Prognostic Role of Preoperative Tricuspid Annular Plane Systolic Excursion (TAPSE) in Mitral Valve Replacement (MVR) for Rheumatic Mitral Stenosis Patients

Tricuspid annular plane systolic excursion has been proposed as a simple and reproducible parameter for quantitative assessment of the right ventricular ejection fraction. The prognostic importance of preoperative TAPSE in patients with mitral valve replacement for rheumatic mitral stenosis patients is still under focused. Therefore, the objective of the study was to predict the outcome after MVR in rheumatic mitral stenosis patients in relation to preoperative TAPSE. This comparative cross-sectional study was conducted at the Department of Cardiac Surgery, National Heart Foundation Hospital and Research Institute. A total of 72 patients of rheumatic mitral stenosis patients who underwent mitral valve replacement were included in the study. They were divided into two groups: Group A and B. Group A included 36 patients with TAPSE 0.05) except for the preoperative TAPSE. Mean TAPSE of Group A was 13.17 (±1.40) and Group B was 18.61 (±1.57), the difference was statistically significant (p 0.05). Among the postoperative complications, including postoperative atrial fibrillation was higher in Group A (30.56%) than Group B (11.11%), mean ventilation time was higher in Group A (27.78%) than Group B (5.56%), length of intensive care was higher in Group A (33.33%) than Group B (11.12%), and hospital stay was higher in Group A (25.0%) than Group B (5.56%), (p < 0.05). Higher preoperative TASPE could be used as a prognostic tool for MVR in rheumatic mitral stenosis patients in our settings.

Three-dimensional printing for heart diseases: clinical application review

Heart diseases remain the top threat to human health,and the treatment of heart diseases changes with each passing day.Convincing evidence shows that three-dimensional(3D)printing allows for a more precise understanding of the complex anatomy associated with various heart diseases.In addition,3D-printed models of cardiac diseases may serve as effective educational tools and for hands-on simulation of surgical interventions.We introduce examples of the clinical applications of different types of 3D printing based on specific cases and clinical application scenarios of 3D printing in treating heart diseases.We also discuss the limitations and clinically unmet needs of 3D printing in this context.

Body-temperature circadian rhythm in 67 patients after heart valve replacement surgery secondary to valvular heart disease

Purpose:Patient body temperature was monitored after cardiac valve replacement,in order to explore the characteristics of body-temperature circadian rhythm and the factors influencing that rhythm.Methods:A cohort of 67 patients who received cardiac valve replacement in a Fuzhou,Fujian province,China,general hospital underwent temperature measurements and analysis(by cosine curve)of their body-temperature circadian rhythm.A biological rhythm model was established through principal component analysis and evaluation of biological rhythm features.Multiple circadian parameters were included through linear regression analysis.Results:Patients’temperature after cardiac valve replacement exhibited circadian characteristics(p<0.05),among which the scores of temperature mesor,amplitude,and acrophase were respectively(37.61
0.08),(0.10
0.09),and33(e355,e119).Body-temperature rhythms were influenced by both gender and cardiopulmonary bypass time(p<0.05).Conclusion:Although some patients’circadian characteristics disappeared after cardiac valve replacement,circadian rhythms remained intact for most patients.Measures that were found to mitigate body-temperature circadian rhythm disruption included building a natural rhythm of light/darkness and decreasing cardiopulmonary bypass time.

“A Prospective Randomized Case-Control Study To Evaluate Mini Right Thoracotomy versus Conventional Sternotomy For Mitral Valve Repair In Rheumatic Heart Disease.”

