Trend and early outcomes in isolated surgical aortic valve replacement in the United Kingdom

Chan, Jeremy; Dimagli, Arnaldo; Fudulu, Daniel; Sinha, Shubhra; Narayan, Pradeep; Dong, Tim; Angelini, Gianni D

doi:10.3389/fcvm.2022.1077279

Cited by 7 publications

(7 citation statements)

References 34 publications

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“…Most importantly, we found that BPVs recently tended to be preferred over MPVs in patients between 50 and 60 years-old, a trend which is not observed to this extent in some other western countries ( 15 ). Added to patients aged from 60 to 65 years-old, they represent the so called middle-aged patients which represent a significant proportion (20%) of the overall population included in our study.…”

Section: Discussioncontrasting

confidence: 55%

Trends in SAVR with biological vs. mechanical valves in middle-aged patients: results from a French large multi-centric survey

Caus,

Chabry,

Nader

et al. 2023

Front. Cardiovasc. Med.

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Background/introductionCurrently, despite continued issues with durability ( 1), biological prosthetic valves are increasingly chosen over mechanical valves for surgical aortic valve replacement (SAVR) in adult patients of all ages, at least in Western countries. For younger patients, this choice means assuming the risks associated with a redo SAVR or valve-in-valve procedure.PurposeTo assess the use of mechanical vs. biological valve prostheses for SAVR relative to patient's age and implant time in a large population extracted from the French National Database EPICARD.MethodsPatients in EPICARD undergoing SAVR from 2007 to 2022 were included from 22 participating public or private centers chosen to represent a balanced representation of centre sizes and geographical discrepancies. Patients with associated pathology of the aorta (aneurysm or dissection) and requiring a vascular aortic prosthesis were excluded. Comparisons were made amongst centers, valve choice, implant date range, and patient age.ResultsWe considered 101,070 valvular heart disease patients and included 72,375 SAVR (mean age 71.4 ± 12.2 years). We observed a mechanical vs. biological prosthesis ratio (MBPR) of 0.14 for the overall population. Before 50 years old (y-o), MBPR was >1.3 (p < 0.001) while patients above 60 years-old received principally biological SAVR (p < 0.0001). Concerning patients between 50 and 60 years-old patients, MPVR was 1.04 (p = 0.03). Patients 50–60 years-old from the first and second study duration quartile (before August 2015) received preferentially mechanical SAVR (p < 0.001). We observed a shift towards more biological SAVR (p < 0.001) for patients from the third and fourth quartile to reach a MBPR at 0.43 during the last years of the series. Incidentally, simultaneous mitral valve replacement were more common in case of mechanical SAVR (p < 0.0001), while associated CABGs were more frequent in case of biological SAVR (p < 0.0001).ConclusionIn a large contemporary French patient population, real world practice showed a recent shift towards a lower age-threshold for biological SAVR as compared to what would suggest contemporary guidelines.

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Section: Discussioncontrasting

confidence: 55%

Trends in SAVR with biological vs. mechanical valves in middle-aged patients: results from a French large multi-centric survey

Caus,

Chabry,

Nader

et al. 2023

Front. Cardiovasc. Med.

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“…It would also be interesting to apply similar ensemble benchmarking approaches to identify the suitable models to use for combining variables and data from new cardiac interventions (e.g. TAVR 98 with that of historical interventions (SAVR) through clustering 99 and trajectory-based approaches. 100 – 102 …”

Section: Limitations and Future Studiesmentioning

confidence: 99%

Cardiac surgery risk prediction using ensemble machine learning to incorporate legacy risk scores: A benchmarking study

et al. 2023

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Objective The introduction of new clinical risk scores (e.g. European System for Cardiac Operative Risk Evaluation (EuroSCORE) II) superseding original scores (e.g. EuroSCORE I) with different variable sets typically result in disparate datasets due to high levels of missingness for new score variables prior to time of adoption. Little is known about the use of ensemble learning to incorporate disparate data from legacy scores. We tested the hypothesised that Homogenenous and Heterogeneous Machine Learning (ML) ensembles will have better performance than ensembles of Dynamic Model Averaging (DMA) for combining knowledge from EuroSCORE I legacy data with EuroSCORE II data to predict cardiac surgery risk. Methods Using the National Adult Cardiac Surgery Audit dataset, we trained 12 different base learner models, based on two different variable sets from either EuroSCORE I (LogES) or EuroScore II (ES II), partitioned by the time of score adoption (1996–2016 or 2012–2016) and evaluated on holdout set (2017–2019). These base learner models were ensembled using nine different combinations of six ML algorithms to produce homogeneous or heterogeneous ensembles. Performance was assessed using a consensus metric. Results Xgboost homogenous ensemble (HE) was the highest performing model (clinical effectiveness metric (CEM) 0.725) with area under the curve (AUC) (0.8327; 95% confidence interval (CI) 0.8323–0.8329) followed by Random Forest HE (CEM 0.723; AUC 0.8325; 95%CI 0.8320–0.8326). Across different heterogenous ensembles, significantly better performance was obtained by combining siloed datasets across time (CEM 0.720) than building ensembles of either 1996–2011 ( t-test adjusted, p = 1.67×10−6) or 2012–2019 ( t-test adjusted, p = 1.35×10−193) datasets alone. Conclusions Both homogenous and heterogenous ML ensembles performed significantly better than DMA ensemble of Bayesian Update models. Time-dependent ensemble combination of variables, having differing qualities according to time of score adoption, enabled previously siloed data to be combined, leading to increased power, clinical interpretability of variables and usage of data.

