Outcomes of Leaflet Resection versus Chordal Replacement for Degenerative Mitral Regurgitation.

BACKGROUND: Debate persists regarding the outcomes of leaflet resection (RESECT) versus chordal replacement (CHORD) for degenerative mitral regurgitation. Our aim was to compare early and late outcomes of the leaflet resection versus chordal replacement techniques for degenerative mitral regurgitation. METHODS: 1066 consecutive patients receiving mitral repair for degenerative regurgitation using RESECT versus CHORD techniques were evaluated from a prospectively maintained database. Propensity score matching was used to compare outcomes in RESECT versus CHORD repairs. RESULTS: CHORD patients had later operative dates, more flail leaflet, and more anterior leaflet disease. With switch to predominant CHORD technique in 2010, the percent repair for all degenerative valves improved significantly from 83% to 91% (P=0.002). 467 patients were matched for baseline characteristics. CHORD patients had larger rings (34mm v 32mm, P<0.001) and more use of an Alfieri stitch (66% v 22%, P< 0.001) in matched patients. 10-year survival was similar for matched patients (RESECT vs CHORD: 86±3% v 84±4%, P=0.5). RESECT patients had a lower 10-year cumulative incidence of mitral reoperation (RESECT vs CHORD: 1±1% v 8±3%, P=0.002), and severe mitral regurgitation (RESECT vs CHORD: 1±1% v 9±5%, P=0.05) compared to matched CHORD patients. Late ejection fraction and mitral gradient were not different between two groups in matched patients, respectively (P=0.9 and P=0.2, respectively). CONCLUSIONS: The use of CHORD technique for degenerative mitral regurgitation increased the repair rates, but CHORD technique had slightly lower repair durability at 10-years compared to RESECT technique. These results could be related to more complex pathology in CHORD group.

Elevated circulating levels of neutrophil extracellular traps after cardiopulmonary bypass surgery as risk factors of postoperative atrial fibrillation and mortality.

Background: Cardiopulmonary bypass (CPB) can trigger a systemic inflammatory response during the perioperative period, which may lead to the consumption of the contact system and the production of neutrophil extracellular traps (NETs). This study attempted to determine whether the formation of NETs and contact activation are a vivid occurrence during CPB and whether they are related to post-operative atrial fibrillation (AF) and survival. Methods: A prospective observational study was conducted in 97 patients who underwent aortic valve and/or aorta replacement surgery with CPB. Circulating markers of NETs [histone-DNA complex, cell-free double stranded DNA (dsDNA), neutrophil elastase] and the contact system [prekallikrein, high molecular weight kininogen (HMWK), activated factor XII (FXIIa)] were measured at four-time points: before surgery (T0), immediately after surgery (T1), 1 day after surgery (T2), and 3 days after surgery (T3). Results: Elevated levels of circulating NETs markers were observed across post-CPB time. Significantly elevated levels of histone-DNA complex and cell-free dsDNA measured T3 were detected in patients with post-operative AF compared to those without. In logistic regression analysis, levels of histone-DNA complex and cell-free dsDNA measured at T3 were significant markers of risk for occurrence of AF. The levels of cell-free dsDNA measured T2 were significantly higher in non-survivors than in survivors. The level of cell-free dsDNA showed significant prognostic value. Conclusions: NETs markers may be useful for the assessment of risk for post-operative AF and mortality. Conduct of additional research regarding the role of NETs as clinical markers and as a therapeutic target in CPB is anticipated.

LC-QTOF/MS-Based Profiling of the Phytochemicals in Ice Plant (Mesembryanthemum crystallinum) and Their Bioactivities.

Recent assessments of the correlations between food and medicine underscore the importance of functional foods in disease prevention and management. Functional foods offer health benefits beyond basic nutrition, with fresh fruits and vegetables being particularly prominent because of their rich polyphenol content. In this study, we elucidated the phytochemicals in ice plant (Mesembryanthemum crystallinum), a globally consumed vegetable, using an LC-QTOF/MS-based untargeted detection method. The phytochemicals were clustered based on their structural similarity using molecular networking and annotated using the in silico tool for network annotation propagation. To identify the bioactive compounds, eight compounds were isolated from ice plant extracts. These compounds were identified using extensive spectroscopic methods, including 1H and 13C nuclear magnetic resonance (NMR) spectroscopy. Additionally, we evaluated the antioxidant and anti-inflammatory activities of all the isolates. Among the tested compounds, three showed antioxidant activity and all eight showed anti-inflammatory activity, demonstrating the potential of ice plant as a functional food.

