Introduction: Surgical operative risk of valvular replacement has been widely studied and it has been shown that postoperative complications incidence and mortality increase with patients’ age. The aim of this study was to assess among elderly patients whom underwent surgical aortic valve replacement using various scoring system and Geriatric Assessment Indexes to predict post-operative risk and long-term outcome. Methods and Results: We prospectively evaluated the incidence, over early and late results, of surgical scores and geriatric profile amid 122 intermediate-risk patients, aged 75 years or more who underwent surgical aortic valve replacement. In a univariate analysis, the EuroScore II (OR 1.73, 95% CI: 1.21-2.48, P =0.002), STS score (OR 1.39, 95% CI: 1.03-1.88, P = 0.03) and a Katz index ≤ 5 (limitation of at least one daily living activity) (OR 3.35, 95% CI: 1.08-10.35, P=0.03) were predictors of a 30-day unfavorable evolution. In a multivariate analysis, only surgical scores were predictive factors. At 6 months, 20 patients had deceased or had to be readmitted to hospital. At 10 years, survival was 48 % [IQR 39-57]. The Katz index ≤ 5 was the only geriatric test independent of an unfavorable outcome at 6 months (OR 4.51, 95% CI: 1.25-16.29, P = 0.02) and of a deleterious effect over long-term survival (OR 3.00, 95% CI: 1.58-5.69, P=0.001). Conclusion: In elderly patients, autonomy assessment with the Katz index allows to distinguish a vulnerable population with less beneficial outcomes after aortic valve replacement.
Introduction: This study report the clinical characteristics, surgical indications, surgical technique and initial outcomes of autologous pericardial aortic valve reconstruction using Ozaki’s procedure. Methods: The study included consecutive patients with isolated aortic valve disease who underwent Ozaki’s procedure between June 2017 and December 2019. Aortic valve cups were reconstructed by autologous pericardium using Ozaki’s procedure. Results: Seventy-two patients were enrolled (mean age 52.9 ± 13 years; 53 males) and consisted of 30 aortic stenosis cases, 20 aortic regurgitation cases, and 22 patients with a combination of both 72 patients, a bicuspid aortic valve was present in 20, and 7 patients had infective endocarditis. Surgery was performed via a full or partial sternotomy. The procedure was successful in 70 case, and two patients were converted to prosthetic valve replacement. The aortic cross-clamp time was 106.3 ± 13.8 minutes, cardiopulmonary bypass time was 136.7 ± 18.5 minutes. One patient died of cardiac tamponade in hospital, and two patients underwent reoperation due to bleeding and sternal infection, respectively, were observed during the follow-up period of 30 days. 1-month postoperative echocardiography revealed that one patient had moderate aortic valve regurgitation, max trans-valvular pressure gradient was 16.1 ± 2.3 mmHg, and aortic valve area was 2.5 ± 0.2 cm ². Conclusions: Aortic valve reconstruction using autologous pericardium by Ozaki’s procedure was feasible, good hemodynamics, and can be applied to all lesions of the aortic valve.
Cardiac involvement is an often fatal and underestimated complication in systemic sclerosis, but only few reports have been published on the surgical intervention of patients with cardiothoracic complication in patient with systemic sclerosis. We hereby present a case of severe mitral valve regurgitation due to infective endocarditis on patient with systemic sclerosis. The patient underwent mitral valve reconstruction and post-operative management of systemic sclerosis.
Objective: Myxoma is the most common form of non-malignant tumor that arises from connective tissue. Totally endoscopic surgery without robotic assistance can resect the entire atrial myxoma. This study aim to evaluate the early results of this surgical method. Methods: From January 2019 to April 2021, 26 patients (20 females, 6 males, mean age 49.5 ± 14.3) were diagnosed with atrial myxoma. All tumors of those patients were resected by totally endoscopic surgery. We evaluated the early outcome of this method based on the following criteria: mortality rates, conversion to open surgery, cardiopulmonary bypass time, aortic cross-clamp time, postoperative time. Results: Totally endoscopic surgery to resect atrial myxoma was successfully performed in all patients with surgical ports on the thoracic wall. The largest incision was not more than 1.5 cm in diameter. Mean cardiopulmonary bypass time was 134 ± 39 minutes, aortic cross-clamp time was 81.4 ± 26.4 minutes, mechanical ventilation time was 10.5 ± 4.6 hours, ICU length of stay was 2.1 ± 0.9 days, postoperative time was 6.9 ± 5.4 days. We had one case in which the excision of myxoma was performed contemporaneously with mitral valve annuloplasty. Conclusions: Initial outcomes of totally endoscopic surgery to resect atrial myxomas were satisfactory. However, to fully evaluate the effectiveness of this method, we need to conduct a long-term follow-up of these patients.
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