scholarly journals Aortic valve neocuspidization with in-body tissue-engineered autologous membranes: preliminary results in a long-term goat model

2021 ◽  
Author(s):  
Takayuki Kawashima ◽  
Tadashi Umeno ◽  
Takeshi Terazawa ◽  
Tomoyuki Wada ◽  
Takashi Shuto ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Young Patients ◽  
High Rate ◽  
Body Tissue ◽  
Histological Evaluation ◽  
Long Term Outcome ◽  
Severe Aortic Regurgitation ◽  
Autologous Pericardium

Abstract OBJECTIVES Aortic valve neocuspidization has shown satisfactory clinical outcomes; however, autologous pericardium durability is a concern for young patients. This study applied an autologous collagenous membrane (Biosheet®), produced by in-body tissue architecture, to aortic valve neocuspidization and investigated its long-term outcome in a goat model. METHODS Moulds were embedded subcutaneously in 6 goats. After 2 months, Biosheets formed in the moulds. We performed aortic valve neocuspidization using a portion of the sheets with a thickness of 0.20–0.35 mm, measured by optical coherence tomography. Animals were subjected to echocardiography and histological evaluation at 6 months (n = 3) and 12 months (n = 3). As a control, the glutaraldehyde-treated autologous pericardium was used in 4 goats that were similarly evaluated at 12 months. RESULTS All animals survived the scheduled period. At 6 months, Biosheets maintained valve function and showed a regeneration response: fusion to the annulus, cell infiltration to the leaflets and appearance of elastic fibres at the ventricular side. After 12 months, the regenerative structure had changed little without regression, and there was negligible calcification in the 1/9 leaflets. However, all cases had one leaflet tear, resulting in moderate-to-severe aortic regurgitation. In the pericardium group, three-fourths of the animals experienced moderate-to-severe aortic regurgitation with a high rate of calcification (9/12 leaflets). CONCLUSIONS Biosheets may have regeneration potential and anti-calcification properties in contrast to autologous pericardium. However, in order to obtain reliable outcome, further improvements are required to strictly control and optimize its thickness, density and homogeneity.

P1676De novo aortic insufficiency following long term LVAD support can be successfully treated with TAVI and a pre-stenting technique

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Kofler ◽  
A Unbehaun ◽  
S Buz ◽  
C Klein ◽  
A Meyer ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Transcatheter Aortic Valve Implantation ◽  
High Rate ◽  
Landing Zone ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation ◽  
Lvad Support

Abstract Background/Introduction Long-term continuous flow left ventricular assist device (cf-LVAD) can result in the development of relevant aortic regurgitation (AR). Although its impact on survival is still controversial, it causes heart failure related symptoms. Current evidence for less invasive strategies to treat AR in cf-LVAD patients is limited. Purpose This study sought to investigate the value of transcatheter aortic valve implantation (TAVI) to treat severe de novo AR in patients on long-term cf-LVAD support. Methods We performed a retrospective analysis of 13 patients with severe AR following cf-LVAD implantation treated with TAVI between 2010 and 2019. TAVI's were performed via transfemoral (n=11), transapical (n=1) and transaxillary (n=1) access route. CoreValve (n=2), LotusValve (n=1), SapienXT (n=1) and Sapien3 (n=9) were used as transcatheter heart valves. In 4 patients, a new off-label strategy using landing-zone pre-stenting with a Sinus-XL stent was used (Figure 1). Results The median time interval from LVAD-implantation to TAVI was 1.7 years [interquartile range (IQR): 1.0 - 3.1]. Median age was 62 years [IQR: 57 - 67]. No procedural mortality or stroke was observed. Overall, device success according to VARC-II criteria was low due to a high rate of second valve necessity (54%). In contrast to the standard implantation technique, device success was 100% when the newly developed pre-stenting technique was applied (Table 1). Aortic regurgitation at discharge was none/trace in all patients. Valve function remained stable in all patients during a median echocardiographic follow-up time of 105 days [IQR: 11 - 298]. Table 1 Overall Sinus-XL prestenting (n=4) NO prestenting (n=9) Device success 7 (54) 4 (100) 3 (33) Procedural mortality 0 (0) 0 (0) 0 (0) Correct positioning of a single valve 7 (54) 4 (100) 3 (33) Intended valve performance 13 (100) 4 (100) 9 (100) Moderate or severe aortic regurgitation 0 (0) 0 (0) 0 (0) Figure 1 Conclusions Transcatheter aortic valve implantation is an efficient tool to treat cf-LVAD induced severe AR. The challenging anatomy of the non-calcified device landing zone causes a relatively high rate of primary device failure, which could be overcome with a pre-stenting technique. Acknowledgement/Funding None

