-
The Journal of Thoracic and... Aug 2014To evaluate the short- and long-term outcomes of concomitant aortic (AVr) and mitral (MVr) valve repair.
OBJECTIVE
To evaluate the short- and long-term outcomes of concomitant aortic (AVr) and mitral (MVr) valve repair.
METHODS
This retrospective analysis of prospectively collected data identified patients who had undergone AVr and MVr surgery from March 1996 to October 2009. Patients were included if they had undergone combined repair on the aortic and mitral valves. Excluded were those <18 years in whom valve replacement was performed. Data were collected on the short-term morbidity and mortality (<30 postoperative days), long-term survival, and freedom from valve-related events and echocardiographic outcomes.
RESULTS
A total of 65 patients underwent AVr and MVr (mean age, 56.4 ± 15.8 years, 46 men). Preoperatively, 30 patients (46.1%) had aortic insufficiency (AI) >2+, 20 patients had AI ≥2+ with aortic dilatation (30.7%), and 4 patients (6.1%) had aortic dilatation only. Of the 65 patients, 57 had tricuspid (87.6%) and 8 had bicuspid aortic valves (12.3%). All patients had mitral insufficiency preoperatively. One in-hospital death occurred (1.5%). At discharge, no patient had AI >2+ versus 30 patients preoperatively (P < .001), and 7 patients had AI >1+ versus 61 patients preoperatively (P < .001). At discharge, the mean left ventricular end-diastolic diameter was 48 ± 7 mm versus 59 ± 9 mm preoperatively (P < .007), and the mean left ventricular end-systolic diameter was 33 ± 5 mm versus 38 ± 14 mm preoperatively (P = .36). The mean clinical follow-up duration was 62 ± 45 months (median, 50; range, 1-177). At the latest follow-up visit, 17 patients were New York Heart Association class ≥2 versus 52 patents preoperatively (P < .001). Four cardiac deaths occurred, and at 1, 5, and 10 years, the freedom from cardiac death was 100%, 93.4% ± 3.7%, and 88.5% ± 5.9%, respectively. Eight valve reinterventions were required, and the freedom from valve reintervention at 1, 5, and 10 years was 95.3% ± 2.6%, 91.6% ± 3.6%, and 78.4% ± 8.0%, respectively. At 1, 5, and 10 years, the freedom from AI 2+ was 98.2% ± 1.7%, 93.4% ± 3.7%, and 88.3% ± 5.8% and the freedom from mitral insufficiency 2+ was 96.4% ± 2.4%, 93.3% ± 3.8%, and 93.3% ± 3.8%, respectively.
CONCLUSIONS
Concomitant AVr/MVr is associated with acceptable survival and freedom from valve reintervention.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Aortic Valve; Aortic Valve Insufficiency; Cardiac Surgical Procedures; Disease-Free Survival; Female; Hospital Mortality; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Mitral Valve; Mitral Valve Insufficiency; Reoperation; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome
PubMed: 24731797
DOI: 10.1016/j.jtcvs.2013.10.016 -
JACC. Cardiovascular Imaging Oct 2018The authors review the optimal sequence of multimodality imaging studies in patients with chronic asymptomatic aortic regurgitation (AR). The initial questions in... (Review)
Review
The authors review the optimal sequence of multimodality imaging studies in patients with chronic asymptomatic aortic regurgitation (AR). The initial questions in evaluating such patients are: 1) is AR severe; and 2) does it significantly impact the left ventricle? Although transthoracic echocardiography is usually able to answer these questions, a cardiovascular magnetic resonance imaging study might be necessary if the data from echocardiography are conflicting or inadequate. If AR is severe and the left ventricle is severely dilated, surgery is indicated. If AR is severe but the left ventricle is not significantly impacted, echocardiographic exercise testing might unmask symptoms. If aortopathy is suspected, cardiovascular magnetic resonance (in younger patients) or computed tomography (in older patients) is necessary. In cases where AR severity or mechanism are unclear and no additional tests are possible, or if there is a potential for aortic valve repair, transesophageal echocardiography is appropriate. Finally, it is good practice to define a follow-up plan with the patient and referring physician, with an explanation as to what can be expected in the future.
