Victor Bautista-Hernandez

Background and aim of the study: Minimally invasive approaches for aortic valve replacement (AVR) are clinically beneficial for patients but are more technically demanding for surgeons. Sutureless AVR is a new and minimally invasive approach. The study aim was to evaluate initial AVR outcomes in patients aged >75 years after setting up a sutureless minimally invasive surgery program. Methods: Between January 2014 and December 2015, a total of 108 patients aged >75 years with indication of isolated elective AVR received a sutureless bioprosthesis using the minimally invasive approach (sutureless group). The latter group was compared with a second group of patients (n = 115) who received a stented valve through a full median sternotomy (stented group) at the authors’ institution between January 2012 and December 2013. After propensity score matching, 95 pairs of patients were available for analysis. Results: Preoperative demographic variables were similar between the matched groups. The aortic cross-clamp (ACC) and cardiopulmonary bypass (CPB) times were each shorter in the sutureless group (p <0.01). Perioperative mortality was 1% in the stented group, but no mortality occurred in the sutureless group (p = 0.32). Early postoperative extubation, intensive care unit and hospital stays, need for transfusion, and overall hospital stay were lower in the sutureless group. Frequency of pacemaker implantation was higher in the sutureless group than in the stented group (8.3% versus 1.9%; p = 0.05). Aortic transvalvular gradients were lower in the sutureless group (p = 0.01). Conclusion: In the authors’ experience, the sutureless aortic valve was a useful tool for establishing a minimally invasive AVR program. The technique was safe, and the shorter ACC and CPB times increased the likelihood of early extubation, reduced the need for blood transfusions, and demonstrated good hemodynamic performance. Patients who underwent sutureless AVR showed an increased need for pacemaker implantation.

The impact of age-associated disorders is increasing as the life expectancy of the population increments. Cardiovascular diseases and neurodegenerative disorders, such as Parkinson’s disease, have the highest social and economic burden and increasing evidence show interrelations between them. Particularly, dysfunction of the cardiovascular nervous system is part of the dysautonomic symptoms of Parkinson’s disease, although more studies are needed to elucidate the role of cardiac function on it. We analyzed the dopaminergic system in the nigrostriatal pathway of Parkinsonian and dyskinetic monkeys and the expression of some key proteins in the metabolism and synthesis of catecholamines in the heart: total and phosphorylated (phospho) tyrosine hydroxylase (TH), and membrane (MB) and soluble (S) isoforms of catechol-O-methyl transferase (COMT). The dopaminergic system was significantly depleted in all MPTP-intoxicated monkeys. MPTP- and MPTP + L-DOPA-treated animals also showed a decrease in total TH expression in both right (RV) and left ventricle (LV). We found a significant increase of phospho-TH in both groups (MPTP and MPTP + L-DOPA) in the LV, while this increase was only observed in MPTP-treated monkeys in the RV. MB-COMT analysis showed a very significant increase of this isoform in the LV of MPTP- and MPTP + L-DOPA-treated animals, with no significant differences in S-COMT levels. These data suggest that MB-COMT is the main isoform implicated in the cardiac noradrenergic changes observed after MPTP treatment, suggesting an increase in noradrenaline (NA) metabolism. Moreover, the increase of TH activity indicates that cardiac noradrenergic neurons still respond despite MPTP treatment.

Introduction Rapid deployment aortic valve replacement has been recently introduced in clinical practice. Different studies have reported a significant reduction in surgical times with excellent hemodynamic profiles and short-term results. However, an increase in permanent pacemaker requirements compared with conventional aortic valve replacement has been described. Nevertheless, risk factors for postoperative pacemaker implantation are not well known. The aim of this study is to report our early outcomes with rapid deployment aortic valve replacement within the RADAR Registry, especially focusing on risk factors for postoperative pacemaker implantation. Methods Between April 2012 and January 2016, 164 patients undergoing isolated or combined aortic valve replacement with Edwards INTUITY Elite (Edwards Lifesciences, Irvine, CA, USA) were included in the RADAR Registry. Pre-, intra- and postoperative clinical data results and complications were recorded, especially focusing on risk factors for the development of postoperative complete or high-grade AV block requiring pacemaker implantation. Patients were followed up for up to 1 year with evaluation of clinical and echocardiographic outcomes. Results A total of 164 consecutive patients were included in this study, where 128 patients (78.05%) had an isolated aortic valve replacement (group 1) and 36 (21.95%) a concomitant procedure (group 2). The surgical approach was ministernotomy in 61 patients (37.20%) and median sternotomy in 100 patients (60.98%). Complications with valve implantation were observed in three patients. Postoperative complete or high-degree AV block requiring a permanent pacemaker implantation developed in ten patients (6.9%). Seven patients died in-hospital (4.27%). No significant differences between groups were found in terms of stroke, postoperative infection, mortality, atrial fibrillation and postoperative atrioventricular block. Seven patients presented acute renal impairment (5.51%) in group 1 versus seven patients (20%) in group 2 (p = 0.007). In multivariate analysis, low weight and preoperative arrhythmia (atrial fibrillation, bifascicular block, left bundle branch block) emerged as risk factors for postoperative AV block requiring a pacer. In median follow-up of 1 year, seven (4.27%) patients died, and no cases of structural valve deterioration or endocarditis were observed. Significant patient-prosthesis mismatch was found in seven (4.27%) patients. Conclusion Initial experience with rapid deployment aortic valve replacement in the RADAR Registry demonstrates low rates of implantation complications and good perioperative and 1-year clinical and echocardiographic outcomes. Incidence of postoperative AV block requiring a pacer correlated with low weight and preoperative arrythmias (atrial fibrillation, bifascicular block and left bundle branch block). Avoidance of oversizing and careful consideration of implantation of this technology in patients with pre-existing arrythmias could minimize the risk for postoperative pacemaker implantation.