Early outcomes of aortic valve replacement with Perceval PLUS sutureless valve: results of the prospective multicentric MANTRA study.

BACKGROUND: The aim of this study is to report the preliminary real-word clinical and hemodynamic performance from the MANTRA study in patients undergoing aortic valve replacement with Perceval PLUS sutureless valve. METHODS: MANTRA is an ongoing "umbrella" prospective, multi-center, international post-market study to collect real-life safety and performance data on Corcym devices (Corcym S.r.l, Saluggia, Italy). Clinical and echocardiographic outcomes were collected preoperatively, at discharge and at each follow up. KCCQ-12 and EQ-5D-5L quality of life questionnaires were collected preoperatively and at 30-days. RESULTS: A total of 328 patients underwent aortic valve replacement with Perceval PLUS in 29 International institutions. Patients were enrolled from July 2021 to October 2023 and enrollment is still ongoing. Mean age was 71.9 ± 6.4 years, mean EuroSCORE II was 2.9 ± 3.9. Minimally invasive approach was performed in 44.2% (145/328) of patients; concomitant procedures were done in 40.8% (134/328) of cases. Thirty-day mortality was 1.8% (6/328) and no re-interventions were reported. Pacemaker implant was required in 4.0% (13/328) of the patients. The assessment of the functional status demonstrated marked and stable improvement in NYHA class in most patients at 30-day follow-up, with significant increase of KCCQ-12 summary score (from 58.8 ± 23.0 to 71.8 ± 22.1, p < 0.0001) and EQ-5D-5L VAS score (from 64.5 ± 20.4 to 72.6 ± 17.5, p < 0.0001). Mean pressure gradient decreased from 46.2 ± 17.3 mmHg to 10.1 ± 4.7 mmHg at 30-day follow-up. Low or no incidence of moderate-to-severe paravalvular or central leak was reported. CONCLUSIONS: Preliminary results demonstrate good clinical outcomes and significant improvement of Quality of Life at 30-days, excellent early hemodynamic performance within patient implanted with Perceval PLUS. TRIAL REGISTRATION: The MANTRA study has been registered in ClinicalTrials.gov (NCT05002543, Initial release 26 July 2021).

Early and mid-term outcomes of tricuspid valve surgery in patients with functional tricuspid regurgitation induced by atrial fibrillation.

Background: The strategy of treatment for tricuspid regurgitation (TR) induced by atrial fibrillation (AF) has not been established. The aim of this study was to evaluate the outcomes of surgical treatment for TR induced by AF. Methods: From 2000 to 2021, a total of 1,301 patients underwent tricuspid valve (TV) surgery. Among them 43 patients who diagnosed as AF induced TR were enrolled. The tricuspid valve-related events (TVRE) included cardiac death, TV reoperation, development of moderate or greater TV disease, congestive heart failure requiring re-admission, and major bleeding or thrombosis. The median follow-up duration was 42.0 months. Results: The interval from diagnosis of AF to more than moderate TR was 61.2 months, and the interval from initial diagnosis of severe TR to surgery was 2.4 months. Concomitant Cox-maze III procedure was performed in 39 patients. The operative mortality occurred in 1 patient, and there was no permanent pacemaker implantation. Overall survival rates at 1- and 5-year were 90.6% and 79.3%, respectively. The cumulative incidence of TVRE at 1- and 5-year were 16.3% and 26.5%, respectively. The cumulative incidences of AF recurrence at 1- and 3-year in the patients with surgical ablation were 29.7% and 67.6%. The TVRE was significantly associated with the longer interval from diagnosis of severe TR to surgery (hazard ratio: 1.023, 95% confidence interval: 1.005-1.042). Conclusions: TV surgery for TR induced by AF showed low surgical mortality and favorable mid-term outcomes. For these patients, early surgery after progress to severe TR can be helpful to decrease the occurrence of TVRE.