Aortic Valve–Sparing Root Replacement (David I Procedure) in Adolescents: Long-Term Outcome

2019 ◽  
Author(s):  
Erik Beckmann ◽  
Andreas Martens ◽  
Heike Krueger ◽  
Wilhelm Korte ◽  
Tim Kaufeld ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Connective Tissue Diseases ◽  
Young Patients ◽  
Term Outcome ◽  
Term Survival ◽  
Long Term Outcome ◽  
Initial Surgery ◽  
Valve Sparing

Introduction Aortic valve-sparing root replacement (David's procedure) is an especially appealing treatment option for young patients. Here, we present the short-, mid, and long-term outcomes of this operation in adolescent patients. Methods Between September 1994 and March 2014, 29 patients aged 6 to 21 years underwent the David-I procedure at our center. We conducted a retrospective study with follow-up. Results The mean age was 16.8 ± 3.4 years and 90% (n = 26) were male. Marfan's syndrome was present in 86% (n = 25) of cases. Ninety-seven percent (n = 28) of cases were performed electively, and one case (3%) was performed emergently for acute aortic dissection type A. There were no early perioperative deaths (0%). Follow-up, which was completed on 100% of patients, comprised a total of 394 patient years and a mean follow-up time of 13.6 ± 5.4 years. The estimates for survival at 1, 5, and 10 years after initial surgery were 100, 97, and 93%, respectively. During follow-up, there were four (14%) late deaths and five (17%) aortic valve-related reoperations. The 1-, 5-, and 10-year estimates for freedom from valve-related reoperation were 100, 86, and 83%, respectively. The perioperative mortality for these five reoperations was 0%. Discussion Aortic valve–sparing root replacement can be performed in adolescents with a very low perioperative risk. Long-term survival seems to be affected by connective tissue diseases.

Analysis of Long-Term Outcome and the Risk of Second Malignancies in Hodgkin Lymphoma Survivors

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 4953-4953
Author(s):  
Ida Cedrych ◽  
Slawomir Blamek ◽  
Andrzej Deptala ◽  
Krzysztof Skladowski
Keyword(s):  
Hodgkin Lymphoma ◽  
Statistical Significance ◽  
Young Patients ◽  
High Rate ◽  
Secondary Cancer ◽  
Secondary Malignancies ◽  
Second Malignancies ◽  
Term Outcome ◽  
Long Term Outcome

Abstract Background: Therapy of Hodgkin lymphoma (HL) can contribute to delayed impairments of health, which some of them (e.g. secondary cancer) can be fatal. Aim: The purpose of this retrospective study was to evaluate long-term outcome of HL survivors and the risk of second malignancies. Methods: The medical report data analysis of 170 patients (pts) with HL treated in one oncological center in Poland between 1979–2005 has been performed. There were 88 females and 82 males, median age 30.5 years (range 16–72). Among the patients there were 22 pts (12.5%) in CSI, 95 pts (55.8%) in CSII, 26 pts (15.4%) in CSIII and 27 pts (15.8%) in CSIV. Half of the 170 pts presented B-symptoms. Chemotherapy (ABVD, MOPP/ABV or MOPP regimen) was given to 155 (93.5%) pts, and radiotherapy alone (mantle-field or involved-field) was given to 11 pts (6.5%). Chemoradiotherapy received 105 pts (61.8%). Results: CR achieved 136 pts (80%), PR 11 pts (6.4%), and progression of HL was observed in 23 pts (13.5%). With a median follow-up of 242 months (range 0–439), there were 37 relapses (21.7%), and 25 deaths (14.7%), usually due to HL progression (20 pts), and also because of secondary cancer (4 pts = 2.4%) and coronary heart disease (1 patient). Five year DFS and OS were 80% and 90% respectively. There was no statistical difference between ABVD and MOPP/ABV regimen efficacy (p=0.94). Late impairments of health were revealed in 78 pts (45.9%), and there were: secondary malignancies, amenorrhea/infertility, skeletal lesions, depressive syndromes, pulmonary fibrosis, polyneuropathy, hypothyroidism, cardiovascular disease, and gastro-duodenal peptic ulcer. Nine pts (5,3%) developed secondary malignancies, i.e.: 2 melanomas, 2 skin basal-cell carcinomas, 1 osteosarcoma, 1 thyroid carcinoma, 1 non-small cell lung cancer, 1 colon carcinoma, 1 cervical carcinoma, and 1 prostate carcinoma. A median time from the end of the treatment to the development of secondary cancer was 114 months (range 28–434). The risk of secondary malignancies development among pts treated with either initial chemotherapy alone or combined modality therapy was similar, and did not reach statistical significance (p=0.20). Conclusions: Chemotherapy or chemoradiotherapy of HL provides freedom from the disease in more than 3/4 of our patients. In the group of fairly young patients such treatment caused a substantial amount of variety of health impairments including secondary malignancies. Despite the high rate of HL curability our study indicates the need of a careful, long term medical surveillance of HL survivors.

