Ploss Valve
2021年9月3日Register here: http://gg.gg/vwd28
*Ploss Valve
*Ploss ValveOur Surgeons
*Ross valve - a leader in water & wastewater control valves. Click below for products and services. Copyright 2016 ross valve mfg co inc.
*A switching valve (ploss) is a three-way valve located between a stethoscope placed over the heart, a blood pressure cuff, and an earpiece. The valve allows the user to eliminate one sound channel and listen only to a patient’s heart or korotkoff (blood pressure) sounds through the other channel. (b) Classification. Class I (general controls).
*After resection of the stenotic aortic valve and debridement of the annulus, the valve was inserted and released. Mean age was 79 years, and mean logistic Euroscore was 13. Subvalvular myectomy was performed in two patients. Prosthetic valve sizes were 19 mm (n = 1), 21 mm (n = 7), 23 mm (n = 6), 25 mm (n = 6), and 27 mm (n = 2).
Switching (Ploss) Valve. Synthetic Cell-Tissue Culture Media & Components. Syringe Holder Adaptor. Target Tangent Screen. Teaching Attachment for an Endoscope. Gan H. Dunnington, MD
Dr. Dunnington is a board-certified cardiothoracic surgeon, specializing in minimally invasive complex cardiac procedures such as the “hybrid” maze for treatment of atrial fibrillation, mitral valve repair and replacements as well as VATS lobectomy for the treatment of lung cancer. Dr. Dunnington received his medical degree from Medical College of Virginia. He completed his residency at Stanford University where he also served as Chief Resident of Surgery. In addition, he also completed a fellowship in cardiothoracic surgery at the University of Virginia.
Prior to joining Adventist Heart Institute, Dr. Dunnington was an assistant professor at Stanford University and assistant director of cardiothoracic surgery at El Camino Hospital—a Stanford University affiliate. Andreas Sakopoulos, MD, FACS
Dr. Sakopoulos graduated with highest honors from the University of Pisa, School of Medicine and Surgery. He continued his education in North America, training at internationally acclaimed cardiovascular surgery programs, including Loma Linda University and the University of Toronto. He performs heart surgery, including coronary artery bypass surgery, “off pump” bypass surgery, mitral valve repairs and replacements, aortic valve replacements, pacemakers, as well as surgery for atrial fibrillation. He also has extensive expertise in the surgical and endovascular treatment of thoracic and abdominal aortic aneurysms. He has spearheaded the St. Helena Hospital Endovascular program and performs cutting edge interventions on the entire cardiovascular system.
Dr. Sakopoulos maintains a busy thoracic surgery practice, performing video assisted thoracoscopy, as well as surgery for the treatment of lung cancer and other chest tumors.
Dr. Sakopoulos is a sought after teacher and has authored numerous publications in all of the leading journals of his field.Our Cardiologists Stewart Allen, MD, FACC
Dr. Allen brings considerable training and expertise in interventional cardiology. He was trained at Wake Forest University in Winston-Salem, North Carolina and completed fellowships in clinical cardiology, cardiovascular research and interventional cardiology.
Dr. Allen’s expertise includes advanced coronary interventions, peripheral artery interventions, and pacemaker placement. He predominately uses the radial artery for heart catheterizations, a technique that patients have overwhelmingly preferred in clinical trials. In addition to practicing as an interventional cardiologist, Dr. Allen has a strong interest in a patient specific, preventative approach. He has served as a spotlight series speaker for the American Heart Association and has given numerous lectures on preventative health and risk factor modification. He has also been designated as a specialist in clinical hypertension by the American Society of Hypertension. He is board certified in Internal Medicine, Cardiovascular Disease, and Interventional Cardiology. Most recently, he has been appointed Medical Director of Cardiology for the Adventist Heart Institute. Madhusudan Borde, MD, FACC, FCCP, FACP, FAHA
Dr. Borde brings exceptional training and experience. He earned his medical degree from Gandhi Medical College in Hyderabad, India receiving the highest marks. He completed internships at Gandhi Hospital in Secundrabad, India, and at Prince George’s General Hospital and Medical Center in Cheverly, Maryland. Following his internships, he completed a residency in internal medicine at Prince George’s General Hospital and Medical Center. He then completed a fellowship in cardiology at Northwestern University Medical School in Chicago, Illinois, where he also taught. He previously served as a staff cardiologist and Chief of Non-Invasive Cardiac Laboratories at David Grant United States Air Force Medical Center at Travis Air Force Base in Fairfield, CA. Dr. Borde is board certified in both internal medicine and cardiology.