Topics: Adult; Aged; Aortic Valve; Aortic Valve Insufficiency; Asymptomatic Diseases; Cardiac Imaging Techniques; Clinical Decision-Making; Female; Hemodynamics; Humans; Male; Middle Aged; Multimodal Imaging; Patient Selection; Predictive Value of Tests; Prevalence; Prognosis; Risk Factors
PubMed: 30286910
DOI: 10.1016/j.jcmg.2018.05.027 -
Anatolian Journal of Cardiology Feb 2019
Topics: Aorta; Aortic Aneurysm; Aortic Valve Insufficiency; Humans; Video Recording
PubMed: 30694811
DOI: 10.14744/AnatolJCardiol.2018.92597 -
The Journal of Thoracic and... Feb 2022
Topics: Aortic Valve; Aortic Valve Insufficiency; Bicuspid Aortic Valve Disease; Humans
PubMed: 32773119
DOI: 10.1016/j.jtcvs.2020.07.018 -
The Annals of Thoracic Surgery Feb 2011
Topics: Aortic Aneurysm; Aortic Valve; Aortic Valve Insufficiency; Blood Vessel Prosthesis Implantation; Echocardiography; Hemodynamics; Humans; Treatment Outcome
PubMed: 21256297
DOI: 10.1016/j.athoracsur.2010.10.051 -
JACC. Cardiovascular Interventions Oct 2021
Topics: Aortic Valve; Aortic Valve Insufficiency; Aortic Valve Stenosis; Heart Valve Prosthesis; Humans; Prosthesis Design; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 34538599
DOI: 10.1016/j.jcin.2021.08.010 -
JACC. Cardiovascular Interventions Jan 2013This study sought to assess the effectiveness of a novel percutaneous method to treat left ventricular assist device (LVAD)-associated severe aortic insufficiency (AI)...
OBJECTIVES
This study sought to assess the effectiveness of a novel percutaneous method to treat left ventricular assist device (LVAD)-associated severe aortic insufficiency (AI) in a series of patients determined to be poor reoperative candidates.
BACKGROUND
The increased use of continuous-flow LVAD in advanced heart failure has led to marked changes in the management of patients with this condition. However, secondary AI can become a significant complication.
METHODS
Five patients with continuous-flow LVAD and severe post-LVAD AI underwent percutaneous transcatheter aortic valve closure from September to October 2011 at a single quaternary care academic medical center. All patients had LVAD implanted as destination therapy. LVAD parameters, hemodynamics, and echocardiographic measurements were obtained before and after aortic valve closure.
RESULTS
All patients underwent successful closure with the Amplatzer cribriform device (AGA Medical, Plymouth, Minnesota) via a percutaneous transcatheter femoral approach with a significant reduction of AI from severe to trivial. Cardiac hemodynamics improved, and the pulmonary capillary wedge pressure was reduced in all patients. There was no change in mitral or tricuspid regurgitation, LVAD power, or pulsatility index.
CONCLUSIONS
Percutaneous transcatheter closure of the aortic valve effectively treats LVAD-associated AI and reduces pulmonary capillary wedge pressure. This procedure should be considered to treat LVAD-associated AI in patients who are poor candidates for repeat operation. Further data are needed to assess long-term results.
