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W Eric R Jamieson - One of the best experts on this subject based on the ideXlab platform.
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porcine and perimount pericardial bioprostheses surgery comparison of carpentier edwards supra annular structural Valve Deterioration in mitral replacement
2013Co-Authors: Tirone E David, W Eric R Jamieson, M Marchand, Thomas W Dubiel, M Aupart, Willem Daenen, Michael P Holden, Eke A Ryba, William N Anderson, Conrad L PelletierAbstract:J Thorac Cardiovasc Surg Tirone E. David, Eke A. Ryba and William N. Anderson, Jr Pellerin, Thomas W. Dubiel, Michel R. Aupart, Willem J. Daenen, Michael P. Holden, W. R. Eric Jamieson, Michel A. Marchand, Conrad L. Pelletier, Robert Norton, Michel PORCINE AND PERIMOUNT PERICARDIAL BIOPROSTHESES SURGERY: COMPARISON OF CARPENTIER-EDWARDS SUPRA-ANNULAR STRUCTURAL Valve Deterioration IN MITRAL REPLACEMENT http://jtcs.ctsnetjournals.org/cgi/content/full/118/2/297 the World Wide Web at: The online version of this article, along with updated information and services, is located on
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what prosthesis should be used at Valve re replacement after structural Valve Deterioration of a bioprosthesis
The Annals of Thoracic Surgery, 2006Co-Authors: W Eric R Jamieson, Eva Germann, Clifford F Hughes, Florence ChanAbstract:Background The fate of bioprostheses (BP) and mechanical prostheses (MP) after Valve re-replacement for bioprostheses is not well-documented. This research compares the late fate of these two Valve types after Valve re-replacement for structural Valve Deterioration (SVD) of a bioprosthesis. Methods Between 1975 and 2000, 298 patients had successful aortic Valve re-replacements (AVRR) (BP n=149, average age=67.1 ± 12.3 years; MP 149, 58.9 ± 10.9) and 442 patients had successful mitral Valve re-replacements (MVRR) (BP 155, 65.8 ± 14.1; MP 287, 60.8 ± 11.7) after SVD of a previous BP. Follow-up was five years in all groups. Results (1) Aortic position (AVRR): Survival favored MP over BP overall, at 10 years (70.3 ± 5.4% vs 56.7 ± 5.7%, p = 0.0220). This survival advantage was seen to be significant only in patients less than 60 years of age (at 10 years, 85.3 ± 4.9% vs 59.2 ± 9.8%, p = 0.038). No significant difference in survival between the two Valve types was observed in patient age groups greater than 60 years of age. Freedoms from Valve-specific complications, including reoperation for SVD-thrombosis, major thromboembolism and hemorrhage, and Valve-related mortality were not significantly different between the two groups overall. (2) Mitral position (MVRR): Survival favored MP over BP overall (58.6 ± 4.2% vs 42.1 ± 5.2%, p = 0.0011), and in patients greater than 70 years of age (32.8 ± 8.9% vs 16.7 ± 7.1%, p = 0.008). Freedoms from Valve-specific complications and Valve-related mortality favored MP over BP. Conclusions There was no clinical performance difference between mechanical and bioprosthetic Valves in patients greater than 60 years of age upon AVRR. Mechanical Valves generally outperformed bioprosthetic Valves in all age groups in MVRR.
