The Journal Of Heart Valve Disease[JOURNAL]
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200 papers
Assessment and Management of Acute Severe Mitral Regurgitation in the Intensive Care Unit.
Leitman M, Tyomkin V, Raanani E … +5 more , Sharony R, Tzatskin L, Peleg E, Blatt A, Vered Z
J Heart Valve Dis · 2017 Mar · PMID 28820545
BACKGROUND AND AIM OF THE STUDY: Acute severe mitral regurgitation (MR) is a serious medical condition. Whilst clear guidelines exist regarding the management of chronic MR, acute severe MR is usually treated on an indiv...
BACKGROUND AND AIM OF THE STUDY: Acute severe mitral regurgitation (MR) is a serious medical condition. Whilst clear guidelines exist regarding the management of chronic MR, acute severe MR is usually treated on an individual basis. Currently, few data exist regarding acute MR in the era of primary coronary interventions (PCI). The present study included patients admitted to the Department of Cardiology during recent years with acute severe MR of different etiologies, and an analysis of these data in the light of previous investigations. METHODS: The digital database of the present authors' hospital was searched for patients diagnosed with severe MR between 2008 and 2015. From a total of 228 patients identified, 19 with primary MR and 17 with secondary (functional) MR were admitted to the Department of Cardiology. The clinical data and outcome of these patients were analyzed. RESULTS: Among patients with MR due to acute myocardial infarction (MI), 13 had functional MR and six had MR due to mechanical complications, namely rupture of the papillary muscle or chordae tendineae. Among patients with MR not in the setting of MI, 13 had primary MR and four had functional MR. Patients with MR due to acute MI were more often in cardiogenic shock or had pulmonary edema and had a higher mortality. The strongest predictor of mortality was the presence of shock, followed by female gender, hypertension, age ≥68 years; previous MI and pulmonary edema were also predictors of mortality. In patients with acute MI and secondary MR, PCI to the culprit coronary artery was associated with a lesser degree of MR on follow up. CONCLUSIONS: Patients with severe MR are at high risk of in-hospital death. Patients with functional MR are likely to benefit from prompt PCI to the culprit artery, and for those with primary MR urgent surgery is life-saving.
Use of Adjuncts Reduces Cardiopulmonary Bypass Time During Minimally Invasive Aortic Valve Replacement.
Wang A, McCartney SL, Williams JB … +4 more , Ganapathi A, Glower DD, Nicoara A, Gaca JG
J Heart Valve Dis · 2017 Mar · PMID 28820544
BACKGROUND: Minimally invasive aortic valve replacement (MIAVR) through a mini-thoracotomy is comparable to AVR through a sternotomy, but may have increased surgical times. The development of adjuncts such as the automat...
BACKGROUND: Minimally invasive aortic valve replacement (MIAVR) through a mini-thoracotomy is comparable to AVR through a sternotomy, but may have increased surgical times. The development of adjuncts such as the automatic knot fastener and percutaneous coronary sinus (CS) catheter may reduce this disadvantage. METHODS: A retrospective review conducted between 2002 and 2015 at a single institution revealed 78 patients who underwent MIAVR with adjuncts. The automatic knot fastener was used on all patients, and a successful CS catheter was placed and confirmed by echocardiography in 67 patients (86%). Patients were propensity matched against those who had MIAVR without adjuncts (n = 78) and through a median sternotomy (n = 78) for assessment of major morbidity. Variables were compared using an unpaired t-test, Wilcoxon rank sum test, chi-squared and Fisher's exact test where appropriate. RESULTS: Patients who underwent MIAVR with adjuncts had shorter cross-clamp times (70.5 versus 108.1 and 84.4 min; p <0.0001) and cardiopulmonary bypass (CPB) times (101.1 versus 166.12 and 127.7 min; p <0.0001) than those who underwent MIAVR without adjuncts or through a median sternotomy. Patients who underwent MIAVR received fewer blood transfusions compared to those undergoing AVR via a median sternotomy (0.6 and 1.2 versus 2.5; p <0.012). Patients who underwent MIAVR with adjuncts had similar rates of new-onset atrial fibrillation (AF) than those undergoing MIAVR without adjuncts (33% versus 22%; p = 0.11), but had higher rates of AF compared to the sternotomy group (33% versus 17%; p = 0.02). Rates of in-hospital morbidity and mortality were similar between all groups. CONCLUSIONS: The use of adjuncts during MIAVR led to a significant shortening of cross-clamp and CPB times, and to a requirement for fewer blood transfusions. Morbidity and mortality rates after MIAVR were similar to those in patients undergoing a median sternotomy.
Minimally Invasive Versus Transcatheter and Surgical Aortic Valve Replacement: A Propensity Matched Study.
Terwelp MD, Thourani VH, Zhao Y … +8 more , Balan P, Loghin C, Ocazionez D, Estrera A, Hoffmann CT, Babaliaros VC, Lamelas J, Nguyen TC
J Heart Valve Dis · 2017 Mar · PMID 28820543
BACKGROUND: An increasing number of options exist for the treatment of severe symptomatic aortic stenosis. The study aim was to compare short-term outcomes in patients undergoing surgical aortic valve replacement (SAVR),...
