Journal: Journal of Cardiac Surgery

Abbreviation

J Card Surg

Publisher

Wiley

Journal Volumes

ISSN

0886-0440
1540-8191

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2020 - 202210
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Publications1 - 10 of 10
  • Transcatheter aortic valve implantation and its impact on mitral valve geometry and function
    Item type: Journal Article
    Meyer, Alexander; Greve, Dustin; Unbehaun, Axel; et al. (2020)
    Journal of Cardiac Surgery
    Background The aim of this study was to evaluate the impact of transcatheter aortic valve implantation (TAVI) on mitral valve geometry and function. Methods Eighty‐four patients underwent TAVI. Forty‐four (52%) patients received a balloon‐expandable valve and 40 (48%) were implanted with a self‐expandable valve. All patients underwent three‐dimensional‐volumetric transesophageal echocardiography of the mitral valve before and immediately after TAVI. A dedicated software was used for assisted semiautomatic measurement of mitral annular geometry. Results During systole, the anterior to posterior (AP) diameter was significantly reduced after the procedure (3.4 ± 0.5 cm vs 3.2 ± 0.5 cm; P < .05). The mitral annular area (10.8 ± 2.8cm2 vs 9.9 ± 2.6cm2; P < .05) as well as the tenting area (1.6 ± 0.7 cm2 vs 1.2 ± 0.6 cm2; P < .001) measured at mid‐systole were reduced after TAVI. Diastolic measures were similar. Patients treated with balloon‐expandable valves showed a significantly larger reduction in the AP diameter compared to self‐expandable valves (−0.25 cm vs −0.11 cm; P < .05). The reduction of the annular area was higher in the balloon‐expandable group (−1.2 ± 1.59 vs −0.22 ± 1.41; P < .05). Grade of mitral regurgitation did improve or remained stable after TAVI. Conclusion TAVI significantly impacts the mitral valve and mitral annular geometry and morphology. The choice of the prosthesis (balloon‐ vs self‐expandable) may be relevant for those changes.
  • Partial ring annuloplasty in the management of mitral annular calcification
    Item type: Other Journal Item
    Akansel, Serdar; Kofler, Markus; Sündermann, Simon H.; et al. (2022)
    Journal of Cardiac Surgery
    Mitral annular calcification (MAC) complicates the management of mitral valve (MV) disease, regardless of its etiology. Strategies to address MV surgery in MAC include two main options with their own pros and cons; respect and resect strategy. Here, we present a case of minimally-invasive MV repair with partial annuloplasty in the management of noncircumferential MAC with respect to strategy. This technique may be an alternative option for rescuing high-risk patients without extensive decalcification.
  • Propensity score-based analysis of 30-day survival in cardiogenic shock patients supported with different microaxial left ventricular assist devices
    Item type: Journal Article
    Nersesian, Gaik; Potapov, Evgenij V.; Nelki, Vivian; et al. (2021)
    Journal of Cardiac Surgery
    Background and methods Microaxial left ventricular assist devices are used increasingly for treating cardiogenic shock. We compared the short-term outcome of patients supported with different microaxial devices for cardiogenic shock. A retrospective propensity score-adjusted analysis was performed in cardiogenic shock patients treated with either the Impella CP (n = 64) or the Impella 5.0/5.5 (n = 62) at two tertiary cardiac care centers between 1/14 and 12/19. Results Patients in the Impella CP group were significantly older (69.6 ± 10.7 vs. 58.7 ± 11.9 years, p = .001), more likely in INTERMACS profile 1 (76.6% vs. 50%, p = .003) and post-C-reactive protein (CPR) (36% vs. 13%, p = .006). The median support time was 2.0 days [0.0, 5.3] in the CP group vs. 8.5 days [4.3, 15.8] in the 5.0/5.5 group (p < .001). The unadjusted 30-day survival was significantly higher in the Impella 5.0/5.5 group (58% vs. 36%, p = .021, odds ratio [OR] for 30-day survival on Impella 5.0/5.5 was 3.68 [95% confidence interval [CI]: [1.46–9.90]], p = .0072). After adjustment, the 30-day survival was similar for both devices (OR: 1.23, 95% CI: [0.34–4.18], p = .744). Lactate levels above 8 mmol/L and preoperative CPR were associated with a significant mortality increase in both cohorts (OR: 10.7, 95% CI: [3.45–47.34], p < .001; OR: 13.2, 95% CI: [4.28–57.89], p < .001, respectively). Conclusion Both Impella devices offer a similar effect with regard to survival in cardiogenic shock patients. Preoperative CPR or lactate levels exceeding 8 mmol/L immediately before implantation have a poor prognosis on Impella CP and Impella 5.0/5.5.
  • Right atriotomy closure with modified ventricular assist device ring
    Item type: Journal Article
    Lanmüller, Pia; Eulert-Grehn, Jaime-Jürgen; Starck, Christoph; et al. (2022)
    Journal of Cardiac Surgery
    Background Severe tricuspid regurgitation is a known risk factor for right ventricular failure (RVF) after left ventricular assist device (LVAD) implantation and is often treated with concomitant tricuspid valve repair (TVR). The right atriotomy needed for exposure of the tricuspid valve may complicate early implantation of a durable right ventricular assist device, which may be needed if RVF persists. Materials & Methods A 53-year-old male patient on Impella and extracorporeal life support was scheduled for LVAD implantation with concomitant TVR. Results We performed a technique for closure of the right atrium after TVR with a modified ventricular assist device ring to facilitate right ventricular support implantation if needed.