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structural Valve Deterioration in mitral replacement surgery comparison of carpentier edwards supra annular porcine and perimount pericardial bioprostheses
The Journal of Thoracic and Cardiovascular Surgery, 1999Co-Authors: W Eric R Jamieson, M Marchand, Conrad L Pelletier, Robert Norton, Michel Pellerin, Thomas W Dubiel, M Aupart, Willem Daenen, Michael P Holden, Tirone E DavidAbstract:Abstract Background: Bioprostheses preserved with glutaraldehyde, both porcine and pericardial, have been available as second-generation prostheses for Valve replacement surgery. The performance with regard to structural Valve Deterioration with the Carpentier-Edwards supra-annular (CE-SAV) porcine bioprosthesis and the Carpentier-Edwards Perimount (CE-P) pericardial bioprosthesis (Baxter Healthcare Corp, Edwards Division, Santa Ana, Calif) was evaluated to determine whether there was a difference in mitral Valve replacement. Methods: The CE-SAV bioprosthesis was implanted in 1266 overall mitral Valve replacements (isolated mitral, 1066; mitral in multiple, 200) and the CE-P bioprosthesis in 429 overall mitral Valve replacements (isolated mitral, 328; mitral in multiple, 101). The mean age of the CE-SAV population was 64.2 ± 12.2 years and that of the CE-P population, 60.7 ± 11.7 years ( P = .0001). For the study, structural Valve Deterioration was diagnosed at reoperation for explantation. Results: The freedom from structural Valve Deterioration was evaluated to 10 years, and the freedom rates reported are at 10 years. For the overall mitral Valve replacement groups, the actuarial freedom from Deterioration was significant ( P = .0001): CE-P > CE-SAV for 40 years or younger, 80% versus 60%; 41 to 50 years, 91% versus 61%; 51 to 60 years, 84% versus 69%; 61 to 70 years, 95% versus 75%. The older than 70-year group was 100% versus 92% (no significant difference). The actual freedom from structural Valve Deterioration also demonstrated the same pattern at 10 years: 40 years or younger, CE-P 82% versus CE-SAV 68%; 41 to 50 years, 92% versus 70%; 51 to 60 years, 90% versus 80%; 61 to 70 years, 97% versus 88%; and older than 70 years, 100% versus 97%. The independent risk factors of structural Valve Deterioration for the overall mitral Valve replacement group were age and age groups and prosthesis type (CE-SAV > CE-P). The prosthesis type either in isolated replacement or in multiple replacement was not predictive of structural Valve Deterioration. The pathology of structural Valve Deterioration was different: 70% of CE-P failures were due to calcification and 57% of CE-SAV failures were due to combined calcification and leaflet tear. Conclusion: The actuarial and actual freedom from structural Valve Deterioration, diagnosed at reoperation, is greater at 10 years for CE-P than for CE-SAV bioprostheses. The mode of failure is different, and the cause remains obscure. Long-term evaluation is recommended, because the different modes of failure may alter the clinical performance by 15 and 20 years. (J Thorac Cardiovasc Surg 1999;118:297-305)
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pregnancy and bioprostheses influence on structural Valve Deterioration
The Annals of Thoracic Surgery, 1995Co-Authors: W Eric R Jamieson, Craig D Miller, Cary W Akins, Ian A Munro, Donald D Glower, Kathleen A Moore, C HendersonAbstract:The long-term performance of bioprostheses was evaluated in women 35 years of age or less to determine the influence of pregnancy on structural Valve Deterioration. Between 1972 and 1992, 237 female patients received 255 biological prostheses. Of the total operations, 53 were performed in patients who experienced pregnancy (P) and 202 in patients who were never pregnant (nonpregnant [NP]). The mean age of the P group was 23.0 ± 5.8 years (standard deviation) (12 to 34 years) and of the NP group it was 27.1 ± 6.3 years (8 to 35 years) ( p p = not significant [NS]). The P group of 52 patients had 94 pregnancies: 70 deliveries (74.5%) and 24 abortions (25.5%) (therapeutic, 14 [15%]). There were a total of 143 Valve-related complications (P, 35; NP, 108); the majority for structural Valve Deterioration (SVD) 43% (109 patients) P 51% (27 patients) and NP 41% (82 patients) ( p = NS). The Valve-related reoperation rate paralleled the SVD rate at 42% (107 patients), P 51% (27 patients) and NP 40% (80 patients) ( p = NS). The overall reoperative mortality rate was 6.0%. The interval from initial implant to reoperation was 99.6 ± 3.6 months ( p = NS groups P and NP). The freedom from SVD at 10 and 15 years for the NP group was 54 ± 5% and 18 ± 5%, respectively; and for the P group, 45 ± 8% and 34 ± 8% ( p = NS). The freedom from reoperation paralleled that of SVD. The freedom from Valve-related mortality at 10 and 15 years for the NP group was 93 ± 2% and 88 ± 4%, respectively; and for P, 92 ± 5% and 92 ± 5%, respectively ( p = NS). At reoperation mechanical prostheses were used in 70% of NP (60 patients) and 59% of P (17 patients). Pregnancy did not significantly influence the incidence of SVD. Bioprostheses provide female patients with the opportunity for uncomplicated pregnancies and normal children.