Purpose: Right mini thoracotomy has been evaluated in many studies for mitral valve repair mainly in degenerative valvular disease but not in rheumatic heart disease. Mitral valve repair is more challenging in rheumatic etiology due to complexity of lesions. This prospective randomized case control study was designed to evaluate repair through mini right thoracotomy and to compare the clinical and echocardiographic outcomes with sternotomy in rheumatic patients. Methods: 25 patients of rheumatic heart disease underwent mitral valve repair through mini right thoracotomy (group I). Various clinical and functional parameters were compared with 25 patients of mitral valve repair through sternotomy (group II). On follow up the results were compared in both groups for clinical and echocardiographic parameters. Results: The various pre-operative demographic parameters were comparable in two groups. Equal rate of mitral valve repair (group I-21/25, 84% and group II-21/25, 84%) was achieved in both groups. The various intra-operative and post-operative clinical parameters were better in group I .There were equivalent functional and valve related outcomes in both groups in term of NYHA class (1.28 ± 0.613 vs 1.08 ± 0.276, P = 0.144), post-operative mitral valve area (2.43 ± 0.891 vs 2.82 ± 0.662, P = 0.090), incidence of more than mild mitral regurgitation (0) and mean pressure gradient across mitral valve (4.98 ± 3.33 vs 4.23 ± 1.5, P = 0.309). Conclusion: Mitral valve repair through mini right thoracotomy approach in rheumatic etiology is feasible and safe with equivalent rate of successful repair as compared to median sternotomy. It is associated with lesser morbidity, cosmetic advantage and lesser resource utilization.

Effect of Psychological Nursing on the Mental State and Quality of Life of Patients After Heart Valve Replacement for Rheumatic Heart Disease

Objective:To explore the effect of psychological nursing on the mental state and quality of life of patients after heart valve replacement for rheumatic heart disease.Methods:Seventy-four patients with rheumatic heart disease that underwent heart valve replacement in Zhenjiang First People's Hospital from January 2017 to May 2020 were selected as the research subjects.Thirty-seven patients that were treated from January 2017 to September 2018 were included in the control group.Routine care was provided for the patients in the control group.From October 2018 to May 2020,the Department of Cardiothoracic Surgery improved their preoperative and postoperative psychological care.Thirty-seven patients that were treated during this period were included in the research group.The research group received psychological nursing care in addition to routine care.The efiects of different nursing modes on the quality of life and postoperative mental state of the patients were determined.Results:The scores for depression,anxiety,somatization,and compulsion in the research group were significantly lower than those in the control group(p<0.05);the scores for the quality of life of patients in the research group were significantly higher than those in the control group(p<0.05).Conclusions:Strengthening psychological nursing for patients with rheumatic heart disease is helpful to improve their quality of life and mental state after heart valve replacement.

Isolated mitral valve replacement with Guangdong-Ⅰ porcine bioprostheses in rheumatic heart valve disease: analysis of 166 cases with long-term follow-up

Objective To study the long-term effects of mitral valve replacement with bioprostheses in rheumatic heart valve disease. Methods 166 patients with rheumatic heart valve disease underwent isolated mitral valve replacement from Jan. 1978 to Dec. 1985. 79 Patients were male and 87 female. Patients’ age ranged from 11 to 53 years [mean (29.4 ± 9.9) years]. The patients were classified into two groups: group 1 (age【 30 years) included 84 patients, group 2 (age≥30 years) 82 cases. Mean CTR is 0.68 *0.08. Most patients were in NYHA function class Ⅲ-Ⅳ. 76. 3% of patients had atrial fibrillation. 6 patients had pre-operative cerebral vascular accidents. Postoperative deaths were excluded. Follow-up extended from 0.4 year to 19.4 years. Results Actuarial estimate of survival rate at 14 years is (52.5 ± 7.0)%. Heart function was improved to class Ⅰ - Ⅱ in most of patients. Late structural valve deterioration occurred in 89 patients. Among them, 59 were re-operated. Actuarial estimate of freedom from

Utilization of edge-to-edge valve plastic technique to correct severe tricuspid regurgitation in patients with congenital heart disease

Objective Tricuspid regurgitation is often associated in patients with congenital heart disease. Significant morbidity and mortality are related to tricuspid valve replacement. Tricuspid valve plasty is still a preferred choice. This report deals with our surgical experience in using edge-to-edge valve plasty technique to correct severe

经食管二维及三维超声心动图在Lux-Valve Plus经血管三尖瓣置换术中的应用:1例报告

重度三尖瓣反流(tricuspid regurgitation,TR)是一种常见的心脏瓣膜病,死亡率高,指南推荐外科手术高风险患者可考虑介入治疗。现有经血管三尖瓣置换术(transcatheter tricuspid valve replacement,TTVR)器械均处于临床研究阶段,超声心动图在术前筛查、术中影像支持、术后即刻评估及随访方面发挥重要作用。本文报道1例外科手术高危的极重度TR患者,行经颈静脉三尖瓣置换术后临床症状改善,并结合文献分析二维及三维经食管超声心动图(transesophageal echocardiography,TEE)在围手术期的注意事项,以期为临床实践提供参考。