Dr. Borde has held many leadership roles, including Director of Critical Care, Chief of Medicine and Chief of Staff at Sutter Solano Medical Center in Vallejo, CA. Peter Chang-Sing, MD, FACC
Dr. Peter Chang-Sing has been in clinical practice in cardiology in Santa Rosa since 1991. He received his B.S. in Biological Sciences and M.S. in Electrical Engineering from Stanford University and was then concurrently enrolled in the M.D. program at Yale Medical School and the PhD program at Harvard Medical School where he also taught. He completed his internship in Internal Medicine at New York University Medical Center and his residency in Internal Medicine and fellowships in Cardiology and Clinical Cardiac Electrophysiology at Cedars-Sinai Medical Center in Los Angeles. He is certified by the American Board of Internal Medicine in Internal Medicine, Cardiovascular Disease and Clinical Cardiac Electrophysiology. He is a Fellow of the American College of Cardiology and a Fellow of the Heart Rhythm Society. He is Chief of Cardiovascular Disease and Cardiac Surgery and Medical Director of the Cardiac Electrophysiology Lab at Santa Rosa Memorial Hospital. His practice consists of consultative as well as procedural cardiology, with interests in congestive heart failure, arrhythmia management and coronary artery disease. He enjoys spending time with his wife and two children, traveling, hiking, fishing and Stanford football. Emily Conway, MD, FACC
Dr. Emily Conway is a board certified cardiologist who is highly regarded by her peers and patients. Dr. Conway is passionate about women’s heart health and serves on the executive leadership committee for the American Heart Association’s Go Red for Women campaign.
Dr. Conway earned her medical degree from Brown University School of Medicine in Providence, Rhode Island. She completed an internship and residency in internal medicine at Thomas Jefferson University Hospital before completing a fellowship in cardiovascular disease at Lankenau Hospital in Wynnewood, Pennsylvania where she served as Chief Fellow. Prior to joining the Adventist Heart Institute, Dr. Pa casinos reopening date. Conway was in private practice for 5 years. She is an active member of the American College of Cardiology, Women in American College of Cardiology, American Society of Echocardiography and the American Heart Association, Go Red for Women. Monica S. Divakaruni, MD
Dr. Monica Divakaruni earned her medical degree from University of California San Francisco School of Medicine in San Francisco, CA. She completed her internship and residency in internal medicine at Stanford University Medical Center, where she served as Chief Resident. In addition, she completed a fellowship in cardiovascular disease and interventional cardiology at Stanford University Medical Center. She is board certified in internal medicine, cardiology and interventional cardiology.
Focusing on innovative treatment options, Dr. Divakaruni keeps at the forefront of new diagnostic testing and the most advanced cardiac catheterization techniques available, including transradial catheterization which provides patients with a shorter, more comfortable recovery and a reduced risk of bleeding.
Dr. Divakaruni is an expert in women’s heart disease and is passionate about providing all aspects of cardiac care – from education to diagnosis and treatment. She is the founder and Medical Director of St. Helena Women’s Heart Center in St. Helena, CA. L. Bing Liem, DO, FHRS, FA
Dr. Liem earned his medical degree from Michigan State University College of Osteopathic Medicine where he received the Zandos Award for Outstanding Academic Achievement. He completed his internship and residency in internal medicine and cardiology in Michigan, and furthered his fellowship in cardiology and electrophysiology at Stanford University Medical Center in Stanford, CA. He then became a faculty member at Stanford for 15 years before pursuing a career in private practice. He is board certified in internal medicine, cardiovascular disease and earned a special competency in cardiac electrophysiology.
