69.7% in MAP group (p = 0.98). Freedom from Cardiac-related event at 5 years was 62.7% for MVR compared to 56.8 % for MAP (p = 0.75). At the last follow-up, recurrence of MR II or greater was present in 4 (14.8%) patients in the MAP group and only one patient required re-operation because of worsening heart failure. In multivariable analysis, independent predictor of increased cardiac-related event was associated with residual pulmonary hypertension (HR, 3.0: p = 0.021)., Conclusions: In high-risk patients with severe FMR. MVR seems to be a reasonable option.

Background: Severe aortic valve stenosis is relatively more prevalent in patients with repeated bleeding episodes. The goal of the present study was to determine the effect of aortic valve replacement on von Willebrand factor levels in patients with aortic stenosis., Methods: von Willebrand factor levels were assessed by using immunoblotting electrophoresis techniques before and 1 month after surgery in 29 consecutive patients with severe aortic valve stenosis., Results: Eight of 29 patients reported episodes of bleeding, including three episodes of major bleeding, in the 6 months before surgery. None of the patients were receiving anticoagulation therapy. Although there was no difference in platelet count before and after surgery, von Willebrand factor levels were significantly greater at 1 month after surgery (p = 0.05) when compared with preoperative values. Further, von Willebrand factor levels were significantly lower in patients with aortic valve prosthesis mismatch than in those patients without this phenomenon (p < 0.05). Electrophoresis experiments showed a deficit in large multimers of von Willebrand factor preoperatively but not postoperatively, except for in those patients with aortic valve prosthesis mismatch., Conclusions: In conclusion, valve replacement can result in increases in von Willebrand factor in patients with aortic valve stenosis.

This study compared the outcomes of combined coronary artery bypass grafting (CABG)/aortic valve replacement (AVR) and CABG alone in patients with moderate aortic stenosis and determined the possible indications for AVR at the time of CABG. Between December 1988 and January 2001, in Tenri Hospital, 41 patients with aortic stenosis underwent CABG: 26 patients underwent the combined procedure and 15 patients underwent CABG alone. The patients who underwent CABG alone were separated them into 2 groups on the basis of the results of annual echocardiography: the rapid progression group, defined by an increase of deltaP by >/=10 mmHg/year, and the slow progression group. Of the 15 patients who underwent CABG alone, the probability of survival at the end of the study in 2001 was 92% at 5 years and 74% at 10 years, and the respective event-free rates were 65% and 50%. Patients less than 70 years old and who were in the rapid progression group had a greater risk for re-operation. The study suggests that patients younger than 70 years old with risk factors for rapid progression should undergo CABG/AVR, and conversely, those older than 70 years old without the risk factors can undergo CABG only.