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“…Митрально-аортальная мембрана (7). Фиброзное кольцо митрального клапана (8). Передняя створка митрального клапана (9).…”

Section: потребность в задней аортопластике у взрослыхunclassified

“…Mitral-aortic membrane (7). Fibrous annulus of the mitral valve (8). Anterior leaflet of the mitral valve (9).…”

Section: потребность в задней аортопластике у взрослыхmentioning

confidence: 99%

“…В последние годы в кардиохирургической практике драматически снизилась доля механических протезов в аортальной позиции в пользу биоклапанов, чья доля возросла с 50% до 80% [8]. Последние изменения в рекомендациях American Heart Association (2017) понизили возрастной коридор пациентов, которым приемлема имплантация биопротеза до 50-70 лет.…”

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Surgical treatment of valvular aortic stenosis in combination with a narrow aortic root. The site of posterior aortoplasty in adults. An overview of the need for this operation, its execution techniques and our experience. Literature review

Sazonenkov,

Tatarintsev,

Ismatov

et al. 2023

Humans and their Health

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Aim: to describe the current state of the problem of surgical expansion of the aortic root during aortic valve replacement. Aortic valve replacement is a radical operation aimed at reducing the symptoms of chronic heart failure, reducing left ventricular overload, regressing its hypertrophy, and thereby increasing the quality and life expectancy of the patient. For the greatest success of the operation, the replacement should be made with the appropriate valve size suitable for the particular patient. Materials and methods. The latest literature data on the place of surgical expansion of the aortic root in the problem of treating aortic stenosis were studied. The own experience of these operations during the implantation of mechanical and biological prostheses in the aortic position in the practice of the cardiosurgical department of the Belgorod Regional Clinical Hospital is presented. Results. The study is devoted to the actual problem of choosing the right size of the prosthesis, the frequency of additional surgical procedures for its placement. Many studies have established an association between prosthesis-patient mismatch (PPM) and surgical outcome. The association of prosthesis-patient mismatch with long-term survival is inverse, although sometimes reported as ambiguous. We reviewed the literature and our experience with the surgical management of narrow aortic root situations to determine the incidence of PPM and the need for an additional surgical procedure of posterior aortoplasty to accommodate the appropriate size of the prosthesis. The results of modern meta-analyses, multicenter studies and limited series of operations presented in the literature are reviewed. The experience of the cardiosurgical department of the Belgorod Regional Clinical Hospital for the period 01.01.2015-30.04.2023 in aortic valve replacement with a small size of the aortic ring (17-20 mm) is presented. The study material consisted of 303 patients. As prosthesis-patient mismatch, we defined all cases of posterior aortoplasty with implantation of an appropriately sized aortic prosthesis. According to modern studies, the incidence of prosthesis-patient mismatch in aortic valve replacement without aortic root plasty is 11-33%. The frequency of posterior aortoplasty in adults is, according to different authors, 5-40%. Our experience has shown that the situation of PPM, which required aortic plasty, occurred in 14.8% of cases of implantation of stented biological prostheses, in 17.3% of cases of implantation of mechanical bicuspid prostheses. In general, on average, aortic plasty was performed in 15.8% of cases. Prosthetic-patient mismatch in aortic valve replacement occurs at a relatively constant rate. Posterior aortoplasty allows implanting the calculated size of the prosthesis and avoiding this problem. Conclusion. Surgery to patch the aortic root to accommodate an adequately sized prosthesis in the aortic position is required in 15-30% of patients with narrow aortic annulus. It allows you to get good hemodynamic results. The surgical risk of the operation is low.

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Trend and early outcomes in isolated surgical aortic valve replacement in the United Kingdom

Cited by 7 publications

References 34 publications

Trends in SAVR with biological vs. mechanical valves in middle-aged patients: results from a French large multi-centric survey

Trends in SAVR with biological vs. mechanical valves in middle-aged patients: results from a French large multi-centric survey

Cardiac surgery risk prediction using ensemble machine learning to incorporate legacy risk scores: A benchmarking study

Surgical treatment of valvular aortic stenosis in combination with a narrow aortic root. The site of posterior aortoplasty in adults. An overview of the need for this operation, its execution techniques and our experience. Literature review

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