Ismail Bouhout

Surgery Versus Transcatheter Interventions for Significant Paravalvular Prosthetic Leaks

OBJECTIVESnThis study sought to assess the relative merit of surgical correction (SC) versus transcatheter reduction onxa0long-term outcomes in patients with significant paravalvular leak (PVL) refractory to medical therapy.nnnBACKGROUNDnPVL is the most frequent dysfunction following prosthetic valve replacement. Although repeat surgery is the gold standard, transcatheter reduction (TR) of PVL has been associated with reduced mortality.nnnMETHODSnFrom 1994 to 2014, 231 patients underwent SC (nxa0= 151) or TR (nxa0= 80) PVL correction. Propensity matchingxa0and Cox proportional hazards regression models were used to assess the effect of either intervention on long-term rates of all-cause death or hospitalization for heart failure. Survival after TR and SC were further compared with the survival inxa0a matched general population and to matched patients undergoing their first surgical valve replacement.nnnRESULTSnOver a median follow-up of 3.5 years, SC was associated with an important reduction in all-causexa0deathxa0orxa0hospitalization for heart failure compared with TR (hazard ratio: 0.28; 95% confidence interval: 0.18xa0toxa00.44; pxa0<xa00.001). There was a trend towards reduced all-cause death following SC versusxa0TRxa0(hazardxa0ratio:xa00.61; 95%xa0confidence interval: 0.37 to 1.02; pxa0= 0.06). Neither intervention normalizedxa0survivalxa0whenxa0compared with axa0general population or patients undergoing their first surgical valvexa0replacement.nnnCONCLUSIONSnIn patients with significant prosthetic PVL, surgery is associated with better long-term outcomesxa0compared with transcatheter intervention, but results in important perioperative mortality and morbidity. Future studies are needed in the face of increasing implementation of transcatheter PVL interventions across thexa0world.

The effect of storage solutions, gene therapy, and antiproliferative agents on endothelial function and saphenous vein graft patency

Vein graft failure remains a major concern after coronary artery bypass graft operations, and is initiated by loss of endothelial cell integrity. Preservation of saphenous vein grafts in the optimal solution after meticulous harvesting can limit the endothelial damage. Despite both experimental and clinical results in favor of buffered solutions, normal saline is still the most widely used solution. This review examines the literature to identify the most optimal storage solutions currently available for vein graft preservation.

Extracardiac Versus lateral tunnel Fontan: A Meta-Analysis of Long-Term Results

BACKGROUNDnThere is growing awareness of the long-term impact of a Fontan circulation on the associated morbidity and mortality. Comparative data on the incidence of supraventricular arrhythmia and sinus node dysfunction following extracardiac conduit (EC) and lateral tunnel (LT) Fontans are controversial. We performed a meta-analysis pooling all available long-term results comparing the EC and LT Fontan, with a special focus on arrhythmia.nnnMETHODSnWe performed a systematic search of PubMed, Embase, and the Cochrane Library for articles reporting long-term results of Fontan comparing the EC and the LT Fontan.nnnRESULTSnTwelve studies were selected with 3,330 patients (1,729 EC, 1,601 LT). Freedom from tachyarrhythmia was significantly higher in the EC group (92% versus 83% at 15 years; p < 0.0001), while there was no difference in term of bradyarrhythmias (pxa0= 0.7). The survival was 93% and 89% at 20 years in the EC and LT groups, respectively (pxa0= 0.007). The risk of thromboembolic events was 2.87% patient-years in the EC group versus 0.9% in the LT group (odds ratio, 2.15; 95% confidence interval, 0.95 to 4.85; pxa0= 0.07).nnnCONCLUSIONSnThe EC Fontan confers long-term survival advantage over the LT Fontan without a higher rate of reoperations. The EC Fontan preserves the sinus node function and reduces significantly the incidence of long-term postoperative arrhythmia.

306: Pregnancy Following Aortic Valve Replacement - Cardiac, Maternal and Fetal Outcomes

Introduction The choice of aortic valve substitute in young women should take the desire for pregnancy into account. Currently however, little is known about pregnancy-related outcomes following aortic valve replacement (AVR). The aim of this study was to assess cardiac, maternal and fetal-related outcomes in female patients with AVR during and after pregnancy. Method A retrospective study of all AVRs performed in women under the age of 40 years at our institution was undertaken. These patients were prospectively followed at our dedicated valve clinic. Patients with Turner syndrome or having undergone a hysterectomy and/or tubal ligation were excluded. Cardiovascular, maternal and fetal outcomes were gathered from medical records and telephone interviews. Results From 1976 to 2011, 77 women underwent 86 isolated AVRs: 65 mechanical prostheses (MPs) and 21 bioprostheses (BPs). The follow-up was 81% complete. Ten patients (13%) had 19 pregnancies at a mean age of 28±6 years. Of those, 5 ended in miscarriages (26%; n=4 BPs and n=1 MPs). Twelve (63%) pregnancies occurred in patients with BPs. The following adverse events were reported: two hospitalizations for syncope (25%), functional prosthetic valve deterioration during pregnancy necessitating reintervention 6 months post-partum (12%) and 4 miscarriages (33%). Nine of the 65 women (14%) with MPs had a hysterectomy or endometrial ablation for excessive uterine bleeding, precluding childbearing potential. In total, 7 pregnancies were reported in women with MPs. Two of them were terminated (n=1, medical advice and n=1 embolic myocardial infarction). The following peri-partum complications occurred: two embolic myocardial infarctions (33%), a postpartum bleeding (16%) and an urgent caesarean for placental abruption (16%). No fetal adverse events were observed. Conclusion Findings from this study suggest that pregnancy in women with prosthetic AVR is associated with an increased risk of cardiac adverse outcomes.

131: Long-term outcomes following isolated mechanical aortic valve repalcement in young adults

Background The ideal aortic valve substitute for young adults ( Methods Between 1997 and 2006, 1159 patients underwent AVR at our institution. All patients undergoing concomittant or redo procedures were excluded. Of those, 470 patients Results Overall actuarial survival at 1, 5 and 10 years was respectively 98±2%, 93±2% and 80±3%, which is lower than the age- and gender-matched general population in the province (Figure). Actuarial freedom from prosthetic valve dysfunction was 99±1%, 92±2% and 88±8% at 1, 5 and 10 years respectively. Actuarial freedom from valve reintervention was 98±1%, 93±1% and 89±2% at 1, 5 and 10 years respectively. Actuarial freedom from thrombo-embolism was 96±1%, 90±2% and 87±2% at 1, 5 and 10 years respectively. Conclusion In young adults undergoing isolated mechanical AVR, survival is lower than expected in an age- and gender-matched general population. Furthermore, there is a low but constant hazard of prosthetic valve reintervention following mechanical AVR. Further studies are required to determine the ideal valve substitute in young adults undergoing AVR. Download : Download full-size image