Incidence and Risk Factors of Pannus after Mechanical Aortic Valve Replacement

2021 ◽  
Author(s):  
Jae Woong Choi ◽  
Ho Young Hwang ◽  
Yeiwon Lee ◽  
Suk Ho Sohn ◽  
Kyung Hwan Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Aortic Valve ◽  
Pressure Gradient ◽  
Valve Replacement ◽  
Cumulative Incidence ◽  
Prosthetic Valve ◽  
Young Age ◽  
Mechanical Aortic Valve ◽  
Valve Size ◽  
Mean Pressure

Abstract Background This study was conducted to evaluate the occurrence rate and risk factors of subaortic pannus (SAP) after bileaflet mechanical aortic valve (AV) replacement. Methods Between 1990 and 2014, 862 patients underwent primary AV replacement with bileaflet mechanical prosthesis. SAP was defined as (1) gradual increase in mean pressure gradient through mechanical AV without any evidence of motion limitation of the leaflets on echocardiography and (2) AV mean pressure gradient >40 mm Hg or AV peak velocity >4 m/s on echocardiography, and (3) any visible subaortic tissue ingrowth beneath the mechanical AV on echocardiography or computed tomography. Clinical and echocardiographic follow-up durations were 13.8 ± 8.0 and 10.7 ± 7.9 years, respectively. Results Mean age was 51.1 ± 12.1 years and concomitant surgeries were performed in 503 patients (58.4%). Overall survival at 10 and 20 years was 84.2 and 67.1%, respectively. SAP occurred in 33 patients, and in only 2 patients during the first 10 years after surgery. The cumulative incidence of SAP formation at 10, 20, and 25 years were 0.3, 5.0, and 9.9%, respectively. The Fine and Gray model demonstrated that small prosthetic valve size (hazard ratio [HR] [95% confidence interval, CI] = 0.738 [0.575–0.946]), young age (HR [95% CI] = 0.944 [0.909–0.981]), and concomitant mitral valve replacement (MVR) (HR [95% CI] = 3.863 [1.358–10.988]) were significant risk factors for the SAP formation. Conclusions SAP occurred gradually over time with 10- and 20-year cumulative incidence of 0.3 and 5.0%, respectively. Young age, small prosthetic valve size, and concomitant MVR were risk factors for SAP formation. Therefore, we recommend efforts to select large prostheses for young patients requiring concomitant MVR.

scholarly journals The Impact of Valvuloarterial Impedance on Left Ventricular Geometrical Change after Transcatheter Aortic Valve Replacement: A Comparison between Valvuloarterial Impedance and Mean Pressure Gradient

2020 ◽  
Vol 9 (10) ◽  
pp. 3143
Author(s):  
Satoshi Yamaguchi ◽  
Yuka Otaki ◽  
Balaji K. Tamarappoo ◽  
Tetsuya Ohira ◽  
Hiroki Ikenaga ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Pressure Gradient ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Left Ventricular ◽  
Transcatheter Aortic Valve ◽  
Lv Mass ◽  
Mean Pressure ◽  
Geometrical Change

Increase in left ventricular (LV) mass develops as a compensatory mechanism against pressure overload in aortic valve stenosis. However, long-standing LV geometrical changes are related to poor prognosis. The LV geometrical change occurs after transcatheter aortic valve replacement (TAVR). The present study aimed to investigate the relationship between improvement in valvuloarterial impedance (Zva) and change in LV mass index (LVMI) and the ratio of LVMI to LV end-diastolic volume index (LVMI/LVEDVI). We compared these relationships to that between Zva and mean pressure gradient (MPG). Baseline and follow-up transthoracic echocardiograms of 301 patients who underwent TAVR from November 2011 to December 2015 were reviewed. Spearman correlation coefficient (ρ) was used to compare ΔLVMI and ΔLVMI/LVEDVI with Zva or MPG. The correlation between ΔZva and ΔLVMI (ρ = 0.47, p < 0.001) was superior to that between ΔMPG and ΔLVMI (ρ = 0.15, p = 0.009) (p for comparison < 0.001). The correlation between ΔZva and ΔLVMI/LVEDVI was statistically significant (ρ = 0.54, p < 0.001); in contrast, that of ΔMPG and ΔLVMI/LVEDVI was not. The improvement in Zva after TAVR was more closely related to LVMI and LVMI/LVEDVI reduction than MPG reduction.

