scholarly journals Current trends in aortic valve-preserving surgery

2020 ◽  
pp. 021849232097593
Author(s):  
Takashi Kunihara
Keyword(s):  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Objective Assessment ◽  
Young Patients ◽  
Left Ventricular ◽  
Multicenter Studies ◽  
Asymptomatic Patients ◽  
Significant Survival ◽  
History Of ◽  
Aortic Valve Reimplantation

The natural history of aortic regurgitation is not as benign as once believed, even in asymptomatic patients with preserved left ventricular function. Aortic valve surgery can prolong survival in these patients. However, both mechanical and biological aortic valve replacement have major disadvantages, especially in young patients. Aortic valve-preserving surgery has attracted a great deal of attention because it has a significant survival benefit over replacement. Nonetheless, aortic valve-preserving surgery has not been widely adopted due to the complexity of the technique and assessment (i.e., long learning curve). With recent technical and theoretical advances, aortic valve-preserving surgery has increasingly been performed with better outcomes, and therefore earlier surgical intervention in cases of aortic regurgitation has been considered. Recent advances in aortic valve-preserving surgery include repair-oriented classification of the etiology of aortic regurgitation, objective assessment of the cusp configuration (i.e., effective height and geometric height), use of aortic annuloplasty, introduction of two reproducible valve-sparing root replacement procedures (i.e., aortic valve reimplantation and aortic root remodeling techniques), standardization of aortic valve-preserving surgery, and assessment of cusp configuration with aortoscopy. A number of prospective multicenter studies are currently underway and will clarify the role of aortic valve-preserving surgery in the treatment of aortic regurgitation in the near future.

Heart valve disease (aortic valve disease): aortic regurgitation

2016 ◽  
Author(s):  
Christophe Tribouilloy ◽  
Patrizio Lancellotti ◽  
Ferande Peters ◽  
José Juan Gómez de Diego ◽  
Luc A. Pierard
Keyword(s):  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Transoesophageal Echocardiography ◽  
Left Ventricular ◽  
Valve Disease ◽  
Doppler Imaging ◽  
Heart Valve Disease ◽  
Associated Lesions ◽  
2D Echocardiography ◽  
Asymptomatic Patients

Echocardiography is the cornerstone examination for the assessment of aortic regurgitation (AR): it provides reliable evaluation of the aortic valve and allows diagnosis and identification of the mechanism of regurgitation. The specific aetiology of the disease can be identified in the majority of cases. A combination of quantitative and quantitative Doppler and two-dimensional (2D) echocardiographic parameters allows the evaluation of the severity of AR and determination of the haemodynamic and left ventricular function repercussions. Echocardiography allows the detection of associated lesions of the aortic root or other valves. In symptomatic patients, echocardiography is essential to confirm the severity of AR. In asymptomatic patients with moderate or severe AR, echocardiography is essential for regular follow-up, by providing precise and reproducible measurements of LV dimensions and function, and for identifying patients who should be considered for elective surgical intervention. In most cases, transthoracic echocardiography (TTE) provides all of the necessary information and transoesophageal echocardiography in usually not required. Real-time three-dimensional (3D) TTE can be complementary to 2D echocardiography for the assessment of the mechanism and quantification of AR by increasing the level of confidence, especially when 2D echocardiographic data are inconclusive or discordant with clinical findings. Tissue Doppler imaging and especially the speckle tracking method are promising approaches to detect early LV dysfunction in patients with asymptomatic severe AR. Echocardiography is therefore the key examination for the assessment of AR and at the centre of the strategic discussion concerning the indications and timing of surgery.

Abstract 2658: Does Aortic Valve Morphology Influence The Natural History Of Aortic Regurgitation?

