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Innovations (Philadelphia, Pa.) 2024The surgical treatment of aortic stenosis continues to evolve, and sutureless aortic valve replacement (SUAVR) is an emerging technology. With the Perceval S (Corcym,... (Review)
Review
OBJECTIVE
The surgical treatment of aortic stenosis continues to evolve, and sutureless aortic valve replacement (SUAVR) is an emerging technology. With the Perceval S (Corcym, London, UK) as the only true sutureless valve on the market, the objective of this review is to analyze the current literature on Perceval S. Focusing on valve design and deployment as well as applications of the technology for challenging pathology, clinical outcomes are assessed, including a comparison with transcatheter AVR (TAVR).
METHODS
PubMed and MEDLINE were searched by 3 authors for studies analyzing SUAVR from inception to May 19, 2023.
RESULTS
SUAVR facilitates minimally invasive surgery and offers an alternative strategy for patients with small aortic annuli. It also has a time-saving advantage for patients who require complex operations. SUAVR results in excellent long-term morbidity, mortality, durability, and hemodynamic function. In comparison with conventional surgical AVR (SAVR), SUAVR does have a greater risk of postoperative pacemaker implantation; however, increasing user experience and refinements in implantation technique have contributed to reductions in this outcome. SUAVR results in morbidity and mortality that is similar to rapid-deployment AVR. Midterm outcomes are superior to TAVR; however, further robust investigation into all of these comparisons is ultimately necessary.
CONCLUSIONS
SUAVR bridges the gap in technology between SAVR and TAVR. The application of this exciting technology will undoubtedly grow in the coming years, during which additional investigation is paramount to optimize preoperative planning, valve deployment, and reintervention strategies.
Topics: Humans; Bioprosthesis; Heart Valve Prosthesis; Aortic Valve Stenosis; Aortic Valve; Sutureless Surgical Procedures; Transcatheter Aortic Valve Replacement; Heart Valve Prosthesis Implantation; Prosthesis Design; Minimally Invasive Surgical Procedures; Treatment Outcome
PubMed: 38465600
DOI: 10.1177/15569845241231989 -
The American Journal of Cardiology Aug 2023Risk prediction scores for long-term outcomes after transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR) are lacking. This study... (Randomized Controlled Trial)
Randomized Controlled Trial
Risk prediction scores for long-term outcomes after transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR) are lacking. This study aimed to develop preprocedural risk scores for 5-year clinical outcomes after TAVI or SAVR. This analysis included 1,660 patients at an intermediate surgical risk with severe aortic stenosis randomly assigned to TAVI (n = 864) or SAVR (n = 796) from the SURTAVI (Surgical Replacement and Transcatheter Aortic Valve Implantation) trial. The primary end point was a composite of all-cause mortality or disabling stroke at 5 years. The secondary end point was a composite of cardiovascular mortality or hospitalizations for valve disease or worsening heart failure at 5 years. Preprocedural multivariable predictors of clinical outcomes were used to calculate a simple risk score for both procedures. At 5 years, the primary end point occurred in 31.3% of the patients with TAVI and 30.8% of the patients with SAVR. Preprocedural predictors differed between TAVI and SAVR. Baseline anticoagulant use was a common predictor for events in both procedures, whereas male sex and a left ventricular ejection fraction <60% were significant predictors for events in patients with TAVI and SAVR, respectively. A total of 4 simple scoring systems were created based on these multivariable predictors. The C-statistics of all models were modest but performed better than the contemporary risk scores. In conclusion, preprocedural predictors of events differ between TAVI and SAVR, necessitating separate risk models. Despite the modest predictive value of the SURTAVI risk scores, they appeared superior to other contemporary scores. Further research is needed to strengthen and validate our risk scores, possibly by including biomarker and echocardiographic parameters.
Topics: Humans; Male; Aortic Valve; Aortic Valve Stenosis; Heart Valve Prosthesis Implantation; Risk Factors; Stroke Volume; Transcatheter Aortic Valve Replacement; Treatment Outcome; Ventricular Function, Left
PubMed: 37307783
DOI: 10.1016/j.amjcard.2023.05.036 -
Multimedia Manual of Cardiothoracic... Nov 2023The Ross-Personalized External Aortic Root Support procedure is a surgical aortic valve replacement technique in which the autologous pulmonary valve is transposed in...
The Ross-Personalized External Aortic Root Support procedure is a surgical aortic valve replacement technique in which the autologous pulmonary valve is transposed in the aortic position to replace the malfunctioning aortic valve and a homograft is implanted in the pulmonary position. To prevent autograft dilatation, a Personalized External Aortic Root Support prosthesis is included in the proximal autograft anastomosis and wrapped around the ascending aorta. The aorta is transected transversely, the aortic valve is resected, and the coronary arteries are mobilized and cut out of the sinuses, leaving a rim. The pulmonary autograft is harvested by transecting the pulmonary artery and part of the right ventricular outflow tract. The autograft is approximated to the aortic root and inverted inside the ventricle. The proximal anastomosis is performed including the prosthesis between the aortic root and the autograft. The coronary buttons are threaded through appropriately positioned and sized holes in the prosthesis and reimplanted into the autograft. The ascending aorta is appropriately adapted and anastomosed with the distal autograft. When the patient is off cardiopulmonary bypass, the prosthesis can be closed longitudinally and is anchored to the distal aortic adventitia.
