ABSTRACTS
Abstracts Voodaarsvergadering Nederlandse Vereniging voor Thoraxchirurgle Utrecht, 12 apfil 2003 Valve-related events after aortic root replacement with cryopreserved aortic homogrfts. Kaya A, Schepens MAAM, Morshuis WJ, Heijmen RJ, Brutel dc la Riviere A*, Dossche KME. Dept. of Cardiothoracic S.;Se;ry, St. Antonius Hospital Nieuwegein and * University Hospital Utrecht (UMCU)
Background: Aortic root replacement with aortic homografts has yielded good early results. To assess mid- and long-term valve-related events, a follow-up study was conducted. Patients and metiods: From September 1989 through August 2002, 200 patients underwent aortic root replacement. Bacterial endocarditis was the predominant indication for surgery (NVE in 65 pts., PVE in 45 pts.). Overall hospital mortality was 7.0% (70%CL: 5.2-8.8%)(n-14). Ofthe 186 hospital survivors, 182 were entered in the follow-up study (97.5%). End-points of the study were valve-related death, reoperation for valve failure, endocarditis, thromboembolic events, anticoagulantrelated bleeding and function of the homograft valve. Follow-up was conducted between January and February 2003; data were collected by one investigator. Results: Mean and median follow-up were 4.9 yrs. and 5.2 yrs. respectively (range 0.1-14.2 yrs.). In total, 20 late deaths occurred (11.0%); of these, 5 were valve-related. The overall survival at five and ten years is 88.7±2.4 % and 70.1± 5.7%. Sixteen patients (9.0%) required reoperation for strucuravalve failure (n=7), false aneurysm (n-5), homgraftvalve endocarditis (n=3) and coronary artery disease(n=1). Four pts. (25%) died after reoperation, all but one had endocarditis of the homograft. Five and ten year freedom from reoperation is 94.7±1.8 and 83.5±4.8%. Endocarditis was reported in 4 pts (2.1%), ofwhom one was treated medically and thre required reoperation. Thromboembolic events (n-1) and anticoagulant-related bleeding events (n.0) were rarely seen. A recent echocardiographic study was available in 130 pts.(72%). A normal function of the homograft was reported in 95 pts. Condlusion: Cryopreserved aortic homografts function well on midand long-term. The incidence of structural valve failure is acceptable. Reoperations for homograft endocarditis carry a high mortality.
Artic valve reoperation in the current era: characics and determinants of outcome Klieverik L.MA, Takkenberg J.J.M., Herwerden L.A. van, Venema A.C., Bogers KJ.J.C. Dept. of Cardio-Thoracic Surgcry, Erasmus Unitvcrsity Medical Center,
Rotterdam, T1he Netherlands
Introduction: Given the increasing number ofprosthetic valve choices, characteristics of aortic valve reoperations may have changed considerably over the years. A retrospective single-center study was undertaken to determine reoperative features and study potential risk factors for hospital and long-term mortality in the past decade. Methods: Between 1991 and 2001 1844 patients underwent aortic valve replacement at Erasmus MC Rotterdam. Data were collected for all 145 aortic valve reoperations in 140 patients >16 years. Potential hospital mortality risk factors including Euroscore were analyzed using univariate logistic regression. Survival analysiswas done using the KaplanMeier method. Results: Mean patient age was 47 years (range 16-79), 63% was male (n-92). At reoperation 38% had a mechanical prosthesis (n=55), 25% a bioprosthesis (n.36), 18% an allograft (n-26), 16% a repaired valve (n-23) and 3% an autograft (n-5). Pannus/tissue ingrowth and periprosthetic leakage were main reoperative causes for mechanical valves, structural failure for tissue valves or repaired valves. Another important
Nethiands Heart Journal, Volume a1, Number 5, May 2003
cause wa active prosthetic endocarditis. Average predicted Euroscore mortalityriskwas 11.5% (range 4.0%-62.8%). Overall hospital mortalitywas 6.9% (n-10). Causeswere heart failure (n=4), sepsis (n=4), CVA (n=1), bleeding (n-1). Important predictors ofhospital mortalitywere dialysis postoperative, rethoracotomy, active prosthesis endocarditis, concomitant surgery, number of previous heart surgery, female gender, higher Euroscore. Ten-year cumulative survival was 76% (95% CI 67%-85%). Condusion: Patients undergoing aortic valve reoperation compnse a diverse population. Different reoperative causes depend on the valve prosthesis type requiring replacement. Ibis senes suggests that results of aortic valve reoperations have improved in the current era.
