Proof of Concept of an Endoscopic Sutureless Valve Sizer

Objective In this paper, we present an endoscopic expandable sizer conceived to allow thoracoscopic aortic valve replacement with a sutureless prosthesis using a dynamic sizing of the aortic annulus. Methods Ten aortic torsos were prepared using a five-trocar thoracoscopic setting. Once the aortotomy was performed and the aortic valve leaflets removed, the technical feasibility of the endoscopic sizing (introduction into the trocar, expansion into the aortic annulus, determination of the valve size, and retraction) with the device was assessed. In case of successful thoracoscopic sizing, endoscopic implantation of a sutureless valve (five LivaNova Perceval prosthesis and five Medtronic 3f Enable bioprosthesis) was performed. Before ascending aorta closure, we assessed the appropriate sealing of the bioprosthesis in the native annulus with camera visualization and a nerve hook inspection. Results All the 10 endoscopic sizings were technically feasible. The scheduled aortic sutureless valve implantations were successfully performed. In all cases, fitting and placement of the sutureless bio-prosthesis in the flaccid heart was satisfactory, with no paraprosthetic leakage detectable by the nerve hook. Conclusions The use of the endoscopic expandable sizer is technically possible. In this early-stage test in the flaccid heart, selection of the valve size was satisfactory during thoracoscopic sutureless aortic bioprosthesis implantation. Further laboratory evaluation with fluid dynamics (aortic root pressurization) will be performed before a clinical study is started.

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Geometric changes in aortic root replacement using Freestyle prosthesis

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01583-y ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Anja Osswald ◽

Alina Zubarevich ◽

Arian Arjomandi Rad ◽

Robert Vardanyan ◽

Konstantin Zhigalov ◽

...

Keyword(s):

Aortic Root ◽

Ascending Aorta ◽

Aortic Root Replacement ◽

Aortic Annulus ◽

Strongly Correlated ◽

Root Volume ◽

Concomitant Surgery ◽

Valve Size ◽

Operative Planning ◽

Geometric Changes

Abstract Background The Medtronic Freestyle prosthesis has proven to be a promising recourse for aortic root replacement in various indications. The present study aims to evaluate clinical outcomes and geometric changes of the aorta after Freestyle implantation. Methods Between October 2005 and November 2020, the computed tomography angiography (CTA) data of 32 patients were analyzed in a cohort of 68 patients that underwent aortic root replacement using Freestyle prosthesis. The minimum and maximum diameters and areas of the aortic annulus, aortic root, ascending aorta, and the proximal aortic arch were measured at a plane perpendicular to the long axis of the aorta using 3D multiplanar reconstruction in both the preoperative (n = 32) and postoperative (n = 10) CTAs. Moreover, volumetric changes of the aortic root and ascending aorta were quantified. Results Mean age was 64.6 ± 10.6 years. Indications for surgery using Freestyle prosthesis were combined aortic valve pathologies, aortic aneurysm or dissection, and endocarditis, with concomitant surgery occurring in 28 out of 32 patients. In-hospital mortality was 18.6%. Preoperative diameter and area measurements of the aortic annulus strongly correlated with the implanted valve size (p < 0.001). Bicuspid valve was present in 28.1% of the patients. Diameter and areas of the aortic root decreased after freestyle implantation, resulting in a reduction of the aortic root volume (45.6 ± 26.3 cm3 to 18.7 ± 4.5 cm3, p = 0.029). Volume of the aortic root and the ascending aorta decreased from 137.3 ± 65.2 cm3 to 54.5 ± 21.1 cm3 after Freestyle implantation (p = 0.023). Conclusion Implantation of the Freestyle prosthesis presents excellent results in restoring the aortic geometry. Preoperative CTA measurements are beneficial to the surgical procedure and valve selection and therefore, if available, should be considered in pre-operative planning.

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Predicting the Ideal Valve Size During Aortic Valve Replacement with Rapid Deployement Bioprosthetic Valves. Is Intraoperative Transesophageal Echocardiogram Reliable?

