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European Heart Journal Sep 2023To support decision-making in children undergoing aortic valve replacement (AVR), by providing a comprehensive overview of published outcomes after paediatric AVR, and... (Meta-Analysis)
Meta-Analysis
AIMS
To support decision-making in children undergoing aortic valve replacement (AVR), by providing a comprehensive overview of published outcomes after paediatric AVR, and microsimulation-based age-specific estimates of outcome with different valve substitutes.
METHODS AND RESULTS
A systematic review of published literature reporting clinical outcome after paediatric AVR (mean age <18 years) published between 1/1/1990 and 11/08/2021 was conducted. Publications reporting outcome after paediatric Ross procedure, mechanical AVR (mAVR), homograft AVR (hAVR), and/or bioprosthetic AVR were considered for inclusion. Early risks (<30d), late event rates (>30d) and time-to-event data were pooled and entered into a microsimulation model. Sixty-eight studies, of which one prospective and 67 retrospective cohort studies, were included, encompassing a total of 5259 patients (37 435 patient-years; median follow-up: 5.9 years; range 1-21 years). Pooled mean age for the Ross procedure, mAVR, and hAVR was 9.2 ± 5.6, 13.0 ± 3.4, and 8.4 ± 5.4 years, respectively. Pooled early mortality for the Ross procedure, mAVR, and hAVR was 3.7% (95% CI, 3.0%-4.7%), 7.0% (5.1%-9.6%), and 10.6% (6.6%-17.0%), respectively, and late mortality rate was 0.5%/year (0.4%-0.7%/year), 1.0%/year (0.6%-1.5%/year), and 1.4%/year (0.8%-2.5%/year), respectively. Microsimulation-based mean life-expectancy in the first 20 years was 18.9 years (18.6-19.1 years) after Ross (relative life-expectancy: 94.8%) and 17.0 years (16.5-17.6 years) after mAVR (relative life-expectancy: 86.3%). Microsimulation-based 20-year risk of aortic valve reintervention was 42.0% (95% CI: 39.6%-44.6%) after Ross and 17.8% (95% CI: 17.0%-19.4%) after mAVR.
CONCLUSION
Results of paediatric AVR are currently suboptimal with substantial mortality especially in the very young with considerable reintervention hazards for all valve substitutes, but the Ross procedure provides a survival benefit over mAVR. Pros and cons of substitutes should be carefully weighed during paediatric valve selection.
Topics: Humans; Child; Adolescent; Aortic Valve; Heart Valve Prosthesis Implantation; Retrospective Studies; Prospective Studies; Heart Valve Prosthesis; Treatment Outcome
PubMed: 37366156
DOI: 10.1093/eurheartj/ehad370 -
Interventional Cardiology Clinics Jul 2024Over the last 2 decades, experience with transcatheter pulmonary valve replacement (TPVR) has grown significantly and has become an effective and reliable way of... (Review)
Review
Over the last 2 decades, experience with transcatheter pulmonary valve replacement (TPVR) has grown significantly and has become an effective and reliable way of treating pulmonary valve regurgitation, right ventricular outflow (RVOT) obstruction, and dysfunctional bioprosthetic valves and conduits. With the introduction of self-expanding valves and prestents, dilated native RVOT can be addressed with the transcatheter approach. In this article, the authors review the current practices, technical challenges, and outcomes of TPVR.
Topics: Humans; Cardiac Catheterization; Heart Valve Prosthesis Implantation; Pulmonary Valve; Heart Defects, Congenital; Pulmonary Valve Insufficiency; Heart Valve Prosthesis; Ventricular Outflow Obstruction; Prosthesis Design; Bioprosthesis
PubMed: 38839170
DOI: 10.1016/j.iccl.2024.03.001 -
JACC. Cardiovascular Interventions Nov 2023
Topics: Humans; Treatment Outcome; Heart Valve Diseases; Mitral Valve; Heart Valve Prosthesis Implantation; Heart Valve Prosthesis; Cardiac Catheterization; Ventricular Outflow Obstruction; Mitral Valve Insufficiency
PubMed: 37968033
DOI: 10.1016/j.jcin.2023.09.034 -
MMW Fortschritte Der Medizin Jul 2023
Topics: Humans; Aortic Valve; Heart Valve Prosthesis
PubMed: 37420049
DOI: 10.1007/s15006-023-2786-2 -
Minimally Invasive Therapy & Allied... Dec 2023A 68-year-old man with a history of valve-sparing aortic root replacement and endoscopic aortic valve replacement was admitted to our hospital with dyspnea....
