ABSTRACT
AIM: Transcatheter aortic valve implantation is increasingly presented as an alternative to aortic valve replacement in the high risk surgical candidate. We review the outcomes of isolated aortic valve replacement to identify contemporary results of aortic valve replacement in such high risk patients. METHODS: Retrospective analysis of 846 patients (mean age 68.7 ± 11.8 years) who underwent aortic valve replacement in a single institution from 1999 to 2008. We considered 10 risk factors as follows: female gender (395 patients, 46.7%), age, left ventricular ejection fraction, New York Heart Association Class, preoperative creatinine clearance, body mass index, peripheral vascular disease (49 patients, 5%), cerebrovascular disease (42 patients, 4.9%), chronic obstructive pulmonary disease (87 patients,10.2%), and redo surgery (53 patients, 6.2%). RESULTS: Twenty-five patients died (2.9%). Age (P=0.032; OR 1.07 per each year increase) was the only significant independent predictor of mortality. Length of stay in the hospital was correlated with age (P<0.0001), New York Heart Association Class (P<0.0001) creatinine clearance (P=0.005) and redo surgery (P=0.006). CONCLUSION: Contemporary aortic valve replacement is a low risk procedure for most patients. Historical risk factors which have been used to define high risk and inoperability, such as pulmonary disease, reoperations, decreased left ventricular ejection fraction and vascular disease, may not be relevant in the current era. This observation should be considered if such criteria are used to define patients for transcatheter aortic valve implantation.
Subject(s)
Aortic Valve/surgery , Cardiac Catheterization/methods , Heart Valve Diseases/surgery , Heart Valve Prosthesis Implantation/methods , Risk Assessment/methods , Aged , Female , Follow-Up Studies , Heart Valve Diseases/mortality , Humans , Italy/epidemiology , Male , Middle Aged , Retrospective Studies , Risk Factors , Survival Rate/trends , Treatment OutcomeABSTRACT
We describe the use of cyanoacrylate glue in conjunction with gelatin-resorcinol-formalin glue for the treatment of type A aortic dissection. Instead of placing an additional suture line 2-3 cm from the edges of the aortic stumps to create a large pocket for gluing, we have been using a cyanoacrylate adhesive for approximating the walls of the true and false lumina without the risk of tearing them. Moreover, the simplicity and quickness of the procedure enables application of the cyanoacrylate glue even deeper into the aortic arch, creating a wider area for gluing the dissected layers.
