Simple Interrupted Suturing for Aortic Valve Replacement in Patients with Severe Aortic Stenosis

Background@#Attaining an adequate effective orifice area (EOA) is definitive goal in aortic valve replacement (AVR). The simple interrupted suture (SIS) technique could be a solution to achieve this goal, but limited data are available in the literature. This study aimed to compare hemodynamic differences between the SIS and non-everting mattress suture (NMS) techniques. @*Methods@#From our database, 215 patients who underwent AVR for severe aortic stenosis were extracted to form the overall cohort. From March 2015 to November 2016, the SIS technique was used in 79 patients, while the NMS technique was used in 136 patients.Hemodynamic outcomes were evaluated, as detected by transthoracic echocardiography and computed tomography. @*Results@#There were no significant differences in baseline characteristics between the 2 groups. On immediate postoperative echocardiography, the SIS group showed a significantly wider EOA (1.6±0.4 vs. 1.4±0.5㎠ , p=0.007) and a lower mean pressure gradient (PG) (13.3±5.4 vs. 17.0±6.0 mm Hg, p<0.001) than the NMS group. On follow-up echocardiography, the SIS group continued to have a wider EOA (1.6±0.4 vs. 1.4±0.3㎠, p<0.001) and a lower mean PG (11.0±5.1 vs. 14.1±5.5 mm Hg, p<0.001). There was no significant difference in paravalvular leakage. @*Conclusion@#The SIS technique for AVR was associated with a wider EOA and a lower mean PG. The SIS technique could be a reasonable option for AVR.

Surgical Ablation of Atrial Fibrillation in Patients Undergoing Bioprosthetic Valve Replacement

BACKGROUND@#Scarce data have been reported on the efficacy of concomitant atrial fibrillation (AF) ablation in patients undergoing bioprosthetic valve replacement.@*METHODS@#From 2001 and 2014, 146 consecutive patients (69.3±9.4 years, 84 females) who underwent bioprosthetic heart valve replacement concomitant with AF ablation were assessed. We evaluated long-term rhythm and valve-related outcomes.@*RESULTS@#During 49.1 months of follow-up (interquartile range, 22.5–96.8 months), 7 in-hospital and 49 (6.7% per person-year) post-discharge deaths occurred. The thromboembolic event-free survival rate at 5 years was 79.2%±3.5%. The freedom from AF recurrence rate at 5 years was 59.8%±4.9%. Multivariate analysis showed that old age (hazard ratio [HR], 1.06; 95% confidence interval [CI], 1.02–1.11; p=0.002), previous cardiac operation (HR, 3.01; 95% CI, 1.22–7.43; p=0.02), and a large left atrial (LA) dimension (HR, 1.02; 95% CI, 1.00–1.05; p=0.045) were significantly associated with AF recurrence.@*CONCLUSION@#The overall long-term clinical outcomes in these predominantly elderly patients undergoing AF ablation concomitantly with bioprosthetic valve replacement were satisfactory; however, AF recurrence was frequent. Older age, a history of prior cardiac surgery, and large LA size were associated with an increased risk of AF recurrence.

Surgical Ablation of Atrial Fibrillation in Patients Undergoing Bioprosthetic Valve Replacement / 대한흉부외과학회지

BACKGROUND: Scarce data have been reported on the efficacy of concomitant atrial fibrillation (AF) ablation in patients undergoing bioprosthetic valve replacement. METHODS: From 2001 and 2014, 146 consecutive patients (69.3±9.4 years, 84 females) who underwent bioprosthetic heart valve replacement concomitant with AF ablation were assessed. We evaluated long-term rhythm and valve-related outcomes. RESULTS: During 49.1 months of follow-up (interquartile range, 22.5–96.8 months), 7 in-hospital and 49 (6.7% per person-year) post-discharge deaths occurred. The thromboembolic event-free survival rate at 5 years was 79.2%±3.5%. The freedom from AF recurrence rate at 5 years was 59.8%±4.9%. Multivariate analysis showed that old age (hazard ratio [HR], 1.06; 95% confidence interval [CI], 1.02–1.11; p=0.002), previous cardiac operation (HR, 3.01; 95% CI, 1.22–7.43; p=0.02), and a large left atrial (LA) dimension (HR, 1.02; 95% CI, 1.00–1.05; p=0.045) were significantly associated with AF recurrence. CONCLUSION: The overall long-term clinical outcomes in these predominantly elderly patients undergoing AF ablation concomitantly with bioprosthetic valve replacement were satisfactory; however, AF recurrence was frequent. Older age, a history of prior cardiac surgery, and large LA size were associated with an increased risk of AF recurrence.

