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Journal of the American College of... Oct 2020It is unknown whether transcatheter valves will have similar durability as surgical bioprosthetic valves. Definitions of structural valve deterioration (SVD), based on... (Comparative Study)
Comparative Study Randomized Controlled Trial
BACKGROUND
It is unknown whether transcatheter valves will have similar durability as surgical bioprosthetic valves. Definitions of structural valve deterioration (SVD), based on valve related reintervention or death, underestimate the incidence of SVD.
OBJECTIVES
This study sought to determine and compare the 5-year incidence of SVD, using new standardized definitions based on echocardiographic follow-up of valve function, in intermediate-risk patients with severe aortic stenosis given transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) in the PARTNER (Placement of Aortic Transcatheter Valves) 2A trial and registry.
METHODS
In the PARTNER 2A trial, patients were randomly assigned to receive either TAVR with the SAPIEN XT or SAVR, whereas in the SAPIEN 3 registry, patients were assigned to TAVR with the SAPIEN 3. The primary endpoint was the incidence of SVD, that is, the composite of SVD-related hemodynamic valve deterioration during echocardiographic follow-up and/or SVD-related bioprosthetic valve failure (BVF) at 5 years.
RESULTS
Compared with SAVR, the SAPIEN-XT TAVR cohort had a significantly higher 5-year exposure adjusted incidence rates (per 100 patient-years) of SVD (1.61 ± 0.24% vs. 0.63 ± 0.16%), SVD-related BVF (0.58 ± 0.14% vs. 0.12 ± 0.07%), and all-cause (structural or nonstructural) BVF (0.81 ± 0.16% vs. 0.27 ± 0.10%) (p ≤ 0.01 for all). The 5-year rates of SVD (0.68 ± 0.18% vs. 0.60 ± 0.17%; p = 0.71), SVD-related BVF (0.29 ± 0.12% vs. 0.14 ± 0.08%; p = 0.25), and all-cause BVF (0.60 ± 0.15% vs. 0.32 ± 0.11%; p = 0.32) in SAPIEN 3 TAVR were not significantly different to a propensity score matched SAVR cohort. The 5-year rates of SVD and SVD-related BVF were significantly lower in SAPIEN 3 versus SAPIEN XT TAVR matched cohorts.
CONCLUSIONS
Compared with SAVR, the second-generation SAPIEN XT balloon-expandable valve has a higher 5-year rate of SVD, whereas the third-generation SAPIEN 3 has a rate of SVD that was not different from SAVR. (The PARTNER II Trial: Placement of AoRTic TraNscathetER Valves - PII A [PARTNERII A]; NCT01314313; The PARTNER II Trial: Placement of AoRTic TraNscathetER Valves II - PARTNER II - PARTNERII - S3 Intermediate [PARTNERII S3i]; NCT03222128).
Topics: Aged; Aged, 80 and over; Aortic Valve Insufficiency; Bioprosthesis; Female; Heart Valve Prosthesis; Humans; Male; Prosthesis Failure; Transcatheter Aortic Valve Replacement
PubMed: 33059828
DOI: 10.1016/j.jacc.2020.08.049 -
Journal of the American College of... Sep 2019
Topics: Aortic Valve Insufficiency; Fluoroquinolones; Humans; Mitral Valve Insufficiency
PubMed: 31514946
DOI: 10.1016/j.jacc.2019.08.002 -
The Journal of Thoracic and... Feb 2022
Topics: Aortic Valve Insufficiency; Heart Valve Prosthesis Implantation; Humans
PubMed: 33581898
DOI: 10.1016/j.jtcvs.2020.12.141 -
BMJ Case Reports Aug 2019A 62-year-old man was admitted to the emergency department due to fever and acute heart failure. A transthoracic echocardiogram revealed severe aortic valve obstruction....
