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International Heart Journal 2016Survival rate in patients with stage D heart failure has improved significantly owing to the development of continuous flow left ventricular assist devices (LVAD), but... (Review)
Review
Survival rate in patients with stage D heart failure has improved significantly owing to the development of continuous flow left ventricular assist devices (LVAD), but aortic insufficiency (AI) still remains one of the major unsolved complications that impairs patient quality of life. There are no established treatments for AI, and preoperative prediction and prevention of AI is needed. The opening of a native aortic valve (AV) is a sufficient condition for prevention of AI, and improvement of LV ejection fraction due to LV reverse remodeling (LVRR) is essential to open a native AV. Preoperative insufficient β-blocker treatment and pulsatile flow LVAD usage are keys for LVRR, opening of an AV, and prevention of AI. The second mechanism that leads to AI is remodeling of the aortic root and degeneration of a native AV, which results from reduced pulse pressure during LVAD support. Centrifugal or pulsatile flow LVAD usage has an advantage in terms of preserving pulsatility, and may prevent AI compared with an axial pump. There is less probability of avoiding AI with sufficient β-blocker treatment, and these patients may be good candidates for concomitant surgical intervention to a native AV at the time of LVAD implantation.
Topics: Aortic Valve Insufficiency; Echocardiography; Heart Failure; Heart-Assist Devices; Hemodynamics; Humans; Intraoperative Complications; Preoperative Period; Prognosis
PubMed: 26742702
DOI: 10.1536/ihj.15-250 -
The Journal of Invasive Cardiology May 2022There are limited invasive treatment options for patients with end-stage heart failure and left ventricular assist device (LVAD) who develop severe aortic valve...
BACKGROUND
There are limited invasive treatment options for patients with end-stage heart failure and left ventricular assist device (LVAD) who develop severe aortic valve regurgitation (AR). One option for such patients is transcatheter aortic valve replacement (TAVR). There are limited data on outcomes of patients with LVAD who receive TAVR for severe AR. We present a series of 4 consecutive patients with LVAD who underwent TAVR for severe AR.
METHODS AND RESULTS
This is a retrospective chart review of 4 consecutive patients with LVAD who underwent TAVR for severe AR. All 4 patients underwent TAVR with a 34-mm self-expanding valve (Medtronic). One patient received a 29-mm balloon-expandable valve (Edwards Lifesciences) within the self-expanding valve (SEV) to postdilate the SEV and minimize paravalvular leak (PVL). All 4 procedures were technically successful. The patient who received rescue valve-in-valve TAVR continued to have persistent mild to moderate PVL.
CONCLUSION
Although technically challenging, TAVR is a feasible option for carefully selected LVAD patients with severe AR. Procedural issues to consider include oversizing the transcatheter heart valve (THV) while being cognizant of the risks of annular rupture and valve dislocation, anticipating and avoiding ventricular migration of the THV and being ready to postdilate the THV if necessary, to limit hemodynamically significant PVL.
Topics: Aortic Valve; Aortic Valve Insufficiency; Aortic Valve Stenosis; Cardiac Catheterization; Heart Valve Prosthesis; Heart-Assist Devices; Humans; Prosthesis Design; Retrospective Studies; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 35343915
DOI: No ID Found -
The Journal of Thoracic and... Jul 2017
Topics: Aortic Valve Insufficiency; Aortic Valve Stenosis; Humans; Transcatheter Aortic Valve Replacement
PubMed: 28438324
DOI: 10.1016/j.jtcvs.2017.03.113 -
European Journal of Cardio-thoracic... Aug 2022
Topics: Aortic Valve; Aortic Valve Insufficiency; Humans; Treatment Outcome
PubMed: 35894653
DOI: 10.1093/ejcts/ezac402 -
Arthritis Research & Therapy May 2022Aortic valve involvement is not uncommon in patients with Takayasu arteritis (TAK) and leading to poor prognosis. The aim of our study was to explore the risk factors of...
OBJECTIVE
Aortic valve involvement is not uncommon in patients with Takayasu arteritis (TAK) and leading to poor prognosis. The aim of our study was to explore the risk factors of aortic valve involvement and to evaluate the prognosis in TAK patients with aortic valve involvement.
METHOD
In this retrospective study, 172 TAK patients were divided into groups with or without aortic valve involvement to identify the risk factors. Patients who underwent aortic valve surgical treatment were followed up to assess cumulative incidence of postoperative adverse events.
RESULTS
A total of 92 TAK patients (53.49%) had aortic valvular lesion. The infiltration of inflammatory cells was found in surgical specimens of aortic valve. Numano type IIb, elevated high-sensitivity C-reactive protein (hs-CRP) level, and dilation of ascending aorta and aortic root were statistically associated with aortic valvular lesion in TAK patients (OR [95%CI] 6.853 [1.685-27.875], p=0.007; 4.896 [1.646-14.561], p=0.004; 4.509 [1.517-13.403], p=0.007; 9.340 [2.188-39.875], p=0.003). The 1-, 5-, and 7-year cumulative incidence of postoperative adverse events were 14.7%, 14.7%, and 31.8%, respectively. Surgical methods (p=0.024, hazard ratio (HR) 0.082) and postoperatively anti-inflammatory therapy (p=0.036, HR 0.144) were identified as potential predictors of postoperative adverse events.
