-
Frontiers in Bioscience (Landmark... May 2024Recent studies highlighted the presence of anti-α-Gal antibodies in patients implanted with commercial bioprosthetic heart valves (BHVs). BHVs expose residual α-Gal...
BACKGROUND
Recent studies highlighted the presence of anti-α-Gal antibodies in patients implanted with commercial bioprosthetic heart valves (BHVs). BHVs expose residual α-Gal xenoantigen and their recognition by the circulating anti-Gal antibodies leads to opsonization of the device's tissue component with the consequent triggering of a deterioration pathway that culminates with calcification. Small animal models such as mice and rats have been broadly involved in the testing of biomaterials by subcutaneous implantation, especially for the effectiveness of BHVs anti-calcific treatments. However, since models employed for this purpose express α-Gal antigen, the implantation of BHVs' leaflets does not elicit a proper immunological response, so the calcification propensity may be dramatically underestimated.
METHODS
An α-Gal knockout (KO) mouse model has been created, using the CRISP/Cas9 approach, and adopted to assess the calcification potential of commercial BHVs leaflets through the surgical implantation in the back subcutis area. Calcium quantification was performed by inductively coupled plasma analysis; immune response against the BHVs leaflets and α-Gal silencing was evaluated through immunological assays.
RESULTS
Two months after the implantation of commercial BHV leaflets, the anti-Gal antibody titers in KO mice doubled when compared with those found in wild-type (WT) ones. Leaflets explanted from KO mice, after one month, showed a four-time increased calcium deposition concerning the ones explanted from WT. The degree of silencing of α-Gal varied, depending on the specific organ that was assessed. In any case, the animal model was suitable for evaluating implanted tissue responses.
CONCLUSIONS
Such mouse model proved to be an accurate tool for the study of the calcific propensity of commercial BHVs leaflets than those hitherto used. Given its reliability, it could also be successfully used to study even other diseases in which the possible involvement of α-Gal has been observed.
Topics: Animals; Heart Valve Prosthesis; Calcinosis; Mice, Knockout; Bioprosthesis; Mice; Disease Models, Animal; Mice, Inbred C57BL; Male
PubMed: 38812319
DOI: 10.31083/j.fbl2905181 -
Journal of Cardiothoracic Surgery May 2024Quadricuspid aortic valve (QAV) is a rare congenital anomaly characterized by the presence of four cusps instead of the usual three. It is estimated to occur in less...
BACKGROUND
Quadricuspid aortic valve (QAV) is a rare congenital anomaly characterized by the presence of four cusps instead of the usual three. It is estimated to occur in less than 0.05% of the population, with Type A (four equal-sized leaflets) accounting for roughly 30% of QAV subtypes. Based on limited clinical series, the usual presentation is progressive aortic valve regurgitation (AR) with symptoms occurring in the fourth to sixth decade of life. Severe aortic valve stenosis (AS) and acute AR are very uncommon.
CASE PRESENTATION
We describe two cases of Type A QAV in patients who remained asymptomatic until their seventies with very uncommon presentations: one with severe AS and one with acute, severe AR and flail leaflet. In Case A, a 72-year-old patient with history of moderate AS presents to clinic with progressive exertional dyspnea. During work-up for transcatheter vs. surgical replacement pre-operative computed tomography angiogram (CTA) reveals a quadricuspid aortic valve with severe AS, and the patient undergoes surgical aortic valve replacement. Pre-discharge transthoracic echocardiography (TTE) shows good prosthetic valve function with no gradient or regurgitation. In Case B, a 76-year-old patient is intubated upon arrival to the hospital for acute desaturation, found to have wide open AR on catheterization, and transferred for emergent intervention. Intraoperative TEE reveals QAV with flail leaflet and severe AR. Repair is considered but deferred ultimately due to emergent nature. Post-operative TTE demonstrates good prosthetic valve function with no regurgitation and normal biventricular function.
CONCLUSIONS
QAV can present as progressive severe AS and acute AR, with symptoms first occurring in the seventh decade of life. The optimal treatment for QAV remains uncertain. Although aortic valve repair or transcatheter option may be feasible in some patients, aortic valve replacement remains a tenable option.
Topics: Humans; Aged; Aortic Valve; Male; Aortic Valve Stenosis; Aortic Valve Insufficiency; Echocardiography; Female; Heart Valve Prosthesis Implantation
PubMed: 38812010
DOI: 10.1186/s13019-024-02696-w -
Sisli Etfal Hastanesi Tip Bulteni 2024This study aims to compare the early results of patients who underwent isolated aortic valve replacement (AVR) with supra-annular and intra-annular AVR.