BACKGROUND: An increasing number of options exist for the treatment of severe symptomatic aortic stenosis. The study aim was to compare short-term outcomes in patients undergoing surgical aortic valve replacement (SAVR), minimally invasive aortic valve replacement (MIAVR), and transcatheter aortic valve replacement (TAVR). METHODS: A multi-institutional retrospective review of 2,571 patients undergoing SAVR (n = 842), MIAVR via right anterior thoracotomy (n = 699) and TAVR (n = 1,030) between 2011 and 2014 was conducted. TAVR patients were further stratified as either transfemoral (TF) or transapical (TA). Propensity matching was performed between MIAVR and SAVR (384 pairs), MIAVR and TA-TAVR (115 pairs), and MIAVR and TF-TAVR (247 pairs). RESULTS: Total numbers of AVR increased between 2011 and 2014. When stratified by procedure type, MIAVR and TF-TAVR accounted for most of the growth, while TA-TAVR and SAVR each experienced a decreased volume. Propensity matched comparisons of SAVR, TF-TAVR, and TA-TAVR versus MIAVR revealed no difference in 30-day mortality. TF-TAVR versus MIAVR revealed that MIAVR had a decreased rate of stroke (0.4% versus 3.6%, p = 0.02) and increased atrial fibrillation (AF; 19.4% versus 4%, p <0.01). When compared to SAVR, MIAVR had a lower incidence of AF (19% versus 32.6%, p <0.01). MIAVR exhibited decreased ventilation time (27.2 versus 134 h, p = 0.03) and intensive care unit time (63.7 versus 92.7 h, p = 0.02) compared to TA-TAVR. CONCLUSIONS: During recent years, MIAVR and TFTAVR have experienced significant growth in volume with near-comparable short-term outcomes, while SAVR and TA-TAVR volumes have declined. These results underscore the importance of surgeons adopting MIAVR and TF-TAVR techniques in order to offer patients optimal outcomes.
Efficacy and Complications of Transcatheter Aortic Valve Implantation With and Without Balloon Aortic Valvuloplasty.
Singh K, Carson K, Akbar Ali O … +4 more , Jayasinghe R, Dick A, Glover C, Labinaz M
J Heart Valve Dis · 2017 Mar · PMID 28820542
BACKGROUND: Transcatheter aortic valve implantation (TAVI) is an effective treatment for severe aortic stenosis in high-risk patients. Several complications related to the TAVI procedure, including aortic regurgitation (...
BACKGROUND: Transcatheter aortic valve implantation (TAVI) is an effective treatment for severe aortic stenosis in high-risk patients. Several complications related to the TAVI procedure, including aortic regurgitation (AR), cerebrovascular accident (CVA) and the requirement for permanent pacemaker (PPM), are thought to be secondary to balloon aortic valvuloplasty (BAV) before TAVI. The aim of the present review was to evaluate any beneficial role of the direct TAVI approach over BAVTAVI. METHODS: A comprehensive search of major databases was performed. Only studies comparing TAVI with and without BAV were included. A total of nine full length articles was included in the analysis. RESULTS: Among 2,650 patients, 1,043 underwent 'direct TAVI' without pre-BAV, while 1,607 underwent TAVI following BAV. Overall, there was no difference between the 30-day all-cause mortality (OR 0.96, 95% CI 0.63-1.47, p = 0.86), CVA (OR 0.81, 95% CI 0.34-1.92, p = 0.63) and PPM implantation (OR 0.84, 95% CI 0.66- 1.05, p = 0.12) between the two approaches. The rate of moderate to severe AR was significantly lower with direct TAVI implantation (OR 0.44, 95% CI 0.20-0.96, p = 0.04). In the case of self-expandable valves, direct TAVI was associated with a lower device success (OR 5.15, 95% CI 1.33-19.9, p = 0.02). CONCLUSIONS: No difference was identified in mortality between direct TAVI and BAV-TAVI. However, direct TAVI is associated with a lower incidence of AR, a finding that would only be confirmed by conducting further randomized studies.
Automatic Estimation of Optimal Deployment of Transcatheter Aortic Valve Implantation Using Computed Tomography.
Kerner A, Abadi S, Dotan R … +3 more , Javitt M, Aronson D, Lessick J
J Heart Valve Dis · 2017 Mar · PMID 28820541
BACKGROUND: A comparison was made between the accuracy of and time saved by using novel automated software for pre-procedural computed tomography (CT) planning before transcatheter aortic valve implantation (TAVI) and ma...