The impact of perivascular tissue preservation on 5-year patency of saphenous vein composite grafts.

OBJECTIVES: This retrospective study was conducted to evaluate the impact of saphenous vein (SV) harvesting with versus without perivascular tissue on the 5-year angiographic patency in coronary artery bypass grafting. METHODS: Among the 944 patients who received coronary artery bypass grafting between 2010 and 2015, 579 patients who received off-pump coronary artery bypass grafting using 1 SV as a Y-composite graft based on the in situ left internal thoracic artery were enrolled. SV harvesting was performed using no-touch technique without perivascular tissue (the NoPVT group) in 342 patients and with perivascular tissue (the PVT group) in 237 patients. Follow-up duration was 84.0 months (interquartile range 66.5-105.4). Propensity score matching was performed, and long-term clinical outcomes and angiographic patency were compared. RESULTS: The average number of distal anastomoses per patient was comparable between the groups, although more SV grafts were anastomosed to left anterior descending territory in the PVT group than in the NoPVT group. Overall survival and cumulative incidence of cardiac death were comparable between the groups, whereas cumulative incidence of target vessel revascularization (1.3% vs 4.3% at 5 year, P = 0.009) and that of major adverse cardiac events (7.3% vs 9.9% at 5 year, P = 0.035) were lower in the PVT group than in the NoPVT group. One-year and 5-year angiographic patency rates of the SV grafts were higher in the PVT group than in the NoPVT group [97.0% vs 91.7% (P = 0.004) and 96.3% vs 89.9% (P = 0.007), respectively]. CONCLUSIONS: SV grafts harvested using no-touch technique with perivascular tissue further improved the 5-year patency of SV composite grafts compared with those without perivascular tissue.

Papillary Renal Cell Carcinoma in Transplanted Kidney and Xp11.2 Translocation/Transcription Factor E3-Rearranged Renal Cell Carcinoma in the Native Kidney: A Case Report.

Concomitant renal cell carcinomas (RCC) of both native and allograft kidneys are extremely rare, and only a few cases have been reported in the available English literature. A particularly rare variant within the adult population is the Xp11.2 translocation/transcription factor E3 (TFE3)-rearranged RCC. Although few case reports of TFE3-rearranged RCC have been reported in children who underwent kidney transplantation (KT), no case of adults with TFE3-rearranged RCC following KT has been reported. Herein, we presented the radiological and pathological findings of a rare metachronous papillary RCC in the allograft kidney and TFE3-rearranged RCC in the native kidney. The TFE3-rearranged RCC in the native kidney exhibited slow expansion in size over five years. Radiologically, it appeared as a slightly enhanced, lobulated mass on contrast-enhanced CT. MRI revealed high signal intensity on T1-weighted images and low signal intensity on T2-weighted images.

Clinical benefits of surgical ablation during isolated aortic valve replacement: a nationwide study.

OBJECTIVES: To compare the early- and long-term clinical outcomes of concomitant surgical ablation (SA) for atrial fibrillation (AF) during isolated aortic valve replacement (AVR) using data from the Korean National Health Insurance Service Database. METHODS: Of 23,332 adult patients who underwent AVR between 2003 and 2019, those with underlying AF with or without concomitant SA were extracted, and propensity score matching analysis was performed. RESULTS: Overall, 1,741 patients with underlying AF with (n = 445, group A) or without (n = 1,296, group N) concomitant SA during isolated AVR were enrolled, from whom 435 pairs were matched in a 1:1 ratio using propensity score matching analysis. The operative mortality and early postoperative morbidities, including bleeding reoperation, stroke, permanent pacemaker implantation and acute kidney injury were comparable between the groups. The overall survival showed no differences between the groups. However, the cumulative incidence of new-onset late ischaemic stroke was significantly lower in group A than group N in propensity score-matched patients [2.3 vs 3.5 per 100 patient-years, adjusted hazard ratio (95% confidence interval) 0.64 (0.43-0.96), Group A versus Group N, respectively]. The cumulative incidence of other morbidities such as reoperation, permanent pacemaker implantation and progression to chronic renal failure showed no difference between groups. CONCLUSIONS: The incidence of late ischaemic stroke was significantly lower when concomitant SA was performed during isolated AVR in patients with underlying AF. Therefore, concomitant SA should be actively considered in patients with underlying AF undergoing isolated AVR to prevent the occurrence of late ischaemic stroke.

