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Robinson A, Nkansah A, Bhat S, Karnik S, Jones S, Fairley A, Leung J, Wancura M, Sacks MS, Dasi LP, Cosgriff-Hernandez E. Hydrogel-polyurethane fiber composites with enhanced microarchitectural control for heart valve replacement. J Biomed Mater Res A 2024; 112:586-599. [PMID: 38018452 DOI: 10.1002/jbm.a.37641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/22/2023] [Accepted: 10/24/2023] [Indexed: 11/30/2023]
Abstract
Polymeric heart valves offer the potential to overcome the limited durability of tissue based bioprosthetic valves and the need for anticoagulant therapy of mechanical valve replacement options. However, developing a single-phase material with requisite biological properties and target mechanical properties remains a challenge. In this study, a composite heart valve material was developed where an electrospun mesh provides tunable mechanical properties and a hydrogel coating confers an antifouling surface for thromboresistance. Key biological responses were evaluated in comparison to glutaraldehyde-fixed pericardium. Platelet and bacterial attachment were reduced by 38% and 98%, respectively, as compared to pericardium that demonstrated the antifouling nature of the hydrogel coating. There was also a notable reduction (59%) in the calcification of the composite material as compared to pericardium. A custom 3D-printed hydrogel coating setup was developed to make valve composites for device-level hemodynamic testing. Regurgitation fraction (9.6 ± 1.8%) and effective orifice area (1.52 ± 0.34 cm2 ) met ISO 5840-2:2021 requirements. Additionally, the mean pressure gradient was comparable to current clinical bioprosthetic heart valves demonstrating preliminary efficacy. Although the hemodynamic properties are promising, it is anticipated that the random microarchitecture will result in suboptimal strain fields and peak stresses that may accelerate leaflet fatigue and degeneration. Previous computational work has demonstrated that bioinspired fiber microarchitectures can improve strain homogeneity of valve materials toward improving durability. To this end, we developed advanced electrospinning methodologies to achieve polyurethane fiber microarchitectures that mimic or exceed the physiological ranges of alignment, tortuosity, and curvilinearity present in the native valve. Control of fiber alignment from a random fiber orientation at a normalized orientation index (NOI) 14.2 ± 6.9% to highly aligned fibers at a NOI of 85.1 ± 1.4%. was achieved through increasing mandrel rotational velocity. Fiber tortuosity and curvilinearity in the range of native valve features were introduced through a post-spinning annealing process and fiber collection on a conical mandrel geometry, respectively. Overall, these studies demonstrate the potential of hydrogel-polyurethane fiber composite as a heart valve material. Future studies will utilize the developed advanced electrospinning methodologies in combination with model-directed fabrication toward optimizing durability as a function of fiber microarchitecture.
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Affiliation(s)
- Andrew Robinson
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, Texas, USA
| | - Abbey Nkansah
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, Texas, USA
| | - Sanchita Bhat
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Shweta Karnik
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Sarah Jones
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, Texas, USA
| | - Ashauntee Fairley
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, Texas, USA
| | - Jonathan Leung
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, Texas, USA
| | - Megan Wancura
- Department of Chemistry, The University of Texas at Austin, Austin, Texas, USA
| | - Michael S Sacks
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, Texas, USA
- James T. Willerson Center for Cardiovascular Modeling and Simulation, The Oden Institute for Computational Engineering and Sciences, Austin, Texas, USA
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, Texas, USA
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
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Wakami T, Koizumi S, Koyama T. Impact of postoperative patient-prosthesis mismatch as a risk factor for early structural valve deterioration after aortic valve replacement with Trifecta bioprosthesis. J Cardiothorac Surg 2022; 17:174. [PMID: 35804395 PMCID: PMC9270818 DOI: 10.1186/s13019-022-01918-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several studies have reported high rates of structural valve deterioration (SVD) in the Trifecta valves. Herein, we analyzed the midterm results of the Trifecta valve and risk factors for early SVD. METHODS We retrospectively reviewed the records of 110 patients who had undergone Trifecta implantation between January 2012 and December 2017. RESULTS We encountered seven cases of Trifecta valve failure. We performed a redo aortic valve replacement in five patients and a transcatheter aortic valve replacement in two patients. The SVD rate was 4.8% at 5 years and 6.6% at 7 years. The mean pressure gradient and peak velocity on the first postoperative echocardiogram in patients with SVD were higher than those in patients without SVD. The SVD rates with and without patient-prosthesis mismatch (PPM) were 2.8% and 12.6% at 5 years and 2.8% and 20.0% at 7 years. PPM is a risk factor for SVD. Noncoronary cusp tears were observed in all patients who had undergone redo surgery. CONCLUSIONS The most common cause of SVD was noncoronary cusp tear. Patients with PPM are at high risk of developing SVD.
