• Journal of Chest Surgery
• /
• v.50 no.6
• /
• pp.467-470
• /
• 2017

Extensive mitral annulus calcifications are considered a contraindication for valve surgery. We describe the case of a 76-year-old female with severe mitral and aortic stenosis associated with extensive calcifications of the heart. The patient underwent an open mitroaortic valve replacement using transcatheter aortic valve implantation with an Edwards SAPIEN XT valve (Edwards Lifesciences Corp., Irvine, CA, USA) in the mitral position. The aortic valve was replaced using a stentless valve prosthesis (LivaNova S OLO; LivaNova PLC, London, UK). Postoperative echocardiography showed that the prosthetic valve was in the correct position and there were no paravalvular leaks. A bailout open transcatheter valve implantation can be considered a safe and effective option in selected cases with an extensively calcified mitral valve.

• Journal of Chest Surgery
• /
• v.54 no.1
• /
• pp.25-30
• /
• 2021

Background: Life-long anticoagulant therapy is mandatory for patients who undergo heart valve replacement with implantation of a mechanical prosthesis. The aim of this study was to investigate the effects of a nurse-led patient educational program concerning oral anticoagulant therapy intake after heart valve replacement surgery on patients' knowledge of important parameters of anticoagulant administration. Methods: In this single-center study, 200 patients who underwent surgical implantation of a mechanical prosthesis were divided into 2 groups. The control group received the basic education concerning oral anticoagulants, while the intervention group received a personalized educational program. Results: Personalized education was correlated with a better regulation of therapeutic international normalized ratio (INR) levels and adequate knowledge among patients. Therapeutic levels of INR were achieved in 45% of the patients during the first month, 71% in the third month, and 89% in the sixth month after discharge in the intervention group, compared to 25%, 47%, and 76% in the control group, respectively. Patients' satisfaction with the information was higher in the intervention group than in the control group. The percentage of satisfaction reached 80% for the intervention group versus 37% for the patients of the control group. Conclusion: The implementation of the nurse-led educational programs was associated with improved clinical results and increased adherence to oral anticoagulant treatment.

• Journal of Chest Surgery
• /
• v.36 no.5
• /
• pp.316-320
• /
• 2003

Background: The detection of circulating microemboli by transcranial Doppler ultrasonography (TCD) has the potential to select the patients with high risk for future symptomatic brain embolism. We prospectively evaluated the positive rate and the frequency of microembolic signals (MES) before and after the heart valve surgery (HVS). Material and Method: Fifty in-patients with heart valve disease were enrolled in this study. Patients with history of previous stroke or heart valve surgery were excluded. Two unilateral TCD monitoring sessions were peformed from middle cerebral artery for 1-hour, before and after HVS. Result: Mechanical Heart valves were implanted in 28 patients, tissue valves were implanted in 10 patients, and remaining 12 patients received mitral valve repair. Positive rate of MES was significantly increased after HVS (50%), compared to that of before HVS (8%, p=0.00). There was no relation between MES after HVS and intensity of anticoagulation, cardiac rhythm, patients' age, and history of hypertension. The positive rate of MES after implantation of mechanical heart valve (71.4%) was significantly higher than those after implantation of tissue valve or mitral valve plasty (p=0.002). Conclusion: Positive rate of MES was increased significantly after the implantation of HVS. The changes of MES in those with mechanical prosthesis may be related to the increased risk or embolism after Hvs.

• Journal of Chest Surgery
• /
• v.19 no.4
• /
• pp.584-594
• /
• 1986

Despite the multivariate improvements in tissue treatment, material, and design of prosthetic heart valves in recent years, numerous complications that may lead to valve dysfunction remain a constant threat after valve replacement. Most common indications for prosthetic valve failure are primary valve failure, infective endocarditis, paravalvular leakage, and thromboembolism. From 1977 to 1986, 15 patients underwent reoperation for prosthetic valve failure in 278 cases of valve surgery. The etiology of prosthetic valve failure were primary valve failure in 12 patients [80 %], infective endocarditis in 2 patients [13.3 %], and a paravalvular leakage [6.7 %]. The average durations of implantation were 45.5 months; 53.9 months in primary valve failure, 16 months in infective endocarditis, and 4 months in paravalvular leakage. The rate of valve failure was high under age of 30 [11/15]. Calcifications and collagen disruption of prosthesis were main cause of primary valve failure in macro- & micropathology. Prosthesis used in reoperation were 5 tissue valves and 10 mechanical valves. Operative mortality were 13.3 % [2/15], due to intractable endocarditis and ventricular arrhythmia.