Topics: Humans; Autografts; Aorta, Thoracic; Transplantation, Autologous; Aortic Valve; Aorta; Aortic Valve Stenosis; Aortic Valve Insufficiency; Pulmonary Valve; Heart Valve Prosthesis Implantation; Reoperation
PubMed: 37942704
DOI: 10.1510/mmcts.2023.077 -
Journal of the American Heart... Nov 2023
Topics: Humans; Aortic Valve; Heart Valve Prosthesis; Transcatheter Aortic Valve Replacement
PubMed: 37929671
DOI: 10.1161/JAHA.123.030953 -
Circulation. Cardiovascular... Nov 2023Coronary accessibility following redo-transcatheter aortic valve replacement (redo-TAVR) is increasingly important, particularly in younger low-risk patients. This study...
BACKGROUND
Coronary accessibility following redo-transcatheter aortic valve replacement (redo-TAVR) is increasingly important, particularly in younger low-risk patients. This study aimed to predict coronary accessibility after simulated Sapien-3 balloon-expandable valve implantation within an Evolut supra-annular, self-expanding valve using pre-TAVR computed tomography (CT) imaging.
METHODS
A total of 219 pre-TAVR CT scans from the Evolut Low-Risk CT substudy were analyzed. Virtual Evolut and Sapien-3 valves were sized using CT-based diameters. Two initial Evolut implant depths were analyzed, 3 and 5 mm. Coronary accessibility was evaluated for 2 Sapien-3 in Evolut implant positions: Sapien-3 outflow at Evolut node 4 and Evolut node 5.
RESULTS
With a 3-mm initial Evolut implant depth, suitable coronary access was predicted in 84% of patients with the Sapien-3 outflow at Evolut node 4, and in 31% of cases with the Sapien-3 outflow at Evolut node 5 (<0.001). Coronary accessibility improved with a 5-mm Evolut implant depth: 97% at node 4 and 65% at node 5 (<0.001). When comparing 3- to 5-mm Evolut implant depth, sinus sequestration was the lowest with Sapien-3 outflow at Evolut node 4 (13% versus 2%; <0.001), and the highest at Evolut node 5 (61% versus 32%; <0.001).
CONCLUSIONS
Coronary accessibility after Sapien-3 in Evolut redo-TAVR relates to the initial Evolut implant depth, the Sapien-3 outflow position within the Evolut, and the native annular anatomy. This CT-based quantitative analysis may provide useful information to inform and refine individualized preprocedural CT planning of the initial TAVR and guide lifetime management for future coronary access after redo-TAVR.
REGISTRATION
URL: https://www.clinicaltrials.gov; Unique identifier: NCT02701283.
Topics: Humans; Aortic Valve; Transcatheter Aortic Valve Replacement; Aortic Valve Stenosis; Heart Valve Prosthesis; Feasibility Studies; Treatment Outcome; Tomography, X-Ray Computed; Prosthesis Design
PubMed: 37988439
DOI: 10.1161/CIRCINTERVENTIONS.123.013238 -
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 -
Journal of Cardiovascular Translational... Aug 2023Coronary flow obstruction following transcatheter aortic valve-in-valve implantation (VIV-TAVI) is associated with a high mortality risk. The aim of this work was to...
Coronary flow obstruction following transcatheter aortic valve-in-valve implantation (VIV-TAVI) is associated with a high mortality risk. The aim of this work was to quantify the coronary perfusion after VIV-TAVI in a high-risk aortic root anatomy. 3D printed models of small aortic root were used to simulate the implantation of a TAVI prosthesis (Portico 23) into surgical prostheses (Trifecta 19 and 21). The aortic root models were tested in a pulsatile in vitro bench setup with a coronary perfusion simulator. The tests were performed at baseline and post-VIV-TAVI procedure in aligned and misaligned commissural configurations under simulated hemodynamic rest and exercise conditions. The experimental design provided highly controllable and repeatable flow and pressure conditions. The left and right coronary mean flow did not differ significantly at pre- and post-VIV-TAVI procedure in any tested configurations. The commissural misalignment did not induce any significant alterations to the coronary flow. High-risk aortic root anatomy did not trigger coronary ostia obstruction or coronary flow alteration after transcatheter aortic valve implantation in a surgical bioprosthesis as shown from in-vitro flow loop tests.
