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Journal of the American College of... Mar 2023
Topics: Humans; Aortic Valve; Heart Valve Prosthesis; Aortic Valve Stenosis; Prosthesis Implantation; Heart Valve Prosthesis Implantation; Prosthesis Design; Treatment Outcome; Bioprosthesis
PubMed: 36889876
DOI: 10.1016/j.jacc.2023.01.011 -
Journal of the American College of... Jan 2021
Topics: Aortic Valve; Bioprosthesis; Epidemics; Heart Valve Prosthesis; Humans; Transcatheter Aortic Valve Replacement
PubMed: 33413935
DOI: 10.1016/j.jacc.2020.11.024 -
Journal of Thrombosis and Haemostasis :... Sep 2023Prosthetic heart valves are the only treatment for most patients with severe valvular heart disease. Mechanical valves, made of metallic components, are the most...
BACKGROUND
Prosthetic heart valves are the only treatment for most patients with severe valvular heart disease. Mechanical valves, made of metallic components, are the most long-lasting type of replacement valves. However, they are prone to thrombosis and require permanent anticoagulation and monitoring, which leads to higher risk of bleeding and impacts the patient's quality of life.
OBJECTIVES
To develop a bioactive coating for mechanical valves with the aim to prevent thrombosis and improve patient outcomes.
METHODS
We used a catechol-based approach to produce a drug-releasing multilayer coating adherent to mechanical valves. The hemodynamic performance of coated Open Pivot valves was verified in a heart model tester, and coating durability in the long term was assessed in a durability tester producing accelerated cardiac cycles. Coating antithrombotic activity was evaluated in vitro with human plasma or whole blood under static and flow conditions and in vivo after surgical valve implantation in a pig's thoracic aorta.
RESULTS
We developed an antithrombotic coating consisting of ticagrelor- and minocycline-releasing cross-linked nanogels covalently linked to polyethylene glycol. We demonstrated the hydrodynamic performance, durability, and hemocompatibility of coated valves. The coating did not increase the contact phase activation of coagulation, and it prevented plasma protein adsorption, platelet adhesion, and thrombus formation. Implantation of coated valves in nonanticoagulated pigs for 1 month efficiently reduced valve thrombosis compared with noncoated valves.
CONCLUSION
Our coating efficiently inhibited mechanical valve thrombosis, which might solve the issues of anticoagulant use in patients and the number of revision surgeries due to valve thrombosis despite anticoagulation.
Topics: Humans; Animals; Swine; Fibrinolytic Agents; Quality of Life; Thrombosis; Heart Valve Diseases; Heart Valve Prosthesis; Anticoagulants; Heart Valves
PubMed: 37196847
DOI: 10.1016/j.jtha.2023.05.004 -
Gaceta Medica de Mexico 2023Heart valve replacement surgery with mechanical or biological prostheses entails a risk of thromboembolism and bleeding complications.
BACKGROUND
Heart valve replacement surgery with mechanical or biological prostheses entails a risk of thromboembolism and bleeding complications.
OBJECTIVE
To determine the complications related to complementary anticoagulation therapy and the probability of risk.
METHODS
One-hundred and sixty-three patients who underwent heart valve replacement between 2002 and 2016 with either mechanical or biological prostheses, and who received vitamin K antagonists after hospital discharge, were studied. Anticoagulation therapy was categorized into optimal and non-optimal according to INR values prior to the development of complications. Patients with comorbidities and other risk factors for thrombosis and/or bleeding were excluded.
RESULTS
In total, 68.7 % of patients received mechanical prostheses, and 31.3 %, biological prostheses (p ≤ 0.001); 25.2 % experienced the complications that motivated the study (p ≤ 0.001), which were hemorrhagic in 48.8 %, thromboembolic in 26.8 %, and of both types in 24.4 % (relative risk = 4.229). Among the patients with complications, 95.1 % received mechanical prostheses, and 4.9 %, biological (p = 0.005); non-optimal INR was identified in 49.7 % (p ≤ 0.001).
CONCLUSIONS
Given the high risk of thromboembolic and hemorrhagic complications, valve prostheses must be carefully chosen, and care priorities should include prevention and follow-up, especially in those patients who require anticoagulation therapy.
Topics: Humans; Tertiary Care Centers; Thromboembolism; Heart Valve Prosthesis; Anticoagulants; Hemorrhage; Heart Valves; Heart Valve Prosthesis Implantation
PubMed: 37494706
DOI: 10.24875/GMM.M23000772 -
JACC. Cardiovascular Interventions Mar 2023Commissural alignment has become an important topic in transcatheter aortic valve replacement (TAVR) because it may improve coronary access, facilitate future valve...
BACKGROUND
Commissural alignment has become an important topic in transcatheter aortic valve replacement (TAVR) because it may improve coronary access, facilitate future valve procedures, and possibly improve valve durability. The efficacy of commissural alignment with ACURATE neo2 has not yet been shown in a large population.
OBJECTIVES
The authors sought to determine the feasibility and success of attempting commissural alignment in an unselected TAVR population treated with the ACURATE neo2 prosthetic heart valve.
METHODS
A total of 170 consecutive patients underwent TAVR with a dedicated implantation technique to align the TAVR valve to the native valve. Using right-left overlap and 3-cusp views, valve orientation was adjusted by rotation of the unexpanded valve at the level of the aortic root. Effectiveness was assessed postprocedure as the degree of misalignment determined by analyzing fluoroscopic valve orientation to corresponding cusp orientation on preprocedural computed tomography. Safety endpoints included mortality, stroke/transient ischemic attack, and additional complications through 30 days.
