| 1. |
- Novén, Johan, et al.
(författare)
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Exercise Echocardiography following Septal Myectomy for Hypertrophic Obstructive Cardiomyopathy
- 2022
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Ingår i: The Thoracic and Cardiovascular Surgeon. - : Georg Thieme Verlag KG. - 0171-6425 .- 1439-1902. ; 70:1, s. 18-25
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To investigate outcome after septal myectomy and to evaluate long-term hemodynamics with exercise echocardiography. Methods This study included 40 consecutive patients operated with septal myectomy for hypertrophic obstructive cardiomyopathy from January 1998 to August 2017 at Skane University Hospital, Lund, Sweden. Perioperative clinical data and echocardiography measurements were reviewed retrospectively. Patients (n = 36) who were alive and living in Sweden were invited for exercise echocardiography to evaluate exercise capacity and hemodynamics, of whom 19 patients performed exercise echocardiography. Results Overall survival was 100% at 1 year and 96% at 5 years following surgery. Preoperative median resting peak LVOT (left ventricular outflow tract) gradient was 80 mm Hg. Septum thickness was reduced from 22 ± 4 mm preoperatively to 16 ± 3 mm postoperatively (p < 0.001). During exercise echocardiography, the peak LVOT gradient was 8 mm Hg at rest, and increased to 13 mm Hg during exercise echocardiography (p = 0.002). None of the patients had dynamic LVOT obstruction during exercise echocardiography, and there was no clinically significant systolic anterior motion or severe mitral insufficiency during exercise. Conclusions Long-term survival following septal myectomy is very good. At long-term follow-up, LVOT gradients were low and exercise echocardiography demonstrated good hemodynamics.
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| 2. |
- Guné, Henrik, et al.
(författare)
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Impact of ABO blood group on bleeding complications after surgery for acute type A aortic dissection
- 2021
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Ingår i: Blood Coagulation and Fibrinolysis. - 1473-5733. ; 32:4, s. 253-258
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Tidskriftsartikel (refereegranskat)abstract
- Excessive bleeding is a serious complication associated with impaired survival after surgery for acute type A aortic dissection (ATAAD). Different ABO blood groups are associated with variable levels of circulating von Willebrand factor and therefore potentially altered risks of surgical haemorrhage. The current study aimed to assess the impact of blood group on bleeding complications after ATAAD surgery. This was a retrospective cohort study including 336 patients surgically treated for ATAAD between January 2004 and January 2019. Patients with blood group O were compared with non-O patients. In total, 152 blood group O patients were compared with 184 non-O patients. There were no differences in rates of massive bleeding (27.0 vs. 25.5%, P = 0.767) or re-exploration for bleeding (16.4 vs. 13.0%, P = 0.379) in blood group O and non-O patients, respectively. Median chest tube output 12 h after surgery was 520 ml (350-815 ml) in blood group O and 490 ml (278-703 ml) in non-O patients (P = 0.229). Blood group O patients received more fibrinogen concentrate (6.1 ± 4.0 vs. 4.9 ± 3.3 g, P = 0.023) but administered units of packed red blood cells [5 (2-8) vs. 4 (2-9) U, P = 0.736], platelets [4 (2-4) vs. 3 (2-5) U, P = 0.521] or plasma [4 (1-7) vs. 4 (0-7) U, P = 0.562] were similar. This study could not demonstrate any association between blood group and bleeding after surgery for ATAAD. It cannot be ruled out that potential differences were levelled out by blood group O patients receiving significantly more fibrinogen concentrate.
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| 3. |
- Johansson, Malin, et al.
(författare)
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Late survival and heart failure after transcatheter aortic valve implantation.
