Browsing by Subject "Aortic stenosis"

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    Comparison of aortic gradient and ventricular mass after valve replacement for aortic stenosis with rapid deployment, sutureless, and conventional bioprostheses
    (Sociedad Española de Cardiología, 2021-06-11) Taboada Martín, Rubén; Arribas Leal, José María; Esteve Pastor, María Asunción; Abellán Alemán, José; Marín, Francisco; Rivera Caravaca, José Miguel; Cánovas López, Sergio; Cirugía, Pediatría y Obstetricia y Ginecología
    Background: The use of rapid deployment and sutureless aortic prostheses is increasing. Previous reports have shown promising results on haemodynamic performance and mortality rates. However, the impact of these bioprostheses on left ventricular mass (LVM) regression remains unknown. We decided to study the changes in remodelling and LVM regression in isolated severe aortic stenosis treated with conventional or Perceval® or Intuity® valves. Method and Results: From January 2011 to January 2016, 324 bioprostheses were implanted in our centre. The collected characteristics were divided into 3 groups: conventional valves, Perceval®, and Intuity®, and they were analysed after 12 months. There were 183 conventional valves (56%), 72 Perceval® (22%), and 69 Intuity® (21.2%). The statistical analysis showed significant differences in transprosthetic postoperative peak gradient (23 [18–29] mm Hg vs. 21 [16–29] mm Hg and 18 [14–24] mm Hg, p < 0.001), ventricular mass electrical criteria regression (Sokolow and Cornell products), and 1-year survival (90 vs. 93% and 97%, log rank p value = 0.04) in conventional, Perceval®, and Intuity® groups. Conclusions: We observed differences in haemodynamic, electrocardiographic, and echocardiographic parameters related to the different types of prosthesis. Patients with the Intuity® prosthesis had the highest reduction in peak aortic gradient and the higher ventricular mass regression. Besides, patients with the Intuity® prosthesis had less risk of mortality during follow-up than the other two groups. Further studies are needed to confirm these findings.
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    Experiencia de 7 años con la protesis aortica de rápido despliegue Edwards Intuity
    (Elsevier, 2021-04) Arribas, José María; Rivera Caravaca, José Miguel; Moreno, José A.; Aranda, Ramón; Masso, Javier; Jiménez, Antonio; Pérez Andreu, Joaquín; Taboada, Rubén; Fernández, Manuel; Aguilar, Juan M.; García Puente, Julio J.; Lorenzo, Maydelin; Gutiérrez, Francisco; Morena, Gonzalo de la; Jara, Rubén; Cánovas López, Sergio; Cirugía, Pediatría y Obstetricia y Ginecología
    Introducción Las prótesis aorticas de rápido despliegue aparecieron hace 10 años para tratar la estenosis aórtica. El sistema de válvula Edwards Intuity es una prótesis biológica basada en la válvula Edwards Magna con un marco infraanular. Presentamos los resultados clínicos y hemodinámicos a corto y largo plazo obtenidos con esta prótesis biológica. Métodos Ciento diecisiete pacientes (65% varones, 75 ± 4,5 años) con estenosis aórtica (gradiente medio preoperatorio de 49,6 ± 12 mm Hg) recibieron una prótesis Edwards Intuity entre septiembre de 2012 y diciembre de 2019. Se incluyeron en una base de datos prospectiva que recogía diferentes variables. La media de seguimiento fue de 36 ± 21 meses. Resultados Mortalidad hospitalaria del 3,4%, supervivencia al año, a los 3 y 6 años del 95%, 90% y 81%, respectivamente. Se utilizó hemiesternotomía media superior en 78 pacientes (67%). La mediana de tiempos de isquemia miocárdica y de circulación extracorpórea de toda la serie fueron 40 (33-50) minutos y 59 (48-73) minutos. Gradientes medios al alta, al año y a los 2 años fueron 10 ± 4 mm, 9 ± 3,5 mm y 8,4 ± 3,4 mm Hg. Ocho pacientes (7%) necesitaron marcapasos en el postoperatorio. Dos pacientes (0,6%) se reintervinieron en seguimiento por endocarditis y otro (0,3%) se reintervino por fuga periprotésica. Conclusión El sistema de válvula Edwards Intuity presenta buenos resultados clínicos y hemodinámicos a corto y largo plazo. Estas prótesis aórticas se pueden considerar una alternativa a las prótesis convencionales, sobre todo en cirugía de mínimo acceso y en intervenciones complejas.----------------
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    Experiencia inicial con la prótesis de despliegue rápido en posición aórtica Edwards Intuity
    (Elsevier, 2016-03-21) Arribas, José M.; García Puente, Julio J.; Jiménez, Antonio; Taboada, Rubén; Ray, Víctor G.; Parra, José M.; Marín, Francisco; Gutiérrez, Francisco; Morena, Gonzalo de la; Cánovas López, Sergio; Cirugía, Pediatría y Obstetricia y Ginecología