Different Gene Expression Patterns in the Lungs of Patients with Secondary Pulmonary Hypertension

BACKGROUND AND OBJECTIVES: Despite the similar degree of pressure or volume overloading, the development of secondary pulmonary hypertension (PH) shows diverse variability among individual patients. SUBJECTS AND METHODS: Using microarray technology, we compared the gene expression pattern of the lung tissues in 13 patients with secondary PH due to congenital shunt (pulmonary arterial hypertension, PAH, n=6) or valvular heart disease (pulmonary venous hypertension, PVH, n=7) with 5 normal subjects. RESULTS: As compared to the normal controls, secondary PH showed a decreased expression of genes encoding transcriptional factors (BHLHB2, EGR3, JUNB, KLF4, KLF6 and MAFF), cytoskeleton protein (VIL2 and XLKD1) and cell differentiation and viability (MCL1, SNF1LK and TNFAIP3). PVH showed an increased expression of genes encoding proliferation of pulmonary capillary endothelial cells (ESM1), cell proliferation (IGFBP2 and BMP6), collagen synthesis (COL4A2 and SERPINH1), and cytoskeleton (TMSL8) as compared with the normal controls. In patients with secondary PH, PVH showed an upregulated expression of proliferation of pulmonary capillary endothelial cells (ESM1), cell proliferation (EGR2, PLK2 and TNC) and collagen synthesis (COL4A1), and an down-regulated expression of inflammation (IL1RL1, IL7R, CCL5, CCL19, CXCR 6 and XCL1/XCL2) and immune response (IGHM and TRA@; TRAC), as compared with PAH. CONCLUSION: There were significant differences in the gene expression pattern in secondary PH patients according to the underlying mechanism. A future study is needed to determine the diagnostic and therapeutic implications of these findings.

Mid-term Results of the Ross Procedure / 대한흉부외과학회지

BACKGROUND: Ross procedure is ideal aortic valve replacement method with several merits of hemodynamic superiority and durability without the need of anticoagulation. Based upon this presumption, we studied its procedure performed in our hospital and tried to get the mid-term results MATERIAL AND METHOD: From Jan 1999 to Oct 2001, 22 patients underwent the Ross procedure. The mean age of experimented (including 17 men and 5 women) was 30.9+/-8.1 (17~44). The diagnosis before the surgery had shown 20 as accompanied with AR and the rest 2 as with ASR. The follow-up period ranged from 0.6 to 40.6 months, mean of 38.9+/-1.6 months, and follow-up rate was 100%. RESULT: There was no operative death and two late deaths, one of whom was cardiac originated and the other, non-cardiac relate The survival rate was 94.1+/-5.7% (40.6 months). Postoperatively there were 2 exploration for bleeding, 3 low cardiac output patients. The pulmonary autograft technique was root replacement in 14 and inclusion technique in 8. Pulmonary homografts were used at the pulmonary position in all cases. There was no patient with significant aortic regurgitation. CONCLUSION: These showed that the mortality and morbidity of the Ross procedure were acceptable and postoperative AR was not significant. However, further long-term follow-up will be necessary for the improvement of the function of pulmonary autograft and homograft.

Acute pericarditis caused by penetrated polymethylmethacrylate of the right ventricle after percutaneous vertebroplasty / 대한내과학회지

Percutaneous vertebroplasty (PVP) has been known as minimally invasive procedure to treat aggressive vertebral hemangioma, painful osteolytic vertebral tumors, and osteoporotic compression fractures. Some cases were reported to be associated with infrequent but serious complications of this procedure, such as severe arterial hypotension, pulmonary embolism, cerebral embolism, paraplegia, and bronchospasm. We report a case of acute pericarditis after PVP, which was treated successfully with open heart surgery.

Clinical Characteristics of Subaortic Complications in Patients with Infective Endocarditis of the Aortic Valve

BACKGROUND AND OBJECTIVE: Assessment of the clinical implications of subaortic complications, such as the involvement of the mitral-aortic intervalvular fibrosa (MAIVF) or anterior mitral valve leaflet (AMVL), were sought in patients with aortic valve infective endocarditis (AoIE). SUCJECTS AND METHODS: The clinical data of 95 consecutive (69 male) AoIE patients were retrospectively analyzed. RESULTS: Subaortic complications were detected in 40 patients (42%). Involvement of the AMVL and MAIVF was present in 16 and 13 patients, respectively, and in 4 patients both were involved. The remaining 7 patients showed metastatic lesions in chordae or interventricular septum. Surgery was performed in 60 patients (63%, Group I) and the other 35 received medical treatment only;surgery was neither feasible due to multiorgan failure in 17 patients (Group II) nor necessary with stable hemodynamics in 18 (Group III). The overall in-hospital mortality was 19% (18/95), which was significantly different according to the treatment group (10% in group I, 65% in group II, and 6% in group III, p<0.001). In group I, patients with subaortic complications showed higher mortality compared to those without (22 vs. 0%, p=0.006). Surgery was performed in 28 patients with a periaortic abscess, and operative mortality was much higher in patients with a MAIVF abscess than in those with an abscess in other sites (40 vs. 0%, p=0.018). The sensitivity of transesophageal echocardiography for a subaortic complication was significantly higher than that of transthoracic echocardiography (89 vs. 41%, p<0.05). CONCLUSION: Subaortic complications were relatively frequent in AoIE, and a MAIVF lesion is associated with a higher operative mortality.