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Hazards of interpreting the late results on durability of bioprosthetic valves. Cautions & suggestions. Int J Cardiol 2016; 221:511-4. [PMID: 27414731 DOI: 10.1016/j.ijcard.2016.07.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 07/07/2016] [Indexed: 11/23/2022]
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302
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303
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Transcatheter Aortic Valve Replacement 2016: A Modern-Day "Through the Looking-Glass" Adventure. J Am Coll Cardiol 2016; 67:1472-1487. [PMID: 27012409 DOI: 10.1016/j.jacc.2015.12.059] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 12/09/2015] [Accepted: 12/15/2015] [Indexed: 11/23/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) has become a safe and effective therapy for patients with severe aortic stenosis (AS). In recent trials, the hemodynamic performance and clinical outcomes of the latest generation of TAVR devices demonstrated at least parity with surgical outcomes in patients of similar risk. Many initial obstacles with TAVR have largely been overcome, including frequent access site complications and concerns about strokes and paravalvular leaks. Using a multidisciplinary heart team approach, patient selection, procedural planning, and device implantation have been refined and optimized such that clinical outcomes are generally predictable and reproducible. Future research will focus on the durability of TAVR devices, further enhancements in clinical outcomes, and adjunctive therapies. On the basis of initial results from ongoing clinical trials, the indication for TAVR will likely expand to lower-risk patients. This review provides an overview of recent progress in this field, and highlights future opportunities and directions.
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Reuven EM, Leviatan Ben-Arye S, Marshanski T, Breimer ME, Yu H, Fellah-Hebia I, Roussel JC, Costa C, Galiñanes M, Mañez R, Le Tourneau T, Soulillou JP, Cozzi E, Chen X, Padler-Karavani V. Characterization of immunogenic Neu5Gc in bioprosthetic heart valves. Xenotransplantation 2016; 23:381-92. [PMID: 27610947 DOI: 10.1111/xen.12260] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 06/13/2016] [Accepted: 08/12/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND The two common sialic acids (Sias) in mammals are N-acetylneuraminic acid (Neu5Ac) and its hydroxylated form N-glycolylneuraminic acid (Neu5Gc). Unlike most mammals, humans cannot synthesize Neu5Gc that is considered foreign and recognized by circulating antibodies. Thus, Neu5Gc is a potential xenogenic carbohydrate antigen in bioprosthetic heart valves (BHV) that tend to deteriorate in time within human patients. METHODS We investigated Neu5Gc expression in non-engineered animal-derived cardiac tissues and in clinically used commercial BHV, and evaluated Neu5Gc immunogenicity on BHV through recognition by human anti-Neu5Gc IgG. RESULTS Neu5Gc was detected by immunohistochemistry in porcine aortic valves and in porcine and bovine pericardium. Qualitative analysis of Sia linkages revealed Siaα2-3>Siaα2-6 on porcine/bovine pericardium while the opposite in porcine aortic/pulmonary valve cusps. Similarly, six commercial BHV containing either porcine aortic valve or porcine/bovine/equine pericardium revealed Siaα2-3>Siaα2-6 expression. Quantitative analysis of Sia by HPLC showed porcine/bovine pericardium express 4-fold higher Neu5Gc levels compared to the porcine aortic/pulmonary valves, with Neu5Ac at 6-fold over Neu5Gc. Likewise, Neu5Gc was expressed on commercial BHV (186.3±16.9 pmol Sia/μg protein), with Neu5Ac at 8-fold over Neu5Gc. Affinity-purified human anti-Neu5Gc IgG showing high specificity toward Neu5Gc-glycans (with no binding to Neu5Ac-glycans) on a glycan microarray, strongly bound to all tested commercial BHV, demonstrating Neu5Gc immune recognition in cardiac xenografts. CONCLUSIONS We conclusively demonstrated Neu5Gc expression in native cardiac tissues, as well as in six commercial BHV. These Neu5Gc xeno-antigens were recognized by human anti-Neu5Gc IgG, supporting their immunogenicity. Altogether, these findings suggest BHV-Neu5Gc/anti-Neu5Gc may play a role in valve deterioration warranting further investigation.
