Raynorelgaard2009

Guidelines currently indicate surgical aortic valve replacement (SAVR) to treat severe cases of aortic stenosis (AS), particularly for low- to medium-risk patients. While several studies have compared health outcomes of tissue and mechanical SAVR, this economic simulation model estimates the difference in long-term healthcare costs associated with tissue relative to mechanical SAVR.

The deterministic and Monte Carlo simulation models used literature-based epidemiological and cost inputs to calculate annual expenditures related to SAVR for up to 25 years after initial surgery. A series of three cohort studies across different age groups provided the health outcome probabilities for tissue valve patients. TEN-010 cell line Outcome probabilities for mechanical valve patients were based on relative risks reported in comparative meta-analyses or large cohort studies.

Relative to mechanical SAVR, the expected net discounted savings for a patient receiving tissue SAVR at age 45/55/65 are $12,266/$15,462/$16,008 ($US, 2018) over a 25-year horizon (95% confidence intervals exceed $0). For a 45-year-old tissue SAVR patient, the estimated per patient cost difference (relative to mechanical SAVR) of re-operation over 25 years ($16,201) were offset by expected savings on anti-coagulation monitoring ($26,257) over the same period. In a sensitivity analysis in which mortality risk is assumed equal, significant long-term savings associated with tissue SAVR still accrue in each of the three age cohorts.

Payers, providers and the health system may financially benefit from the use of tissue valves as significant savings were associated with the use of tissue valves relative to mechanical valves for SAVR.

Payers, providers and the health system may financially benefit from the use of tissue valves as significant savings were associated with the use of tissue valves relative to mechanical valves for SAVR.

Minimally invasive aortic valve replacement via anterior right thoracotomy (ART) has shown to be safe and feasible. However, acceptance within the surgical community is low. Rapid deployment aortic valves may be a game-changer due to simplified surgical technique and shorter operative times. Therefore, the combination of advanced surgical techniques like the ART access with rapid deployment aortic valves was assessed within this study.

We retrospectively analyzed all patients undergoing ART with the Edwards Intuity valve system between 2011 and 2018. Patient data were collected prospectively in an ongoing, single center registry. Data analysis regarding valve-outcome was performed according to current guidelines.

165 patients underwent aortic valve replacement via the ART access with the Edwards Intuity valve system (73+/-9 years, 49% female, median EuroSCORE II 1.6 (0.6-10.6)). Median cardiopulmonary bypass time was 114 (61-310)min and median aortic cross clamp time was 80 (45-230)min. 30-day as well as in hospital mortality was 0.6% (n=1). Postoperative neurological events occurred in 3%, resulting in major neurological deficit in one patient. Intermediate and long-term survival was 99%, 98% and 93% after 6 months, 1 year and 3 years respectively.

Implantation of the Edwards Intuity valve system via ART is safe, feasible and reproducible. The overall results of this single center experience are excellent compared to contemporary series of both surgical (SAVR) as well as transcatheter aortic valve replacements (TAVR).

Implantation of the Edwards Intuity valve system via ART is safe, feasible and reproducible. The overall results of this single center experience are excellent compared to contemporary series of both surgical (SAVR) as well as transcatheter aortic valve replacements (TAVR).

Limited surgical options are available for patients with extensive mitral annular calcification. Several reports have shown the feasibility of surgical mitral valve replacement utilizing a transcatheter aortic valve in the mitral position (MVR-TAVR). We review our 30-day and 1-year outcomes utilizing a minimally invasive approach for MVR-TAVR.

Between 2017-2019, 16 patients underwent MVR-TAVR under direct vision. Primary endpoints included overall survival, technical success, and effectiveness. Secondary endpoints included valve and cardiac hemodynamics post-operatively and during follow-up.

The 16 patients (69% females) were from ages 53 to 88 years (average 77±9). Comorbidities on presentation 31% (5/16) were reoperative surgeries, 13% (3/16) had right ventricular dysfunction, 31% (5/16) had severe pulmonary hypertension, and 20% (3/16) had chronic kidney disease. Isolated surgery was performed on 69% (11/16) of patients, with a cross-clamp (58%[7/12]) or on a fibrillating heart (42%[5/12]), while concomitant surgery was performed in 31% (5/16) of patients with a cross-clamp. Upon follow up, the estimated 30-day mortality rate was 12.5% and the 1-year mortality rate was 36.2%. A moderate post-operative paravalvular leak (PVL) was evident immediately in one patient and a severe PVL after 30-day follow-up in another. In addition, one patient had mild LVOTO and another had moderate mitral valve stenosis. At 1-year follow up, there were no changes to the mild PVL and moderate stenosis identified post-surgery.

Mini-thoracotomy MVR-TAVR is an acceptable alternative to conventional and transcatheter MVR in patients with mitral valve disease and extensive mitral annular calcification.

Mini-thoracotomy MVR-TAVR is an acceptable alternative to conventional and transcatheter MVR in patients with mitral valve disease and extensive mitral annular calcification.

This study aimed to investigate the prognosis after segmentectomy as compared to lobectomy for small-sized lung adenocarcinoma with spread through air spaces (STAS).

This retrospective study included 609 patients who underwent lobectomy or segmentectomy with lymph node dissection for clinical stage IA lung adenocarcinoma between April 2011 and March 2020 at the Hiroshima University Hospital. Patient characteristics and prognosis after segmentectomy and lobectomy were investigated.

STAS was detected in 293 (48.1%) patients. The recurrence-free survival (RFS) rate was significantly worse with STAS-positive adenocarcinoma than with STAS-negative adenocarcinoma in both patients who underwent lobectomy (5-year RFS 68.2% vs. 90.2%; P<0.001) and those who underwent segmentectomy (5-year RFS 81.3% vs. 93.0%; P = 0.003). Among the patients with STAS, there was no significant difference in RFS between patients who underwent lobectomy (5-year RFS 68.2%) and those who underwent segmentectomy (5-year RFS 81.3%; P = 0.