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actuarial versus actual risk of porcine structural Valve Deterioration
The Journal of Thoracic and Cardiovascular Surgery, 1994Co-Authors: Gary L. Grunkemeier, W Eric R Jamieson, Craig D Miller, Albert StarrAbstract:Abstract Actuarial analysis, using nonparametric (e.g., life table or Kaplan-Meier) or parametric (statistical modeling) methods, is used to describe and compare survival probabilities by allowing for partial survival times (censoring). Although devised to describe freedom from death, this method has been extended to nonfatal complications, such as freedom from tissue Valve failure. However, the risk described for nonfatal events is that which a patient would experience provided he were immortal . And patients with Valve disease have a relatively high risk of dying, generating the question: "What is the chance the Valve will fail before the patient dies? " To answer this more practical (for individual patient management and population resource allocation) question requires an estimate of what we call actual failure, that is, the percentage of patients whose Valve will actually fail before they die. This risk is less than the risk which the usual actuarial curve describes. This difference increases with patient age, because older patients have a lower risk of tissue failure and a higher risk of death than younger patients. (J THORAC CARDIOVASC SURG 1994;108:709-18)
W R E Jamieson - One of the best experts on this subject based on the ideXlab platform.
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actuarial versus actual freedom from structural Valve Deterioration with the carpentier edwards porcine bioprostheses
Canadian Journal of Cardiology, 1999Co-Authors: W R E Jamieson, L H Burr, Robert T Miyagishima, Eva Germann, William N AndersonAbstract:BACKGROUND: The clinical performance of porcine bioprostheses for Valve replacement surgery has been evaluated for over three decades by actuarial analysis as the standard for reporting time-related results. The incidence of structural Valve Deterioration (SVD) is used for the selection of prostheses for various subsets of patients. Actual or cumulative incidence analysis may provide a superior method to determine durability of bioprostheses. OBJECTIVE: To compare actuarial versus actual methodology in determining the durability of porcine bioprostheses for aortic (AVR) and mitral Valve replacement (MVR). PATIENTS AND METHODS: Carpentier-Edwards porcine bioprostheses were implanted between 1975 and 1995 in 2237 AVR and 1582 MVR. The mean age for AVR patients was 65.4+/-12 years and for MVR patients 61.7+/-12 years. The cumulative follow-up for AVR was 14,810 years (mean 6.6+/-4.7) and for MVR 9718 years (mean 6. 1+/-4.5). RESULTS: For AVR the actual freedom from SVD was 87.4+/-2. 0% and 95.6+/-1.8% in those aged 61 to 70 years and more than 70 years, respectively; the actuarial freedom was 75.9+/-4.2% and 82. 3+/-7.9%, respectively. For MVR the actual freedom from SVD was 69. 4+/-2.5% and 92.9+/-1.9% for those aged 61 to 70 years and more than 70 years, respectively; the actuarial freedom was 25.5+/-5.7% and 79. 5+/-6.0%, respectively. Predictors of freedom from SVD for AVR were identified as advancing age, falling into the age groups 61 to 70 and those older than 70 years, and intermediate Valve sizes; predictors for MVR were advancing age and age older than 70 years. CONCLUSIONS: Comparison of methods of durability assessment revealed that actual freedom from SVD supports porcine bioprostheses for AVR in patients more than 60 years of age and for MVR in patients more than 70 years of age. This evaluation with experience to 15 years supports the indications for use of porcine bioprostheses.