10.22541/au.162672107.74961308/v2 ◽

2021 ◽

Author(s):

Ali Al-Alameri ◽

Alejandro Macias ◽

Daniel Buitrago ◽

Alvaro Montoya ◽

Evan Markell ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Transesophageal Echocardiography ◽

Valve Replacement ◽

Aortic Annulus ◽

Significant Difference ◽

Valve Size ◽

The Mean ◽

Rapid Deployment ◽

Bioprosthetic Valves

Objective: To describe experience with using intraoperative Transesophageal Echocardiography to reliably predict the size of the rapid deployment prosthetic valve by measuring the native aortic annulus Methods: Retrospective review of single institution series of patients undergoing Aortic Valve Replacement with Rapid Deployement Bioprosthetic Valves. Included were patients that had their native aortic valve replaced either isolated or as part of any additional procedure. Aortic annulus was measured prior to initiation of the operation using transesophageal echocardiography (TEE). Correlation analysis was conducted between Echocardiographic annular measurements and actual implanted valve sizes. Results: Twenty five patients underwent rapid deployment valve implantation in the aortic position. Of these, 36% of patients had the same size valve as the measured aortic annulus, 48% of patients had a valve implanted that was 1 mm different, and 16% of patients had 2 mm difference. The mean annular size based was 22.4 mm (range: 21-28 mm). The mean valve size implanted was 23.3 mm (range: 21-27 mm). There was no statistically significant difference between the mean annular measurement and the valve size selected (0.9 mm , p = 0.8). Conclusion: TEE can further enhance valve sizing and guidance through a proper and safe deployment. Although evident in our experience, larger scale studies are needed to further elucidate conclusions on the importance of avoiding under-sizing valves.

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MULTISPIRAL COMPUTER TOMOGRAPHY IN DIAGNOSTICS OF PATIENTS WITH THE PATHOLOGY OF ASCENDING DEPARTMENT OF THE AORTA IN BEFORE AND POSTOPERATIVE PERIOD

Diagnostic radiology and radiotherapy ◽

10.22328/2079-5343-2018-9-3-28-35 ◽

2018 ◽

pp. 28-35

Author(s):

E. P. Yasakova ◽

V. S. Pykhteev ◽

S. A. Belash ◽

E. I. Zyablova ◽

V. A. Porkhanov

Keyword(s):

Computed Tomography ◽

Aortic Valve ◽

Postoperative Period ◽

Diagnostic Value ◽

Ascending Aorta ◽

Postoperative Results ◽

Transcatheter Aortic Valve ◽

Technical Issues

This review presents current information on the diagnosis of patients with pathology of the ascending aorta in the pre and postoperative period using multispiral computed tomography. The authors paid attention to the importance of valuation of the valvular apparatus elements, the geometry of the root of the aorta (effective coaptation height, Henle triangles, aortic regurgitation area, etc.), the features of which are necessary for the surgeon to solve technical issues of the forthcoming operation. A comparison of the diagnostic value of multispiral computed tomography and transthoracic echocardiography with respect to the visualization of valvular structures is shown. The role of multispiral computed tomography in the planning of transcatheter aortic valve replacement and the determination of results after intervention is described. With the help of multispiral computed tomography, assessing the state of the ascending aorta, the aortic root and aortic valve elements, the surgeon has an opportunity to choose the optimal variant of the valve-preserving operation and to evaluate postoperative results in the preoperative period.

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Early Hemodynamic Results in Patients with Small Aortic Annulus after Aortic Valve Replacement

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000380 ◽

2017 ◽

Vol 12 (4) ◽

pp. 254-258 ◽

Cited By ~ 3

Author(s):

