AORTIC VALVE REPLACEMENT

Precise determination of the size of aortic annulus is very important for thepreoperative evaluation before aortic valve replacement. Objectives: To determine thepreoperative prosthesis size using echocardiography in patients undergoing aortic valvereplacement. Study Design: Prospective observational study. Setting: Ch. Pervaiz ElahiInstitute of Cardiology (CPEIC) Multan. Period: January 2013 to October 2014. Methods: (100patients) Aortic annulus sizes were measured with TTE one week before surgery and with thehelp of sizer per-operatively. The data was analyzed by using SPSS V16. Quantitative variableswere analyzed using mean and standard deviation and percentages were used for qualitativevariables. Dependent sample t test was used to see accuracy of TTE in measuring aortic annulussize. Results: Out of hundred patients, 84(84%) were male. Mean age of the patients was 33.77+13.17 years. 51% patients underwent isolated Aortic valve replacement; redo-operations weredone only in 4% patients. In 96% patient’s mechanical prosthesis was used and in 4% patient’sboiprosthesis was used for valve replacement. We found no significant difference in Aorticannulus measured pre-operatively with the TTE (23.54+ 3.54) and measured per-operativewith the sizer (23.96+3.36) with highly insignificant p-value 0.58.Aortic annulus size was almostsame measured by these two techniques. Conclusion: Aortic annulus size measured with TTEhelps to arrange the optimum size prosthesis before aortic valve replacement surgery.

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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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Abstract 190: Risk Factors and Outcomes of Hyperbilirubinemia Following Transcatheter Aortic Valve Replacement

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.190 ◽

2017 ◽

Vol 10 (suppl_3) ◽

Author(s):

Stephanie Jou ◽

Li Zhang ◽

Batyrjan Bulibek ◽

Mohammad El-Hajjar ◽

Augustin Delago ◽

...

Keyword(s):

Risk Factors ◽

Aortic Valve ◽

Confidence Interval ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Hazard Ratio ◽

P Value ◽

Transcatheter Aortic Valve ◽

Significant Difference

Background: It has been established that postoperative hyperbilirubinemia is associated with increased mortality and morbidity after cardiac surgery. However, hyperbilirubinemia after transcatheter aortic valve replacement (TAVR) has not yet been a subject of clinical research. We evaluated the incidence and risk factors of post-TAVR hyperbilirubinemia, and aimed to determine its prognostic significance. Methods: A retrospective observational study was conducted on 241 consecutive TAVR patients between January 2011 and December 2014 in our institution. We excluded 15 patients with documented chronic hepatic or biliary disorders, or prior liver transplant. Hyperbilirubinemia was defined as any value above the upper limit of normal total bilirubin within 1 week of TAVR. Results: Eighty-two patients out of 226 (36.3%) had post-TAVR hyperbilirubinemia. After adjustment for confounders, there was no significant difference in in-hospital mortality (3.7% (3 of 82) vs. 1.4% (2 of 144); p-value = 0.26) and 1-year mortality (7.3% (6 of 82) vs 5.6% (8 of 144); p-value = 0.60) between patients with and without elevated bilirubin following TAVR. However, there was a trend for hyperbilirubinemic patients to have a longer intensive care unit stay (145.3 +/-202.2 hours vs. 113.2 +/-93.4 hours; p-value = 0.14) and hospital stay (14.1 +/-11.2 days vs. 12.1 +/-8.6 days; p-value = 0.16). Multivariable analysis revealed that preoperative hyperbilirubinemia (hazard ratio 62.88, 95% confidence interval 15.80 to 250.32; p-value <0.0001) and preoperative atrial fibrillation (hazard ratio 2.40, 95% confidence interval 1.21 to 4.78; p-value = 0.01) were strongly associated with post-TAVR hyperbilirubinemia. Conclusions: The cause of post-TAVR hyperbilirubinemia may be multifactorial. It is not a rare event and may impact the short-term outcomes. Thus, monitoring bilirubin should be considered an integrated part of TAVR patient care. Optimal management of post-TAVR hyperbilirubinemia remains challenging.