BACKGROUND: A comparison was made between the accuracy of and time saved by using novel automated software for pre-procedural computed tomography (CT) planning before transcatheter aortic valve implantation (TAVI) and manual methods. Preprocedural CT to assess aortic annulus dimensions and predict the optimal C-arm implant angle before TAVI can reduce complications related to incorrect prosthesis sizing and positioning. METHODS: A total of 61 consecutive patients underwent TAVI using either the SAPIEN XT or CoreValve prosthesis. Pre-procedural CT scans were analysed using three methods: automatic; semi-automatic; and manual. For each method, annular dimensions were measured and the optimal implantation angle was predicted. After TAVI the actual post-deployment angle orthogonal to the prosthesis was determined using aortic fluoroscopy. The difference between the predicted angle by CT and the measured post-deployment angle was calculated for each method. RESULTS: For all methods the mean angular difference with the actual post-deployment angle was similar at ~9 ± 7°. There was a significant difference between the SAPIEN XT (6.6 ± 5.8°) and CoreValve (11.5 ± 6.9°, p <0.001) prostheses due to a consistently greater left anterior oblique and caudal angulation for the CoreValve. Although the annular area correlated well among all methods, 'automatic' results were consistently larger than 'manual' results. Interobserver variability was low for all measures. The fully automatic method saved 98 s, and the semiautomatic method 40 s per case. CONCLUSIONS: The use of automatic software enabled a rapid and accurate prediction of implantation angles, though results differed for specific manufacturers. Annular areas were overestimated by the automatic method, and thus required manual adjustments.
Endoscopic Port Access Surgery for Late Orthotopic Cardiac Transplantation Atrioventricular Valve Disease.
van der Merwe J, Casselman F, Stockman B … +3 more , Vermeulen Y, Degrieck I, Van Praet F
J Heart Valve Dis · 2017 Mar · PMID 28820540
BACKGROUND: The study aim was to present details of the perioperative and long-term outcomes of redo-endoscopic port access surgery (REPAS) for late atrioventricular valve disease (AVVD) in orthotopic cardiac transplant...
BACKGROUND: The study aim was to present details of the perioperative and long-term outcomes of redo-endoscopic port access surgery (REPAS) for late atrioventricular valve disease (AVVD) in orthotopic cardiac transplant (OCT) patients. METHODS: Between February 2004 and October 2015, REPAS was performed for late AVVD in seven consecutive OCT patients (mean age 57.9 ± 17.2 years; EuroSCORE II 21.2 ± 14.7%) at the authors' institution. The mean OCT-REPAS time interval was 7.8 ± 4.6 years (range: 1.3-13.8 years). NYHA class III or IV symptoms were present in four patients (57%). The mean left ventricular ejection fraction was 52.9 ± 3.9%, and surgical indications included severe mitral valve (MV) and tricuspid valve (TV) regurgitation in three patients (44%) and six patients (86%), respectively. Etiological factors included endomyocardial biopsy trauma (n = 6; 86%), degenerative disease (n = 2; 29%), and fungal endocarditis (n = 1; 14%). RESULTS: Procedures performed included MV repair (n = 3; 43%) and TV replacement (n = 3; 43%). There were no sternotomy conversions or revisions for any cause. The mean cardiopulmonary bypass and ischemic times were 178.4 ± 48.6 min and 118.3 ± 39.5 min, respectively. In-hospital morbidities included hospital-acquired pneumonia (n = 2; 29%). There were no wound infections or 30-day mortalities. The mean duration of hospitalization was 18.3 ± 11.0 days. A mean of 29.2 ± 45.6 patient-months (total 204.3 patient-months) was available for long-term clinical and echocardiographic analysis (n = 7; 100% complete). No MV or TV reinterventions were required. NYHA class ≤II was achieved in five patients (71%). No patient presented with residual MV regurgitation greater than grade I. CONCLUSIONS: REPAS for late AVVD in OCT patients is a safe and durable procedure with favorable technique-related mortality, in-hospital morbidity, and long-term cardiac-specific outcomes at experienced centers. The present technique provided an attractive benchmark against which emerging percutaneous interventions may be measured, and earlier referral of patients should be considered.
Image of the Month: Concomitant Tricuspid and Mitral Native Valve Infective Endocarditis.
Jeong SJ, Seol SH, Sang Song P
J Heart Valve Dis · 2017 Jan · PMID 28544844
A 33-year-old immunocompetent man was admitted to the authors' hospital with a one-month duration of fevers, chills, and non-productive coughs, and suddenonset weakness and ischemic pain of both lower extremities. Physic...
A 33-year-old immunocompetent man was admitted to the authors' hospital with a one-month duration of fevers, chills, and non-productive coughs, and suddenonset weakness and ischemic pain of both lower extremities. Physical examination revealed crepitating rales heard over bilateral lung fields. On auscultation, a grade 2~3/6 systolic murmur was heard over the leftlower sternal border and apical area. Transthoracic echocardiography revealed a mobile mass on the tricuspid valve compatible with vegetation, in addition to concomitant mitral valve vegetation (Video 1). Thoracic computed tomography (CT) with contrast revealed cavitary lesions of the left and right lung fields (Fig. 1A and B). Abdominal CT showed a splenic infarction (Fig. 2A), a renal infarction (Fig. 2B), and thromboembolic occlusion of the distal aorta and right common iliac artery (Fig. 3). The patient denied any history of intravenous drug abuse. Blood cultures grew Streptococcus agalactiae (penicillin G-sensitive with a minimal inhibitory concentration ≤0.06 μg/ml). Video 1: Transthoracic echocardiography showing mobile masses on tricuspid and mitral valves compatible with vegetation on the apical four-chamber view.
