“Respect When You Can, Resect When You Should”: A Realistic Approach to Posterior Leaflet Mitral Valve Repair
https://www.ctsnet.org/jans/%E2%80%9Crespect-when-you-can-resect-when-you-should%E2%80%9D-realistic-approach-posterior-leaflet-mitral-valve?utm_source=iContact&utm_medium=email&utm_campaign=ctsnet&utm_content=JANS+12%2F7%2F2018
J Thorac Cardiovasc Surg 2018;156:1856-66
“respect when you can, resect when you should” concept
Resection was performed only if an excess tissue in height or width was present. The excess tissue in height was treated if P2, after a complete unfolding, was twice as high than P1 or P3. In such cases, a transverse resection of P2 was performed to bring it to approximately the same height as P1 and P3 (P2 being slightly higher than P1 and P3 in a normal valve).
This usually removes the rough area that was thickened. During this
operative step, great care was taken to individualize the secondary, and
even marginal, chordae that were at the adequate length (when compared
with the reference point) to resuspend the new free edge of P2. As far as
the excess in width is concerned, it was treated and carried out each time
there was an obvious and natural transverse folding of the leaflet. The
most objective way to evaluate such an excess of tissue in width was to
lay P2 on the posterior ventricular wall and to see if there was any natural
folding. When this happened, a small triangular resection was performed,
the base of the triangle being at the level of the free edge and the apex at the
annulus. A small resection was often effective in eliminating the excess
transverse tissue without putting the posterior leaflet (PL) under tension
2005 - 2015
701 consecutive severe mitral regurgitation
441 degenerative: 376 posterior leaflet prolapse (24.7% isolated P2 and 75.3% P2 associated with other segments)
aged 65.8 ± 13 years, and 70.5% were male.
Median follow-up was 61.1 months.
There were 3 hospital deaths (0.8%). Reoperation was necessary in 7 patients (1.9%).
After 1, 5, and 10 years,
overall survival was 97.8%, 93.6%, and 86.7%
recurrent/residual >2+ mitral regurgitation was 0.7%, 1.9%, and 5.9%
New York Heart Association III/IV at 0.8%, 1.9%, and 5.3%.
2018年12月21日金曜日
2018年12月20日木曜日
Outcomes Following Surgical Revascularization With Single Versus Bilateral Internal Thoracic Arterial Grafts in Patients With Left Main Coronary Artery Disease Undergoing Coronary Artery Bypass Grafting: Insights From the EXCEL Trial
Outcomes Following Surgical Revascularization With Single Versus Bilateral Internal Thoracic Arterial Grafts in Patients With Left Main Coronary Artery Disease Undergoing Coronary Artery Bypass Grafting: Insights From the EXCEL Trial
Eur J Cardiothorac Surg. 2018 Aug 27. doi: 10.1093/ejcts/ezy291.
https://www.ctsnet.org/jans/outcomes-following-surgical-revascularization-single-versus-bilateral-internal-thoracic?utm_source=iContact&utm_medium=email&utm_campaign=ctsnet&utm_content=JANS+12%2F7%2F2018
The EXCEL trial randomized 1905 patients with left main coronary artery disease to percutaneous coronary intervention with everolimus-eluting stents versus CABG.
Among the 905 patients undergoing CABG, 688 (76.0%) received SITA and 217 (24.0%) received BITA.
The unadjusted 3-year composite primary endpoint of
death, stroke or myocardial infarction (MI) 15.6% of SITA = 11.6% of BITA
all-cause death 6.7% = 3.3%
Sternal wound dehiscence within 30 days 1.8% = 2.2% !!!
CONCLUSIONS:
In the EXCEL trial, there were no clinical differences at 3 years between SITA or BITA revascularization in patients with left main coronary artery disease.
Eur J Cardiothorac Surg. 2018 Aug 27. doi: 10.1093/ejcts/ezy291.
https://www.ctsnet.org/jans/outcomes-following-surgical-revascularization-single-versus-bilateral-internal-thoracic?utm_source=iContact&utm_medium=email&utm_campaign=ctsnet&utm_content=JANS+12%2F7%2F2018
The EXCEL trial randomized 1905 patients with left main coronary artery disease to percutaneous coronary intervention with everolimus-eluting stents versus CABG.
Among the 905 patients undergoing CABG, 688 (76.0%) received SITA and 217 (24.0%) received BITA.
The unadjusted 3-year composite primary endpoint of
death, stroke or myocardial infarction (MI) 15.6% of SITA = 11.6% of BITA
all-cause death 6.7% = 3.3%
Sternal wound dehiscence within 30 days 1.8% = 2.2% !!!
CONCLUSIONS:
In the EXCEL trial, there were no clinical differences at 3 years between SITA or BITA revascularization in patients with left main coronary artery disease.