OBJECTIVES
This study aims to compare the early results of patients who underwent isolated aortic valve replacement (AVR) with supra-annular and intra-annular AVR.
METHODS
Between 2013 and 2019, 113 patients (77 males; mean age 57.8±16.36 years) who underwent isolated AVR were evaluated. The patients were divided into two groups those who underwent supra-annular (n=59) and intra-annular (n=54) AVR. The most commonly used valves in surgeries St Jude Medical Masters (St. Jude Medical, Minneapolis, MN, USA), (n=35, 30.9%), Sorin Mitroflow (Sorin Group Inc., Mitroflow Division, Canada), (n=32, 28.3%, and Carbomedics Top Hat (Sulzer, Carbomedics, Austin, TX), (n=31, 27.4%).
RESULTS
The cross-clamp (XCL) and cardiopulmonary bypass (CPB) times of the patients who underwent supra-annular AVR were found to be significantly higher than the patients who underwent intra-annular AVR. However, there was no significant difference between the two groups in terms of postoperative adverse events. There was no significant difference between the two groups in the postoperative first-week transthoracic echocardiographic (TTE) findings.
CONCLUSION
When comparing supra-annular and intra-annular valve positioning results in patients undergoing isolated AVR, no significant difference was found between the groups in terms of postoperative complications, gradient differences in postoperative TTE, and ejection fractions. Supra-annular valve positioning should be considered, especially in patients with small annulus, in the presence of suitable anatomical features. However, this issue needs to be investigated in future prospective studies with more patients.
PubMed: 38808047
DOI: 10.14744/SEMB.2024.39112 -
Cureus Apr 2024We sought to determine whether there is a relationship between the fluoroscopic working angle used to achieve a co-planar view during the deployment of the prosthesis...
BACKGROUND
We sought to determine whether there is a relationship between the fluoroscopic working angle used to achieve a co-planar view during the deployment of the prosthesis during transcatheter aortic valve implantation (TAVI) and rates of complications, including paravalvular leaks, complete heart block, annular rupture, stroke, valve embolization, discharge to a skilled nursing facility and death within thirty days.
METHODS
All patients undergoing TAVI at our institution from 2015 to 2022 were retrospectively analyzed. Images were reviewed to determine the fluoroscopic working angle during deployment, and medical records were used to determine the incidence and type of complication. A multilayer perceptron was employed to evaluate the predictive ability of the fluoroscopic working angle during deployment on complications of one-day and 30-day paravalvular leak, 30-day mortality, the need for a new pacemaker, discharge to a skilled nursing facility, stroke and the requirement for emergency intervention.
RESULTS
Eight hundred and thirty-four patients were included in the study. Fluoroscopic working angle had excellent predictive value for stroke (area under the receiver operating characteristic curve (AUROC) of 0.812), one-day (AUROC 0.850), and 30-day paravalvular leak (AUROC 0.801). However, feature importance and scaled weighting analysis indicated that only a working angle in the left anterior oblique/cranial quadrant was informative for the development of an outcome of interest specific to a working angle quadrant (30-day paravalvular leak).
CONCLUSION
Fluoroscopic working angle may be a useful way to further refine well-established risk calculi during TAVI.
PubMed: 38803728
DOI: 10.7759/cureus.59144 -
Revista Medica de Chile Jun 2023We report a 31-year-old woman who was previously subjected to aortic, mitral, and tricuspid valve replacement in three different surgical episodes. She was admitted to...
We report a 31-year-old woman who was previously subjected to aortic, mitral, and tricuspid valve replacement in three different surgical episodes. She was admitted to our cardiology section with acute right heart failure symptoms. She was studied by echocardiography, right/left heart catheterization, cardiac CT scan and cardiac magnetic resonance. A severe tricuspid stenosis due to biological prosthesis dysfunction was diagnosed. Due to high operative risk and risk of postoperative right ventricular failure, the patient was rejected for cardiovascular surgery. We decided on a percutaneous tricuspid "valve in valve replacement". The procedure was done successfully by venous femoral approach, with a balloon expandable prosthesis. Tricuspid stenosis was corrected and the patient evolved with remission of heart failure symptoms.
Topics: Humans; Female; Adult; Tricuspid Valve Stenosis; Treatment Outcome; Heart Valve Prosthesis Implantation
PubMed: 38801388
DOI: 10.4067/s0034-98872023000600792 -
Kocuria kristinae-Induced Infective Endocarditis: Unveiling an Emerging Threat in Clinical Practice.Cureus Apr 2024Infective endocarditis (IE) remains a formidable challenge in clinical practice due to several causative agents, each presenting with unique diagnostic and therapeutic...