A New Sign of Severe Aortic Regurgitation Detected Through Airflow Analysis in Mechanical Ventilation.
C Garcia-Rubira J, J Cristo-Ropero M, Almendro-Delia M … +1 more , Hidalgo-Urbano R
J Heart Valve Dis · 2017 Jan · PMID 28544843
A 72-year-old female with a previous history of aortic valve replacement by biological prosthesis was admitted with progressive heart failure. The clinical course was unfavorable, requiring inotropic support and invasive...
A 72-year-old female with a previous history of aortic valve replacement by biological prosthesis was admitted with progressive heart failure. The clinical course was unfavorable, requiring inotropic support and invasive mechanical ventilation. Auto-triggering of the ventilator from cardiac origin has been previously described, and explained as a consequence of hyperdynamic circulation. In our case, the oscillatory movements due to the aortic regurgitation are transmitted to the airway. Early recognition of this condition can facilitate not only the correction this asynchrony in mechanical ventilation but also should raise the suspicion of aortic regurgitation.
Transfemoral Valve-In-Valve in a Degenerated Small Aortic Bioprosthesis: Five-Year Follow Up.
Salizzoni S, Conrotto F, Rinaldi M … +4 more , Paolo Ussia G, Ferraro G, Giorgi M, D'Amico M
J Heart Valve Dis · 2017 Jan · PMID 28544842
A small-sized bioprosthesis can limit transcatheter valve-in-valve (V-in-V) implantations. The case is reported of a 91-year-old woman who had successfully undergone a V-in-V procedure with a 26 mm CoreValve in a previou...
A small-sized bioprosthesis can limit transcatheter valve-in-valve (V-in-V) implantations. The case is reported of a 91-year-old woman who had successfully undergone a V-in-V procedure with a 26 mm CoreValve in a previously implanted Mitroflow 19 mm valve. At the five-year follow up the prosthesis showed good echocardiographic function and the patient was alive and free from major symptoms. The patient died three months after the follow up examination at the age of 96 years. This case demonstrates the feasibility, with acceptable longterm functioning, of a V-in-V procedure involving a small bioprosthesis. To the authors' knowledge, the present report is the longest follow up of a patient who underwent V-in-V transcatheter aortic valve implantation in a 19 mm bioprosthesis (15.4 mm internal diameter). Video 1: Preoperative aortography showing moderate-to-severe aortic regurgitation. Video 2: Pre-implantation aortic balloon valvuloplasty. Video 3: Post-deployment aortography showing moderate-to-severe aortic regurgitation. Video 4: The final result. After post-dilation of the under-expanded 26 mm CoreValve, the aortic regurgitation is slightly reduced.
Transcatheter Valve-in-Valve Implantation: Failing Tricuspid Bioprosthesis in a Patient with Ebsteins Anomaly.
Villablanca PA, Shah AM, Briceno DF … +5 more , Zaidi AN, Chau M, Garcia MJ, Slovut D, Taub C
J Heart Valve Dis · 2017 Jan · PMID 28544841
Transcatheter valve-in-valve (VIV) implantation has been recently proposed as an alternative to surgical reoperative aortic valve replacement in patients with a failing aortic bioprosthesis. Experience with transcatheter...
Transcatheter valve-in-valve (VIV) implantation has been recently proposed as an alternative to surgical reoperative aortic valve replacement in patients with a failing aortic bioprosthesis. Experience with transcatheter VIV implantation at other valve positions is very limited. Herein is reported the case of an 18-year-old man with Ebstein's anomaly and severe tricuspid valve (TV) regurgitation status after bioprosthetic valve replacement, who developed new dyspnea on exertion three years after the initial valve replacement. Transesophageal echocardiography showed a severely dilated right atrium and new TV stenosis with an immobile leaflet. The patient underwent successful VIV implantation of a 29-mm SAPIEN XT bioprosthetic valve, with resolution of symptoms and no residual TV regurgitation or stenosis at the two-year follow up. Video 1: Degenerative bioprosthetic tricuspid valve. TEE showing the degenerative bioprosthetic tricuspid valve, and color Doppler during systole showing severe tricuspid regurgitation. Video 2: Degenerative bioprosthetic tricuspid valve. Three-dimensional TEE showing stenosis with an immobile leaflet creating a coaptation defect, viewed from the right atrium. Video 3: Transcatheter VIV replacement with a 29-mm Edwards SAPIEN XT deployed within the tricuspid valve prosthesis. Final result after valve implantation, demonstrating a patent valve orifice, and appropriate apposition of transcatheter valve within a pre-existing surgical Carpentier-Edwards bioprosthetic valve, viewed from the right ventricle. Video 4: Transcatheter VIV replacement with a 29-mm Edwards SAPIEN XT deployed within the tricuspid valve prosthesis. Final result after valve implantation, demonstrating a patent valve orifice, and appropriate apposition of transcatheter valve within a pre-existing surgical Carpentier-Edwards bioprosthetic valve, viewed from the right atrium.