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Joan Alguersuari ◽  
Antonia Sambola ◽  
Pilar Tornos ◽  
Arturo Evangelista
Keyword(s):  
Aortic Valve ◽  
Natural History ◽  
Aortic Regurgitation ◽  
Wall Stress ◽  
Left Ventricular ◽  
Regurgitant Fraction ◽  
History Of ◽  
The Impact ◽  
Ascending Aortic Diameter

BACKROUND: The influence of the morphology of aortic valve on the natural history of aortic regurgitation (AR) is uncertain. OBJECTIVE: To assess the natural history of AR in patients with bicuspid aortic valve (BAV) comparing with tricuspid aortic valve (TAV). METHODS AND RESULTS: Ninety-five patients with asymptomatic severe chronic AR were prospectively studied. Follow-up period was 7+/- 2 years. Forty-one patients (42%) had BAV and were significantly younger than patients with TAV (39 +/- 11 vs 47 +/- 14 years, p=0.001). Mean ascending aortic diameter (AAD) was significantly larger in BAV (42 +/- 7 vs 37 +/- 5 mm, p=0.0001). Differences in AAD persisted until the end of the follow-up (47 +/- 6 vs 40 +/-5 mm, p=0.0001). The percentatge of increase in AAD was 12 +/- 5% in BAV and 8 +/- 5% in TAV with yearly increase of 0.83 mm in BAV and 0.42 mm in TAV. The changes in left ventricle diameters, mass index, wall stress, regurgitant fraction and ejection fraction were similar in BAV and TAV. Patients with BAV did not need surgery earlier due to AR than patients with TAV (4.7 +/- 2 vs 4.8 +/- 3 years). At 5 years follow-up 11 patients with BAV (27%) and 10 patients with TAV (23%) needed surgery. CONCLUSIONS: Patients with BAV are younger, had a larger AAD and a higher rate of AAD enlargement than patients with TAV. The morphology of the aortic valve (BAV vs TAV) had no infuence in the progression of AR and the impact on left ventricular function.

Presence of adipose tissue in aortic valves from aortic regurgitation patients: pathophysiological role and clinical implications

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Sadaba Cipriain ◽  
A.M Navarro Echeverria ◽  
C.R Tiraplegui Garjon ◽  
A Garcia De La Pena Urtasun ◽  
V Arrieta Paniagua ◽  
...  
Keyword(s):  
Adipose Tissue ◽  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Systolic Function ◽  
Statistical Significance ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
Funding Source ◽  
Matrix Remodeling ◽  
Aortic Valves

Abstract Introduction Adipose tissue is a common constituent of the heart and it is located, without great clinical relevance, frequently in the pericardium. The presence of adipose tissue in the aortic valve is rare, with unknown significance on valve structural properties and function. Aortic regurgitation (AR) is the third most prevalent valve disease, although it is uncommon to find it in isolation. Myxoid degeneration may be the cause or result of AR, although the pathophysiology remains poorly understood. Purpose To describe and characterize the presence of adipose tissue in the aortic valves from a cohort of AR patients. Methods 116 patients undergoing aortic valve replacement due to severe AR were enrolled. We classified them in two groups according to the histological results showing presence or absence of adipose tissue in the aortic valves. In the valve tissue molecular analysis were performed by RT-PCR, Western Blot and ELISA to analyze markers of adipocytes (leptin, adiponectin, resistin), inflammation (Rantes, interleukin-6, interleukin-1β), extracellular matrix remodeling (metalloproteinases-1, -2 and -9), proteoglycans (aggrecan, hyaluronan, lumican, syndecan-1, decorin) and fibrosis (collagens, fibronectin). Results Adipose tissue was found in 63% of the aortic valves analyzed. Baseline characteristics (age, hypertension, dyslipidemia, diabetes, smoking, left ventricular telediastolic diameter, left ventricular systolic function, ascending aorta) were similar in patients presenting valve adipose tissue as compared with patients without valve adipose tissue. Valves containing adipocytes exhibited a higher leptin content (p<0.001), fibronectin (p<0.01), decorin (p<0,0001), hyaluronan (p=0.03), aggrecan (p=0.04) and metalloproteinase 1 (p=0.03). Interestingly, the presence of adipocytes in the valve was positively correlated with valve thickness measured by echocardiogram (Pearson chi2 statistical significance = 26.3345 p<0.001). Conclusion To our knowledge, this is the first study that describes the presence of adipose cells in aortic valves from a cohort of AR patients. Aortic valves containing adipocytes were thicker and exhibited significant higher levels of proteoglycans, suggesting that adipocytes could contribute to the myxomatous degeneration process. Our results propose that the valve adipose tissue could play a role in the pathophysiology of AR. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Gobierno de Navarra

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