Long-term Mortality Predictors in Patients with Small Aortic Annulus Undergoing Aortic Valve Replacement with a 19- or 21-mm Bioprosthesis

Oliveira, Jenny Lourdes Rivas de; Arnoni, Renato Tambellini; Santos, Magaly Arrais dos; Almeida, Antonio Flávio Sanchez de; Issa, Mário; Arnoni, Antoninho S; Chaccur, Paulo; Souza, Luiz Carlos Bento de

doi:10.5935/1678-9741.20160060

Cited by 6 publications

(8 citation statements)

References 21 publications

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“…Patients who received small valves ≤ 21mm had poorer mid and long-term survival compared to patients receiving larger-sized valves (≥ 23). Some authors have noted in their series of patients who received small aortic valves (19-21mm) had no adverse intermediate and long-term survival outcomes [8,9]. Although, Blackstone et al noted in their series a 1-2% increase in 30-day mortality in patients with small aortic valves [8].…”

Section: Resultsmentioning

confidence: 99%

Aortic Valve Replacement with Sutured Valves in the Elderly: Does the Absolute Valve Size Matter?

Omoregbee,

Elhassan,

Kesieme

et al. 2024

Preprint

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Background: The objective during Sutured aortic valve replacement (AVR) is to implant the largest possible valve. Root enlargement to allow implantation of larger valves is not without risks in the elderly. This study investigates the influence of small-size sutured valves on medium and long-term outcomes in the elderly in this era where sutureless valves could be an alternative based on their design. Methods: We retrospectively collected and verified data for 1,097 patients who were ≥65 years old and underwent Isolated AVR at our institution from January 2010 to January 2022. Patients who underwent concomitant procedures or root enlargements were excluded. Based on implanted valve sizes, patients were divided into: Group A (19-21mm) and Group B (23- 29mm). Results: Most patients were in Group B 739 (67%) compared to Group A which had 358 (33%) patients. Group A patients were younger, predominantly female, with smaller body surface area, and higher mean Logistic EuroSCORE. Biological valves were implanted in most patients. Although, there was no significant difference in in-hospital mortality between the groups. The Kaplan Meier 5- and 10-year survival rates were 77 % and 49% for group A versus 81% and 62% for group B (p=0.002), which was significant. Conclusions: Our study shows that sutured aortic valve sizes ≤21mm adversely affect medium and long-term outcomes after AVR in the elderly, with women affected disproportionately.

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Section: Resultsmentioning

confidence: 99%

Aortic Valve Replacement with Sutured Valves in the Elderly: Does the Absolute Valve Size Matter?

Omoregbee,

Elhassan,

Kesieme

et al. 2024

Preprint

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“…In the study by Otto et al, the prevalence of rheumatic disease in patients with severe PPM was 43.1%, while in the Brazilian study by Oliveira et al it was 29.7%. 3,18 The incidence of rheumatic disease remains high in Brazil, so a high proportion in relation to degenerative disease was expected compared with studies conducted in high-income countries, as shown by Mothy et al 32 The proportion of NYHA functional class II or III was significantly higher in patients with moderate or severe PPM than in those with mild PPM. These data contrast with those described by Vicchio et al, who administered a questionnaire to patients with PPM but did not identify a significant difference in functional class in those with severe PPM.…”

Section: Bispo Et Al Patient-prosthesis Mismatch In Prosthetic Aortic...mentioning

confidence: 94%

“…1,2 In Brazil, according to the Information Technology Department of the Brazilian Unified Health System (DATASUS for short, in Portuguese), 17.4% of major cardiovascular operations include prosthetic valve implantation. 3 It is known that, after prosthetic valve implantation, patients with significant aortic stenosis progress with clinical and ventricular function improvement and increased survival. 4,5 The figure summarizes the hemodynamic characteristics of the patients' prosthetic valves (text boxes) and the main results of the study (bar graphs).…”

Section: Clinical and Echocardiographic Aspects Of Patient-prosthesis...mentioning

confidence: 99%

Clinical and Echocardiographic Aspects of Patient-Prosthesis Mismatch in Patients With Prosthetic Aortic Valves

