Comparison of Postoperative Outcomes of Sutureless versus Stented Bioprosthetic Aortic Valve Replacement

Abstract Objective: Sutureless aortic valve replacement (Su-AVR) offers an alternative to supra-annular stented biological aortic prostheses. This single-center study aimed to compare early outcomes after aortic valve replacement with sutureless and conventional stented bioprostheses. Methods: In this retrospective study, we analyzed 52 patients who underwent aortic valve replacement with sutureless and stented bioprostheses between January 2013 and October 2017. Sorin Perceval S sutureless valves were implanted in group 1 and Sorin Mitroflow stented bioprosthetic valves were used in group 2. Postoperative outcomes, including demographics, cardiopulmonary bypass (CPB) times, cross-clamp times, morbidity and mortality, as well as echocardiography in the first month, were compared. Results: Mortality occurred in 1 (3.6%) patient in group 1, and in 2 (8.3%) patients in group 2 (P=0.186). Group 1 had significantly shorter CPB (61.6±26.1 min vs. 106.3±32.7 min, P=0.001) and cross-clamp (30.9±13.6 min vs. 73.3±17.3 min, P=0.001) times. The length of stay in the intensive care unit (1.9±1.3 days vs. 2.4±4.9 days, P=0.598) and hospital stay (7.6±2.7 days vs. 7.3±2.6 days, P=0.66) were similar. Postoperatively, there was no statistically significant difference between the two groups in echocardiography results, and morbidities. The mean aortic valve gradient was 13.5±5.8 mmHg in group 1 and 14.5±8.0 mmHg in group 2 (P=0.634). Paravalvular regurgitation was diagnosed in 3 (10.7%) patients in group 1 and in 1 (4.2%) patient in group 2 (P=0.220). Conclusions: Su-AVR resulted in shorter cross-clamp and CPB times. However, early mortality, postoperative morbidity, and echocardiography results were similar between groups.

Comparison of Postoperative Outcomes of Sutureless versus Stented Bioprosthetic Aortic Valve Replacement.

OBJECTIVE: Sutureless aortic valve replacement (Su-AVR) offers an alternative to supra-annular stented biological aortic prostheses. This single-center study aimed to compare early outcomes after aortic valve replacement with sutureless and conventional stented bioprostheses. METHODS: In this retrospective study, we analyzed 52 patients who underwent aortic valve replacement with sutureless and stented bioprostheses between January 2013 and October 2017. Sorin Perceval S sutureless valves were implanted in group 1 and Sorin Mitroflow stented bioprosthetic valves were used in group 2. Postoperative outcomes, including demographics, cardiopulmonary bypass (CPB) times, cross-clamp times, morbidity and mortality, as well as echocardiography in the first month, were compared. RESULTS: Mortality occurred in 1 (3.6%) patient in group 1, and in 2 (8.3%) patients in group 2 (P=0.186). Group 1 had significantly shorter CPB (61.6±26.1 min vs. 106.3±32.7 min, P=0.001) and crossclamp (30.9±13.6 min vs. 73.3±17.3 min, P=0.001) times. The length of stay in the intensive care unit (1.9±1.3 days vs. 2.4±4.9 days, P=0.598) and hospital stay (7.6±2.7 days vs. 7.3±2.6 days, P=0.66) were similar. Postoperatively, there was no statistically significant difference between the two groups in echocardiography results, and morbidities. The mean aortic valve gradient was 13.5±5.8 mmHg in group 1 and 14.5±8.0 mmHg in group 2 (P=0.634). Paravalvular regurgitation was diagnosed in 3 (10.7%) patients in group 1 and in 1 (4.2%) patient in group 2 (P=0.220). CONCLUSIONS: Su-AVR resulted in shorter cross-clamp and CPB times. However, early mortality, postoperative morbidity, and echocardiography results were similar between groups.

Apelin-13: A Promising Biomarker for Age-Related Macular Degeneration?