Repair of the mitral anterior leaflet and commissures Kerchove L.AL. de, Versteegh M.I.M., Dion RA.E. Leids UniversitairMedisch Centrum, Leiden. Introduction: To describe the techniques used to repair anterior leaflet (AML) and commissures and to assess postoperative results. Methods: From January 2000 to December 2002, 397 mitral valve procedures, ofwhich 84 % repairs(MVrep), were perforned in our instiftuion Outofthese 333 MVrep, 136patientsunderwentrepairofAML (89), postrior comnissre (72) and antenor commnissu (26), completed with posterior leaflet repair (79) and annuloplasty (116). There were 100 males, mean age was 59.2 years (17 to 83 years). 43.3 % (59/136) ofthe patientswere in NYHA I or II, 7.4 % (10/136) were not elective, 13.2 % (18/136) have had prior heart operation (4 MVrep). Etiologies were fibro-elastic deficiency (55), endocarditis (20), rheumatic (19), ischemnic (18), Barlow disease (13), congenital (9), Marfan disease (2). Ihe techiques used to repawrAML and comminsures consisted ofchordal replacement with Goretex (70), plication of papillary muscle (18), bilateral comnuissurotomy (15), sliding plasty and annulus plication (14), pericardial patch (12), closure of perforation or cleft (8), Alfieri stitches (8), chordal shortening (3), triangular resection (3), flip-over (2). Associated procedures were CABG (28), aortic valve and/or root surgery (17), tricuspid valve repairs (18), left ventricle aneurysmectomy (2). Results: Inmaoperative TEE showed residual mitral regurgitation (MR) grade 1 in 133 patients. TTE at discharge showed MRgrade 51 in 108 patients (108/124: 87.1 %) and grade II in eight (8/124: 6.5 %). 9 patients (9/136: 6.6 %) needed early MV reoperation (3 re-repairs, 6 replacements). 12 patients (12/136: 8,8 %) died during hospital stay: 6 CHF, 2 respiratory complication, 3 multiple organ failure, 1 sepsis. During the mean follow-up of 15 months, 5 other patients have needed nitral valve replacement for endocarditis, stenosis, ring dehiscence and 2 MVrep filures. Condlusion: AML and commissures can be efficiendy repaired with an acceptable rate of residual MR and stenosis.
Evaluation of hydrophilic polymer coated extracorporeal circuits: et bovine Cloin E.W.C., Weerwind P.W., KeijzerM.H. de, Feron J.C.M., Brouwer M.H.J. University Medical Center Nijmegen, Nimegen.
Introductiorn This studywas designed to evaluate the intinsic tirombogenicity of the extracorporeal circuit during cardiopulmonary bypass (CPB) support with minimal interference of the so-called materialindependentfictors; using the novel biopassive inert hydrophilic polymer (poly-2-methoxyethylarylate) coated CPB system. Methods: Ten calves (mean bodyweight 85 * 9 kg) were randomly assigned to a poly-2-methoxyethylacrylate (PMEA) coated or an uncoated (control) CPB system. After a bolus injection of heparin (200
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Abstracts
IU/kg bodyweight) before cannulation via the carotid artery and jugular vein, a low heparinization protocol (20 IU/kg/hr) was adopted, allowing the activated clotting time (ACT) to drop below 200 seconds during the course of the experiment. Under standardized conditions the calves were perfused for 6 hours at-a blood flow rate of 3 L/min. Blood samples were taken for measurement ofplatelet procoagulant phospholipid activity, whole blood platelet function, platelet count, fibrinopeptide A, antiXa activity, and ACT. In addition, the inlet and outlet oxygenator pressures were also monitored. Results: Blood platelets showed a decrease in the ability to generate ionomycin-induced procoagulant activity, manifest directly after start of CPB, which was significantly attenuated using an uncoated system. Moreover, the whole blood platelet responsiveness was significantly attenuated during the control experiments. The loss of platelet function was accompanied by a 61% fall in blood platelet count during the control experiments versus 31% in the PMEA experiments (P=0.001). The plasma heparin levels dropped in both experimental groups to 1,28 U/mL (P>0.05). Furthermore, after 60 minutes of CPB support the ACT in presence of heparinase increased progressively during the control experiments (P
