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Circulation Feb 2024
Topics: Humans; Aortic Valve; Incidence; Heart Valve Prosthesis; Aortic Valve Stenosis; Aorta
PubMed: 38408150
DOI: 10.1161/CIRCULATIONAHA.123.067816 -
The Journal of Invasive Cardiology Sep 2023A 78-year-old woman with a background of hypertension and osteoarthritis presented with a history of syncope secondary to severe aortic stenosis. She underwent a...
A 78-year-old woman with a background of hypertension and osteoarthritis presented with a history of syncope secondary to severe aortic stenosis. She underwent a computed tomography (CT) scan that showed a heavily calcific trileaflet aortic valve.
Topics: Female; Humans; Aged; Aortic Valve Stenosis; Aortic Valve; Transcatheter Aortic Valve Replacement; Calcinosis
PubMed: 37983111
DOI: 10.25270/jic/22.00363 -
The Journal of Thoracic and... Oct 2023Increasing use of bioprostheses for surgical aortic valve replacement (SAVR) in younger patients, together with wider use of transcatheter aortic valve replacement,...
OBJECTIVE
Increasing use of bioprostheses for surgical aortic valve replacement (SAVR) in younger patients, together with wider use of transcatheter aortic valve replacement, necessitates understanding risks associated with surgical valve reintervention. Therefore, we sought to identify risks of reoperative SAVR compared with those of primary isolated SAVR.
METHODS
From January 1980 to July 2017, 7037 patients underwent nonemergency isolated SAVR, with 753 reoperations and 6284 primary isolated operations. These 2 groups were propensity score-matched on 46 preoperative variables, yielding 581 patient pairs for comparing outcomes.
RESULTS
Among propensity score-matched patients, aortic clamp time (median 63 vs 52 minutes; P < .0001), cardiopulmonary bypass time (median 88 vs 67 minutes; P < .0001), and postoperative stay (median 7.1 vs 6.9 days; P = .003) were longer for reoperative SAVR than primary isolated SAVR. Hospital mortality after reoperative SAVR decreased from 3.4% in 1985 to 1.3% in 2011, similar to that of primary isolated SAVR. Occurrence of stroke, deep sternal wound infection, and new renal dialysis was similar. Blood transfusion (67% vs 36%; P < .0001) and reoperations for bleeding/tamponade (6.4% vs 3.1%; P = .009) were more common after reoperative SAVR. Survival at 1, 5, 10, and 20 years was 94%, 82%, 64%, and 33% after reoperative SAVR and 95%, 86%, 72%, and 46% after elective primary isolated SAVR.
CONCLUSIONS
Risk of mortality and morbidity after reoperative SAVR has declined and is now similar to that of primary isolated SAVR. Decisions regarding prosthesis choice and SAVR versus transcatheter aortic valve replacement should be made in the context of lifelong disease management rather than avoidance of reoperation.
Topics: Humans; Aortic Valve; Heart Valve Prosthesis Implantation; Reoperation; Aortic Valve Stenosis; Treatment Outcome; Transcatheter Aortic Valve Replacement; Risk Factors
PubMed: 35397951
DOI: 10.1016/j.jtcvs.2022.02.052 -
The Journal of Thoracic and... Oct 2023There is controversy on how to address mild aortic root dilation during concomitant aortic valve replacement: composite aortic valve conduit replacement or separate... (Review)
Review
OBJECTIVE
There is controversy on how to address mild aortic root dilation during concomitant aortic valve replacement: composite aortic valve conduit replacement or separate ascending aorta and aortic valve replacement. We reviewed our experience to address the issue.
METHODS
We retrospectively reviewed 778 adult nonsyndromic patients with aortic root diameter 55 mm or less who received replacement of the ascending aorta and aortic valve from January 1994 to June 2017. Patients were divided into 2 groups based on the type of aortic root intervention: composite aortic valve conduit replacement in 406 patients (52%) and separate ascending aorta and aortic valve replacement in 372 patients (48%). Propensity matching was used to mitigate differences in baseline patient characteristics and produced 188 matched pairs.
RESULTS
Sinus of Valsalva diameter was 43 mm (39-47). Operative mortality occurred in 3 patients (2%) in the composite aortic valve conduit replacement group and in 5 patients (3%) in the separate ascending aorta and aortic valve replacement group (P = .470). Median follow-up was 9.6 years (8.4-10.1). Long-term mortality was similar in the 2 groups (P = .083). Repeat operation was performed in 13 patients (7%) in the composite aortic valve conduit replacement group and in 19 patients (10%) in the separate ascending aorta and aortic valve replacement group (P = .365). Sinus of Valsalva diameter decreased 2 mm (-4-0; median follow-up 41 months) in the propensity-matched separate ascending aorta and aortic valve replacement group.
CONCLUSIONS
In patients with mild aortic root dilation, separate ascending aorta and aortic valve replacement results in a similar risk of repeat operation and mortality in comparison with composite aortic valve replacement. Separate ascending aorta and aortic valve replacement is not associated with subsequent aortic root dilation on medium-term echocardiography follow-up.