Throughout his career, Dr. Liem has held many leadership titles including directorship of the arrhythmia program at Stanford University. He currently belongs to the Board of Directors for the Heart and Vascular Institute and Scientific Advisory Board for the Genomic Institute at El Camino Hospital. He has been an investigator in over 60 clinical trials and published peer-reviewed scientific papers. He has also been involved in the development of many medical devices in Silicon Valley. Dr. Liem has a special interest in device-based therapy for arrhythmia and heart failure and in the overall treatment of complex arrhythmias. Whie Oh, MD, FACC, FAIC, NASPE
Museum slot zeist. Dr. Oh received his medical degree from Seoul National University College of Medicine in Seoul, South Korea. After Internships at Red Cross Hospital in Seoul and St. Thomas Hospital in Nashville, Tennessee, Dr. Oh had two residencies at Adventist Health White Memorial in Los Angeles. He is Board certified in Internal Medicine, Cardiovascular Diseases and Interventional Cardiology. Jeong Sik Park, MD, FACC, FAIC, NASPE
Dr. Park received his medical degree from Seoul National University College of Medicine in Seoul, South Korea. After an Internship and Residency at Seoul National University Hospital, Dr. Park had a Fellowship and Residency at Loma Linda University Medical Center. He is Board certified in Internal Medicine, Cardiovascular Diseases, Nuclear Cardiology and Echocardiography. David R. Ploss, MD
Dr. David R. Ploss is a board-certified cardiologist with twenty years of active practice experience. He earned his medical degree from Tufts University School of Medicine in Boston, Massachusetts, graduating in 1987. He completed a residency in internal medicine at University of California San Francisco followed by a fellowship in cardiology at California Pacific Medical Center in San Francisco, CA. He then completed a second fellowship in cardiac electrophysiology at the West Los Angeles VA Medical Center in Los Angeles, CA.
Dr. Ploss joins the Adventist Heart Institute after growing the Pacific Heart Group to become the largest cardiology practice in Humboldt County. While a member of the medical community there, he served as Chief of Staff and Director of the Cardiac Catheterization Laboratory. Also, in tandem with the local Community Health Clinic System and St. Joseph Hospital, he helped to develop and direct a community Congestive Heart Failure Clinic in Humboldt County. Prior to this, Dr. Ploss was at the Dayton Heart Center in Dayton, Ohio where he developed the cardiac electrophysiology services.
Dr. Ploss brings with him many years of excellence and experience. He is an active member of the Heart Rhythm Society, American College of Cardiology and the American Medical Association. He is interested in the arts and local politics and previously served as president of the Redwood Art Association. Jon S. Portnoff, MD
Dr. Portnoff has been practicing in Ukiah for over 25 years. Dr. Portnoff treats and cares for a patient throughout the cardiac process, whether it be advanced testing to a procedure. Dr. Portnoff is a graduate of American University of the Caribbean. He did his residency at the University of Wisconsin Medical School in Milwaukee, and had his fellowship training at Loma Linda University Medical School before coming to Ukiah.
Introduction
Aortic valve stenosis is the most common valve disease, resulting in a prognosis of 30-50% mortality at one-year follow-up without intervention for severe and symptomatic cases (1,2). Currently, the conventional treatment of severe aortic valve disease is surgical aortic valve replacement (AVR) through a median sternotomy, with complications and mortality decreasing in recent years (3). However, in an era transformed by an aging population, the presenting patient is increasingly older and sicker with heavily calcified valves, root calcification and with diffuse atherosclerosis and diabetes (4). This modern surgical challenge has triggered the development of less invasive procedures, assumed to diminish the operative risk. Thus, recent advances in technologies have led to the introduction of alternative treatment modalities including sutureless AVR (SU-AVR).
