Browsing by Subject "Aortic valve replacement"
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- PublicationOpen AccessContact pathway in surgical and transcatheter aortic valve replacement(Frontiers Media, 2022-07-22) Morena Barrio, María Eugenia de la; Corral, Javier; López García, Cecilia; Jiménez Díaz, Víctor Alonso; Miñano, Antonia; Juan-Salvadores, Pablo; Esteve Pastor, María Asunción; Baz Alonso, José Antonio; Rubio, Ana María; Sarabia Tirado, Francisco; García Navarro, Miguel; García Lara, Juan; Marín, Francisco; Vicente, Vicente; Pinar, Eduardo; Cánovas López, Sergio; Morena, Gonzalo de la; Cirugía, Pediatría y Obstetricia y GinecologíaBackground: Aortic valve replacement is the gold standard treatment for severe symptomatic aortic stenosis, but thrombosis of bioprosthetic valves (PVT) remains a concern. Objective: To analyze the factors involved in the contact pathway during aortic valve replacement and to assess their impact on the development of thromboembolic complications. Methods: The study was conducted in 232 consecutive patients who underwent: transcatheter aortic valve replacement (TAVR, N = 155), and surgical valve replacement (SAVR, N = 77) (MUVITAVI project). Demographic and clinical data, outcomes including a combined end point (CEP) of thrombotic events, and imaging controls were recruited. Samples were collected 24 h before and 48 h after valve replacement. FXII, FXI and (pre)kallikrein were evaluated by Western Blot and specific ELISA with nanobodies. Results: The CEP of thrombotic events was reached by 19 patients: 13 patients presented systemic embolic events and 6 patients subclinical PVT. Valve replacement did not cause FXII activation or generation of kallikrein. There was a significant reduction of FXI levels associated with the procedure, which was statistically more pronounced in SAVR than in TAVR. Cases with reductions of FXI below 80% of basal values had a lower incidence of embolic events during the procedure than patients in whom FXI increased above 150%: 2.7 vs. 16.7%; p: 0.04. Conclusion: TAVR or SAVR did not significantly activate the contact pathway. A significant reduction of FXI, was observed, particularly in SAVR, associated with lower incidence of thrombotic events. These results encourage evaluating the usefulness and safety of FXI-directed antithrombotic treatments in these patients.
- PublicationRestrictedDifferences in life expectancy between men and women after aortic valve replacement(Oxford University Press, 2021-03-27) Hernández Vaquero, Daniel; Rodríguez Caulo, Emiliano; Vigil Escalera, Carlota; Blanco Herrera, Oscar; Berastegui, Elisabet; Arias Dachary, Javier; Souaf, Souhayla; Parody, Gertrudis; Laguna, Gregorio; Adsuar, Alejandro; Castellá, Manuel; Valderrama, José F.; Pulitani, Ivana; Cánovas López, Sergio; Ferreiro, Andrea; García Valentín, Antonio; Carnero, Manuel; Pareja, Pilar; Corrales, José A.; Blázquez, José A.; Macías, Diego; Fletcher-Sanfeliu, Delfina; Martínez, Daniel; Martín, Elio; Martín, Miren; Margarit, Juan; Hernández Estefanía, Rafael; Monguió, Emilio; Otero, Juan; Silva, Jacobo; Cirugía, Pediatría y Obstetricia y GinecologíaOBJECTIVES: Some researchers have observed an increased number of deaths during the follow-up of young patients who undergo aortic valve replacement due to severe aortic stenosis, suggesting that this procedure does not restore their life expectancy. Our goal was to confirm these findings and explore sex-based differences. METHODS: All patients between 50 and 65 years of age who underwent isolated aortic valve replacement in 27 Spanish centres during an 18-year period were included. We compared observed and expected survival at 15 years of follow-up and estimated the cumulative incidence of death from a competing risks point of view. We stratified by sex and analysed if being a woman was an independent risk factor for death. RESULTS: For men, the observed survival at 10 and 15 years of follow-up was 85% [95% confidence interval (CI) 83.6%–86.4%] and 72.3% (95% CI 69.7%–74.7%), respectively whereas the expected survival was 88.1% and 78.8%. For women, the observed survival at 10 and 15 years was 85% (95% CI 82.8%–86.9%) and 73% (95% CI 69.1%–76.4%), whereas the expected survival was 94.6% and 89.4%. At 15 years of follow-up, the cumulative incidence of death due to the disease in men and women was 8.2% and 16.7%, respectively. In addition, being a woman was an independent risk factor for death (hazard ratio = 1.23 (95% CI 1.02–1.48; P = 0.03). CONCLUSIONS: After the aortic valve replacement, men and women do not have their life expectancy restored, but this loss is much higher in women than in men. In addition, being a woman is a risk factor for long-term death. Reasons for these findings are unknown and must be investigated.
