scholarly journals Sutureless bioprothesis in aortic valve surgery

2020 ◽  
Vol 98 (6) ◽  
pp. 440-448
Author(s):  
I. A. Borisov ◽  
V. V. Dalinin ◽  
V. B. Simonenko ◽  
A. A. Sergovencev ◽  
P. E. Kraynukov
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Heart Surgery ◽  
Functional Class ◽  
Long Term Results ◽  
Number Of Patients

Objective: aortic valve replacement is a «gold standard» in the surgical treatment of aortic stenosis. At the same time, an increasing number of patients require combined surgical interventions in addition to aortic valve replacement. Currently, surgical mortality in isolated aortic stenosis varies between 3–8% in low-risk patients under 70 years old and around 5–11% in elderly patients, rising up to 15% in cases of combined heart surgery. The use of sutureless valves for open implantation requires careful analysis of the immediate and long-term results of their implantation and comparison to the results of standard methods of treatment. Material and methods. The study was designed as a prospective-retrospective study for evaluation of results of different types of biological prostheses use in case of isolated aortic valve stenosis and together with concomitant cardiac pathology. The study included patients over 65 years old with aortic stenosis, who underwent aortic valve replacement. The patients were divided into two groups. The comparison was carried out by the following criteria: intraoperative data, the number and nature of postoperative complications, survival, freedom from ischemic events and from reoperation, dynamics of transaortic gradient, hemodynamic characteristics for the entire evaluation period (5 years). Results. In the group of patients with implanted sutureless valves, there was a smaller number of postoperative complications, faster recovery, significantly lower mortality rates, higher freedom from valve-related complications in postoperative period.Conclusions. The use of sutureless prostheses is justified for the aortic valve replacement and is safer compared to standard valves, in the absence of contraindications. Surgical treatment of patients with aortic stenosis with the use of sutureless valves led to significant clinical improvement in most of them, both in the functional class and in the threshold of tolerance to physical activity. The level of typical valve replacement complications was significantly lower. Simplicity and reproducibility of the procedure, fast learning process can certainly contribute s to wider and more active implementation of this technology in clinical practice.

scholarly journals Current Clinical Evidence on Rapid Deployment Aortic Valve Replacement: Sutureless Aortic Bioprostheses

2016 ◽  
Vol 11 (1) ◽  
pp. 7-14 ◽  
Author(s):  
Glenn R. Barnhart ◽  
Malakh Lal Shrestha
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Western World ◽  
High Risk Population ◽  
Additional Tool ◽  
Age Related ◽  
Number Of Patients ◽  
Rapid Deployment

Aortic stenosis is the most common valvular heart disease in the Western world. It is caused primarily by age-related degeneration and progressive calcification typically detected in patients 65 years and older. In patients presenting with symptoms of heart failure, the average survival rate is only 2 years without appropriate treatment. Approximately one half of all patients die within the first 2 to 3 years of symptom onset. In addition, the age of the patients presenting for aortic valve replacement (AVR) is increased along with the demographic changes. The Society of Thoracic Surgeons (STS) database shows that the number of patients older than 80 years has increased from 12% to 24% during the past 20 years. At the same time, the percentage of candidates requiring AVR as well as concomitant coronary bypass surgery has increased from 5% to 25%. Surgical AVR continues to be the criterion standard for treatment of aortic stenosis, improving survival and quality of life. Recent advances in prosthetic valve technology, such as transcatheter AVR, have expanded the indication for AVR to the extreme high-risk population, and the most recent surgical innovation, rapid deployment AVR, provides an additional tool to the surgeons’ armamentarium.

scholarly journals Association between Nutritional Status and Mortality after Aortic Valve Replacement Procedure in Elderly with Severe Aortic Stenosis