    Objetivo Disponemos de una nueva clase de prótesis aórticas de despliegue rápido para tratamiento quirúrgico de la estenosis aórtica. Permitirían disminuir los tiempos quirúrgicos y facilitarían la cirugía mínimamente invasiva. Presentamos nuestra experiencia inicial con la válvula Edwards Intuity en el contexto del estudio multicéntrico Foundation. Pacientes y métodos Entre septiembre de 2012 y febrero de 2014 se implantaron 25 prótesis aórticas Edwards Intuity en 26 pacientes (77 ± 4,3 años; 52% varones). Veinticuatro (96%) fueron reemplazo valvular aislado, y 9 pacientes (36%) tuvieron abordaje mínimamente invasivo. Los pacientes fueron estudiados al alta, a los 3 meses y al año de la intervención. Resultados Hubo éxito en el implante en el 96,2% de los pacientes (25/26). No hubo mortalidad hospitalaria. Seguimiento medio de 11 ± 5,4 meses, supervivencia acumulada del 96%. Un paciente falleció a los 11 meses por un ictus isquémico. El tiempo medio de pinzamiento aórtico fue de 38,2 ± 10,1 min y el tiempo medio de circulación extracorpórea, de 62,4 ± 11,1 min. A los 3 meses, el área valvular efectiva media fue de 1,70 ± 0,42 cm2. El 91% de los pacientes (23/25) estaban en grado funcional i en el seguimiento. Conclusiones El implante de la válvula Edwards Intuity para el tratamiento de la estenosis aórtica ha sido factible, seguro y eficaz. Los tiempos de isquemia miocárdica y de circulación extracorpórea parecen reducirse en comparación con la cirugía valvular aórtica habitual. El comportamiento hemodinámico inicial de la prótesis Edwards Intuity es excelente.--------------
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    Incidence and causes of pacemaker implantation during postoperative period of aortic valve replacement with rapid deployment prosthesis
    (Wiley, 2019-12) Arribas, José María; Soriano, Laura; Rivera Caravaca, José Miguel; Lorenzo, Maydelin; Muñoz, Carmen; Taboada, Rubén; Jiménez, Antonio; Martínez, Juan; García Puente, Julio; Gutiérrez, Francisco; Manzano, Sergio; Cánovas López, Sergio; Cirugía, Pediatría y Obstetricia y Ginecología
    Background Aortic stenosis is currently the most frequently occurring valve pathology. Developments, such as transcatheter prostheses and rapid deployment prostheses, allow for the offer of a valve replacement to higher risk patients, but these techniques are linked with a higher need for a permanent pacemaker during the immediate postoperative period. Methods We studied the incidence and the factors associated with permanent pacemaker implantation after aortic valve replacement with Edwards Intuity rapid deployment prosthesis. Results Between October 2012 and December 2016, the Edwards Intuity prosthesis was implanted in 71 patients (68% male, 75.3 ± 5 years old). Six patients (8%) required a permanent pacemaker during immediate postoperative period. Univariate analysis showed that a history of acute myocardial infarction (AMI) (P = .046, B = 7.5, 95% CI [1.039-54.1]) and preoperative amiodarone (P = .009, B = 31.5; 95% CI [2.32-426]) were associated with a higher need for a pacemaker during the postoperative period. Conclusions The incidence of permanent pacemaker implantation during the immediate postoperative period of aortic valve replacement with Edwards Intuity prosthesis was 8%, a value which is within the limits reported for conventional aortic prostheses. Preoperative amiodarone treatment and previous AMI may increase the need for a pacemaker during the postoperative period of these aortic prostheses.
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    Mid-term outcomes of rapid deployment aortic prostheses in patients with small aortic annulus
    (Oxford University Press, 2021-06-28) Arribas Leal, José M.; Rivera Caravaca, José Miguel; Aranda Domene, Ramón; Moreno Moreno, José A.; Espinosa García, Dolores; Jiménez Aceituna, Antonio; Pérez Andreu, Joaquín; Taboada Martín, Rubén; Saura Espín, Daniel R.; Cánovas López, Sergio; Cirugía, Pediatría y Obstetricia y Ginecología
    OBJECTIVES: The Edwards Intuity valve is a rapid deployment aortic prosthesis that favours less invasive approaches. However, evidence about the clinical behaviour of their smaller sizes is scarce. Herein, we studied haemodynamic behaviours and clinical outcomes of small Intuity prostheses (19–21 mm) in comparison to larger Intuity prostheses (>21 mm). METHODS: This is an observational study including patients implanted with an Edwards Intuity rapid deployment aortic prosthesis. Patients with prosthesis sizes 19–21 and >21 mm were included. Baseline and perioperative variables, as well as adverse events during the follow-up were recorded and compared between groups. RESULTS: A total of 122 patients (37% female, mean age 75 ± 4.5 years) were included, of whom 54 (45%) were implanted with a small prosthesis and 68 (55%) with a prosthesis >21 mm. There were no significant differences between patients with small Intuity prostheses and patients with larger prostheses regarding in-hospital mortality (2% vs 4%, P = 0.43) or mortality during the follow-up (3.41 vs 2.45 per 100 patients-years; P = 0.58). Survival in the small Intuity valve group was 95% at 1 year and 83% at 6 years, whereas in the larger Intuity valve group was 96% at 1 year and 78% at 6 years. The presence of a small prosthesis did not influence mid-term survival (log-rank P-value = 0.62). CONCLUSIONS: This study showed good clinical performance of Intuity aortic prostheses with appropriate mid-term survival in patients with the small aortic annulus. Thus, the Edwards Intuity rapid deployment aortic prosthesis may be considered as a potential option in patients with the small aortic annulus.