Redo Tricuspid Valve Repair with Leaflet Augmentation Using the Left Atrial Wall.
Endo D, Kuwaki K, Yamamoto T … +1 more , Amano A
J Heart Valve Dis · 2017 Jan · PMID 28544840
The case is reported of a 79-year-old female who received a patch augmentation of the tricuspid anterior and septal leaflets with a resected left atrial wall to address recurrent tricuspid regurgitation, including tricus...
The case is reported of a 79-year-old female who received a patch augmentation of the tricuspid anterior and septal leaflets with a resected left atrial wall to address recurrent tricuspid regurgitation, including tricuspid valve tethering. The patient was admitted to the authors' hospital for chronic heart failure with paravalvular leakage after aortic valve replacement and recurrent severe tricuspid regurgitation. She had undergone two previous cardiac surgeries. Re-tricuspid repair required an augmentation of the tricuspid valve leaflets in addition to tricuspid annuloplasty. As the autologous pericardium was unsuitable for a patch due to thickened and stiffened changes, the decision was taken to use a left atrial wall resected to reduce the size of giant left atrium, which was thin and easy to handle. This is the first report of tricuspid leaflet augmentation using a patch derived from the left atrial wall, which is a useful method in patients where pericardium is not available.
Isolated Right Ventricular Apical Trabecular Hypoplasia: A Case Report.
Tan Q, Zi J, Zhu M … +1 more , Wang A
J Heart Valve Dis · 2017 Jan · PMID 28544839
Right ventricular (RV) hypoplasia with isolated myocardial disease and complete absence of RV trabeculae is a rare congenital heart disease, the current treatment of which is ineffective. Here, a rare case is presented o...
Right ventricular (RV) hypoplasia with isolated myocardial disease and complete absence of RV trabeculae is a rare congenital heart disease, the current treatment of which is ineffective. Here, a rare case is presented of a middle-aged female patient with RV hypoplasia complicated by tricuspid regurgitation, right atrial thrombus, and atrial fibrillation. The patient was treated with a one-and-a-half ventricular repair, and showed significant improvements in cardiac function and physical activity tolerance. The study results suggest that this surgical approach can significantly improve the prognosis of an adult patient with isolated RV hypoplasia.
Granulomatosis with Polyangiitis Presenting with Acute Aortic and Mitral Regurgitation: Case Report and Big-Data Analysis.
Al-Kindi SG, Amer Al-Aiti M, Yang M … +1 more , Josephson RA
J Heart Valve Dis · 2017 Jan · PMID 28544838
Granulomatosis with polyangiitis (GPA) is a rare vasculitis that can have multisystem involvement, though cardiac involvement is very rare. The case is described of a 53-year-old woman who presented with acute aortic and...
Granulomatosis with polyangiitis (GPA) is a rare vasculitis that can have multisystem involvement, though cardiac involvement is very rare. The case is described of a 53-year-old woman who presented with acute aortic and mitral valve regurgitation requiring surgical intervention. Pathology from the excised aortic valve showed geographic necrosis concerning for GPA. Subsequent rheumatologic testing was positive for anti-serine proteinase 3 (PR3) antibody, consistent with GPA. A year after the valve surgery the patient was found to have a vegetation of the mitral valve and elevated PR3 antibody levels, and was successfully treated with an intensification of immunosuppression. The cardiac involvement of GPA is discussed and big data analyzed to identify the epidemiology of valvular involvement. In conclusion, GPA can have multiple different valvular manifestations with a high recurrence rate. GPA should be considered in patients who present with acute valvular disease without any clear precipitant.
Candida Endocarditis: A Review of Twelve Episodes in Eleven Patients.
Lejko Zupanc T, Logar M
J Heart Valve Dis · 2017 Jan · PMID 28544837
BACKGROUND: Candida spp. are a rare but important cause of infective endocarditis. The study aim was to describe pertinent clinical data on consecutive patients with Candida endocarditis treated at a tertiary referral ce...
BACKGROUND: Candida spp. are a rare but important cause of infective endocarditis. The study aim was to describe pertinent clinical data on consecutive patients with Candida endocarditis treated at a tertiary referral center between 1984 and 2013. METHODS: A retrospective search of the authors' endocarditis database was performed and the medical records of patients with confirmed Candida endocarditis were reviewed. Important data relating to demographics, medical history and clinical data, as well as information on outcome and treatment, were extracted. RESULTS: Between 1984 and 2013, a total of 12 episodes of Candida endocarditis in 11 patients (age range: 18 to 85 years) were treated at the authors' department (1.6% of all endocarditis episodes). Prosthetic valve endocarditis (PVE) was present in six patients. In 72% of cases the infection was healthcare-acquired. Endocarditis was shown to occur from 30 days to more than 600 days after cardiovascular surgery. Six patients were surgically treated. All removed valves were microbiologically positive, despite previous antifungal treatment. One patient with two episodes of Candida parapsilosis PVE was successfully treated conservatively, as was one patient with polymicrobial liver abscess, fungal spondylodiscitis and vegetation on the aortic valve. The total mortality rate was 45%. CONCLUSIONS: Candida endocarditis has a high mortality, and because of its rare occurrence it is difficult to define the most appropriate treatment. There may be a considerable time lag between cardiovascular surgery and the advent of endocarditis.