As a cardiac valve substitute, sutureless prostheses reduce the need for sutures after annular decalcification, thereby reducing aortic cross-clamp and cardiopulmonary bypass (CPB) duration and facilitating a minimally invasive approach. While there is current data supporting reduced surgical operative times with SU-AVR (5,6), whether the use of this technology results in improved clinical outcomes remains uncertain. The present systematic review and meta-analysis aims to identify and analyze the available evidence on the safety, clinical efficacy and complications of sutureless valves for AVR.MethodsLiterature search strategy
Electronic searches were performed using Ovid Medline, PubMed, Cochrane Central Register of Controlled Trials (CCTR), Cochrane Database of Systematic Reviews (CDSR), ACP Journal Club, and Database of Abstracts of Review of Effectiveness (DARE) from their dates of inception to January 2014. To achieve the maximum sensitivity of the search strategy, we combined the terms: “sutureless” AND “aortic valve” AND “surgery OR operation OR replacement” as either key words or MeSH terms. The reference lists of all retrieved articles were reviewed for further identification of potentially relevant studies, assessed using the inclusion and exclusion criteria. Expert academic cardiothoracic surgeons (Marco Di Eusanio, Tristan D. Yan) were consulted as to whether they knew of any unpublished data.Selection criteria
Eligible studies for the present systematic review and meta-analysis included those in which patient cohorts underwent AVR using a sutureless valve such as Perceval S (Sorin Group, Saluggia), 3F Enable (ATS Medical, Minneapolis), Trilogy (Arbor Surgical Technologies, California) or Edwards Intuity (Edwards Lifesciences, California). Studies that did not include mortality or complications as endpoints were excluded. When institutions published duplicate studies with accumulating numbers of patients or increased lengths of follow-up, only the most complete reports were included for quantitative assessment at each time interval. All publications were limited to those involving human subjects and in the English language. Abstracts, case reports, conference presentations, editorials, reviews and expert opinions were excluded.Data extraction and critical appraisal
All data were extracted from article texts, tables and figures. Two investigators independently reviewed each retrieved article (K.P., Y.C.T.). Discrepancies between the two reviewers were resolved by discussion and consensus. If the study provided medians and interquartile ranges instead of means and SDs, we imputed the means and SDs as described by Hozo et al. (7). Because quality scoring is controversial in meta-analyses of observational studies, two reviewers (K.P., Y.C.T.) independently appraised each article included in our analysis according to a critical review checklist of the Dutch Cochrane Centre proposed by MOOSE (8). The key points of this checklist include: (I) clear definition of study population; (II) clear definition of outcomes and outcome assessment; (III) independent assessment of outcome parameters; (IV) sufficient duration of follow-up; (V) no selective loss during follow-up; and (VI) important confounders and prognostic factors identified. The final results were reviewed by senior investigators (M.D.E., T.D.Y.).Statistical analysis
A meta-analysis of proportions was conducted for the available main perioperative and postoperative variables. Firstly, to establish variance of raw proportions, a Freeman-Tukey transformation was applied (9). To incorporate heterogeneity (anticipated among the included studies), transformed proportions were combined using DerSimonian-Laird random effects models (10). Finally the pooled estimates were back-transformed. Heterogeneity was evaluated using Cochran Q and I2 test. Weighted means were calculated by determining the total number of events divided by total sample size. Weighted Pearson’s coefficient (rs) was used to calculate correlation coefficients for meta-regression analysis of outcomes based on midpoint of study periods. All analyses were performed using the metafor package for R version 3.01. P values <0.05 were considered statistically significant.
Evidence of publication bias was sought using Begg methods. Contour-enhanced funnel plot was performed to aid in interpretation of the funnel plot. Possible asymmetry was investigated using trim-and-fill analysis.ResultsQuality of studies
A total of 361 studies were identified through six electronic database searches and from other sources such as reference lists (Figure 1). After exclusion of duplicate or irrelevant references, 46 potentially relevant articles were retrieved. After detailed evaluation of these articles, 12 studies remained for assessment, including a total of 1,037 patients undergoing SU-AVR.Figure 1 Summary of search strategy (PRISMA flow-chart) for relevant studies on sutureless aortic valve replacement (SU-AVR).
All of the included 12 studies were observational studies, with 10 prospective (5,6,11-18), 2 retrospective (19,20) and 2 propensity-matched studies (11,15) (Table 1). There were 7 studies (6,11-14,16,19) which consisted of 50 or more patients undergoing AVR with a sutureless valve, while the remaining 5 studies had fewer than 50 patients (5,15,17,18,20). The Perceval S valve (n=502) was used in 6 studies (5,6,11,13,15,21), the 3F Enable valve (n=316) used in 4 studies (16,18-20), Trilogy valve (n=32) (17) and Edwards Intuity valve (n=146) used in one study (12) each.
