scholarly journals COMPARATIVE ASSESSMENT OF CLINICAL AND HEMODYNAMIC OUTCOMES AFTER AORTIC HEART VALVE REPLACEMENT WITH XENOAORTIC AND XENOPERICARDIAL BIOLOGICAL PROSTHESES FOR DEGENERATIVE AORTIC VALVULAR DISEASE

2018 ◽  
Vol 7 (2) ◽  
pp. 50-60
Author(s):  
S. A. Fedorov ◽  
A. P. Medvedev ◽  
V. A. Chiginev ◽  
S. A. Zhurko ◽  
A. B. Gamzaev ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
The Mean ◽  
Group 2 ◽  
Biological Prostheses ◽  
Group 1

Aim. To assess clinical and hemodynamic outcomes of aortic valve replacement with xenoaortic biological prosthesis “Aspire Vascutek” and xenopericardial biological prosthesis “UniLine”. Methods. 130 patients who underwent aortic valve replacement with bioprostheses in the period from October 2012 to March 2016 were included in the study. All patients were enrolled into two groups according to the model of the implanted device. 65 recipients of xenoaortic bioprostheses “Aspire Vascutek” were included in Group 1, whereas patients (n = 65) xenopericardial bioprostheses “UniLine” were assigned in Group 2. Males prevailed in Group 1 (63%, the mean age - 66.4±5.5 years). 85% of Group 1 patients had heart failure Strazhesko-Vasilenko IIA grade and 94% of patients had chronic heart failure NYHA III. Similarly, male patients (58%) prevailed in Group 2. The mean age of Group 2 patients was 66.5±3.65 years. All patients in Group 2 II had heart failure Strazhesko-Vasilenko IIA grade and chronic heart failure NYHA III. Results Two patients in Group 1 died in the early postoperative period (the overall mortality was 1.5%). All patients had chronic heart failure NYHA I-II at discharge. Peak transvalvular pressure gradient significantly decreased in the in-hospital period, particularly in Group 2 patients (82,3±22,7 mm Hg vs. 28.8±7.6 mm Hg). 88% of Group 1 patients underwent the 60-month follow-up, and 96% of Group 2 patients - the 48-month follow-up. Transvalvular pressure gradients decreased progressively in both study groups within 60 months follow-up. This decrease was more pronounced in recipients of xenopericardial biological prostheses. Conclusion. Aortic valve replacement with xenopericardial bioprostheses “UniLine” and xenoaortic bioprostheses “Aspire Vascutek” for aortic valvular disease allows treating intracardiac hemodynamic derangements and achieving good clinical and hemodynamic outcomes.

Abstract 9947: Predictors of Left Ventricular Dysfunction After Aortic Valve Replacement in Patients With Mixed Aortic Valve Disease

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Alexander Egbe ◽  
Joeseph Poterucha ◽  
Carole Warnes
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Left Ventricular Dysfunction ◽  
Aortic Valve Disease ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Group 2 ◽  
Group 1

Objectives: Predictors of left ventricular dysfunction (LVD) after aortic valve replacement (AVR) in mixed aortic valve disease (MAVD) have not been studied. Objective was to determine prevalence and predictors of early and late LVD at 1 and 5 years post-AVR. Methods: Retrospective review of 247 patients (Age 63±8 years, males 81%) with moderate/severe MAVD who underwent AVR at the Mayo Clinic from 1994-2013. Only patients with follow-up data at 1 year post AVR were included (n=239). Cohort divided into 3 groups based on data collected prior to AVR, 1 and 5 years post AVR. LVD was defined as ejection fraction <50%. Results: LVD was present in 11/239 at baseline. At 1-year post AVR, 181 had normal EF (group 1) while 58/239 (24%) had early LVD (group 2). Predictors of LVD were atrial fibrillation (hazard ratio [HR] 1.83 confidence interval [CI] 1.59-1.98, p=0.001), age >70 years (HR: 3.12, CI: 2.33-4.18, p= <0.0001), CABG (HR: 2.17, CI: 2.24-5.93, p= <0.0001), and severe MAVD pre-operatively (HR: 2.87, CI: 2.33-3.17, p= 0.01), and hypertension (HR: 1.83, CI: 1.35-2.46, p= <0.0001). Prevalence of late LVD was 24% (47/197-group 3) and LVMI at 1 year post AVR was predictive of late LVD (HR 1.65, CI 1.11-3.8 per 10 g/ m 2 increment, p= 0.04)). Group 2 had less reverse LV remodeling compared to group 1 at 1 year post AVR (142±39 vs 129±42 g/ m 2 , p=0.02). Conclusions: Risk of LVD was significant even in subset of patients with moderate MAVD. Risk stratification of MAVD should be based on both clinical and echocardiographic parameters. Our data suggest earlier surgical intervention may be required in the MAVD population to prevent postoperative LVD but further studies are needed. Figure legend: FU: follow up

scholarly journals Prognostic Value of Ventricular‐Arterial Coupling After Transcatheter Aortic Valve Replacement on Midterm Clinical Outcomes

