scholarly journals Aneurysmatic aortic root in bicuspid aortic valve stenosis: mini-invasive approach with sutureless prosthesis

2015 ◽  
Vol 82 (2) ◽  
Author(s):  
Francesco Pollari ◽  
Giuseppe Santarpino ◽  
Steffen Pfeiffer ◽  
Theodor Fischlein
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Aortic Valve Stenosis ◽  
Coronary Sinus ◽  
Aortic Root ◽  
Minimal Invasive ◽  
Sinus Of Valsalva ◽  
Invasive Approach ◽  
First Case

The implantation of sutureless bioprosthesis is currently not recommended in patients affected by bicuspid aortic valve because lacking data and follow up. We report the first case of a patient affected by bicuspid aortic valve stenosis and aneurysm of non coronary sinus of Valsalva that underwent a successful substitution of aneurysmatic sinus and minimal invasive sutureless implantation.

P6496Endovascular reconstruction from aortic valve to aortic arch by one-piece valved-fenestrated-bifurcated endografting in animal experiments

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Z P Jing ◽  
J X Feng ◽  
X H Bao ◽  
T Li ◽  
Y Zhao ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Arch ◽  
Aortic Root ◽  
Animal Experiments ◽  
Proximal Part ◽  
Minimal Invasive ◽  
Left Ventricular ◽  
Technical Success Rate

Abstract Aims The possibility of endovascular reconstruction of aortic valve, sinus of Valsalva, and ascending aorta by a minimal-invasive single endograft has not been proven in vivo. Combining our own long-term experiences from transcatheter aortic valve replacement (TAVR) and Thoracic Endovascular Repair (TEVAR) for ascending and arch dissection, we designed the special endo-graft: a novel one-piece valved-fenestrated-bifurcated endografting, and tried to endovascularly reconstruct the area from Left ventricular outflow tract to aortic arch in animal experiments. Methods and results For 20 healthy adult female pigs weighed between 62.3±2.2 kilograms, we did aortic compute tomography angiography (CTA) examinations and measured morphologic parameters of aortic root. Then we accordingly customized the valved-fenestrated-bifurcated endograft. The endograft was delivered through transapical access and endovascularly reconstructed the segment from aortic valve to proximal part of aortic arch. The overall technical success rate was 95% because of one case of delivery system failure. Instant transesophageal echography (TEE) and aortic CTA confirmed ideal position of the endograft, satisfactory function of aortic valve, and the patency of coronary arteries in all subjects. During follow-up, 12 subjects were sacrificed according to the plan and seven were followed up for 8.1±3.6 months. There was one unplanned death of cardiac infection (unplanned mortality: 5.3%). Follow-up re-examinations (aortic CTA, cardiac ultrasound, and electrocardiogram) found no adverse events. Among 12 sacrificed subjects, there was no evidence of fenestrations alignment lost and no myocardial ischemia according to the pathological analysis. Conclusion The novel one-piece valved-fenestrated-bifurcated endografting might be feasible for minimal-invasive reconstruction of aortic root in animal models, thus provided a prospect to simultaneously treat pathologies involving aortic valve and aortic root in endovascular way.

scholarly journals Long-term follow-up of supra-annular pulmonary autograft aortic root replacement in patients with bicuspid aortic valve☆

2008 ◽  
Vol 34 (3) ◽  
pp. 583-588 ◽  
Author(s):  
Feyzan Özaslan ◽  
Thomas Wittlinger ◽  
Nadejna Monsefi ◽  
Tamimount Bouhmidi ◽  
Sinthu Theres ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Aortic Root ◽  
Aortic Root Replacement ◽  
Pulmonary Autograft ◽  
Long Term Follow Up

scholarly journals Aortopathy in patients with bicuspid aortic valve stenosis: role of aortic root functional parameters

2015 ◽  
Vol 49 (2) ◽  
pp. 635-644 ◽  
Author(s):  
Evaldas Girdauskas ◽  
Mina Rouman ◽  
Kushtrim Disha ◽  
Andres Espinoza ◽  
Georg Dubslaff ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Aortic Valve Stenosis ◽  
Aortic Root ◽  
Functional Parameters

Procedural and clinical outcomes of type 0 versus type 1 bicuspid aortic valve stenosis treated with transcatheter valve replacement: insights from the BEAT international collaborative registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Ielasi ◽  
E Moscarella ◽  
A Mangieri ◽  
D Tchetche ◽  
W Kim ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Clinical Outcomes ◽  
Valve Replacement ◽  
Bicuspid Aortic Valve ◽  
Aortic Valve Stenosis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Transvalvular Gradient

