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European Heart Journal Oct 2023
Topics: Humans; Endocarditis; Endocarditis, Bacterial; Heart Valve Prosthesis; Prosthesis-Related Infections; Positron Emission Tomography Computed Tomography; Fluorodeoxyglucose F18; Radiopharmaceuticals
PubMed: 37622656
DOI: 10.1093/eurheartj/ehad193 -
Lancet (London, England) Oct 2023With increasing numbers of patients undergoing transcatheter aortic valve replacement (TAVR), data on management of failed TAVR, including repeat TAVR procedure, are...
BACKGROUND
With increasing numbers of patients undergoing transcatheter aortic valve replacement (TAVR), data on management of failed TAVR, including repeat TAVR procedure, are needed. The aim of this study was to assess the safety and efficacy of redo-TAVR in a national registry.
METHODS
This study included all consecutive patients in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry from Nov 9, 2011, to Dec 30, 2022 who underwent TAVR with balloon-expandable valves in failed transcatheter heart valves (redo-TAVR) or native aortic valves (native-TAVR). Procedural, echocardiographic, and clinical outcomes were compared between redo-TAVR and native-TAVR cohorts using propensity score matching.
FINDINGS
Among 350 591 patients (1320 redo-TAVR; 349 271 native-TAVR), 1320 propensity-matched pairs of patients undergoing redo-TAVR and native-TAVR were analysed (redo-TAVR cohort: mean age 78 years [SD 9]; 559 [42·3%] of 1320 female, 761 [57·7%] male; mean predicted surgical risk of 30-day mortality 8·1%). The rates of procedural complications of redo-TAVR were low (coronary compression or obstruction: four [0·3%] of 1320; intraprocedural death: eight [0·6%] of 1320; conversion to open heart surgery: six [0·5%] of 1319) and similar to native-TAVR. There was no significant difference between redo-TAVR and native-TAVR populations in death at 30 days (4·7% vs 4·0%, p=0·36) or 1 year (17·5% vs 19·0%, p=0·57), and stroke at 30 days (2·0% vs 1·9%, p=0·84) or 1 year (3·2% vs 3·5%, p=0·80). Redo-TAVR reduced aortic valve gradients at 1 year, although they were higher in the redo-TAVR group compared with the native-TAVR group (15 mm Hg vs 12 mm Hg; p<0·0001). Moderate or severe aortic regurgitation rates were similar between redo-TAVR and native-TAVR groups at 1 year (1·8% vs 3·3%, p=0·18). Death or stroke after redo-TAVR were not significantly affected by the timing of redo-TAVR (before or after 1 year of index TAVR), or by index transcatheter valve type (balloon-expandable or non-balloon-expandable).
INTERPRETATION
Redo-TAVR with balloon-expandable valves effectively treated dysfunction of the index TAVR procedure with low procedural complication rates, and death and stroke rates similar to those in patients with a similar clinical profile and predicted risk undergoing TAVR for native aortic valve stenosis. Redo-TAVR with balloon-expandable valves might be a reasonable treatment for failed TAVR in selected patients.
FUNDING
Edwards Lifesciences.
Topics: Humans; Male; Female; Aged; Transcatheter Aortic Valve Replacement; Heart Valve Prosthesis; Treatment Outcome; Aortic Valve; Aortic Valve Stenosis; Stroke; Registries; Risk Factors; Prosthesis Design
PubMed: 37660719
DOI: 10.1016/S0140-6736(23)01636-7 -
The Journal of Thoracic and... Jul 2023
Topics: Pregnancy; Female; Humans; Heart; Heart Valve Diseases; Pregnancy Complications, Cardiovascular; Heart Defects, Congenital; Pregnancy Outcome; Heart Valve Prosthesis
PubMed: 36658028
DOI: 10.1016/j.jtcvs.2022.12.016 -
Deutsches Arzteblatt International Oct 2023In Germany, a total of 38 547 heart valve procedures were performed in 2022. With a growing number of patients undergoing the surgical and interventional implantation of... (Review)
Review
BACKGROUND
In Germany, a total of 38 547 heart valve procedures were performed in 2022. With a growing number of patients undergoing the surgical and interventional implantation of heart valves, the incidence of prosthetic endocarditis is also rising.
METHODS
We summarize the current state of the prophylaxis, diagnosis, and treatment of prosthetic endocarditis in a selective review of the literature.
RESULTS
Prosthetic endocarditis accounts for 10-30% of all cases of endocarditis. As its echocardiographic and microbiologic findings are often less specific than those of native endocarditis, its diagnosis now increasingly relies on alternative imaging modalities such as F-18-FDG PET-CT. Anti-infective and surgical treatment are made more difficult by biofilm formation on the prosthetic valve and the frequent formation of perivalvular abscesses.