2021 ◽  
Author(s):  
Hiroaki Yokoyama ◽  
Futoshi Yamanaka ◽  
Koki Shishido ◽  
Tomoki Ochiai ◽  
Shohei Yokota ◽  
...  
Keyword(s):  
Heart Failure ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Cardiovascular Death ◽  
Transcatheter Aortic Valve ◽  
Group 4 ◽  
Group 2

Background Ventricular‐arterial coupling predicts outcomes in patients with heart failure. The arterial elastance to end‐systolic elastance ratio (Ea/Ees) is a noninvasively assessed index that reflects ventricular‐arterial coupling. We aimed to determine the prognostic value of ventricular‐arterial coupling assessed through Ea/Ees after transcatheter aortic valve replacement to predict clinical events. Methods and Results We retrieved data on 1378 patients (70% women) who underwent transcatheter aortic valve replacement between October 2013 and May 2017 from the OCEAN‐TAVI (Optimized transCathEter vAlvular iNtervention) Japanese multicenter registry. We determined the association between Ea/Ees and the composite end point of hospitalization for heart failure and cardiovascular death by classifying the patients into quartiles based on Ea/Ees values (group 1: <0.326; group 2: 0.326–0.453; group 3: 0.453–0.666; and group 4: >0.666) during the midterm follow‐up after transcatheter aortic valve replacement. During a median follow‐up period of 736 days (interquartile range, 414–956), there were 247 (17.9%) all‐cause deaths, 89 (6.5%) cardiovascular deaths, 130 (9.4%) hospitalizations for heart failure, and 199 (14.4%) composite events of hospitalization for heart failure and cardiovascular death. The incidence of the composite end point was significantly higher in group 2 (hazard ratio [HR], 1.76; 95% CI, 1.08–2.87 [ P =0.024]), group 3 (HR, 2.43; 95% CI, 1.53–3.86 [ P <0.001]), and group 4 (HR, 2.89; 95% CI, 1.83–4.57 [ P <0.001]) than that in group 1. On adjusted multivariable Cox analysis, Ea/Ees was significantly associated with composite events (HR, 1.47 per 1‐unit increase; 95% CI, 1.08–2.01 [ P =0.015]). Conclusions These findings suggest that a higher Ea/Ees at discharge after transcatheter aortic valve replacement is associated with adverse clinical outcomes during midterm follow‐up. Registration URL: https://www.upload.umin.ac.jp/ . Unique identifier: UMIN000020423.

Minimally Invasive Transaortic Repair of the Mitral Valve

2011 ◽  
Vol 14 (4) ◽  
pp. 232 ◽  
Author(s):  
Orlando Santana ◽  
Joseph Lamelas
Keyword(s):  
Mitral Valve ◽  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Aortic Valve Replacement ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Operative Mortality ◽  
The Mean ◽  
Transaortic Approach

<p><b>Objective:</b> We retrospectively evaluated the results of an edge-to-edge repair (Alfieri stitch) of the mitral valve performed via a transaortic approach in patients who were undergoing minimally invasive aortic valve replacement.</p><p><b>Methods:</b> From January 2010 to September 2010, 6 patients underwent minimally invasive edge-to-edge repair of the mitral valve via a transaortic approach with concomitant aortic valve replacement. The patients were considered to be candidates for this procedure if they were deemed by the surgeon to be high-risk for a double valve procedure and if on preoperative transesophageal echocardiogram the mitral regurgitation jet originated from the middle portion (A2/P2 segments) of the mitral valve.</p><p><b>Results:</b> There was no operative mortality. Mean cardiopulmonary bypass time was 137 minutes, and mean cross-clamp time was 111 minutes. There was a significant improvement in the mean mitral regurgitation grade, with a mean of 3.8 preoperatively and 0.8 postoperatively. The ejection fraction remained stable, with mean preoperative and postoperative ejection fractions of 43.3% and 47.5%, respectively. Follow-up transthoracic echocardiograms obtained at a mean of 33 days postoperatively (range, 8-108 days) showed no significant worsening of mitral regurgitation.</p><p><b>Conclusion:</b> Transaortic repair of the mitral valve is feasible in patients undergoing minimally invasive aortic valve replacement.</p>

scholarly journals Surgical repair of the moderately dilated ascending aorta combined with bicuspid aortic valve replacement