2018年12月9日日曜日
Outcomes Following Surgical Revascularization With Single Versus Bilateral Internal Thoracic Arterial Grafts in Patients With Left Main Coronary Artery Disease Undergoing Coronary Artery Bypass Grafting: Insights From the EXCEL Trial
https://www.ctsnet.org/jans/outcomes-following-surgical-revascularization-single-versus-bilateral-internal-thoracic?utm_source=iContact&utm_medium=email&utm_campaign=ctsnet&utm_content=JANS+12%2F7%2F2018
SITA vs. BITA
The EXCEL trial randomized 1905 patients with LMT coronary artery disease to percutaneous coronary intervention with everolimus-eluting stents versus CABG.
Among the 905 patients undergoing CABG, 688 (76.0%) received SITA and 217 (24.0%) received BITA.
The BITA group
younger (66.1 ± 9.5 vs 64.5 ± 9.3 years, P = 0.020)
less likely female (24.3% vs 14.3%, P = 0.002)
diabetic (28.8% vs 15.2%, P < 0.001)
a lower prevalence of peripheral vessel disease (10.2% vs 5.5%, P = 0.040).
The unadjusted 3-year composite primary endpoint of death, stroke or myocardial infarction (MI) occurred in 15.6% of SITA vs 11.6% of BITA patients (P = 0.17).
The SITA group tended to have a higher 3-year rate of all-cause death compared with the BITA group (6.7% vs 3.3%; P = 0.070).
Stroke, MI and ischaemia-driven revascularization outcomes were not significantly different between groups.
After adjusting for baseline differences, neither the composite of death, stroke or MI [hazard ratio (HR) 1.12, 95% confidence interval (CI) 0.71–1.78; P = 0.62] nor mortality (HR 1.36, 95% CI 0.60–3.12; P = 0.46) was significantly higher with SITA.
The rehospitalization rate after 3 years was higher in the SITA group (35.8% vs 26.0%, P = 0.008), a difference which was no longer present after multivariable adjustment (HR 1.27, 95% CI 0.93–1.74; P = 0.13).
Sternal wound dehiscence within 30 days did not occur more often in the BITA group compared to the SITA group (1.8% vs 2.2%, P > 0.99).
CONCLUSIONS
In the EXCEL trial, there were no clinical differences at 3 years between SITA or BITA revascularization in patients with left main coronary artery disease.
The selection of SITA or BITA was not randamized.
So probably SITA group had more likely complicated pts and worse results.
It seems to me that no differences and more comfortable with BITA due to less anastomosis.
https://www.ctsnet.org/jans/outcomes-following-surgical-revascularization-single-versus-bilateral-internal-thoracic?utm_source=iContact&utm_medium=email&utm_campaign=ctsnet&utm_content=JANS+12%2F7%2F2018
SITA vs. BITA
The EXCEL trial randomized 1905 patients with LMT coronary artery disease to percutaneous coronary intervention with everolimus-eluting stents versus CABG.
Among the 905 patients undergoing CABG, 688 (76.0%) received SITA and 217 (24.0%) received BITA.
The BITA group
younger (66.1 ± 9.5 vs 64.5 ± 9.3 years, P = 0.020)
less likely female (24.3% vs 14.3%, P = 0.002)
diabetic (28.8% vs 15.2%, P < 0.001)
a lower prevalence of peripheral vessel disease (10.2% vs 5.5%, P = 0.040).
The unadjusted 3-year composite primary endpoint of death, stroke or myocardial infarction (MI) occurred in 15.6% of SITA vs 11.6% of BITA patients (P = 0.17).
The SITA group tended to have a higher 3-year rate of all-cause death compared with the BITA group (6.7% vs 3.3%; P = 0.070).
Stroke, MI and ischaemia-driven revascularization outcomes were not significantly different between groups.
After adjusting for baseline differences, neither the composite of death, stroke or MI [hazard ratio (HR) 1.12, 95% confidence interval (CI) 0.71–1.78; P = 0.62] nor mortality (HR 1.36, 95% CI 0.60–3.12; P = 0.46) was significantly higher with SITA.
The rehospitalization rate after 3 years was higher in the SITA group (35.8% vs 26.0%, P = 0.008), a difference which was no longer present after multivariable adjustment (HR 1.27, 95% CI 0.93–1.74; P = 0.13).
Sternal wound dehiscence within 30 days did not occur more often in the BITA group compared to the SITA group (1.8% vs 2.2%, P > 0.99).
CONCLUSIONS
In the EXCEL trial, there were no clinical differences at 3 years between SITA or BITA revascularization in patients with left main coronary artery disease.
The selection of SITA or BITA was not randamized.
So probably SITA group had more likely complicated pts and worse results.
It seems to me that no differences and more comfortable with BITA due to less anastomosis.