CONCLUSION
Increased awareness of this clinical entity in the outpatient setting will promote the earlier initiation of appropriate diagnostic studies. Proper diagnostic evaluation is an essential prerequisite for the early detection and timely treatment of prosthetic endocarditis, with the goal of preventing progressive destruction and thus improving the outcome. Preventive and educative measures should be intensified, and certified, multidisciplinary endocarditis teams should be established. Antibiotic prophylaxis is now given much more restrictively than in earlier years; the risk of infection must be weighed against the potential development of both individual and collective resistance to antibiotic drugs.
Topics: Humans; Positron Emission Tomography Computed Tomography; Fluorodeoxyglucose F18; Heart Valve Prosthesis; Endocarditis; Heart, Artificial
PubMed: 37427994
DOI: 10.3238/arztebl.m2023.0104 -
The Journal of Heart and Lung... Jun 2024Heart valve replacement in children is an unsolved problem in congenital cardiac surgery because state-of-the-art heart valve implants do not grow. This leads to serial... (Review)
Review
Heart valve replacement in children is an unsolved problem in congenital cardiac surgery because state-of-the-art heart valve implants do not grow. This leads to serial repeat operations to replace outgrown heart valve implants. Partial heart transplantation is a new transplant that helps alleviate this problem by delivering growing heart valve implants. In the future, partial heart transplantation has the potential to complement conventional heart transplantation for treating children with congenital cardiac disease primarily affecting the heart valves.
Topics: Humans; Heart Transplantation; Child; Heart Defects, Congenital; Heart Valve Prosthesis; Forecasting; Heart Valve Prosthesis Implantation
PubMed: 38368912
DOI: 10.1016/j.healun.2024.02.010 -
Heart (British Cardiac Society) Dec 2023As the population ages and treatment options for heart valve disease increase, the number of patients with intracardiac valve prostheses is growing rapidly. Although all... (Review)
Review
As the population ages and treatment options for heart valve disease increase, the number of patients with intracardiac valve prostheses is growing rapidly. Although all devices have the potential to cause thrombus formation, the propensity depends on the type of prosthesis as well as risk of the individual patient. Mechanical valve prostheses carry the highest (and persistent) risk of thromboembolism, and these patients require anticoagulation with vitamin K antagonists (warfarin). Required international normalised ratio levels are dependent on the location of the valve (mitral>aortic), type of valve (ball and cage vs bilealfet vs On-X bilealfet) and rhythm. The risk of tissue (biological) prosthesis is highest soon after surgery and is dependent on individual patient risk including age, valve location (mitral>aortic), history of thromboembolic events and rhythm. In patients with no other indication for anticoagulation, there is uncertainty on the benefits of anticoagulation versus antiplatelet therapy in patients with tissue prostheses or repaired native valves. Patients with an a priori indication for anticoagulation with a direct oral anticoagulant can continue taking this class of drug. Patients with transcatheter aortic valve implantation devices and no additional evidence-based indication for dual antiplatelet therapy or anticoagulation can be maintained on aspirin monotherapy. Patients undergoing transcatheter instrumentation in the mitral valve position should be anticoagulated, although there is currently no published evidence for antithrombotic management in this group of patients. Patients with thrombosed devices (commonly mitral mechanical) should preferably be treated surgically. Patients at high risk of thromboembolism (with mechanical prostheses) should undergo bridging therapy when undergoing surgery.
Topics: Humans; Fibrinolytic Agents; Heart Valve Prosthesis; Anticoagulants; Thromboembolism; Thrombosis; Heart Valve Prosthesis Implantation; Mitral Valve; Aortic Valve
PubMed: 37438054
DOI: 10.1136/heartjnl-2022-321387 -
Perfect prosthetic heart valve: generative design with machine learning, modeling, and optimization.Frontiers in Bioengineering and... 2023Majority of modern techniques for creating and optimizing the geometry of medical devices are based on a combination of computer-aided designs and the utility of the...