Pierre Olivier Dionne ◽

Frédéric Poulin ◽

Denis Bouchard ◽

Philippe Généreux ◽

Reda Ibrahim ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Implantation ◽

Aortic Annulus ◽

Transcatheter Aortic Valve ◽

Significant Difference ◽

Valve Size ◽

Aortic Valve Implantation ◽

Valve Implantation

Objective Patients with a small aortic annulus (≤21 mm) have an increased risk of patient-prosthesis mismatch after valve replacement. The aim of this study was to compare the early hemodynamic performance of the balloon-expandable transaortic valve implantation Edwards system (SAPIEN) and the sutureless Perceval prostheses. Methods Fifty patients underwent transcatheter aortic valve implantation, and 113 patients underwent sutureless aortic valve replacement. Mean ± SD aortic annulus diameter was 19.7 ± 1 mm, with no significant difference between groups. SAPIEN valve size was 23 mm in 40 patients (80%) and 26 mm in 10 patients (20%). Perceval valve size was small in 45 patients (40%), medium in 62 patients (55%), and large in 6 patients (5%). Transthoracic Doppler echocardiographic images were collected at baseline and before discharge. Results There were no significant difference in predischarge effective orifice area (SAPIEN: 1.5 ± 0.5 cm2 and Perceval: 1.48 ± 0.34 cm2, P = 0.58) and indexed effective orifice areas (SAPIEN: 0.93 ± 0.32 cm2/m2 and Perceval: 0.88 ± 0.22 cm2/m2, P = 0.42). Predischarge mean ± SD transaortic gradient was lower with the SAPIEN than with Perceval valves (12 ± 6 and 17 ± 6 mm Hg, respectively, P < 0.001). Rates of moderate and severe prosthesis-patient mismatch were similar (SAPIEN: 44% and 10% and Perceval: 50% and 14%, P = 0.53 and 0.75, respectively). There were no moderate-severe paravalvular leaks. Conclusions Although indexed effective orifice areas were similar, transcatheter aortic valve implantation with the balloon-expandable SAPIEN system yielded lower predischarge transaortic mean gradients than the surgically implanted Perceval, in patients with a small annulus.

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Three-Dimensional Transesophageal Echocardiography as an Alternative to Multidetector Computed Tomography in Aortic Annular Diameter Measurements for Transcatheter Aortic Valve Implantation

Biology ◽

10.3390/biology10020132 ◽

2021 ◽

Vol 10 (2) ◽

pp. 132

Author(s):

Ciprian Nicusor Dima ◽

Marian Gaspar ◽

Cristian Mornos ◽

Aniko Mornos ◽

Petru Deutsch ◽

...

Keyword(s):

Aortic Valve ◽

Transesophageal Echocardiography ◽

Transcatheter Aortic Valve Implantation ◽

Open Heart Surgery ◽

Three Dimensional ◽

Aortic Annulus ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation ◽

Selection Of

Background and objectives: Transcatheter aortic valve implantation (TAVI) is a therapeutic choice for high surgical risk patients, serving as an alternative to open-heart surgery. Correct measurement of the aortic annulus, which leads to the selection of a suitable prosthesis and accurate outcome prediction, is essential for the success of TAVI. The objective of this study is to evaluate the accuracy of novel imaging te chniques in measuring the aortic annulus by comparing multi-detector computer tomography (MDCT) and three-dimensional transesophageal echocardiography (3D TEE) for the selection of the optimal prosthesis. Materials and Methods: Measurements of the aortic annulus have been performed on 25 patients using MDCT and TEE, and the correlation and agreement levels between the two measuring techniques were analyzed. MDCT measurements were used for the sizing of the prostheses. Results: MDCT and TEE measurements of aortic annular diameters were significantly correlated, with a mean difference of 0.001 cm. Conclusions: 3D TEE measurements have been in good agreement with MDCT and, therefore, 3D TEE can be used as an alternative in cases where MDCT is contraindicated or not available.

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Modified Danielson Technique for Prosthetic Aortic Valve Endocarditis and Aortoventricular Discontinuity

Texas Heart Institute Journal ◽

10.14503/thij-17-6506 ◽

2020 ◽

Vol 47 (2) ◽

pp. 117-120

Author(s):

Gianfranco Filippone ◽

Claudia Calia ◽

Mario Finazzo ◽

Fabio Fazzari ◽

Giovanni Caruana ◽

...