Infective endocarditis (IE) remains a formidable challenge in clinical practice due to several causative agents, each presenting with unique diagnostic and therapeutic dilemmas. , a coagulase-negative, catalase-positive Gram-positive coccus, has recently emerged as an uncommon but increasingly recognized pathogen in the cause of IE. This case report highlights the clinical characteristics, risk factors, and challenges associated with -induced IE. We conducted a comprehensive literature review and identified several case reports on as a causative agent. Due to its indolent nature and the subtle presentation of symptoms, along with its ability to form biofilms, delayed diagnosis of is often seen, thereby emphasizing the need for heightened clinical suspicion. The predisposing factors for infection include underlying cardiac abnormalities, prosthetic heart valves, and immunocompromised states. Additionally, antimicrobial susceptibility patterns and optimal treatment strategies remain unclear, warranting further investigation. This abstract presents the case of a 75-year-old male with IE secondary to on a prosthetic mitral valve. We aim to highlight the need for increased awareness among clinicians to facilitate early recognition and prompt initiation of targeted therapeutic interventions. Unraveling the intricacies of pathogenicity is crucial for refining diagnostic approaches and optimizing patient outcomes.
PubMed: 38800330
DOI: 10.7759/cureus.58979 -
Structural Heart : the Journal of the... May 2024The current clinical practice standard is 10% to 20% oversizing of self-expanding valves in transcatheter aortic valve replacement. We aimed to determine whether >20%...
BACKGROUND
The current clinical practice standard is 10% to 20% oversizing of self-expanding valves in transcatheter aortic valve replacement. We aimed to determine whether >20% oversizing of self-expanding valves (Medtronic Evolut) would lead to better valve performance with similar or better outcomes.
METHODS
From October 2011 to December 2016, we approached all transcatheter aortic valve replacement patients with a conscious attempt at large oversizing (>20%). The most common valve used, excluding those used in valve-in-valve patients, was the 29-mm Evolut R (29%). We used a retrospective chart review to compare moderate oversizing (group 1; 10% to 20%) with large oversizing (group 2; >20%).
RESULTS
Of 556 patients, 45% were male; the overall mean Society of Thoracic Surgeons risk score was 5.8 ± 3.8. Eighty-five (15%) patients needed a pacemaker, and 21 (3.8%) developed significant paravalvular leak. Mean oversizing was 20.3% ± 6.0%, with 41.4% of patients included in group 1 and 54.5% in group 2. Incidences of complications in group 2 vs. group 1 were as follows: a) paravalvular leak (2.0 vs. 6.1%; odds ratio = 0.31, = 0.01), b) pacemaker (15 vs. 14%), c) gastrointestinal bleed (n = 4 vs. 0; 1.3 vs. 0.0%; = 0.03), d) annular dissection (n = 1 vs. 0; 0.3 vs. 0%; = 0.29), e) mortality (n = 5 vs. 4; 1.6 vs. 1.7%). Incidence of paravalvular leak was higher in those who died than survivors (13 vs. 1.3%; ≤ 0.0001).
CONCLUSIONS
These data suggest that, in current self-expanding valves, >20% oversizing delivers a significantly lower prevalence of paravalvular leak without an increase in other complications. Since paravalvular leak is associated with increased mortality, >20% oversizing may represent a superior prosthesis choice.
PubMed: 38799807
DOI: 10.1016/j.shj.2023.100278 -
Structural Heart : the Journal of the... May 2024Bioprosthetic valve fracture (BVF) during valve-in-valve TAVR (transcatheter aortic valve replacement) is a procedural adjunct designed to optimize the expansion of the...
BACKGROUND
Bioprosthetic valve fracture (BVF) during valve-in-valve TAVR (transcatheter aortic valve replacement) is a procedural adjunct designed to optimize the expansion of the transcatheter heart valve and reduce patient-prosthesis mismatch by using a high-pressure balloon to intentionally fracture the surgical heart valve (SHV).
METHODS
We performed bench testing on 15 bioprosthetic SHV to examine the optimal balloon size and pressure for BVF. We assessed morphological changes and expansion of SHV by computed tomography angiography. Successful BVF was defined as balloon waist disappearance on fluoroscopy and/or sudden pressure drop during balloon inflation.