Differences in Brain Metabolite Profiles Between Normothermia and Hypothermia.

BACKGROUND: This study evaluated the difference in brain metabolite profiles between normothermia and hypothermia reaching 25°C in humans in vivo. METHODS: Thirteen patients who underwent thoracic aorta surgery under moderate hypothermia were prospectively enrolled. Plasma samples were collected simultaneously from the arteries and veins to estimate metabolite uptake or release. Targeted metabolomics based on liquid chromatographic mass spectrometry and direct flow injection were performed, and changes in the profiles of respective metabolites from normothermia to hypothermia were compared. The ratios of metabolite concentrations in venous blood samples to those in arterial blood samples (V/A ratios) were calculated, and log2 transformation of the ratios [log2(V/A)] was performed for comparison between the temperature groups. RESULTS: Targeted metabolomics were performed for 140 metabolites, including 20 amino acids, 13 biogenic amines, 10 acylcarnitines, 82 glycerophospholipids, 14 sphingomyelins, and 1 hexose. Of the 140 metabolites analyzed, 137 metabolites were released from the brain in normothermia, and the release of 132 of these 137 metabolites was decreased in hypothermia. Two metabolites (dopamine and hexose) showed constant release from the brain in hypothermia, and 3 metabolites (2 glycophospholipids and 1 sphingomyelin) showed conversion from release to uptake in hypothermia. Glutamic acid demonstrated a distinct brain metabolism in that it was taken up by the brain in normothermia, and the uptake was increased in hypothermia. CONCLUSION: Targeted metabolomics demonstrated various degrees of changes in the release of metabolites by the hypothermic brain. The release of most metabolites was decreased in hypothermia, whereas glutamic acid showed a distinct brain metabolism.

Comparable Outcomes of Bicuspid Aortic Valves for Rapid-Deployment Aortic Valve Replacement.

Background: Edwards Intuity is recognized as a relatively contraindicated bioprosthesis for bicuspid aortic valve disease. This study compared the early echocardiographic and clinical outcomes of rapid-deployment aortic valve replacement for bicuspid versus tricuspid aortic valves. Methods: Of 278 patients who underwent rapid-deployment aortic valve replacement using Intuity at Seoul National University Hospital, 252 patients were enrolled after excluding those with pure aortic regurgitation, prosthetic valve failure, endocarditis, and quadricuspid valves. The bicuspid and tricuspid groups included 147 and 105 patients, respectively. Early outcomes and the incidence of paravalvular leak were compared between the groups. A subgroup analysis compared the outcomes for type 0 versus type 1 or 2 bicuspid valves. Results: The bicuspid group had more male and younger patients. Comorbidities, including diabetes mellitus, hypertension, chronic kidney disease, and coronary artery disease, were less prevalent in the bicuspid group. Early echocardiographic evaluations demonstrated that the incidence of ≥mild paravalvular leak did not differ significantly between the groups (5.5% vs. 1.0% in the bicuspid vs. tricuspid groups, p=0.09), and the early clinical outcomes were also comparable between the groups. In the subgroup analysis between type 0 and type 1 or 2 bicuspid valves, the incidence of mild or greater paravalvular leak (2.4% vs. 6.7% in type 0 vs. type 1 or 2, p=0.34) and clinical outcomes were comparable. Conclusion: Rapid-deployment aortic valve replacement for bicuspid aortic valves demonstrated comparable early echocardiographic and clinical outcomes to those for tricuspid aortic valves, and the outcomes were also satisfactory for type 0 bicuspid aortic valves.

Machine-learning-based prediction of survival and mitral regurgitation recurrence in patients undergoing mitral valve repair.

