Doppler Hemodynamics of CarboMedics Prosthetic Valves in Aortic Position at Rest and Exercise

1996 ◽  
Vol 4 (3) ◽  
pp. 146-151
Author(s):  
Ichiro Shimada ◽  
Hitoshi Okabayashi ◽  
Takeshi Nishina ◽  
Kenji Minatoya ◽  
Yoshiharu Soga ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Pressure Gradient ◽  
Valve Replacement ◽  
Performance Index ◽  
Heart Valves ◽  
Peak Pressure ◽  
Prosthetic Heart Valves ◽  
Pressure Gradients ◽  
Theoretical Performance

To evaluate the size adequacy of CarboMedics prosthetic heart valves, Doppler pressure gradients after aortic valve replacement were determined at rest and immediately after exercise in 83 patients, at a mean time of 18.8 days after aortic valve replacement with CarboMedics prosthetic heart valves (31 standard and 52 R-series). There were 54 males and 29 females, average age 55 years; 12 had pure aortic stenosis, 47 had aortic regurgitation, and 24 had combined lesions. Exercise significantly increased (p < 0.01) the peak velocity (from 2.50 to 2.88 m/sec), the peak pressure gradient (from 25.9 to 34.6 mm Hg), and the mean pressure gradient (from 13.9 to 18.4 mm Hg). Significant differences were observed even in patients with seemingly large valve sizes. Significant correlation (p < 0.0001) was observed between pressure gradients at rest and immediately after exercise, as well as between pressure gradients and theoretical performance index. A theoretical performance index larger than 1.0 cm2/m2 was needed to obtain a postexercise Doppler peak pressure gradient of less than 60 mm Hg early after aortic valve replacement using either the Carbomedics standard or R-series prosthetic heart valves.

Technique of surgical aortic valve implantation using single interrupted annular sutures

2020 ◽  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Heart Valves ◽  
Intraoperative Complications ◽  
Coronary Artery Occlusion ◽  
Artery Occlusion ◽  
Prosthetic Heart Valves ◽  
Surgical Aortic Valve Replacement ◽  
Conduction Disturbances

The introduction of the first surgical prosthetic heart valves in the early 1960s made effective treatment of aortic valve disease possible. The goal of surgical aortic valve replacement is to replace the diseased aortic valve with a properly functioning, sufficiently large prosthesis while avoiding intraoperative complications such as conduction disturbances, coronary artery occlusion, or paravalvular leaks. Although most commonly, non-everting pledgeted mattress sutures are used to implant the prosthesis during surgical aortic valve replacement , interrupted single sutures without pledgets can be a useful alternative, especially in patients with a small tissue annulus, because they theoretically maximize the orifice available for flow. This tutorial discusses the surgical technique of surgical aortic valve replacement using interrupted single annular sutures.

Abstract 15174: Failing Aortic Tissue Valves in Patients at High Surgical Risk: Comparison of Outcomes After Transcatheter Aortic Valve-in-valve Procedures and Redo Surgical Aortic Valve Replacement

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Miriam Silaschi ◽  
Olaf Wendler ◽  
Liesa Castro ◽  
Moritz Seiffert ◽  
Edith Lubos ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Pacemaker Implantation ◽  
Pressure Gradients ◽  
Surgical Aortic Valve Replacement ◽  
Surgical Risk ◽  
Transcatheter Aortic Valve ◽  
High Surgical Risk ◽  
Valve In Valve

Objectives: Transcatheter aortic valve-in-valve implantation (ViV) is an innovative treatment for failed tissue valves (TV) in patients at high surgical risk. However, direct comparative data with standard repeat surgical aortic valve replacement (RE-SAVR) is scarce. We aimed to compare outcomes after ViV to conventional RE-SAVR in two European centers with established interventional programs. Methods: Retrospectively we explored in-hospital databases for patients ≥60 years, treated for degenerated TV. Patients with endocarditis and combined procedures were excluded. Primary endpoints were adjudicated according to VARC-2 criteria. Results: Between 2002 and 2015, 130 patients were treated for isolated failure of aortic TV’s (ViV: n=71, RE-SAVR: n=59). In ViV, Edwards Sapien valve (ESV) was most frequently used (n=36) but implanted into larger TV’s (CoreValve TV size: 22.2±1.3mm vs. ESV TV size: 24.1±2.0mm, p<0.01). Both age and logistic EuroSCORE I were higher in ViV compared to RE-SAVR (78.6±7.5 vs. 72.9±6.5 ys, p<0.01; 25.1±18.9 vs. 16.8±9.4%, p<0.01). Thirty-day mortality was not significantly different with 4.2% (3/71) after ViV vs. 5.1% (3/59) post RE-SAVR (p=1.0). Device success was achieved in 54.9% (n=39) in ViV and all RE-SAVR patients (p<0.01). Perioperative stroke was not observed after ViV and in 2 patients after RE-SAVR (3.4%, p=0.2). Intensive-care stay was longer after RE-SAVR (3.4±2.9d vs. 1.9±1.8d, p<0.01). Following ViV, 22.5% (n=16) of patients had mild aortic regurgitation, vs. 11.3% (n=8; p=0.25) after RE-SAVR. Mean transvalvular pressure gradients at discharge were higher post ViV (19.3±7.3 vs.12.2±5.6mmHg, p<0.01). Rate of permanent pacemaker implantation was lower after ViV (9.9% vs. 27.1%, p<0.01). Survival at 90- and 180-days was 93.8% and 91.8% vs. 94.4% and 94.4% after ViV and RE-SAVR respectively (p=0.87). Conclusion: Despite a higher risk profile, early mortality was not different between the two treatment arms. Although ViV resulted in elevated postoperative transvalvular pressure gradients and therefore a lower rate of device success, mortality after 180-days was similar to RE-SAVR. At present, both techniques serve as complementary approaches and allow individualized patient care.

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.

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