scholarly journals Modified fibrinolytic therapy as treatment of mechanical aortic valve thrombosis

2021 ◽  
Vol 9 ◽  
pp. 2050313X2199920
Author(s):  
Ala Mustafa ◽  
Todd Thomas ◽  
Robert Murdock ◽  
Samuel Congello
Keyword(s):  
Aortic Valve ◽  
Valve Replacement ◽  
Prosthetic Valve ◽  
Treatment Options ◽  
Fibrinolytic Therapy ◽  
Current Management ◽  
Prosthetic Valve Thrombosis ◽  
Mechanical Aortic Valve ◽  
Valve Thrombosis ◽  
Surgical Valve Replacement

Prosthetic valve thrombosis is a rare phenomenon with limited treatment options. Current management choices include anticoagulation with or without fibrinolysis or surgical valve replacement for appropriate candidates. We report an alternative fibrinolytic and anticoagulation regimen resulting in successful treatment of a patient presenting with mechanical aortic valve thrombosis.

P1840Mid-term results of bioprosthetic aortic valve replacement with the Trifecta valve: A word of caution

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
P Werner ◽  
M Russo ◽  
M Seewald ◽  
I Coti ◽  
T Haberl ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Pressure Gradient ◽  
Valve Replacement ◽  
Composite Endpoint ◽  
Surgical Aortic Valve Replacement ◽  
Structural Valve Deterioration ◽  
Mean Pressure ◽  
Overall Mortality

Abstract Background Structural valve deterioration (SVD) with associated bioprosthetic valve dysfunction remains an unsolved problem, exposing patients to the risk of aortic valve re-intervention after surgical aortic valve replacement (SAVR). Several strategies have been proposed to improve prosthesis design for optimal performance. The leaflets of the Trifecta valve are mounted on the outside of the prosthetic stent to achieve a larger orifice area. Although favourable early clinical outcomes have been reported, long-term durability still needs to be assessed. Purpose The aim of the current study was to assess the mid-term overall mortality and re-intervention rate in patients who received a Trifecta valve with a follow-up >5 years. Methods Patients who underwent SAVR at our centre between 2011 and 2012 were identified in the internal, prospective database. All patients with implantation of a Trifecta valve in aortic position were included. Primary endpoints were freedom from overall mortality and from re-operation at latest follow-up (FU). Additionally, assessment of echocardiographic parameters at baseline and follow-up was performed. Results Seventy-six patients (age 77.3±9.5 years, BMI 28.6±5.8, 68% male) were included in the study. EuroScore II was 7.2% (± 7.7) while mean STS-Mortality score was 2.4±1.1%. Of all procedures, 53% were isolated aortic valve replacements, whereas concomitant procedures were performed in 47% of cases (37% CABG, 12% mitral surgery, 8% tricuspid surgery). Baseline echocardiographic assessment showed a mean pressure gradient (MPG) of 51±21 mmHG, a peak pressure gradient (PPG) of 78±36 mmHG and a peak velocity (Vmax) of 4.2±1.1 m/s. Thirty-day mortality was 7%. Freedom from overall mortality at 1 year and 5 years was 84% and 73%, respectively. Freedom from death and freedom from re-operation at latest FU (6.7±0.5 years) was 68% and 90%, respectively. In a composite endpoint analysis, freedom from death or re-intervention at latest follow up was 60%. A total of 7 patients underwent aortic valve re-interventions (re-replacements n=5, valve-in-valve n=2). Indications for re-interventions were SVD (n=5), NSVD (n=1, pannus ingrowth) and endocarditis (n=1). One case of re-stenosis occurred in a patient who was deemed not feasible for aortic valve re-intervention and died. Kaplan Meier analysis Conclusion(s) To our knowledge, this patient cohort presents with the lowest rate of freedom from re-operation (90%, 6.7±0.5 years) after SAVR with the Trifecta valve. A relatively high number of SVD and NSVD has been observed, which might be attributable to the specific leaflet mounting or the deformable valve frame of the first generation. Current results call for further investigation with prospective echocardiographic follow-up in this patient group. Acknowledgement/Funding None

scholarly journals Mid-term assessment of structural valve deterioration of perceval S sutureless prosthesis using the last European consensus definition