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Affiliation(s)
- Eliran Moshe Reuven
- Department of Cell Research and Immunology, Tel Aviv University, Tel Aviv, Israel
| | | | - Tal Marshanski
- Department of Cell Research and Immunology, Tel Aviv University, Tel Aviv, Israel
| | - Michael E Breimer
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Hai Yu
- Department of Chemistry, University of California-Davis, Davis, CA, USA
| | - Imen Fellah-Hebia
- Department of Thoracic and Cardiovascular Surgery, Institut du Thorax, University Hospital, Nantes, France
| | - Jean-Christian Roussel
- Department of Thoracic and Cardiovascular Surgery, Institut du Thorax, University Hospital, Nantes, France
| | - Cristina Costa
- Infectious Diseases and Transplantation Division, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Manuel Galiñanes
- Department of Cardiac Surgery, Reparative Therapy of the Heart, Hospital Universitari Vall d'Hebron and Vall d'Hebron Research Institute, Barcelona, Spain
| | - Rafael Mañez
- Infectious Diseases and Transplantation Division, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Thierry Le Tourneau
- Department of Cardiology, Institut du Thorax, University Hospital, Nantes, France
| | - Jean-Paul Soulillou
- Institut de Transplantation-Urologie-Néphrologie, INSERM Unité Mixte de Recherche 1064, Centre Hospitalo Universitaire de Nantes, Nantes, France
| | - Emanuele Cozzi
- Transplant Immunology Unit, Department of Transfusion Medicine, Padua University Hospital, Padua, Italy
| | - Xi Chen
- Department of Chemistry, University of California-Davis, Davis, CA, USA
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305
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Chiu P, Miller DC. Evolution of surgical therapy for Stanford acute type A aortic dissection. Ann Cardiothorac Surg 2016; 5:275-95. [PMID: 27563541 DOI: 10.21037/acs.2016.05.05] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Acute type A aortic dissection (AcA-AoD) is a surgical emergency associated with very high morbidity and mortality. Unfortunately, the early outcome of emergency surgical repair has not improved substantially over the last 20 years. Many of the same debates occur repeatedly regarding operative extent and optimal conduct of the operation. The question remains: are patients suffering from too large an operation or too small? The pendulum favoring routine aortic valve resuspension, when feasible, has swung towards frequent aortic root replacement. This already aggressive approach is now being challenged with the even more extensive valve-sparing aortic root replacement (V-SARR) in selected patients. Distally, open replacement of most of the transverse arch is best in most patients. The need for late aortic re-intervention has not been shown to be affected by more extensive distal operative procedures, but the contemporary enthusiasm for a distal frozen elephant trunk (FET) only seems to build. It must be remembered that the first and foremost goal of the operation is to have an operative survivor; additional measures to reduce late morbidity are secondary aspirations. With increasing experience, true contraindications to emergency surgical operation have dwindled, but patients with advanced age, multiple comorbidities, and major neurological deficits do not fare well. The endovascular revolution, moreover, has spawned innovative options for modern practice, including ascending stent graft and adaptations of the old flap fenestration technique. Despite the increasingly complex operations and ever expanding therapies, this life-threatening disease remains a stubborn challenge for all cardiovascular surgeons. Development of specialized thoracic aortic teams and regionalization of care for patients with AcA-AoD offers the most promise to improve overall results.
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Affiliation(s)
- Peter Chiu
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, CA, USA
| | - D Craig Miller
- Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, CA, USA
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306
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Sievers HH, Scharfschwerdt M. Every millimeter counts. J Thorac Cardiovasc Surg 2016; 152:1028-9. [PMID: 27546563 DOI: 10.1016/j.jtcvs.2016.07.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 07/01/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Hans-Hinrich Sievers
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
| | - Michael Scharfschwerdt
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
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307
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Tasca G, Vismara R, Mangini A, Romagnoni C, Contino M, Redaelli A, Fiore GB, Antona C. Comparison of the Performance of a Sutureless Bioprosthesis With Two Pericardial Stented Valves on Small Annuli: An In Vitro Study. Ann Thorac Surg 2016; 103:139-144. [PMID: 27544288 DOI: 10.1016/j.athoracsur.2016.05.089] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 03/21/2016] [Accepted: 05/23/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Aortic valve replacement has evolved recently with the development of the sutureless bioprosthesis. One such valve is the Perceval bioprosthesis, which is built by mounting leaflets of bovine pericardium to a thin stent; this approach has the potential to provide an excellent fluid dynamic performance. We undertook an in vitro study to compare the hydrodynamic performance of the sutureless bioprosthesis with two standard pericardial stented bioprostheses (Crown and Magna). METHODS Tests were conducted using a mock loop, testing on two sizes of the three prostheses. The prosthesis sizes were chosen to house the valves in porcine aortic roots with a native annulus diameter of 19 mm (n = 6) or 21 mm (n = 6). The stroke volume ranged from 25 mL to 105 mL at a simulated heart rate of 70 beats per minute. RESULTS Mean pressure drop and energy loss rose with increasing stroke volume in all of the valves tested (p < 0.001), with the sutureless valve showing the lowest values for both variables (p < 0.001). Effective orifice area values were stable across the stroke volume intervals and were larger in the sutureless valves (p < 0.001). CONCLUSIONS All of the valves tested provided good fluid dynamic performances. The sutureless bioprosthesis provided the best performance with the least hindrance to flow behavior. From the hydrodynamic perspective, the sutureless prosthesis may present an advance in the evolution of bioprostheses, ensuring low gradients and potential for low incidence of patient-prosthesis mismatch even in small annuli.