Aortic Valve Replacement with the Labcor TLPB Supra Porcine Bioprosthesis: Intermediate Clinical and Echocardiographic Outcomes.
Schlömicher M, Taghiyev Z, Al-Jabery Y … +6 more , Lukas Haldenwang P, Markthaler L, Moustafine V, Maria Laczkovics A, Thomas Strauch J, Bechtel M
J Heart Valve Dis · 2017 Jan · PMID 28544836
BACKGROUND: The Labcor TBLP Supra™ prosthesis is a second-generation tissue valve that has evolved from the Labcor TBLP™ prosthesis, first introduced in 1984. The Supra prosthesis is a triple-composite porcine valve, wit...
BACKGROUND: The Labcor TBLP Supra™ prosthesis is a second-generation tissue valve that has evolved from the Labcor TBLP™ prosthesis, first introduced in 1984. The Supra prosthesis is a triple-composite porcine valve, with no specific anticalcification treatment being used in its production other than standard tissue fixation with 0.4% glutaraldehyde. To date, more than 100,000 Supra valves have been implanted, mainly in South America. Despite this remarkably high number of implants, only marginal data exist concerning durability and safety issues. Hence, the study aim was to analyze short-term and intermediate outcomes relating to the clinical and hemodynamic performance of the Supra valve, as well as complication rates METHODS: A follow up study was initiated to evaluate outcomes and durability of the Labcor Supra prosthesis. Between September 2004 and October 2010, a total of 331 patients (mean age 75.8 ± 7.2 years; mean logistic EuroSCORE 8.5 ± 2.3%) underwent aortic valve replacement using the Supra porcine bioprosthesis. RESULTS: The 30-day mortality rate was 4.8% (n = 16). The overall actuarial five-year survival was 72.3 ± 4.9%, and eight-year survival was 60.4 ± 5.6%. Actuarial freedom from reoperation was 96.3 ± 2.4% after five years, and 92.5 ± 3.5% after eight years. Actuarial freedom from structural valve deterioration (SVD) was 99.7 ± 0.3% at five years, and 97.2 ± 0.8% at eight years; actuarial freedom from thromboembolism was 97.5 ± 1.0% and 95.7 ± 1.6% at these times. Actuarial freedom from event rates for endocarditis were 99.5 ± 0.3% and 96.8 ± 0.6%, and 96.1 ± 0.9% and 93.0 ± 1.4% for reoperation CONCLUSIONS: No evidence was found of increased rates of SVD. All parameters studied were comparable to those examined for other second-generation porcine prostheses. Further long-term follow up investigations are required however, for the final judgment of this prosthesis.
Leaflet Mechanical Properties of Carpentier-Edwards Perimount Magna Pericardial Aortic Bioprostheses.
Kuang H, Xuan Y, Lu M … +5 more , Mookhoek A, Wisneski AD, Guccione JM, Ge L, Tseng EE
J Heart Valve Dis · 2017 Jan · PMID 28544835
BACKGROUND: Transcatheter aortic valve replacement (TAVR) has recently been shown to be equivalent to surgical aortic valve replacement (SAVR) in intermediate-risk patients. As TAVR expands towards the traditionally SAVR...
BACKGROUND: Transcatheter aortic valve replacement (TAVR) has recently been shown to be equivalent to surgical aortic valve replacement (SAVR) in intermediate-risk patients. As TAVR expands towards the traditionally SAVR population, TAVR versus SAVR durability becomes increasingly important. While the durability of TAVR is unknown, valve design - particularly with regards to leaflet stress - impacts on valve durability. Although leaflet stress cannot be measured directly, it can be determined using finite element modeling, with such models requiring the mechanical properties of the leaflets. Balloon-expandable TAVR involves the use of bovine pericardial leaflets treated in the same manner as surgical bioprosthetic leaflets. The study aim was to determine the leaflet mechanical properties of Carpentier-Edwards bioprostheses for future TAVR and SAVR computational models. METHODS: A total of 35 leaflets were excised from 12 Carpentier-Edwards Model 3000TFX Perimount Magna aortic bioprostheses (21 mm, 23 mm, and 25 mm) and subjected to displacement-controlled equibiaxial stretch testing. The stress-strain data acquired were fitted to a Fung constitutive model to describe the material properties in circumferential and radial directions. Leaflet stiffness was calculated at specified physiological stress, corresponding to zero pressure, systemic pressure, and between zero and systemic pressure. RESULTS: The 21-mm bioprostheses had significantly thinner leaflets than the larger bioprostheses. A non-linear stress-strain relationship was observed in all leaflets along the circumferential and radial directions. No significant difference in leaflet stiffness at systemic pressure, or between zero and systemic pressure, was found among the three bioprosthesis sizes. However, the leaflets from the 23 mm bioprosthesis were significantly more compliant than those of the 21 mm and 25 mm bioprostheses at zero pressure in the circumferential direction. No differences were observed in leaflet stiffness in circumferential versus radial directions. CONCLUSIONS: The bovine pericardial leaflets from Carpentier-Edwards Perimount Magna bioprostheses showed no differences in material properties among different valve sizes at systemic pressure. The thinner 21 mm leaflets did not show any corresponding differences in leaflet stiffness, which suggests that the thinner TAV leaflets may have a similar stiffness to their thicker SAV counterparts.
