Reply to Nezic et al.

Falk, Volkmar; Baumgartner, Helmut

doi:10.1093/ejcts/ezy147

Cited by 5 publications

(11 citation statements)

References 2 publications

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“…grade II. 1 Nevertheless, there are different surgical concepts. There are concerns regarding operative risk due to prolonged cardiopulmonary bypass time during concomitant TV sur-gery, especially that using a minimally invasive approach.…”

Section: Introductionmentioning

confidence: 99%

Concomitant Tricuspid Valve Repair during Minimally Invasive Mitral Valve Repair

Pfannmueller

Misfeld

Davierwala

et al. 2019

Thorac Cardiovasc Surg

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Background Concomitant use of tricuspid valve (TV) surgery and minimally invasive mitral valve (MV) repair is debatable due to a prolonged time of surgery with presumably elevated operative risk. Herein, we examined cardiopulmonary bypass times and 30-day mortality in patients who underwent MV repair with and without concomitant TV surgery. Methods We retrospectively evaluated 3,962 patients with MV regurgitation who underwent minimally invasive MV repair without (n = 3,463; MVr group) and with (n = 499; MVr + TVr group) concomitant TV surgery between 1999 and 2014. Preoperative parameters between the groups were significantly different; therefore, propensity score matching was performed. Results Mean cardiopulmonary bypass time for all patients was 125.5 ± 55.8 minutes in MVr and 162.0 ± 58.0 minutes in MVr + TVr (p < 0.001). Overall 30-day mortality was significantly different between these groups (4.8 vs. 2.1%; p < 0.001); however, after adjustment, there was no significant difference (3.3 vs. 1.2%; p = 0.07). Backward logistic regression revealed that cardiopulmonary bypass time was not a significant predictor for early mortality within the MVr + TVr cohort. Conclusion Concomitant TV repair using prosthetic rings through a minimally invasive approach is safe and does not lead to elevated early mortality in our patient cohort. Therefore, prolonged cardiopulmonary bypass time should not be the sole reason to rule out MV repair with concomitant TV repair and to prefer the use of suture techniques, which saves only a few minutes compared with prosthetic ring implantation.

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Section: Introductionmentioning

confidence: 99%

Concomitant Tricuspid Valve Repair during Minimally Invasive Mitral Valve Repair

Pfannmueller

Misfeld

Davierwala

et al. 2019

Thorac Cardiovasc Surg

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“…A billentyűműtétek növelik a thromboemboliás szövődmények kockázatát, ezért ilyenkor antithromboticus kezelésre van szükség. A leginkább megfelelő antithromboticus stratégia módjáról és annak időtartamáról relatíve kevés tudományos bizonyíték áll rendelkezésre, így az ajánlások alacsony evidenciaszinttel bírnak [28].…”

Section: Antikoagulálás a Posztoperatív Időszakban áThidaló Terápiaunclassified

“…A subcutan LMWH-val való áthidaló terápiát egyszerűbb kivitelezhetősége miatt széles körben alkalmazzák az UFH-val szemben. A subcutan enoxaparin jól alkalmazható a már terápiás antikoagulációban részesülő betegeknél a VKA átmeneti leállításakor: ekkor hasonló vagy nagyobb biztonságot nyújt, mint az UFH, így megfontolható az LMWH használata az UFH terápiás alternatívájaként, alkalmazása azonban "off-label" (indikáción túli) felhasználásnak felel meg [28,32]. Az LMWH terápiás dozírozása enoxaparin esetén a következők szerint történik: 1 mg/ttkg, subcutan adagolva, naponta kétszer.…”

Section: Mechanikus Billentyűkunclassified

“…Amint az INR a megfelelő céltartományt elérte, az áthidaló kezelést le kell állítani [1]. A mechanikus billentyűvel rendelkező betegek esetében a cél-INR-érték függ a beteget meghatározó tényezőktől (például korábbi thromboemboliás esemény vagy pitvarfibrilláció), valamint az implantált protézis thrombogenitasától és a beültetés helyétől (aorta, mitralis vagy tricuspidalis) [28]. A mechanikus aortabillentyűk cél-INR-értékének mediánja 2,5 (2,0-3,0), amennyiben nem áll fenn további thromboemboliára utaló kockázati tényező [28,29,31].…”

Section: Mechanikus Billentyűkunclassified

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Thrombocytagátló és antikoagulációs terápia a szívsebészetben napjainkban

