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Arquivos Brasileiros de Cardiologia May 2022After fourteen decades of medical and technological evolution, infective endocarditis continues to challenge physicians in its daily diagnosis and management. Its...
After fourteen decades of medical and technological evolution, infective endocarditis continues to challenge physicians in its daily diagnosis and management. Its increasing incidence, demographic shifts (affecting older patients), microbiology with higher rates of Staphylococcus infection, still frequent serious complications and substantial mortality make endocarditis a very complex disease. Despite this, innovations in the diagnosis, involving microbiology and imaging, and improvements in intensive care and cardiac surgical techniques, materials and timing can impact the prognosis of this disease. Ongoing challenges persist, including rethinking prophylaxis, improving the diagnosis criteria comprising blood culture-negative endocarditis and prosthetic valve endocarditis, timing of surgical intervention, and whether to perform surgery in the presence of ischemic stroke or in intravenous drug users. A combined strategy on infective endocarditis is crucial, involving advanced clinical decisions and protocols, a multidisciplinary approach, national healthcare organization and health policies to achieve better results for our patients.
Topics: Cardiac Surgical Procedures; Endocarditis; Endocarditis, Bacterial; Heart Valve Prosthesis; Humans; Staphylococcal Infections
PubMed: 35613200
DOI: 10.36660/abc.20200798 -
Medical Engineering & Physics Mar 2022Bioprosthetic aortic heart valves are known to degenerate within 7-15 years of implantation. Currently, the options for treating a failing valve are (a) redo surgical...
Bioprosthetic aortic heart valves are known to degenerate within 7-15 years of implantation. Currently, the options for treating a failing valve are (a) redo surgical aortic valve replacement or, increasingly, (b) valve-in-valve transcatheter aortic valve implantation (ViV-TAVI). The ViV-TAVI procedure is referred to as redo-TAVI when the failing valve is a TAVI device. Repeated procedures, such as two or three valve-in-valves, significantly reduce the effective valve flow area, putting a limit on recurrent treatments. With increasing life expectancy and the use of TAVI in younger, lower-risk patients, the demand for multiple replacement procedures will inevitably increase. Against this background, we describe a novel valve system named exchangeable-TAVI (e-TAVI) in which an electromagnetic catheter is used to remove and retrieve a failed exchangeable valve, followed by the immediate deployment of a new valve. The e-TAVI system comprises (i) an exchangeable valve, (ii) a permanent holding member that anchors the exchangeable valve and (iii) a dedicated catheter with electromagnets for removal of the exchangeable valve. Simulations have been performed to determine the forces, frame design and electromagnetic parameters required to crimp and retrieve a 26 mm diameter valve. An optimum configuration was found to comprise a 12 cell self-expanding frame with circular ferromagnetic regions of 1 mm radius and 0.5 mm thickness, along with eight electromagnets of 1 mm radius and 2 mm thickness. A force of 2.87 N and a current of 2.52 A per electromagnet were required to partially crimp the frame to an envelope radius of 11 mm. While this amount of force allowed the frame to be crimped solely through magnetic attraction, re-sheathing of the frame was not possible due to the weaker shear holding force of the magnets. Also, the current was close to the fusing current of the copper wire needed to fit sufficient windings into the available volume. These issues led to the conclusion that, in addition to the magnetic coupling, a mechanical mating between the removal catheter and the exchangeable valve is needed. This would decrease both the force that the electromagnets had to exert during crimping and the current required to generate this force.
Topics: Aortic Valve; Aortic Valve Stenosis; Bioprosthesis; Heart Valve Prosthesis; Humans; Magnetic Phenomena; Treatment Outcome
PubMed: 35232544
DOI: 10.1016/j.medengphy.2022.103761 -
Journal of the American College of... Jun 2020
Topics: Aortic Valve; Heart Valve Prosthesis; Humans; Thrombosis; Tomography
PubMed: 32553253
DOI: 10.1016/j.jacc.2020.04.060 -
Journal of Cardiac Surgery Oct 2020The disturbance in the international normalized ratio (INR) in patients receiving warfarin therapy is of concern. We aimed to evaluate coagulation features in...
BACKGROUND
The disturbance in the international normalized ratio (INR) in patients receiving warfarin therapy is of concern. We aimed to evaluate coagulation features in hospitalized patients under warfarin treatment for prosthetic heart valves during the novel coronavirus disease 2019 (COVID-19) pneumonia pandemic.