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Porcine bioprostheses in the elderly : clinical performance by age groups and Valve positions. Discussion
The Annals of Thoracic Surgery, 1995Co-Authors: L H Burr, W R E Jamieson, Robert T Miyagishima, Eva Germann, Munro Ai, W. W. Angell, F. J. Schoen, C. A. S. Marrin, G. SchuchamnnAbstract:Porcine bioprostheses have been recommended and used for cardiac Valve replacement in the elderly. A review of 1,984 patients with 2,042 operations, performed between 1975 and 1992, has afforded a detailed evaluation of clinical performance by Valve positions and age groups within the elderly population. The numbers of operations performed by age groups were 65 to 69 years, 719 ; 70 to 74 years, 745 ; 75 to 79 years, 431 ; 80 to 84 years, 119 ; and 85 years or older, 28. The early mortality rate overall was 9.5% (195 patients), range 6.9% to 17.8% by age groups (p mitral Valve replacement). The freedom from structural Valve Deterioration by Valve positions between age groups was different (p < 0.05). The freedom from structural Valve Deterioration for aortic Valve replacement at 10 years was 95% ± 2% for 65 to 69 years and 99% ± 1% for 70 to 74 years. The freedom from structural Valve Deterioration for mitral Valve replacement at 10 years was 70% ± 5% for 65 to 69 years, 90% ± 4% for 70 to 74 years, and 94% ± 6% for 75 to 79 years. The freedom from Valve-related reoperation paralleled that for structural Valve Deterioration. The freedom from overall complications (morbidity and mortality) at 10 years was 70% ± 2% for aortic Valve replacement, 54% ± 4% for mitral Valve replacement, and 49% ± 9% for multiple replacement (p < 0.05). Porcine bioprostheses should still be implanted for aortic Valve replacement in the elderly 65 years of age and older and for mitral Valve replacement in patients 70 years of age and older. The incidence of Valve-related complications remains low, and long-term survival is excellent.
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Carpentier-Edwards supraannular porcine bioprosthesis : clinical performance to twelve years. Discussion
The Annals of Thoracic Surgery, 1995Co-Authors: W R E Jamieson, L H Burr, Robert T Miyagishima, Michael T Janusz, Florence Chan, Hilton Ling, Guy Fradet, F. O. Tyers, Joan Macnab, C HendersonAbstract:The Carpentier-Edwards supraannular porcine bioprosthesis, a second-generation biologic prosthesis, has had clinical performance assessment to 12 years. This bioprosthesis was used in 2,489 operations in 2,444 patients between 1982 and 1992, inclusive (mean age 64.1 years, age range 6 to 89 years). There were 1,335 aortic Valve replacements (AVR), 938 mitral Valve replacements (MVR), and 200 multiple Valve replacements (MR). Concomitant procedures were performed in 1,017 cases (40.9%). The age group distribution was : 35 years or younger, 83 patients ; 36 to 50 years, 245 ; 51 to 64 years, 728 ; 65 to 69 years, 458 ; and 70 years and older, 975. The total follow-up was 12,785 patient-years (mean, 5.1 years) and was 96% complete. The early mortality rate was 7.4% (185 patients), and the late mortality was 4.9%/patient year (623). Concomitant procedures influenced both early and late mortality (p MVR, MR). The freedom from thromboembolism was not different by Valve position. The freedom from major thromboembolism at 12 years was 82% ± 4% (p = not significant by Valve position). The overall freedom from antithromboembolic hemorrhage was 96% ± 1% at 12 years (p MVR > MR). The overall freedom from Valve-related reoperation at 12 years was 58% ± 5% (p MVR, MR), and from Valve-related mortality 89% ± 2% (p MVR > MR). The freedom from residual morbidity (permanent impairment) at 12 years was 87% ± 4% (p = not significant by Valve position). The freedom from structural Valve Deterioration overall at 12 years was 63% ± 5% ; at 10 years it was 90% ± 2% for AVR, 72% ± 3% for MVR, and 61% ± 8% for MR (p MVR, MR). The freedom from structural Valve Deterioration by age groups by Valve position was not significant for 35 years and less, but was significant for 36 to 50, 51 to 64, and 70 years and older (p MVR > MR), and for 65 to 69 years (p MR > MVR). The freedom from structural Valve Deterioration at 10 years after AVR by Valve position for age groups was 36 to 50 years, 85% ± 6% ; 70 years and older, 99% ± 1% ; 51 to 64 years, 84% ± 4% ; and 65 to 69 years, 96% ± 2% (p < 0.05). The freedom from structural Valve Deterioration at 10 years for MVR and MR was not different by age groups ; for ages greater than 70, rates were 90% ± 4% for MVR and 84% ± 12% for MR. The second-generation Carpentier-Edwards supraannular porcine bioprosthesis has structural Valve Deterioration as a major Valve-related complication, but is recommended for AVR in patients 65 years of age or older and for MVR in those aged 70 years or more.