- PublicationRestrictedIncidence 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 GinecologíaBackground 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.
- PublicationRestrictedLife expectancy after aortic valve replacement in young patients(Elsevier, 2021-06-05) Hernández Vaquero, Daniel; Rodríguez Caulo, Emiliano; Vigil Escalera, Carlota; Blanco Herrera, Óscar; Berastegui, Elisabet; Arias Dachary, Javier; Souaf, Souhayla; Parody, Gertrudis; Laguna, Gregorio; Adsuar, Alejandro; Castellá, Manuel; Valderrama, José F.; Pulitani, Ivana; Cánovas López, Sergio; Ferreiro, Andrea; García Valentín, Antonio; Carnero, Manuel; Pareja, Pilar; Corrales, José A.; Blázquez, José A.; Macías, Diego; Fletcher-Sanfeliu, Delfina; Martínez, Daniel; Martín, Elio; Martín, Miren; Margarit, Juan; Hernández Estefanía, Rafael; Monguió, Emilio; Otero, Juan; Silva, Jacobo; Cirugía, Pediatría y Obstetricia y GinecologíaIntroduction and objectives: In young patients with severe aortic stenosis, it is unknown whether their life expectancy restored after aortic valve replacement (AVR) is unknown. Methods: We analyzed all patients aged between 50 and 65 years who underwent isolated AVR in 27 Spanish centers during an 18-year period. We compared observed and expected survival at 15 years of follow-up. We repeated all analyses for patients without complications in the postoperative period. Results: A total of 5084 patients were analyzed. For the overall sample, observed survival at 10 and 15 years was 85.3% (95%CI, 84.1%-86.4%) and 73.7% (95%CI, 71.6%-75.6%), respectively. Expected survival was 90.1% and 82.1%. Cumulative relative survival for 1, 5, 10 and 15 years of follow-up was 97.4% (95%CI, 96.9%-97.9%), 96.5% (95%CI, 95.7%-97.3%), 94.7% (95%CI, 93.3%-95.9%), and 89.8% (95%CI, 87.3%-92.1%). For patients without complications, cumulative relative survival for 1, 5, 10 and 15 years was 100.3% (95%CI, 99.8%-100.5%), 98.9% (95%CI 97.6% -99.9%), 97.3% (95%CI, 94.9%-99.4%), and 91.9% (95%CI, 86.5%-96.8%). Conclusions: Life expectancy in young patients who have severe aortic stenosis and undergo AVR is lower than that of the general population. Life expectancy of individuals without complications during the postoperative period is also reduced. Therefore, baseline characteristics are likely the main factors that explain the reduction in life expectancy.
