Trends in Heart Valve Surgery in Korea: A Report from the Heart Valve Surgery Registry Database

Choi, Jong-Woo; Kim, Joon Bum; Jung, Yoo Jin; Hwang, Ho Young; Kim, Kyung Hwan; Yoo, Jae Suk; Lee, Sak; Lee, Seung Hyun; Sung, Kiick; Je, Hyung Gon; Lim, Mi Hee; Chang, Byung Chul; Hong, Soon Chan; Lee, Heemoon; Shin, Young Kee; Kim, Jae Hyun; Lim, Cheong

doi:10.5090/jcs.22.016

Cited by 3 publications

(9 citation statements)

References 14 publications

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“…Consistent with other studies (1,22,23), the operative mortality of redo AVR in our study was 4.6%. Mortality around 5% observed with heterogeneous surgical patients, including reoperation involving aortic surgery (22,23) and various surgical indications (1). Moreover,…”

Section: Accepted Manuscriptsupporting

confidence: 93%

“…Prosthetic valve endocarditis is one of the most important indications of redo AVR and, its reported mortality rate is between 5% and 17% (24,25). In numerous previous studies, prosthetic valve endocarditis as an indication for redo AVR was a risk factor for early mortality, which is similar to our findings (1,26,27).…”

Section: Accepted Manuscriptsupporting

confidence: 90%

“…As the proportion of patients undergoing bioprosthetic AVR is increasing, 4 increasing numbers of patients are expected to require redo AVR. 5,6 Based on reports of a relatively high risk of redo surgical AVR with around 5% operative mortality, 1 ViV-TAVI has been increasingly used. Although some previous observational studies found that ViV-TAVI was associated with lower early mortality than redo AV, 7,8 those were not randomized controlled trials.…”

Section: Commentmentioning

confidence: 99%

“…Aortic valve replacement (AVR) is one of the most frequently performed open heart surgeries (1). With the increase in patients undergoing AVR, patients who require redo AVR due to structural valve degeneration (SVD), prosthetic valve endocarditis, paravalvular leak or thrombosis/pannus formation are also increasing.…”

Section: Introductionmentioning

confidence: 99%

“…Aortic valve replacement (AVR) is one of the most frequently performed open heart surgeries. 1 With the increase in patients undergoing AVR, patients who require redo AVR due to structural valve degeneration (SVD), prosthetic valve endocarditis, paravalvular leak or thrombosis/pannus formation are also increasing. With the increase in the number of patients using aortic valve bioprostheses and recent advances in valve-in-valve transcatheter aortic valve implantation (ViV-TAVI), an increase in the number of patients with failing bioprostheses is to be expected.…”

Section: Introductionmentioning

confidence: 99%

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Recent Outcomes of Surgical Redo Aortic Valve Replacement in Prosthetic Valve Failure

Kang,

Soehartono,

Choi

et al. 2024

Thorac Cardiovasc Surg

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Background. As redo surgical aortic valve replacement(AVR) is relatively high risk, valve-in-valve transcatheter AVR has emerged as an alternative for failed prostheses. However, the majority of studies are outdated. This study assessed the current clinical outcomes of redo AVR. Methods and Results. This study enrolled 324 patients who underwent redo AVR due to prosthetic valve failure from 2010 to 2021 in four tertiary centers. The primary outcome was operative mortality. The secondary outcomes were overall survival, cardiac death, and aortic valve-related events. Logistic regression analysis, clustered Cox proportional hazards models, and competing risk analysis were used to evaluate the independent risk factors. Redo AVR was performed in 242 patients without endocarditis and 82 patients with endocarditis. Overall operative mortality was 4.6% (15 deaths). Excluding patients with endocarditis, the operative mortality of redo AVR decreased to 2.5%. Multivariate analyses demonstrated that endocarditis (HR 3.990, P=0.014), longer cardiopulmonary bypass time (HR 1.006, P=0.037) and lower left ventricular ejection fraction (LVEF) (HR 0.956, P=0.034) were risk factors of operative mortality. Endocarditis and lower LVEF were independent predictors of overall survival. Conclusions. The relatively high risk of redo AVR was due to reoperation for prosthetic valve endocarditis. The outcomes of redo AVR for non-endocarditis are excellent. Our findings suggest that patients without endocarditis, especially with acceptable LVEF, can be treated safely with redo AVR.