In-Vitro Pulsatile Flow Measurement in Prosthetic Heart Valves: An Inter-Laboratory Comparison.
Retta SM, Kepner J, Marquez S … +3 more , Herman BA, S Shu MC, Grossman LW
J Heart Valve Dis · 2017 Jan · PMID 28544834
BACKGROUND AND AIM OF STUDY: One of the first steps in qualifying a new prosthetic valve for eventual clinical use is preclinical flow performance testing in vitro. Such testing is typically performed in an in-vitro test...
BACKGROUND AND AIM OF STUDY: One of the first steps in qualifying a new prosthetic valve for eventual clinical use is preclinical flow performance testing in vitro. Such testing is typically performed in an in-vitro test system that simulates the pumping mechanics of the left ventricle of the heart, generally referred to as a pulse duplicator or duplicator. Historically, test results in these systems have varied from duplicator to duplicator. This collaborative effort between heart valve manufacturers and the Food and Drug Administration (FDA) was designed to evaluate the variability of the pulse duplicator test technology for pulsatile flow performance measurement in an interlaboratory round robin. METHODS: The participants jointly developed and followed a limited test protocol based on accepted methods outlined in the International Standards Organization 5840: Cardiovascular Implants - Cardiac Valve Prostheses, and in the FDA Replacement Heart Valve Guidance. One 25 mm valve, each of four basic designs, was circulated to test centers which included four manufacturers and two FDA duplicators. The pressure drop and regurgitation data were then collected and summarized by the FDA. RESULTS: Considerable variation was observed in hydrodynamic performance measures of pressure drop across the valve and back flow leakage through the valve among the different duplicators. Despite the variations seen in these measures, the results from all centers showed that the valves conformed to certain minimum performance criteria. CONCLUSIONS: Despite the fact that the valves would have been judged to have met Minimum Performance Requirements of effective orifice area and regurgitant fraction, as specified in the international standard, variations in measurements existed among duplicators. Valve manufacturers should use a reference valve of similar design in hydrodynamic performance testing to assess the individual measurement conditions in the duplicator.
How Heart Valves Evolve to Adapt to an Extreme-Pressure System: Morphologic and Biomechanical Properties of Giraffe Heart Valves.
Amstrup Funder J, Christian Danielsen C, Baandrup U … +5 more , Martin Bibby B, Carl Andelius T, Toft Brøndum E, Wang T, Michael Hasenkam J
J Heart Valve Dis · 2017 Jan · PMID 28544833
BACKGROUND: Heart valves which exist naturally in an extreme-pressure system must have evolved in a way to resist the stresses of high pressure. Giraffes are interesting as they naturally have a blood pressure twice that...
BACKGROUND: Heart valves which exist naturally in an extreme-pressure system must have evolved in a way to resist the stresses of high pressure. Giraffes are interesting as they naturally have a blood pressure twice that of humans. Thus, knowledge regarding giraffe heart valves may aid in developing techniques to design improved pressure-resistant biological heart valves. METHODS: Heart valves from 12 giraffes and 10 calves were explanted and subjected to either biomechanical or morphological examinations. Strips from the heart valves were subjected to cyclic loading tests, followed by failure tests. Thickness measurements and analyses of elastin and collagen content were also made. Valve specimens were stained with hematoxylin and eosin, elastic van Gieson stain, Masson's trichrome and Fraser-Lendrum stain, as well as immunohistochemical reactions for morphological examinations. RESULTS: The aortic valve was shown to be 70% (95% CI 42-103%) stronger in the giraffe than in its bovine counterpart (p <0.001). No significant difference was found between mitral or pulmonary valves. After normalization for collagen, no significant differences were found in strength between species. The giraffe aortic valve was found to be significantly stiffer than the bovine aortic valve (p <0.001), with no significant difference between mitral and pulmonary valves. On a dry weight basis, the aortic (10.9%), pulmonary (4.3%), and mitral valves (9.6%) of giraffes contained significantly more collagen than those of calves. The elastin contents of the pulmonary valves (2.5%) and aortic valves (1.5%) were also higher in giraffes. CONCLUSIONS: The greater strength of the giraffe aortic valve is most likely due to a compact collagen construction. Both, collagen and elastin contents were higher in giraffes than in calves, which would make giraffe valves more resistant to the high-pressure forces. However, collagen also stiffens and thickens the valves. The mitral leaflets showed similar (but mostly insignificant) trends in strength, stiffness, and collagen content.