- 2016
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Ingår i: Asian cardiovascular & thoracic annals. - : SAGE Publications. - 1816-5370 .- 0218-4923. ; 24:4, s. 318-325
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Tidskriftsartikel (refereegranskat)abstract
- Short-term survival in patients undergoing transcatheter aortic valve implantation is favorable. Our aim was to evaluate late survival and composite clinical endpoints specified by the Valve Academic Research Consortium-2, including rehospitalization for congestive heart failure.
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| 4. |
- Kaartama, Tuukka, et al.
(författare)
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Difference in Outcome Following Surgery for Native Aortic and Mitral Valve Infective Endocarditis
- 2019
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Ingår i: The Thoracic and Cardiovascular Surgeon. - : Georg Thieme Verlag KG. - 0171-6425 .- 1439-1902. ; 67:8, s. 652-658
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: We investigated differences in clinical presentation, microbiology, and short- and long-term results according to the affected valve in patients who underwent surgery for left-sided native valve infective endocarditis (IE).METHODS: This was a single-center retrospective study of 117 patients with isolated mitral valve IE (group M) and 140 patients with isolated aortic valve IE (group A) who underwent surgery between 1998 and 2015.RESULTS: The mean age of patients in group M was 62 ± 14 years, whereas in group A the patients were 56 ± 14 years old (p = 0.001). There were 61 females (52% of patients) in group M and 31 females (22% of patients) in group A (p < 0.001). Abscesses were more common in group A than in group B. Staphylococcus aureus was more frequent in group M (47%, n = 55) than in group A (21%, n = 30; p < 0.001). The length of time from symptom onset to surgery was longer in group A than in group M, but the time from diagnosis to surgery was shorter in group A than in group M. Ninety-day mortality was similar in group M and group A in patients operated within 48 hours after diagnosis, but in patients who were operated more than 48 hours after diagnosis the 90-day mortality was 15% in group M and 3% in group A (p = 0.006).CONCLUSION: There were considerable differences in preoperative characteristics, microbiology, timing of surgery, and outcomes between patients who underwent surgery for isolated aortic valve IE and those who were operated for isolated mitral valve IE.
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| 5. |
- Larsson, Mårten, et al.
(författare)
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The effect of postoperative anticoagulation on false lumen patency after surgery for acute type A aortic dissection
- 2021
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Ingår i: Journal of Cardiothoracic Surgery. - : Springer Science and Business Media LLC. - 1749-8090. ; 16:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Patent false lumen has been shown to have a negative impact on prognosis after surgery for acute type A aortic dissection (ATAAD). We aimed to assess the effect of postoperative anticoagulation on false lumen patency and clinical outcomes in relation to false lumen status. Methods: Postoperative computed tomographies of 156 patients undergoing ATAAD DeBakey type I surgery were retrospectively evaluated for false lumen patency. The patients were divided into groups determined by anticoagulation treatment at discharge. Uni- and multivariable logistic regression was used for analysing the effect of anticoagulation on the false lumen, and Kaplan–Meier estimates were used to assess the association of a patent false lumen with the incidence of reoperation and long-term survival. Results: A patent false lumen was present in 81% of the patients. Postoperative anticoagulants were not associated with a patent false lumen (p = 0.48) in univariable analysis. In multivariable analysis, both hemiarch replacement (OR 0.15, CI95% 0.05–0.49, p = 0.001) and the use of betablockers had a protective effect (OR 0.29, CI95% 0.10–0.85, p = 0.023). The Kaplan–Meier estimates for survival and the composite endpoint of survival and freedom from distal reintervention indicated no difference in outcome between patients in regard to anticoagulation treatment (survival p = 0.43, composite p = 0.82) or false lumen status (survival p = 0.21, composite p = 0.09). Conclusion: This study could not show negative effects from the postoperative use of anticoagulants on false lumen status, nor that false lumen patency was associated with poorer prognosis. A hemiarch procedure was shown to be associated with reduced risk of false lumen patency.
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| 6. |
- Nozohoor, Shahab, et al.