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pregnancy and bioprostheses influence on structural Valve Deterioration discussion
The Annals of Thoracic Surgery, 1995Co-Authors: W R E Jamieson, Cary W Akins, Donald D Glower, Kathleen A Moore, C Henderson, D C Miller, I Munro, B G Barrattboyes, D F Pupello, Lawrence H CohnAbstract:The long-term performance of bioprostheses was evaluated in women 35 years of age or less to determine the influence of pregnancy on structural Valve Deterioration. Between 1972 and 1992, 237 female patients received 255 biological prostheses. Of the total operations, 53 were performed in patients who experienced pregnancy (P) and 202 in patients who were never pregnant (nonpregnant [NP]). The mean age of the P group was 23.0 ± 5.8 years (standard deviation) (12 to 34 years) and of the NP group it was 27.1 ± 6.3 years (8 to 35 years) (p < 0.05). The mean follow-up for the NP group was 6.8 years and for the P group it was 7.9 years. The late mortality was 2.26%/patient-year overall, 2.71%/patient-year for the NP group and 0.89%/patient-year for the P group (p = not significant [NS]). The P group of 52 patients had 94 pregnancies : 70 deliveries (74.5%) and 24 abortions (25.5%) (therapeutic, 14 [15%]). There were a total of 143 Valve-related complications (P, 35 ; NP, 108) ; the majority for structural Valve Deterioration (SVD) 43% (109 patients), P 51% (27 patients) and NP 41% (82 patients) (p = NS). The Valve-related reoperation rate paralleled the SVD rate at 42% (107 patients), P 51% (27 patients) and NP 40% (80 patients) (p = NS). The overall reoperative mortality rate was 6.0%. The interval from initial implant to reoperation was 99.6 ± 3.6 months (p = NS groups P and NP). The freedom from SVD at 10 and 15 years for the NP group was 54 ± 5% and 18 ± 5%, respectively ; and for the P group, 45 ± 8% and 34 ± 8% (p = NS). The freedom from reoperation paralleled that of SVD. The freedom from Valve-related mortality at 10 and 15 years for the NP group was 93 ± 2% and 88 ± 4%, respectively ; and for P, 92 ± 5% and 92 ± 5%, respectively (p = NS). At reoperation mechanical prostheses were used in 70% of NP (60 patients) and 59% of P (17 patients). Pregnancy did not significantly influence the incidence of SVD. Bioprostheses provide female patients with the opportunity for uncomplicated pregnancies and normal children.
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carpentier edwards standard and supra annular porcine bioprostheses 10 year comparison of structural Valve Deterioration
Journal of Heart Valve Disease, 1994Co-Authors: W R E Jamieson, L H Burr, G F Tyers, A I MunroAbstract:: From 1975 to 1986 the Carpentier-Edwards standard (CE-S) and supra-annular (CE-SAV) porcine bioprostheses were implanted in 1213 and 1000 patients, respectively. The mean age of the standard group was 57.6 years (range 8 to 85 years) while in the supra-annular group it was 60.7 years (range 13 to 85 years). The freedom from structural Valve Deterioration (SVD) at 10 years for the entire patient population was 79.4% +/- 3.1% with CE-SAV and 76.1% +/- 1.6% with CE-S (p < 0.05). The overall freedom from SVD for those patients undergoing mitral Valve replacement (MVR) was 74.5% +/- 4.6% for CE-SAV and 68.7% +/- 2.8% for CE-S (p = NS), while for those undergoing aortic Valve replacement (AVR) it was 86.5% +/- 4.3% for CE-SAV and 84.1% +/- 2.0% for CE-S (p = NS). In those patients under 35 years of age undergoing MVR, the freedom from SVD for CE-SAV and CE-S was 94.4% +/- 5.4% and 62.9% +/- 8.6%, respectively (p < 0.05 at 8 years); for those aged 36-50 years, it was 75.6% +/- 7.4% and 61.7% +/- 6.0%; for those aged 51-65 years, it was 76.2% +/- 7.4% and 69.6% +/- 4.2%; for those over 65 years, it was 74.1% +/- 7.1% and 82.2% +/- 5.2%; for those aged 65-69 years, it was 70.2% +/- 8.7% and 63.7% +/- 8.1%; and for those over 70 years of age, it was 79.2% +/- 8.7% and 95.3% +/- 3.2%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
Farid Foroutan - One of the best experts on this subject based on the ideXlab platform.
