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Journal of Cardiothoracic Surgery Aug 2021A review was conducted on the composition, advantages and limitations of available aortic valve prototypes to create an ideal valve for percutaneous implantation.... (Review)
Review
AIMS
A review was conducted on the composition, advantages and limitations of available aortic valve prototypes to create an ideal valve for percutaneous implantation. Patients Patients with multiple comorbidities who cannot withstand the risks of open cardiac surgery.
METHODOLOGY
The search was performed using online databases and textbooks. Articles were excluded based on specific criterion.
RESULTS
Ten prototypes created between 2006 and 2019 were found and reviewed. The prototypes had a set of advantages and limitations with their characteristics coinciding at times.
CONCLUSIONS
The ideal percutaneously implantable aortic valve should have minimum coaptation height, zero folds in the leaflets, minimum valve height, minimum leaflet flexion and three leaflets. It can be composed of biological or synthetic material, as long as it provides minimal risk of thrombosis. However, more studies are needed to ensure other ideal parameters.
Topics: Aortic Valve; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans
PubMed: 34362403
DOI: 10.1186/s13019-021-01597-6 -
PloS One 2023Prosthetic valve endocarditis (PVE) is a serious infection associated with high mortality that often requires surgical treatment.
BACKGROUND
Prosthetic valve endocarditis (PVE) is a serious infection associated with high mortality that often requires surgical treatment.
METHODS
Study on clinical characteristics and prognosis of a large contemporary prospective cohort of prosthetic valve endocarditis (PVE) that included patients diagnosed between January 2008 and December 2020. Univariate and multivariate analysis of factors associated with in-hospital mortality was performed.
RESULTS
The study included 1354 cases of PVE. The median age was 71 years with an interquartile range of 62-77 years and 66.9% of the cases were male. Patients diagnosed during the first year after valve implantation (early onset) were characterized by a higher proportion of cases due to coagulase-negative staphylococci and Candida and more perivalvular complications than patients detected after the first year (late onset). In-hospital mortality of PVE in this series was 32.6%; specifically, it was 35.4% in the period 2008-2013 and 29.9% in 2014-2020 (p = 0.031). Variables associated with in-hospital mortality were: Age-adjusted Charlson comorbidity index (OR: 1.15, 95% CI: 1.08-1.23), intracardiac abscess (OR:1.78, 95% CI:1.30-2.44), acute heart failure related to PVE (OR: 3. 11, 95% CI: 2.31-4.19), acute renal failure (OR: 3.11, 95% CI:1.14-2.09), septic shock (OR: 5.56, 95% CI:3.55-8.71), persistent bacteremia (OR: 1.85, 95% CI: 1.21-2.83) and surgery indicated but not performed (OR: 2.08, 95% CI: 1.49-2.89). In-hospital mortality in patients with surgical indication according to guidelines was 31.3% in operated patients and 51.3% in non-operated patients (p<0.001). In the latter group, there were more cases of advanced age, comorbidity, hospital acquired PVE, PVE due to Staphylococcus aureus, septic shock, and stroke.
CONCLUSIONS
Not performing cardiac surgery in patients with PVE and surgical indication, according to guidelines, has a significant negative effect on in-hospital mortality. Strategies to better discriminate patients who can benefit most from surgery would be desirable.
Topics: Humans; Male; Middle Aged; Aged; Female; Prognosis; Endocarditis, Bacterial; Heart Valve Prosthesis; Shock, Septic; Endocarditis; Registries
PubMed: 37682961
DOI: 10.1371/journal.pone.0290998 -
Annals of Cardiac Anaesthesia 2022Worldwide, about 13% of the 200,000 annual recipients of prosthetic heart valves (PHV) present for various surgical procedures. Also, more and more females are opting... (Review)
Review
Worldwide, about 13% of the 200,000 annual recipients of prosthetic heart valves (PHV) present for various surgical procedures. Also, more and more females are opting for pregnancies after having PHV. All patients with PHV present unique challenges for the anesthesiologists, surgeons and obstetricians (in case of deliveries). They have to deal with the perioperative management of anticoagulation and a host of other issues involved. We reviewed the English language medical literature relevant to the different aspects of perioperative management of patients with PHV, particularly the guidelines of reputed societies that appeared in the last 20 years. Regression of cardiac pathophysiology following valve replacement is variable both in extent and timeline. The extent to which reverse remodeling occurs depends on the perioperative status of the heart. We discussed the perioperative assessment of patients with PHV, including focused history and relevant investigations with the inferences drawn. We examined the need for prophylaxis against infective endocarditis and management of anticoagulation in such patients in the perioperative period and the guidelines of reputed societies. We also reviewed the conduct of anesthesia, including general and regional anesthesia (neuraxial and peripheral nerve/plexus blocks) in such patients. Finally, we discussed the management of delivery in this group of high-risk patients. From the discussion of different aspects of perioperative management of patients with PHV, we hope to guide in formulating the comprehensive plan of management of safe anesthesia in such patients.