(författare)
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ABO blood group does not impact incidence or outcomes of surgery for acute type A aortic dissection
- 2020
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Ingår i: Scandinavian Cardiovascular Journal. - : Taylor & Francis. - 1401-7431 .- 1651-2006. ; 54:2, s. 124-129
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To evaluate the distribution and impact of ABO blood groups on postoperative outcomes in patients undergoing surgery for acute type A aortic dissection (ATAAD).Design: A total of 1144 surgical ATAAD patients from eight Nordic centres constituting the Nordic consortium for acute type A aortic dissection (NORCAAD) were analysed. Blood group O patients were compared to non-O subjects. The relative frequency of blood groups was assessed with t-distribution, modified for weighted proportions. Multivariable logistic regression was performed to identify independent predictors of 30-day mortality. Cox regression analyses were performed for assessing independent predictors of late mortality.Results: There was no significant difference in the proportions of blood group O between the study populations in the NORCAAD registry and the background population (40.6 (95% CI 37.7-43.4)% vs 39.0 (95% CI 39.0-39.0)%). ABO blood group was not associated with any significant change in risk of 30-day or late mortality, with the exception of blood group A being an independent predictor of late mortality. Prevalence of postoperative complications was similar between the ABO blood groups.Conclusions: In this large cohort of Nordic ATAAD patients, there were no associations between ABO blood group and surgical incidence or outcomes, including postoperative complications and survival.
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| 7. |
- Ragnarsson, Sigurdur, et al.
(författare)
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Assessment of Mitral Valve Repair With Exercise Echocardiography : Artificial Chordae vs Leaflet Resection
- 2017
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Ingår i: Seminars in Thoracic and Cardiovascular Surgery. - : Elsevier BV. - 1043-0679. ; 29:1, s. 25-32
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Tidskriftsartikel (refereegranskat)abstract
- Abstract: Mitral valve (MV) repair with artificial chordae (AC) or leaflet resection (LR) is associated with good hemodynamics at rest. The aim of this study was to compare these techniques in terms of exercise capacity and echocardiographic parameters of hemodynamics at rest and peak exercise. We conducted a study in 2015 of 56 patients, who had undergone surgery for degenerative posterior mitral leaflet prolapse between 2005 and 2014 using either AC (n = 24) or LR (n = 32). Clinical data were collected, exercise capacity was measured, and resting echocardiography and peak exercise echocardiography were performed. No significant differences were detected among groups regarding exercise duration or peak exercise workload measured in Watts (W) (AC: 136 ± 43 W and LR: 131 ± 40 W; P = 0.65). The mean mitral gradient at rest was 3.0 ± 1.3 mm Hg in the AC group and 3.0 ± 1.0 mm Hg in the LR group (P = 0.90). The mean MV gradients at peak exercise did not differ significantly between groups (AC: 8.3 ± 3.4 and LR: 11.3 ± 8.7; P = 0.19). Four patients (17%) in the AC group and 1 (3%) in the LR group had systolic anterior motion, P = 0.15. We conclude that both methods of posterior MV leaflet repair were associated with good hemodynamics at rest and peak exercise. The groups had comparable exercise capacity. MV pressure gradients at rest and peak exercise were similar in both groups.
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| 8. |
- Ragnarsson, Sigurdur, et al.
(författare)
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Clinical Presentation of Native Mitral Valve Infective Endocarditis Determines Long-Term Outcome after Surgery.
- 2015
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Ingår i: Journal of Cardiac Surgery. - : Hindawi Limited. - 1540-8191 .- 0886-0440. ; 30:9, s. 669-676
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Tidskriftsartikel (refereegranskat)abstract
- Surgery is performed in up to half of all cases of active infective endocarditis (IE) but the associated mortality remains high. The aim was to examine the effect of the preoperative clinical presentation on long-term survival of patients undergoing surgery for isolated native mitral valve infective endocarditis.
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| 9. |
- Ragnarsson, Sigurdur, et al.