2019 ◽  
Vol 47 (4) ◽  
pp. 299-309
Author(s):  
V. E. Uspenskiy ◽  
E. G. Malev ◽  
N. D. Gavriliuk ◽  
B. K. Salavatov ◽  
S. A. Ermolov ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Blood Pressure Level ◽  
Pressure Level ◽  
Increased Risk ◽  
Group 2 ◽  
Group 1

Background: Ascending aortic (AA) dilatation is common in patients with bicuspid aortic valve (BAV). In BAV replacement, surgery of the AA is indicated in the case if AA diameter exceeds 45 mm. Aortic valve replacement combined with an AA intervention is associated with increased risk of complications. The feasibility of the reduction ascending aortoplasty for correction of the dilated AA remains disputable.Aim: To analyze the results of BAV surgical replacement with simultaneous surgical correction of the borderline AA dilatation (45-50 mm) by the reduction aortoplasty (RAP) or supracoronary AA replacement (SPR).Materials and methods: This single center prospective non-randomized study included 53 patients with significant BAV stenosis and AA dilatation (45-50 mm), divided into 2 groups: BAV surgical replacement combined with RAP AA replacement (group 1, 36 patients) and BAV replacement with SPR (group 2, 17 patients). There were no significant differences between the patients of the two groups in their characteristics of the underlying disease, complications and comorbidities.Results: Hospital mortality was 0%. No between-group differences in the early postoperative course were found. At later term, 44 (81.5%) patients were assessed; median (dispersion) of the follow-up was 36 (25; 50) months. Two patients from the group 2 died during the follow-up. The long-term survival was better in the group 1 (p = 0.028). No differences in the combined adverse event rate were observed between the groups (p = 0.633). The median (dispersion) of the AA absolute increment and the rate of dilatation after RAP were 1.0 (0.0; 3.0) mm and 0.24 (0.00; 0.95) mm/year, respectively. The predictor of AA increment rate ≥ 2 mm/year was the baseline blood pressure level (odds ratio 1.321, 95% confidence interval 1.050-1.662; p=0.017). The threshold preoperative blood pressure value for the increased risk of the long-term AA expansion rate was 138 mmHg.Conclusion: The efficacy and safety of RAP and SRP combined with BAV replacement in AA borderline dilatation are similar. Combined BAV surgery and RAP is effective and safe in patients with systolic blood pressure level ≤ 135 mmHg. Combined BAV replacement with SRP seems reasonable in patients with arterial hypertension.

Intermediate Outcomes after Rapid Deployment Aortic Valve Replacement in Multiple Valve Surgery

2019 ◽  
Vol 68 (07) ◽  
pp. 595-601
Author(s):  
Markus Schlömicher ◽  
Matthias Bechtel ◽  
Zulfugar Taghiyev ◽  
Hamid Naraghi ◽  
Peter Lukas Haldenwang ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Valve Surgery ◽  
Actuarial Survival ◽  
Intermediate Outcomes ◽  
The Mean ◽  
Rapid Deployment

Abstract Background Multiple valve surgery is associated with significant higher operative risks. Reduced cross-clamp and cardiopulmonary bypass times in multiple valve surgery may potentially be beneficial as they can be considered independent risk factors for increased morbidity and mortality following cardiac surgery. We report first intermediate outcomes of the Edwards Intuity valve system (Edwards Lifesciences, Irvine, California, United States) in combined procedures Methods Fifty-eight patients underwent rapid deployment aortic valve replacement with concomitant mitral valve surgery between January 2014 and November 2017 in our institution. The valve was assessed echocardiographically after 12 months. The median follow-up was 1.7 years with a cumulative follow-up time of 115.3 patient years. Results The mean age was 73.5 ± 6.2 years and the mean logistic Euroscore was 11.6 ± 3.1%. Concomitant mitral valve repair was performed in 43 cases (74.1%), and mitral valve replacement in 15 cases (19.0%). The mean cross-clamp time was 93 ± 21 minutes along with a mean bypass time of 118 ± 24 minutes. All-cause mortality after 30 days was 8.6%. Overall actuarial survival at 1 year was 87.2 ± 4.5% and after 2 years 82.8 ± 5.3%, respectively. Conclusions Rapid deployment aortic valve replacement in multiple valve surgery can be performed safely with good intermediate outcomes in elderly, high-risk patients.