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structural Valve Deterioration after transcatheter aortic Valve implantation
Heart, 2017Co-Authors: Farid Foroutan, Gordon H Guyatt, Catherine M Otto, Reed A C Siemieniuk, Stefan Schandelmaier, Thomas Agoritsas, Per Olav Vandvik, Sai BhagraAbstract:Background Transcatheter aortic Valve implantation (TAVI), widely used to treat high-risk patients with severe symptomatic aortic stenosis, has recently been extended to younger patients at lower operative risk in whom long-term durability of TAVI devices is an important concern. Therefore, we conducted a systematic review and meta-analysis of observational studies addressing the frequency of structural Valve Deterioration (SVD) after TAVI. Methods We searched Medline, Embase, Cochrane Database of Systematic Reviews, and Cochrane CENTRAL from 2002 to September 2016. We included observational studies following patients with TAVI for at least 2 years. Independently and in duplicate, we evaluated study eligibility, extracted data, and assessed risk of bias for SVD post-TAVI. Our review used the GRADE system to assess quality of evidence. We pooled incidence rates using a random effects model. Results Thirteen studies including 8914 patients, with a median follow-up between 1.6 and 5 years, reported an incidence of SVD post-TAVI between 0 to 1.34 per 100 patient years. The pooled incidence of SVD was 28.08 per 10 000 patients/year (95% CI 2.46 to 73.44 per 100 patient years). Of those who developed SVD, 12% underwent Valve re-intervention. Confidence in the evidence was moderate due to inconsistency among studies. Conclusion Structural Valve Deterioration is probably an infrequent event within the first 5 years after TAVI. Ascertaining the impact of SVD and the need for Valve-related re-interventions to inform recommendations for patients with a longer life-expectancy will require studies including a large number of patients with longer follow-up (>10 years).
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Prognosis after surgical replacement with a bioprosthetic aortic Valve in patients with severe symptomatic aortic stenosis: systematic review of observational studies
BMJ, 2016Co-Authors: Farid Foroutan, Gordon H Guyatt, Sai Bhagra, Kathleen O’brien, Eva Bain, M. Stein, Rakhshan Kamran, Yaping Chang, Tahira DevjiAbstract:Objective To determine the frequency of survival, stroke, atrial fibrillation, structural Valve Deterioration, and length of hospital stay after surgical replacement of an aortic Valve (SAVR) with a bioprosthetic Valve in patients with severe symptomatic aortic stenosis. Design Systematic review and meta-analysis of observational studies. Data sources Medline, Embase, PubMed (non-Medline records only), Cochrane Database of Systematic Reviews, and Cochrane CENTRAL from 2002 to June 2016. Study selection Eligible observational studies followed patients after SAVR with a bioprosthetic Valve for at least two years. Methods Reviewers, independently and in duplicate, evaluated study eligibility, extracted data, and assessed risk of bias for patient important outcomes. We used the GRADE system to quantify absolute effects and quality of evidence. Published survival curves provided data for survival and freedom from structural Valve Deterioration, and random effect models provided the framework for estimates of pooled incidence rates of stroke, atrial fibrillation, and length of hospital stay. Results In patients undergoing SAVR with a bioprosthetic Valve, median survival was 16 years in those aged 65 or less, 12 years in those aged 65 to 75, seven years in those aged 75 to 85, and six years in those aged more than 85. The incidence rate of stroke was 0.25 per 100 patient years (95% confidence interval 0.06 to 0.54) and atrial fibrillation 2.90 per 100 patient years (1.78 to 4.79). Post-SAVR, freedom from structural Valve Deterioration was 94.0% at 10 years, 81.7% at 15 years, and 52% at 20 years, and mean length of hospital stay was 12 days (95% confidence interval 9 to 15). Conclusion Patients with severe symptomatic aortic stenosis undergoing SAVR with a bioprosthetic Valve can expect only slightly lower survival than those without aortic stenosis, and a low incidence of stroke and, up to 10 years, of structural Valve Deterioration. The rate of Deterioration increases rapidly after 10 years, and particularly after 15 years.