(författare)
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Late right ventricular performance after mitral valve repair assessed by exercise echocardiography
- 2018
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Ingår i: General Thoracic and Cardiovascular Surgery. - : Springer Science and Business Media LLC. - 1863-6705 .- 1863-6713. ; 66:7, s. 398-404
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The aim of the study was to evaluate the right ventricular (RV) performance during exercise in patients who underwent mitral valve repair for chronic mitral valve insufficiency relative to healthy individuals and to assess exercise capacity using a semisupine ergometer. Methods: We studied 56 patients who underwent mitral valve repair for degenerative posterior mitral leaflet prolapse between 2005 and 2014 and a control group of 13 healthy individuals. Clinical data were collected prospectively, and echocardiographic measurements of RV function were obtained at rest and at peak exercise. Results: One-third of the study patients had RV systolic dysfunction as indicated by tricuspid annular plane excursion (TAPSE) at rest. Resting TAPSE was lower in the study group (16.7 ± 3.3 mm) than in the control group (24.4 ± 4.3 mm), p < 0.001. TAPSE increased in both groups during exercise and exercise was shown to have a significant main effect on TAPSE F(1, 52) = 80, p < 0.001. TAPSE increased more in the control group and an interaction was detected between the participant groups (study group vs. control group) and exercise, F(1, 52) = 24, p < 0.001. In the study group, Poor postoperative RV function was associated with preoperative left ventricular dilatation but was not correlated with impaired maximum exercise capacity. Conclusions: Despite the excellent clinical outcome during rest and exercise after mitral valve repair, our results suggest patients that have undergone mitral valve repair due to posterior leaflet prolapse have significantly reduced RV function at rest and during exercise compared to healthy controls at long-term follow-up, as measured by TAPSE.
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| 10. |
- Ragnarsson, Sigurdur, et al.
(författare)
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Pacemaker implantation following tricuspid valve annuloplasty.
- 2023
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Ingår i: JTCVS open. - 2666-2736. ; 16, s. 276-289
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Tidskriftsartikel (refereegranskat)abstract
- Tricuspid annuloplasty is associated with increased risk of atrioventricular block and subsequent implantation of a permanent pacemaker. However, the exact incidence of permanent pacemaker, associated risk factors, and outcomes in this frame remain debated. The aim of the study was to report permanent pacemaker incidence, risk factors, and outcomes after tricuspid annuloplasty from nationwide databases.By using data from multiple Swedish mandatory national registries, all patients (n = 1502) who underwent tricuspid annuloplasty in Sweden from 2006 to 2020 were identified. Patients who needed permanent pacemaker within 30 days from surgery were compared with those who did not. The cumulative incidence of permanent pacemaker implantation was estimated. A multivariable logistic regression model was fit to identify risk factors of 30-day permanent pacemaker implantation. The association between permanent pacemaker implantation and long-term survival was evaluated with multivariable Cox regression.The 30-day permanent pacemaker rate was 14.2% (214/1502). Patients with permanent pacemakers were older (69.8 ± 10.3 years vs 67.5 ± 12.4 years, P = .012). Independent risk factors of permanent pacemaker implantation were concomitant mitral valve surgery (odds ratio, 2.07; 95% CI, 1.34-3.27), ablation surgery (odds ratio, 1.59; 95% CI, 1.12-2.23), and surgery performed in a low-volume center (odds ratio, 1.85; 95% CI, 1.17-2.83). Permanent pacemaker implantation was not associated with increased long-term mortality risk (adjusted hazard ratio, 0.74; 95% CI, 0.53-1.03).This nationwide study demonstrated a high risk of permanent pacemaker implantation within 30 days of tricuspid annuloplasty. However, patients who needed a permanent pacemaker did not have worse long-term survival, and the cumulative incidence of heart failure and major adverse cardiovascular events was similar to patients who did not receive a permanent pacemaker.
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