CONCLUSIONS
Regularly echocardiogram screening is suggested in patients with Numano type IIb and aggressive treatment should be performed early in TAK patients. As for TAK patients with aortic valve surgery, aortic root replacement seems to be the preferred option and regular anti-inflammatory therapy may reduce the occurrence of adverse events of them.
Topics: Aortic Valve; Aortic Valve Insufficiency; Humans; Prognosis; Retrospective Studies; Risk Factors; Takayasu Arteritis
PubMed: 35526024
DOI: 10.1186/s13075-022-02788-9 -
The Journal of Thoracic and... Apr 2018The aim of the study was to evaluate operative techniques and long-term results after aortic valve or root repair in patients aged 75 years or more.
OBJECTIVES
The aim of the study was to evaluate operative techniques and long-term results after aortic valve or root repair in patients aged 75 years or more.
METHODS
Between November 2002 and January 2016, a total of 815 patients underwent aortic valve or root repair. Among them were 100 patients aged 75 years or more (mean, 78 ± 3; range, 75-88 years), including 17 patients operated on an emergency basis because of acute aortic dissection. None/trivial, mild, moderate, and severe insufficiency grades were presented in 9, 23, 27, and 41 patients, respectively. The surgery comprised root repair, cusp repair, and a combination of both in 45, 16, and 39 patients, respectively.
RESULTS
Early (30-day) mortality and the rate of permanent neurologic deficit were 2% for each. The follow-up was 99% complete, resulting in 427 patient/years. During the follow-up period (mean duration, 4.3 ± 3.2; range, 0.02-11.1 years), only 1 patient developed a relevant aortic insufficiency and required aortic valve reoperation. There were 24 late deaths, which occurred on average 50.0 ± 40.6 months (range, 2.4-135.0) after surgery at the average patient age of 82 ± 5 years (range, 75-90). Estimated survival at 5 and 8 years was 76.4% ± 5.1% and 71.3% ± 5.9%, respectively, and was similar to those of the sex- and age-matched general population.
CONCLUSIONS
Reconstructive aortic valve surgery is a suitable and justifiable surgical option in selected elderly patients undergoing operation by surgeons with considerable experience in this kind of surgery. It offers low cardiac and valve-related mortality and morbidity, leading to life expectancy applicable to the patients' ages.
Topics: Age Factors; Aged; Aged, 80 and over; Aortic Valve; Aortic Valve Insufficiency; Cardiac Surgical Procedures; Echocardiography, Doppler, Color; Echocardiography, Transesophageal; Female; Hospital Mortality; Humans; Male; Postoperative Complications; Prospective Studies; Plastic Surgery Procedures; Risk Factors; Severity of Illness Index; Time Factors; Treatment Outcome
PubMed: 29342427
DOI: 10.1016/j.jtcvs.2017.11.096 -
The Journal of Thoracic and... Jan 2019The study objective was to examine the long-term results of the Ross procedure in a cohort of patients followed prospectively for more than 2 decades.
OBJECTIVE
The study objective was to examine the long-term results of the Ross procedure in a cohort of patients followed prospectively for more than 2 decades.
METHODS
From 1990 to 2004, 212 consecutive patients with a median age (interquartile range) of 34 years (28-41) underwent the Ross procedure; 82% had congenital aortic valve disease. The technique of aortic root replacement was used in one half of the patients. Patients have been followed prospectively for a median (interquartile range) of 18.0 (14.6-21.2) years. Valve function was assessed by echocardiography.
RESULTS
Cumulative mortality at 20 years was 10.8% (95% confidence interval, 6.5-17.8). Thirty patients required Ross-related reoperations and 3 for coronary artery disease. The cumulative probability of Ross-related reoperations at 20 years was 16.8% (95% confidence interval, 11.3-24.5), on the pulmonary autograft was 11.5% (95% confidence interval, 7.2-18.0), and on the pulmonary homograft was 8.2% (4.6-14.7). The implantation technique was not associated with the cumulative incidence of reoperations on the pulmonary autograft. The development of moderate or severe aortic insufficiency and pulmonary homograft dysfunction increased with time. At 20 years, the probability of aortic insufficiency was 13% (95% confidence interval, 8.0-20.3) and of pulmonary homograft dysfunction was 19.7% (95% confidence interval, 13.9-27.2). Preoperative aortic insufficiency was associated with increased odds of postoperative aortic insufficiency.
CONCLUSIONS
The long-term results of the Ross procedure are excellent regardless of the implantation technique, but there is a progressive deterioration of function of both semilunar valves.