Only 5 studies reported mean follow-up equal or greater than 12 months (5,6,11,18,21). One study (14) repo
https://diarynote-jp.indered.space
*Ploss Valve
*Ploss ValveOur Surgeons
*Ross valve - a leader in water & wastewater control valves. Click below for products and services. Copyright 2016 ross valve mfg co inc.
*A switching valve (ploss) is a three-way valve located between a stethoscope placed over the heart, a blood pressure cuff, and an earpiece. The valve allows the user to eliminate one sound channel and listen only to a patient’s heart or korotkoff (blood pressure) sounds through the other channel. (b) Classification. Class I (general controls).
*After resection of the stenotic aortic valve and debridement of the annulus, the valve was inserted and released. Mean age was 79 years, and mean logistic Euroscore was 13. Subvalvular myectomy was performed in two patients. Prosthetic valve sizes were 19 mm (n = 1), 21 mm (n = 7), 23 mm (n = 6), 25 mm (n = 6), and 27 mm (n = 2).
Switching (Ploss) Valve. Synthetic Cell-Tissue Culture Media & Components. Syringe Holder Adaptor. Target Tangent Screen. Teaching Attachment for an Endoscope. Gan H. Dunnington, MD
Dr. Dunnington is a board-certified cardiothoracic surgeon, specializing in minimally invasive complex cardiac procedures such as the “hybrid” maze for treatment of atrial fibrillation, mitral valve repair and replacements as well as VATS lobectomy for the treatment of lung cancer. Dr. Dunnington received his medical degree from Medical College of Virginia. He completed his residency at Stanford University where he also served as Chief Resident of Surgery. In addition, he also completed a fellowship in cardiothoracic surgery at the University of Virginia.
Prior to joining Adventist Heart Institute, Dr. Dunnington was an assistant professor at Stanford University and assistant director of cardiothoracic surgery at El Camino Hospital—a Stanford University affiliate. Andreas Sakopoulos, MD, FACS
Dr. Sakopoulos graduated with highest honors from the University of Pisa, School of Medicine and Surgery. He continued his education in North America, training at internationally acclaimed cardiovascular surgery programs, including Loma Linda University and the University of Toronto. He performs heart surgery, including coronary artery bypass surgery, “off pump” bypass surgery, mitral valve repairs and replacements, aortic valve replacements, pacemakers, as well as surgery for atrial fibrillation. He also has extensive expertise in the surgical and endovascular treatment of thoracic and abdominal aortic aneurysms. He has spearheaded the St. Helena Hospital Endovascular program and performs cutting edge interventions on the entire cardiovascular system.
Dr. Sakopoulos maintains a busy thoracic surgery practice, performing video assisted thoracoscopy, as well as surgery for the treatment of lung cancer and other chest tumors.
Dr. Sakopoulos is a sought after teacher and has authored numerous publications in all of the leading journals of his field.Our Cardiologists Stewart Allen, MD, FACC
Dr. Allen brings considerable training and expertise in interventional cardiology. He was trained at Wake Forest University in Winston-Salem, North Carolina and completed fellowships in clinical cardiology, cardiovascular research and interventional cardiology.
Dr. Allen’s expertise includes advanced coronary interventions, peripheral artery interventions, and pacemaker placement. He predominately uses the radial artery for heart catheterizations, a technique that patients have overwhelmingly preferred in clinical trials. In addition to practicing as an interventional cardiologist, Dr. Allen has a strong interest in a patient specific, preventative approach. He has served as a spotlight series speaker for the American Heart Association and has given numerous lectures on preventative health and risk factor modification. He has also been designated as a specialist in clinical hypertension by the American Society of Hypertension. He is board certified in Internal Medicine, Cardiovascular Disease, and Interventional Cardiology. Most recently, he has been appointed Medical Director of Cardiology for the Adventist Heart Institute. Madhusudan Borde, MD, FACC, FCCP, FACP, FAHA
Dr. Borde brings exceptional training and experience. He earned his medical degree from Gandhi Medical College in Hyderabad, India receiving the highest marks. He completed internships at Gandhi Hospital in Secundrabad, India, and at Prince George’s General Hospital and Medical Center in Cheverly, Maryland. Following his internships, he completed a residency in internal medicine at Prince George’s General Hospital and Medical Center. He then completed a fellowship in cardiology at Northwestern University Medical School in Chicago, Illinois, where he also taught. He previously served as a staff cardiologist and Chief of Non-Invasive Cardiac Laboratories at David Grant United States Air Force Medical Center at Travis Air Force Base in Fairfield, CA. Dr. Borde is board certified in both internal medicine and cardiology.