• Journal of Yeungnam Medical Science
• /
• v.31 no.2
• /
• pp.144-147
• /
• 2014

Despite the necessity of surgical aortic valve replacement, many patients with symptomatic severe aortic stenosis (AS) cannot undergo surgery because of their severe comorbidities. In these high-risk patients, percutaneous transcatheter aortic valve implantation (TAVI) can be safely accomplished. However, no study has shown that TAVI can be performed for patients with severe AS accompanied by acute decompensated heart failure. In this case report, 1 patient presented a case of severe pulmonary hypertension with decompensated heart failure after diagnosis with severe AS, and was successfully treated via emergency TAVI. Without any invasive treatment, acute decompensated heart failure with severe pulmonary hypertension is common in patients with severe AS, and it can increase mortality rates. In conclusion, TAVI can be considered one of the treatment options for severe as presented as acute decompensated heart failure patients with pulmonary hypertension.

• Journal of Chest Surgery
• /
• v.29 no.5
• /
• pp.504-509
• /
• 1996

When a valve prosthesis is to be implanted in the aortic position, simple interrupted suture, figure-of- eight suture, or horizontal mattress suture technique is used as a suture method. However, the suture techniques may be unacceptable for aortic valve replacement in patients with friable annulus caused by some lesions, such as endocarditis and degenerative change. We used an alternative technique for the aortic vlave replacement in 4 patients with valve endocarditis, ) patients with degenerative valvular lesion, and 1 with rheumatic valvular disease. Mattress sutures through the annulus were placed with pledgets on the ventricular side of the annulus, whi h resulted in implantation of the prosthesis at a supra-annular level. Mechanical valves of 21 mm or larger were implanted in the supra-annular position in all patients and there was no impeded motion of leaflets during the follow-up period of mean 13.3 mouths. The transvalvular pressure gradient was less than 6 mm Hg in 3 patients and 20 to 40 mm Hg in 5 patients. The supra-annular implantation of mechanical aortic valve using a vertical mattress suture technique may be a useful alternative method of aortic valve replacement for the selected patients with friable or destroyed aortic annulus.

• Journal of Chest Surgery
• /
• v.51 no.1
• /
• pp.1-7
• /
• 2018

Background: Sutureless aortic valve replacement (SU-AVR) has been developed as an alternative surgical treatment for patients with symptomatic severe aortic stenosis (AS). The aim of this study was to evaluate the clinical outcomes of SU-AVR through an assessment of hemodynamic performance and safety. Methods: From December 2014 to June 2016, a total of 12 consecutive patients with severe AS underwent SU-AVR. The endpoints were overall survival and valve-related complications (paravalvular leakage, valve thrombosis, migration, endocarditis, and permanent pacemaker implantation). The mean follow-up duration was $18.1{\pm}8.6months$. Results: The mean age of the patients was $77.1{\pm}5.8years$ and their mean Society of Thoracic Surgeons score was $9.2{\pm}17.7$. The mean cardiopulmonary bypass and aortic cross-clamp times were $94.5{\pm}37.3$ minutes and $54.9{\pm}12.5minutes$, respectively. Follow-up echocardiography showed good prosthesis function with low transvalvular pressure gradients (mean, $13.9{\pm}8.6mm\;Hg$ and peak, $27.2{\pm}15.0mm\;Hg$) at a mean of $9.9{\pm}4.2months$. No cases of primary paravalvular leakage, valve thrombosis, migration, or endocarditis were reported. A new permanent pacemaker was implanted in 1 patient (8.3%). The 1-year overall survival rate was $83.3%{\pm}10.8%$. Conclusion: Our initial experience with SU-AVR demonstrated excellent early clinical outcomes with good hemodynamic results. However, there was a high incidence of permanent pacemaker implantation compared to the rate for conventional AVR, which is a problem that should be solved.

