scholarly journals Aortic valve replacement in a patient with self-reported systemic multiple metal allergy

2021 ◽  
Author(s):  
Saori Nagura ◽  
Mari Sakai ◽  
Hayato Obi ◽  
Kazuaki Fukahara
Keyword(s):  
Cardiac Surgery ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Patch Test ◽  
Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Metal Allergy ◽  
Palmoplantar Pustulosis ◽  
Patient Reported

AbstractWe report our experience with aortic valve replacement in a patient with severe aortic stenosis who had self-reported allergies to multiple metals. The patient was a 74-year-old man. He developed palmoplantar pustulosis after using a dental prosthesis, and a patch test revealed reactions to several metals; therefore, he was diagnosed with systemic metal allergy. His condition progressed to severe aortic stenosis, and bioprosthetic aortic valve replacement was planned. The Avalus valve (Medtronic, Minneapolis, MN, USA) was selected for aortic valve replacement, since the patient reported having allergies to several metals. While most devices used in cardiac surgery contain some amount of metal, the Avalus bioprosthetic valve does not contain metal in the stent and has been extremely useful for aortic valve replacement in patients with suspected metal allergies.

scholarly journals Influence of Transcatheter Aortic Valve Replacement on Patients With Severe Aortic Stenosis Undergoing Non-cardiac Surgery

2020 ◽  
Author(s):  
Tadashi Omoto ◽  
Atsushi Aoki ◽  
Kazuto Maruta ◽  
Tomoaki Masuda ◽  
Yui Horikawa
Keyword(s):  
Cardiac Surgery ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Cardiac Disease ◽  
Transcatheter Aortic Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Completion Rate ◽  
Transcatheter Aortic Valve

Abstract Objectives: The purpose of this study was to clarify the influence of introduction of transcatheter aortic valve replacement (TAVR)on patients with aortic stenosis(AS) undergoing non-cardiac surgery.Methods: Thirty-four patients with severe AS diagnosed by preoperative evaluation for non-cardiac surgery were reviewed and compared in following two categories. First,patient’s profile and surgical risk were compared between pre-TAVR group (n=10) and post-TAVR group (n=24)according to before or after the introduction of TAVR. Second, completion rate of non-cardiac surgery and interval between two operation were compared between surgical aortic valve replacement(AVR)patients before introduction of TAVR (pre-AVR group (n=10)), AVR patientsafter introduction of TAVR (post-AVR (n=12)), and TAVR patients (TAVR group (n=12)).Results: Ageand Japan score were higherin post-TAVR group than in pre-TAVR group. Malignancy was the most common non-cardiac disease (80%) in pre-TAVR group, however, orthopedic disease became the most common (50%) in post-TAVR group. Completion rate of non-cardiac operation in pre-AVR, post-AVR and TAVR group were 70%, 33%, and 75% (post-AVR vs. TAVR: p=0.010), and interval between two operations were 129±98 days, 87±40 days and 27±15 days, respectively (pre AVR vs. TAVR: p=0.034 and post AVR vs. TAVR: p=0.025).In Post-TAVR group, AVR was selected because of unfit condition for TAVR in 5 out of 12 patients. Conclusions:After introduction of TAVR, more senile and high-risk patients became the candidate for two staged operation and orthopedics became the most common non-cardiac disease. Innovation of transcatheter valvular interventionsand expansion of indication for currently evaluated as “unfit for TAVR” might be crucial issue for non-cardiac surgery with severe AS.

scholarly journals Influence of Transcatheter Aortic Valve Replacement on Patients with Severe Aortic Stenosis Undergoing Non-Cardiac Surgery

2020 ◽  
Author(s):  
Tadashi Omoto ◽  
Atsushi Aoki ◽  
Kazuto Maruta ◽  
Tomoaki Masuda ◽  
Yui Horikawa
Keyword(s):  
Cardiac Surgery ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Cardiac Disease ◽  
Transcatheter Aortic Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Completion Rate ◽  
Transcatheter Aortic Valve

Abstract Objectives: The purpose of this study was to clarify the influence of transcatheter aortic valve replacement (TAVR) in patients with aortic stenosis (AS) undergoing non-cardiac surgery.Methods: Thirty-four patients with severe AS diagnosed by preoperative evaluation for non-cardiac surgery were reviewed and compared in two categories. First, patient profiles and surgical risk were compared before (pre-TAVR group; n=10) and after (post-TAVR group; n=24) the introduction of TAVR. Second, the completion rate of non-cardiac surgery and interval between the two cardiac and non-cardiac operations were compared between surgical aortic valve replacement (AVR) patients before the introduction of TAVR (pre-AVR group (n=10)), in AVR patients after the introduction of TAVR (post-AVR (n=12)), and in TAVR patients (TAVR group (n=12)).Results: Age and Japan score were higher in the post-TAVR group than in the pre-TAVR group. Malignancy was the most common non-cardiac disease (80%) in the pre-TAVR group, whereas orthopedic disease was the most common (50%) in the post-TAVR group. Completion rate of non-cardiac operation in the pre-AVR, post-AVR and TAVR groups was 70%, 33%, and 75% (post-AVR vs. TAVR: p=0.010), and the interval between the two operations was 129±98 days, 87±40 days and 27±15 days, respectively (pre AVR vs. TAVR: p=0.034 and post AVR vs. TAVR: p=0.025). In the post-TAVR group, AVR was selected because of a lack of fitness for TAVR in 5 of 12 patients.Conclusions: After the introduction of TAVR, more senile and high-risk patients became candidates for a two-stage operation, and orthopedic conditions became the most common non-cardiac disease. Innovation in transcatheter valvular interventions and expansion of indications for patients currently evaluated as “unfit for TAVR” might be crucial issues for non-cardiac surgery with severe AS.

scholarly journals Aortic valve function post-replacement of severe aortic stenosis by transcatheter procedure versus surgery: a systematic review and metanalysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Charbel Abi Khalil ◽  
Barbara Ignatiuk ◽  
Guliz Erdem ◽  
Hiam Chemaitelly ◽  
Fabio Barilli ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Randomized Clinical Trials ◽  
Severe Aortic Stenosis ◽  
Paravalvular Leak ◽  
Effective Orifice Area ◽  
Surgical Aortic Valve Replacement ◽  
Transcatheter Heart Valve

AbstractTranscatheter aortic valve replacement (TAVR) has shown to reduce mortality compared to surgical aortic valve replacement (sAVR). However, it is unknown which procedure is associated with better post-procedural valvular function. We conducted a meta-analysis of randomized clinical trials that compared TAVR to sAVR for at least 2 years. The primary outcome was post-procedural patient-prosthesis-mismatch (PPM). Secondary outcomes were post-procedural and 2-year: effective orifice area (EOA), paravalvular gradient (PVG) and moderate/severe paravalvular leak (PVL). We identified 6 trials with a total of 7022 participants with severe aortic stenosis. TAVR was associated with 37% (95% CI [0.51–0.78) mean RR reduction of post-procedural PPM, a decrease that was not affected by the surgical risk at inclusion, neither by the transcatheter heart valve system. Postprocedural changes in gradient and EOA were also in favor of TAVR as there was a pooled mean difference decrease of 0.56 (95% CI [0.73–0.38]) in gradient and an increase of 0.47 (95% CI [0.38–0.56]) in EOA. Additionally, self-expandable valves were associated with a higher decrease in gradient than balloon ones (beta = 0.38; 95% CI [0.12–0.64]). However, TAVR was associated with a higher risk of moderate/severe PVL (pooled RR: 9.54, 95% CI [5.53–16.46]). All results were sustainable at 2 years.

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