PURPOSE: To investigate the value of serum apelin-13 levels in patients with age-related macular degeneration (AMD). METHODS: Patients with dry-type AMD, patients with treatment-naïve neovascular-type AMD, and healthy controls were included in this study. Diagnoses were confirmed on detailed fundus examination, optical coherence tomography (OCT), and fundus fluorescein angiography (FFA). Central foveal thickness and subfoveal choroidal thickness were evaluated. Both serum apelin-13 and vascular endothelial growth factor (VEGF) levels were measured by a competitive enzyme-linked immunosorbent assay (ELISA) principle. RESULTS: A total of 84 subjects, i.e., 24 in the dry-type AMD group (group 1), 27 in the neovascular-type AMD group (group 2), and 33 in the control group (group 3) were included in the study. Mean best-corrected visual acuity (BCVA) was 76 ± 4.5, 48.4 ± 16.3, and 83.4 ± 3.09 ETDRS letters in group 1, 2, and 3, respectively. The level of serum VEGF was 44.11 ± 26.14, 56.53 ± 53.77, and 61.47 ± 41.62 pg/mL in groups 1, 2, and 3, respectively (p = 0.553, p = 0.286, and p = 0.896, respectively). The level of serum apelin-13 was 586.47 ± 167.56, 622.18 ± 324.52, and 379.31 ± 171.96 pg/mL in groups 1, 2, and 3, respectively (p = 0.847, p = 0.04, and p ≤ 0.001, respectively). There was a negative correlation between the level of serum apelin and visual acuity (VA) and choroidal thickness. CONCLUSION: Serum apelin-13 levels were higher in both dry-type and neovascular-type AMD patients than in controls. Further studies demonstrating the relationship of the level of serum apelin-13 and AMD are needed.

THE EFFECT OF AGE ON AFLIBERCEPT (EYLEA) RESPONSE IN DIABETIC MACULAR EDEMA.

PURPOSE: To investigate the effect of age on aflibercept (Eylea) response in macular edema secondary to treatment-naive diabetic eyes. METHODS: Two hundred seventy-three eyes of 273 treatment-naive patients with macular edema secondary to diabetes mellitus were enrolled in this study. The patients in the study were divided into the following 4 groups according to their ages: Group 1 (40-50 years), Group 2 (51-60 years), Group 3 (61-70 years), and Group 4 (>70 years). Three consecutive injections at intervals of 1 month were applied to all diabetic patients. The efficacy of the aflibercept treatment on macular edema according to age groups was assessed by optical coherence tomography by comparing the central foveal thickness (CFT) values and mean visual acuity changes after initial and three loading dose injections. RESULTS: After three consecutive aflibercept injections, the mean reduction of CFT in Groups 1, 2, 3, and 4 were -256.4 ± 110.9, -197.4 ± 96.4, -189.4 ± 110.8, and -186.2 ± 118.9 µm, respectively. The changes of CFT was significantly different between age groups (P = 0.003, analysis of covariance). The improvement of visual acuity was significantly different in each group (P < 0.001 in all groups, paired-samples t-test), and changes of visual acuity was significantly different between age groups (P < 0.05, analysis of covariance). In addition, ages of patients were correlated with the mean reduction of CFT and mean improvement of visual acuity for the whole study group (r = -0.183, P = 0.002 for CFT; r = -0.682, P < 0.001 for visual acuity, Pearson correlation). CONCLUSION: In this study, it was observed that the efficacy of aflibercept treatment was found to be more effective in younger patients in treatment-naive diabetic macular edema patients.

Ozurdex completely located inside a crystallized lens - Results of 14 months.

PURPOSE: To report the therapeutic efficacy and results of an accidentally injected intralenticular sustained-release dexamethasone implant (Ozurdex) in a patient with macular edema secondary to central retinal vein occlusion at 14 months after injection. OBSERVATIONS: We present a 70-year-old female patient with central retinal vein occlusion who underwent an Ozurdex injection. Patient discontinued from the treatment period during the 14-month and there was no ophthalmologic examination of the patient. Detailed ophthalmological examination was performed. Ozurdex localization was determined by Pentacam rotating Scheimpflug System. The implant was accidentally injected into the crystalline lens. It did not cause a totally lens opacification but did result only in a posterior subcapsular cataract. The macular edema did not resolve, and the patient underwent phacoemulsification surgery. CONCLUSIONS AND IMPORTANCE: Ozurdex that totally located inside the crystallize lens may not have the therapeutic effects.