OBJECTIVE: We investigated long-term outcomes of bicuspid aortic valve (BAV) repair, with external annuloplasty, according to aorta phenotype. METHODS: Between 2003 and 2020, all patients with BAV operated on for aortic insufficiency (AI) and/or aneurysm were included. Repairs included isolated AI repair with subvalvular with or without sinotubular junction (STJ) (single or double) annuloplasty, supracoronary aorta replacement (with or without hemiroot remodeling), and root remodeling with external subvalvular ring annuloplasty. RESULTS: Among 343 patients operated, reparability rate was 81.3% (n = 279; age 46 ± 13.3 years). At 10 years (median follow-up: 3.42 years; interquartile range, 1.1, 5.8), survival was 93.9% (n = 8 deaths, similar to general population), cumulative incidence of reoperation was 6.2% (n = 10), AI grade >2 was 5.8% (n = 9), and grade >1 was 23.0% (n = 30). BAV repair stabilizing both the annulus and STJ with annuloplasty, compared with nonstabilized STJ repair (single annuloplasty), had lower incidence of reoperation (2.6% vs 22.5%, P = .0018) and AI grade >2 (1.2% vs 23.6%, P < .001) at 9 years. Initial commissural angle <160° was not a risk factor for reoperation, compared with angle ≥160° if symmetrical repair was achieved (2.7% and 4.1%, respectively, at 6 years, P = .85). Multivariable model showed that absence of STJ stabilization (odds ratio, 6.7; 95% confidence interval, 2.1-20, P = .001) increased recurrent AI, but not initial commissural angle <160° (odds ratio, 1.01; 95% confidence interval, 0.39-2.63, P = .98). Commissures adjusted symmetrically led to lower transvalvular gradient, compared with nonsymmetrical repair (8.7 mm Hg vs 10.2 mm Hg, P = .029). CONCLUSIONS: BAV repair, tailored to aorta phenotype, is associated with excellent durable outcomes if both annulus and STJ are reduced and stabilized with external ring annuloplasty. Commissural angle <160° is not associated with reoperation if symmetrical repair is achieved.
- MeSH
- anuloplastika srdeční chlopně * škodlivé účinky mortalita metody MeSH
- aortální aneurysma chirurgie diagnostické zobrazování mortalita MeSH
- aortální chlopeň chirurgie abnormality diagnostické zobrazování patofyziologie MeSH
- aortální insuficience * chirurgie patofyziologie diagnostické zobrazování mortalita MeSH
- bikuspidální aortální chlopeň * chirurgie patofyziologie MeSH
- časové faktory MeSH
- chirurgická náhrada chlopně škodlivé účinky přístrojové vybavení MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- pooperační komplikace etiologie MeSH
- reoperace statistika a číselné údaje MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVES: Class I triggers for severe and chronic aortic regurgitation surgery mainly rely on symptoms or systolic dysfunction, resulting in a negative outcome despite surgical correction. Therefore, US and European guidelines now advocate for earlier surgery. We sought to determine whether earlier surgery leads to improved postoperative survival. METHODS: We evaluated the postoperative survival of patients who underwent surgery for severe aortic regurgitation in the international multicenter registry for aortic valve surgery, Aortic Valve Insufficiency and Ascending Aorta Aneurysm International Registry, over a median follow-up of 37 months. RESULTS: Among 1899 patients (aged 49 ± 15 years, 85% were male), 83% and 84% had class I indication according to the American Heart Association and European Society of Cardiology, respectively, and most were offered repair surgery (92%). Twelve patients (0.6%) died after surgery, and 68 patients died within 10 years after the procedure. Heart failure symptoms (hazard ratio, 2.60 [1.20-5.66], P = .016) and either left ventricular end-systolic diameter greater than 50 mm or left ventricular end-systolic diameter index greater than 25 mm/m2 (hazard ratio, 1.64 [1.05-2.55], P = .030) predicted survival independently over and above age, gender, and bicuspid phenotype. Therefore, patients who underwent surgery based on any class I trigger had worse adjusted survival. However, patients who underwent surgery while meeting early imaging triggers (left ventricular end-systolic diameter index 20-25 mm/m2 or left ventricular ejection fraction 50% to 55%) had no significant outcome penalty. CONCLUSIONS: In this international registry of severe aortic regurgitation, surgery when meeting class I triggers led to postoperative outcome penalty compared with earlier triggers (left ventricular end-systolic diameter index 20-25 mm/m2 or ventricular ejection fraction 50%-55%). This observation, which applies to expert centers where aortic valve repair is feasible, should encourage the global use of repair techniques and the conduction of randomized trials.