A 68-year-old man with a history of valve-sparing aortic root replacement and endoscopic aortic valve replacement was admitted to our hospital with dyspnea. Transthoracic echocardiography revealed severe pulmonary valve regurgitation. The patient had undergone cardiac surgery twice, through median sternotomy and right thoracotomy; therefore, we planned endoscopic pulmonary valve replacement the left thoracic approach. The patient was placed in a modified right lateral decubitus position and underwent mild hypothermic cardiopulmonary bypass. An on-pump beating-heart technique was used during surgery. The 3D endoscopic system and trocars for surgical instruments were inserted through the left 3rd and 4th intercostal spaces. After incision of the pulmonary artery, the pulmonary cusps were resected. A 27-mm St Jude Medical Epic heart valve was implanted in the intra-annular position. Subsequently, the left atrial appendage was resected. The patient was discharged without complications. To our knowledge, this is the first case of totally endoscopic pulmonary valve replacement.
Topics: Male; Humans; Aged; Heart Valve Prosthesis Implantation; Pulmonary Valve; Cardiac Surgical Procedures; Endoscopy; Heart Valve Prosthesis; Aortic Valve; Minimally Invasive Surgical Procedures
PubMed: 37729442
DOI: 10.1080/13645706.2023.2250422 -
Expert Review of Medical Devices 2023Transcatheter aortic valve implantation (TAVI) is the standard of care for selected patients with severe aortic stenosis, irrespective of the surgical risk. Over the... (Review)
Review
INTRODUCTION
Transcatheter aortic valve implantation (TAVI) is the standard of care for selected patients with severe aortic stenosis, irrespective of the surgical risk. Over the last two decades of TAVI practice, multiple limitations were identified. In addition, the extension of TAVI into a wider patient spectrum created new challenges.
AREAS COVERED
This review provides an overview of emerging transcatheter heart valves (THVs) beyond the approved contemporary THVs for the treatment of aortic stenosis.
EXPERT OPINION
The incidence of degenerative aortic stenosis is expected to increase with more aging of the population. Therefore, TAVI needs to meet this increase in the number of patients indicated for aortic valve replacement alongside a wide and complex anatomical variability. An increasing number of Aortic THVs are available in the market. This includes upgraded iterations of contemporary devices and innovative devices developed by emerging manufacturers. The new devices aim for the reduction or elimination of undesirable outcomes like paravalvular leakage and conduction disturbances requiring permanent pacemaker implantation. Alternatively, emerging THVs should provide feasibility regarding yet unproven TAVI indications like Bicuspid aortic valve, aortic regurgitation, or very large anatomy. Furthermore, some of the emerging THVs are designed to tackle the long-term durability issue of biological valves.
