Aortic valve: Conventional valve replacement and transcatheter valve implantation

2018 ◽  
pp. 97-110
Author(s):  
Jörg Kempfert ◽  
Thomas Walther
Keyword(s):  
Heart Failure ◽  
Aortic Valve ◽  
Valve Replacement ◽  
Major Surgery ◽  
Excellent Outcome ◽  
Average Survival ◽  
Risk Patients ◽  
History Of ◽  
Transcatheter Valve ◽  
Valve Implantation

The natural history of untreated severe aortic valve stenosis (AS), with an average survival of 3 years after the onset of angina or syncope and only 1½ years after onset of heart failure, strongly suggests early surgical therapy which represents the only curative option. Since the first pioneering work in the early 1960s, conventional aortic valve replacement (AVR) has become a routine procedure performed more than 200,000 times annually worldwide. The surgical technique of AVR has evolved to a highly standardized procedure resulting in excellent outcome and patient safety. Transcatheter techniques have emerged in the last decade allowing for valve implantation with avoidance of important complications of major surgery particularly in high-risk patients. However, potential drawbacks and procedure-related complications remain important. The techniques and technologies continue to emerge and improve. Conventional surgery, valve substitutes, and transcatheter technologies are discussed in this chapter.

Three-Year Survival Comparison between Transcatheter and Surgical Aortic Valve Replacement for Intermediate- and Low-Risk Patients

2018 ◽  
Vol 13 (3) ◽  
pp. 153-162 ◽  
Author(s):  
Juan A. Siordia ◽  
Jackquelin M. Loera ◽  
Matt Scanlon ◽  
Jessie Evans ◽  
Peter A. Knight
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Implantation ◽  
Low Risk ◽  
Surgical Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
Risk Patients ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Transcatheter aortic valve implantation is a suitable therapeutic intervention for patients deemed inoperable or high risk for surgical aortic valve replacement. Current investigations question whether it is a suitable alternative to surgery for intermediate- and low-risk patients. The following meta-analysis presents a comparison between transcatheter versus surgical aortic valve replacement in patients that are intermediate and low risk for surgery. Articles were collected via an electronic search using Google Scholar and PubMed. Articles of interest included studies comparing the survival of intermediate- and low-risk patients undergoing transcatheter aortic valve implantation to those undergoing surgical aortic valve replacement. Primary end points included 1-, 2-, and 3-year survival. Secondary end points included postintervention thromboembolic events, stroke, transient ischemic attacks, major vascular complications, permanent pacemaker implantation, life-threatening bleeding, acute kidney injury, atrial fibrillation, and moderate-to-severe aortic regurgitation. Six studies met the criteria for the meta-analysis. One- and two-year survival comparisons showed no difference between the two interventions. Surgical aortic valve replacement, however, presented with favorable 3-year survival compared with the transcatheter approach. Transcatheter aortic valve implantation had more major vascular complications, permanent pacemaker implantation, and moderate-to-severe aortic regurgitation rates compared with surgery. Surgical aortic valve replacement presented more life-threatening bleeding, acute kidney injury, and atrial fibrillation compared with a transcatheter approach. There was no statistical difference between the two approaches in terms of thromboembolic events, strokes, or transient ischemic attack rates. Surgical aortic valve replacement presents favorable 3-year survival rates compared with transcatheter aortic valve implantation.

scholarly journals Sutureless replacement versus transcatheter valve implantation in aortic valve stenosis: A propensity-matched analysis of 2 strategies in high-risk patients

2014 ◽  
Vol 147 (2) ◽  
pp. 561-567 ◽  
Author(s):  
Giuseppe Santarpino ◽  
Steffen Pfeiffer ◽  
Jürgen Jessl ◽  
Angelo Maria Dell’Aquila ◽  
Francesco Pollari ◽  
...  
Keyword(s):  
High Risk ◽  
Aortic Valve ◽  
Aortic Valve Stenosis ◽  
High Risk Patients ◽  
Risk Patients ◽  
Transcatheter Valve ◽  
Valve Implantation

scholarly journals Complex cardiac surgery in a high-risk patient with new-onset severe mitral regurgitation and aorta to right ventricular fistula after transcatheter aortic valve implantation: a case report