- MeSH
- aneurysma vzestupné aorty MeSH
- aortální aneurysma chirurgie mortalita diagnostické zobrazování MeSH
- aortální chlopeň chirurgie diagnostické zobrazování patofyziologie MeSH
- aortální insuficience * chirurgie mortalita diagnostické zobrazování patofyziologie MeSH
- čas zasáhnout při rozvinutí nemoci MeSH
- časové faktory MeSH
- chirurgická náhrada chlopně škodlivé účinky mortalita MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- registrace * MeSH
- rizikové faktory MeSH
- senioři MeSH
- stupeň závažnosti nemoci MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- pozorovací studie MeSH
- srovnávací studie MeSH
Pure aortic regurgitation and dilation of aortic annulus are the most significant risk factors for the failure of pulmonary autograft after the Ross procedure. Aortic annuloplasty has a positive effect on the durability of the autograft. Previously, we described a technique for external annuloplasty with dedicated CORONEO ring. In the present manuscript, we suggest the sizing of annuloplasty based on the diameter of pulmonary autograft annulus.
- MeSH
- aortální chlopeň diagnostické zobrazování chirurgie MeSH
- aortální insuficience * diagnostické zobrazování chirurgie etiologie MeSH
- aortální stenóza * chirurgie MeSH
- autologní štěp MeSH
- autologní transplantace škodlivé účinky MeSH
- lidé MeSH
- následné studie MeSH
- plicní chlopeň * transplantace MeSH
- reoperace škodlivé účinky MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- aortální insuficience diagnostické zobrazování MeSH
- aortální stenóza chirurgie diagnostické zobrazování patofyziologie patologie MeSH
- diagnostické techniky kardiovaskulární MeSH
- echokardiografie MeSH
- fyzikální vyšetření MeSH
- hemodynamické monitorování MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- mitrální insuficience chirurgie diagnostické zobrazování patologie MeSH
- mitrální stenóza diagnóza patofyziologie MeSH
- nemoci srdečních chlopní * chirurgie diagnostické zobrazování klasifikace patologie MeSH
- srdeční chlopně umělé klasifikace MeSH
- stupeň závažnosti nemoci MeSH
- trikuspidální insuficience diagnostické zobrazování terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
BACKGROUND: Use of the current echocardiography-based indications for aortic regurgitation (AR) surgery might result in late valve replacement at the stage of irreversible myocardial damage. Therefore, we aimed to identify simple models combining multiple echocardiography or magnetic resonance imaging (MRI)-derived indices and natriuretic peptides (BNP [brain natriuretic peptide] or NT-proBNP [N-terminnal pro-B type natriuretic peptide]) to predict early disease decompensation in asymptomatic severe AR. METHODS: This prospective and multicenter study included asymptomatic patients with severe AR, preserved left ventricular ejection fraction (>50%), and sinus rhythm. The echocardiography and MRI images were analyzed centrally in the CoreLab. The study end point was the onset of indication for aortic valve surgery as per current guidelines. RESULTS: The derivative cohort consisted of 127 asymptomatic patients (age 45±14 years, 84% males) with 41 (32%) end points during a median follow-up of 1375 (interquartile range, 1041-1783) days. In multivariable Cox regression analysis, age, BNP, 3-dimensional vena contracta area, MRI left ventricular end-diastolic volume index, regurgitant volume, and a fraction were identified as independent predictors of end point (all P<0.05). However, a combined model including one parameter of AR assessment (MRI regurgitant volume or regurgitant fraction or 3-dimensional vena contracta area), 1 parameter of left ventricular remodeling (MRI left ventricular end-diastolic volume index or echocardiography 2-dimensional global longitudinal strain or E wave), and BNP showed significantly higher predictive accuracy (area under the curve, 0.74-0.81) than any parameter alone (area under the curve, 0.61-0.72). These findings were confirmed in the validation cohort (n=100 patients, 38 end points). CONCLUSIONS: In asymptomatic severe AR, multimodality and multiparametric model combining 2 imaging indices with natriuretic peptides, showed high accuracy to identify early disease decompensation. Further prospective studies are warranted to explore the clinical benefit of implementing these models to guide patient management. REGISTRATION: URL: https://www. CLINICALTRIALS: gov; Unique identifier: NCT02910349.
- MeSH
- aortální insuficience * diagnostické zobrazování etiologie chirurgie MeSH
- dospělí MeSH
- echokardiografie MeSH
- funkce levé komory srdeční MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- natriuretický peptid typu B MeSH
- tepový objem MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
Standardization of aortic valve repair techniques with use of a calibrated annuloplasty have led to improved long-term outcomes in dystrophic aortic insufficiency. It can also improve dissemination of techniques and rates of aortic valve repair. Dystrophic aortic insufficiency can be found in three aortic phenotypes: dilated aortic root, dilated ascending aorta and isolated aortic insufficiency. The aortic annulus is invariably dilated above 25 mm in the vast majority of cases of aortic insufficiency, regardless of whether the aorta is dilated or not. A dilated annulus is a risk factor for late failure of aortic valve repair if not addressed at the time of surgery. We perform a calibrated annuloplasty at both sub- and supra-valvular levels in order to restore the ratio of sinotubular junction and annulus. Current evidence shows aortic valve repair reduces valve-related mortality compared to prosthetic valve replacement, with an improved quality of life.
