scholarly journals Supra-annular aortic valve replacement: technique and early outcomes

2021 ◽  
Author(s):  
Nathanael Shraer ◽  
Ramzi Ramadan ◽  
Alexandre Azmoun ◽  
Julien Guihaire
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Hospital Mortality ◽  
Valve Replacement ◽  
Marked Decrease ◽  
Aortic Annulus ◽  
Operative Outcomes ◽  
Operative Complications ◽  
Replacement Technique ◽  
The Mean

OBJECTIVES: The supra-annular aortic valve replacement (SA-AVR) allows for implantation of larger prostheses. We describe the technique, early post-operative outcomes and hospital mortality. METHODS: Patients who underwent SA-AVR with the Carpentier-Edwards Magna Ease bioprosthesis between December 2010 and December 2017 were retrospectively reviewed. The prosthesis was sutured to the aortic annulus along the coronary sinuses, and in a supra-annular position along the non-coronary sinus. RESULTS: 115 patients were included (mean age: 71,6 years ± 9,4). Mean bioprosthesis diameter was 23,3 ± 1,7 mm. Four early deaths were observed in the ICU. Early post-operative complications included: re-operation for bleeding (n=6), tamponade (n=7), permanent atrioventricular block (n=4) and hemodialysis (n=2). In-hospital mortality was 3,48%. Postoperative echocardiography showed a marked decrease in the mean left ventricle – aorta gradient (50,4 ± 16,1 mmHg vs 11,3 ± 4,05 mmHg). CONCLUSION: SA-AVR is safe and associated with favourable immediate outcomes in patients with small aortic annulus.

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

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.

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

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.

scholarly journals Effect of conventional and rapid-deployment aortic valve replacement on the distance from the aortic annulus to coronary arteries

2020 ◽  
Author(s):  
Iuliana Coti ◽  
Udo Maierhofer ◽  
Claus Rath ◽  
Paul Werner ◽  
Christian Loewe ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Coronary Arteries ◽  
Left Coronary Artery ◽  
Aortic Annulus ◽  
Significant Difference ◽  
The Mean ◽  
Rapid Deployment

Abstract OBJECTIVES This study aimed to compare the effect of surgical aortic valve replacement (SAVR) on coronary height in patients undergoing SAVR with rapid-deployment or SAVR with several standard sutured bioprostheses. This study may identify patients at higher risk of coronary obstruction during valve-in-valve procedures. METHODS We analysed 112 patients [mean age 71 (9 SD) years] who underwent SAVR with either a rapid-deployment aortic bioprosthesis (EDWARDS INTUITY Elite Valve) or other standard sutured biological valves. The coronary heights were assessed by computed tomography scan with the Philips 3D HeartNavigator system. RESULTS Two groups of patients were analysed: 51 (45.5%) patients implanted with an RD-AVR, which is a supra-annular valve that requires 3 anchoring sutures without the use of pledgets, and 61 (54.5%) patients implanted with a conventional supra-annular sutured bioprosthesis. The mean right and left coronary artery-to-annulus (RCAA and LCAA) heights at baseline were 16.9 (4.6 SD) and 14.2 (4.0 SD) mm in the standard sutured group and 16.3 (3.5 SD) and 12.8 (2.9 SD) mm in the RD-AVR group, respectively; a significantly shorter distance was observed for the left coronary artery in the rapid-deployment group (P = 0.420 for RCAA height and P = 0.044 for LCAA). Postoperatively, the mean RCAA and LCAA heights were significantly decreased in both groups compared to baseline. A mean of 11.5 (4.8 SD) mm for the RCAA and 7.9 (4.3 SD) mm for the LCAA in the standard sutured group as well as 14.4 (3.9 SD) mm for the RCAA and 9.0 (3.1 SD) mm for the LCAA in the RD-AVR group were observed (P < 0.001 for RCAA and LCAA in both the sutured and rapid-deployment groups). Despite the significant difference in the mean distance from the left coronary artery to annulus between the groups at baseline, the postoperative mean distance of the LCAA to the sewing ring was still higher in the RD-AVR group. CONCLUSIONS A significantly shorter coronary artery-to-aortic annulus distance for both the right and left main coronary arteries was observed after AVR with different conventional sutured supra-annular bioprostheses compared to AVR with rapid-deployment valves. These findings might be relevant for bioprosthesis selection, especially for young patients.

Impact of Aortic Annulus Enlargement on the Outcomes of Aortic Valve Replacement: A Meta-analysis

2020 ◽  
Author(s):  
Michel Pompeu B.O. Sá ◽  
Konstantin Zhigalov ◽  
Luiz Rafael P. Cavalcanti ◽  
Antonio C. Escorel Neto ◽  
Sérgio C. Rayol ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Meta Analysis ◽  
Aortic Annulus

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>

Use and outcomes of emergency treatment strategies in patients with aortic valve stenosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S.M Piepenburg ◽  
K Kaier ◽  
C Olivier ◽  
M Zehender ◽  
C Bode ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Hospital Mortality ◽  
Valve Replacement ◽  
Aortic Valve Stenosis ◽  
Emergency Treatment ◽  
Funding Source ◽  
Artery Disease

