Paravalvular regurgitation after conventional aortic and mitral valve replacement: A benchmark for alternative approaches Brett F. Duncan, MD, Patrick.

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Presentation transcript:

Paravalvular regurgitation after conventional aortic and mitral valve replacement: A benchmark for alternative approaches Brett F. Duncan, MD, Patrick M. McCarthy, MD, Jane Kruse, RN, BSN, Adin-Cristian Andrei, PhD, Zhi Li, MS, Hyde M. Russell, MD, Travis O. Abicht, MD, Vera H. Rigolin, MD, James D. Thomas, MD, Charles J. Davidson, MD, Robert O. Bonow, MD, S. Chris Malaisrie, MD The Journal of Thoracic and Cardiovascular Surgery Volume 150, Issue 4, Pages 860-868.e1 (October 2015) DOI: 10.1016/j.jtcvs.2015.06.047 Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 PVR incidence and reinterventions. PVR incidence by severity at discharge and in follow-up including and excluding endocarditis for AVR (A), MVR (B), and AVR + MVR (C) cohorts. Reinterventions include second crossclamp for repair during index operation or reoperation in follow-up. Incidence of PVR 1+ or 2+ or greater was not significantly different between groups at any time point. Significant differences in intraoperative PVR (P = .009), second crossclamp for repair (P = .003), and reoperation for PVR in follow-up (AVR vs MVR, P = .032). AVR, Aortic valve replacement; MVR, mitral valve replacement; PVR, paravalvular regurgitation; SBE, subacute bacterial endocarditis. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 860-868.e1DOI: (10.1016/j.jtcvs.2015.06.047) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 PVR in valve replacement surgery. Incidence of PVR at discharge and in follow-up including and excluding subacute bacterial endocarditis. Overall incidence of mild to severe PVR (≥1+) during follow-up was 2.2%, 2.9%, and 2.9% for AVR, MVR, and AVR + MVR cases, respectively. Clinically significant moderate or greater PVR (≥2+) occurred in 0.9% of patients after AVR, 2.2% of patients after MVR, and 0% of patients after AVR + MVR, and in only 0.5% of AVR and 0.4% of MVR cases after excluding subacute bacterial endocarditis. AVR, Aortic valve replacement; MVR, mitral valve replacement; SBE, subacute bacterial endocarditis. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 860-868.e1DOI: (10.1016/j.jtcvs.2015.06.047) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Kaplan–Meier survival estimates. Kaplan–Meier estimates of medium-term overall survival stratified by presence of trivial of greater PVR at discharge in patients undergoing AVR (A) and MVR (B) and by mild or greater PVR in follow-up in patients undergoing AVR (C) and MVR (D). AVR, Aortic valve replacement; FU, follow-up; MVR, mitral valve replacement; PVR, paravalvular regurgitation. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 860-868.e1DOI: (10.1016/j.jtcvs.2015.06.047) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions

PVR in valve replacement surgery PVR in valve replacement surgery. Incidence of PVR at discharge and in follow-up including and excluding subacute bacterial endocarditis. The Journal of Thoracic and Cardiovascular Surgery 2015 150, 860-868.e1DOI: (10.1016/j.jtcvs.2015.06.047) Copyright © 2015 The American Association for Thoracic Surgery Terms and Conditions