Nutrients ◽  
2019 ◽  
Vol 11 (2) ◽  
pp. 446 ◽  
Author(s):  
Edyta Wernio ◽  
Sylwia Małgorzewicz ◽  
Jolanta Anna Dardzińska ◽  
Dariusz Jagielak ◽  
Jan Rogowski ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Mortality Rate ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Nutritional Status ◽  
Aortic Valve Replacement ◽  
Elderly Patients ◽  
Valve Replacement ◽  
Aortic Valve Area ◽  
One Year

Background: There is still a lack of data on the nutritional status of older people with aortic stenosis (AS) and the effect of poor nutrition on the occurrence of complications and mortality after an aortic valve replacement (AVR) procedure. The aim of this study was to assess the impact of selected nutritional status parameters in elderly patients with severe AS on the occurrence of postoperative complications and one-year mortality after the AVR procedure. Methods: 101 elderly patients with AS aged 74.6 ± 5.2 years who qualified for surgical treatment (aortic valve area [AVA] 0.73 ± 0.2 cm2) were enrolled in the study. A nutritional status assessment was performed before AVR surgery, and the frequency of postoperative complications occurring within 30 days of surgery was assessed. The one-year mortality rate was also captured. Results: Adverse events (both major and minor) up to 30 days occurred in 49.5% (n = 50) of the study population. Low Mini Nutritional Assessment (f-MNA) and Subjective Global Assessment (7-SGA) scores and low concentrations of total cholesterol, LDL-cholesterol, and prealbumin were associated with a higher risk of postoperative complications. The risk of complications increased 1.22 times (95% CI; 1.030–1.453; p = 0.019) with an impaired nutritional status. The annual mortality rate in the study group was 7.9%. Unintentional weight loss of >2.8% in the six months preceding surgery proved useful for predicting death within the first year after AVR surgery. Conclusions: The results indicate that poor nutritional status is an important factor affecting the adverse outcomes in elderly patients with severe aortic valve stenosis undergoing an AVR procedure.

Successful Aortic Valve Replacement With Perceval Bioprosthesis for Aortic Stenosis With Membranous Ventricular Septum Aneurysm

2021 ◽  
pp. 155698452098425
Author(s):  
Shuhei Nishijima ◽  
Yoshitsugu Nakamura ◽  
Borut Gersak ◽  
Shigetaka Namiki ◽  
Tsunashi Kouzaki ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Postoperative Complications ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Contrast Enhancement ◽  
Valve Replacement ◽  
Bioprosthetic Valve ◽  
Ventricular Septum

Membranous ventricular septum aneurysm (MVSA) is extremely rare, especially when coexisting with aortic stenosis (AS), and reports regarding the available treatment for MVSA with AS are limited. Aortic valve replacement (AVR) can be challenging because of anatomical reasons. In this case report, a patient with MVSA and severe AS was treated with AVR with the sutureless Perceval bioprosthesis. After implantation, no paravalvular leakage was detected in echocardiography, and no other postoperative complications were observed. Postoperative electrocardiography-gated computed tomography revealed no contrast enhancement for MVSA. The MVSA was closed by the Perceval bioprosthetic valve. Thus, patients with simultaneous MVSA and AS may be effectively treated with AVR using a Perceval bioprosthesis.

scholarly journals Comparative results of surgical and transcatheter (TAVI) treatment of aortic stenosis in patients over 75 years old

2018 ◽  
pp. 21-26
Author(s):  
N. L. Bayandin ◽  
A. G. Krotovsky ◽  
K. N. Vasilyev ◽  
A. A. Moiseev ◽  
T. V. Setyn
Keyword(s):  
Postoperative Complications ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Postoperative Period ◽  
Age Group ◽  
Intraoperative Blood Loss ◽  
Cardiovascular Failure ◽  
High Operative Risk