METHODS
Between 20 February and 28 March 2020, 10 patients (7 males) who were under warfarin therapy for prosthetic heart valves were hospitalized after a diagnosis of COVID-19 in Tehran Heart Center, Tehran, Iran. The clinical, paraclinical, and in-hospital outcomes were described. The patients were followed for 4 weeks.
RESULTS
The median age was 62 years. All the patients received antiviral treatment, either lopinavir/ritonavir or oseltamivir. The serum level of high-sensitivity C-reactive protein ranged between 0.24 and 15.24 mg/dL. Alanine aminotransaminase was normal in all the patients except for two, with levels 1.6 and 4.2 times above normal values. The INR increased in all the patients. One (10%) patient died in the hospital. No bleeding, ischemic, or thrombotic events occurred during the hospital stay and within the 4-week follow-up.
CONCLUSIONS
Antiviral therapy in patients with COVID-19 with prosthetic heart valves might be an issue responsible for an uncontrolled INR. Liver injury may happen in a minority of patients. Bridging in these patients during the antiviral treatment might be required and because of significant INR fluctuations, it might be safer to prescribe antiviral treatment in an inpatient setting.
Topics: Adult; Aged; Aged, 80 and over; Anticoagulants; Antiviral Agents; Betacoronavirus; COVID-19; Comorbidity; Coronavirus Infections; Female; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Iran; Male; Middle Aged; Pandemics; Pneumonia, Viral; Retrospective Studies; SARS-CoV-2; Thromboembolism
PubMed: 33043651
DOI: 10.1111/jocs.14707 -
Journal of Internal Medicine Sep 2022Prosthetic valve endocarditis (PVE) is a feared complication after heart valve surgery. Studies on differences in bacteriology in various types of PVE are limited.
BACKGROUND
Prosthetic valve endocarditis (PVE) is a feared complication after heart valve surgery. Studies on differences in bacteriology in various types of PVE are limited.
OBJECTIVES
This study aimed to investigate the microbiology of PVE depending on the type of prosthetic valve and timing of diagnosis.
METHODS
A retrospective study based on the Swedish Registry on Infective Endocarditis focusing on PVE was conducted. The cohort was divided into mechanical and bioprosthetic valves; into endocarditis localization in the aortic, mitral, or tricuspid valve; and into early and late PVE. The microbiology in these groups was compared. Predictors of Staphylococcus aureus as the cause of PVE were examined by multivariable logistic regression.
RESULTS
A total of 780 episodes of PVE in 749 patients were compared regarding the distribution of causative microbiological agents. The most common agents included alpha-hemolytic streptococci (29%), S. aureus (22%), enterococci (14%), coagulase-negative staphylococci (CoNS) (12%), and Cutibacterium acnes (6%). S. aureus was more commonly found on mechanical valves compared to bioprosthetic ones (36% vs. 17%, p < 0.001) whereas alpha-hemolytic streptococci, enterococci, and CoNS were more common on bioprosthetic valves. There were no significant differences in the microbiology of PVE affecting mitral or aortic valves or in cases of early and late PVE. Predictors for S. aureus as the cause of PVE were end-stage renal disease, intravenous drug use, mechanical valve, and tricuspid localization of endocarditis.
CONCLUSIONS
The type of prosthetic heart valve is associated with the causative pathogen. Patients with mechanical valves are more likely to have PVE caused by S. aureus.
Topics: Endocarditis; Endocarditis, Bacterial; Heart Valve Prosthesis; Humans; Prosthesis-Related Infections; Registries; Retrospective Studies; Staphylococcus aureus
PubMed: 35373870
DOI: 10.1111/joim.13491 -
Clinical Cardiology Jul 2019Hemolysis is an unintended sequel of temporary or permanent intracardiac devices. However, limited data exist on the characteristics and treatment of hemolysis in... (Review)
Review
Hemolysis is an unintended sequel of temporary or permanent intracardiac devices. However, limited data exist on the characteristics and treatment of hemolysis in patients with cardiac prostheses. This entity, albeit uncommon, often poses significant diagnostic and management challenges to the clinical cardiologist. In this article, we aim to provide a contemporary overview of the incidence, mechanisms, diagnosis, and management of cardiac prosthesis-related hemolysis.