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Affiliation(s)
- Giordano Tasca
- Cardiovascular Department, Cardiac Surgery Unit, Ospedale "A. Manzoni" di Lecco, Lecco; Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan.
| | - Riccardo Vismara
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan; FoRCardioLab, Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan
| | - Andrea Mangini
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan; FoRCardioLab, Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan; Cardiovascular Surgery Department, "L. Sacco" Hospital, Università degli Studi di Milano, Milan, Italy
| | - Claudia Romagnoni
- FoRCardioLab, Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan; Cardiovascular Surgery Department, "L. Sacco" Hospital, Università degli Studi di Milano, Milan, Italy
| | - Monica Contino
- FoRCardioLab, Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan; Cardiovascular Surgery Department, "L. Sacco" Hospital, Università degli Studi di Milano, Milan, Italy
| | - Alberto Redaelli
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan; FoRCardioLab, Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan
| | - Gianfranco Beniamino Fiore
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan; FoRCardioLab, Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan
| | - Carlo Antona
- FoRCardioLab, Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan; Cardiovascular Surgery Department, "L. Sacco" Hospital, Università degli Studi di Milano, Milan, Italy
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308
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Heidary Rouchi A, Radmehr H, Tavakoli SA, Jafarzadeh Kashi TS, Mahdavi-Mazdeh M. Iranian homograft heart valves: assessment of durability and late outcome. Cell Tissue Bank 2016; 17:603-610. [PMID: 27501816 DOI: 10.1007/s10561-016-9573-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 07/29/2016] [Indexed: 11/26/2022]
Abstract
Durability and the rate of complications of homograft heart valves, adjusted for patient-related contributors and surgical techniques, rely mainly on the quality of allografts which in turn are mirrored in the donor characteristics and most importantly recovery and processing procedures. Aimed to assess the quality, a study was conducted to figure out the durability and late outcome following homograft replacement with valved conduits procured by the Iranian Tissue Bank. Retrospectively, the pre-implantation, perioperative and follow-up data of 400 non-consecutive recipients of cryopreserved heart valves (222 pulmonary and 178 aortic) from 2006 to 2015 were collected and analyzed in terms of variables reflecting late outcome including adverse events and durability. In the context of durability, the event of interest was defined as the need for homograft replacement and homograft-related death. The mean follow-up time (SD) of study entrants (male/female ratio, 1.4) was 49.8 (36.3) months. Median age at the time of implantation was 11 years. Total 10-years mortality was 21 % (84/400), including 66.7 % early (30-days mortality: 56/84) and 33.3 % late (28/84). Overall late complication rate was 2 %. Median survival time was 120 months (95 % CI 83.3-156.6). The pulmonary valves appeared to be more durable (P value <0.001) and survival probabilities in small sized grafts were lower (P value 0.008). One-, five-, and ten-year graft survival was 82, 76 and 73 %, respectively. The evidences suggest that the homografts function satisfactory with low rate of late complications; nevertheless, more emphasis should be given to make long-term durability comparable.