Topics: Humans; Treatment Outcome; Aortic Valve; Transcatheter Aortic Valve Replacement; Aortic Valve Stenosis; Aortic Valve Insufficiency; Heart Valve Prosthesis
PubMed: 37933200
DOI: 10.1080/17434440.2023.2277229 -
Expert-Level Intelligence for Prosthetic Valve Endocarditis Detection: Can Radiomics Bridge the Gap?JACC. Cardiovascular Imaging Jul 2023
Topics: Humans; Endocarditis, Bacterial; Heart Valve Prosthesis; Predictive Value of Tests; Endocarditis; Aortic Valve; Prosthesis-Related Infections
PubMed: 37227332
DOI: 10.1016/j.jcmg.2023.03.019 -
The American Journal of Cardiology Dec 2023Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) in patients with failed bioprostheses arose as an alternative to redo surgical aortic valve... (Meta-Analysis)
Meta-Analysis
Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) in patients with failed bioprostheses arose as an alternative to redo surgical aortic valve replacement. There is an increasing interest in exploring the differences between self-expanding valves (SEVs) and balloon-expandable valves (BEVs). Our study aimed to evaluate the all-cause mortality in ViV-TAVI with SEV versus BEV in patients with failed bioprostheses. We performed a study-level meta-analysis of reconstructed time-to-event data from Kaplan-Meier curves of studies published by March 30, 2023. A total of 5 studies met our eligibility criteria and included 1,454 patients who underwent ViV-TAVI (862 with SEV and 592 with BEV). Almost all BEVs were iterations of the Edwards BEVs (SAPIEN, SAPIEN XT, and SAPIEN 3) and almost all SEVs were iterations of the Medtronic SEVs (CoreValve/Evolut). During the first year after ViV-TAVI, 67 deaths (11.8%) occurred in patients treated with BEV compared with 92 deaths (11.1%) in patients treated with SEV (hazard ratio 0.92, 95% confidence interval 0.66 to 1.27, p = 0.632). At 8 years of follow-up, the all-cause death was not statistically significantly different between the groups, with mortality rates of 65.4% in the group treated BEV and 58.8% in the group treated with SEV (hazard ratio 0.91, 95% confidence interval 0.75 to 1.09, p = 0.302). The restricted mean survival time was overall 0.25 years greater with SEV than BEV, but this difference was not statistically significant (p = 0.278), which indicates no lifetime gain or loss with SEV in comparison with BEV. There seems to be no difference in terms of all-cause death in ViV-TAVI with SEV versus BEV. Randomized controlled trials are warranted to validate our results.
Topics: Humans; Transcatheter Aortic Valve Replacement; Aortic Valve Stenosis; Aortic Valve; Heart Valve Prosthesis; Survival Rate; Treatment Outcome; Prosthesis Design
PubMed: 37875248
DOI: 10.1016/j.amjcard.2023.09.108 -
Aortic stenosis may not be fatal anymore in wealthy societies: but what about the rest of the world?Heart (British Cardiac Society) Sep 2023
Topics: Humans; Aortic Valve Stenosis; Aortic Valve; Transcatheter Aortic Valve Replacement; Heart Valve Prosthesis; Treatment Outcome; Heart Valve Prosthesis Implantation; Prosthesis Design
PubMed: 37236642
DOI: 10.1136/heartjnl-2023-322737 -
Journal of the American College of... Apr 2024During the past 6 decades, there have been numerous changes in prosthetic valve endocarditis (PVE), currently affecting an older population and increasing in incidence... (Review)
Review
During the past 6 decades, there have been numerous changes in prosthetic valve endocarditis (PVE), currently affecting an older population and increasing in incidence in patients with transcatheter-implanted valves. Significant microbiologic (molecular biology) and imaging diagnostic (fluorine-18 fluorodeoxyglucose-positron emission tomography/computed tomography) advances have been incorporated into the 2023 Duke-International Society for Cardiovascular Infectious Diseases infective endocarditis diagnostic criteria, thus increasing the diagnostic sensitivity for PVE without sacrificing specificity in validation studies. PVE is a life-threatening disease requiring management by multidisciplinary endocarditis teams in cardiac centers to improve outcomes. Novel surgical options are now available, and an increasing set of patients may avoid surgical intervention despite indication. Selected patients may complete parenteral or oral antimicrobial treatment at home. Finally, patients with prosthetic valves implanted surgically or by the transcatheter approach are candidates for antibiotic prophylaxis before invasive dental procedures.
Topics: Humans; Endocarditis, Bacterial; Heart Valve Prosthesis; Prosthesis-Related Infections; Endocarditis; Positron Emission Tomography Computed Tomography
PubMed: 38599718
DOI: 10.1016/j.jacc.2024.01.037