Effect of the prosthesis–patient mismatch on long-term clinical outcomes after isolated aortic valve replacement for aortic stenosis: A prospective observational study

Aortic valve replacement for aortic stenosis represents one of the most frequent surgical procedures on heart valves. These patients often have concomitant mitral regurgitation. To reveal whether the moderate mitral regurgitation will improve after aortic valve replacement alone, we performed a systematic review and meta-analysis. We identified 27 studies with 4452 patients that underwent aortic valve replacement for aortic stenosis and had co-existent mitral regurgitation. Primary end point was the impact of aortic valve replacement on the concomitant mitral regurgitation. Secondary end points were the analysis of the left ventricle reverse remodeling and long-term survival. Our results showed that there was significant improvement in mitral regurgitation postoperatively (RR, 1.65; 95% CI 1.36–2.00; p < 0.00001) with the average decrease of 0.46 (WMD; 95% CI 0.35–0.57; p < 0.00001). The effect is more pronounced in the elderly population. Perioperative mortality was higher (p < 0.0001) and long-term survival significantly worse (p < 0.00001) in patients that had moderate/severe mitral regurgitation preoperatively. We conclude that after aortic valve replacement alone there are fair chances but for only slight improvement in concomitant mitral regurgitation. The secondary moderate mitral regurgitation should be addressed at the time of aortic valve replacement. A more conservative approach should be followed for elderly and high-risk patients.

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Association of aortic valvular complex calcification burden with procedural and long-term clinical outcomes after transcatheter aortic valve replacement

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeab180 ◽

2021 ◽

Author(s):

Euihong Ko ◽

Do-Yoon Kang ◽

Jung-Min Ahn ◽

Tae Oh Kim ◽

Ju Hyeon Kim ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Clinical Outcomes ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

High Tertile ◽

Transcatheter Aortic Valve ◽

All Cause Mortality ◽

Composite Outcomes

Abstract Aims This study aimed to assess the impact of valvular/subvalvular calcium burden on procedural and long-term outcomes in patients undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS). Methods and results In this prospective observational cohort study, we included patients with AS undergoing TAVR between March 2010 and December 2019. Calcium burden at baseline was quantified using multidetector computed tomography and the patients were classified into tertile groups according to the amount of calcium. Procedural outcomes [paravalvular leakage (PVL) or permanent pacemaker insertion (PPI)] and 12-month clinical outcomes (composite of death, stroke, or rehospitalization, and all-cause mortality) were assessed. A total of 676 patients (age, 79.8 ± 5.4 years) were analysed. The 30-day rates of moderate or severe PVL (P-for-trend = 0.03) and PPI (P-for-trend = 0.002) proportionally increased with the tertile levels of calcium volume. The 12-month rate of primary composite outcomes was 34.2% in low-tertile, 23.9% in middle-tertile, and 25.8% in high-tertile groups (log-rank P = 0.02). After multivariable adjustment, the risk for primary composite outcomes at 12 months was not significantly different between the tertile groups of calcium volume [reference = low-tertile; middle-tertile, hazard ratio (HR) 0.81; 95% confidence interval (CI) 0.54–1.22; P = 0.31; high-tertile, HR 0.93; 95% CI 0.56–1.57; P = 0.80]. A similar pattern was observed for all-cause mortality. Conclusion The rates of PVL and PPI proportionally increased according to the levels of valvular/subvalvular calcium volume, while the adjusted risks for composite outcomes and mortality at 12 months were not significantly different.

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Postoperative delirium and quality of life after transcatheter and surgical aortic valve replacement: A prospective observational study

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2021.11.023 ◽

2021 ◽

Author(s):

Danny Feike Hoogma ◽

Elisabeth Venmans ◽

Layth Al Tmimi ◽

Jos Tournoy ◽

Peter Verbrugghe ◽

...