2020 ◽  
Vol 4 (5) ◽  
pp. 1-5
Author(s):  
Mario Verdugo-Marchese ◽  
Pierre Monney ◽  
Olivier Muller ◽  
Matthias Kirsch
Keyword(s):  
Heart Failure ◽  
Cardiac Surgery ◽  
High Risk ◽  
Aortic Valve ◽  
Right Ventricular ◽  
Left Ventricular ◽  
Transcatheter Aortic Valve ◽  
Risk Patients ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Background Transcatheter aortic valve implantation (TAVI) is the procedure of choice for aortic stenosis in high surgical risk patients, but it is no free from complications. Case summary A 86-year-old patient with severe aortic stenosis underwent TAVI 3 years ago with an Edwards Sapiens valve by femoral access. In the echocardiography follow-up, an aorta–right ventricular (Ao-RV) fistula was noted with restrictive flow and no significant shunt and it was treated conservatively. Three years after TAVI, the patient underwent cardiac surgery because of worsening heart failure due to a severe degenerative mitral regurgitation with tethering of P2 due to left ventricular remodelling, a posterior jet of severe regurgitation, and left ventricular dilatation. Surgical replacement of the TAVI and aortic root with a bioprosthesis (Medtronic Freestyle) and direct closure of the fistula was performed along with the mitral valve replacement. The patient was discharged with a good clinical result and no evidence of remaining Ao-RV fistula at transthoracic echocardiography. Discussion Aorta–right ventricular fistula is a rare entity. Most reported cases arise after rupture of a congenital coronary sinus aneurism, endocarditis, trauma, and aortic valve or aortic root surgery. This is the 10th reported case after TAVI (9 after an Edwards Sapiens TAVI). Non-significant shunt can be treated conservatively but development of heart failure and death are described in significant shunts. Balloon post-dilatation and the absence of surgical calcium debridement inherent to TAVI may theoretically contribute to the development of the fistula. Surgical replacement and closure of the fistula is a therapeutic option for this entity even in high-risk patients.

Abstract 2307: Contemporary Perioperative Results of Isolated Aortic Valve Replacement for Aortic Stenosis: Implications for Transcatheter Aortic Valve Implantation

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
S C Malaisrie ◽  
Patrick M McCarthy ◽  
Edwin C McGee ◽  
Richard Lee ◽  
Vera Rigolin ◽  
...  
Keyword(s):  
High Risk ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Operative Mortality ◽  
Transcatheter Aortic Valve ◽  
Risk Patients ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Transcatheter aortic valve implantation (AVI) is compelling for some high-risk patients with aortic stenosis (AS). However, comparison of procedure outcomes with older surgical series may overestimate operative risk. We therefore analyzed our contemporary series of isolated aortic valve replacement (AVR) for AS. From April 2004 to January 2008, 642 patients underwent AVR with or without concomitant cardiac procedures. Of these patients, 175 patients had an isolated AVR, and 140 patients underwent isolated AVR for AS. The characteristics were age 68, male gender 56%, ejection fraction 57%. Sixty-four percent had a minimally-invasive AVR and 18% were reoperations. Twenty percent were 80 years old or greater, 35% were in NYHA functional class III-IV, and 4% had an estimated operative mortality of 10% or greater using the Society of Thoracic Surgery (STS) risk calculator. Thirty-day mortality was 0%, but there was one in-hospital death (0.7%) from complications of an esophageal perforation. Reoperation for bleeding occurred in 5.7%, cerebrovascular accident (CVA) in 0%, acute renal failure (ARF) in 2.9%, myocardial infarction (MI) in 0%. Bioprosthetic valves were used in 98.6% and mechanical in 1.4%. Mean gradient decreased from 48 mmHg to10 mmHg. Actuarial survival was 97% and 90% at 1 and 3 years. Patients >80 years (n=28) were more likely to have an increased length of hospital stay (9.8 versus 6.3 days, p=0.01) and less likely to be discharged to home (48% versus 86%, p<0.01) as compared to patients <80 years. Today, AVR for AS can be performed in many high-risk patients with low operative mortality and morbidity, although patients over 80 years are at greater risk of prolonged recovery. Transcatheter AVI should be compared to this high threshold.

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