Showing papers by "Stuart J. Head published in 2010"

Long term follow up after surgery in congenitally corrected transposition of the great arteries with a right ventricle in the systemic circulation

Abstract: Aim of the study: To investigate the long-term outcome of surgical treatment for congenitally corrected transposition of the great arteries (CCTGA), in patients with biventricular repair with the right ventricle as systemic ventricle. Methods: A total of 32 patients with CCTGA were operated between January 1972 and October 2008. These operations comprised 18 patients with a repair with a normal left ventricular outflow tract, 11 patients with a Rastelli repair of the left ventricle to the pulmonary artery and 3 patients with a cardiac transplantation. Results: Excluding the cardiac transplantation patients, mean age at operation was 16 years (sd 15 years, range 1 week - 49 years). Median follow-up was 12 years (sd 10 years, range 7 days - 32 years). Survival obtained from Kaplan-Meier analysis at 20 years after surgery was 63% (CI 53-73%). For the non-Rastelli group these data at 20 years were 62% (CI 48-76%) and for the Rastelli group 67% (CI 51-83%). Freedom of reoperation at 20 years was 32% (CI 19-45%) in the overall group. In the non-Rastelli group the data at 20 years were 47% (CI 11-83%) and for the Rastelli group 21% (CI 0-54%) after almost 19 years. Conclusions: Long term follow up confirms that surgery in CCTGA with the right ventricle as systemic ventricle has a suboptimal survival and limited freedom of reoperation. Death occurred mostly as a result of cardiac failure.

Transcatheter aortic valve implantation after PARTNER: what is up next?

Abstract: Recently, the results of the Placement of Aortic Transcatheter Valves (PARTNER) trial were published in the New England Journal of Medicine. A group of high-risk patients with severe aortic stenosis (AS) deemed non-surgical candidates were randomised to either transcatheter aortic valve implantation (TAVI) or standard medical therapy including balloon aortic valvuloplasty (BAV). The authors need to be congratulated on their excellent results. The one-year results showed a reduced rate of death to 30.7% in the TAVI group, compared to 50.7% in the standard therapy group. Safety assessment was however less in favour of the percutaneous technique, as 6.7% suffered a stroke or TIA 30 days within randomisation, compared to only 1.7% in the standard therapy patients (p=0.03). After one year, this difference was still significant (10.6% vs 4.5%, p=0.04). Despite this increased incidence of thromboembolic events, the authors conclude that TAVI is the new golden standard for patients with severe AS who are too sick for surgery. However, in the spring of 2011, the trial will provide the long anticipated answers to whether randomisation to TAVI is superior to surgical aortic valve replacement (AVR) in patients categorised as surgical candidates. Since its introduction in 2002, TAVI has been used to treat highrisk or inoperable patients. In the PARTNER study as well, only high-risk patients were included having in the TAVI and standard therapy groups a mean Logistic EuroSCORE (LES) of 26.4% and 30.4%, respectively, and the Society of Thoracic Surgery (STS) predicted risk of mortality scores of 11.2% and 12.1%, respectively. Other published data have also shown these high surgical risks in TAVI treated patients. Bern and Rotterdam gathered data on 1,122 patients who underwent TAVI or AVR. In this cohort, the mean LES of patients treated with TAVI (n=114) or AVR (n=1,008) was 20.1%±13.4% and 9.1%±10.2%, respectively. Hence, the The Surgeon’s Corner