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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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Management of Small Aortic Root during Aortic Valve Replacement

The Egyptian Cardiothoracic Surgeon ◽

10.35810/ects.v2i1.100 ◽

2020 ◽

Vol 2 (1) ◽

pp. 1-7

Author(s):

Ahmed Nabil Malek ◽

Mohamed A.K. Salama Ayyad ◽

Hussein Elkhayat ◽

Ahmed El-Minshawy

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Aortic Root ◽

Aortic Annulus ◽

Early Results ◽

Significant Difference ◽

Small Aortic Root ◽

Group A ◽

Aortic Root Enlargement

Background: Concomitant aortic root enlargement (ARE) increases the risk of aortic valve replacement (AVR). The objectives of this study were to identify the patients who needed aortic root enlargement and compare the outcomes and the risk of adding ARE to AVR. Methods: We retrospectively reviewed 62 patients who underwent isolated mechanical aortic valve replacement between 2017 and 2019. We divided the patients into two groups: group A included patients with small aortic root who had AVR with one of the different surgical strategies for small aortic annulus (n= 32) and group B, which included patients with a normal aortic annulus and underwent conventional AVR (n= 30). Group A was further sub-divided based on the surgical strategy into 4 categories; patients who had supra-annular implantation of size 19 mm St. Jude prosthetic valve (n= 11; 34.4%), Nicks procedure (n= 13 40.6%), Manougian procedure (n= 4; 12.5%), Konno procedure (n= 4; 12.5%). Results: Group A patients were significantly younger (26.16 ± 11.49 vs. 34.63 ± 8.9 years; p< 0.001) and had lower body weight (55.09 ± 21.41 vs. 69.80 ± 19.20; p= 0.01). Group A had significantly smaller valves (p = 0.03), and total cardiopulmonary bypass (148.65 ± 44.09 vs. 97.46 ± 20.90 minutes; p<0.001) and aortic cross-clamp times (118.13 ± 36.70 vs. 78.06 ± 16.01 minutes; p < 0.001) were significantly longer in group A. There was no significant difference in operative complications between groups. Among patients with small aortic root; Konno procedure had the longest bypass time (236.3 ± 19.70 minutes; p<0.001); cross-clamp time (192.5 ± 22.2 minutes; p <0.001); mechanical ventilation (4.75 ± 0.50 hours; p<0.001) and intensive care unit stay (6.50 ± 0.57 days; p <0.001). Patients with supra-annular implantation of the St. Jude valve had a significantly higher postoperative pressure gradient (14.64 ± 6.84 mmHg; p= 0.02). No difference in procedure complications was observed among aortic root enlargement procedures. Conclusion: Patients who had aortic root enlargement procedure were younger, with lower weight and body surface area. Surgical procedures used to manage small aortic root had comparable early results, and no technique was superior to the others.

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AN EARLY EGYPTIAN EXPERIENCEIN OZAKI TECHNIQUE

International Journal of Advanced Research ◽

10.21474/ijar01/12025 ◽

2020 ◽

Vol 8 (11) ◽

pp. 444-448

Author(s):

Mohamed A. El-badawy ◽

◽

Mohamed R. Abdelbaky ◽

Mostafa M. Abdalraouf ◽

Hussein A. Zaher ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Postoperative Bleeding ◽

Mechanical Valve ◽

Mortality And Morbidity ◽

Replacement Surgery ◽

Significant Difference ◽

The Mean

Background: The advantage of Ozaki technique for aortic valve replacement surgery over the conventional approach is still debated. This study aimed to evaluate early outcomes after aortic valve replacement using the Ozaki technique Methods: We prospectively included 20 patients who had aortic valve replacement May 2018 to June 2020. Postoperative bleeding, mechanical ventilation, ICU stay and echocardiographic outcomes were observed. Results: The mean age was 39.9ÃƒÂ‚Ã‚Â±14.8 (20-69) years.13 patient had aortic regurge while 7 had aortic stenosis. Aortic cross-clamp (76.2ÃƒÂ‚Ã‚Â±8.5 (60-100) and cardiopulmonary bypass times (103.8ÃƒÂ‚Ã‚Â±15.3 (80-125).One patient (5%) was converted to aortic valve replacement by mechanical valve due to significant aortic regurge. Neither significant gradient nor regurge was found on one month follow-up echography. Freedom from infective endocarditis was found in all patients. No significant difference was found in the ejection fraction pre and post-operative. Conclusion: This novel technique seems to have a promising and favorable outcome with no need for anticoagulation and lesser post-operative complication compared to ordinary aortic valve replacement. This technique is associated with low mortality and morbidity.

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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/v1 ◽

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

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

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivaa247 ◽

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.

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