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Affiliation(s)
- Alireza Heidary Rouchi
- Iranian Tissue Bank and Research Center, Tehran University of Medical Sciences, Imam Khomeini Hospital Complex, Keshavarz Blvd., Tehran, 1419731351, Iran
| | - Hassan Radmehr
- Department of Cardiac Surgery, Children Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Amirhosein Tavakoli
- Iranian Tissue Bank and Research Center, Tehran University of Medical Sciences, Imam Khomeini Hospital Complex, Keshavarz Blvd., Tehran, 1419731351, Iran
| | | | - Mitra Mahdavi-Mazdeh
- Iranian Tissue Bank and Research Center, Tehran University of Medical Sciences, Imam Khomeini Hospital Complex, Keshavarz Blvd., Tehran, 1419731351, Iran.
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309
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Masri A, Gillinov AM, Johnston DM, Sabik JF, Svensson LG, Rodriguez LL, Kapadia SR, Stewart WJ, Grimm RA, Griffin BP, Desai MY. Anticoagulation versus antiplatelet or no therapy in patients undergoing bioprosthetic valve implantation: a systematic review and meta-analysis. Heart 2016; 103:40-48. [DOI: 10.1136/heartjnl-2016-309630] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 07/07/2016] [Accepted: 07/10/2016] [Indexed: 12/18/2022] Open
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310
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Valve Type, Size, and Deployment Location Affect Hemodynamics in an In Vitro Valve-in-Valve Model. JACC Cardiovasc Interv 2016; 9:1618-28. [DOI: 10.1016/j.jcin.2016.05.030] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/13/2016] [Accepted: 05/16/2016] [Indexed: 11/20/2022]
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311
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Konventioneller Aortenklappenersatz. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2016. [DOI: 10.1007/s00398-016-0095-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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312
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313
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Jaffer IH, Whitlock RP. A mechanical heart valve is the best choice. HEART ASIA 2016; 8:62-4. [PMID: 27326236 DOI: 10.1136/heartasia-2015-010660] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 02/10/2016] [Indexed: 11/03/2022]
Abstract
The choice of prosthesis type in patients with valvular heart disease should always be individualised. The treating heart team must weigh the concerns surrounding durability of bioprosthetic valves compared with mechanical valves and the need for lifelong anticoagulation required with mechanical valves. In general, guidelines recommend that patients under the age of 60 would benefit from a mechanical valve, and those over 70 would benefit from a bioprosthetic valve. We would argue, in this context, that the most appropriate choice for this patient would be undertaking a mitral valve replacement with a mechanical prosthesis. This recommendation is based on two considerations: first, there is a high likelihood of failure of a bioprosthesis within an unacceptably short period of time, which would then necessitate a higher risk reoperation. Second, there is high likelihood of needing long-term anticoagulation in a patient with severe mitral stenosis due to the development of atrial fibrillation. While we do acknowledge the difficulty in managing long-term anticoagulation of patients in rural settings, there have nonetheless been significant advancements in this realm with the use of pharmacist-led thrombosis clinics and point of care international normalised ratio (INR) devices in the treatment of rural patients in low-income and middle-income countries. For these reasons, therefore, we would strongly advocate for a mechanical valve in this 44-year-old patient from a rural setting.
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Affiliation(s)
- Iqbal H Jaffer
- Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada; Division of Cardiac Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Richard P Whitlock
- Division of Cardiac Surgery, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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314
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Tasca G, Fiore GB, Mangini A, Romagnoni C, Gamba A, Redaelli A, Antona C, Vismara R. Opening–closing pattern of four pericardial prostheses: results from an in vitro study of leaflet kinematics. J Artif Organs 2016; 19:350-356. [DOI: 10.1007/s10047-016-0910-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 05/13/2016] [Indexed: 10/21/2022]
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315
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Affiliation(s)
- Eric E Roselli
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, 9500 Euclid Ave, Desk J4-1, Cleveland, OH 44195-5108.
