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ABSTRACT: The Ross procedure is safe and effective for children with aortic valve disease. Pulmonary homograft degeneration, proposed to be immune-mediated, is a major cause of reoperation. Cyclosporine increased homograft valve survival in animals, but has not been studied in humans. To investigate the efficacy of low-dose cyclosporine in preventing homograft degeneration and complications, a retrospective historical-controlled study was performed on data of all children who underwent Ross procedure and received cyclosporine. The primary endpoint was homograft function at the last follow-up; secondary endpoints were readmission, reoperation, death, and safety. Seventeen patients were matched with 16 controls. At the end of the follow-up period (cyclosporine, 6.7 years; controls, 8 years), homograft stenosis and/or regurgitation were present in half of all patients. Three (18%) patients in the cyclosporine group and 5 (29%) in the control group were readmitted. Surgical intervention due to homograft failure was needed in 1 (6%) cyclosporine patient and 3 (19%) of the controls. Although cyclosporine failed to show a significant difference in signs of homograft degeneration, it might decrease the need for reoperation following the Ross procedure. Larger prospective well-designed studies are required to confirm these findings.
Asian cardiovascular & thoracic annals 12/2010; 18(6):563-8.
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ABSTRACT: Preservation of the subvalvar apparatus during mitral valve replacement (MVR) is associated with improved ventricular function and patient outcome. The Quattro valve is a chordally supported stentless mitral valve bioprosthesis that undergoes anticalcification treatment and is sutured to both annulus and papillary muscles heads, thus preserving annuloventricular continuity. The study aim was to assess the mid-term hemodynamic and functional results following MVR using the Quattro valve.
Between 1998 and 2005, a total of 76 patients received the Quattro valve at the authors' institution. A competing-risks methodology was used to determine the time-related prevalence of four mutually exclusive end-states: death; subsequent valve removal for dysfunction; subsequent valve removal for endocarditis; and survival without valve reoperation. Serial echocardiograms (n = 321) were collected, and regression models adjusted for repeated measures were used to model the longitudinal progression of the prosthesis mitral valve area (MVA), peak gradient (PG), mean gradient (MG), mitral regurgitation (MR) and ejection fraction (EF) over time.
The median patient age was 33 years, and the most common underlying pathology rheumatic fever (46%). Of the patients, 35 (46%) had undergone a prior mitral surgery. A competing-risks analysis showed that, at 10 years after Quattro implantation, 11% of patients had died without subsequent replacement, 57% underwent valve replacement for dysfunction, 7% for endocarditis, and 26% remained alive without reoperation. Overall, 24 valves were explanted (five for endocarditis and 19 for valve malfunction). On multivariable analysis, risk factors for reoperation were prior mitral surgery (p = 0.03), especially prior MVR (p = 0.04). Serial echocardiographic data showed progressive increases in PG and MR, a decrease in MVA, and stable MG and EF.
In a fairly young population, the longevity of the Quattro valve was limited by a high risk of endocarditis and reoperation requirement. In addition to valve degeneration, malfunction without structural change was a frequent cause of prosthesis replacement. This may be due to an unpredictable geometric ventricular adaptation to the prosthesis, with subsequent development of prosthesis insufficiency or subvalvar stenosis. Further evaluation is required to identify the best candidates to receive the Quattro bioprosthesis.
The Journal of heart valve disease 05/2010; 19(3):304-11. · 0.81 Impact Factor
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ABSTRACT: We evaluated the role of the MEF2A as a risk factor for coronary artery disease (CAD) in 1186 subjects with angiographically documented disease compared with 885 CAD-free individuals in the Saudi population. Screening the gene revealed exon 11 as the most polymorphic of all coding regions, harbouring several substitution polymorphisms and insertion/deletions (indels) at a locus containing an 11 CAG trinucleotide chain and a CCGCCGCCA sequence, which introduced frameshifts and premature stop codons at nt146637 and nt146647, nt146780 or nt146783. While these indels were not significantly associated with CAD, a causative relationship was established for rs1059759 G>C [1.21(1.02-1.43); p=0.029], and a borderline one for rs34851361 A>G [1.22(0.9-1.54); p=0.088]. Importantly, a haplotype 1A-2G-3G-4A-5C-6G-7G-8A constructed from the studied SNPs was also associated with CAD [6.39(0.93-43.75); p=0.0052]. These results identify MEF2A gene as a susceptibility gene for CAD.
Atherosclerosis 09/2009; 209(1):152-4. · 3.79 Impact Factor
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ABSTRACT: There is lack of information regarding the long-term behavior of aortic valve reconstruction with pericardium (AoR). A 16-year follow-up is reported here.
Between 1988 and 1995, 92 consecutive patients had AoR with bovine (Group I, n=27) or glutaraldehyde-treated autologous pericardium (Group II, n=65). The mean age was 30 years (range 12-68). There were 65% males, 92% in sinus rhythm, 84% had rheumatic etiology and 36% had 'other valve' surgery. Mitral valve replacement with a mechanical prosthesis is a contraindication to the operation.
Hospital mortality was 2%. The reconstructed aortic valve performed well with excellent hemodynamics. The mean follow-up interval was 10.5+/-4 years, range 9-16 years (longer for group I,12 versus 10 years) with 4% late deaths and seven patients lost to follow-up. Survival rate was 85+/-4%. There were no episodes of thromboembolism. Freedom from reoperation for the whole group was 68+/-5% at 10 years and 47+/-6% at 16 years. For group I, it was 68+/-9% at 10 years and 48+/-10% at 16 years, while for group II it was 72+/-6 and 45+/-8% at 10 and 15 years, respectively. Excluding endocarditis (one in group I and seven in group II) and 'other' reasons for reoperation (two in group I and three in group II), the freedom from structural valve degeneration (SVD) at 10 and 16 years was 78+/-1 and 55+/-10% for group I. For group II, it was 80+/-5% at 10 years and 58+/-9% at 15 years. The mean interval at which the valve degenerated was 8.8 years+/-3.6 and did not differ between the two groups.
AoR is feasible with good hemodynamics, low mortality and thromboembolic rate. Its behavior at 10 years is comparable to that of stentless aortic valve bioprosthesis. It can be performed with either xenopericardium or glutaraldehyde-treated autologous pericardium, but the latter has the advantage of being inexpensive and readily available.
European Journal of Cardio-Thoracic Surgery 09/2005; 28(2):200-5; discussion 205. · 2.55 Impact Factor