- PublicationRestrictedRisk factors for postoperative pacemaker implantation after rapid deployment aortic valve replacement: results from the RADAR registry(Springer, 2021-03-04) González Barbeito, Miguel; Arribas, José María; Vazquez, Alejandro; Carnero, Manuel; Sarralde, José Aurelio; Cal Purriños, Natalia; Cánovas López, Sergio; Martoto, Luis; Gutiérrez, Francisco; Hornero, Fernando; Bautista Hernández, Victor; Cirugía, Pediatría y Obstetricia y GinecologíaIntroduction: Rapid deployment aortic valve replacement has been recently introduced in clinical practice. Different studies have reported a significant reduction in surgical times with excellent hemodynamic profiles and short-term results. However, an increase in permanent pacemaker requirements compared with conventional aortic valve replacement has been described. Nevertheless, risk factors for postoperative pacemaker implantation are not well known. The aim of this study is to report our early outcomes with rapid deployment aortic valve replacement within the RADAR Registry, especially focusing on risk factors for postoperative pacemaker implantation. Methods: Between April 2012 and January 2016, 164 patients undergoing isolated or combined aortic valve replacement with Edwards INTUITY Elite (Edwards Lifesciences, Irvine, CA, USA) were included in the RADAR Registry. Pre-, intra- and postoperative clinical data results and complications were recorded, especially focusing on risk factors for the development of postoperative complete or high-grade AV block requiring pacemaker implantation. Patients were followed up for up to 1 year with evaluation of clinical and echocardiographic outcomes. Results: A total of 164 consecutive patients were included in this study, where 128 patients (78.05%) had an isolated aortic valve replacement (group 1) and 36 (21.95%) a concomitant procedure (group 2). The surgical approach was ministernotomy in 61 patients (37.20%) and median sternotomy in 100 patients (60.98%). Complications with valve implantation were observed in three patients. Postoperative complete or high-degree AV block requiring a permanent pacemaker implantation developed in ten patients (6.9%). Seven patients died in-hospital (4.27%). No significant differences between groups were found in terms of stroke, postoperative infection, mortality, atrial fibrillation and postoperative atrioventricular block. Seven patients presented acute renal impairment (5.51%) in group 1 versus seven patients (20%) in group 2 (p = 0.007). In multivariate analysis, low weight and preoperative arrhythmia (atrial fibrillation, bifascicular block, left bundle branch block) emerged as risk factors for postoperative AV block requiring a pacer. In median follow-up of 1 year, seven (4.27%) patients died, and no cases of structural valve deterioration or endocarditis were observed. Significant patient-prosthesis mismatch was found in seven (4.27%) patients. Conclusion: Initial experience with rapid deployment aortic valve replacement in the RADAR Registry demonstrates low rates of implantation complications and good perioperative and 1-year clinical and echocardiographic outcomes. Incidence of postoperative AV block requiring a pacer correlated with low weight and preoperative arrythmias (atrial fibrillation, bifascicular block and left bundle branch block). Avoidance of oversizing and careful consideration of implantation of this technology in patients with pre-existing arrythmias could minimize the risk for postoperative pacemaker implantation.
- PublicationOpen AccessVon Willebrand factor is associated with atrial fibrillation development in ischaemic patients after cardiac surgery(Oxford University Press, 2016-09) Lahoz, Álvaro; Roldan, Vanessa; Jover, Eva; Romero Aniorte, Ana I.; Jara Rubio, Rubén; Arribas, José María; García Alberola, Arcadio; Cánovas López, Sergio; Valdés, Mariano; Marín, Francisco; Martínez Cáceres, Carlos Manuel; Hernández Romero, Diana; Cirugía, Pediatría y Obstetricia y GinecologíaAims Atrial fibrillation (AF) is associated with an increased morbidity and mortality after cardiac surgery. Von Willebrand factor (vWF) has been proposed as a biomarker of endothelial damage/dysfunction. We hypothesized that vWF levels could be used as valuable biomarker for AF occurrence after cardiac surgery. Moreover, we explored the potential association between vWF and tissue remodelling as possible implication in post-surgical AF. Methods and results We prospectively recruited 100 consecutive patients who undergoing programmed cardiac surgery with cardiopulmonary bypass and with no previous history of AF. Plasma vWF levels were determined from citrated plasma samples. Right atrial appendage tissue was obtained during cardiac surgery, and vWF expression as well as interstitial fibrosis was analysed by immunostaining and Masson's trichrome, respectively. We found raised vWF plasma levels in ischaemic vs. valvular patients (200.2 ± 66.3 vs. 157.2 ± 84.3 IU/dL; P = 0.015). Fibrosis degree was associated with plasma vWF levels. Plasma vWF was an independent prognostic marker for AF development in ischaemic patients [odds ratio, OR 6.44 (95% confidence interval, CI 1.40–36.57), P = 0.035]. Conclusion Plasma vWF levels are associated with tissue fibrosis in patients undergoing cardiac surgery and with post-surgical AF development in ischaemic patients. These findings suggest an association among vWF levels, atrial remodelling, and AF development. It is supported by higher vWF expression in right atrial tissue in ischaemic patients, who developed post-surgical AF.