Topics: Adolescent; Adult; Allografts; Aortic Valve; Aortic Valve Insufficiency; Autografts; Echocardiography; Female; Humans; Male; Middle Aged; Pulmonary Valve; Reoperation; Time Factors; Treatment Outcome; Young Adult
PubMed: 30104067
DOI: 10.1016/j.jtcvs.2018.06.037 -
The Journal of Thoracic and... Feb 2022The objective was to design and evaluate a clinically relevant, novel ex vivo bicuspid aortic valve model that mimics the most common human phenotype with associated...
OBJECTIVE
The objective was to design and evaluate a clinically relevant, novel ex vivo bicuspid aortic valve model that mimics the most common human phenotype with associated aortic regurgitation.
METHODS
Three bovine aortic valves were mounted asymmetrically in a previously validated 3-dimensional-printed left heart simulator. The non-right commissure and the non-left commissure were both shifted slightly toward the left-right commissure, and the left and right coronary cusps were sewn together. The left-right commissure was then detached and reimplanted 10 mm lower than its native height. Free margin shortening was used for valve repair. Hemodynamic status, high-speed videography, and echocardiography data were collected before and after the repair.
RESULTS
The bicuspid aortic valve model was successfully produced and repaired. High-speed videography confirmed prolapse of the fused cusp of the baseline bicuspid aortic valve models in diastole. Hemodynamic and pressure data confirmed accurate simulation of diseased conditions with aortic regurgitation and the subsequent repair. Regurgitant fraction postrepair was significantly reduced compared with that at baseline (14.5 ± 4.4% vs 28.6% ± 3.4%; P = .037). There was no change in peak velocity, peak gradient, or mean gradient across the valve pre- versus postrepair: 293.3 ± 18.3 cm/sec versus 325.3 ± 58.2 cm/sec (P = .29), 34.3 ± 4.2 mm Hg versus 43.3 ± 15.4 mm Hg (P = .30), and 11 ± 1 mm Hg versus 9.3 ± 2.5 mm Hg (P = .34), respectively.
CONCLUSIONS
An ex vivo bicuspid aortic valve model was designed that recapitulated the most common human phenotype with aortic regurgitation. These valves were successfully repaired, validating its potential for evaluating valve hemodynamics and optimizing surgical repair for bicuspid aortic valves.
Topics: Animals; Aortic Valve Insufficiency; Bicuspid Aortic Valve Disease; Cardiovascular Surgical Procedures; Cattle; Echocardiography; Hemodynamics; Humans; Models, Anatomic
PubMed: 32747120
DOI: 10.1016/j.jtcvs.2020.06.028 -
Archives of Cardiovascular Diseases Feb 2023Transcatheter aortic valve implantation now has a major role in the treatment of patients with severe aortic stenosis. However, evidence is scarce on its feasibility and... (Observational Study)
Observational Study
BACKGROUND
Transcatheter aortic valve implantation now has a major role in the treatment of patients with severe aortic stenosis. However, evidence is scarce on its feasibility and safety to treat patients with pure aortic regurgitation.
AIMS
We sought to evaluate the results of transcatheter aortic valve implantation using the balloon-expandable SAPIEN 3 transcatheter heart valve (Edwards Lifesciences, Irvine, CA, USA) in patients with pure aortic regurgitation on native non-calcified valves.
METHODS
We conducted a retrospective and prospective French multicentre observational study. We included all patients with symptomatic severe pure aortic regurgitation on native non-calcified valves, contraindicated to or at high risk for surgical valve replacement, who underwent transcatheter aortic valve implantation using the SAPIEN 3 transcatheter heart valve.
RESULTS
A total of 37 patients (male sex, 73%) with a median age of 81years (interquartile range 69-85years) were screened using transthoracic echocardiography and computed tomography and were included at eight French centres. At baseline, 83.8% of patients (n=31) had dyspnoea New York Heart Association class≥III. The device success rate was 94.6% (n=35). At 30days, the all-cause mortality rate was 8.1% (n=3) and valve migration occurred in 10.8% of cases (n=4). Dyspnoea New York Heart Association class≤II was seen in 86.5% of patients (n=32), and all survivors had aortic regurgitation grade≤1. At 1-year follow-up, all-cause mortality was 16.2% (n=6), 89.7% (n=26/29) of survivors were in New York Heart Association class≤II and all had aortic regurgitation grade≤2.
CONCLUSION
Transcatheter aortic valve implantation using the SAPIEN 3 transcatheter heart valve seems promising to treat selected high-risk patients with pure aortic regurgitation on non-calcified native valves, contraindicated to surgical aortic valve replacement.
Topics: Humans; Male; Aged; Aged, 80 and over; Transcatheter Aortic Valve Replacement; Aortic Valve Insufficiency; Aortic Valve Stenosis; Retrospective Studies; Prospective Studies; Treatment Outcome; Aortic Valve; Heart Valve Prosthesis; Prosthesis Design
PubMed: 36707263
DOI: 10.1016/j.acvd.2022.12.003 -
JACC. Cardiovascular Imaging Oct 2022
Topics: Aortic Valve Insufficiency; Echocardiography; Humans; Mitral Valve Insufficiency; Predictive Value of Tests; Severity of Illness Index
PubMed: 36202452
DOI: 10.1016/j.jcmg.2022.07.007