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316
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317
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Mosquera VX, Bouzas-Mosquera A, Velasco-García C, Muñiz J, Estévez-Cid F, Portela-Torron F, Herrera-Noreña JM, Cuenca-Castillo JJ. Long-Term Outcomes and Durability of the Mitroflow Aortic Bioprosthesis. J Card Surg 2016; 31:264-73. [DOI: 10.1111/jocs.12726] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Victor X. Mosquera
- Department of Cardiac Surgery; Complejo Hospitalario Universitario de A Coruña; A Coruña Spain
| | | | - Carlos Velasco-García
- Department of Cardiac Surgery; Complejo Hospitalario Universitario de A Coruña; A Coruña Spain
| | - Javier Muñiz
- Instituto Universitario de Ciencias de la Salud; Universidad de A Coruña; A Coruña Spain
| | - Francisco Estévez-Cid
- Department of Cardiac Surgery; Complejo Hospitalario Universitario de A Coruña; A Coruña Spain
| | | | - José M. Herrera-Noreña
- Department of Cardiac Surgery; Complejo Hospitalario Universitario de A Coruña; A Coruña Spain
| | - José J. Cuenca-Castillo
- Department of Cardiac Surgery; Complejo Hospitalario Universitario de A Coruña; A Coruña Spain
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318
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Baldeo C, Hritani A, Baldeo C, Percy R. Does chemo-radiation predispose to structural valve deterioration? Int J Cardiol 2016; 211:53-4. [PMID: 26974696 DOI: 10.1016/j.ijcard.2016.02.155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 02/29/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Candice Baldeo
- University of Florida - Jacksonville, Internal Medicine Department, United States.
| | - AbdulWahab Hritani
- University of Florida - Jacksonville, Internal Medicine Department, United States
| | | | - Robert Percy
- University of Florida - Jacksonville, Department of Cardiology, United States
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319
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D’Onofrio A, Facchin M, Besola L, Manzan E, Tessari C, Bizzotto E, Bianco R, Tarantini G, Napodano M, Fraccaro C, Buja P, Covolo E, Yzeiraj E, Pittarello D, Isabella G, Iliceto S, Gerosa G. Intermediate Clinical and Hemodynamic Outcomes After Transcatheter Aortic Valve Implantation. Ann Thorac Surg 2016; 101:881-8; Dissicussion 888. [DOI: 10.1016/j.athoracsur.2015.08.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 06/26/2015] [Accepted: 08/08/2015] [Indexed: 12/29/2022]
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320
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Mader N, Rudolph T, Baldus S, Wahlers T. [TAVI in Germany. What have we learned from current studies?]. Herz 2016; 41:97-101. [PMID: 26838062 DOI: 10.1007/s00059-016-4406-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) has become an established treatment for symptomatic aortic valve stenosis in inoperable patients and high-risk patients. In Germany the TAVI procedure has now surpassed the annual numbers of isolated surgical aortic valve replacement with a recent trend towards treatment of intermediate-risk patients; however, before TAVI can also be used in patients with lower surgical risk, studies are required to demonstrate the safety and efficacy of this method for this patient population.
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Affiliation(s)
- N Mader
- Klinik für Herz- und Thoraxchirurgie, Herzzentrum, Universitätsklinik zu Köln, Kerpener Strasse 62, 50937, Köln, Deutschland.
| | - T Rudolph
- Klinik III für Innere Medizin, Herzzentrum, Universität zu Köln, Kerpener Straße 62, 50937, Köln, Deutschland
| | - S Baldus
- Klinik III für Innere Medizin, Herzzentrum, Universität zu Köln, Kerpener Straße 62, 50937, Köln, Deutschland
| | - Th Wahlers
- Klinik für Herz- und Thoraxchirurgie, Herzzentrum, Universitätsklinik zu Köln, Kerpener Strasse 62, 50937, Köln, Deutschland
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321
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Reineke D, Gisler F, Englberger L, Carrel T. Mechanical versus biological aortic valve replacement strategies. Expert Rev Cardiovasc Ther 2016; 14:423-30. [DOI: 10.1586/14779072.2016.1133293] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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322
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Raghav V, Okafor I, Quach M, Dang L, Marquez S, Yoganathan AP. Long-Term Durability of Carpentier-Edwards Magna Ease Valve: A One Billion Cycle In Vitro Study. Ann Thorac Surg 2016; 101:1759-65. [PMID: 26806168 DOI: 10.1016/j.athoracsur.2015.10.069] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 08/24/2015] [Accepted: 10/26/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Durability and hemodynamic performance are top considerations in selecting a valve for valve replacement surgery. This study was conducted in order to evaluate the long-term mechanical durability and hydrodynamic performance of the Carpentier-Edwards PERIMOUNT Magna Ease Bioprostheses, through 1 billion cycles (equivalent to 25 years). METHODS In vitro valve hydrodynamic performance, durability, and quantitative flow visualization were conducted in accordance with ISO 5840:2005 heart valve standard. The study valves were subjected to accelerated valve cycling to an equivalent of 25 years of wear. Hydrodynamic evaluations at intervals of 100 million cycles (2.5 years) were performed on the study valves. New uncycled Magna Ease valves were used as hydrodynamic controls in this study. A quantitative assessment of the fluid motion downstream of the control and study valves was performed using particle image velocimetry. The results between the test and control valves were compared to assess valve performance after an equivalent of 25 years of wear. RESULTS All study valves met the ISO 5840 requirements for effective orifice area, 1.81 ± 0.06 cm(2) and 2.06 ± 0.17 cm(2), and regurgitant fraction, 1.11% ± 0.87% and 2.5% ± 2.34%, for the 21 mm and 23 mm study valves, respectively. The flow characterization of the control valves and the billion-cycle valves demonstrated that the valves exhibited similar flow characteristics. The velocity and shear stress fields were similar between the control and study valves. CONCLUSIONS The Magna Ease valves demonstrated excellent durability and hydrodynamic performance after an equivalent of 25 years of simulated in vitro wear. All study valves successfully endured 1 billion cycles of simulated wear, 5 times longer than the standard requirement for a tissue valve as stipulated in ISO 5840.