RESULTS
Of 170 patients, 167 (98.2%) could be analyzed for alignment, and all 170, for safety outcomes. Most patients (97%) had successful alignment (≤ mild misalignment), with 80% with commissural alignment, while the degrees of misalignment were 17% mild, 1.2% moderate, 1.8% severe.
CONCLUSIONS
In this large evaluation of a commissural alignment technique, alignment was achieved in nearly all patients without safety concerns or impact to procedure duration. Commissural alignment appears effective and safe across all patients with this novel technique.
Topics: Humans; Aortic Valve; Aortic Valve Stenosis; Risk Factors; Prosthesis Design; Treatment Outcome; Transcatheter Aortic Valve Replacement; Heart Valve Prosthesis; Multidetector Computed Tomography
PubMed: 36990556
DOI: 10.1016/j.jcin.2023.01.018 -
International Journal of Surgery... Nov 2023Improved durability of modern biologic prostheses and growing experience with the transcatheter valve-in-valve technique have contributed to a substantial increase in...
BACKGROUND
Improved durability of modern biologic prostheses and growing experience with the transcatheter valve-in-valve technique have contributed to a substantial increase in the use of bioprostheses in younger patients. However, discussion of prosthetic valve selection in dialysis patients remains scarce as the guidelines are updated. This study aims to compare long-term outcomes between propensity score-matched cohorts of dialysis patients who underwent primary aortic valve replacement with a mechanical prosthesis or a bioprosthesis.
MATERIALS AND METHODS
Longitudinal data of dialysis patients who underwent primary aortic valve replacement between 1 January 2001 and 31 December 2018, were retrieved from the National Health Insurance Research Database.
RESULTS
A total of 891 eligible patients were identified, of whom 243 ideally matched pairs of patients were analyzed. There was no significant difference in all-cause mortality (hazard ratio 1.11, 95% CI: 0.88-1.40) or the incidence of major adverse prosthesis-related events between the two groups (hazard ratio 1.03, 95% CI: 0.84-1.25). In patients younger than 50 years of age, using a mechanical prosthesis was associated with a significantly longer survival time across 10 years of follow-up than using a bioprosthesis (restricted mean survival time) at 10 years: 7.24 (95% CI: 6.33-8.14) years for mechanical prosthesis versus 5.25 (95% CI: 4.25-6.25) years for bioprosthesis, restricted mean survival time difference 1.99 years, 95% CI: -3.34 to -0.64).
CONCLUSION
A 2-year survival gain in favor of mechanical prostheses was identified in dialysis patients younger than 50 years. The authors suggest mechanical prostheses for aortic valve replacement in these younger patients.
Topics: Humans; Child; Aortic Valve; Heart Valve Prosthesis Implantation; Retrospective Studies; Treatment Outcome; Prosthesis Design; Renal Dialysis; Heart Valve Prosthesis; Bioprosthesis; Reoperation
PubMed: 37526125
DOI: 10.1097/JS9.0000000000000611 -
The Journal of Invasive Cardiology Apr 2021A 36-year-old woman with a history of redo mitral valve replacement (bileaflet mechanical mitral valve prosthesis) in 2002 for prosthetic mitral valve endocarditis...
A 36-year-old woman with a history of redo mitral valve replacement (bileaflet mechanical mitral valve prosthesis) in 2002 for prosthetic mitral valve endocarditis presented to the emergency department with a history of recurrent palpitations. A transthoracic echocardiogram was performed and falsely indicated a diagnosis of prosthetic mitral valve thrombosis. However, review of the echocardiogram by an experienced echocardiologist revised the diagnosis to microbubbles formation phenomenon with mechanical mitral prosthesis. Frame-by-frame analysis or reducing the frame rate of the recorded echocardiographic loop is vital to demonstrate the growing or dissipation of microbubbles and hence to avoid inadvertent thrombolytic therapy or surgical intervention.
Topics: Adult; Female; Heart Valve Prosthesis; Humans; Microbubbles; Mitral Valve; Thrombolytic Therapy; Thrombosis
PubMed: 33794483
DOI: No ID Found -
Methodist DeBakey Cardiovascular Journal 2023Over the last 20 years, transcatheter aortic valve replacement (TAVR) has revolutionized the management of aortic stenosis and has become the standard of care across the... (Review)
Review
Over the last 20 years, transcatheter aortic valve replacement (TAVR) has revolutionized the management of aortic stenosis and has become the standard of care across the entire spectrum of surgical risk. Expansion of TAVR in treating younger, lower-risk patients with longer life expectancies, and treating earlier in the disease process, has seen a continuous evolution in device technology, with several next-generation transcatheter heart valves developed to minimize procedural complications and improve patient outcomes. This review provides an update on the latest advances in transcatheter delivery systems, devices, and leaflet technology.
Topics: Humans; Transcatheter Aortic Valve Replacement; Aortic Valve; Heart Valve Prosthesis; Treatment Outcome; Aortic Valve Stenosis; Risk Factors
PubMed: 37213874
DOI: 10.14797/mdcvj.1230 -
The Journal of Thoracic and... May 2021
Topics: Aortic Valve; Heart Valve Prosthesis; Humans; Robotics
PubMed: 33288237
DOI: 10.1016/j.jtcvs.2020.10.112 -
Journal of the American College of... May 2023
Topics: Humans; Aortic Valve; Heart Valve Prosthesis; Transcatheter Aortic Valve Replacement; Aortic Valve Stenosis; Treatment Outcome; Risk Factors; Heart Valve Prosthesis Implantation
PubMed: 37100484
DOI: 10.1016/j.jacc.2023.03.006