Outcomes of Self-Expanding Transcatheter Pulmonary Valves:Extended Follow-Up of a Prospective Trial

Background:The Venus-P valve was the first self-expanding valve used world-wide for transcatheter pulmonary valve replacement(TPVR)in patients with severe pulmonary regurgitation(PR).We intended to report the extended follow-up results from the prospective trial(No.NCT02590679).Methods:A total of 38 patients with severe PR(mean age 24.2±13.2)were included.Follow-up data were obtained after implanted at 1,6,and 12 months and yearly after.The frame geometry was assessed on post-implant computer tomography(CT)scanning by calculating the non-circularity[circularity ratio(minimum diameter/maximum diameter)<0.9]and under-expansion[expansion ratio(derived external valve area/nominal external valve area)<0.9).Adverse events(all-cause mortality,reintervention,valve dysfunction,stent fracture and endocarditis)were recorded.Results:All valves were implanted successfully with normal function at discharge.Geometric CT analysis showed underexpanded valve was detected in 22 patients(63%)and non-circular valve was seen in 16 patients(46%).During a median follow-up of 4.8 years(range 0.3-8.1),there were 1 death and 1 surgical explant,both resulting from endocarditis.Five-year freedom from valve dysfunction and stent fracture were 84.8%(95%CI 74.8-94.7)and 83.5%(95%CI 73.8-93.2).Endocarditis occurred in 3 patients at a median time of 7 months.Stent fracture was more common in patients with non-circularity stents.Conclusion:TPVR using Venus-P valve is associated with favorable outcomes at 5 years.Non-circular shapes in the valve level may have a higher risk of stent fracture.

Prevalence of Preoperative Anemia in Elective Rheumatic Valve Surgery at a Tertiary Care Center in Nepal

Background: Rheumatic Valvular Heart disease (RVHD) is common in developing countries often associated with anemia;however its burden is often overlooked. Anemic patients undergoing surgery are likely to receive blood transfusion, increasing morbidity and mortality. Prevalence of anemia in cardiac surgical patients are studied extensively, however its burden in RVHD is lacking. This study attempted to investigate the prevalence of preoperative anemia in RVHD and its effect on blood transfusion, morbidity and mortality in patients undergoing valve surgery. Methods: This is a retrospective observational study conducted at a tertiary care hospital in Nepal. We considered 340 patients who underwent Rheumatic valve replacement surgery from 2014 January to December 2016 and data on their socio-demographic and clinical characteristics were extracted from the patient’s records. The analyses meeting the study objectives were conducted using IBM SPSS v25 for Windows (IBM Statistical Package for Social Sciences, 2015IBM Corporation, New York, United States). Results: The prevalence of no anemia, mild, moderate, and severe anemia was 34.1%, 57.7%, 39.6%, 2.5%, respectively. The units of Red Blood Cell used for transfusion were 1.2 units, 2.0 units, 2.3 units, and 1.6 units in patients without anemia, and those with mild, moderate and severe anemia respectively. The incidence of reexploration was higher in patients with severe anemia as compared to the non anemic with an incidence of 66.6%. A proportion of the patients with no anemia, mild, moderate and severe anemia with less than 7 days stay in the intensive care unit were 89%, 82%, 84.7% and 100% respectively. The length of hospital stay more than 10 days was seen in 58.9%, 71.6%, 63% and 100% in patients with no anemia, mild, moderate and severe anemia. An overall incidence of mortality in anemic patients was 11% while in non anemic patients was 5.3%. Conclusions: The prevalence of anemia was high in the Nepalese patients with Rheumatic valvular heart disease planned for elective surgery. There was an increased incidence of blood transfusion, longer hospital stay, and increased mortality in anemic patients compared to their non anemic counterparts.

