Impact of Non-Valvular Non-Coronary Concomitant Procedures on Outcomes of Surgical Aortic Valve Replacement in Intermediate Risk Patients.

INTRODUCTION: advanced age and concomitant procedures could increase the risk of perioperative complications during surgical aortic valve replacement (SAVR). We aimed to evaluate results of elderly patients undergoing SAVR and evaluate the impact of concomitant non-valvular, non-coronary procedures on the outcomes. METHODS: A retrospective single-centre study, evaluating 464 elderly patients (mean age = 75.6 ± 4 years) undergoing either isolated-SAVR (I-SAVR = 211) or combined-SAVR (C-SAVR = 253) between 01/2007 and 12/2017. Combined-SAVR involved non-valvular, non-coronary procedures. Study endpoints are postoperative results concerning the VARC-II criteria, valve dysfunction, long-term freedom from redo-AVR and survival. RESULTS: males were 52.8%. Patients had an intermediate risk profile (mean EuroSCORE-II (%) 5.2 ± 5). Postoperative results reported no significant differences in incidence of re-exploration for bleeding (6.6% vs. 6.7%, p = 1.0), stroke (0.9% vs. 0.4%, p = 0.59), dialysis (6.2% vs. 9.5%, p = 0.23) and pacemaker implantation (3.3% vs. 2.8%, p = 0.79) between I-SAVR and C-SAVR groups. Thirty-day (2.4% vs. 7.1% p = 0.03), one-year (5.7% vs. 13.8%, p = 0.003) and overall mortality (24.6% vs. 37.5%, p = 0.002) were lower in the isolated-SAVR group. Re-AVR was indicated in 1.7% of patients due to endocarditis. CONCLUSIONS: SAVR in elderly patients offers good outcomes with increased life quality and rare re-operation for structural valvular deterioration. Mortality rates were significantly higher when SAVR was combined with another "non-valvular, non-coronary" procedure.

Long-Term Single-Center Outcomes of Patients With Chronic Renal Dialysis Undergoing Cardiac Surgery.

BACKGROUND: The prevalence of dialysis-dependent chronic renal failure (DD-CRF) is growing worldwide. Such patients are exposed to a higher cardiovascular risk because of severe calcification and congestive heart failure caused by volume overload, with poor outcomes. This study aimed to evaluate outcomes of patients with DD-CRF who were undergoing cardiac surgery in a single institution (West German Heart and Vascular Centre Essen, University Hospital Essen, Essen, Germany). METHODS: A retrospective evaluation of 241 consecutive patients who presented with DD-CRF and were undergoing cardiac-surgery between January 2000 and December 2017 was conducted. End points were major adverse cardiac and cerebrovascular events and long-term survival. Additionally, Cox regression multivariate analysis was performed to detect independent predictors of mortality. Follow-up was 98.3% complete through August 2018. RESULTS: The mean age of the study cohort was 63 ± 12.2 years, and 65.1% of these patients were male. Congestive heart failure (CHF) was present in 41.5% of patients, 30.7% had a previous myocardial infarction, 9.1% had previous cardiac surgery, and 22.4% needed urgent or emergency surgery. These patients underwent isolated coronary artery bypass grafting (44.8%), isolated procedures other than coronary artery bypass grafting (17.8%), or concomitant procedures (37.3%). Early outcomes reported in-hospital mortality in 10.4%, low cardiac output syndrome in 7.1%, and stroke in 2.1% of patients, respectively. Overall mortality was recorded in 61% of patients at last follow-up. Cox regression multivariate analysis reported age 60 years or older (hazard ratio [HR], 2.36; 95% confidence interval [CI], 1.62 to 3.45; P < .001) and CHF (HR, 1.95; 95% CI, 1.37 to 2.78; P < .001) as positive predictors of death and subsequent kidney transplantation (HR, 0.35; 95% CI, 0.20 to 0.59; P < .001) as a negative predictor of death. CONCLUSIONS: Cardiac surgery in patients with DD-CRF is associated with high morbidity and mortality. Interestingly, overall mortality was mainly not cardiac related, and older patients or those who presented with CHF had the worst life expectancy. However, subsequent kidney transplantation positively affected long-term survival in these patients.

Outcomes of mitral valve repair in acute native mitral valve infective endocarditis.

OBJECTIVES: Mitral valve repair (MVR) is considered the treatment of choice for mitral valve (MV) regurgitation. However, MVR in acute native MV infective endocarditis is technically challenging and not commonly performed. Our goal was to report our outcomes of MVR in acute native MV infective endocarditis. METHODS: Between January 2016 and December 2017, 35 patients presenting with acute native MV infective endocarditis underwent MVR. Primary end points were successful MVR and freedom from recurrent endocarditis. Secondary end point was the postoperative incidence of major adverse events. RESULTS: The mean age was 58 ± 13 years (74% men) and the median logistic EuroSCORE was 17.1%. Twenty patients underwent isolated MVR; the other 15 patients underwent concomitant procedures. MVR was performed with removal of the vegetation (vegectomy), limited resection of the infected tissue, direct closure of the defect, besides annuloplasty in all patients. Mean intensive care and hospital stays were 5 and 17 days, respectively. All-cause mortality was 11% (4/35) at 30 days and a total of 23% (8/35) within a follow-up period of 10 ± 7.7 months. Endocarditis recurred in 2 patients 15 and 8 months after surgery, respectively. Both underwent successful MV re-repair. Follow-up echocardiography indicated none-to-trace, mild or moderate regurgitation in 15, 10 and 2 patients, respectively. CONCLUSIONS: Although MVR in acute native MV infective endocarditis is a complex procedure, it offers a treatment option for such patients with acceptable short-term results. Limited resection in addition to annuloplasty is our preferred method of repair. Nevertheless, long-term results in a larger cohort are still mandatory.