Choose an application

• Reference Manager
• EndNote
• RefWorks (Direct export to RefWorks)

Introduction: Surgical aortic valve replacement for patients with aortic valve disease can be performed with a bioprosthetic or mechanical valve. The use of bioprosthetic valves has increased, making durability an important concern. The Trifecta valve is a third generation bioprosthetic valve, of which we recently encountered a cluster of patients with structural valve degeneration. Patients and methods: First a literature review was performed in order to obtain background information. Then, all patient who had been treated with a Trifecta valve were identified. We reviewed their medical records, follow-up, echocardiographic results and survival. Results: Between November 2010 and June 2017 a total of 301 Trifecta valves were implanted. The mean age of patients was 75,1 years (standard deviation 7,5 years) and concomitant surgery was performed on 57,5% of the patients. Overall survival after one year and five years following surgery was 94,3% and 74,8%, respectively. Reoperation-free survival at one-year and five years following implantation was 98,1% (262/267) and 96,7% (89/92), respectively. The mean post-operative gradients ranged from 13,8 mmHg for the 19 mm valve to 7,1 mmHg for the 27 mm valve. We encountered seven cases of structural valve degeneration with a mean durability of 61 months (standard deviation 8,7 months). Discussion: The Trifecta valve has proven an excellent hemodynamic performance on the short- and mid-term. But early structural valve degeneration as reported in our hospital and published articles might become an issue on the long term. We suggest continuous follow-up of Trifecta patients with special attention for symptoms of valve failure.

Choose an application

• Reference Manager
• EndNote
• RefWorks (Direct export to RefWorks)

Context: TAVR is currently an acceptable treatment option for patients with symptomatic aortic stenosis at very high, high and intermediate surgical risk but has been creeping into even lower risk patient population in the last years. Solid evidence is lacking to support TAVR in low-risk patients as alternative to SAVR as results have been equivocal. Objective: This systematic review aims to investigate current and updated evidence on TAVR vs. SAVR outcomes in low and intermediate surgical risk patient groups by analysing metaanalysis, observational studies and randomized controlled trials on this topic. Data Sources: PubMed, EMBASE, Cochrane, Web of Science and clinicaltrials.gov were systematically searched. Study Selection: One reviewer conducted the eligibility process in a systematic manner. A total of 14 meta-analysis were finally included along with 3 RCT and 9 observational studies. Data Extraction and Synthesis: Baseline characteristics and relevant outcomes were extracted systematically from all included studies. Data was then summarized and presented as HR, OR or RR on forest plots. Results and conclusions: No significant differences were found between SAVR and TAVR in lower risk patient groups in myocardial infarction, stroke or all-cause death. TAVR performed worse than SAVR in terms of paravalvular leak, pacemaker implantation, and re-intervention.

Choose an application

• Reference Manager
• EndNote
• RefWorks (Direct export to RefWorks)

Background: Antegrade selective cerebral perfusion (ASCP) has recently been established as the preferred cerebral protection technique during aortic arch surgery without a general consensus regarding its superiority. The aim of this review was to asses its protective effects in comparison with the alternative cerebral protection strategies, the optimal temperature management and the adequacy of unilateral perfusion (uASCP). Method: A literature search was conducted in the PubMed database. Mortality, permanent and neurologic deficit (PND and TND) and other postoperative outcomes were extracted for data-analysis. The mean mortality, PND and TND were computed for sub-analyses. No statistical analysis was performed to evaluate significance. Results: Twenty-two articles were included. Retrograde cerebral perfusion (RCP) resulted in comparison with ASCP and deep hypothermic circulatory arrest (DHCA) in the lowest incidence of mortality (7.17% vs. 8.22% vs. 12.81% resp.), PND (7.23% vs. 7.70% vs. 10.49% resp.) and TND (4.43% vs. 4.52% vs. 6.74% resp.), but only ASCP showed a significant decrease in individual studies. Moderate HCA (MHCA) resulted in comparison with DHCA in the lowest incidence of mortality (9.7% vs. 12.37% resp.), PND (5.8% vs. 6.02% resp.) and TND (8.88% vs. 10.03% resp.). The studies of uASCP vs. bilateral ASCP had contradictory results, but uASCP resulted overall in a lower mortality rate (3.5% vs. 4.59% resp.) and PND rate (2.45% vs. 4.95% resp.) Conclusion: We conclude that ASCP with moderate HCA is a safe and valid alternative cerebral protection strategy and should be preferred especially in extensive aortic arch surgery. Unilateral ASCP is safe in restricted conditions, but conversion to bilateral ASCP should be considered otherwise.

Choose an application

• Reference Manager
• EndNote
• RefWorks (Direct export to RefWorks)

OBJECTIVE: The study aim was to compare in-hospital morbidity and mortality of a new aortic valve repair program in UZ Leuven with the clinical results of prosthetic valves in patients with severe aortic insufficiency. METHODS: Twenty-nine patients who underwent aortic valve repair were compared to 33 patients who underwent aortic valve replacement from 2013 to 2017. Propensity score matching yielded 2 groups of 12 matched patients. Patient follow-up was complete until discharge and inserted into the AVIATOR database. RESULTS: All patients survived surgery. One patient in the repair group underwent reoperation for AV nodal re-entrant tachycardia. There were no other serious complications. Average extracorporeal circulation time and average aortic crossclamp time were significantly longer in the repair group than in the replacement group (p < 0.001). Hospital stay, ICU stay and echographic outcome data proved no significant difference between both groups. CONCLUSION: The early results of our new aortic valve repair program are satisfying. Except for longer surgery duration, both valve replacement and valve-sparing procedures show comparable short-term results in patients with severe aortic insufficiency. However, more patient data and longer follow-up are required to evaluate long term mortality and morbidity.

Choose an application

• Reference Manager
• EndNote
• RefWorks (Direct export to RefWorks)

ABSTRACT INTRODUCTION Acute Type A Aortic dissection (AAAD) is a dangerous cardiovascular emergency. Debate still rages about the optimal type and extend of the surgery, both on the distal and proximal end of the tear. Often at the proximal side of the tear, the aortic root is also afflicted. Standard procedure then is use of composite valve-graft replacement (Bentall procedure). Recently, there is increasing use of valve-sparing root replacement (VSRR) techniques (either Yacoub remodeling or David reimplantation) in AAAD in selected patients. We compare VSRR to the Bentall procedure. METHODS Using PRISMA guidelines, we searched PubMed and identified 1678 studies. 10 were included in our review. We compared mean age, early mortality, 5-year survival and rate of reoperation. RESULTS Mean age was lower in the VSRR, but only significant in 1 study. Early mortality and 5-year survival were comparable. There were more reoperations in the VSRR group. DISCUSSION Sceptics of VSRR procedures argue that the higher complexity of VSRR procedures makes it to dangerous in AAAD. Early mortality didn’t indicate that in carefully selected patients. Indicating that surgeons make the appropriate choice within their capabilities when they opt VSRR over Bentall. Another concern is the higher reoperation rate which would also be a higher risk of death later. The data suggest that the increased number of reoperations doesn’t impact late survival. We couldn’t identify any higher risk of opting into VSRR over Bentall in correctly chosen patients. CONCLUSION In correctly selected patients, VSRR is a viable alternative to Bentall in AAAD.