Bispo,

Hemerly,

Kyiose

et al. 2023

ABC Imagem Cardiovascular

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Introduction: Patient-prosthesis mismatch (PPM) is considered to occur if a prosthetic heart valve has a high transvalvular pressure gradient and a reduced indexed valve area, despite normally functioning discs. PPM may have clinical and hemodynamic repercussions for patients. Objective: To analyze the clinical and echocardiographic characteristics of PPM in patients with prosthetic aortic valves. Methods: Patients aged 18 years or over with a biological or mechanical aortic valve undergoing follow-up since February 2010 were included. PPM was considered mild if the indexed valve area was ≥ 0.85 cm 2 /m 2 and severe if ≤ 0.65 cm 2 /m 2 . Variables were compared between groups with moderate or severe PPM (PPMAO2) and mild PPM (PPMAO1); significant if p<0.05.Results: Sixty patients (36 women) with prosthetic aortic valves (29 biological and 31 mechanical) were included. PPMAO2 was diagnosed in 12 patients (20%), who had a mean valve area of 0.66 cm²/m² and mean gradient of 24 mm Hg. Functional class II or III was more frequent in the PPMAO2 group (66.7%) than in the PPMAO1 group (20.8%); p<0.001. Left atrial volume (51 ± 16 mL/m 2 x 40 ± 12 mL/m 2 ; p=0.002) and left ventricular septal and wall thicknesses (10.83 mm x 10 mm; p=0.018) were higher in the PPMAO2 group.Conclusions: Moderate or severe PPM occurred in 20% of patients. These patients were more symptomatic and had higher left atrial volumes and left ventricular myocardial wall thickness.

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“…20 In patients with SAA undergoing SAVR, concomitant surgery and reduced ejection fraction (EF) are major predictors of mortality. 21 Long-term adverse outcomes were attributable to age as well as comorbidities. 10…”

Section: Definition Of Saamentioning

confidence: 99%

Surgical aortic valve replacement in small aortic annulus

Vaidya

Cavanaugh

Sandhu

2021

Journal of Cardiac Surgery

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Background: Although aortic valve replacement (AVR) has been the standard of treatment for severe aortic stenosis, a small aortic annulus (SAA) poses significant challenges. Improvements in valve designs and evolution in surgical techniques have led to improved outcomes, however, the ideal prosthetic valve remains elusive.Methods: We performed a comprehensive literature review to discuss the surgical management of aortic stenosis, with a special focus on patients with SAA.Results: Stentless valves and root replacement techniques have been shown to overcome the hemodynamic challenges associated with conventional stented bioprostheses, but are technically challenging and require longer cross-clamp times. Sutureless and rapid deployment valves mitigate the long operative time while maintaining the hemodynamic advantages. The use of transcatheter AVR has emerged as another reasonable alternative and has shown promise among patients with SAA, however, long-term outcomes are awaited. Conclusion:There is no consensus regarding the type of valve prosthesis or replacement technique among patients with SAA. Consideration of patient comorbidities and valvular anatomy is paramount in planning the optimal strategy for AVR. Further long-term clinical trials are necessary to assess outcomes and achieve progress toward the development of the ideal prosthesis. K E Y W O R D S aorta and great vessels, clinical review, valve repair/replacement 1 | INTRODUCTION Valvular aortic stenosis (AS) is a disease characterized by leaflet thickening and calcification. Left untreated, it progresses from early sclerotic lesions to left ventricular outflow obstruction, resulting in reduced cardiac output, decreased exercise tolerance, heart failure, and death. 1 Valvular anatomy, hemodynamics, symptoms, as well as effects on left ventricular function, determine the severity of disease (Table 1). | METHODSA search was conducted on PubMed and results were reviewed for articles published up until April 30, 2020. Search terms included "aortic stenosis," "aortic valve replacement," "small aortic annulus," "aortic valve disease," and "cardiac surgery," or any combination thereof. All article types including original fulllength articles, meta-analyses, prior reviews, and case series were included.

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Long-term Mortality Predictors in Patients with Small Aortic Annulus Undergoing Aortic Valve Replacement with a 19- or 21-mm Bioprosthesis

Cited by 6 publications

References 21 publications

Aortic Valve Replacement with Sutured Valves in the Elderly: Does the Absolute Valve Size Matter?

Aortic Valve Replacement with Sutured Valves in the Elderly: Does the Absolute Valve Size Matter?

Clinical and Echocardiographic Aspects of Patient-Prosthesis Mismatch in Patients With Prosthetic Aortic Valves

Surgical aortic valve replacement in small aortic annulus

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