Variablity of Mechanical or Tissue Valve Implantation in Patients Undergoing Surgical Aortic Valve Replacement in Spain: National Retrospective Analysis from 2007 to 2018

Background: There is no robust evidence regarding the types of valves implanted among patients undergoing surgical aortic valve replacement (SAVR) in Spain. Methods: All cases of patients undergoing SAVR ± coronary artery bypass grafting from January 2007 to December 2018 in the public Spanish National Health System were included. We analyzed the trends of SAVR volume, risk profile and type of implanted valve across time and place. Using multivariable logistic regression, we identified factors associated with biological SAVR. Results: In total, 62,870 episodes of SAVR in 15 Spanish territories were included. In 35,693 (56.8%), a tissue valve was implanted. The annual volume of procedures increased from 107.3/million (2007) to 128.6 (2017). In 2018, it fell to 108.5. Age increased and Charlson’s comorbity index worsened throughout the study period. Tissue valve implantation increased in most regions. After adjusting for other covariates, we observed a high variability in aortic valve implantation across different regions, with differences of as much as 20-fold in the use of tissue valves. Conclusions: Between 2007 and 2018, we detected a significant increase in the use of bioprostheses in patients undergoing SAVR in Spain, and a great variability in the types of valve between the Spanish territories, which was not explained by the different risk profiles of patients.

Management of a mechanical aortic valve during left ventricular assist device implantation in a previously replaced aortic root

The use of left ventricular assist device (LVAD) in patients with mechanical aortic valves may result in thromboembolic events due to blood stasis around the valve and intermittent valve opening. Mechanical aortic valves encountered during LVAD implantation are managed by replacement with a tissue valve, or closure of the valve with a patch. Closure of the valve carries the risk of sudden death in cases of LVAD stoppage. Replacing the whole mechanical valve conduit is time consuming and carries a significant risk of bleeding and right ventricular (RV) failure. We describe an alternative technique of replacing a mechanical aortic valve by breaking its inner leaflets and sewing a tissue valve on top of the mechanical valve ring.

Prosthetic valve endocarditis caused by silent infection of methicillin-resistant coagulase-negative staphylococci

Surgery for prosthetic valve endocarditis in the mitral valve position is still challenging for surgeons. Reconstruction of the mitral annulus is useful for patients with a mitral annulus disputed by infection. Here, we report a redo mitral valve replacement using a collar-reinforced tissue valve, which was inserted into a mitral annulus reconstructed with a bovine patch. Though the preoperative blood culture detected Streptococcus anginosus, the intraoperative culture detected methicillin-resistant coagulase-negative staphylococci (MRCNS). MRCNS is rarely detected because of its indolent nature.

Is Bridging Anticoagulation with Heparin after Valve Replacement Surgery Mandatory? - A Prospective Observational Study in a Centre of Bangladesh

Background: This is a prospective observational single center study to determine whether bridging anticoagulation with heparin along with warfarin is mandatory in a heterogenous group of patients undergoing valve replacement surgery either single or multiple valve (with mechanical or tissue valve) in the post-operative period. Methods: Perioperative data were collected in 41 patients undergoing multiple valve replacement at this center from July/2019 to September/2019 irrespective of age, sex, number and type of valve replaced. No bridging anticoagulation was given in preoperative and postoperative period in these patients. They were prospectively observed for the incidence of any thromboembolic end bleeding events with daily measurement of International Normalized Ratio (INR) till INR reached at therapeutic level for oral anticoagulant warfarin and complications of warfarin therapy. Results: All the patient suffered from chronic Rheumatic heart disease. Single valve disease was in 70.73% and multiple valve disease was in 29.27% cases. Two patients had left atrial thrombus, seven patient (14.63%) had preoperative atrial fibrillation (AF). Postoperative new onset AF was present in 10 (24.39%) cases. No thromboembolism occurred in these patients and warfarin over anticoagulation was found in 1/41 patient. Conclusion: Patients undergoing valve replacement surgery without concomitant postoperative bridging anticoagulation with heparin do not suffer from any thromboembolic and bleeding complications even at lower level of INR. This study also shows that single and multiple valve (both mechanical and tissue valve) have the same in hospital outcome in relation to thromboembolism and bleeding complications. Cardiovasc. j. 2020; 13(1): 27-34

Dysfunction Patterns of Epoxy-Treated Tissue Heart Valves

Purpose: to perform comparative morphological analysis of causes of dysfunction of epoxy-treated, xenoaortic and xenopericardial, tissues heart valves.Materials and methods. We included in this study 475 patients with mitral valve disease who have undergone heart valve replacement with tissue valve: (“KemCor”, n=211 [group 1]; “PeriCor”, n=126 [group 2]; and “UniLine”, n=138 [group 3]). Degenerative changes in 26 tissue valves (n=9 “KemCor”, n=11 “PeriCor”, and n=6 “UniLine”) explanted from the mitral position during the repeat replacement were evaluated macroscopically for the presence of calcifications, perforations, leaflet tears and ruptures, pannus, and leaflet fusion to the stent frame. Analysis of survival, freedom from dysfunction and reoperation of the studied tissue heart valves was performed for the period from January 1, 1995 to March 01, 2017.Results: Pannus overgrowth on the stent struts with extension onto the leaflets was seen on 53.8% of explanted tissue valves. “KemCor” and “PeriCor” tissue valves demonstrated over 70% rate of adhesion formation at the commissure, and in 93% of these cases there were leaflet ruptures at the commissure. Signs of calcification of different grades had 57.6% of specimens. Over 50% of “PeriCor” and “UniLine” tissue valve specimens had calcification at the stent frame. Calcified pannus was noted in 35% of all studied tissue heart valves. Interestingly, dysfunction in 53.3% of the studied tissue heart valves with detected calcification was not associated with calcific deposits. The 6-year actuarial survival for groups I, II and III was 73.5, 66.1 and 87.6%, respectively (group I vs. group II, p=0.6; group II vs. group III - p<0.05; group I vs. group III - p<0.05). The actuarial freedom from reoperation was 81.9%, 75.0% and 94.2%, respectively (pI-II>0.05; pII-III<0.05; pI-III<0.05). The actuarial freedom from dysfunction was 79.6%, 75.0%, and 94.2%, respectively (pI-II>0.05; pII-III<0.05; pI-III<0.05).Conclusion. The structure of dysfunctions of the studied tissue heart valves was represented by primary tissue failure, calcification and pannus growth. Specific design of the “UniLine” valve allowed to prevent the formation of adhesions between leaflets and the frame in the commissure buttress area, and as a result leaflet rupture from the stent struts. Xenopericardial “UniLine” tissue valves turned out to be superior to xenoaortic “KemCor” and “PeriCor” tissue valves in terms of survival, freedom from reoperations and dysfunction within the 6-year follow-up.