Abstracts Voodaarsvergadering Nederlandse Vereniging voor Thoraxchirurgle Utrecht, 12 apfil 2003 Valve-related events after aortic root replacement with cryopreserved aortic homogrfts. Kaya A, Schepens MAAM, Morshuis WJ, Heijmen RJ, Brutel dc la Riviere A*, Dossche KME. Dept. of Cardiothoracic S.;Se;ry, St. Antonius Hospital Nieuwegein and * University Hospital Utrecht (UMCU)
Background: Aortic root replacement with aortic homografts has yielded good early results. To assess mid- and long-term valve-related events, a follow-up study was conducted. Patients and metiods: From September 1989 through August 2002, 200 patients underwent aortic root replacement. Bacterial endocarditis was the predominant indication for surgery (NVE in 65 pts., PVE in 45 pts.). Overall hospital mortality was 7.0% (70%CL: 5.2-8.8%)(n-14). Ofthe 186 hospital survivors, 182 were entered in the follow-up study (97.5%). End-points of the study were valve-related death, reoperation for valve failure, endocarditis, thromboembolic events, anticoagulantrelated bleeding and function of the homograft valve. Follow-up was conducted between January and February 2003; data were collected by one investigator. Results: Mean and median follow-up were 4.9 yrs. and 5.2 yrs. respectively (range 0.1-14.2 yrs.). In total, 20 late deaths occurred (11.0%); of these, 5 were valve-related. The overall survival at five and ten years is 88.7±2.4 % and 70.1± 5.7%. Sixteen patients (9.0%) required reoperation for strucuravalve failure (n=7), false aneurysm (n-5), homgraftvalve endocarditis (n=3) and coronary artery disease(n=1). Four pts. (25%) died after reoperation, all but one had endocarditis of the homograft. Five and ten year freedom from reoperation is 94.7±1.8 and 83.5±4.8%. Endocarditis was reported in 4 pts (2.1%), ofwhom one was treated medically and thre required reoperation. Thromboembolic events (n-1) and anticoagulant-related bleeding events (n.0) were rarely seen. A recent echocardiographic study was available in 130 pts.(72%). A normal function of the homograft was reported in 95 pts. Condlusion: Cryopreserved aortic homografts function well on midand long-term. The incidence of structural valve failure is acceptable. Reoperations for homograft endocarditis carry a high mortality.
Artic valve reoperation in the current era: characics and determinants of outcome Klieverik L.MA, Takkenberg J.J.M., Herwerden L.A. van, Venema A.C., Bogers KJ.J.C. Dept. of Cardio-Thoracic Surgcry, Erasmus Unitvcrsity Medical Center,
Rotterdam, T1he Netherlands
Introduction: Given the increasing number ofprosthetic valve choices, characteristics of aortic valve reoperations may have changed considerably over the years. A retrospective single-center study was undertaken to determine reoperative features and study potential risk factors for hospital and long-term mortality in the past decade. Methods: Between 1991 and 2001 1844 patients underwent aortic valve replacement at Erasmus MC Rotterdam. Data were collected for all 145 aortic valve reoperations in 140 patients >16 years. Potential hospital mortality risk factors including Euroscore were analyzed using univariate logistic regression. Survival analysiswas done using the KaplanMeier method. Results: Mean patient age was 47 years (range 16-79), 63% was male (n-92). At reoperation 38% had a mechanical prosthesis (n=55), 25% a bioprosthesis (n.36), 18% an allograft (n-26), 16% a repaired valve (n-23) and 3% an autograft (n-5). Pannus/tissue ingrowth and periprosthetic leakage were main reoperative causes for mechanical valves, structural failure for tissue valves or repaired valves. Another important
Nethiands Heart Journal, Volume a1, Number 5, May 2003
cause wa active prosthetic endocarditis. Average predicted Euroscore mortalityriskwas 11.5% (range 4.0%-62.8%). Overall hospital mortalitywas 6.9% (n-10). Causeswere heart failure (n=4), sepsis (n=4), CVA (n=1), bleeding (n-1). Important predictors ofhospital mortalitywere dialysis postoperative, rethoracotomy, active prosthesis endocarditis, concomitant surgery, number of previous heart surgery, female gender, higher Euroscore. Ten-year cumulative survival was 76% (95% CI 67%-85%). Condusion: Patients undergoing aortic valve reoperation compnse a diverse population. Different reoperative causes depend on the valve prosthesis type requiring replacement. Ibis senes suggests that results of aortic valve reoperations have improved in the current era.