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Affiliation(s)
- Vrishank Raghav
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta
| | - Ikechukwu Okafor
- School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | | | - Lynn Dang
- Edwards Lifesciences, Irvine, California
| | | | - Ajit P Yoganathan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta; School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, Georgia.
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323
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Barnhart GR, Shrestha ML. Current Clinical Evidence on Rapid Deployment Aortic Valve Replacement: Sutureless Aortic Bioprostheses. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016. [DOI: 10.1177/155698451601100103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Glenn R. Barnhart
- Department of Cardiac Surgery, Swedish Heart and Vascular Institute, Swedish Medical Center, Seattle, WA USA
| | - Malakh Lal Shrestha
- Department of Cardio-thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Ius F, Koigeldiyev N, Roumieh M, Ismail I, Tudorache I, Shrestha M, Fleissner F, Haverich A, Cebotari S. Impact of sinuses of Valsalva on prosthesis durability in patients undergoing ascending aorta and aortic valve replacement with Carpentier-Edwards bioprosthesis: a propensity score-based study. Eur J Cardiothorac Surg 2015; 49:1676-84. [PMID: 26656448 DOI: 10.1093/ejcts/ezv425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 10/13/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The effect of sinuses of Valsalva on aortic bioprosthesis durability has not been investigated so far. The aim of this study was to compare durability of the Carpentier-Edwards aortic bioprosthesis in patients undergoing aortic valve and ascending aorta replacement as a composite bioconduit (Group A, case group) versus patients undergoing separate replacement of the aortic valve and ascending aorta, with preservation of the aortic root (Group B, control group), between January 2000 and January 2014. METHODS Records of Group A (n = 133) and Group B (n = 162) patients were retrospectively reviewed. End-points were evaluated among groups in three ways: before and after propensity score 1:1 matching (Group A, n = 94; Group B, n = 94 patients) and after patient stratification through quintiles of propensity scores. RESULTS There was no difference among groups regarding mean and maximal trans-prosthetic pressure gradients at discharge (P = 0.07 and 0.45, respectively). Maximal trans-prosthetic gradients were lower in Group A patients at last control (P = 0.03). Structural valve deterioration (SVD) was due to prosthesis regurgitation (Group A, n = 5; Group B, n = 1), stenosis (Group A, n = 2; Group B, n = 5) or combined (Group A, n = 4; Group B, n = 2). After a mean follow-up of 68 ± 42 months, there was no difference among groups, at 5 and 12 years, regarding mortality, freedom from SVD, from redo aortic valve replacement for SVD and cardiac redo of any type, before and after matching and after stratification according to quintiles of propensity scores. CONCLUSIONS Within the 12-year follow-up, the absence of the sinuses of Valsalva seems to have no influence on durability of Carpentier Edwards aortic bioprosthesis. Longer follow-up may be warranted.