Percutaneous Antegrade Trans-Septal Closure of Mitral Paravalvular Leak without Creation of an Arteriovenous Wire Loop in Patients with Coexistent Mechanical Aortic Valve.
Kilic T, Coskun S, Karauzum K … +2 more , Yavuz S, Sahin T
J Heart Valve Dis · 2017 Jan · PMID 28544832
BACKGROUND: Various approaches such as antegrade trans-septal, retrograde transfemoral and transapical techniques have been used to close mitral paravalvular leak (PVL) in patients with an aortic prosthesis. During the i...
BACKGROUND: Various approaches such as antegrade trans-septal, retrograde transfemoral and transapical techniques have been used to close mitral paravalvular leak (PVL) in patients with an aortic prosthesis. During the implementation of these techniques, an arteriovenous guidewire loop is often created for device delivery. However, passing through a mechanical aortic valve may cause hemodynamic compromise and prolong the procedure. To date, no studies have evaluated antegrade mitral PVL closure without the use of an arteriovenous wire loop in patients with a mechanical aortic prosthesis. Herein is described a different mitral PVL closure technique by means of a trans-septal approach without construction of an arteriovenous guidewire loop in this type of patient. METHODS: Four patients (two males, two females; mean age 57 ± 10 years; range: 46-67 years) with severe mitral PVL and a mechanical aortic prosthesis were referred for percutaneous closure of a mitral PVL. All patients underwent antegrade trans-septal mitral PVL closure without the creation of an arteriovenous wire loop. Data prospectively collected included assessments from preoperative and postoperative two- and three-dimensional transesophageal echocardiography (TEE). RESULTS: Preoperative TEE demonstrated severe mitral PVL in all four patients. All patients experienced a substantial reduction in symptoms associated with the marked reduction in PVL following repair. There were no procedural complications. The median procedural time was 113 min (range: 50-145 min) and median fluoroscopy time was 23 min (range: 17-25 min). CONCLUSIONS: An alternative, safe, effective and efficient mitral PVL closure approach in patients with a mechanical aortic prosthesis has been devised. This technique can prevent aortic valve dysfunction, reduce costs, and also decrease complication rates.
Aortic Root Surgery in Marfan Syndrome: Medium-Term Outcome in a Single-Center Experience.
Attenhofer Jost CH, Connolly HM, Scott CG … +3 more , Ammash NM, Bowen JM, Schaff HV
J Heart Valve Dis · 2017 Jan · PMID 28544831
BACKGROUND: The study aim was to analyze the authors' experience with aortic root surgery in Marfan syndrome (MFS), and to expand the surgical outcome data of patients meeting the Ghent criteria (Marfan registry). METHOD...
BACKGROUND: The study aim was to analyze the authors' experience with aortic root surgery in Marfan syndrome (MFS), and to expand the surgical outcome data of patients meeting the Ghent criteria (Marfan registry). METHODS: Analyses were performed of data acquired from MFS patients (who met the Ghent criteria), including an aortic root surgery and Kaplan-Meier survival. RESULTS: Between April 2004 and February 2012, a total of 59 MFS patients (mean age at surgery 36 ± 13 years) underwent 67 operations for aortic root aneurysm (n = 52), aortic valve (AV) regurgitation (n = 15), acute aortic dissection (n = 2), and/or mitral valve (MV) regurgitation resulting from MV prolapse (n = 7). Of 59 initial operations, 21 (36%) involved AV-replacing root surgery, 38 (64%) AV-sparing root surgery, seven (12%) aortic arch or hemi-arch repair, and five (8%) simultaneous MV surgery. There were no early mortalities. The mean follow up was 6.8 ± 1.2 years, with five deaths (8%) and a relatively low reoperation rate (10 reoperations in nine patients; 14%). Seven reoperations involved AV or aortic root surgery (including four for AV regurgitation following failed AV-sparing surgery), two MV repair/replacements, and one coronary artery bypass graft. Eight patients (21%) with AV-sparing surgery had moderate/severe AV regurgitation at the last follow up before re-intervention. The mean five-year freedom from postoperative death was 91.2 ± 8.8%, from cardiac reoperation 86.3 ± 4.5%, and more-than-moderate AV regurgitation 90.3 ± 4.8%. CONCLUSIONS: Prophylactic aortic surgery in MFS patients with AV-replacing root or AV-sparing root surgery carries a low risk of operative morbidity and death when performed at an experienced center. AV-sparing root surgery increases the risk of AV regurgitation and, possibly, of re-intervention. Regular clinical follow up is important after any aortic root surgery in MFS patients, with a delineation of risk factors for AV regurgitation after AV rootsparing surgery.
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