OBJECTIVES: This study was conducted to assess long-term clinical outcomes after mitral valve repair using machine-learning techniques. METHODS: We retrospectively evaluated 436 consecutive patients (mean age: 54.7 ± 15.4; 235 males) who underwent mitral valve repair between January 2000 and December 2017. Actuarial survival and freedom from significant (≥ moderate) mitral regurgitation (MR) were clinical end points. To evaluate the independent risk factors, random survival forest (RSF), extreme gradient boost (XGBoost), support vector machine, Cox proportional hazards model and general linear models with elastic net regularization were used. Concordance indices (C-indices) of each model were estimated. RESULTS: The operative mortality was 0.9% (N = 4). Reoperation was required in 15 patients (3.5%). In terms of C-index, the overall performance of the XGBoost (C-index 0.806) and RSF models (C-index 0.814) was better than that of the Cox model (C-index 0.733) in overall survival. For the recurrent MR, the C-index for XGBoost was 0.718, which was the highest among the 5 models. Compared to the Cox model (C-index 0.545), the C-indices of the XGBoost (C-index 0.718) and RSF models (C-index 0.692) were higher. CONCLUSIONS: Machine-learning techniques can be a useful tool for both prediction and interpretation in the survival and recurrent MR. From the machine-learning techniques examined here, the long-term clinical outcomes of mitral valve repair were excellent. The complexity of MV increased the risk of late mitral valve-related reoperation.

A Controlled Trial Comparing One-Year Hemodynamics of Two Bovine Pericardial Valves.

BACKGROUND: This randomized controlled trial was designed to compare 1-year hemodynamic performances and clinical outcomes after aortic valve replacement (AVR) using a recently introduced (the AVALUS group) and worldwide used (the CEPME group) bovine pericardial bioprostheses. METHODS: Patients were screened to enroll 70 patients in each group based on a noninferiority design. The primary endpoint of the trial was the mean pressure gradient across the aortic valve (AVMPG) at 1 year after surgery. One-year echocardiographic data were obtained from 92.1% (129 of 140 patients) of the study patients. RESULTS: There were no differences in baseline characteristics, including sex and body surface area (1.64 ± 0.18 vs. 1.65 ± 0.15 m2) between the groups. The AVMPG on 1-year echocardiography was 14.0 ± 4.3 and 13.9 ± 5.1 mmHg in the AVALUS and CEPME groups, respectively (the p-value for noninferiority was 0.0004). In the subgroup analyses for the respective size of the prostheses, AVMPG of the 19-mm prostheses was significantly lower in the AVALUS group than in the CEPME group (14.0 ± 4.3 vs. 20.0 ± 4.7 mmHg, p = 0.012), whereas those of the other sizes were not significantly different between the two groups. There were no significant differences in the effective orifice area (1.49 ± 0.40 vs. 1.53 ± 0.38 cm2, p = 0.500) or effective orifice area index (0.91 ± 0.22 vs 0.93 ± 0.23 cm2/m2, p = 0.570) in all the patients, or in the subgroup analysis for the 19-mm prosthesis. There were no differences in the 1-year clinical outcomes between the two groups. CONCLUSION: The 1-year hemodynamic and clinical outcomes of the AVALUS group were noninferior to those of the CEPME group (NCT03796442).

Suture tie-down forces and cyclic contractile forces after undersized tricuspid annuloplasty using a Tri-Ad Adams tricuspid annuloplasty ring in an ovine model.