Tóth,

Németh,

Rashed

2021

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Összefoglaló. Egy szívműtét tervezésekor és a perioperatív időszakban egyaránt kiemelkedő jelentősége van a megfelelő thrombocytagátló és antikoaguláns kezelés alkalmazásának. Írásunk célja összefoglalni és ismertetni a jelenleg érvényes nemzetközi ajánlásokat és a jelentős tanulmányok eredményeit, összpontosítva a Magyarországon alkalmazásban lévő gyakorlatra. A bizonyítékokon alapuló iránymutatások alábbi, legújabb adatai döntően a European Association for Cardio-Thoracic Surgery és a European Society of Cardiology ajánlásaira épülnek, ezeket kiegészítettük az American College of Cardiology, az American Heart Association és a Society of Thoracic Surgeons útmutatásaival, végül egyes témákban hozzáfűztük az elmúlt időszak meghatározó tanulmányainak főbb eredményeit. Cikkünkben érintjük a mono- és kettős thrombocytagátló, továbbá az oralis antikoaguláns kezelés szerepkörét, beleértve az új típusú thrombocytagátló és oralis antikoaguláns gyógyszereket, valamint az áthidaló terápia fontosságát az antikoagulálásban, a különböző típusú beültetett szívbillentyűk esetén betartandó antikoagulálási ajánlásokat, valamint kitérünk a perioperatív pitvarfibrilláció, a posztoperatív thrombosisprofilaxis és a vérzésveszély esetén történő gyógyszeres kezelés témájára. Figyelembe veendő, hogy a jelen információk folyamatos frissítésen mennek keresztül, a lenti javaslatok csupán a jelen helyzetet mutatják be. Orv Hetil. 2021; 162(48): 1910–1919. Summary. The use of appropriate antiplatelet and anticoagulant therapy has got an outstanding role both in the planning of cardiac surgery and also during the perioperative period. The aim of our paper is to summarize and present the current international recommendations and the results of significant studies, focusing on the current practice in Hungary. The following informations are based on the evidence-based guidelines and recommendations of the European Association for Cardio-Thoracic Surgery and the European Society of Cardiology, supplemented by guidelines from the American College of Cardiology, the American Heart Association and the Society of Thoracic Surgeons, finally we added some topics from the main results of major studies of the last years. In this paper, we discuss the role of mono- and dual anti-platelet and oral anticoagulant therapy, including the mechanism of novel antiplatelet and oral anticoagulant drugs, the importance of bridging therapy in anticoagulation, postoperative thrombosis prophylaxis and the medication practice in the case of bleeding risk. It should be noted that though the present information has been recently updated, the suggestions below only illustrate the current state of evidence. Orv Hetil. 2021; 162(48): 1910–1919.

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“…1 In the current era of evidence-based practice when patient-centered care is becoming the norm, the Heart-Team approach has become an integral part of care and has received Class I recommendations in the 2017 editions of both the AHA/ACC Focused Update of the 2014 Guideline for the Management of Patients with Valvular Heart Disease and the ESC/EACTS Guidelines for the management of valvular heart disease. 2,3 The Heart-Team plays a central role in the patient care process, from adequate patient selection and procedural planning to improved patient education and follow-up care. 4 Although decision-making becomes more complex with a growing number of treatment alternatives, a multidisciplinary assessment allows for optimization of care through better recommendations, shared decision-making, and informed patient participation.…”

Section: Introductionmentioning

confidence: 99%

Changes in outcomes over time in intermediate‐risk patients treated for severe aortic stenosis

et al. 2020

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Background: The advent of transcatheter aortic valve replacement (TAVR) has changed the practice of treating patients with severe aortic stenosis (AS). Heart-Teams have improved their decision-making process to refer patients to the best and safest treatment. The evidence allowed centers to increase funding and TAVR volume and extend indications to different risk categories of patients. This study evaluates the outcomes of intermediate-risk patients treated for severe AS in an academic center. Methods: Between 2012 and 2019, 812 patients with AS underwent TAVR or surgical aortic valve replacement (SAVR). A propensity score-matching analytic strategy was used to balance groups and adjust for time periods. Outcomes were recorded according to the Society of Thoracic Surgeons Guidelines; the primary outcome being 30-day mortality and the secondary outcomes being perioperative course and complications. Results: No difference in mortality was seen but complications differed: more postoperative transient ischemic attacks, permanent pacemaker implantations, and perivalvular leaks in the transcatheter group, while more acute kidney injuries, atrial fibrillation, delirium, postoperative infections and bleeding, tamponade and need for reoperation in the surgical group as well as a longer hospital length-of-stay. However, over the years, morbidities/mortality decreased for all patients treated for AS. Conclusions: Data showed an improvement in morbidities/mortality for intermediaterisk patients treated with SAVR or TAVR. Increased funding allowed for a higher TAVR volume by increasing access to this technology. Also, the difference in complications could impact healthcare costs. By incorporating important metrics such as length-ofstay, readmission rates, and complications into decision-making, the Heart-Team can improve clinical outcomes, healthcare economics, and resource utilization.

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Reply to Nezic et al.

Cited by 5 publications

References 2 publications

Concomitant Tricuspid Valve Repair during Minimally Invasive Mitral Valve Repair

Concomitant Tricuspid Valve Repair during Minimally Invasive Mitral Valve Repair

Thrombocytagátló és antikoagulációs terápia a szívsebészetben napjainkban

Changes in outcomes over time in intermediate‐risk patients treated for severe aortic stenosis

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