Jessica Forcillo

Carpentier-Edwards pericardial valve in the aortic position: 25-years experience.

BACKGROUNDnThe Carpentier-Edwards pericardial valve was designed to minimize structural valve deterioration. Excellent durability and low incidence of valve-related complications have been reported. The objective of the present study was to analyze clinical results after 25 years of experience with this valve implanted in the aortic position. The effect of patient age at the time of surgery was also evaluated.nnnMETHODSnThis is a retrospective cohort study of 2,405 patients from November 1981 to March 2011. Primary outcomes of interest were survival and freedom from major adverse effects such as thromboembolic, endocarditis, and reoperation.nnnRESULTSnSixty percent were male, with a mean age of 71 ± 9 years old. Actuarial survival rates including early deaths averaged 78% ± 2%, 55% ± 2%, and 16 % ± 2% after 5, 10, and 20 years of follow-up, respectively. The freedom rate of valve reoperation for prosthesis dysfunction and all other causes averaged 98 % ± 0.2%, 96% ± 1%, and 67% ± 4% at 5, 10, and 20 years. Patients younger than 60 years of age had a 15-year survival averaging 54% ± 5% compared with patients aged between 60 and 70 years of age averaging 46% ± 3% and with patients older than 70 years of age averaging 28% ± 3% (p = 0.001). Survival at 5, 10, and 20 years for patients who had concomitant CABG [coronary artery bypass grafting] were 78% ± 1%, 55% ± 2%, and 9% ± 3% compared with no concomitant CABG (84% ± 1%, 62% ± 2%, and 22% ± 3% (p < 0.001)).nnnCONCLUSIONSnCarpentier-Edwards pericardial valve implantation in the aortic position is secure and durable. The effects of age influence reoperation rate and survival as well as a concomitant coronary artery bypass procedure.

The perimount valve in the aortic position: twenty-year experience with patients under 60 years old.

BACKGROUNDnWith improved durability of contemporary bioprostheses, surgeons are now recommending biologic valves in younger patients. However, long-term outcomes of patients younger than 60 years old undergoing biologic aortic valve implantation are not well known.nnnMETHODSnFrom November 1991 to March 2011, 144 patients less than 60 years old underwent aortic valve replacement (AVR) with Carpentier-Edwards pericardial valves (Edwards Lifesciences, Irvine, CA). Mean follow-up was 10±4 years. Outcomes were reported according to published guidelines.nnnRESULTSnSeventy-five percent of patients were male, with a mean age of 51±9 years. Actuarial survival rates including early deaths were 89%±3%, 79%±4%, and 57%±6% after 5, 10, and 15 years of follow-up, respectively. Survival of patients was comparatively lower than a gender- and age-matched general population at all time points. The freedom from major adverse cardiac events (myocardial infarction, heart failure, hemorrhage, thromboembolic event, and endocarditis) was 89%±3%, 87%±3%, and 75%±6% at 5, 10, and 15 years after surgery. The freedom rate from prosthetic valve dysfunction was 97%±2%, 84%±4%, and 57%±6% at 5, 10, and 15 years after surgery. Patients with a diagnosis of structural valve deterioration (29 of 37, 78%) underwent reoperation 11±5 years after the initial valve replacement with no perioperative mortality.nnnCONCLUSIONSnIn patients younger than 60 years undergoing AVR, the Carpentier-Edwards Perimount bioprosthesis provided satisfactory clinical outcomes. However, late survival was inferior to an age- and gender-matched population. Structural valve deterioration and the need for reintervention were common late after implantation, but reoperation for prosthetic valve dysfunction was associated with a very low risk of mortality.

Perioperative outcomes with sutureless versus stented biological aortic valves in elderly persons

OBJECTIVESnSutureless aortic valves are deemed suitable for patients considered at high risk for surgery. The objective of this study is to evaluate the perioperative results of implanting a sutureless valve in elderly persons, compared with a stented biological valve in the aortic position.nnnMETHODSnBetween 2011 and 2015, 76 patients underwent aortic valve replacement with the Perceval prosthesis (Sorin Group, Saluggia, Italy). The group was compared with 319 consecutive patients who received aortic valve replacement with the stented valve in that same period.nnnRESULTSnThe mean age of patients was 83xa0±xa02xa0years in the Perceval group and 83xa0±xa03xa0years in the stented valve group (Pxa0=xa0.3). Preoperative demographics were similar in both groups. Median cardiopulmonary bypass and crossclamp times were lower in the Perceval group than in the stented valve group (Pxa0<xa0.001). Mortality was 5% in the Perceval group and 6% in the stented valve group (Pxa0=xa0.8). There were more pacemaker implantations in the Perceval group than in the stented valve group (17% vs 8%; Pxa0=xa0.02). A subgroup analysis of patients who underwent aortic valve replacement and concomitant procedures showed the same results as the entire cohort.nnnCONCLUSIONSnAortic valve replacement with a sutureless prosthesis resulted in shorter aortic crossclamp and bypass times compared with a stented biological prosthesis. The reduced cardiopulmonary bypass and aortic crossclamp times obtained using the Perceval prosthesis did not translate into perioperative gains in our population of elderly patients.

