ABSTRACT
BACKGROUND: Short-term oral anticoagulation (OAC) is recommended for patients after surgical bioprosthetic aortic valve replacement (bAVR); however, the potential benefits remain controversial. This study evaluated the effects of short-term OAC following bAVR. METHODS: From 2010 to 2017, total 450 patients who underwent bAVR were enrolled. The outcomes of patients who did (OAC group) and who did not receive OAC (without-OAC group) after bAVR were compared. Propensity-score matching (PSM) was used to adjust for potential confounders, and a 1:1 matched cohort was formed. The main outcomes were all-cause mortality and bioprosthetic valve dysfunction (BVD). RESULTS: A total of 175 (39%) patients received OAC after bAVR. The median follow-up period was 2.9 years, the median duration of OAC use was 4 months; 162 pairs of patients were identified after the PSM. There was no significant difference in the prevalence of 1-year embolism/ischemic stroke between the OAC and without-OAC group in PSM cohort (0.62% vs. 1.89% for embolism, p = 0.623; 0 vs. 1.23% for ischemic stroke, p = 0.499). The prevalence of 1-year intracranial hemorrhage (ICH) between OAC and without-OAC group was also comparable (0.62% vs. 0.62%, p = 1). The OAC group had a lower all-cause mortality (adjusted hazard ratio (aHR):0.488, 95% confidence interval (CI): 0.259-0.919). There was also a trend for reduced BVD in the OAC group (aHR: 0.661, 95% CI: 0.339-1.290). CONCLUSION: Our study demonstrated that short-term OAC use after bAVR was associated with lower all-cause mortality. The prevalence of 1-year embolism/ischemic stroke/ICH were comparable despite of OAC use.
Subject(s)
Heart Valve Prosthesis Implantation , Heart Valve Prosthesis , Ischemic Stroke , Humans , Aortic Valve/surgery , Heart Valve Prosthesis Implantation/adverse effects , Heart Valve Prosthesis/adverse effects , Anticoagulants , Treatment OutcomeABSTRACT
OBJECTIVE: Quadricuspid truncal valves are susceptible to regurgitation, and tricuspid configuration is considered more durable after repairing the truncal valve. We report a new method by excising the excessive truncal cuspid to reconstruct a new competent aortic valve. METHODS: Bilateral pulmonary banding failed to stabilize a 4-month-old baby with type I truncus arteriosus and quadricuspid truncal valve with severe regurgitation, so surgery was performed. The aorta was transected, and the pulmonary arteries was separated from the aorta. There was an excessive cusp between the right coronary and left coronary cusp. A transannular incision was carried into the right ventricular outflow tract through the left border of the right coronary cusp. We performed truncal valve repair by translocating the excessive cusp, its annulus, and its wall to the right ventricular outflow tract side and reconstructing the neoaortic valve to tricuspid. Ventricular septal defect was repair through a right ventricular outflow tract approach. The floor of the right ventricular outflow tract was made from the excised cusp, including its wall and the resected posterior aortic wall. Then the anterior wall was reconstructed with bovine pericardial patch with a 19-mm porcine valve. RESULTS: Postoperative echocardiography confirmed a tricuspid neo-aortic valve with trivial aortic regurgitation, no residual ventricular septal defect, and a patent right ventricular outflow tract. CONCLUSIONS: We present the surgical technique to repair a quadricuspid truncal valve insufficiency by using the excessive anterior cusp and its pedicled flap for reconstruction of the pulmonary pathway and restoration of the tricuspid truncal valve.
Subject(s)
Aortic Valve Insufficiency/surgery , Aortic Valve/surgery , Bioprosthesis , Heart Defects, Congenital/surgery , Heart Valve Prosthesis Implantation/instrumentation , Heart Valve Prosthesis , Heart Ventricles/surgery , Surgical Flaps , Aortic Valve/abnormalities , Aortic Valve/diagnostic imaging , Aortic Valve/physiopathology , Aortic Valve Insufficiency/diagnostic imaging , Aortic Valve Insufficiency/physiopathology , Aortography/methods , Computed Tomography Angiography , Coronary Angiography/methods , Echocardiography, Transesophageal , Heart Defects, Congenital/diagnostic imaging , Heart Defects, Congenital/physiopathology , Heart Ventricles/diagnostic imaging , Heart Ventricles/physiopathology , Hemodynamics , Heterografts , Humans , Infant , Male , Pericardium/transplantation , Prosthesis Design , Recovery of Function , Severity of Illness Index , Treatment Outcome , Ventricular Function, RightABSTRACT
Ebstein's anomaly in combination with tetralogy of Fallot (TOF) is rare. We report a male infant with these combined anomalies who presented with severe cyanosis, heart failure, and respiratory distress after birth. Biventricular repair was successfully performed with 1-stage correction of his ventricular septal defect (VSD), right ventricular outflow tract (RVOT) obstruction, and tricuspid regurgitation. The downward displaced tricuspid valve was also restored to the normal annulus position. The infant recovered well. The surgical technique for this rare and severe anomaly is reported here.