Dr. Borde has held many leadership roles, including Director of Critical Care, Chief of Medicine and Chief of Staff at Sutter Solano Medical Center in Vallejo, CA. Peter Chang-Sing, MD, FACC
Dr. Peter Chang-Sing has been in clinical practice in cardiology in Santa Rosa since 1991. He received his B.S. in Biological Sciences and M.S. in Electrical Engineering from Stanford University and was then concurrently enrolled in the M.D. program at Yale Medical School and the PhD program at Harvard Medical School where he also taught. He completed his internship in Internal Medicine at New York University Medical Center and his residency in Internal Medicine and fellowships in Cardiology and Clinical Cardiac Electrophysiology at Cedars-Sinai Medical Center in Los Angeles. He is certified by the American Board of Internal Medicine in Internal Medicine, Cardiovascular Disease and Clinical Cardiac Electrophysiology. He is a Fellow of the American College of Cardiology and a Fellow of the Heart Rhythm Society. He is Chief of Cardiovascular Disease and Cardiac Surgery and Medical Director of the Cardiac Electrophysiology Lab at Santa Rosa Memorial Hospital. His practice consists of consultative as well as procedural cardiology, with interests in congestive heart failure, arrhythmia management and coronary artery disease. He enjoys spending time with his wife and two children, traveling, hiking, fishing and Stanford football. Emily Conway, MD, FACC
Dr. Emily Conway is a board certified cardiologist who is highly regarded by her peers and patients. Dr. Conway is passionate about women’s heart health and serves on the executive leadership committee for the American Heart Association’s Go Red for Women campaign.
Dr. Conway earned her medical degree from Brown University School of Medicine in Providence, Rhode Island. She completed an internship and residency in internal medicine at Thomas Jefferson University Hospital before completing a fellowship in cardiovascular disease at Lankenau Hospital in Wynnewood, Pennsylvania where she served as Chief Fellow. Prior to joining the Adventist Heart Institute, Dr. Pa casinos reopening date. Conway was in private practice for 5 years. She is an active member of the American College of Cardiology, Women in American College of Cardiology, American Society of Echocardiography and the American Heart Association, Go Red for Women. Monica S. Divakaruni, MD
Dr. Monica Divakaruni earned her medical degree from University of California San Francisco School of Medicine in San Francisco, CA. She completed her internship and residency in internal medicine at Stanford University Medical Center, where she served as Chief Resident. In addition, she completed a fellowship in cardiovascular disease and interventional cardiology at Stanford University Medical Center. She is board certified in internal medicine, cardiology and interventional cardiology.
Focusing on innovative treatment options, Dr. Divakaruni keeps at the forefront of new diagnostic testing and the most advanced cardiac catheterization techniques available, including transradial catheterization which provides patients with a shorter, more comfortable recovery and a reduced risk of bleeding.
Dr. Divakaruni is an expert in women’s heart disease and is passionate about providing all aspects of cardiac care – from education to diagnosis and treatment. She is the founder and Medical Director of St. Helena Women’s Heart Center in St. Helena, CA. L. Bing Liem, DO, FHRS, FA
Dr. Liem earned his medical degree from Michigan State University College of Osteopathic Medicine where he received the Zandos Award for Outstanding Academic Achievement. He completed his internship and residency in internal medicine and cardiology in Michigan, and furthered his fellowship in cardiology and electrophysiology at Stanford University Medical Center in Stanford, CA. He then became a faculty member at Stanford for 15 years before pursuing a career in private practice. He is board certified in internal medicine, cardiovascular disease and earned a special competency in cardiac electrophysiology.