2020 ◽  
Author(s):  
José Manuel Martínez-Comendador ◽  
Francisco Estevez-Cid ◽  
Miguel González Barbeito ◽  
Carlos Velasco García De Sierra ◽  
Alberto Bouzas Mosquera ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Pressure Gradient ◽  
Valve Replacement ◽  
Consensus Definition ◽  
Structural Valve Deterioration ◽  
Mean Pressure ◽  
The Mean ◽  
Bioprosthetic Valves

Abstract OBJECTIVES Durability of sutureless aortic bioprosthetic valves remains a major issue. The aim of this study was to assess structural valve deterioration (SVD) and bioprosthetic valve failure (BVF) of the Perceval bioprosthesis using the new proposed standardized definitions. METHODS All patients who underwent aortic valve replacement with sutureless Perceval S prostheses up to September 2016 were included. Clinical and echocardiographic follow-up was performed. New standardized definitions were used to assess the durability of sutureless bioprosthetic valves. From 2013 to 2016, 214 patients were included. RESULTS The mean age and EuroSCORE II were 79 years and 2.74. Thirty-day mortality was 0.47%. The survival rate was 96.8%, 88.1% and 85.7% at 1, 3 and 4 years, respectively. The median echocardiographic follow-up was 3.28 years. The mean pressure gradient was 11.3 mmHg. No cases showed evidence of severe SVD, 17 patients had moderate SVD with a mean pressure gradient of 24 mmHg and 8 patients had definite late BVF. The incidence of moderate SVD and BVF at 4 years was 8.8% and 2.9%, respectively. CONCLUSIONS Mid-term follow-up to 6.3 years after aortic valve replacement with the Perceval bioprosthesis documents favourable haemodynamic and clinical outcomes and low rates of SVD and BVF.

Abstract 15471: Structural Valve Degeneration of Transcatheter Aortic Valve Replacement in a Veterans Affairs Population

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Rachel Yang ◽  
Vimala Ponna ◽  
Kendrick A Shunk ◽  
Jeffrey Zimmet ◽  
Liang Ge ◽  
...  
Keyword(s):  
Risk Factors ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Veterans Affairs ◽  
Patient Specific ◽  
Surgical Risk ◽  
Transcatheter Aortic Valve ◽  
Valve Size

Introduction: Transcatheter aortic valve replacement (TAVR), previously reserved for intermediate to prohibitive surgical risk, has now expanded to patients with severe aortic stenosis of any surgical risk. However, bioprostheses are prone to structural valve degeneration (SVD), a progressive process that limits valve durability. As the population undergoing TAVR shifts toward a lower-risk and younger profile, long-term durability is a crucial determinant for patient outcomes. Our objective was to report the characteristics of and assess risk factors for SVD in a veteran TAVR population. Methods: Patients undergoing TAVR at our Veterans Affairs Medical Center were retrospectively evaluated for SVD and other endpoints using recently standardized consensus criteria. Multivariate Cox proportional hazards analysis was performed to evaluate risk factors for SVD. Results: From 2013 to 2020, 312 patients (median age 79.0) underwent TAVR. Survival from all-cause mortality was 90.8% at 1 year, 76.1% at 3 years, and 64.0% at 5 years (Figure 1). Cumulative freedom from SVD was 98.0% at 1 year, 95.7% at 3 years, and 91.8% at 5 years. The 13 patients who met criteria for SVD were classified as moderate hemodynamic, and 2 required intervention. Median time to SVD was 1.04 years. Independent predictors of SVD include age (HR=0.92, CI:0.86-0.99) and valve size (HR=0.16, CI:0.03-0.81). Conclusions: SVD was evident at a low but detectable rate in 5 year follow-up, and associated with risk factors of patient age and implanted valve size. Further understanding of TAVR biomechanics will be essential to inform patient-specific risk of SVD. Figure 1: Kaplan-Meier curves of survival and freedom from SVD

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