Sai Bhagra - One of the best experts on this subject based on the ideXlab platform.
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structural Valve Deterioration after transcatheter aortic Valve implantation
Heart, 2017Co-Authors: Farid Foroutan, Gordon H Guyatt, Catherine M Otto, Reed A C Siemieniuk, Stefan Schandelmaier, Thomas Agoritsas, Per Olav Vandvik, Sai BhagraAbstract:Background Transcatheter aortic Valve implantation (TAVI), widely used to treat high-risk patients with severe symptomatic aortic stenosis, has recently been extended to younger patients at lower operative risk in whom long-term durability of TAVI devices is an important concern. Therefore, we conducted a systematic review and meta-analysis of observational studies addressing the frequency of structural Valve Deterioration (SVD) after TAVI. Methods We searched Medline, Embase, Cochrane Database of Systematic Reviews, and Cochrane CENTRAL from 2002 to September 2016. We included observational studies following patients with TAVI for at least 2 years. Independently and in duplicate, we evaluated study eligibility, extracted data, and assessed risk of bias for SVD post-TAVI. Our review used the GRADE system to assess quality of evidence. We pooled incidence rates using a random effects model. Results Thirteen studies including 8914 patients, with a median follow-up between 1.6 and 5 years, reported an incidence of SVD post-TAVI between 0 to 1.34 per 100 patient years. The pooled incidence of SVD was 28.08 per 10 000 patients/year (95% CI 2.46 to 73.44 per 100 patient years). Of those who developed SVD, 12% underwent Valve re-intervention. Confidence in the evidence was moderate due to inconsistency among studies. Conclusion Structural Valve Deterioration is probably an infrequent event within the first 5 years after TAVI. Ascertaining the impact of SVD and the need for Valve-related re-interventions to inform recommendations for patients with a longer life-expectancy will require studies including a large number of patients with longer follow-up (>10 years).
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Prognosis after surgical replacement with a bioprosthetic aortic Valve in patients with severe symptomatic aortic stenosis: systematic review of observational studies
BMJ, 2016Co-Authors: Farid Foroutan, Gordon H Guyatt, Sai Bhagra, Kathleen O’brien, Eva Bain, M. Stein, Rakhshan Kamran, Yaping Chang, Tahira DevjiAbstract:Objective To determine the frequency of survival, stroke, atrial fibrillation, structural Valve Deterioration, and length of hospital stay after surgical replacement of an aortic Valve (SAVR) with a bioprosthetic Valve in patients with severe symptomatic aortic stenosis. Design Systematic review and meta-analysis of observational studies. Data sources Medline, Embase, PubMed (non-Medline records only), Cochrane Database of Systematic Reviews, and Cochrane CENTRAL from 2002 to June 2016. Study selection Eligible observational studies followed patients after SAVR with a bioprosthetic Valve for at least two years. Methods Reviewers, independently and in duplicate, evaluated study eligibility, extracted data, and assessed risk of bias for patient important outcomes. We used the GRADE system to quantify absolute effects and quality of evidence. Published survival curves provided data for survival and freedom from structural Valve Deterioration, and random effect models provided the framework for estimates of pooled incidence rates of stroke, atrial fibrillation, and length of hospital stay. Results In patients undergoing SAVR with a bioprosthetic Valve, median survival was 16 years in those aged 65 or less, 12 years in those aged 65 to 75, seven years in those aged 75 to 85, and six years in those aged more than 85. The incidence rate of stroke was 0.25 per 100 patient years (95% confidence interval 0.06 to 0.54) and atrial fibrillation 2.90 per 100 patient years (1.78 to 4.79). Post-SAVR, freedom from structural Valve Deterioration was 94.0% at 10 years, 81.7% at 15 years, and 52% at 20 years, and mean length of hospital stay was 12 days (95% confidence interval 9 to 15). Conclusion Patients with severe symptomatic aortic stenosis undergoing SAVR with a bioprosthetic Valve can expect only slightly lower survival than those without aortic stenosis, and a low incidence of stroke and, up to 10 years, of structural Valve Deterioration. The rate of Deterioration increases rapidly after 10 years, and particularly after 15 years.