Aim. To assess the results of transcatheter aortic valve implantation (TAVI) in comparison with open surgery for aortic stenosis in patients over 75 years old. Material and methods. We analyzed the results of 33 operations of aortic valve replacement in patients with aortic stenosis performed in the Moscow Municipal Clinical Hospital No. 15 in the period from June 2012 to September 2017. The first group included 21 TAVI operations. In 15 patients TAVI was performed through the femoral artery, 6  — transthoracic through the cardiac apex. All patients with transcatheter intervention were implanted with SAPIEN valves. In the postoperative period all patients showed a decrease in the systolic pressure gradient on the valve to 9,8±4,06 mm Hg. Aortic valve area after the operation has increased on average from 0,72±0,1 cm2 to 1,9±0,3 cm2. For comparison, a control group of 12 patients who underwent aortic valve replacement under cardiopulmonary bypass was formed. All patients had a high operative risk. Euroscore II 6,3±4,9, STS 5,2±3,4.Results. There were no cases of death in the TAVI group. These patients had the following postoperative complications: 3 patients (13,6%)  — complete atrioventricular block, which required permanent pacemaker implantation; it was a significantly more frequent complication of transcatheter interventions. Less frequently in the postoperative period patients had severe acute cardiovascular failure (p=0,001), acute renal failure (p=0,05), paroxysmal atrial fibrillation (p=0,001). The volume of intraoperative blood loss was significantly less in the TAVI group: 147,6±84,4 ml and 666,7±322,9 ml (p=0,05). Mortality in the surgical group was 33% (4 patients). In the surgical group in 2 cases the cause of death was multiple organ failure, in two cases — acute cardiovascular failure. Patients from this group patients had the following postoperative complications: bleeding requiring a resternotomy — 2 (16,7%), pneumonia — 1 (8,3%), heart failure in the postoperative period, requiring prolonged cardiotonic support — 9 (75%), one patient underwent mechanical hemodynamic support, renal failure requiring renal replacement therapy in one patient.Conclusion. Even though surgical aortic valve replacement is the “gold standard” for treating patients with aortic stenosis, the results of operations in the older age group is not sufficient due to the high frequency of postoperative complications. TAVI, proposed by Cribier A, et al. in 2002, gives better results in patients over 75 age group due to the lower incidence of complications in the postoperative period, less intraoperative blood loss. We suppose that it is an alternative for patients of the older age group and high operative risk.

scholarly journals Percutaneous versus Surgical Intervention for Severe Aortic Valve Stenosis: A Systematic Review

2021 ◽  
Vol 2021 ◽  
pp. 1-26
Author(s):  
Adelaide Iervolino ◽  
Sanjeet Singh Avtaar Singh ◽  
Pierluigi Nappi ◽  
Francesca Bellomo ◽  
Francesco Nappi
Keyword(s):  
Systematic Review ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Aortic Valve Stenosis ◽  
Long Term Results ◽  
Transcatheter Aortic Valve

Aortic stenosis is a disease that is increasing in prevalence and manifests as decreased cardiac output, which if left untreated can result in heart failure and ultimately death. It is primarily a disease of the elderly who often have multiple comorbidities. The advent of transcatheter aortic valve therapies has changed the way we treat these conditions. However, long-term results of these therapies remain uncertain. Recently, there has been an increasing number of studies examining the role of both surgical aortic valve replacement and transcatheter aortic valve replacement. We therefore performed a systematic review using Ovid MEDLINE, Ovid Embase, and the Cochrane Library. Two investigators searched papers published between January 1, 2007, and to date using the following terms: “aortic valve stenosis,” “aortic valve operation,” and “transcatheter aortic valve therapy.” Both strategies in aortic stenosis treatment highlighted specific indications alongside the pitfalls such as structural valve degeneration and valve thrombosis which have a bearing on clinical outcomes. We propose some recommendations to help clinicians in the decision-making process as technological improvements make both surgical and transcatheter therapies viable options for patients with aortic stenosis. Finally, we assess the role of finite element analysis in patient selection for aortic valve replacement. THVT and AVR-S are both useful tools in the armamentarium against aortic stenosis. The decision between the two treatment strategies should be best guided by a strong robust evidence base, ideally with a long-term follow-up. This is best performed by the heart team with the patient as the center of the discussion.

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