scholarly journals Regression of Left Ventricular Mass after Implantation of the Sutureless 3f Enable Aortic Bioprosthesis

2015 ◽  
Vol 42 (2) ◽  
pp. 117-123
Author(s):  
Giovanni Concistrè ◽  
Antonio Miceli ◽  
Federica Marchi ◽  
Francesca Chiaramonti ◽  
Mattia Glauber ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Left Ventricular Mass ◽  
Valve Replacement ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Mass ◽  
The Mean

Left ventricular hypertrophy in aortic stenosis is considered a compensatory response for the maintenance of systolic function but a risk factor for cardiac morbidity and death. We investigated the degree of left ventricular mass regression after implantation of the sutureless Medtronic 3f Enable® Aortic Bioprosthesis. We studied 19 patients who, from May 2010 through July 2011, underwent isolated aortic valve replacement with the 3f Enable bioprosthetic valve, with clinical and echocardiographic follow-up at 6 months. The mean age was 77.1 ± 5.1 years (range, 68–86 yr); 14 patients were women (73.7%); and the mean logistic EuroSCORE was 15.4% ± 11.8%. Echocardiography was performed preoperatively, at discharge, and at 6 months' follow-up. The left ventricular mass was calculated by means of the Devereux formula and indexed to body surface area. The left ventricular mass index decreased from 146.1 ± 47.6 g/m2 at baseline to 118.1 ± 39.8 g/m2 at follow-up (P=0.003). The left ventricular ejection fraction did not change significantly. The mean transaortic gradient decreased from 57.3 ± 14.2 mmHg at baseline to 12.3 ± 4.6 mmHg at discharge and 12.2 ± 5.3 mmHg at follow-up (P &lt;0.001), and these decreases were accompanied by substantial clinical improvement. No moderate or severe paravalvular leakage was present at discharge or at follow-up. In isolated aortic stenosis, aortic valve replacement with the 3f Enable bioprosthesis results in significant regression of left ventricular mass at 6 months' follow-up. However, this regression needs to be verified by long-term echocardiographic follow-up.

scholarly journals Electrocardiographic Strain Pattern Is a Major Determinant of Rehospitalization for Heart Failure After Transcatheter Aortic Valve Replacement

2021 ◽  
Vol 10 (3) ◽  
Author(s):  
Joé Heger ◽  
Antonin Trimaille ◽  
Marion Kibler ◽  
Benjamin Marchandot ◽  
Marilou Peillex ◽  
...  
Keyword(s):  
Heart Failure ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Bundle Branch Block ◽  
Strain Pattern ◽  
Transcatheter Aortic Valve

Background Electrocardiographic strain pattern (ESP) has recently been associated with increased adverse outcome in aortic stenosis and after surgical aortic valve replacement. Our study sought to determine the impact and incremental value of ESP pattern in predicting adverse outcome after transcatheter aortic valve replacement. Methods and Results A total of 585 patients with severe aortic stenosis (mean age, 83±7 years; men, 39.8%) were enrolled for transcatheter aortic valve replacement from November 2012 to May 2018. ESP was defined as ≥1‐mm concave down‐sloping ST‐segment depression and asymmetrical T‐wave inversion in the lateral leads. The primary end points of the study were all‐cause mortality, rehospitalization for heart failure, myocardial infarction, and stroke. A total of 178 (30.4%) patients were excluded because of left bundle‐branch block (n=103) or right bundle‐branch block (n=75). Among the 407 remaining patients, 106 had ESP (26.04%). At a median follow‐up of 20.00 months (11.70–29.42 months), no impact of electric strain on overall and cardiac death could be established. By contrast, incidence of rehospitalization for heart failure was significantly higher (33/106 [31.1%] versus 33/301 [11%]; P <0.001) in patients with ESP. By multivariate analyses, ESP remained a strong predictor of rehospitalization for heart failure (hazard ratio, 2.75 [95% CI, 1.61–4.67]; P <0.001). Conclusions In patients with aortic stenosis who were eligible for transcatheter aortic valve replacement, ESP is frequent and associated with an increased risk of postinterventional heart failure regardless of preoperative left ventricular hypertrophy. ESP represents an easy, objective, reliable, and low‐cost tool to identify patients who may benefit from intensified postinterventional follow‐up.