- MeSH
- anuloplastika srdeční chlopně * škodlivé účinky přístrojové vybavení mortalita MeSH
- aortální aneurysma diagnostické zobrazování mortalita patofyziologie chirurgie MeSH
- aortální chlopeň diagnostické zobrazování patofyziologie chirurgie MeSH
- aortální insuficience diagnostické zobrazování mortalita patofyziologie chirurgie MeSH
- chirurgická náhrada chlopně * škodlivé účinky přístrojové vybavení mortalita MeSH
- hemodynamika MeSH
- kvalita života MeSH
- lidé MeSH
- obnova funkce MeSH
- rizikové faktory MeSH
- srdeční chlopně umělé MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Mucopolysaccharidosis type VII (MPS VII) is a rare autosomal recessive lysosomal storage disorder. MPS VII is caused by mutations in the GUSB gene that encodes β-glucuronidase. Adult MPS VII patients present with musculoskeletal abnormalities, coarse features, and corneal clouding. Cardiac and valvular impairment are common; however, severe valvular disease necessitating surgery has not yet been reported. We present a 32-year-old male MPS VII patient admitted to our hospital with decompensated heart failure. We identified aortic valve disease with severe stenosis (valve area 0.69 cm2) and moderate regurgitation. Severe mitral valve stenosis (valve area 1 cm2) with moderate to severe regurgitation was also found in the patient. In addition, an occlusion of the right coronary artery (RCA) was documented. The patient underwent surgical replacement of the mitral and aortic valves with mechanical prostheses and implantation of a venous bypass graft to his RCA. The surgery led to a significant improvement of his clinical symptoms. Six months after the procedure, both mechanical valves function normally. Histopathological assessment identified chronic inflammatory infiltrates, fibrosis and calcifications in both resected valves. Foamy cytoplasmic transformation was most evident in the valvular interstitial cells. The ultrastructural vacuolar abnormality seen in these cells corresponded to storage changes observed in other MPSs. In conclusion, we describe clinical findings and valvular pathology in an MPS VII patient with the first-reported successful combined surgical valve replacement and myocardial revascularization. The histological and ultrastructural analyses revealed that the lysosomal storage predominantly affected the valvular interstitial cells.
- MeSH
- aortální insuficience diagnostické zobrazování etiologie chirurgie MeSH
- aortální stenóza diagnostické zobrazování etiologie chirurgie MeSH
- chirurgická náhrada chlopně * MeSH
- dospělí MeSH
- koronární bypass * MeSH
- koronární okluze diagnostické zobrazování etiologie chirurgie MeSH
- lidé MeSH
- mitrální insuficience diagnostické zobrazování etiologie chirurgie MeSH
- mitrální stenóza diagnostické zobrazování etiologie chirurgie MeSH
- mukopolysacharidóza VII komplikace diagnóza MeSH
- stupeň závažnosti nemoci MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- MeSH
- ANCA-asociované vaskulitidy diagnóza farmakoterapie MeSH
- aortální chlopeň diagnostické zobrazování chirurgie MeSH
- aortální insuficience diagnostické zobrazování chirurgie MeSH
- aplikace orální MeSH
- dítě MeSH
- lidé MeSH
- methylprednisolon aplikace a dávkování terapeutické užití MeSH
- počítačová rentgenová tomografie metody MeSH
- prednison aplikace a dávkování terapeutické užití MeSH
- rituximab aplikace a dávkování terapeutické užití MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- práce podpořená grantem MeSH
Infective endocarditis was initially defined as a disease of patients with pre-existing valvular abnormalities. In contemporary medicine a valvular prosthesis and implanted medical devices are the most common risk factors for infective endocarditis. A case report is presented regarding an 18-year-old female with a medical history of a 12-year implanted Amplatzer occluder. Echocardiography showed an endocarditis focus in the right atrium communicating to the left atrium and destruction of the non-coronary leaflet of the aortic valve, with aortic valve insufficiency. Blood culture was positive for multi-resistant Staphylococcus aureus. The aortic valve, the Amplatzer device and part of the anterior leaflet of the mitral valve were excised. Pericardium was used for reconstruction of the anterior leaflet of the mitral valve, the interatrial septum and the wall of the left atrium. A mechanical prosthesis of the aortic valve was implanted. Control echocardiography was done four months after surgery. The evaluation did not show any recurrence of endocarditis. The published literature shows, in correlation with the presented case report, the occurrence of endocarditis late in the course of Amplatzer implantation highlights the need for vigilance in the population of patients with the device.
- MeSH
- aortální insuficience diagnostické zobrazování chirurgie MeSH
- chirurgická náhrada chlopně MeSH
- echokardiografie MeSH
- endokarditida * diagnostické zobrazování chirurgie MeSH
- kardiochirurgické výkony metody MeSH
- lidé MeSH
- mitrální insuficience diagnostické zobrazování chirurgie MeSH
- mladiství MeSH
- septální okluder * škodlivé účinky MeSH
- Staphylococcus aureus patogenita MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mladiství MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- práce podpořená grantem MeSH