Abstract Introduction and aim Current emergency treatment options for severe aortic valve stenosis include surgical aortic valve replacement (SAVR), transcatheter aortic valve replacement (TAVR) and balloon valvuloplasty (BV). So far no larger patient population has been evaluated regarding clinical characteristics and outcomes. Therefore we aimed to describe the use and outcome of the three therapy options in a broad registry study. Method and results Using German nationwide electronic health records, we evaluated emergency admissions of symptomatic patients with severe aortic valve stenosis between 2014 and 2017. Patients were grouped according to SAVR, TAVR or BV only treatments. Primary outcome was in-hospital mortality. Secondary outcomes were stroke, acute kidney injury, periprocedural pacemaker implantation, delirium and prolonged mechanical ventilation &gt;48 hours. Stepwise multivariable logistic regression analyses including baseline characteristics were performed to assess outcome risks. 8,651 patients with emergency admission for severe aortic valve stenosis were identified. The median age was 79 years and comorbidities included NYHA classes III-IV (52%), coronary artery disease (50%), atrial fibrillation (41%) and diabetes mellitus (33%). Overall in-hospital mortality was 6.2% during a mean length of stay of 22±15 days. TAVR was the most common treatment (6,357 [73.5%]), followed by SAVR (1,557 [18%]) and BV (737 8.5%]). Patients who were treated with TAVR or BV were significantly older than patients with SAVR (mean age 81.3±6.5 and 81.2±6.9 versus 67.2±11.0 years, p&lt;0.001), had more relevant comorbidities (coronary artery disease 52–91% vs. 21.8%; p&lt;0.001), worse NYHA classes III-IV (55–65% vs. 34.5%; p&lt;0.001) and higher EuroSCORES (24.6±14.3 and 23.4±13.9 vs. 9.5±7.6; p&lt;0.001) than SAVR patients. Patients treated with BV only had the highest in-hospital mortality compared with TAVR or SAVR (20.9% vs. 5.1 and 3.5%; p&lt;0.001). Compared with BV only, SAVR patients (adjusted odds ratio [aOR] 0.25; 95% confidence interval [CI] 0.14–0.46; p&lt;0.001) and TAVR patients (aOR 0.37; 95% CI 0.28–0.50; p&lt;0.001) had a lower risk for in-hospital mortality. Conclusion In-hospital mortality for emergency patients with symptomatic severe aortic valve stenosis is high. Our results showed that BV only therapy was associated with highest mortality, which is in line with current research. Yet, there is a trend towards more TAVR interventions and this study might imply that balloon valvuloplasty alone is insufficient. The role of BV as a bridging strategy to TAVR or SAVR needs to be further investigated. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Heart Center Freiburg University, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Freiburg, Germany

Two-Directional Aortic Annular Enlargement for Aortic Valve Replacement in the Small Aortic Annulus

1997 ◽  
Vol 63 (1) ◽  
pp. 261-263 ◽  
Author(s):  
Masaki Otaki, MD ◽  
Hidetaka Oku, MD ◽  
Susumu Nakamoto, MD ◽  
Hitoshi Kitayama, MD ◽  
Masao Ueda, MD ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Aortic Annulus ◽  
Small Aortic Annulus

scholarly journals Development and In-Hospital Mortality of Transcatheter and Surgical Aortic Valve Replacement in 2015 in Germany

2018 ◽  
Vol 72 (4) ◽  
pp. 475-476 ◽  
Author(s):  
Peter Stachon ◽  
Manfred Zehender ◽  
Christoph Bode ◽  
Constantin von zur Mühlen ◽  
Klaus Kaier
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Hospital Mortality ◽  
Valve Replacement ◽  
Surgical Aortic Valve Replacement

scholarly journals Predictors of Early Mortality After Aortic Valve Replacement in Middle-Aged Rheumatic Patients

2019 ◽  
Vol 1 (3) ◽  
pp. 105-111
Author(s):  
Essam Hassan ◽  
Sameh Sersar
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Median Sternotomy ◽  
Early Postoperative Period ◽  
Early Mortality ◽  
P Value ◽  
The Mean ◽  
Valve Prostheses ◽  
Rheumatic Patients

Background: Several risk factors, including emergency surgery, predicted early mortality after aortic valve replacement (AVR).  Euroscore II is used to predict the mortality after cardiac operations. We aimed to review our experience in AVR and determine the early mortality predictors Methods: We collected the data of 200 rheumatic patients who had standard AVR in two centers. Median sternotomy and cardiopulmonary bypass were used in all patients. Transcatheter and minimally invasive aortic valve replacement patients were excluded. We used 15 types of aortic valve prostheses, either mechanical or biological. Follow-up echocardiography was done in the intensive care unit, on discharge, and one month after discharge.     Results: 128 patients (64%) had mechanical AVR, and 130 patients (65%) were males. The mean age was 48.2 ± 19 years, and body mass index was 1.8 ± 0.2 Kg/m2. The mean preoperative ejection fraction was 54 ± 9.4 %, end-diastolic dimension was 5.3 ± 0.8 cm, and end-systolic dimension was 3.5 ± 0.9 cm. Nine patients (4.5%) died in the early postoperative period (6 months). Euroscore II was the only factor significantly associated with early mortality (P value= 0.031).  The mean Euroscore II was 1.3 ± 0.9 and 10.1 ± 10.7 for survivors and non-survivors, respectively.  Conclusion: Euroscore II score was significantly associated with early mortality after aortic valve replacement in rheumatic patients and can be used for risk stratification in those patients.

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