Abstract Background Transcatheter aortic valve replacement (TAVR) is an established therapy for symptomatic severe aortic stenosis. Bicuspid aortic valves (BAV) were generally excluded from randomized trials due to anatomic features that may challenge TAVR (valve morphology, annulus geometry and size and severe calcifications). Nevertheless real-world registries have shown that a consistent number of BAV has been treated with TAVR. Whether BAV phenotype may affect acute or long-term outcomes following TAVR still remains unclear. Purpose Evaluate the impact of BAV phenotype on procedural and clinical outcomes after TAVR with new generation valves. Methods Patients included in the BEAT (Balloon vs Self-Expandable valve for the treatment of bicuspid Aortic valve sTenosis) registry were classified according to the BAV phenotype. Procedural and clinical outcomes of type 0 (2 cusps, 1 commissure, no raphe) vs type 1 (1 raphe) BAV are here reported. Primary endpoint was post-procedural device success, according to Valve Academic Research Consortium–2 (VARC-2) criteria. Secondary endpoints included procedural complications, rate of permanent pacemaker (PM) implantation and assessment of clinical outcomes at 30-day and 1-year follow-up. Results BAV 0 phenotype was present in 25 (7.1%) cases, and BAV 1 in 218 (61.8%). 3 (0.9%) patients with BAV 2 phenotype and 105 (29.8%) patients in whom BAV phenotype was undeterminable were excluded. Baseline characteristics of the two populations were well balanced. Mean STS score tended to be lower in type 0 vs type 1 BAV (3.35% ±1.8 vs 4.5% ± 3.0, p=0.062). Mean transvalvular gradient, aortic valve area (AVA), and left ventricular ejection fraction didn't differ between groups. According to CT findings moderate-severe aortic valve calcifications were less frequently present in type 0 vs type 1 (52% vs 71.1%, p=0.01). TAVR was performed under conscious sedation in most patients (89.7%), no differences were noted in terms of valve type, valve size, pre and postdilation between groups. There was no significant difference in any peri-procedural complication including pericardial tamponade, second valve implantation, valve embolization, annular rupture, aortic dissection, coronary occlusion, conversion to open surgery, and need of PM between groups however VARC-2 success tended to be lower in type 0 BAV versus type 1 (72% vs 86.7%; p=0.07). A higher rate of mean transvalvular gradient>20 mmHg was observed in the type 0 vs type 1 groups (respectively 24% vs 6%, p=0.007), while no differences were reported in the rate of moderate-severe aortic regurgitation. At 30-day and 1-year follow-up we did not find differences in clinical outcomes. Conclusions Our study confirms the feasibility of TAVR in both type 0 and type 1 BAV, however despite a lower rate of moderate-severe calcifications, a trend toward a lower VARC device success and a higher rate of mean transvalvular gradient >20 mmHg was observed in type 0 vs type 1 BAV. Funding Acknowledgement Type of funding source: None

P1816Aortic root morphology in bicuspid aortic valve is related to the type of BAV

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
P Masi ◽  
O Milleron ◽  
J F Paul ◽  
F Arnoult ◽  
N Ould Ouali ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Coronary Sinus ◽  
Aortic Root ◽  
Sagittal Plane ◽  
Root Surface ◽  
Root Surface Area ◽  
Type I ◽  
Increased Risk ◽  
Valve Opening

Abstract Background Dilatation of the ascending aorta associated with bicuspid aortic valve (BAV) is common and has been associated with an increased risk of aortic dissection. However, the causal links between BAV types, aortic valve dysfunction and aorta phenotype are still poorly understood. Our hypothesis is that aortic root dilatation in BAV is an anatomic modification related to the BAV type. Purpose To assess whether the morphology and orientation of the aortic root can be predicted by the type of BAV. Methods 86 patients with BAV without significant valvulopathy (aortic regurgitation <2 and no more than mild stenosis with mean gradient <10mmHg) referred for aortic aneurysm assessment and who had benefited from TTE and CT were studied. Definitions Typical BAVs have a horizontal valve opening (type I L-R and type 0 anteroposterior) while atypical BAVs have a vertical valve opening (type I N-R and type 0 lateral) (Figure). Asymmetry of the root is evaluated in type I BAV using the normalized diameter ND = sinus to commissure diameter/mean of the 3 sinus to commissure diameters. We compared, in the typical (n=64) and atypical (n=22) BAVs, using CT, the asymmetry of the root using the normalized diameter, the orientation of the bicuspid aortic valve opening and the orientation of the largest diameter of the aortic root using the sagittal plane as a reference (Figure). Results Patients with typical and atypical BAVs were comparable for age, sex, weight, height, aortic root surface area and maximum aortic root diameter. Aortic root asymmetric modifications were related to the type of BAV with: – a predominant non coronary sinus dilatation in type I L-R (Non coronary sinus to commissure normalized diameter = 1.02 in Type I l-R vs 0.98 in type I R-N; p=0.0004). – a predominant left coronary sinus dilatation in type I L-N (left coronary sinus to commissure normalized diameter = 1.07 in type I R-N vs 1.01 in type I L-R; p<0.0001). – a significantly larger anteroposterior diameter in type 0 typical BAVs (45mm vs 40mm p=0.02) and a significantly larger lateral diameter in type 0 atypical BAVs (48mm vs 39mm p=0.0003). The orientation of the aortic valve opening is correlated with the type of BAV: Using the sagittal plan as a reference, this angle is 144,9° for the typical BAVs vs 56,6° for the atypical BAVs p<0.0001 (Figure). The orientation of the maximal aortic diameter is correlated with the type of BAV: Using the sagittal plan as a reference, this angle is 64.3° for the typical BAVs and 143,1° for the atypical BAVs p<0.0001 (Figure 1). Figure 1 Conclusion The morphology and orientation of the aortic root in BAVs are strongly correlated with the type of BAV, suggesting anatomical modifications rather than aortopathy.