Topics: Adult; Humans; Aortic Valve; Aorta, Thoracic; Retrospective Studies; Treatment Outcome; Aorta; Heart Valve Prosthesis Implantation; Dilatation, Pathologic
PubMed: 35863966
DOI: 10.1016/j.jtcvs.2022.03.044 -
The Thoracic and Cardiovascular Surgeon Dec 2023Transcatheter aortic valve replacement (TAVR) for a degenerated surgical bioprosthesis (valve-in-valve [ViV]) has become an established procedure. Elevated gradients and...
BACKGROUND
Transcatheter aortic valve replacement (TAVR) for a degenerated surgical bioprosthesis (valve-in-valve [ViV]) has become an established procedure. Elevated gradients and patient-prosthesis mismatch (PPM) have previously been reported in mixed TAVR cohorts. We analyzed our single-center experience using the third-generation self-expanding Medtronic Evolut R prosthesis, with an emphasis on the incidence and outcomes of PPM.
METHODS
This is a retrospective analysis of prospectively collected data from our TAVR database. Intraprocedural and intrahospital outcomes are reported.
RESULTS
Eighty-six patients underwent ViV-TAVR with the Evolut R prosthesis. Mean age was 75.5 ± 9.5 years, 64% were males. The mean log EuroScore was 21.6 ± 15.7%. The mean time between initial surgical valve implantation and ViV-TAVR was 8.8 ± 3.2 years. The mean true internal diameter of the implanted surgical valves was 20.9 ± 2.2 mm. Post-AVR, 60% had no PPM, 34% had moderate PPM, and 6% had severe PPM. After ViV-TAVR, 33% had no PPM, 29% had moderate, and 39% had severe PPM. After implantation, the mean transvalvular gradient was reduced significantly from 36.4 ± 15.2 to 15.5 ± 9.1 mm Hg ( < 0.001). No patient had more than mild aortic regurgitation after ViV-TAVR. No conversion to surgery was necessary. Estimated Kaplan-Meier survival at 1 year for all patients was 87.4%. One-year survival showed no significant difference according to post-ViV PPM groups ( = 0.356).
CONCLUSION
ViV-TAVR using a supra-annular valve resulted in low procedural and in-hospital complication rates. However, moderate or severe PPM was common, with no influence on short-term survival. PPM may not be a suitable factor to predict survival after ViV-TAVR.
Topics: Male; Humans; Aged; Aged, 80 and over; Female; Aortic Valve; Heart Valve Prosthesis Implantation; Heart Valve Prosthesis; Aortic Valve Stenosis; Retrospective Studies; Incidence; Prosthesis Design; Treatment Outcome; Transcatheter Aortic Valve Replacement; Bioprosthesis
PubMed: 35255516
DOI: 10.1055/s-0042-1742755 -
The Annals of Thoracic Surgery Jun 2024
Topics: Humans; Heart Valve Prosthesis Implantation; Aortic Valve; Aortic Valve Stenosis
PubMed: 38608744
DOI: 10.1016/j.athoracsur.2024.03.031 -
General Thoracic and Cardiovascular... Jul 2024In the case of mitral repair with severe aortic regurgitation, aortotomy and selective cardioplegia are necessary for myocardiac protection. In this situation, the...
In the case of mitral repair with severe aortic regurgitation, aortotomy and selective cardioplegia are necessary for myocardiac protection. In this situation, the saline test for mitral valve repair cannot be accomplished due to incomplete left ventricular filing. In patients undergoing mitral valve repair concomitant with severe aortic valve insufficiency, after cardiac stand still was achieved by selective cardioplegia. Each center of the aortic leaflet, termed the node of Arantius, was stitch up using a 5-0 polypropylene suture, forming a clover leaflet shape. This stitch inhibits aortic valve opening and reduces saline leakage thorough aortic valve. We have termed this procedure as the "Clover Stitch Technique". Upon completion of this technique, mitral valve repair can be undertaken via a right-side left atrial incision. This technique enables accurate evaluation of mitral valve morphology or the extent of regurgitation, repeatedly without complicated manipulations during and after mitral valve repair.
Topics: Humans; Aortic Valve Insufficiency; Suture Techniques; Mitral Valve Insufficiency; Aortic Valve; Mitral Valve; Treatment Outcome; Heart Valve Prosthesis Implantation; Heart Arrest, Induced; Aged
PubMed: 38418678
DOI: 10.1007/s11748-024-02018-w -
JACC. Cardiovascular Interventions Apr 2024
Comparative Study
Topics: Humans; Transcatheter Aortic Valve Replacement; Treatment Outcome; Aortic Valve; Aortic Valve Stenosis; Heart Valve Prosthesis; Time Factors; Risk Factors; Heart Valve Prosthesis Implantation; Male; Female; Aged, 80 and over; Aged; Risk Assessment
PubMed: 38573258
DOI: 10.1016/j.jcin.2024.02.027 -
JACC. Cardiovascular Imaging Sep 2023
Topics: Humans; Aortic Valve; Lipoprotein(a); Predictive Value of Tests; Aortic Valve Stenosis; Inflammation
PubMed: 37052566
DOI: 10.1016/j.jcmg.2023.02.013 -
Chinese Medical Journal May 2024
Topics: Humans; Transcatheter Aortic Valve Replacement; Aortic Valve Stenosis; Aortic Valve
PubMed: 38533588
DOI: 10.1097/CM9.0000000000003082