Mitral Valve Repair with Artificial Chordae for Posterior Leaflet Disease

Background: Recently, the concept of “Respect rather than resect” has been proposed in an attempt to restore mitral valve function. We investigated the results of mitral valve repair for posterior leaflet disease. Methods: Between April 2008 and July 2017, mitral valve repair was performed in 78 cases at our facility. Among them, 37 cases were analyzed. We divided patients into three groups according to the repair techniques used: artificial chordae technique, which uses the anchoring-technique and measured tube technique (Group A, 23 cases), resection and suture technique (Group R, 10 cases), and artificial chordae together with resection and suture technique (Group AR, 4 cases), and compared their postoperative outcomes. Results: Residual postoperative mitral regurgitation (MR) grade in groups A, R and AR at discharge were 0.3 ± 0.4, 0.8 ± 0.9 and 0.0 ± 0.0 (p = 0.07), respectively. Mitral valve areas (cm2) in groups A, R and AR were 3.2 ± 0.6, 2.9 ± 0.6 and 3.0 ± 0.6 (p = 0.47), respectively. Freedom from severe MR at 5 years postoperatively was seen in 91.7%, 90% and 100% (p = 0.92) in groups A, R and AR, respectively. Conclusions: There was no significant difference in postoperative outcomes, as assessed echocardiographically, between the artificial chordae technique and resection and suture technique. The results of all repair techniques were satisfactory.

A Systematic Approach to Pulmonary Valve Replacement in the Current Era

Background:Pulmonary valve replacement(PVR)can be accomplished via surgical,transcatheter,or hybrid approaches.There are inherent advantages to transcatheter PVR and hybrid PVR without cardiopulmonary bypass.We review the methods and results of a standardized institutional approach to PVR.Methods:Retrospective review of all PVR cases between February 2017 and February 2020.Hybrid PVR entailed off-pump RVOT plication with percutaneous transcatheter PVR.Results:Primary transcatheter PVR was attempted in 37,hybrid PVR was performed in 11,and on-pump surgical PVR was performed in 9.Median age at PVR was 27 years(6–65).Primary transcatheter PVR was successful in 35/37(2 converted to surgical).Standard surgical PVR was utilized for positive coronary compression testing(n=4),stent/valve system migration(n=2),or patient preference(n=3).In the hybrid group mean RVOT diameter was 34 mm(32–38).Median length of stay was 1 day for transcatheter PVR,5 for surgical,and 3 for hybrid(p=0.02).Median follow-up was 1.5 years.Re-interventions were one balloon valve dilation in a transcatheter PVR,and one valve dilation with subsequent transcatheter valve-in-valve PVR in the surgical cohort.One hybrid patient expired 11 months post procedure.Conclusions:A systematic approach to PVR utilizing all approaches in pre-defined order of preference leads to consistent outcomes in a wide variety of anatomic configurations.Transcatheter PVR may be accomplished in the majority of patients.When necessary,hybrid off-pump RVOT plication with transcatheter PVR avoids the need for cardiopulmonary bypass.

Clinical results of tricuspid valve replacement—a 21-case report

Objective： To summarize the clinical experiences of 21 patients treated with tricuspid valve replacement （TVR） and investigate the surgical indications and methods. Methods： Data from 21 patients who underwent TVR from December 2002 to March 2009 were retrospectively collected and analyzed. The mean age was 48.86± 15.37 years （range： 20-72 years）. The underlying disease of the patients was classified as rheumatic （n = 10）, congenital （n = 8）, endocarditis （n = 2） or chest trauma （n = 1）. Previous cardiac surgery had been performed in 12 patients （57.14%）. Results： In-hospital death occurred in two patients （9.52%）. Postoperative morbidities included cardiac failure （n = 2）, bleeding related re-operation （n = 1）, and plural effusion （n = 2）. Conclusion： The early outcomes of TVR were acceptable. At the present time TVR can be performed through optimal perioperative management.

Percutaneous pulmonary and tricuspid valve implantations: An update

The field of percutaneous valvular interventions is one of the most exciting and rapidly developing within interventional cardiology.Percutaneous procedures focusing on aortic and mitral valve replacement or interventional treatment as well as techniques of percutaneous pulmonary valve implantation have already reached worldwide clinical acceptance and routine interventional procedure status.Although techniquesof percutaneous pulmonary valve implantation have been described just a decade ago,two stent-mounted complementary devices were successfully introduced and more than 3000 of these procedures have been performed worldwide.In contrast,percutaneous treatment of tricuspid valve dysfunction is still evolving on a much earlier level and has so far not reached routine interventional procedure status.Taking into account that an "interdisciplinary challenging",heterogeneous population of patients previously treated by corrective,semi-corrective or palliative surgical procedures is growing inexorably,there is a rapidly increasing need of treatment options besides redo-surgery.Therefore,the review intends to reflect on clinical expansion of percutaneous pulmonary and tricuspid valve procedures,to update on current devices,to discuss indications and patient selection criteria,to report on clinical results and finally to consider future directions.