Majority of modern techniques for creating and optimizing the geometry of medical devices are based on a combination of computer-aided designs and the utility of the finite element method This approach, however, is limited by the number of geometries that can be investigated and by the time required for design optimization. To address this issue, we propose a generative design approach that combines machine learning (ML) methods and optimization algorithms. We evaluate eight different machine learning methods, including decision tree-based and boosting algorithms, neural networks, and ensembles. For optimal design, we investigate six state-of-the-art optimization algorithms, including Random Search, Tree-structured Parzen Estimator, CMA-ES-based algorithm, Nondominated Sorting Genetic Algorithm, Multiobjective Tree-structured Parzen Estimator, and Quasi-Monte Carlo Algorithm. In our study, we apply the proposed approach to study the generative design of a prosthetic heart valve (PHV). The design constraints of the prosthetic heart valve, including spatial requirements, materials, and manufacturing methods, are used as inputs, and the proposed approach produces a final design and a corresponding score to determine if the design is effective. Extensive testing leads to the conclusion that utilizing a combination of ensemble methods in conjunction with a Tree-structured Parzen Estimator or a Nondominated Sorting Genetic Algorithm is the most effective method in generating new designs with a relatively low error rate. Specifically, the Mean Absolute Percentage Error was found to be 11.8% and 10.2% for lumen and peak stress prediction respectively. Furthermore, it was observed that both optimization techniques result in design scores of approximately 95%. From both a scientific and applied perspective, this approach aims to select the most efficient geometry with given input parameters, which can then be prototyped and used for subsequent experiments. By proposing this approach, we believe it will replace or complement CAD-FEM-based modeling, thereby accelerating the design process and finding better designs within given constraints. The repository, which contains the essential components of the study, including curated source code, dataset, and trained models, is publicly available at https://github.com/ViacheslavDanilov/generative_design.
PubMed: 37781537
DOI: 10.3389/fbioe.2023.1238130 -
EuroIntervention : Journal of EuroPCR... Nov 2023Mitral regurgitation is the second most frequent heart valve disease in Europe and the most frequent in the US. Although surgery is the therapy of choice when... (Review)
Review
Mitral regurgitation is the second most frequent heart valve disease in Europe and the most frequent in the US. Although surgery is the therapy of choice when intervention is indicated, transcatheter mitral valve repair or replacement are alternatives for patients who are not eligible for surgery. However, the development of transcatheter mitral valves is slower than expected. Although several transcatheter heart valves have been developed, only one has been commercialised. Indeed, most of these devices are being evaluated in clinical studies, with promising initial results. In this review, we propose an overview on transcatheter mitral valve replacement for the treatment of native mitral valve disease, from indication to results, including patients with severe annular calcification, and we provide you with a glimpse into the future of these therapies.
Topics: Humans; Mitral Valve; Heart Valve Prosthesis Implantation; Heart Valve Prosthesis; Treatment Outcome; Heart Valve Diseases; Mitral Valve Insufficiency; Cardiac Catheterization
PubMed: 37994096
DOI: 10.4244/EIJ-D-22-00890 -
Annals of Biomedical Engineering Nov 2023A common feature of congenital heart disease is the presence of right ventricular outflow tract (RVOT) obstruction that can range from mild to severe and can lead to... (Review)
Review
A common feature of congenital heart disease is the presence of right ventricular outflow tract (RVOT) obstruction that can range from mild to severe and can lead to atresia of the pulmonary valve, in extreme conditions. RVOT abnormalities can frequently be corrected surgically or via interventional means. However, most of these patients will ultimately develop pulmonary valve insufficiency and eventual right ventricular dilation, which will require a pulmonary valve replacement at some point in their life to mitigate the detrimental effects of pulmonary valve regurgitation (PVR) on the right ventricle (RV). The evolution from the studies done by Philip Bonhoeffer to implant a pulmonary valve via transcatheter means, have provided a bedrock for transcatheter pulmonary valve replacement (TPVR). Yet, several areas of unmet need for a demographic of patients still exist. Here, we discuss the clinical unmet needs in children under 20 Kg and expand the use of hybrid and other TPVR approaches along with the current indications and contraindications for pulmonary valve replacement. The constraints and limitations from commercially available pulmonary valves will be discussed from a clinical standpoint. Finally, we explore the use of hybrid and periventricular delivery of transcatheter pulmonary valves in younger patients.
Topics: Child; Humans; Pulmonary Valve; Heart Valve Prosthesis Implantation; Heart Valve Prosthesis; Prosthesis Design; Cardiac Catheterization; Treatment Outcome; Pulmonary Valve Insufficiency; Heart Defects, Congenital; Ventricular Outflow Obstruction, Right; Retrospective Studies
PubMed: 37543538
DOI: 10.1007/s10439-023-03328-5 -
Heart (British Cardiac Society) Sep 2023
Topics: Humans; Aortic Valve; Aortic Valve Stenosis; Transcatheter Aortic Valve Replacement; Calcinosis; Multidetector Computed Tomography; Heart Valve Prosthesis; Treatment Outcome; Prosthesis Design; Heart Valve Prosthesis Implantation
PubMed: 37290901
DOI: 10.1136/heartjnl-2023-322771