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.
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.
Abstract: Objective To find out the factors which influence plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and assess whether preoperative plasma NT-proBNP levels can predict postoperative outcomes of cardiac surgery. Methods A total of 120 patients including 83 males and 37 females undergoing various cardiac procedures between December 2008 and May 2009 were included in the study. Their age ranged from 25 to 84 years with an average age of 62.13 years. Through pathological diagnosis, 35 patients had heart valve diseases, 74 had coronary artery diseases, 3 had congenital heart diseases and 8 had aortic aneurysm. NT-proBNP, creatinine, cardiac troponin T (cTnT) and creatine kinase-MB (CK-MB) levels were measured preoperatively and 24 hours after operation. Ventilation time, length of stay in ICU or in hospital, and mortality were closely monitored after operation. The following events were regarded as endpoints: (1) ICU stay timegt;4 d; (2) Ventilation timegt;48 h; (3) Death occurred during the first 30 days after operation. Receiver operating characteristic (ROC) curve was used to analyze the prediction function of NTproBNP on endpoint events. Based on the cutoff value, the patients were divided into the NT-proBNP increasing group and nonincreasing group. Univariate and logistic multifactor analysis were adopted to analyze factors which had an influence on preoperative NT-proBNP level. Results NT-proBNP concentration [CM(159mm]increased significantly from 37.5-30 867.0 pg/ml (1 929.12±3 749.44 pg/ml) preoperatively to 177.7-35 000.0pg/ml(2 950.32±4 006.14 pg/ml) 24 hours after operation (t=-2.599, P=0.012). ROC curve demonstrated that a cutoff value above 867 pg/ml preoperatively could predict endpoint events with a sensitivity of 77.8% and a specificity of 62.7%. Ventilation time and length of stay in hospital for the patients in the NT-proBNP increasing group were significantly longer than those of patients in the nonincreasing group (26.44±32.75 h vs. 14.49±9.23 h, t=2.507, P=0.015; 23.70±24.02 d vs. 16.21±8.11 d, t=2.117,P=0.039). Influencing factors on preoperative NTproBNP level included preoperative atrial fibrillation, heart function classification, left ventricular enddiastolic dimension (LVEDD), ejection fraction (EF), pulmonary artery pressure, preoperative creatinine, cTnT and pathological diagnosis. EF (P=0.007) and preoperative atrial fibrillation (P=0.018) were independently associated with preoperative NT-proBNP level. Preoperative NTproBNP was closely related to ventilation time (P=0.015), and length of stay in hospital (P=0.039). Conclusion Preoperative plasma NT-proBNP level presents a high individual variability in patients undergoing cardiac surgery. Ejection fraction and preoperative atrial fibrillation are independently associated with preoperative NT-proBNP level. Preoperative NT-proBNP is a valuable marker in predicting bad outcome in patients undergoing heart surgery.
ObjectiveTo explore the clinical value of soluble suppression of tumorigenesis-2 (sST2) in replacement of N-terminal fragment of the brain natriuretic peptide precursor (NT-proBNP) in cardiac function evaluation in renal failure patients after cardiac surgery.MethodsSixty patients with renal insufficiency after cardiac surgery from January 2019 to June 2019 were divided into a test group, including 34 males and 26 females, with an average age of 49-78 (63.3±4.5) years. Another 60 patients with normal renal function were divided into a control group, including 37 males and 23 females, with an average age of 53-77 (61.7±3.8) years. The perioperative left ventricular ejection fraction, cardiac troponin T, creatine kinase-MB, sST2 and NT-proBNP were compared.ResultsIn patients of the test group, the NT-proBNP level increased significantly during perioperative period, and the change range was different from other cardiac function indexes. The change of sST2 in perioperative period was similar to other cardiac function indexes, which could reflect the change degree of cardiac function after operation.ConclusionsST2 is more important to reflect the change degree of cardiac function in patients with renal dysfunction after cardiac surgery than NT-proBNP.
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.