A Rare Case of Infective Mediastinitis after Melody Valve Implantation

Pulmonary valve implant is frequently necessary in children and adults with congenital heart disease.Infective endocarditis represents a rare but life-threatening complication after transcatheter pulmonary valve implantation.There are various treatments for native or prosthetic valve endocarditis.Surgical intervention,combined with intravenous antibiotic treatment,is of paramount importance,in case of concomitant mediastinal infection,in order to ensure the radical debridement of all infected tissue,avoiding any recurrent endocarditis.In this report,we describe a rare case of mediastinitis,associated with an infected endocarditis,occurring 8 months after Melody(Medtronic
,Minneapolis,USA)valve implant,successfully treated with the implantation of a homograft to reconstruct the right ventricular outflow tract.

Use of the GORE^(®) DrySeal Flex Introducer Sheath to Facilitate Implantation of the Transcatheter Venus P-valve

Objectives:We report our experience of using the 65 cm large diameter GORE^(®) DrySeal Flex Introducer sheath to facilitate transcatheter implantation of the Venus P-valve in the pulmonary position.Background:Transcatheter implantation of pulmonary valves can be difficult due to rigidity of the valve delivery system or the anatomy of the RVOT and pulmonary artery bifurcation and the risk of iatrogenic damage to the tricuspid valve support apparatus.Using long sheaths to pass and protect the tricuspid valve may facilitate the procedure.Methods:Multi-centre registry of patients who underwent transcatheter pulmonary valve implantation of the Venus P-valve using the GORE^(®) DrySeal Flex introducer sheath to facilitate passage of the valve to the right ventricular outflow tract.Procedural success,time to valve implantation and radiation safety parameters were analyzed.These data were compared to a control group of subjects treated between July 2014 and May 2016 with the same valve but without the use of GORE^(®) DrySeal.Results:Between December 2016 and September 2018,the Venus P-valve was successfully deployed through the GORE^(®) DrySeal in 12 patients.There were no procedure-related complications.As a control group,10 subjects treated between July 2014 and May 2016 were included.Total procedure time was significantly shorter in the GORE^(®) DrySeal group compared to the control group 96±27 min vs.164±12 min(p<0.001).Total screening time was significantly shorter in the GORE^(®) DrySeal group(24±11 min)when compared with the control group(32±14 min,p<0.001).Conclusions:We describe a modification to the previously described techniques of implanting the Venus P-valve in the pulmonary position after surgical repair of congenital heart disease.In our experience,the GORE^(®) DrySeal sheath has considerably facilitated the procedure and reduced the potential risks.

Neocuspidization of the Pulmonary Valve with Autologous Pericardium in the Adult Patient with Ventricular Septal Defect and Infective Endocarditis: A Case Report and Review of the Literature

Congenital heart disease (CHD) is one of the risk factors for developing infective endocarditis (IE). Right-sided IEoccurs in 5%–10% of endocarditis cases, and pulmonary valve (PV) is involved in less than 2% of such patients.Literature data are few, and optimal treatment methods, indications for surgery, and types of operative techniquesare still under debate. We present an adult patient with a rare combination of the ventricular septal defect (VSD)and PV IE who underwent surgical treatment. Neocuspidization with autologous pericardium was utilized for thereconstruction of his PV. We discuss details of this novel surgical technique.