Keyword(s):

Aortic Valve ◽

Valve Replacement ◽

Prosthetic Valve Endocarditis ◽

Ascending Aorta ◽

Aortic Annulus ◽

Modified Technique ◽

Vein Grafts ◽

Treatment Techniques ◽

Prosthetic Aortic Valve ◽

Surgical Valve Replacement

Endocarditis is a devastating complication of prosthetic aortic valve replacement. The infective process can destroy aortic annulus tissue, making conventional surgical valve replacement difficult or impossible and causing aortoventricular discontinuity. Several treatment techniques have been proposed. One of these, the Danielson technique, involves translocating the aortic valve to the native ascending aorta, débriding the abscess cavity, closing the coronary ostia, and bypassing the coronary arteries with a Y anastomosis between 2 vein grafts. We describe our use of a modified Danielson technique in a 68-year-old man with advanced prosthetic valve endocarditis that was associated with aortic annulus destruction and aortoventricular discontinuity. This modified technique enables safer, more secure anchoring of a replacement valve, reduces the risks and concerns associated with bypass grafts, and successfully treats aortoventricular discontinuity.

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Sutureless Prosthesis Implantation and Ascending Aorta Replacement through a Ministernotomy Approach

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000479 ◽

2018 ◽

Vol 13 (3) ◽

pp. 239-241

Author(s):

Antonio Lio ◽

Matteo Ferrarini ◽

Antonio Miceli ◽

Mattia Glauber

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Significant Proportion ◽

Ascending Aorta ◽

Prosthesis Implantation ◽

Sutureless Valve ◽

Aorta Replacement ◽

Valve Implantation ◽

Ascending Aorta Replacement

A significant proportion of patients undergoing aortic valve replacement have a dilated ascending aorta; presence of an ascending aorta aneurysm is viewed as a contraindication for sutureless valve implantation for the potential risk of prosthesis dislodgment. We describe our technique of sutureless prosthesis implantation and concomitant ascending aorta replacement through an upper ministernotomy. Seven patients underwent aortic valve replacement with a sutureless prosthesis and concomitant ascending aorta replacement between November 2014 and October 2016. A J-shaped upper ministernotomy was performed in all patients. Diameter of vascular graft for the replacement of the dilated ascending aorta was chosen according to the size of the selected prosthesis, to recreate a ratio between diameters of the new sinotubular junction and the aortic annulus that should be less than 1.3. Postoperatively. no patient died in hospital. No paravalvular leakage or prosthesis dislodgment was reported. Mean ± SD cardiopulmonary bypass and cross-clamp times were 142 ± 52 minutes and 85 ± 18 minutes, respectively. In patients undergoing aortic valve replacement and ascending aorta replacement, sutureless valve implantation is a safe and reproducible procedure associated with good postoperative results.

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Abstract 2131: The Association of Coarctation of Aorta Diminishes the Occurrence of Ascending Aorta Dilation in Children and Young Adults with Bicommissural Aortic Valves.

Circulation ◽

10.1161/circ.116.suppl_16.ii_462 ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Thieu Nguyen ◽

Andrea Z Beaton ◽

Wyman W Lai ◽

Prema Ramaswamy ◽

Ira A Parness ◽

...

Keyword(s):

