Commentary: The Holy Grail Quest for the Perfect Aortic Valve Prosthesis

Purpose To present a novel technique to successfully cross a mechanical aortic valve prosthesis. Technique A 55-year-old female patient with genetically verified Marfan syndrome presented with a 5-cm anastomotic aneurysm of the proximal aortic arch after previous ascending aortic replacement due to a type A aortic dissection in 2007. The patient also underwent mechanical aortic valve replacement in 1991. A 3-stage hybrid repair was planned. The first 2 steps included debranching of the supra-aortic vessels. In the third procedure, a custom-made double branched endovascular stent-graft with a short 35-mm introducer tip was implanted. The mechanical valve was passed with the tip of the dilator on the lateral site of the leaflet, without destructing the valve and with only mild symptoms of aortic insufficiency, as one leaflet continued to work. This allowed the implantation of the stent-graft directly distally of the coronary arteries. Postoperative computed tomography angiography showed no endoleaks and patent coronary and supra-aortic vessels. Conclusion Passing a mechanical aortic valve prosthesis at the proper position is feasible and allows adequate endovascular treatment in complex arch anatomy. However, caution should be taken during positioning of the endovascular graft as the tip may potentially damage the valve prosthesis.

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Diagnosis by Intraoperative Transesophageal Echocardiography of Acute Thrombosis of Mechanical Aortic Valve Prosthesis Associated with the Use of Biological Glue

Anesthesia & Analgesia ◽

10.1097/00000539-200105000-00008 ◽

2001 ◽

pp. 1123-1125 ◽

Cited By ~ 14

Author(s):

Michael J. Gillham ◽

Claude P. Tousignant

Keyword(s):

Aortic Valve ◽

Transesophageal Echocardiography ◽

Valve Prosthesis ◽

Acute Thrombosis ◽

Mechanical Aortic Valve ◽

Biological Glue ◽

Intraoperative Transesophageal Echocardiography ◽

Aortic Valve Prosthesis

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A New Generation of Aortic Valve Prosthesis: Design, Manufacture and Hydrodynamic Assessment

ASME 2012 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2012-80609 ◽

2012 ◽

Author(s):

Benyamin Rahmani ◽

Hossein Ghanbari ◽

Spyridon Tzamtzis ◽

Gaetano Burriesci ◽

Alexander M. Seifalian

Keyword(s):

Aortic Valve ◽

Heart Valves ◽

Artery Bypass ◽

Polymeric Materials ◽

Valve Prosthesis ◽

Nanocomposite Polymer ◽

Cardiac Procedure ◽

Aortic Valve Prosthesis ◽

Suboptimal Design ◽

New Generation

Aortic valve replacement (AVR) is the second most common cardiac procedure after coronary artery bypass grafting, accounting for more than 200,000 transplantations annually worldwide [1]. Currently available mechanical and bioprosthetic heart valve replacements are not ideal as they are associated with relevant complications. The tri-leaflet polymeric heart valves (PHVs) have been widely investigated as possible alternative to these substitutes. However, the clinical application of PHVs has been limited by their suboptimal design and poor durability of available polymeric materials. This study presents a new concept of surgical aortic valve using a novel nanocomposite polymer.

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Thrombosis of the Björk-Shiley Aortic Valve Prosthesis

JAMA ◽

10.1001/jama.1978.03290130105038 ◽

1978 ◽

Vol 240 (13) ◽

pp. 1411 ◽

Cited By ~ 7

Author(s):

Milton J. Sands

Keyword(s):

Aortic Valve ◽

Valve Prosthesis ◽

Aortic Valve Prosthesis

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CRT-800.01 Multicentric Experience With Lotus Valve: A Second Generation Transcatheter Aortic Valve Prosthesis Fully Repositionable And Retrievable

JACC Cardiovascular Interventions ◽

10.1016/j.jcin.2016.12.208 ◽

2017 ◽

Vol 10 (3) ◽

pp. S61

Author(s):

Daniele Gemma ◽

Raul Moreno ◽

Mariano Larman ◽

Rui Campante Teles ◽

Lino Patricio ◽

...

Keyword(s):

Aortic Valve ◽

Second Generation ◽

Valve Prosthesis ◽

Transcatheter Aortic Valve ◽

Aortic Valve Prosthesis

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Frequency of Conduction Disturbances After Transcatheter Implantation of an Edwards Sapien Aortic Valve Prosthesis

The American Journal of Cardiology ◽

10.1016/j.amjcard.2010.04.029 ◽

2010 ◽

Vol 106 (5) ◽

pp. 707-712 ◽

Cited By ~ 61

Author(s):

Matthieu Godin ◽

Helene Eltchaninoff ◽

Akira Furuta ◽

Christophe Tron ◽

Frederic Anselme ◽

...

Keyword(s):

Aortic Valve ◽

Valve Prosthesis ◽

Conduction Disturbances ◽

Edwards Sapien ◽

Aortic Valve Prosthesis ◽

Transcatheter Implantation

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Minimally invasive redo aortic valve replacement with a sutureless valve implant

10.1510/mmcts.2021.008 ◽

2021 ◽

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Minimally Invasive ◽

Valve Replacement ◽

Valve Prosthesis ◽

Mechanical Prosthesis ◽

Invasive Approach ◽

Replacement Procedure ◽

Aortic Valve Prosthesis ◽

Sutureless Valve

Reoperations for a dysfunctional mechanical aortic valve prosthesis are usually performed with a repeat sternotomy. Reopening the chest may be associated with a heart structure tear, bleeding, excessive transfusion, and a possible unfavorable outcome. Experience performing a redo aortic valve replacement with a minimally invasive approach and avoiding lysis of the pericardial adhesions is growing. We describe a redo aortic valve replacement procedure performed because of subvalvular pannus formation in a patient with a mechanical prosthesis. A partial J-shaped hemisternotomy at the 3rd intercostal space was performed; the ascending aorta was exposed and the valve was replaced with a sutureless bioprosthesis. The video tutorial shows the surgical approach, cardiopulmonary bypass solutions, and sutureless valve deployment.

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