American Association for Thoracic Surgery
International Society of Heart Transplantation
Article: Comparison of Early Clinical Outcomes Following Transcatheter Aortic Valve Implantation versus Surgical Aortic Valve Replacement versus Optimal Medical Therapy in Patients Older than 80 Years with Symptomatic Severe Aortic Stenosis.Eui Im, Myeong-Ki Hong, Young-Guk Ko, Dong-Ho Shin, Jung-Sun Kim, Byeong-Keuk Kim, Donghoon Choi, Chi Young Shim, Hyuk-Jae Chang, Jae-Kwang Shim, Young-Lan Kwak, Sak Lee, Byung-Chul Chang, Yangsoo Jang[show abstract] [hide abstract]
ABSTRACT: Purpose: Transcatheter aortic valve implantation (TAVI) has become an attractive therapeutic strategy for severe aortic stenosis (AS) in elderly patients due to its minimally-invasive nature. Therefore, early results of its clinical outcomes in elderly Korean patients were evaluated. Materials and Methods: We compared early clinical outcomes of TAVI, surgical aortic valve replacement (SAVR), and optimal medical therapy (OMT) in patients aged ≥80 years with symptomatic severe AS. Treatment groups were allocated as follows: TAVI (n=10), SAVR (n=14), and OMT (n=42). Results: Baseline clinical characteristics including predicted operative mortality were similar among the three groups. However, patients with New York Heart Association functional class III or IV symptoms and smaller aortic valve area were treated with TAVI or SAVR rather than OMT. In-hospital combined safety endpoints (all-cause mortality, major stroke, peri-procedural myocardial infarction, life-threatening bleeding, major vascular complication, and acute kidney injury) after TAVI or SAVR were significantly lower in the TAVI group than in the SAVR group (10.0% vs. 71.4%, respectively, p=0.005), along with an acceptable rate of symptom improvement and device success. During the follow-up period, the TAVI group showed the lowest rate of 3-month major adverse cardiovascular and cerebrovascular events, a composite of all-cause mortality, myocardial infarction, major stroke, and re-hospitalization (TAVI 0.0% vs. SAVR 50.0% vs. OMT 42.9%, p=0.017). Conclusion: Treatment with TAVI was associated with lower event rates compared to SAVR or OMT. Therefore, TAVI may be considered as the first therapeutic strategy in selected patients aged ≥80 years with symptomatic severe AS.Yonsei medical journal 05/2013; 54(3):596-602. · 0.77 Impact Factor
Article: The Incidence and Clinical Outcome of Constrictive Physiology after Coronary Artery Bypass Graft Surgery.Eui Im, Chi Young Shim, Geu-Ru Hong, Kyung-Jong Yoo, Young-Nam Youn, Byung-Chul Chang, Yangsoo Jang, Namsik Chung, Jong-Won HaJournal of the American College of Cardiology 03/2013; · 14.16 Impact Factor
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ABSTRACT: The study aim was to identify adequate therapeutic ranges of the International Normalized Ratio (INR) in Korean patients receiving warfarin after prosthetic mechanical heart valve replacement. Retrospective chart reviews were conducted of 818 patients for a total follow up period of 8,100 patient-years; all details of major complication events of thromboembolism and bleeding were recorded. The INR-incidence of complication curve was plotted, and an adequate INR determined from the intersections of 95% confidence interval (CI) curves of complication rates to ensure the lowest incidences of both thromboembolic and bleeding complications. An analysis of a subgroup of patients with atrial fibrillation (AF) was performed to evaluate the complication occurrence. A total of 69 complications occurred, of which 36 were thromboembolic events and 33 were bleeding. The adequate ranges of INR were determined as: 2.0-2.5 for patients with aortic or mitral valve replacement; 2.1-2.6 for those with aortic plus mitral valve replacement; and 2.3-2.8 for those with tricuspid valve replacement with or without other valves. It has been shown that, by keeping the INR levels within these therapeutic ranges, complication risks could be significantly reduced by up to 51%. The overall incidence of complications was increased if the patients had AF (hazards risk (HR) = 1.27, 95% CI = 1.05-1.52). The study results may provide evidence for the application of low-intensity warfarin therapies in Asian patients, including Koreans. In addition, the method of determining adequate INR levels by using INR-incidence of complications curves might be employed in many clinical settings.The Journal of heart valve disease 01/2013; 22(1):102-9. · 0.81 Impact Factor
Article: The first korean patient with severe aortic stenosis and bilateral iliofemoral artery disease treated with transcatheter aortic valve implantation by transsubclavian approach.Seung-Jun Lee, Young-Guk Ko, Ji-Young Shim, Sak Lee, Byung-Chul Chang, Jae-Kwang Shim, Young-Ran Kwak, Myeong-Ki Hong[show abstract] [hide abstract]
ABSTRACT: Transcatheter aortic valve implantation (TAVI) is indicated as an alternative treatment modality to surgical aortic valve replacement for high risk patients. The standard retrograde approach through the femoral artery is not feasible in the case of unfavorable iliofemoral anatomy or severe peripheral arterial disease (PAD). However, patients with aortic stenosis (AS) have a higher prevalence of for PAD because both diseases are consequences of atherosclerotic degenerative changes. Transsubclavian, transapical, and direct access to the ascending aorta by thoracotomy are alternative routes for the TAVI procedure. In this report, we present the first Korean patient with symptomatic severe AS and bilateral iliofemoral artery disease who was successfully treated with TAVI using a CoreValve (Medtronic, Minneapolis, MN, USA) by transsubclavian approach.Korean Circulation Journal 11/2012; 42(11):796-9.
Article: The First Case of Successful Transcatheter Aortic Valve Implantation Using CoreValve in Korea.In-Soo Kim, Young-Guk Ko, Sanghoon Shin, Ji-Young Shim, Sak Lee, Byung-Chul Chang, Jae-Kwang Shim, Young-Ran Kwak, Myeong-Ki Hong[show abstract] [hide abstract]
ABSTRACT: Surgical replacement of the aortic valve is the standard therapy for severe aortic valve stenosis. However, it is generally associated with increased mortality and morbidities in older individuals. Transcatheter aortic valve implantation (TAVI) is a less invasive procedure and has shown similar clinical outcomes as surgical treatment in elderly patients at high risk for conventional surgery. In this report, we describe the first case of TAVI using a CoreValve in Korea. An 84-year-old man with symptomatic severe aortic valve stenosis was successfully treated by transfemoral TAVI. The patient was discharged without any significant complications and remained free of adverse clinical event for a follow-up duration of 6 months.Korean Circulation Journal 11/2012; 42(11):788-91.