A 62-year-old man was admitted to the emergency department due to fever and acute heart failure. A transthoracic echocardiogram revealed severe aortic valve obstruction. He was an hepatic transplant recipient and was medicated with everolimus. He underwent mitral and aortic valve replacement with prosthetic valves 4 years ago. Due to his medical background, therapy and clinical presentation, empirical therapy for infective endocarditis was started. Transoesophageal echocardiogram showed severe aortic valve regurgitation but no other findings suggestive of endocarditis. Computed tomography (CT) revealed pulmonary infiltrates compatible with infection and no evidence of septic embolisation. Multiple sets of blood cultures were negative. was isolated in bronchial lavage and antibiotic therapy was adjusted. The patient underwent aortic valve replacement, with no macroscopic findings suggestive of endocarditis. was isolated in the surgically removed valve. Dual antibiotic therapy was successfully administered for 6 weeks.
Topics: Acute Disease; Anti-Bacterial Agents; Aortic Valve Insufficiency; Bronchoalveolar Lavage Fluid; Bronchoscopy; Diagnosis, Differential; Echocardiography, Transesophageal; Endocarditis, Bacterial; Heart Failure; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Lung; Male; Middle Aged; Proteus mirabilis; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 31466989
DOI: 10.1136/bcr-2019-230575 -
The Journal of Invasive Cardiology Sep 2023A 56-year-old man presented with typical angina for 1 day and a prior history of exertional dyspnea of 6 months duration. Clinically, he was diagnosed with severe aortic...
A 56-year-old man presented with typical angina for 1 day and a prior history of exertional dyspnea of 6 months duration. Clinically, he was diagnosed with severe aortic regurgitation (AR). Electrocardiogram showed left ventricular hypertrophy with volume overload.
Topics: Male; Humans; Middle Aged; Quadricuspid Aortic Valve; Angina Pectoris; Aortic Valve Insufficiency; Dyspnea; Electrocardiography
PubMed: 37983112
DOI: 10.25270/jic/22.00325 -
European Journal of Pediatrics Oct 2021Congenital anomalies of the aortic valve frequently necessitate intervention in childhood. The most common aortic valve pathologies present in childhood are aortic... (Review)
Review
Congenital anomalies of the aortic valve frequently necessitate intervention in childhood. The most common aortic valve pathologies present in childhood are aortic stenosis and insufficiency. Presentation of aortic valve disease depends on severity and presence of concomitant syndromes and valvular disorders. Treatment options are largely categorised as medical, percutaneous repair or surgical repair and replacement. Surgical techniques have been refined over the last few years making this the mainstay of treatment in paediatric cases. Whilst repair is considered in most instances before replacement, there are substantial limitations which are reflected in the frequency of reintervention and restenosis rate. Replacements are typically undertaken with tissue or mechanical prosthesis. The current gold-standard aortic valve replacement surgery is called the Ross procedure-where replacement is undertaken with a competent pulmonic valve and a simultaneous pulmonary homograft.Conclusion: In this review, we aim to outline the various surgical options and discuss efficacy and complications of various interventions. What is Known: • Congenital aortic valve defects repair options medically and surgically What is New: • Comparisons between surgical options for aortic valve repair including efficacy, risks and long-term outcomes.
Topics: Aortic Valve; Aortic Valve Insufficiency; Aortic Valve Stenosis; Child; Heart Valve Diseases; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Treatment Outcome
PubMed: 33970315
DOI: 10.1007/s00431-021-04092-1 -
Multimedia Manual of Cardiothoracic... Oct 2021Aortic valve neocuspidization with fixed autologous pericardium according to the Ozaki technique has been proven to be an effective therapy for the treatment of aortic...
Aortic valve neocuspidization with fixed autologous pericardium according to the Ozaki technique has been proven to be an effective therapy for the treatment of aortic valvulopathies of various entities (aortic stenosis, aortic regurgitation, aortic valve endocarditis) in both tricuspid and bicuspid aortic valves. Thus, aortic valve neocuspidization with fixed autologous pericardium represents a versatile alternative to complex aortic valve repair, with better hemodynamics compared to biological aortic valve replacement and without the need for lifelong anticoagulation, which characterizes mechanical aortic valve replacement. The authors meticulously describe all the technical steps of this highly reproducible, standardized procedure.