Ruediger Lange - One of the best experts on this subject based on the ideXlab platform.
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Structural Valve Deterioration 4 Years After Transcatheter Aortic Valve Replacement Imaging and Pathohistological Findings
Circulation, 2015Co-Authors: Marcus-andré Deutsch, N. Patrick Mayr, Gerald Assmann, Albrecht Will, Markus Krane, Nicolo Piazza, Sabine Bleiziffer, Ruediger LangeAbstract:Transcatheter aortic Valve replacement (TAVR) has been developed as an alternative treatment modality for those patients with severe symptomatic aortic Valve stenosis in whom the risk for conventional surgical aortic Valve replacement (AVR) is considered too high or prohibitive.1 However, knowledge regarding longer-term Valve durability, especially in younger patients, is very limited. Herein, we report on a 48-year-old female patient presenting with structural Valve Deterioration 4 years after rescue percutaneous TAVR with a CoreValve bioprosthesis (Medtronic Inc, Minneapolis, Minn). We show the imaging features as well as the macro- and microscopic findings of a deteriorated transcatheter heart Valve. In 2010, our then 44-year-old female patient was admitted to the hospital because of rapidly progressive decompensated heart failure. She presented in a markedly reduced general health condition with severe dyspnoe (New York Heart Association class IV), pronounced pulmonary congestion, and bilateral leg edema. Medical history revealed pulmonary embolism in October 2009. At the age of 10 she had undergone previous cardiac surgery for correcting postductal aortic isthmus stenosis. Clinical chemistry showed elevated liver enzymes and signs of beginning renal failure. NT-proBNP was 16.000 ng/L (reference level,
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structural Valve Deterioration 4 years after transcatheter aortic Valve replacement imaging and pathohistological findings
Circulation, 2015Co-Authors: Marcus-andré Deutsch, Gerald Assmann, Albrecht Will, Markus Krane, Nicolo Piazza, Sabine Bleiziffer, Patrick N Mayr, Ruediger LangeAbstract:Transcatheter aortic Valve replacement (TAVR) has been developed as an alternative treatment modality for those patients with severe symptomatic aortic Valve stenosis in whom the risk for conventional surgical aortic Valve replacement (AVR) is considered too high or prohibitive.1 However, knowledge regarding longer-term Valve durability, especially in younger patients, is very limited. Herein, we report on a 48-year-old female patient presenting with structural Valve Deterioration 4 years after rescue percutaneous TAVR with a CoreValve bioprosthesis (Medtronic Inc, Minneapolis, Minn). We show the imaging features as well as the macro- and microscopic findings of a deteriorated transcatheter heart Valve. In 2010, our then 44-year-old female patient was admitted to the hospital because of rapidly progressive decompensated heart failure. She presented in a markedly reduced general health condition with severe dyspnoe (New York Heart Association class IV), pronounced pulmonary congestion, and bilateral leg edema. Medical history revealed pulmonary embolism in October 2009. At the age of 10 she had undergone previous cardiac surgery for correcting postductal aortic isthmus stenosis. Clinical chemistry showed elevated liver enzymes and signs of beginning renal failure. NT-proBNP was 16.000 ng/L (reference level, <170 ng/L). Echocardiography (iE33, Philips Healthcare, Hamburg, Germany) revealed a stenotic bicuspid Valve with bulky calcifications (effective orifice area 0.5cm2, maximum systolic pressure gradient 81 mm Hg, mean pressure gradient 42 mm Hg), concomitant mild regurgitation, and severe left ventricular dysfunction (left ventricular ejection fraction 30%). Additionally, moderate tricuspid regurgitation and reduced right ventricular function was detected. Doppler analysis of tricuspid regurgitant velocity spectrum revealed an estimated systolic pulmonary artery pressure of 70 mm Hg. Because operative risk was considered too …