Topics: Adult; Aged; Aortic Valve; Aortic Valve Insufficiency; Cardiac Catheterization; Chicago; Echocardiography, Doppler, Color; Echocardiography, Transesophageal; Female; Heart Failure; Heart-Assist Devices; Hemodynamics; Humans; Male; Middle Aged; Prosthesis Design; Pulmonary Wedge Pressure; Pulsatile Flow; Septal Occluder Device; Severity of Illness Index; Treatment Outcome; Ventricular Function, Left
PubMed: 23347865
DOI: 10.1016/j.jcin.2012.08.021 -
Circulation Journal : Official Journal... 2014Paravalvular aortic regurgitation (AR) negatively affects prognosis following transcatheter aortic valve replacement (TAVR). As transcatheter heart valves (THV) are... (Review)
Review
Paravalvular aortic regurgitation (AR) negatively affects prognosis following transcatheter aortic valve replacement (TAVR). As transcatheter heart valves (THV) are anchored using a certain degree of oversizing at the level of the aortic annulus, incomplete stent frame expansion because of heavily annular calcifications, suboptimal placement of the prosthesis, and/or annulus-prosthesis size-mismatch can contribute to paravalvular AR with subsequent increased mortality risk. Echocardiography is essential to differentiate between transvalvular and paravalvular AR and to further elucidate the etiology of AR during the procedure. However, because echocardiographic quantification of AR in TAVR patients remains challenging, especially in the implantation situation, a multimodal approach to the evaluation of AR with use of hemodynamic measurements and imaging modalities is useful to precisely quantify the severity of AR immediately after valve deployment. "Next-generation" THVs are already on the market and first results show that paravalvular AR related to design modifications (eg, paravalvular space-fillers, full repositionability) are rarely seen in these valve types.
Topics: Animals; Aortic Valve Insufficiency; Calcinosis; Cardiac Catheterization; Heart Valve Prosthesis Implantation; Humans; Postoperative Complications
PubMed: 24632758
DOI: 10.1253/circj.cj-14-0113 -
Asian Cardiovascular & Thoracic Annals Sep 2022There are increasing reports of early externally mounted pericardial Trifecta bioprosthesis failure. We compared the hemodynamic performance of Trifecta and...
BACKGROUND
There are increasing reports of early externally mounted pericardial Trifecta bioprosthesis failure. We compared the hemodynamic performance of Trifecta and Carpentier-Edwards Perimount Magna Ease valves to determine the failure mechanism.
METHODS
We retrospectively included 270 consecutive patients (age: 73.4 ± 8.2 years; 57.5% male; mean follow-up: 48.0 ± 20.3 months) who underwent aortic valve replacement from 2014 to 2021 at a single center and compared the Trifecta ( = 137) and Carpentier-Edwards Perimount Magna Ease valve ( = 133) patients.
RESULTS
The prosthetic valve major aortic regurgitation incidence was higher for the Trifecta than that for the Carpentier-Edwards Perimount Magna Ease valve (6.3% vs. 0%, < 0.009). Among the Trifecta failures, 33% developed structural valve deterioration, but all requiring redo aortic valve replacement developed major prosthetic valve aortic regurgitation. Freedom at 5 years from redo aortic valve replacement due to structural valve deterioration was significantly lower for Trifecta (89.4% vs. 100%, = 0.003). The reoperation hazards were determined for Trifecta (vs. Carpentier-Edwards Perimount Magna Ease): 11.6 (1.47-90.9; = 0.02), prosthetic valve aortic regurgitation: 2.38 (1.70-3.32; < 0.01), structural valve deterioration: 20.82 (4.08-106.2; < 0.01), 5-year mean transprosthetic pressure gradient: 1.14 per 1-point increase (1.03-1.24; = 0.007), and urgent surgery: 10.1 (2.59-39.0; = 0.001). The Cox regression analysis identified that prosthetic valve aortic regurgitation solely contributed to redo aortic valve replacement (hazard ratio: 2.38; confidence intervals: 1.70-3.32).
CONCLUSIONS
Significantly, more early failures occurred with the Trifecta valve than the Carpentier-Edwards Perimount Magna Ease valve but the Trifecta showed reasonable mean transprosthetic pressure gradient over time. Prosthetic valve aortic regurgitation and calcific structural valve deterioration synergistically contributed to Trifecta valve failure alternatively.
Topics: Aged; Aged, 80 and over; Aortic Valve; Aortic Valve Insufficiency; Bioprosthesis; Female; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Hemodynamics; Humans; Male; Prosthesis Design; Retrospective Studies; Treatment Outcome
PubMed: 35603636
DOI: 10.1177/02184923221100994 -
The Journal of Thoracic and... Sep 2015
Topics: Animals; Aortic Valve; Aortic Valve Insufficiency
PubMed: 26210262
DOI: 10.1016/j.jtcvs.2015.06.053