2018年9月30日日曜日
Transcatheter Mitral-Valve Repair in Patients With Heart Failure
Transcatheter Mitral-Valve Repair in Patients With Heart Failure
https://www.ctsnet.org/jans/transcatheter-mitral-valve-repair-patients-heart-failure?utm_source=iContact&utm_medium=email&utm_campaign=ctsnet&utm_content=JANS+9%2F28%2F2018
This multicenter RCT study evaluated the efficacy of medical therapy plus transcatheter valve repair (MitraClip) to medical therapy alone for heart failure accompanied by secondary moderate to severe mitral regurgitation.
The device group experienced significantly fewer hospitalizations and lower mortality at 24 months follow-up.
Neither surgical repair nor surgical replacement of the mitral valve has been shown to lower the rate of hospitalization or death associated with secondary mitral regurgitation, and both procedures confer a substantial risk of complications.
Why are there the difference between surgery and MitraClip?
If surgery is too invasive, the mortality of surgical survivor must be improved.
According to MR improvement, MVR must be better than MVP and Mitraclip. But there were no differences between MVR and MVP.
I doubt some limitations affect the results.
1. Abbot's trial It might cause COI.
2. F/U doctors know who are MitraClip patients due to XP.
https://www.ctsnet.org/jans/transcatheter-mitral-valve-repair-patients-heart-failure?utm_source=iContact&utm_medium=email&utm_campaign=ctsnet&utm_content=JANS+9%2F28%2F2018
This multicenter RCT study evaluated the efficacy of medical therapy plus transcatheter valve repair (MitraClip) to medical therapy alone for heart failure accompanied by secondary moderate to severe mitral regurgitation.
The device group experienced significantly fewer hospitalizations and lower mortality at 24 months follow-up.
Neither surgical repair nor surgical replacement of the mitral valve has been shown to lower the rate of hospitalization or death associated with secondary mitral regurgitation, and both procedures confer a substantial risk of complications.
Why are there the difference between surgery and MitraClip?
If surgery is too invasive, the mortality of surgical survivor must be improved.
According to MR improvement, MVR must be better than MVP and Mitraclip. But there were no differences between MVR and MVP.
I doubt some limitations affect the results.
1. Abbot's trial It might cause COI.
2. F/U doctors know who are MitraClip patients due to XP.
2018年9月26日水曜日
Combined Transaortic and Transapical Approach to Septal Myectomy for Complex Long-Segment Hypertrophy
Combined Transaortic and Transapical Approach to Septal Myectomy for Complex Long-Segment Hypertrophy
https://www.ctsnet.org/article/combined-transaortic-and-transapical-approach-septal-myectomy-complex-long-segment?utm_source=iContact&utm_medium=email&utm_campaign=ctsnet&utm_content=Pulse+9%2F25%2F2018
Standard Morrow's myectomy + myectomy through LV apex 5cm incision
https://www.ctsnet.org/article/combined-transaortic-and-transapical-approach-septal-myectomy-complex-long-segment?utm_source=iContact&utm_medium=email&utm_campaign=ctsnet&utm_content=Pulse+9%2F25%2F2018
Standard Morrow's myectomy + myectomy through LV apex 5cm incision
Aortic Valve Replacement With Right Anterior Thoracotomy, Sutureless Valves, and Ultrafast-Track Anesthesia: A Truly Minimally Invasive Approach in Ancona
Aortic Valve Replacement With Right Anterior Thoracotomy, Sutureless Valves, and Ultrafast-Track Anesthesia: A Truly Minimally Invasive Approach in Ancona
https://www.ctsnet.org/article/aortic-valve-replacement-right-anterior-thoracotomy-sutureless-valves-and-ultrafast-track?utm_source=iContact&utm_medium=email&utm_campaign=ctsnet&utm_content=Pulse+9%2F25%2F2018MICS-AVR
Need the disrtance between Aortomy and aortic valve over 7cm
Standard antegrade CP x1
Sutureless valve Perceval (crimp)
Every Nadia 1 suture
2018年3月7日水曜日
Right Coronary Aneurysm With Coronary Arteriovenous Fistula to Right Atrium
https://www.ctsnet.org/article/right-coronary-aneurysm-coronary-arteriovenous-fistula-right-atrium
The fistula between the proximal of RCA and SVC
They had some choices
1 Open the fistula, and close the entry and exit through the fistula ( or through the SVC). No need bypass.
2 Close the proximal RCA and the exit through the fistula ( or through the SVC). need bypass.
They chose 2. Why? I am afraid that SVG long term patancy. maybe too close.
The fistula between the proximal of RCA and SVC
They had some choices
1 Open the fistula, and close the entry and exit through the fistula ( or through the SVC). No need bypass.
2 Close the proximal RCA and the exit through the fistula ( or through the SVC). need bypass.
They chose 2. Why? I am afraid that SVG long term patancy. maybe too close.
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