scholarly journals Long-term Outcome of Extensive Mitral Valve Reconstruction With Autologous Pericardium and Artificial Chordae for Treatment of Destructive Active Infective Endocarditis of the Mitral Valve

2021 ◽  
Author(s):  
Kazuma Handa ◽  
Takafumi Masai ◽  
Toshihiro Ohata ◽  
Tomohiko Sakamoto ◽  
Toru Kuratani
Keyword(s):  
Infective Endocarditis ◽  
Mitral Valve ◽  
Young Patients ◽  
Left Ventricular Ejection ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Autologous Pericardium ◽  
Valve Reconstruction ◽  
Artificial Chordae

Abstract Objective: Mitral valve (MV) repair is a well-accepted surgical approach for infective endocarditis (IE). In our hospital, extensive MV reconstruction with fresh autologous pericardium (AP) and artificial chordae (AC) has been performed for patients with profoundly extensive and destructive IE in which valve reconstruction would be extremely challenging, especially in young patients to avoid mechanical valve replacement. Long-term outcome including the future performance of the newly created leaflet has not been established. Methods: Five patients (50 ± 30 years of age; 3 men, 2 women) underwent this procedure from January 2011 to December 2020. In all patients, preoperative cardiac function was good (left ventricular ejection fraction, 70% ± 5%). After complete debridement of the infective valve tissue, the MV was reconstructed with large, fresh, trimmed AP and AC.Results: The reconstructed leaflets were anterior in three patients and posterior in four, and AC were placed in four patients. All patients showed an uneventful postoperative course and were discharged to home 35 ± 5 days postoperatively after completion of intravenous antibiotic therapy. Pre-discharge echocardiography revealed no or trivial mitral regurgitation (MR) in all patients. The mean follow-up period was 7.2 (range, 1.3–9.5) years, and no patients developed recurrence of the IE. The latest echocardiography in four patients showed trivial/mild MR with good leaflet function. One patient developed recurrence of MR, 5 months postoperatively. Conclusions: The short- and long-term outcomes of this procedure were satisfactory. This procedure might be considered as an effective and valuable option, especially in young patients.

scholarly journals Long-term outcome of extensive mitral valve reconstruction with autologous pericardium and artificial chordae for treatment of destructive active infective endocarditis of the mitral valve

2021 ◽  
Author(s):  
Kazuma Handa ◽  
Takafumi Masai ◽  
Toshihiro Ohata ◽  
Tomohiko Sakamoto ◽  
Yusuke Yanagino
Keyword(s):  
Infective Endocarditis ◽  
Mitral Valve ◽  
Young Patients ◽  
Left Ventricular Ejection ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Autologous Pericardium ◽  
Valve Reconstruction ◽  
Artificial Chordae

Background and aim: Mitral valve (MV) repair is a well-accepted surgical approach for infective endocarditis (IE). In our hospital, extensive MV reconstruction with fresh autologous pericardium (AP) and artificial chordae (AC) has been performed for patients with profoundly extensive and destructive IE in which valve reconstruction would be extremely challenging, especially in young patients to avoid mechanical valve replacement. Long-term outcome including the future performance of the newly created leaflet has not been established. Methods: Five patients (50 ± 30 years of age; 3 men, 2 women) underwent this procedure from January 2011 to December 2020. In all patients, preoperative cardiac function was good (left ventricular ejection fraction, 70% ± 5%). After complete debridement of the infective valve tissue, the MV was reconstructed with large, fresh, trimmed AP and AC. Results: The reconstructed leaflets were anterior in three patients and posterior in four, and AC were placed in four patients. All patients showed an uneventful postoperative course and were discharged to home 35 ± 5 days postoperatively after completion of intravenous antibiotic therapy. Pre-discharge echocardiography revealed no or trivial mitral regurgitation (MR) in all patients. The mean follow-up period was 7.2 (range, 1.3–9.5) years, and no patients developed recurrence of the IE. The latest echocardiography in four patients showed trivial/mild MR with good leaflet function. One patient developed recurrence of MR, 5 months postoperatively. Conclusions: The short- and long-term outcomes of this procedure were satisfactory. This procedure might be considered as an effective and valuable option, especially in young patients.

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