OBJECTIVES: This study evaluated suture tie-down forces and cyclic contractile forces (CCFs) after undersized tricuspid annuloplasty using a hybrid band. METHODS: Downsized tricuspid annuloplasty was planned in adult male sheep using 8 force transducers attached from the septal to the anterior annular areas of the ring (segments 1 and 2, flexible septal; segments 3 and 4, semi-rigid posterior; segments 5 and 6, semi-rigid anterior; segments 7 and 8, flexible anterior). CCFs were analysed at 3 different levels of peak right ventricular pressure (RVP): 30, 50 and 70 mmHg. RESULTS: Eight 5-year-old male Corriedale sheep (average body weight = 66.8 kg) were used. The average suture tie-down force was 4.42 [standard deviation (SD): 2.32] N. When the forces were compared, it was lowest in the flexible anterior area and highest in the flexible septal area (P < 0.001). With the RVP of 30 mmHg, the average CCFs was lowest at segment 3 [0.07 (SD: 0.07) N] and highest at segment 7 [0.15 (SD: 0.08) N]. The CCFs were 0.12 (SD: 0.1) N, 0.09 (SD: 0.12) N, 0.14 (SD: 0.1) N and 0.13 (SD: 0.09) N in the flexible septal, semi-rigid posterior, semi-rigid anterior and flexible anterior parts, respectively (P = 0.208). As the peak RVP increased to 50 and 70 mmHg, the CCFs of each area increased significantly (P < 0.001). Despite this increase, the CCFs remained low (0.1 and 0.3 N), and differences in CCFs between segments and between annular areas showed similar patterns. CONCLUSIONS: The flexible end of the hybrid band reduces the CCFs and might prevent annular tears after ring tricuspid annuloplasty, and the risk of tear would be low even in the septal area.

The long-term outcomes of surgical ablation for atrial fibrillation during redo left-sided valvular surgery.

Background: This study evaluated the outcome of surgical ablation (SA) for atrial fibrillation (AF) concomitant with redo left-sided valvular surgery. Methods: The study enrolled 224 AF patients (paroxysmal: 13 patients, persistent: 76 patients, long-standing persistent AF: 135 patients) undergoing redo open heart surgery for left-sided valve disease. The early results and long-term clinical outcomes were compared between those who underwent concomitant SA for AF (SA group) and did not (NSA group). Propensity score adjusted Cox regression analysis of overall survival and competing risk analysis of the other clinical outcomes were performed. Results: Seventy-three patients were classified as the SA group and 151 as the NSA group. The median follow-up duration was 124 (1.0-249.5) months. The median ages of the patients in the SA and NSA groups were 54.1±11.3 and 58.4±11.1 years, respectively. There were no significant differences between the groups in the early in-hospital mortality rate (5.5% vs. 9.3%, P=0.474) or postoperative complications, except for low cardiac output syndrome (11.0% vs. 23.8%, P=0.036). Overall survival was better in the SA group [hazard ratio, 0.452; 95% confidence interval (CI): 0.218-0.936, P=0.032]. The incidence of recurrent AF was significantly higher in the SA group on multivariate analysis [hazard ratio, 3.440; 95% CI: 1.987-5.950, P<0.001]. The cumulative incidence of the composite of thromboembolism and bleeding was lower in the SA than NSA group [hazard ratio, 0.338; 95% CI: 0.127-0.897, P=0.029]. Conclusions: The concomitant surgical arrhythmia ablation with redo cardiac surgery for left-sided heart disease resulted in a better overall survival, higher incidence of sinus conversion, and lower incidence of a composite of thromboembolism and major bleeding. Concomitant SA procedure should be considered in patients undergoing redo cardiac surgery.

Clear Cell Borderline Tumor of the Ovary: A Case Report.

Clear cell borderline ovarian tumor (CCBOT) is quite rare, and only a few cases of CCBOT have been reported. Unlike most borderline ovarian tumors, CCBOTs appear solid because they are almost always pathologically adenofibromatous. Herein, we report the MRI findings of a CCBOT discovered in a 22-year-old female.

Incidence of and Risk Factors for the Development of Significant Tricuspid Regurgitation after Isolated Aortic Valve Replacement.

