Aortic valve replacement: A prospective trial comparing aortic root with coronary sinus perfusion using blood cardioplegia (CP)

ObjectOur goal was to assess the implant depth of a Venus-A prosthesis during transcatheter aortic valve replacement (TAVR) when the areas of eccentric calcification were distributed in different sections of the aortic valve.MethodsA total of 53 patients with eccentric calcification of the aortic valve who underwent TAVR with a Venus-A prosthesis from January 2018 to November 2019 were retrospectively analyzed. The patients were divided into three groups (A, B, and C) according to the location of the eccentric calcification, which was determined by preprocedural computerized tomography angiography (CTA) images. The prosthesis release process and position were evaluated by contrast aortography during TAVR, and the differences in valve implant depths were compared among the three groups. The effects of different aortic root structures and procedural strategies on prosthesis implant depth were analyzed.ResultsEleven patients had eccentric calcification in region A; 19 patients, in region B; and 23 patients, in region C. The patients with eccentric calcification in region B had a higher risk of prosthesis migration (10.5% upward and 21.1% downward), and the position of the prosthesis after TAVR in group B was the deepest among the three groups. When eccentric calcification was located in region A or C, the prosthesis was released at the standard position with more stability, and the location of the prosthesis was less deep after TAVR (region A: 4.12 ± 3.4 mm; region B: 10.2 ± 5.3 mm; region C: 8.4 ± 4.0 mm; region A vs. region B, P = 0.0004; region C vs. region B; and P = 0.0360). In addition, the left ventricular outflow tract (LVOT) (P = 0.0213) and aortic root angulation (P = 0.0263) also had a significant effect on implant depth in the aortic root structure of the patients. The prosthesis size was 28.3 ± 2.4 in the deep implant group and 26.4 ± 2.0 in the appropriate implant group (P = 0.0068).ConclusionThe implant depth of the Venus-A prosthesis is closely related to the distribution of eccentric calcification in the aortic valve during TAVR. Surgeons should adjust the surgical strategy according to aortic root morphology to prevent prosthesis migration.

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Clinical case: aortic valve replacement with aortic root reconstruction and coronary artery bypass grafting in 73-yo obese female patient

Clinical Practice ◽

10.17816/clinpract09171-75 ◽

2018 ◽

Vol 9 (1) ◽

pp. 71-75

Author(s):

D. V. Borisov ◽

A. S. Zotov ◽

S. A. Vachev ◽

A. V. Troitskiy ◽

R. I. Khabazov

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Female Patient ◽

Valve Replacement ◽

Aortic Root ◽

Artery Bypass ◽

Bypass Grafting ◽

Obese Female

Aortic valve replacement is the second most common cardiac surgery procedure. Prosthesis-patient size mismatch can increase the incidence of adverse events postoperatively, it also leads to increased left ventricular load. Some studies describe the higher mortality in this group of patients. It is also proved that patients with severe aortic stenosis usually have impaired platelet aggregation and low von Willebrand factor causing bleeding disorders. We report a case of successful aortic valve replacement and aortic root enlargement (Nicks technique) combined with coronary artery bypass grafting (left internal mammary artery to the left anterior descending artery) and left atrial appendage resection in 73-y.o. obese female patient. Postoperative course was uneventful.

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Tanned xenograft pericardium for aortic root enlargement during aortic valve replacement

Journal of the American College of Cardiology ◽

10.1016/0735-1097(91)92410-n ◽

1991 ◽

Vol 17 (2) ◽

pp. A361

Author(s):

Donato Sisto ◽

Sylvia Fernandes ◽

Antonio Palma ◽

Michele Nanna ◽

Robert Frater

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Aortic Root ◽

Aortic Root Enlargement

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Hemodynamic and Angiographie Late Results Following Enlargement of Narrow Aortic Root Using Autologous Pericardium in Prosthetic Aortic Valve Replacement

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-2007-1014143 ◽

1985 ◽

Vol 33 (05) ◽

pp. 288-295 ◽

Cited By ~ 8

Author(s):

H. Dalichau ◽

A. Hannekum ◽

B. Niehues ◽

A. Irion ◽

B. Herse

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Aortic Root ◽

Late Results ◽

Autologous Pericardium ◽

Prosthetic Aortic Valve

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The impact of del Nido cardioplegia solution on blood morphology parameters

Perfusion ◽

10.1177/02676591211049020 ◽

2021 ◽

pp. 026765912110490

Author(s):

Krzysztof Sanetra ◽

Wojciech Domaradzki ◽

Marek Cisowski ◽

Rajesh Shrestha ◽

Krzysztof Białek ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Blood Cell ◽

Valve Replacement ◽

Transfusion Rate ◽

Blood Cardioplegia ◽

Blood Morphology ◽

Cold Blood ◽

Cold Blood Cardioplegia ◽

Morphology Parameters

Background: Crystalloid cardioplegic solutions are believed to reduce hemoglobin significantly and increase the transfusion rate. However, recent reports indicate that the del Nido cardioplegia may preserve blood morphology parameters. Methods: In “The del Nido versus cold blood cardioplegia in aortic valve Replacement” trial patients undergoing aortic valve replacement were randomized into the del Nido (DN) or cold blood cardioplegia (CB) group. For the subanalysis, patients who underwent blood transfusions were excluded from the study. Red blood cell (RBC) count, hemoglobin, white blood cell (WBC) count and platelet (PLT) count were measured before the surgery, 24-, 48-, and 96 hours postoperatively. Furthermore, percental variation in first-last measure was compared in groups. In addition, indexed normalized ratio (INR) and activated partial thromboplastin time (aPTT) were compared preoperatively and 24 hours after the surgery. Results: Eighteen (24%) patients from the del Nido group and 22 (29.3%) patients from the CB group received blood product transfusions (p = 0.560) and were excluded from further analysis. As such, 57 patients remained in DN group and 53 patients remained in CB group. No difference was found in RBC, hemoglobin, WBC, and platelet count in time intervals. Percental variation in first-last measure revealed higher fall in RBC (p = 0.0024) and hemoglobin (p = 0.0028) in the CB group. No difference was shown in preoperative and 24-hour postoperative INR and aPTT. Conclusions: The del Nido cardioplegia does not decrease blood morphology parameters when compared to cold blood cardioplegia and may be used alternatively regardless of bleeding and coagulopathy risk.

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