Throughout his career, Dr. Liem has held many leadership titles including directorship of the arrhythmia program at Stanford University. He currently belongs to the Board of Directors for the Heart and Vascular Institute and Scientific Advisory Board for the Genomic Institute at El Camino Hospital. He has been an investigator in over 60 clinical trials and published peer-reviewed scientific papers. He has also been involved in the development of many medical devices in Silicon Valley. Dr. Liem has a special interest in device-based therapy for arrhythmia and heart failure and in the overall treatment of complex arrhythmias. Whie Oh, MD, FACC, FAIC, NASPE
Museum slot zeist. Dr. Oh received his medical degree from Seoul National University College of Medicine in Seoul, South Korea. After Internships at Red Cross Hospital in Seoul and St. Thomas Hospital in Nashville, Tennessee, Dr. Oh had two residencies at Adventist Health White Memorial in Los Angeles. He is Board certified in Internal Medicine, Cardiovascular Diseases and Interventional Cardiology. Jeong Sik Park, MD, FACC, FAIC, NASPE
Dr. Park received his medical degree from Seoul National University College of Medicine in Seoul, South Korea. After an Internship and Residency at Seoul National University Hospital, Dr. Park had a Fellowship and Residency at Loma Linda University Medical Center. He is Board certified in Internal Medicine, Cardiovascular Diseases, Nuclear Cardiology and Echocardiography. David R. Ploss, MD
Dr. David R. Ploss is a board-certified cardiologist with twenty years of active practice experience. He earned his medical degree from Tufts University School of Medicine in Boston, Massachusetts, graduating in 1987. He completed a residency in internal medicine at University of California San Francisco followed by a fellowship in cardiology at California Pacific Medical Center in San Francisco, CA. He then completed a second fellowship in cardiac electrophysiology at the West Los Angeles VA Medical Center in Los Angeles, CA.
Dr. Ploss joins the Adventist Heart Institute after growing the Pacific Heart Group to become the largest cardiology practice in Humboldt County. While a member of the medical community there, he served as Chief of Staff and Director of the Cardiac Catheterization Laboratory. Also, in tandem with the local Community Health Clinic System and St. Joseph Hospital, he helped to develop and direct a community Congestive Heart Failure Clinic in Humboldt County. Prior to this, Dr. Ploss was at the Dayton Heart Center in Dayton, Ohio where he developed the cardiac electrophysiology services.
Dr. Ploss brings with him many years of excellence and experience. He is an active member of the Heart Rhythm Society, American College of Cardiology and the American Medical Association. He is interested in the arts and local politics and previously served as president of the Redwood Art Association. Jon S. Portnoff, MD
Dr. Portnoff has been practicing in Ukiah for over 25 years. Dr. Portnoff treats and cares for a patient throughout the cardiac process, whether it be advanced testing to a procedure. Dr. Portnoff is a graduate of American University of the Caribbean. He did his residency at the University of Wisconsin Medical School in Milwaukee, and had his fellowship training at Loma Linda University Medical School before coming to Ukiah.
Introduction
Aortic valve stenosis is the most common valve disease, resulting in a prognosis of 30-50% mortality at one-year follow-up without intervention for severe and symptomatic cases (1,2). Currently, the conventional treatment of severe aortic valve disease is surgical aortic valve replacement (AVR) through a median sternotomy, with complications and mortality decreasing in recent years (3). However, in an era transformed by an aging population, the presenting patient is increasingly older and sicker with heavily calcified valves, root calcification and with diffuse atherosclerosis and diabetes (4). This modern surgical challenge has triggered the development of less invasive procedures, assumed to diminish the operative risk. Thus, recent advances in technologies have led to the introduction of alternative treatment modalities including sutureless AVR (SU-AVR).