Background: The durability of bioprostheses in the pulmonary position in patients with congenital heart disease remains suboptimal. The new INSPIRIS Resilia aortic valve is characterized by a pericardial tissue that could improve hemodynamic performance and durability. We report initial experience with this valve in the pulmonary position in children and young patients. Methods: A retrospective study was performed. Demographic, clinical, and echocardiographic data were recorded at hospital stay and through follow-up. Results: Between June 2017 and October 2019, 21 patients (14 males) underwent implantation of an INSPIRIS Resilia bioprosthesis. The most common diagnosis was repaired tetralogy of Fallot (n = 14). Mean age was 31 ± 16.6 years. Seven patients were children (the youngest 4 years old). One patient with tetralogy of Fallot and preoperative right ventricular failure died after surgery from multiorgan failure. No patient had a permanent pacemaker after surgery or other major complications. Early echocardiograms depicted a mean peak gradient across the valve of 17 ± 7.23 mm Hg, with no paravalvular leaks. At a median follow-up of 20 months (range 1–29 months), all discharged patients were alive without clinical complications. Most recent echocardiograms show good gradients with no paravalvular leaks. Conclusions: In our experience, the INSPIRIS Resilia aortic valve in the pulmonary position provides excellent in-hospital and short-term results in children and young patients with congenital heart disease. Despite showing here one of the longest follow-ups with this prosthesis, longer investigations are required to assess its durability and the feasibility of valve-in-valve procedures in this challenging population. Abreviations: PVR: pulmonary valve replacement; CHD: congenital heart disease; SVD: structural valve deterioration; AVR, aortic valve replacment; ViV, valve-in-valve; RVOT, right ventricular outflow tract

Objectives: Rapid deployment aortic valve replacement has been recently introduced in clinical practice. Different studies have reported a significant reduction in surgical times with excellent hemodynamic profile and short-term results. However, an increase in permanent pacemaker requirements when compared with conventional aortic valve replacement has been described. Nevertheless, risk factors for postoperative pacemaker implantation are not well known. Methods: Between April 2012 and January 2016, a total of 164 patients undergoing isolated or combined aortic valve replacement with a rapid deployment valve were included in the RADAR Registry. Pre-, intra-, and postoperative clinical data results and complications were recorded, especially focusing on risk factors for the development of postoperative complete or high-grade AV block requiring pacemaker implantation. Patients were followed-up for up to 1 year. Result: A total of 164 consecutive patients were included in this study, where 128 patients (78.05%) had an isolated aortic valve replacement (group 1) and 36 (21.95%) a concomitant procedure (group 2). Surgical approach was ministernotomy in 61 patients (37.20%) and median sternotomy in 100 patients (60.98%). Complications with valve implantation were observed in 3 patients. Postoperative complete or high-degree AV block requiring a permanent pacemaker implantation developed in 6.9%. 7 patients died in-hospital (4.27%). No significant differences between groups were found in terms of stroke, postoperative infection, mortality, atrial fibrillation and postoperative atrioventricular block. 7 patients presented acute renal impairment (5.51%) in group 1 vs. 7 patients (20%) in group 2 (p = 0.007). In multivariate analysis, low weight, preoperative arrhythmias (atrial fibrillation, bifascicular block, and left bundle branch block) emerged as risk factors for postoperative AV block requiring a pacer. For a median follow-up for 1 year, 7 (4.27%) patients died, no cases or structural valve deterioration or endocarditis were observed. Conclusion: Initial experience with rapid deployment aortic valve replacement demonstrates low rates of implantation complications, good perioperative and 1 year outcomes. Incidence of postoperative AV block requiring a pacer correlated with low weight and preoperative arrhythmias. Avoidance of oversizing and careful consideration of implantation of this technology in patients with preexisting arrhythmias could minimize the risk for postoperative pacemaker implantation. Publication Date: 19 February 2021 (online) © 2021. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Background: Autonomic dysfunction is a well‐known dominant symptom in the advanced stages of Parkinson's disease. However, the role of cardiac sympathetic nerves still needs to be elucidated.Objectives: To evaluate cardiac sympathetic response in Parkinsonian and dyskinetic monkeys.Methods: Adult male monkeys were divided into 1 of the following 3 groups: controls, 1‐methyl‐4‐phenyl‐1,2,3,6‐tetrahydropyridine–treated monkeys, and 1‐methyl‐4‐phenyl‐1,2,3,6‐tetrahydropyridine+levodopa–treated animals. Noradrenaline, its metabolite normetanephrine, and phospho‐Heat shock proten 27 (p‐Hsp27) at serine 82 levels were analyzed in the left and right ventricles of the heart. Tyrosine hydroxylase immunohistochemistry was performed in the ventral mesencephalon.Results: The results were the following: (1) 1‐methyl‐4‐phenyl‐1,2,3,6‐tetrahydropyridine intoxication significantly increased normetanephrine levels and decreased noradrenaline turnover in the right ventricle without changes in the left ventricle; however, (2) levodopa treatment decreased noradrenaline levels and enhanced the normetanephrine/noradrenaline ratio in parallel with a very significant increase of Hsp27 activity in both ventricles.Conclusions: Levodopa treatment could induce protective cardiac effects through the increased Hsp27 activity. © 2019 International Parkinson and Movement Disorder Society