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Section: Accepted Manuscriptsupporting

confidence: 93%

Section: Accepted Manuscriptsupporting

confidence: 90%

Section: Commentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Recent Outcomes of Surgical Redo Aortic Valve Replacement in Prosthetic Valve Failure

Kang,

Soehartono,

Choi

et al. 2024

Thorac Cardiovasc Surg

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Clinical benefits of surgical ablation during isolated aortic valve replacement: a nationwide study

Kim,

Kang

et al. 2024

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES To compare the early- and long-term clinical outcomes of concomitant surgical ablation (SA) for atrial fibrillation (AF) during isolated aortic valve replacement (AVR) using data from the Korean National Health Insurance Service Database. METHODS Of 23,332 adult patients who underwent AVR between 2003 and 2019, those with underlying AF with or without concomitant surgical ablation were extracted, and propensity score matching (PSM) analysis was performed. RESULTS Overall, 1,741 patients with underlying AF with (n = 445, Group A) or without (n = 1,296, Group N) concomitant SA during isolated AVR were enrolled, from whom 435 pairs were matched in a 1:1 ratio using PSM analysis. The operative mortality and early postoperative morbidities, including bleeding reoperation, stroke, permanent pacemaker (PPM) implantation, and acute kidney injury were comparable between the groups. The overall survival showed no differences between the groups. However, the cumulative incidence of new-onset late ischemic stroke was significantly lower in Group A than Group N in propensity score matched patients (2.3 versus 3.5 per 100 patient-years, adjusted HR, [95% CI], 0.64 [0.43, 0.96], Group A versus Group N, respectively). The cumulative incidence of other morbidities such as reoperation, PPM implantation, and progression to chronic renal failure showed no difference between groups. CONCLUSIONS The incidence of late ischemic stroke was significantly lower when concomitant SA was performed during isolated AVR in patients with underlying AF. Therefore, concomitant SA should be actively considered in patients with underlying AF undergoing isolated AVR to prevent the occurrence of late ischemic stroke.

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Shifts in Clinical Characteristics, Treatment, and Outcome for Rheumatic Mitral Stenosis: Insights From a 20-Year Multicentre Registry Study in Korea

Lee,

Cho,

Kim

et al. 2024

J Korean Med Sci

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Background The rapid economic development of South Korea provides a unique model to study changes in the clinical characteristics, treatment approaches, and clinical outcomes of patients with rheumatic mitral stenosis (MS) relative to socioeconomic growth. Methods From the Multicenter mitrAl STEnosis with Rheumatic etiology (MASTER) registry, 2,337 patients diagnosed with moderate or severe rheumatic MS between January 2001 and December 2020 were analyzed. Patients were grouped into consecutive 5-year intervals based on their year of diagnosis. Clinical characteristics, echocardiographic data, and clinical outcomes were assessed. Results Over 20 years, the severity of mitral stenosis increased from 79.1% to 90.2%; similarly, the average age at diagnosis increased from 54.3 to 63.0 years (all P < 0.001). Comorbidities such as hypertension and atrial fibrillation increased (6.3% to 29.5% and 41.4% to 46.9%, respectively; all P for trend < 0.05). The rate of mitral intervention within five years after diagnosis increased from 31.2% to 47.4% ( P for trend < 0.001). However, clinical outcomes of rheumatic mitral stenosis deteriorated over time in the composite outcomes (log-rank test, P < 0.001). Conversely, the incidence of stroke remained stable (60.6–73.7%; P < 0.001), which might be attributed to the increased use of anticoagulation therapy. Conclusion This study observed an increase in patient age, comorbidities, and valve disease severity as the country transitioned from a developing to developed status. Despite a rise in mitral valve interventions, clinical outcomes deteriorated over 20 years, highlighting the need for modified treatment approaches to improve patient outcomes.

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Trends in Heart Valve Surgery in Korea: A Report from the Heart Valve Surgery Registry Database

Cited by 3 publications

References 14 publications

Recent Outcomes of Surgical Redo Aortic Valve Replacement in Prosthetic Valve Failure

Recent Outcomes of Surgical Redo Aortic Valve Replacement in Prosthetic Valve Failure

Clinical benefits of surgical ablation during isolated aortic valve replacement: a nationwide study

Shifts in Clinical Characteristics, Treatment, and Outcome for Rheumatic Mitral Stenosis: Insights From a 20-Year Multicentre Registry Study in Korea

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