As a cardiac valve substitute, sutureless prostheses reduce the need for sutures after annular decalcification, thereby reducing aortic cross-clamp and cardiopulmonary bypass (CPB) duration and facilitating a minimally invasive approach. While there is current data supporting reduced surgical operative times with SU-AVR (5,6), whether the use of this technology results in improved clinical outcomes remains uncertain. The present systematic review and meta-analysis aims to identify and analyze the available evidence on the safety, clinical efficacy and complications of sutureless valves for AVR.MethodsLiterature search strategy
Electronic searches were performed using Ovid Medline, PubMed, Cochrane Central Register of Controlled Trials (CCTR), Cochrane Database of Systematic Reviews (CDSR), ACP Journal Club, and Database of Abstracts of Review of Effectiveness (DARE) from their dates of inception to January 2014. To achieve the maximum sensitivity of the search strategy, we combined the terms: “sutureless” AND “aortic valve” AND “surgery OR operation OR replacement” as either key words or MeSH terms. The reference lists of all retrieved articles were reviewed for further identification of potentially relevant studies, assessed using the inclusion and exclusion criteria. Expert academic cardiothoracic surgeons (Marco Di Eusanio, Tristan D. Yan) were consulted as to whether they knew of any unpublished data.Selection criteria
Eligible studies for the present systematic review and meta-analysis included those in which patient cohorts underwent AVR using a sutureless valve such as Perceval S (Sorin Group, Saluggia), 3F Enable (ATS Medical, Minneapolis), Trilogy (Arbor Surgical Technologies, California) or Edwards Intuity (Edwards Lifesciences, California). Studies that did not include mortality or complications as endpoints were excluded. When institutions published duplicate studies with accumulating numbers of patients or increased lengths of follow-up, only the most complete reports were included for quantitative assessment at each time interval. All publications were limited to those involving human subjects and in the English language. Abstracts, case reports, conference presentations, editorials, reviews and expert opinions were excluded.Data extraction and critical appraisal
All data were extracted from article texts, tables and figures. Two investigators independently reviewed each retrieved article (K.P., Y.C.T.). Discrepancies between the two reviewers were resolved by discussion and consensus. If the study provided medians and interquartile ranges instead of means and SDs, we imputed the means and SDs as described by Hozo et al. (7). Because quality scoring is controversial in meta-analyses of observational studies, two reviewers (K.P., Y.C.T.) independently appraised each article included in our analysis according to a critical review checklist of the Dutch Cochrane Centre proposed by MOOSE (8). The key points of this checklist include: (I) clear definition of study population; (II) clear definition of outcomes and outcome assessment; (III) independent assessment of outcome parameters; (IV) sufficient duration of follow-up; (V) no selective loss during follow-up; and (VI) important confounders and prognostic factors identified. The final results were reviewed by senior investigators (M.D.E., T.D.Y.).Statistical analysis
A meta-analysis of proportions was conducted for the available main perioperative and postoperative variables. Firstly, to establish variance of raw proportions, a Freeman-Tukey transformation was applied (9). To incorporate heterogeneity (anticipated among the included studies), transformed proportions were combined using DerSimonian-Laird random effects models (10). Finally the pooled estimates were back-transformed. Heterogeneity was evaluated using Cochran Q and I2 test. Weighted means were calculated by determining the total number of events divided by total sample size. Weighted Pearson’s coefficient (rs) was used to calculate correlation coefficients for meta-regression analysis of outcomes based on midpoint of study periods. All analyses were performed using the metafor package for R version 3.01. P values <0.05 were considered statistically significant.
Evidence of publication bias was sought using Begg methods. Contour-enhanced funnel plot was performed to aid in interpretation of the funnel plot. Possible asymmetry was investigated using trim-and-fill analysis.ResultsQuality of studies
A total of 361 studies were identified through six electronic database searches and from other sources such as reference lists (Figure 1). After exclusion of duplicate or irrelevant references, 46 potentially relevant articles were retrieved. After detailed evaluation of these articles, 12 studies remained for assessment, including a total of 1,037 patients undergoing SU-AVR.Figure 1 Summary of search strategy (PRISMA flow-chart) for relevant studies on sutureless aortic valve replacement (SU-AVR).
All of the included 12 studies were observational studies, with 10 prospective (5,6,11-18), 2 retrospective (19,20) and 2 propensity-matched studies (11,15) (Table 1). There were 7 studies (6,11-14,16,19) which consisted of 50 or more patients undergoing AVR with a sutureless valve, while the remaining 5 studies had fewer than 50 patients (5,15,17,18,20). The Perceval S valve (n=502) was used in 6 studies (5,6,11,13,15,21), the 3F Enable valve (n=316) used in 4 studies (16,18-20), Trilogy valve (n=32) (17) and Edwards Intuity valve (n=146) used in one study (12) each.
Only 5 studies reported mean follow-up equal or greater than 12 months (5,6,11,18,21). One study (14) repo
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