Aortic valve replacement in patients with a left ventricular ejection fraction ≤35% performed via a minimally invasive right thoracotomy

Santana, Orlando; Xydas, Steve; Williams, Roy F.; Pietra, Angelo La; Mawad, Maurice; Behrens, Vicente; Escolar, Esteban; Mihos, Christos G.

doi:10.21037/jtd.2017.06.32

Cited by 5 publications

(4 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These results indicate a large benefit of surgery in patients with low LVEF ( 18 ). This is a similar finding to other studies of MVR as well as minimally invasive valve replacement surgery ( 19 - 21 ). Overall, patients with VHD and low LVEF have severe perioperative disease and a difficult postoperative recovery, but surgical valve treatment over pharmacological treatment is beneficial for survival ( 22 - 26 ).…”

Section: Discussionsupporting

confidence: 91%

A retrospective study: do patients with left ventricular ejection fraction ≤50% benefit from heart valve surgery?

Zhou¹,

Lv²,

Huang³

et al. 2022

J Thorac Dis

View full text Add to dashboard Cite

Background: Left ventricular ejection fraction (LVEF) is an indicator of heart failure, and it is controversial whether patients with reduced preoperative left ventricular ejection fraction can benefit from heart valve surgery. We aimed to assess the differences in clinical characteristics after surgery in patients with different grades of reduced preoperative LVEF to guide clinical management.Methods: A total of 100 heart valve disease patients with low LVEF (≤50%) who had undergone valve surgery in the Department of Cardiology. The patients were divided into 3 groups according to their LVEF measured by echocardiography before surgery, with LVEF ≤40% as group A, 40%< LVEF ≤45% as group B, and 45%< LVEF ≤50% as group C. Clinical characteristics such as postoperative LVEF values, oxygenation index, liver function and inflammatory index, intra-aortic balloon pump (IABP) utilization rate, and mortality were compared among the three groups of patients.Results: There was no statistically significant difference in the preoperative baseline data between the three groups of patients (P>0.05). The clinical outcomes of patients in group A (n=28) were similar to those of patients in groups B (n=39) and C (n=33) (P>0.05). The vasoactive-inotropic score (VIS), postoperative ventilator use time, length of stay in the care unit, IABP use rate, and mortality rate on the first postoperative day were higher in group A. By comparing the preoperative and postoperative (within 48 hours and 3 months after surgery) cardiac echocardiograms of the 3 groups, we learned that LVEF increased, LV end-systolic internal diameter and LV end-diastolic internal diameter decreased, and ventricular remodeling improved after surgery compared with the preoperative period (P<0.05). The postoperative improvement was more obvious in group A than in groups B and C. Three months after surgery, LVEF increased to 55%, the LV end-systolic internal diameter decreased to 39 mm, and the LV end-diastolic internal diameter decreased to about 55 mm in each group (P>0.05).Conclusions: Patients with heart valve disease and low LVEF should be actively treated with heart valve surgery, which can significantly improve the patient's left ventricular reverse remodeling and cardiac function, thereby facilitating survival.

show abstract

Section: Discussionsupporting

confidence: 91%

A retrospective study: do patients with left ventricular ejection fraction ≤50% benefit from heart valve surgery?

Zhou¹,

Lv²,

Huang³

et al. 2022

J Thorac Dis

View full text Add to dashboard Cite

show abstract

“…12 Despite that, SAVR was associated with good long-term outcomes with the recovery of ventricular function and functional class. 13,14…”

Section: Discussionmentioning

confidence: 99%

“…12 Despite that, SAVR was associated with good longterm outcomes with the recovery of ventricular function and functional class. 13,14 TAVR was presented as an attractive alternative to SAVR, and the indications were expanded to include low-risk patients. 15 The benefits vs the risks of TAVR in patients with low EF are controversial.…”

Section: Discussionmentioning

confidence: 99%

Surgical vs Transcatheter Aortic Valve Replacement in Patients With a Low Ejection Fraction

et al. 2022

View full text Add to dashboard Cite

Currently, there is no preference for surgical (SAVR) vs transcatheter (TAVR) aortic valve replacement in patients with low ejection fraction (EF). The present study retrospectively compared the outcomes of SAVR vs TAVR in patients with EF ≤40% (70 SAVR and 117 TAVR patients). Study outcomes were survival and the composite endpoint of stroke, aortic valve reintervention, and heart failure readmission. The patients who had TAVR were older (median: 75 (25-75th percentiles: 69-81) vs 51 (39-66) years old; P < .001) with higher EuroSCORE II (4.95 (2.99-9.85) vs 2 (1.5-3.25); P < .001). Postoperative renal impairment was more common with SAVR (8 (12.5%) vs 4 (3.42%); P = .03), and they had longer hospital stay [9 (7-15) vs 4 (2-8) days; P < .001). There was no difference between groups in stroke, reintervention, and readmission (Sub-distributional Hazard ratio: .95 (.37-2.45); P = .92). Survival at 1 and 5 years was 95% and 91% with SAVR and 89% and 63% with TAVR. Adjusted survival was comparable between groups. EF improved significantly (β: .28 (.23-.33); P < 0.001) with no difference between groups ( P = .85). In conclusion, TAVR could be as safe as SAVR in patients with low EF.

show abstract

“…Literature has established the improvement of EF and outcomes after valve replacement due to aortic stenosis [ 42 , 43 ].…”

Section: Discussionmentioning

confidence: 99%

Cardiac Cachexia Associated With Valvular Heart Failure

Rodriguez-Guerra¹,

Pandey²,

Vittorio³

2021

Cureus

View full text Add to dashboard Cite

Cardiac cachexia (CC) represents a serious complication of heart failure (HF). This condition could be directly related to mortality. The weight or muscle mass loss has to be monitored in our patients with HF to avoid potential complications.We report a case of an elderly patient with a history of aortic stenosis (AS) who presented with progressive shortness of breath limiting his daily activities associated with weight loss. Signs of heart failure were evident on physical examination, and valvulopathy was also evident. His echocardiogram showed reduced ejection fraction (EF) with structural changes and severe aortic stenosis. He was not a candidate for cardiothoracic surgery, and a transcatheter aortic valve replacement (TAVR) was performed. After the procedure, his symptoms improved, and during the outpatient follow-up, his cardiac function and dry weight improved.Cardiac cachexia could be caused by reversible cardiomyopathy. Early assessment and approach are critical for the outcome of our patients, impacting their quality of life and outcome in terms of morbidity and mortality consequences.

show abstract

Aortic valve replacement in patients with a left ventricular ejection fraction ≤35% performed via a minimally invasive right thoracotomy

Cited by 5 publications

References 34 publications

A retrospective study: do patients with left ventricular ejection fraction ≤50% benefit from heart valve surgery?

A retrospective study: do patients with left ventricular ejection fraction ≤50% benefit from heart valve surgery?

Surgical vs Transcatheter Aortic Valve Replacement in Patients With a Low Ejection Fraction

Cardiac Cachexia Associated With Valvular Heart Failure

Contact Info

Product

Resources

About