For patients with aortic valve disease who require replacement of their native valve, surgical aortic valve replacement (SAVR) has been the standard of care. Due to the hemorrhage and thromboembolic risks of long-term anticoagulation therapy for mechanical prosthesis, bioprosthetic aortic valve replacement (AVR) has a trend to be used in younger patients, which raising the concern for the durability of bioprosthetic valves. The newly published 5-year outcomes of PERIGON trial, with no structural valve deterioration, again demonstrated the favorable durability of the new generation bioprosthetic valves, further providing the evidence of using bioprosthetic AVR in younger patients. At the meantime, the rapid progress of transcatheter aortic valve implantation (TAVI) has brought a new treatment option. For younger patients with low risks, choosing SAVR or TAVI becomes a critical decision. This paper reviews the outcomes of PERIGON trial and its implications to the clinical practice and research of bioprosthetic AVR.
The advent of transcatheter aortic valve replacement (TAVR) has brought up a new treatment option for patients with severe aortic valve disease. However, with the continuous expansion of surgical indications, problems such as structural valve deterioration caused by biological prosthesis have become increasingly prominent. In the newly announced 5-year follow-up results of COMMENCE (SAVR) trial, the aortic bioprosthesis using the new RESILIA biotissue material demonstrated extraordinary clinical safety, efficacy and durability with zero structural valve deterioration and excellent hemodynamic evaluation results. As a result, patients with valvular heart disease have more diverse therapeutic options. However, the choice between surgical aortic valve replacement (SAVR) and TAVR, biological prosthesis and mechanical prosthesis, etc, has become more and more prominent, which brings more difficulties to clinicians. This paper reviews the research background, 5-year follow-up results of COMMENCE trial and the implications for aortic valve surgery in China.
Objective To evaluate the efficacy of Radiofrequency （RF） modified maze procedure combined with open-heart surgery for atrial fibrillation （AF）. Methods From January 2003 to October 2004, 66 patients underwent the RF modified maze Ⅲ procedure for AF combined with open-heart surgery. The preoperative and postoperative indexes of electrocardiogram and echoeardiogram were compared through retrospective analysis and follow-up. Postoperative cardiac function and thromboembolie events were evaluated through telephone and mail. Results The time needed for RF modified maze Ⅲ was 18.61±3.56 min. There were no hospital deaths and the complications was 15.15%（10/66）. Follow-up duration was 14.25±6.47 months with 95.45%（63/66） completion. At the lastest follow-up, the rate of freedom from AF was 80.95% （51/63）and the rate of restoration to sinus rhythm was 74.60%（47/63）. No thromboembolic events was seen. 77.78%（49/63） of patients were in NYHA class Ⅰ. Significant decrease was seen in both left atrial dimension （LAD） and left ventricular dimension （LVD）（P〈0.01） more than 6 months after operation. Conclusion RF modified maze Ⅲ procedure as an adjunctive procedure is safe, time-sparing and effective in eliminating AF.
Abstract: Objective To compare the change of left heart funct ion in pat ients w ith bio logical valves replacement of small ao rt ic roo t w ith mechanical valve rep lacement, and to find w hether there is p ro sthesis-patient mismatch (PPM ) or not after operation. Methods Left ventricular ejection fraction (LV EF ) , left ventricular fractional shortening (LVFS) , left vent ricular mass index, the indexed effective orifice area (EOA I) , and peak pressure gradients across aortic valve in 20 patients with small aortic root (≤21mm in diameter) receiving biological valves rep lacement (biological valves group ) were studied by Doppler echocardiography before the operation and 6 months to 1 year after operation. The results were compared with those of 20 patients who received mechanical valves replacement (mechanical valves group ). Results Comparing with those before operation, there was a significant increase in LVEF, LV FS, EOAI of all patients 6 months to 1 year after operation . There was a significant reduction in the left ventricular mass index, peak pressure gradients across aortic valve in all patients. EOAI of all patients were between 0.88 cm2/m2 and 1. 32 cm 2/m 2. LVEF, LVFS, EOAI, left ventricular mass index, and peak pressure gradients across aortic valve between biological valves group and mechanical valves group (79% ±8% vs. 81%±10%; 43%±9% vs. 37%±8%; 1. 11±0. 14 vs. 0. 92±0. 11; 89. 10±16. 70g/m 2 vs. 95. 30±15.10 g/m 2; 18. 80±12. 60 mmHg vs. 22. 30±12. 00 mmHg) showed no significant difference 6 months to 1 year after operation (P gt;0.05). Conclus ion Patients with small aortic root receiving biological valves have a significant increase in the left heart function, and have no PPM.
Abstract: Human leukocyte antigen (HLA) is the key antigen mediating rejection and panel reactive antibody (PRA) represent anti-HLA antibodiesin circulation. HLA typing and PRA testing are carried out generally before organ transplantation. With research on the relationship among HLA, PRA and heart transplantation developing, the value of HLA typing and PRA testing in heart transplantation has received more attention and their clinical using strategy has been improved. This article will review the strategy of HLA typing, the clinical value of HLA typing, time-selection in HLA typing, reason and mechanism of rising PRA, clinical sense of PRA testing and treatment of sensitized patients.
Abstract： Objective To summarize our operative experiences of cardiac reoperation after mechanical valve prosthesis replacement and investigate the causes of reoperation and the perioperative techniques and operation methods. Methods From January 2001 to December 2008, we performed reoperation on 105 patients (59 males and 46 females, aged 50.2±10.6 years old) who had undergone mechanical valve prosthesis replacement. Among the patients, there were 31 cases of mitral valvular replacement (+ tricuspid valvular plasticity), 38 cases of aortic valvular replacement (+ tricuspid valvular plasticity), 11 cases of Bentall procedure, 7 cases of mitral and aortic bivalvular replacement (+tricuspid valvular plasticity), 8 cases of tricuspid valvular replacement, 6 cases of repairing of prosthetic leakage, and 4 others cases. The time interval between two operations was 3 months to 18 years (46.3 ±31.9 months). Before reoperation, the cardiac function (NYHA) of the patients was class Ⅱ in 27 patients, class Ⅲ in 53 patients, and class Ⅳ in 25 patients. Results There were 6 hospital deaths with a mortality of 5.71%(6/105). All others recovered to NYHA class ⅠⅡ. The causes of mortality included 1 case of multiple organ failure, 1 case of low cardiac output after operation, 1 case of aortic pseudoaneurysm rupture, 1 case of severe infection due to brain complication and 2 cases of prosthetic valve endocarditis (PVE). The causes for cardiac reoperation after mechanical valve prosthesis replacement were 67 cases of prosthetic leakage (63.80%), 16 cases of PVE (15.23%), 14 cases of prosthetic thrombosis (13.33%) and 8 cases of other valvular anomalies. Followup was done for 11 to 107 months, which showed two cases late deaths of cardiac arrest and cerebral hemorrhage. Conclusion Patients who have received mechanical valve prosthesis replacement may undergo cardiac reoperation due to paravalvular prosthetic leakage, paravalvular endocarditis, and prosthetic thrombosis. The keys to a successful cardiac reoperation include appropriate preoperative preparations, operational timing, and suitable choosing of cardiopulmonary bypass and operational skills.