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Affiliation(s)
- Fabio Ius
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Nurbol Koigeldiyev
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Mazen Roumieh
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Issam Ismail
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Igor Tudorache
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Malakh Shrestha
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Felix Fleissner
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Serghei Cebotari
- Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany
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325
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Durability of internally stented pericardial aortic valves: Prosthesis size matters. J Thorac Cardiovasc Surg 2015; 151:762-763. [PMID: 26628356 DOI: 10.1016/j.jtcvs.2015.10.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 10/29/2015] [Indexed: 11/22/2022]
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326
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Svensson LG, Blackstone EH. Mechanical versus biologic valves: Clicking engines or quiet electrics or hybrids? J Thorac Cardiovasc Surg 2015; 150:1396-8. [DOI: 10.1016/j.jtcvs.2015.09.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 09/05/2015] [Indexed: 10/23/2022]
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327
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Paradis JM, Del Trigo M, Puri R, Rodés-Cabau J. Transcatheter Valve-in-Valve and Valve-in-Ring for Treating Aortic and Mitral Surgical Prosthetic Dysfunction. J Am Coll Cardiol 2015; 66:2019-2037. [DOI: 10.1016/j.jacc.2015.09.015] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 09/08/2015] [Indexed: 10/22/2022]
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328
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Affiliation(s)
- Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.
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329
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Heimansohn D, Roselli EE, Thourani VH, Wang S, Voisine P, Ye J, Dabir R, Moon M. North American trial results at 1 year with the Sorin Freedom SOLO pericardial aortic valve. Eur J Cardiothorac Surg 2015; 49:493-9; discussion 499. [PMID: 26003957 DOI: 10.1093/ejcts/ezv169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 03/25/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES A North American prospective, 15-centre Food and Drug Administration (FDA) valve trial was designed to assess the safety and effectiveness of the Freedom SOLO stentless pericardial aortic valve in the treatment of surgical aortic valve disease. METHODS Beginning in 2010, 251 patients (mean: 74.7 ± 7.5 years), were recruited in the Freedom SOLO aortic valve trial. One hundred eighty-nine patients have been followed for at least 1 year and are the basis for this review. Preoperatively, 54% of patients had NYHA functional class III or IV symptoms, and the majority of patients had a normal ejection fraction (EF) (median EF = 61%). Concomitant procedures were performed in 61.9% of patients, with coronary artery bypass grafting (CABG) (48.7%) being the most common followed by a MAZE procedure (13.7%). Reoperations were performed in 8.5% of patients in the study. RESULTS The entire cohort of 251 patients enrolled had 7 deaths prior to 30 days, 2 of which were valve-related (aspiration pneumonia and sudden death) and 5 were not valve-related. There were 11 deaths after 30 days, 1 valve-related (unknown cardiac death) and 10 not valve-related. Five valves were explanted, 3 early (endocarditis, acute insufficiency and possible root dissection) and 2 late (endocarditis). Thirty-day adverse events include arrhythmias requiring permanent pacemaker (4.2%), thromboembolic events (3.7%) and thrombocytopenia (7.4%). One-year follow-up of all 189 patients demonstrated mean gradients for valve sizes 19, 21, 23, 25 and 27 mm of 11.7, 7.8, 6.3, 4.6 and 5.0 mmHg, respectively. Effective orifice areas for the same valve sizes were 1.2, 1.3, 1.6, 1.8 and 1.9 cm(2), respectively. Ninety-six percent of patients (181/189) were in NYHA class I or II at the 1-year follow-up. CONCLUSIONS The Freedom SOLO stentless pericardial aortic valve demonstrated excellent haemodynamics and a good safety profile out to the 1 year of follow-up.
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Affiliation(s)
- David Heimansohn
- Department of Cardiothoracic Surgery, St Vincent Heart Center, Indianapolis, IN, USA
| | - Eric E Roselli
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Vinod H Thourani
- Division of Cardiothoracic Surgery, Emory University, Atlanta, GA, USA
| | - Shaohua Wang
- Department of Cardiothoracic Surgery, University of Alberta, Edmonton, AB, USA
| | | | - Jian Ye
- St. Paul's Hospital, Vancouver, BC, Canada
| | - Reza Dabir
- Great Lakes Cardiovascular and Thoracic Surgeons, Dearborn, MI, USA
| | - Michael Moon
- Mazankowski Alberta Heart Institute, Edmonton, AB, Canada
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330
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Rosu C, Soltesz EG. Selection of Valve Prostheses. Semin Thorac Cardiovasc Surg 2015; 27:152-8. [DOI: 10.1053/j.semtcvs.2015.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2015] [Indexed: 11/11/2022]
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