Topics: Aortic Valve; Aortic Valve Insufficiency; Aortic Valve Stenosis; Bioprosthesis; Heart Valve Prosthesis; Humans; Pericardium; Treatment Outcome
PubMed: 34672143
DOI: 10.1510/mmcts.2021.060 -
Multimedia Manual of Cardiothoracic... May 2022Treatment of pediatric aortic valve disease is controversial. In this regard, interest is growing in the neocuspidization of the aortic valve according to Ozaki. In this...
Treatment of pediatric aortic valve disease is controversial. In this regard, interest is growing in the neocuspidization of the aortic valve according to Ozaki. In this video tutorial, we illustrate briefly the entire reconstruction technique of a neoaortic valve with pretreated autologous pericardium used in our institution in pediatric patients by describing a case of an incompetent native tricuspid aortic valve.
Topics: Aortic Valve; Aortic Valve Insufficiency; Child; Humans; Pericardium; Transplantation, Autologous; Treatment Outcome; Tricuspid Valve
PubMed: 35616958
DOI: 10.1510/mmcts.2022.021 -
Current Cardiology Reviews 2023Aortic valve insufficiency (AI) describes the pathology of blood leaking through the aortic valve to the left ventricle during diastole and is classified as mild,... (Review)
Review
Aortic valve insufficiency (AI) describes the pathology of blood leaking through the aortic valve to the left ventricle during diastole and is classified as mild, moderate or severe according to the volume of regurgitating blood. Intervention is required in severe AI when the patient is symptomatic or when the left ventricular function is impaired. Aortic valve replacement has been considered the gold standard for decades for these patients, but several repair techniques have recently emerged that offer exceptional stability and long-term outcomes. The appropriate method of repair is selected based on the mechanism of AI and each patient's anatomic variations. This review aims to describe different pathologies of AI based on its anatomy, along with the different surgical techniques of aortic repair and their reported results.
Topics: Humans; Aortic Valve Insufficiency; Aortic Valve; Heart Valve Prosthesis Implantation; Heart Valve Prosthesis; Ventricular Function, Left; Treatment Outcome
PubMed: 35490315
DOI: 10.2174/1573403X18666220427120235 -
Archives of Cardiovascular Diseases Nov 2022Results and durability of aortic valve replacement in aortic stenosis are well known, but no study has focused on the results of aortic valve replacement in aortic...
BACKGROUND
Results and durability of aortic valve replacement in aortic stenosis are well known, but no study has focused on the results of aortic valve replacement in aortic insufficiency.
AIM
The aim of this retrospective study was to describe our mid-term outcomes after aortic valve replacement for aortic insufficiency.
METHODS
All consecutive adult patients who underwent bioprosthetic aortic valve replacement for aortic insufficiency at two European centres (in France and Germany) between May 2005 and December 2020 were analysed.
RESULTS
During the study period, 289 patients were included. Mean age was 56.9±12.5 years. Overall operative mortality was 1.5%, and the 10-year survival estimate rate was 75.0%, which was significantly lower than in the age- and sex-matched general population, with a standardized mortality ratio of 2.88 (95% confidence interval 1.96-4.08; P<0001). Freedom from aortic valve-related death was 87.6%, and from aortic valve-related reoperation was 87.4%. No patient aged>60 years was reoperated on during follow-up. Freedom from severe structural valve deterioration at 10 years was 73.3%, and freedom from moderate structural valve deterioration at 10 years was 50.3%. Freedom from major adverse valve-related events at 10 years was 69.7%.
CONCLUSIONS
Although bioprosthetic aortic valve replacement for aortic insufficiency shows good early results, 10-year mortality and major adverse valve-related event rates in young patients may be a concern, with a reduction in life expectancy compared with the general population.
Topics: Adult; Humans; Middle Aged; Aged; Aortic Valve; Retrospective Studies; Heart Valve Prosthesis Implantation; Postoperative Complications; Bioprosthesis; Heart Valve Prosthesis; Aortic Valve Insufficiency; Aortic Valve Stenosis; Reoperation
PubMed: 36272966
DOI: 10.1016/j.acvd.2022.08.001