Topics: Anticoagulants; Endocarditis; Female; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Heart Valves; Humans; Pregnancy
PubMed: 35799551
DOI: 10.4103/aca.aca_109_21 -
Internal Medicine (Tokyo, Japan) Feb 2024
Topics: Humans; Candida; Endocarditis, Bacterial; Heart Valve Prosthesis; Endocarditis; Candidiasis; Antifungal Agents
PubMed: 37316271
DOI: 10.2169/internalmedicine.1987-23 -
The Journal of Thoracic and... Apr 2022
Review
Topics: Algorithms; Anticoagulants; Aortic Valve; Computed Tomography Angiography; Echocardiography; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Incidence; Thrombosis
PubMed: 34556359
DOI: 10.1016/j.jtcvs.2021.07.052 -
The Journal of Thoracic and... Mar 2020
Topics: Animals; Bioprosthesis; Cattle; Heart Valve Prosthesis; Stents
PubMed: 31371110
DOI: 10.1016/j.jtcvs.2019.06.048 -
The Journal of Thoracic and... May 2021To report the implant experience and long-term outcomes from a large tertiary care referral center on surgical aortic valve replacement (SAVR) with a contemporary...
OBJECTIVES
To report the implant experience and long-term outcomes from a large tertiary care referral center on surgical aortic valve replacement (SAVR) with a contemporary stented pericardial bioprosthesis with anticalcification treatment.
METHODS
Patients underwent SAVR using the Trifecta valve at a single institution. Endpoints included procedural outcomes, adverse events, prosthesis-patient mismatch (PPM), long-term survival, and valve durability. Follow-up included 30-day, 6-month, and annual assessments. Treatment for structural valve deterioration (SVD) included surgical explant and valve-in-valve (V-in-V) transcatheter aortic valve implantation (TAVI).
RESULTS
SAVR was performed in 1241 patients (median age, 73.5 ± 6.4 years; 54% male; median logistic EuroSCORE, 7.8) with concomitant procedures in 713 cases (57.5%). Intraprocedural mortality was 1.4%, and 30-day mortality was 6.0%. At hospital discharge, 68 patients (5.5%) had moderate PPM, and no patients had severe PPM. Adverse events included cardiac arrhythmias (44.7%, mostly atrial fibrillation), respiratory failure (22.9%), acute renal failure requiring temporary renal replacement therapy (12.9%), and low cardiac output syndrome (3.3%). Follow-up data were available over a total of 5469 patient-years (median duration of follow-up, 4.7 years). Freedom at 8 years from all-cause mortality, valve-related mortality, reoperation for SVD (redo SAVR or V-in-V TAVI), and endocarditis were 78.4%, 98.0%, 93.3%, and 96.5%, respectively. Of the 30 patients with SVD, 17 were treated by V-in-V TAVI and 13 underwent surgical explant.
CONCLUSIONS
Outcomes from this large single-center cohort at increased surgical risk demonstrate excellent long-term durability of the Trifecta valve for SAVR and feasibility of treating SVD by V-in-V TAVI.
Topics: Aged; Aged, 80 and over; Animals; Aortic Valve; Aortic Valve Stenosis; Bioprosthesis; Cattle; Cohort Studies; Female; Heart Valve Prosthesis; Humans; Male; Reoperation; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 31932059
DOI: 10.1016/j.jtcvs.2019.11.028 -
Interactive Cardiovascular and Thoracic... Aug 2022
Topics: Bioprosthesis; Heart Valve Prosthesis; Humans; Pacemaker, Artificial
PubMed: 35924972
DOI: 10.1093/icvts/ivac206 -
Multimedia Manual of Cardiothoracic... Apr 2023Endoscopic aortic valve replacement is a fascinating and rapidly growing surgical activity. In the setting of minimally invasive surgical procedures, compared with...
Endoscopic aortic valve replacement is a fascinating and rapidly growing surgical activity. In the setting of minimally invasive surgical procedures, compared with mitral and tricuspid procedures, aortic valve operations increase the challenge for several reasons. If one relies only on the thoracoscope, the surgical planning and set-up, including the placement of the working port and technical surgical manoeuvres like the aortic cross-clamp, the aortotomy and the aortorrhaphy can be difficult and may lead to severe complications or an increased rate of conversion to sternotomy. A well-developed preoperative decision-making process that includes knowledge of the prosthetic valve characteristics and their implications in an endoscopic environment is crucial for a successful endoscopic aortic valve programme. This video tutorial provides tips and tricks useful for endoscopic aortic valve replacement by paying attention to the patient's anatomy, to the available prosthetic valve types and to their impact on the surgical set-up.
Topics: Humans; Aortic Valve; Heart Valve Prosthesis Implantation; Heart Valve Prosthesis; Endoscopy; Minimally Invasive Surgical Procedures
PubMed: 37009910
DOI: 10.1510/mmcts.2023.007 -
JACC. Cardiovascular Imaging Dec 2020
Topics: Endocarditis; Endocarditis, Bacterial; Fluorodeoxyglucose F18; Heart Valve Prosthesis; Humans; Positron Emission Tomography Computed Tomography; Predictive Value of Tests; Reference Standards; Uncertainty
PubMed: 32828768
DOI: 10.1016/j.jcmg.2020.06.023