Background: The late progression of tricuspid regurgitation (TR) after mitral valve surgery is well known. However, few reports have described the progression of TR after aortic valve surgery. We investigated the incidence of and risk factors for the development of significant TR after isolated aortic valve replacement (AVR). Methods: This study analyzed patients with less than moderate TR who underwent isolated AVR at Seoul National University Hospital from January 1990 to December 2018. Significant TR was defined as moderate or higher. Echocardiographic follow-up was performed in all patients. The Fine-Gray model was used to identify clinical risk factors for the development of significant TR. Results: In total, 583 patients (61.7±14.2 years old) were included. Operative mortality occurred in 9 patients (1.5%), and the overall survival rates at 10, 20, and 25 years were 91.1%, 83.2%, and 78.9%, respectively. Sixteen patients (2.7%) developed significant TR during the follow-up period (13 moderate; 3 severe). The cumulative incidence of significant TR at 10, 20, and 25 years was 0.77%, 3.83%, and 6.42%, respectively. No patients underwent reoperation or reintervention of the tricuspid valve. Hemodialysis or peritoneal dialysis for chronic kidney disease (hazard ratio [HR], 5.188; 95% confidence interval [CI], 1.154-23.322) and preoperative mild TR (HR, 5.919; 95% CI, 2.059-17.017) were associated with the development of significant TR in the multivariable analysis. Conclusion: TR progression after isolated AVR in patients with less than moderate TR is rare. Preoperative mild TR and hemodialysis or peritoneal dialysis for chronic kidney disease were significant risk factors for the development of TR.

Aortic Valve Replacement by Subannular Endomyocardial Implantation of Valve Prosthesis in Behçet's Disease.

The novel anastomosis technique, "subannular endomyocardial implantation of valve prosthesis (SEIV)," focuses on excluding aortic annular tissue from suture line to avoid vascular inflammation in Behçet's disease (BD). We aimed to validate that SEIV could prevent prosthetic valve detachment (PVD) after aortic valve replacement (AVR) in BD patients and retrospectively analyzed the medical records of five BD patients who underwent AVR. There was no operative death. Two complete atrioventricular blocks occurred; in one of them, a permanent pacemaker (PPM) was inserted before discharge. The other one was discharged without a PPM; however, he died suddenly 32 days postoperatively. The median follow-up period was 3.3 years. There was a case of PVD with newly developed Valsalva sinus aneurysm requiring the Bentall operation at 3.6 years postoperatively. In conclusion, SEIV might prevent PVD in BD patients who underwent AVR. However, aortic root pathology related to BD activity and resulting PVD may occur later.

Long-term clinical outcomes of tricuspid valve replacement using bovine versus porcine valves: a nationwide population-based study.

OBJECTIVES: The early and long-term clinical outcomes of bovine versus porcine tricuspid valve replacement (TVR) were compared based on the nationwide database from the National Health Insurance Service. METHODS: Of 1464 patients who underwent TVR from 2002 to 2018 in Korea, 541 were enrolled after excluding mechanical TVR, re-TVR, complex congenital heart disease, Ebstein anomaly and age <19 years at operation. Bovine (group B) and porcine valves (group P) were used in 342 and 199 patients, respectively. The median follow-up duration was 4.1 years [interquartile range 1.2-9.0]. Inverse probability of treatment weighting analysis was performed for adjustment between the groups. Early and long-term clinical outcomes, including all-cause mortality, ischaemic stroke, haemorrhagic stroke, endocarditis and reoperation, were compared. RESULTS: In inverse probability of treatment weighting analysis, operative mortality and early clinical outcomes were comparable between the groups. The cumulative incidence of all-cause mortality demonstrated no significant differences between the groups [36.8% vs 38.0% at 5 years in group B versus group P; adjusted hazard ratio = 0.93; P = 0.617]. The cumulative incidence of cardiac death, ischaemic stroke, haemorrhagic stroke and endocarditis also demonstrated no significant differences between the groups (28.1% vs 25.9%, 7.1% vs 1.2%, 3.2% vs 4.2% and 9.7% vs 6.0% at 5 years in group B versus group P, respectively). However, the cumulative incidence of reoperation was higher in group B than in group P (20.2% vs 3.4% at 5 years in group B vs group P; adjusted hazard ratio = 4.76; P = 0.006). CONCLUSIONS: Early clinical outcomes and long-term outcomes, including all-cause mortality, cardiac death, ischaemic stroke, haemorrhagic stroke and endocarditis, were comparable between bovine and porcine TVRs. However, porcine valves demonstrated a lower cumulative incidence of reoperation than bovine valves.