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Ascending Aorta ◽

Aortic Annulus ◽

Sinotubular Junction ◽

Z Scores ◽

Group A ◽

Group B ◽

Aortic Dimensions

Objectives: To explore the difference in ascending aortic dilatation between subgroups of bicuspid aortic valve (BAV) patients with and without coarctation of the aorta (CoA). Methods: Our echocardiographic database (1993–2006) was searched for BAV patients with CoA (Group A) and without CoA (Group B). Measurements at the aortic annulus, root, sinotubular junction, and ascending aorta were obtained for each patient, and body surface area-adjusted Z-score values were compared. Exclusion criteria included more than mild aortic stenosis or regurgitation, previous balloon aortic valvuloplasty, or complex left heart disease; plus Turner, Noonan, Williams, and Marfan Syndromes. Results: The median age in Group A (n=53) was 11.3 yrs (range 0 to 30) with median follow-up of 7 yrs (0 to 12.7); median age in Group B (n=145) was 8.7 yrs (0 to 29) with median follow-up of 4 yrs (0 to 13.1). Group B patients had significantly greater aortic annulus, sinotubular junction, and ascending aortic dimensions (ascending aorta Z-scores shown in Figure , p<0.0001). Group A ascending aortic dimensions did not differ significantly from the normal population. The rate of growth of the ascending aorta in Group B was higher in the first 10 years of life. Conclusion: The ascending aorta in patients with bicuspid aortic valve and coarctation does not dilate to the same degree as patients with isolated bicuspid aortic valve. This may reflect an inherent difference in aortic wall properties between the two groups. Comparison of Ascending Aorta Z Scores

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1644 Unusual management of dislodged TAVR prosthesis, Nightmare in Cath lab

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.1034 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

A Alnabti ◽

G Abushahba ◽

S Abujalala ◽

E Khalifa ◽

A M Alkhulaifi ◽

...

Keyword(s):

Case Report ◽

Aortic Valve ◽

Aortic Root ◽

Surgical Intervention ◽

Left Ventricular ◽

Ascending Aorta ◽

Aortic Annulus ◽

Lv Function ◽

Transverse Diameter ◽

Valve Prosthesis

Abstract Introduction The Trans aortic valve replacement( TAVR) is well established technique that is basically designed for patient with sever aortic stenosis with high surgical risk. We describe a TAVR procedure was complicated with valve dislodgment and treated without surgical intervention Case report 75 year old Female Patient hypertensive, diabetic, Hypothyroidism and Atrial Fibrillation on oral anticoagulation. Her transthoracic echocardiography(TTE) showed sever critical aortic valve stenosis and calculated aortic valve are was 0.6 cm² and Peak gradient is 68mmhg and mean 46 mmHg , sever Left ventricular dysfunction and estimated EF 25 % . The CT Aortogram showed The aortic annulus maximum transverse diameter measures was 30 mm and the anteroposterior diameter was 25 mm. The sinus of Valsalva measures 37 mm was Sino tubular junction measures 24 mm and the proximal ascending aorta measures 39 mm. There is no evidence of coronary artery disease by the CT coronary angiogram. Because of depressed LV function, it was decided to do the TAVR with ECMO (Extra Corporeal Membrane Oxygenation) support. Based on CT measurements, CoreValve29 was selected The native valve is pre dilated then CoreValve29 was advanced. Unfortunately valve was larger than the aortic annulus and during trial to valve deployment ( Fig A) ,valve jumped into proximal ascending aorta in opining position just few centimeters from coronary ostium ( Fig B). We advance balloon for maximum dilatation of core valve 29 to ensure fixation of valve in ascending aorta and complete opening of valve leaflets. A second smaller valve (coreValve26) was advanced through the dislodged valve and crossing through its leaflet of first core valve (which settled in aorta) and successfully reaches the aortic annulus and confirming proper positioning of the coreValve26 and then deployed safely The coreValve26 was deployed in acceptable position and coreValve29 was hooked and well-fixed to 26 valves in proximal ascending aorta (Fig C). Coronary flow was secured and confirmed by aortic root injection (Fig F). Patient kept supported on ECMO before and during the TAVR procedure. The patient tolerated the procedure and was stable hemodynamically throughout the procedure. Successful ECMO weaning and patient hemodynamically remained stable with Total bypass time on ECMO was 142 minutes. Post procedure chest X ray showed two corValves hooked together in aortic root and ascending aorta in (Fig D). Follow up TTE showed improved EF systolic LV function (EF 39 %). Normal functioning aortic valve prosthesis. Conclusion Up to our knowledge, this is the first case that valve dislodgment was treated percutaneously not required urgent surgical intervention. Although it is one case report, however it could open the ideas for new approach how to manage difficult cases with dislodged valve with percutaneous approach. Abstract 1644 Figure.

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