scholarly journals Impact of anticoagulation therapy on valve haemodynamic deterioration following transcatheter aortic valve replacement

Heart ◽  
2018 ◽  
Vol 104 (10) ◽  
pp. 814-820 ◽  
Author(s):  
María Del Trigo ◽  
Antonio J Muñoz-García ◽  
Azeem Latib ◽  
Vincent Auffret ◽  
Harindra C Wijeysundera ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Vitamin K Antagonists ◽  
Anticoagulation Therapy ◽  
Transcatheter Aortic Valve ◽  
Increased Risk ◽  
The Mean

ObjectiveTo evaluate the changes in transvalvular gradients and the incidence of valve haemodynamic deterioration (VHD) following transcatheter aortic valve replacement (TAVR), according to use of anticoagulation therapy.Methods and resultsThis multicentre study included 2466 patients (46% men; mean age 81±7 years) who underwent TAVR with echocardiography performed at 12-month follow-up. Anticoagulation therapy was used in 707 patients (28.7%) following TAVR (AC group). A total of 663 patients received vitamin K antagonists, and 44 patients received direct oral anticoagulants. A propensity score matching analysis was performed to adjust for intergroup (AC vs non-AC post-TAVR) differences. A total of 622 patients per group were included in the propensity-matched analysis. VHD was defined as a ≥10 mm Hg increase in the mean transprosthetic gradient at follow-up (vs hospital discharge). The mean clinical follow-up was 29±18 months. The mean transvalvular gradient significantly increased at follow-up in the non-AC group within the global cohort (P=0.003), whereas it remained stable over time in the AC group (P=0.323). The incidence of VHD was significantly lower in the AC group (0.6%) compared with the non-AC group (3.7%, P<0.001), and these significant differences remained within the propensity-matched populations (0.6% vs 3.9% in the AC and non-AC groups, respectively, P<0.001). The occurrence of VHD did not associate with an increased risk of all-cause death (P=0.468), cardiovascular death (P=0.539) or stroke (P=0.170) at follow-up.ConclusionsThe lack of anticoagulation therapy post-TAVR was associated with significant increments in transvalvular gradients and a greater risk of VHD. VHD was subclinical in most cases and did not associate with major adverse clinical events. Future randomised trials are needed to determine if systematic anticoagulation therapy post-TAVR would reduce the incidence of VHD.

scholarly journals Re-sternotomy for aortic valve replacement with patent coronary artery bypass grafts

2021 ◽  
Author(s):  
Suvitesh Luthra ◽  
Pietro Malvindi ◽  
Sajiram Sarvananthan ◽  
Chiemezie Okorocha ◽  
Sunil Ohri
Keyword(s):  
Coronary Artery ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Hospital Mortality ◽  
Valve Replacement ◽  
Term Survival ◽  
Group 2 ◽  
Patent Coronary Artery ◽  
Group 1

Objective - The aim was to evaluate early and long-term outcomes of re-sternotomy for aortic valve replacement with previous patent coronary artery grafts. Methods - Data for re-sternotomy for aortic valve replacements (group 1 isolated AVR, group 2 AVR with concomitant procedure) were collected (2000-19). Logistic regression analysis was performed to identify predictors of in-hospital mortality and postoperative composite outcome (in-hospital death, TIA/stroke, renal failure requiring new hemofiltration, deep sternal wound infection, re-exploration for bleeding/tamponade and length of stay >30 days). Survival curves were compared using log rank test. Cox proportion hazards model was used for predictors of long term survival. Results – Total 178 patients were included (groups 1 - 90 patients, group 2 - 88 patients). Mean age was 75±4 years and mean log EuroSCORE was 17±12% (15 ± 8% - group 1 vs 19 ± 14% - group 2, p=0.06). Mean follow up was 6.3±4.4 years. Cardiovascular injury occurred in 12%. LIMA was most commonly injured. In-hospital mortality was 7.8% (5% - group 1 versus 10.2% - group 2, p=0.247). NYHA class III-IV, perioperative IABP and cardiovascular injury were independent predictors of in-hospital mortality (HR; 13.33, 95% CI; 2.04, 83.33, p=0.007). Survival was significantly worse with cardio-vascular injury at re-sternotomy up to 5 years (46% versus 67%, p=0.025) and postoperative complications (p=0.023). Survival was significantly lower than age matched first time AVR and UK population. Conclusions – Long term survival is significantly impaired by cardiovascular injury and perioperative complications of re-sternotomy.

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