Risk Factors for Starr-Edwards Prosthetic Valve Dysfunction: New Insights into an Old Prosthesis

Background: Starr-Edwards prosthetic valves were used for valve replacement, but due to their high thrombogenic risk, they were withdrawn from market. Nevertheless, there are some cases of Starr-Edwards prosthetic valve carriers that have shown long-term survival reaching up to 50 years. The objective of this study was to determine survival in 12 patients with mechanical Starr-Edwards?prosthetic valve and risk factors for predicting valve dysfunction. Methods: Cross-sectional study of patients who had valve replacement with a Starr-Edwards prosthetic valve in a single center from 1968 to 1990. Socio-demographic data, valvular dysfunction variables and mortality were recorded. Logistic regression models to determine valvular dysfunction were constructed. Survival was analyzed with Cox regression and Kaplan-Meier survival curves. Results: A total of 12 patients were analyzed. The median age was 59 years (48.5 - 64). Eleven patients had normal right and left ventricular function. The most common cause of valve replacement was rheumatic valve disease (75%) and it was more frequently in mitral position (50%). Valvular dysfunction was detected in 3 patients (25%). Atrial fibrillation had the highest association with valvular dysfunction (P = 0.005). Stroke was seen in 25% of the population and the overall mortality was 33.3%. Conclusions: The survival of patients with Starr-Edwards prosthetic valve was 66.66% in the 50-year follow-up. Atrial fibrillation had the highest association with prosthetic valvular dysfunction.

High-Risk Congenital Coronary Abnormalities in Patients with Bicuspid Aortic Valve

Objective:Abnormal coronary artery origin(ACAO)from the opposite sinus with inter-arterial course of the ectopic proximal vessel is associated with the greatest potential for clinical manifestations,specifically sudden death.Data remain limited regarding the association between bicuspid aortic valve(BAV)and this potentially dangerous coronary variant reported in up to 0.6%in the general population.We investigated the frequency of this high-risk ACAO with inter-arterial course in our surgical series of BAV patients.Methods and Results:We conducted a retrospective study to identify BAV patients with ACAO and inter-arterial course who underwent elective aortic valve/root surgery between 2010 and 2019 in our tertiary center.A total of 279 consecutive patients with BAV were identified.Among these,four patients(1.4%)had ACAO with inter-arterial course.Three patients had abnormal right coronary artery arising from the theoretical opposite coronary sinus with intramural course.The fourth patient presented an abnormal left coronary artery from a single coronary artery arising from the theoretical right coronary sinus with a long inter-arterial course.Conclusion:Our results from a single-center experience support high-risk ACAOS may be more frequently diagnosed in BAV patients,especially in surgical series,justifying a careful preoperative assessment.

Clinical outcomes in patients with native valve infective endocarditis and diabetes mellitus

BACKGROUND There is a lack of data on the clinical outcomes in patients with native valve infective endocarditis(NVIE)and diabetes mellitus(DM).AIM To investigate(1)trends in the prevalence of DM among patients with NVIE;and(2)the impact of DM on NVIE outcomes.METHODS We identified 76385 with NVIE from the 2004 to 2014 National Inpatient Sample,of which 22284(28%)had DM.We assessed trends in DM from 2004 to 2014 using the Cochrane Armitage test.We compared baseline comorbidities,microorganisms,and in-patients procedures between those with vs without DM.Propensity match analysis and multivariate logistic regression were used to investigate study outcomes in in-hospital mortality,stroke,acute heart failure,cardiogenic shock,septic shock,and atrioventricular block.RESULTS Crude rates of DM increased from in 22%in 2004 to 30%in 2014.There were significant differences in demographics,comorbidities and NVIE risk factors between the two groups.Staphylococcus aureus was the most common organism identified with higher rates in patients with DM(33.1%vs 35.6%;P<0.0001).After propensity matching,in-hospital mortality(11.1%vs 11.9%;P<0.0001),stroke(2.3%vs 3.0%;P<0.0001),acute heart failure(4.6%vs 6.5%;P=0.001),cardiogenic shock(1.5%vs 1.9%;P<0.0001),septic shock(7.2%vs 9.6%;P<0.0001),and atrioventricular block(1.5%vs 2.4%;P<0.0001),were significantly higher in patients with DM.Independent predictors of mortality in NVIE patients with DM include hemodialysis,congestive heart failure,atrial fibrillation,staphylococcus aureus,and older age.CONCLUSION There is an increasing prevalence of DM in NVIE and it is associated with poorer outcomes.Further studies are crucial to identify the clinical,and sociodemographic contributors to this trend and develop strategies to mitigate its attendant risk.