Topics: Anemia, Hemolytic; Global Health; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Incidence
PubMed: 31039274
DOI: 10.1002/clc.23191 -
Clinical Infectious Diseases : An... Dec 2023Infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is associated with high mortality and surgery is rarely performed. Thus, to inform on...
BACKGROUND
Infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is associated with high mortality and surgery is rarely performed. Thus, to inform on preventive measures and treatment strategies, we investigated patient characteristics and microbiology of IE after TAVI.
METHODS
Using Danish nationwide registries, we identified patients with IE after TAVI, IE after non-TAVI prosthetic valve (nTPV), and native valve IE. Patient characteristics; overall, early (≤12 m), and late IE (>12 m) microbiology; and unadjusted and adjusted mortality were compared.
RESULTS
We identified 273, 1022, and 5376 cases of IE after TAVI, IE after nTPV, and native valve IE. Age and frailty were highest among TAVI IE (4.8%; median age: 82 y; 61.9% frail). Enterococcus spp. were common for IE after TAVI (27.1%) and IE after nTPV (21.2%) compared with native valve IE (11.4%). Blood culture-negative IE was rare in IE after TAVI (5.5%) compared with IE after nTPV (15.2%) and native valve IE (13.5%). The unadjusted 90-day mortality was comparable, but the 5-year mortality was highest for IE after TAVI (75.2% vs 57.2% vs 53.6%). In Cox models adjusted for patient characteristics and bacterial etiology for 1-90 days and 91-365 days, there was no significant difference in mortality rates.
CONCLUSIONS
Patients with IE after TAVI are older and frailer, enterococci and streptococci are often the etiologic agents, and are rarely blood culture negative compared with other IE patients. Future studies regarding antibiotic prophylaxis strategies covering enterococci should be considered in this setting.
Topics: Humans; Aged, 80 and over; Transcatheter Aortic Valve Replacement; Prosthesis-Related Infections; Endocarditis, Bacterial; Endocarditis; Enterococcus; Risk Factors; Treatment Outcome; Heart Valve Prosthesis
PubMed: 37470442
DOI: 10.1093/cid/ciad431 -
The Journal of Invasive Cardiology Jun 2022Data are lacking regarding the outcomes of balloon postdilation (BPD) for the Acurate neo and neo2 devices. The aim of this study was to assess the impact of BPD in a...
BACKGROUND
Data are lacking regarding the outcomes of balloon postdilation (BPD) for the Acurate neo and neo2 devices. The aim of this study was to assess the impact of BPD in a large, single-center cohort of patients treated with the Acurate platform.
METHODS
For this retrospective analysis, we included all patients with severe aortic stenosis who underwent transfemoral transcatheter aortic valve replacement (TAVR) with the Acurate neo or neo2 prosthesis at our institution.
RESULTS
Among 1417 Acurate recipients, BPD was required in 521 cases (36.8%) for relevant paravalvular regurgitation (PVR) (n = 418) and incomplete prosthesis expansion or increased transprosthetic gradients (n = 103). Overall, BPD was successful in 87.9% and led to a significant reduction of more-than-mild PVR from 32.0% to 7.5% (P<.001). In the BPD group, prosthesis-patient mismatch (PPM) was less common. Prosthetic leaflet damage or valve dislodgment due to BPD occurred in 6 cases (1.2%). All other outcomes were similar between groups with and without BPD, including rates of aortic root injury, stroke, acute kidney injury, permanent pacemaker implantation, and all-cause 30-day mortality. Independent predictors of the need for BPD were higher mean transaortic gradients, severe aortic valve calcification, less prosthesis oversizing, and the use of larger prosthesis sizes.
CONCLUSION
For transfemoral TAVR using the Acurate neo/neo2, BPD effectively reduces relevant PVR and decreases the risk of PPM without increasing adverse events. Transcatheter heart valve damage associated with BPD is rare, commonly avoidable, and does not jeopardize the net benefit of BPD.