RESULTS
Nine valves met the definition of BVF, 3 of which were confirmed by disruption of the stent frame. We classified surgical valves into 3 subsets: 1) fracturable with metal stent frame (MSF), 2) fracturable with polymer stent frame (PSF) and 3) nonfracturable. In general, valves with MSF were fractured using a balloon size = true internal diameter plus 3-5 mm inflated at high pressure (16-20 ATM) whereas valves with PSF could be fractured with a balloon size = true internal diameter plus 3-5 mm and lower balloon pressure (6-14 ATM). Gains in computed tomography angiography derived inflow area after BVF were 12.3% for MSF and 3.6% for PSF SHV.
CONCLUSIONS
Gains in CT-determined valve area after BVF depend on the physical properties of the SHV, which in turn influences pressure thresholds and balloon sizing strategy for optimal BVF. Elastic recoil of PSF valves limits the gains in inflow area after BVF.
PubMed: 38799806
DOI: 10.1016/j.shj.2023.100276 -
Microorganisms Apr 2024Infective endocarditis (IE) is a pathological condition caused by various microbial agents that can lead to severe complications affecting the heart. Accurate diagnosis...
BACKGROUND
Infective endocarditis (IE) is a pathological condition caused by various microbial agents that can lead to severe complications affecting the heart. Accurate diagnosis is crucial for the effective management of patients with IE. Blood culture is the gold standard for identifying the primary infectious agents, which is a key factor in diagnosing IE using the modified Duke criteria.
OBJECTIVE
The main objective of this study was to investigate the distribution of the etiological agents of IE and the most common secondary diagnoses associated with it.
METHOD
A total of 152 patients aged 23-95 years with a diagnosis of IE and proven etiology (through blood cultures or serological tests) were included in this study.
RESULTS
The most common etiological agent identified through blood tests was , which was detected in 39 patients (23.5%). was the second most common agent and was identified in 33 patients (19.9%), followed by Staphylococcus epidermidis, which was identified in 12 patients (13.1%). Nine patients (5.8%) had high levels of anti- IgG phase I and II antibodies.
CONCLUSIONS
IE is a leading cause of death in the Department of Infectious Diseases. Early and accurate diagnosis, along with interdisciplinary treatment, can significantly increase the chances of patient survival. Currently, and are the dominant etiological agents of IE, highlighting the need to revise protocols for prophylaxis, diagnosis, and initial treatment of this condition.
PubMed: 38792742
DOI: 10.3390/microorganisms12050910 -
Journal of Cardiothoracic Surgery May 2024Mitral valve failure is one of the most common valvular heart diseases worldwide. Valve replacement and repair have an impact on the quality of life of patients.... (Comparative Study)
Comparative Study
OBJECTIVE
Mitral valve failure is one of the most common valvular heart diseases worldwide. Valve replacement and repair have an impact on the quality of life of patients. Therefore, the present study was conducted to compare the quality of life in patients with mitral valve replacement and those who underwent mitral valve repair.
METHODS
In this cross-sectional study, we considered all cardiac patients with ischemic mitral insufficiency who underwent mitral valve repair and patients with a history of valve replacement in Imam Ali Hospital of Kermanshah between 2014 and 2020. Two Minnesota and general quality of life questionnaires along with a checklist for demographic variables were used for data collection. Data analysis was performed using SPSS version 21 software.
RESULTS
The mean quality of life score based on the general quality of life scale in the valve repair group was 32.33 (SD = 2.29) and in the valve replacement group 32.89(SD = 2.60), (p = 0.917). Also, mean quality of life, as measured by the Minnesota MLHFQ was 60.89(SD = 17.67) in the valve repair group and 63.42 (SD = 12.13) in the valve replacement group (p = 0.308). The results showed that the average general quality of life was different in study groups regarding education. Tukey's post hoc test showed that the average general quality of life in illiterate people is significantly lower than in people with academic degrees (P-value = 0.001).
CONCLUSION
The quality of life of the patients in both the valve repair and replacement groups was at an average level. There was no significant difference between the general quality of life and the Minnesota scales, suggesting that both tools can be effectively used to measure patients' quality of life. The study's findings can be valuable for monitoring patients, screening for conditions, and enhancing communication between doctors and patients.
Topics: Humans; Quality of Life; Cross-Sectional Studies; Male; Female; Heart Valve Prosthesis Implantation; Middle Aged; Mitral Valve Insufficiency; Mitral Valve; Iran; Aged; Surveys and Questionnaires; Adult
PubMed: 38789973
DOI: 10.1186/s13019-024-02780-1