Topics: Humans; Transcatheter Aortic Valve Replacement; Aortic Valve; Aorta, Thoracic; Heart Valve Prosthesis; Prosthesis Failure; Heart Valve Prosthesis Implantation; Perfusion; Coronary Occlusion; Bioprosthesis; Aortic Valve Stenosis; Prosthesis Design; Treatment Outcome
PubMed: 37097591
DOI: 10.1007/s12265-023-10364-y -
Revista Portuguesa de Cardiologia :... Sep 2023
Topics: Humans; Transcatheter Aortic Valve Replacement; Aortic Valve; Aortic Valve Stenosis; Treatment Outcome; Heart Valve Prosthesis; Risk Factors
PubMed: 36958575
DOI: 10.1016/j.repc.2023.03.008 -
Journal of Nuclear Medicine : Official... Sep 2023Calcific aortic valve disease (CAVD) is a prevailing disease with increasing occurrence and no known medical therapy. mice have a high prevalence of bicuspid aortic...
Calcific aortic valve disease (CAVD) is a prevailing disease with increasing occurrence and no known medical therapy. mice have a high prevalence of bicuspid aortic valve (BAV), spontaneous aortic valve calcification, and aortic stenosis (AS). F-NaF PET/CT can detect the aortic valve calcification process in humans. However, its feasibility in preclinical models of CAVD remains to be determined. Here, we sought to validate F-NaF PET/CT for tracking murine aortic valve calcification and leveraged it to examine the development of calcification with aging and its interdependence with BAV and AS in mice. mice at 3-4 mo, 10-16 mo, and 18-24 mo underwent echocardiography, F-NaF PET/CT ( = 34, or autoradiography ( = 45)), and tissue analysis. A subset of mice underwent both PET/CT and autoradiography ( = 12). The aortic valve signal was quantified as SUV on PET/CT and as percentage injected dose per square centimeter on autoradiography. The valve tissue sections were analyzed by microscopy to identify tricuspid and bicuspid aortic valves. The aortic valve F-NaF signal on PET/CT was significantly higher at 18-24 mo ( < 0.0001) and 10-16 mo ( < 0.05) than at 3-4 mo. Additionally, at 18-24 mo BAV had a higher F-NaF signal than tricuspid aortic valves ( < 0.05). These findings were confirmed by autoradiography, with BAV having significantly higher F-NaF uptake in each age group. A significant correlation between PET and autoradiography data (Pearson = 0.79, < 0.01) established the accuracy of PET quantification. The rate of calcification with aging was significantly faster for BAV ( < 0.05). Transaortic valve flow velocity was significantly higher in animals with BAV at all ages. Finally, there was a significant correlation between transaortic valve flow velocity and aortic valve calcification by both PET/CT ( = 0.55, < 0.001) and autoradiography ( = 0.45, < 0.01). F-NaF PET/CT links valvular calcification to BAV and aging in mice and suggests that AS may promote calcification. In addition to addressing the pathobiology of valvular calcification, F-NaF PET/CT may be a valuable tool for evaluation of emerging therapeutic interventions in CAVD.
Topics: Humans; Mice; Animals; Aortic Valve; Bicuspid Aortic Valve Disease; Positron Emission Tomography Computed Tomography; Disease Models, Animal; Aortic Valve Stenosis
PubMed: 37321825
DOI: 10.2967/jnumed.123.265516 -
Cellular and Molecular Life Sciences :... Aug 2023Aortic valve degeneration (AVD) is a life-threatening condition that has no medical treatment and lacks individual therapies. Although extensively studied with standard...
Aortic valve degeneration (AVD) is a life-threatening condition that has no medical treatment and lacks individual therapies. Although extensively studied with standard approaches, aetiologies behind AVD are unclear. We compared abundances of extracellular matrix (ECM) proteins from excised valve tissues of 88 patients with isolated AVD of normal tricuspid (TAV) and congenital bicuspid aortic valves (BAV), quantified more than 1400 proteins per ECM sample by mass spectrometry, and demonstrated that local ECM preserves molecular cues of the pathophysiological processes. The BAV ECM showed enrichment with fibrosis markers, namely Tenascin C, Osteoprotegerin, and Thrombospondin-2. The abnormal physical stress on BAV may cause a mechanical injury leading to a continuous Tenascin C-driven presence of myofibroblasts and persistent fibrosis. The TAV ECM exhibited enrichment with Annexin A3 (p = 1.1 × 10 and the fold change 6.5) and a significant deficit in proteins involved in high-density lipid metabolism. These results were validated by orthogonal methods. The difference in the ECM landscape suggests distinct aetiologies between AVD of BAV and TAV; warrants different treatments of the patients with BAV and TAV; elucidates the molecular basis of AVD; and implies possible new therapeutic approaches. Our publicly available database (human_avd_ecm.surgsci.uu.se) is a rich source for medical doctors and researchers who are interested in AVD or heart ECM in general. Systematic proteomic analysis of local ECM using the methods described here may facilitate future studies of various tissues and organs in development and disease.
Topics: Humans; Aortic Valve; Tenascin; Proteomics; Extracellular Matrix; Aorta
PubMed: 37632572
DOI: 10.1007/s00018-023-04926-1