Topics: Aortic Valve; Aortic Valve Stenosis; Heart Valve Prosthesis; Humans; Prosthesis Design; Retrospective Studies; Risk Factors; Time Factors; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 35593542
DOI: No ID Found -
Journal of Thrombosis and Thrombolysis Apr 2023Since the beginning of the SARS-CoV-2 (COVID-19) pandemic, correlation of venous thromboembolism (VTE) and COVID-19 infection has been well established. Increased... (Review)
Review
Since the beginning of the SARS-CoV-2 (COVID-19) pandemic, correlation of venous thromboembolism (VTE) and COVID-19 infection has been well established. Increased inflammatory response in the setting of COVID-19 infection is associated with VTE and hypercoagulability. Venous and arterial thrombotic events in COVID-19 infection have been well documented; however, few cases have been reported involving cardiac valve prostheses. In this review, we present a total of eight cases involving COVID-19-related prosthetic valve thrombosis (PVT), as identified in a systematic review. These eight cases describe valve position (mitral versus aortic) and prosthesis type (bioprosthetic versus mechanical), and all cases demonstrate incidents of PVT associated with simultaneous or recent COVID-19 infection. None of these eight cases display obvious non-adherence to anticoagulation; five of the cases occurred greater than three years after the most recent valve replacement. Our review offers insights into PVT in COVID-19 infected patients including an indication for increased monitoring in the peri-infectious period. We explore valve thrombosis as a mechanism for prosthetic valve failure. We describe potential differences in antithrombotic strategies that may offer added antithrombotic protection during COVID-19 infection. With the growing population of valve replacement patients and recurring COVID-19 infection surges, it is imperative to explore relationships between COVID-19 and PVT.
Topics: Humans; Fibrinolytic Agents; Venous Thromboembolism; COVID-19; SARS-CoV-2; Heart Valve Diseases; Heart Valve Prosthesis; Thrombosis; Aortic Valve
PubMed: 36528721
DOI: 10.1007/s11239-022-02746-x -
Journal of the American College of... Jan 2022Transcatheter pulmonary valve (TPV) replacement (TPVR) has become the standard therapy for postoperative pulmonary outflow tract dysfunction in patients with a...
BACKGROUND
Transcatheter pulmonary valve (TPV) replacement (TPVR) has become the standard therapy for postoperative pulmonary outflow tract dysfunction in patients with a prosthetic conduit/valve, but there is limited information about risk factors for death or reintervention after this procedure.
OBJECTIVES
This study sought to evaluate mid- and long-term outcomes after TPVR in a large multicenter cohort.
METHODS
International registry focused on time-related outcomes after TPVR.
RESULTS
Investigators submitted data for 2,476 patients who underwent TPVR and were followed up for 8,475 patient-years. A total of 95 patients died after TPVR, most commonly from heart failure (n = 24). The cumulative incidence of death was 8.9% (95% CI: 6.9%-11.5%) 8 years after TPVR. On multivariable analysis, age at TPVR (HR: 1.04 per year; 95% CI: 1.03-1.06 per year; P < 0.001), a prosthetic valve in other positions (HR: 2.1; 95% CI: 1.2-3.7; P = 0.014), and an existing transvenous pacemaker/implantable cardioverter-defibrillator (HR: 2.1; 95% CI: 1.3-3.4; P = 0.004) were associated with death. A total of 258 patients underwent TPV reintervention. At 8 years, the cumulative incidence of any TPV reintervention was 25.1% (95% CI: 21.8%-28.5%) and of surgical TPV reintervention was 14.4% (95% CI: 11.9%-17.2%). Risk factors for surgical reintervention included age (0.95 per year [95% CI: 0.93-0.97 per year]; P < 0.001), prior endocarditis (2.5 [95% CI: 1.4-4.3]; P = 0.001), TPVR into a stented bioprosthetic valve (1.7 [95% CI: 1.2-2.5]; P = 0.007), and postimplant gradient (1.4 per 10 mm Hg [95% CI: 1.2-1.7 per 10 mm Hg]: P < 0.001).
CONCLUSIONS
These findings support the conclusion that survival and freedom from reintervention or surgery after TPVR are generally comparable to outcomes of surgical conduit/valve replacement across a wide age range.
Topics: Adolescent; Adult; Age Factors; Child; Child, Preschool; Defibrillators, Implantable; Endocarditis; Female; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Infant; Infant, Newborn; Male; Middle Aged; Pacemaker, Artificial; Pulmonary Valve; Registries; Reoperation; Young Adult
PubMed: 34991785
DOI: 10.1016/j.jacc.2021.10.031