Keyword(s):

Quality Of Life ◽

Aortic Valve ◽

Observational Study ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Postoperative Delirium ◽

Prospective Observational Study ◽

Surgical Aortic Valve Replacement

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Prognosis of persistent mitral regurgitation in patients undergoing transcatheter aortic valve replacement

Clinical Research in Cardiology ◽

10.1007/s00392-020-01618-9 ◽

2020 ◽

Vol 109 (10) ◽

pp. 1261-1270 ◽

Cited By ~ 1

Author(s):

Victor Mauri ◽

Maria I. Körber ◽

Elmar Kuhn ◽

Tobias Schmidt ◽

Christian Frerker ◽

...

Keyword(s):

Aortic Valve ◽

Mitral Regurgitation ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Severe Aortic Stenosis ◽

Transcatheter Aortic Valve ◽

The Impact

Abstract Objective The objective of this study was to assess imaging predictors of mitral regurgitation (MR) improvement and to evaluate the impact of MR regression on long-term outcome in patients undergoing transcatheter aortic valve replacement (TAVR). Background Concomitant MR is a frequent finding in patients with severe aortic stenosis but usually left untreated at the time of TAVR. Methods Mitral regurgitation was graded by transthoracic echocardiography before and after TAVR in 677 consecutive patients with severe aortic stenosis. 2-year mortality was related to the degree of baseline and discharge MR. Morphological echo analysis was performed to determine predictors of MR improvement. Results 15.2% of patients presented with baseline MR ≥ 3 +, which was associated with a significantly decreased 2-year survival (57.7% vs. 74.4%, P < 0.001). MR improved in 50% of patients following TAVR, with 44% regressing to MR ≤ 2 +. MR improvement to ≤ 2 + was associated with significantly better survival compared to patients with persistent MR ≥ 3 +. Baseline parameters including non-severe baseline MR, the extent of mitral annular calcification and large annular dimension (≥ 32 mm) predicted the likelihood of an improvement to MR ≤ 2 +. A score based on these parameters selected groups with differing probability of MR ≤ 2 + post TAVR ranging from 10.5 to 94.4% (AUC 0.816; P < 0.001), and was predictive for 2-year mortality. Conclusion Unresolved severe MR is a critical determinant of long term mortality following TAVR. Persistence of severe MR following TAVR can be predicted using selected parameters derived from TTE-imaging. These data call for close follow up and additional mitral valve treatment in this subgroup. Graphic abstract Factors associated with MR persistence or regression after TAVR

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Associations of residual left ventricular and left atrial remodeling with clinical outcomes in patients after aortic valve replacement for severe aortic stenosis

Journal of Cardiology ◽

10.1016/j.jjcc.2015.09.017 ◽

2016 ◽

Vol 68 (3) ◽

pp. 241-247 ◽

Cited By ~ 8

Author(s):

Takeshi Hatani ◽

Takeshi Kitai ◽

Ryosuke Murai ◽

Kitae Kim ◽

Natsuhiko Ehara ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Clinical Outcomes ◽

Valve Replacement ◽

Left Atrial ◽

Severe Aortic Stenosis ◽

Left Ventricular ◽

Atrial Remodeling ◽

Left Atrial Remodeling

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Ross Procedure: How to Do It and How to Teach It

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135119852324 ◽

2019 ◽

Vol 10 (5) ◽

pp. 624-627

Author(s):

Jeremy L. Herrmann ◽

Amanda R. Stram ◽

John W. Brown

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Prosthetic Valve ◽

Pulmonary Valve ◽

Prosthetic Graft ◽

Ascending Aorta ◽

Ross Procedure

Prosthesis choice for aortic valve replacement (AVR) in children is frequently compromised by unavailability of prostheses in very small sizes, the lack of prosthetic valve growth, and risks associated with long-term anticoagulation. The Ross procedure with pulmonary valve autograft offers several advantages for pediatric and adult patients. We describe our current Ross AVR technique including replacement of the ascending aorta with a prosthetic graft. The procedure shown in the video involves an adult-sized male with a bicuspid aortic valve, mixed aortic stenosis and insufficiency, and a dilated ascending aorta.

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