• Journal of Chest Surgery
• /
• v.33 no.1
• /
• pp.45-50
• /
• 2000

Background: The CarboMedics prosthetic heart valve was produced in an attempt to improve the existing valve designs and was especially concerned with easily the implantation and further reduction of turbulence. Precise positioning of the valve in situ was achieved by the abilityof the valve to rotate relative to the sewing ring. Improved monitoring is possible due to increased radiopacity and the dacron sewing ring is coated with carbon to reduce pannus overgrowth. The leaflets have an opening angle of 78 degrees that apparently allows a rapid synchronous closure The aim of this study was to analyze the clinical performance of the CarboMedics valve prostheses(45 mitral 13 aortic and 7 double aortic-mitral valve replacement) were implanted in 65 patients(mean age 48.75$\pm$9.74 years) Result: The operative mortality was 3.1%(2/65) causes of death were low cardiac output syndrome. Total follow up was 1831 patient-months and mean follow up was 29.06$\pm$10.97 months/patient. No structural failure hemorrhage valve thrombosis and late death have been observed. Embolism occurred at a rate of 0.65%/Patient-year. Actuarial survival and thrombo-mbolism free rate at 36 months were 96.9% and 98.4% respectively. Consclusions: The CarboMedics valve stands for low valve related complicatons.

• Journal of Chest Surgery
• /
• v.49 no.3
• /
• pp.165-170
• /
• 2016

Background: In elderly high-risk surgical patients, sutureless aortic valve replacement (AVR) should be an alternative to standard AVR. The potential advantages of sutureless aortic prostheses include reducing cross-clamping and cardiopulmonary bypass (CPB) time and facilitating minimally invasive surgery and complex cardiac interventions, while maintaining satisfactory hemodynamic outcomes and low rates of paravalvular leakage. The current study reports our single-center experience regarding the early outcomes of sutureless aortic valve implantation. Methods: Between October 2012 and June 2015, 65 patients scheduled for surgical valve replacement with symptomatic aortic valve disease and New York Heart Association function of class II or higher were included to this study. Perceval S (Sorin Biomedica Cardio Srl, Sallugia, Italy) and Edwards Intuity (Edwards Lifesciences, Irvine, CA, USA) valves were used. Results: The mean age of the patients was $71.15{\pm}8.60years$. Forty-four patients (67.7%) were female. The average preoperative left ventricular ejection fraction was $56.9{\pm}9.93$. The CPB time was $96.51{\pm}41.27minutes$ and the cross-clamping time was $60.85{\pm}27.08minutes$. The intubation time was $8.95{\pm}4.19hours$, and the intensive care unit and hospital stays were $2.89{\pm}1.42days$ and $7.86{\pm}1.42days$, respectively. The mean quantity of drainage from chest tubes was $407.69{\pm}149.28mL$. The hospital mortality rate was 3.1%. A total of five patients (7.69%) died during follow-up. The mean follow-up time was $687.24{\pm}24.76days$. The one-year survival rate was over 90%. Conclusion: In the last few years, several models of valvular sutureless bioprostheses have been developed. The present study evaluating the single-center early outcomes of sutureless aortic valve implantation presents the results of an innovative surgical technique, finding that it resulted in appropriate hemodynamic conditions with acceptable ischemic time.

• Journal of Chest Surgery
• /
• v.29 no.12
• /
• pp.1337-1341
• /
• 1996

From September 1989 to March 1996, 13 patients with prosthetic valve thrombosis underwent reoperdtion on 16 occasions. The mean interval between implantation and reoperation was 27.8 months. The anticoagulation status was inadequate in 44% of th Instances. The majority(75%) were in NYHA functional class IV, 6 of them being in shock. Reoperation was performed for valve replacement(15 of 16 occasions) or thrombectomy(1 of 16 occasions) within 3 to 192 hours(mean 33.5 hours). Operative mortality at reoperation was 25%(4 patients). Re-thrombosis occurred In 3 patients. Long-term outcome was satisfactory in all survivors with a mean follow-up of 30.B months. The present results indicate that an early diagnosis and prompt surgical intervention is needed to decrease operative mortality.