Repair of the mitral anterior leaflet and commissures Kerchove L.AL. de, Versteegh M.I.M., Dion RA.E. Leids UniversitairMedisch Centrum, Leiden. Introduction: To describe the techniques used to repair anterior leaflet (AML) and commissures and to assess postoperative results. Methods: From January 2000 to December 2002, 397 mitral valve procedures, ofwhich 84 % repairs(MVrep), were perforned in our instiftuion Outofthese 333 MVrep, 136patientsunderwentrepairofAML (89), postrior comnissre (72) and antenor commnissu (26), completed with posterior leaflet repair (79) and annuloplasty (116). There were 100 males, mean age was 59.2 years (17 to 83 years). 43.3 % (59/136) ofthe patientswere in NYHA I or II, 7.4 % (10/136) were not elective, 13.2 % (18/136) have had prior heart operation (4 MVrep). Etiologies were fibro-elastic deficiency (55), endocarditis (20), rheumatic (19), ischemnic (18), Barlow disease (13), congenital (9), Marfan disease (2). Ihe techiques used to repawrAML and comminsures consisted ofchordal replacement with Goretex (70), plication of papillary muscle (18), bilateral comnuissurotomy (15), sliding plasty and annulus plication (14), pericardial patch (12), closure of perforation or cleft (8), Alfieri stitches (8), chordal shortening (3), triangular resection (3), flip-over (2). Associated procedures were CABG (28), aortic valve and/or root surgery (17), tricuspid valve repairs (18), left ventricle aneurysmectomy (2). Results: Inmaoperative TEE showed residual mitral regurgitation (MR) grade 1 in 133 patients. TTE at discharge showed MRgrade 51 in 108 patients (108/124: 87.1 %) and grade II in eight (8/124: 6.5 %). 9 patients (9/136: 6.6 %) needed early MV reoperation (3 re-repairs, 6 replacements). 12 patients (12/136: 8,8 %) died during hospital stay: 6 CHF, 2 respiratory complication, 3 multiple organ failure, 1 sepsis. During the mean follow-up of 15 months, 5 other patients have needed nitral valve replacement for endocarditis, stenosis, ring dehiscence and 2 MVrep filures. Condlusion: AML and commissures can be efficiendy repaired with an acceptable rate of residual MR and stenosis.
Evaluation of hydrophilic polymer coated extracorporeal circuits: et bovine Cloin E.W.C., Weerwind P.W., KeijzerM.H. de, Feron J.C.M., Brouwer M.H.J. University Medical Center Nijmegen, Nimegen.
Introductiorn This studywas designed to evaluate the intinsic tirombogenicity of the extracorporeal circuit during cardiopulmonary bypass (CPB) support with minimal interference of the so-called materialindependentfictors; using the novel biopassive inert hydrophilic polymer (poly-2-methoxyethylarylate) coated CPB system. Methods: Ten calves (mean bodyweight 85 * 9 kg) were randomly assigned to a poly-2-methoxyethylacrylate (PMEA) coated or an uncoated (control) CPB system. After a bolus injection of heparin (200
235
Abstracts
IU/kg bodyweight) before cannulation via the carotid artery and jugular vein, a low heparinization protocol (20 IU/kg/hr) was adopted, allowing the activated clotting time (ACT) to drop below 200 seconds during the course of the experiment. Under standardized conditions the calves were perfused for 6 hours at-a blood flow rate of 3 L/min. Blood samples were taken for measurement ofplatelet procoagulant phospholipid activity, whole blood platelet function, platelet count, fibrinopeptide A, antiXa activity, and ACT. In addition, the inlet and outlet oxygenator pressures were also monitored. Results: Blood platelets showed a decrease in the ability to generate ionomycin-induced procoagulant activity, manifest directly after start of CPB, which was significantly attenuated using an uncoated system. Moreover, the whole blood platelet responsiveness was significantly attenuated during the control experiments. The loss of platelet function was accompanied by a 61% fall in blood platelet count during the control experiments versus 31% in the PMEA experiments (P=0.001). The plasma heparin levels dropped in both experimental groups to 1,28 U/mL (P>0.05). Furthermore, after 60 minutes of CPB support the ACT in presence of heparinase increased progressively during the control experiments (P