The Ross procedure: total root technique

We describe our technique for the Ross procedure using a total root technique without any foreign material for autograft support. We insist on technical principles, based on the surgical anatomy of the aortic and pulmonary root, aimed at optimizing aortic root dynamics while ensuring long-term stability of the autograft root.

Armentarium of topical hemostatic products in cardiovascular surgery: an update.

Within Canada, 2.6 million in-hospital surgical procedures are completed annually. Significant bleeding following is the most common surgical complication, occurring in up to 25% of all surgeries. Bleeding causes increased mortality and morbidity, by increasing the number of transfusions required, secondary to increased cumulative blood loss, and by causing hemodynamic instability. A solution to this issue encountered during surgery is the use of hemostatic products. The objectives of this manuscript are (1) to review the spectrum of hemostatic products available in cardiovascular surgery and (2) to provide an update on new topical products soon available, or in development, for optimizing hemostasis during surgical procedures.

Prevention of Venous Graft Disease After Coronary Artery Bypass Grafting: Is Ex Vivo Statin Exposure an Answer?

The excellent early results of coronary artery bypass grafting (CABG) are limited in the long term by vein graft failure. Ten years after CABG 50% of vein conduits are occluded or severely diseased, whereas more than 90% of internal thoracic artery (ITA) grafts are patent and disease-free. Because of this, total arterial revascularization has been advocated to avoid use of vein grafts and their subsequent suboptimal fate. The pathology of vein graft disease consists of thrombosis, neointimal hyperplasia (NeoH), and vein graft atherosclerosis which affect graft permeability and longevity. Indeed, vein graft failure leads to decreased survival, recurrent angina, late myocardial infarction, and the need for further intervention. Aspirin and lipid-lowering agents improve vein graft patency rates over the medium term, but their effect on long-term results are unknown. New approaches are being developed to preserve vein graft patency over time.

A NOVEL APPROACH FOR THE SURGICAL MANAGEMENT OF UNICUSPID AORTIC VALVES: TECHNICAL FEASIBILITY AND EARLY ECHOCARDIOGRAPHIC Results

BACKGROUND: Gastrointestinal (GI) bleeding is a major complication of cardiac surgery. The objective of this study was to determine the incidence of GI bleeding in patients after cardiac surgery, to assess the perioperative risk factors and to identify GI tract pathology associated with bleeding events. METHODS: From January 2002 until January 2013, 159 GI bleeds were identified in 9175 patients having cardiac surgery at a tertiary referral hospital. Mean patient age was 65.6 +/-11.5 years. A logistic multiple regression analysis was used to determine incidence and independent predictors of GI bleeding. Endoscopy reports were reviewed on all patients and findings were analyzed to determine the etiology of bleeding events. RESULTS: Mean incidence of GI bleeding was 1.73%. Upper GI bleeds accounted for 72% of all bleeds. Endoscopy data determined that gastric or duodenal ulceration was the source in 78% of patients, while stress gastritis accounted for only 14%. Independent risk factors for post-operative GI bleeding included age, cerebrovascular disease, peripheral vascular disease, chronic renal failure and congestive heart failure (p<0.01). In-hospital mortality was 11.32% in patients that had post-op GI bleeding. CONCLUSION: Gastrointestinal hemorrhage is a rare but serious complication of cardiac surgery. Contrary to previous evidence, the present study suggests the majority of bleeds are caused by peptic ulcer disease rather than stress gastritis. This suggests pre-operative risk factor modification, and most importantly, Helicobacter Pylori testing and eradication therapy may be important in mitigating the risk of bleeding. 339 A NOVEL APPROACH FOR THE SURGICAL MANAGEMENT OF UNICUSPID AORTIC VALVES: TECHNICAL FEASIBILITY AND EARLY ECHOCARDIOGRAPHIC RESULTS