  • Surgical explantation of a partially detached cardioband device
    Item type: Journal Article
    Kempfert, Jörg; Akansel, Serdar; Sündermann, Simon H.; et al. (2020)
    Journal of Cardiac Surgery
    Transcatheter repair systems are becoming increasingly popular as a potential solution for high-risk and inoperable patients with mitral regurgitation. The cardioband (Edwards Lifesciences, Irvine, California) is a transcatheter direct annuloplasty device, based on the concept of an undersized ring annuloplasty. We report a case of minimally invasive surgical explantation of a failed cardioband device 21 months after its implantation. Intraoperatively, it was found that three anchors of the cardioband device were detached from the posterior annulus at P2. In this report, a "cut and unscrew" technique with some tips and tricks is presented for the removal of the device.
  • Lifetime management of aortic valve disease: Aligning surgical and transcatheter armamentarium to set the tone for the present and the future
    Item type: Review Article
    Pompeu Sà, Michel; Ramlawi, Basel; Sicouri, Serge; et al. (2022)
    Journal of Cardiac Surgery
    Transcatheter aortic valve replacement (TAVR) has already received the green light for high-, intermediate- and low-risk profiles and is an alternative for all patients regardless of age. It is clear that there has been a push towards the use of TAVR in younger and younger patients (<65 years), which has never been formally tested in randomized controlled trials but seems inevitable as TAVR technology makes steady progress. Lifetime management as a concept will set the tone in the field of the structural heart. Some subjects in this scenario arise, including the importance of optimized prosthetic hemodynamics for lifetime care; surgical procedures in the aortic root; management of structural valve degeneration with valve-in-valve procedures (TAVR-in-surgical aortic valve replacement [SAVR] and TAVR-in-TAVR) and redo SAVR; commissural alignment and cusp overlap for TAVR; the rise in the number of surgical procedures for TAVR explantation; and the renewed interest in the Ross procedure. This article reviews all these issues which will become commonplace during heart team meetings and preoperative conversations with patients in the coming years.
  • Endovascular treatment of an anastomotic outflow graft pseudoaneurysm of the descending aorta after implantation of a left ventricular assist device
    Item type: Journal Article
    Nersesian, Gaik; Solowjowa, Natalia; Falk, Volkmar; et al. (2020)
    Journal of Cardiac Surgery
    Introduction: Outflow graft (OG) obstruction is a dangerous complication that may occur for various reasons after the implantation of the left ventricular assist device (LVAD). Case Report: In this study, we describe the case of a 67‐year‐old patient on LVAD support who developed a late pseudoaneurysm of the OG anastomosis (to the descending aorta) causing OG stenosis at the level of the anastomosis. The patient was treated with a customized fenestrated endovascular stent graft placed into the descending aorta and stent implantation into the OG.
  • Surgical treatment of outflow graft kinking complicated by external obstruction with a fibrin mass in a patient with LVAD
    Item type: Journal Article
    Nersesian, Gaik; Van Praet, Karel M.; van Kampen, Antonia; et al. (2020)
    Journal of Cardiac Surgery
    Background Outflow graft (OG) obstruction is a dangerous complication that may occur for various reasons after left ventricular assist device (LVAD) implantation. Case Summary We describe the case of a 51‐year‐old patient on LVAD support who developed significant OG kinking and external OG obstruction due to a fibrin mass causing severe stenosis. Both the OG kinking and external obstruction were eliminated via a left lateral thoracotomy.
  • Minimally invasive surgical aortic valve replacement: The RALT approach
    Item type: Journal Article
    Van Praet, Karel M.; van Kampen, Antonia; Kofler, Markus; et al. (2020)
    Journal of Cardiac Surgery
    Less-invasive techniques for cardiothoracic surgical procedures are designed to limit surgical trauma, but the technical requirements and preoperative planning are more demanding than those for conventional sternotomy. Patient selection, interdisciplinary collaboration, and surgical skills are key factors for procedural success. Aortic valve replacement is frequently performed through an upper hemisternotomy, but the right anterior minithoracotomy represents an even less traumatic, technical advancement. Preoperative assessment of the ascending aorta in relation to the sternum is mandatory to select patients and the intercostal access site. This description of the surgical technique focuses on the specific procedural details including the obligatory planning with computed tomography and our cannulation strategy. We also sought to define the anatomical ascending aorta-sternal relationship, as it is of utmost importance in preoperative computed tomographic planning.
  • Reply to Del Giglio, Tamagnini, Biondi, and Di Mauro
    Item type: Other Journal Item
    Van Praet, Karel M.; Kofler, Markus; Unbehaun, Axel; et al. (2020)
    Journal of Cardiac Surgery
Publications1 - 10 of 10