scholarly journals A rare case of anaerobic streptococci endocarditis in a young female with bicuspid aortic valve: case report

2020 ◽  
Author(s):  
Despina Toader ◽  
Mioara Cocora ◽  
Constantin Bătăiosu ◽  
Luminiă Ocroteală
Keyword(s):  
Infective Endocarditis ◽  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Aortic Root ◽  
Young Female ◽  
High Rate ◽  
Ventricular Septum ◽  
Ventricular Septum Defect ◽  
Aortic Root Abscess

Abstract Background Bicuspid aortic valve is the most common congenital cardiovascular malformation and occurs in 1–2% of the population. The haemodynamic changes appear early, leading to tissue damage and predisposing to germs attachment. The development of perivalvular extension is a constant in bicuspid aortic valve endocarditis. Infective endocarditis with anaerobic bacteria is a rare condition with a high rate of mortality. Case summary We report a case of a young female with bicuspid aortic valve infective endocarditis. Involved bacteria were anaerobic streptococci, and the clinical course of the diseases was very aggressive. The echocardiographic evaluation revealed aortic and mitral regurgitation, perivalvular abscess, ventricular septum defect, and pericardial effusion. The surgery approach consisted of the aortic valve replacement with a mechanical prosthesis after radical resection of aortic root abscess and reconstruction of the annulus. The ventricular septum defect was also closed with a pericardial patch. Anticoagulation started the first day after surgery. The patient was received antibiotic therapy for 10 days before and 4 weeks after surgical intervention. Evolution was very good at 1 and 6 months follow-up. Discussion This is a severe case of endocarditis, complicated with extensive valvular destruction, aortic root abscess, and fistula. Perivalvular complications are frequent in patients with bicuspid aortic valve endocarditis. The ‘take away’ message is that echocardiography is an essential tool for diagnosis, management, and follow-up of patients with infective endocarditis.

scholarly journals Longer-term Outcomes after Bicuspid Aortic Valve Repair in 142 Patients

2021 ◽  
Author(s):  
Mojyan Safari ◽  
Nadejda Monsefi ◽  
Afsaneh Karimian-Tabrizi ◽  
Aleksandra Miskovic ◽  
A Vanlinden ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Aortic Root ◽  
Reoperation Rate ◽  
Aortic Root Replacement ◽  
Aortic Root Dilatation ◽  
Group 2 ◽  
Aortic Valve Reimplantation ◽  
Group 1

Background The aim of this study was to evaluate the longer-term results of bicuspid aortic valve (BAV) repair with or without aortic root replacement. Methods From 1999 to 2017, 142 patients with or without aortic root dilatation who underwent repair of a regurgitant BAV were included in the study. Ninety-four patients underwent isolated BAV repair (Group 1; mean age 45±14 years) and 48 patients underwent valve-sparing aortic root replacement plus BAV repair (aortic valve reimplantation – Group 2; mean age 49±13 years. Median follow-up time was 5.9 years (range 0.5-15) in Group 1 and 3 years (range 0.5-16) in Group 2, respectively. Results In-hospital mortality was 1% in group 1, and 2% in Group 2 (p=0.6). The 5- and 10-year survival was 93±2.9% and 81±5.8% in Group 1 and 96±3.1% and 96±3.1% in Group 2, respectively (p=0.31). Eleven patients of Group 1 (1.7% /patient-year) and 5 patients of Group 2 (2.2%/patient-year) underwent reoperation of the aortic valve (p=0.5). The 5- and 10-year freedom from reoperation were 93.0±2.1% and 77.1±7.1% in Group 1 and 93.0±5.0% and 76.7±9.6% in Group 2 (p=0.83), respectively. At latest follow-up only 2 patients of Group 1 and 1 patient of Group 2 had AR=2° (p=0.7). The cumulative linearized incidence of all valve-related complications (bleeding, stroke, endocarditis, reoperation) was 2.9%/patient-year in Group 1 and 4%/patient-year in Group 2, respectively (p=0.6). Conclusions Isolated BAV repair and combined aortic valve reimplantation plus BAV repair provide good clinical longer-term outcomes with relatively low reoperation rate and durable valve function.

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