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Affiliation(s)
- Tatsuto Wakami
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima Minamimachi Chuoku Kobeshi Hyogoken, Kobe, 650-047, Japan
| | - Shigeki Koizumi
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima Minamimachi Chuoku Kobeshi Hyogoken, Kobe, 650-047, Japan
| | - Tadaaki Koyama
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima Minamimachi Chuoku Kobeshi Hyogoken, Kobe, 650-047, Japan.
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Fard A, Mahmood Z, Nair S, Shaikhrezai K, Al-Attar N. Analysis of incidence and reasons for re-intervention after aortic valve replacement using the Trifecta aortic bioprosthesis. Curr Probl Cardiol 2022; 48:101125. [PMID: 35114295 DOI: 10.1016/j.cpcardiol.2022.101125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 01/25/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Trifecta bioprosthesis claims favourable haemodynamic performance. However, reports of structural valve deterioration (SVD) raise concerns of its long-term durability. We assessed outcomes with the Trifecta valve over a 10-year period. METHODS All patients receiving Trifecta bioprostheses between October 2011 and October 2020 were included. Perioperative and survival characteristics were prospectively collated in an independent database. Re-intervention was recorded as a surrogate for SVD. RESULTS 944 patients (mean age 72.82 years ± 8.13, 58% male) underwent aortic valve replacement with the Trifecta valve. At 10-years, 1.4% of patients required a redo operation, giving an overall freedom from re-intervention of 98.6%. The mean time to re-intervention was 48.87 months. Survival was 73.58% and 76.92% in patients who did not require re-intervention vs re-intervention group, respectively. CONCLUSIONS In a large, single-centre cohort, the Trifecta aortic bioprosthesis had a 1.4% all-cause re-intervention rate at 10-years, with insignificant impact on survival.
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Affiliation(s)
| | - Zahid Mahmood
- Golden Jubilee National Hospital, Clydebank, Scotland
| | | | | | - Nawwar Al-Attar
- University of Glasgow, Glasgow, UK; Golden Jubilee National Hospital, Clydebank, Scotland.
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Reply: Prosthesis−patient mismatch: No consensus yet. JTCVS OPEN 2021; 8:247-248. [PMID: 36004140 PMCID: PMC9390170 DOI: 10.1016/j.xjon.2021.07.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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5
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Aitaliyev S, Rumbinaitė E, Mėlinytė-Ankudavičė K, Nekrošius R, Keturakis V, Benetis R. Early outcomes of patient-prosthesis mismatch following aortic valve replacement. Perfusion 2021; 37:692-699. [PMID: 34080457 PMCID: PMC9500169 DOI: 10.1177/02676591211023286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Patient-prosthesis mismatch (PPM) has been associated with numerous short- and long-term adverse events. This study aimed to evaluate the effect of PPM on early postoperative results after aortic valve replacement (AVR) in daily practice. METHODS In this single-centre retrospective study, 150 non-consecutive patients from March 2019 to January 2020 with clinically indicated AVR with/without concomitant surgery were analysed. The study protocol included operative mortality, complication rate, and pre- and postoperative echocardiographic data. PPM was considered severe with indexed effective orifice area at <0.65 cm2/m2, moderate at 0.65-0.85 cm2/m2 and none at >0.85 cm2/m2. RESULTS Moderate PPM was observed in 16 patients (10.6%). No patient had severe PPM. PPM was not related to early mortality (r = 0.40, p = 0.630), intra- (r = -0.076, p = 0.352) and postoperative (r = -0.0134, p = 0.102) events. CONCLUSION In this study, moderate PPM was a frequent finding after AVR, whereas severe PPM was not observed. PPM did not affect the early results after AVR. A long-term follow-up study in a large patient population is required to assess the actual influence of residual PPM.
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Affiliation(s)
- Serik Aitaliyev
- Department of Cardiac, Thoracic and Vascular Surgery, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Egle Rumbinaitė
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Rokas Nekrošius
- Department of Cardiac, Thoracic and Vascular Surgery, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Vytenis Keturakis
- Department of Cardiac, Thoracic and Vascular Surgery, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rimantas Benetis
- Department of Cardiac, Thoracic and Vascular Surgery, Hospital of Lithuanian University of Health Sciences Kauno Klinikos, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Atluri P. Reply: Establishing clarity on valve labeling. J Thorac Cardiovasc Surg 2021; 161:e372-e373. [PMID: 33487418 DOI: 10.1016/j.jtcvs.2020.12.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 12/04/2020] [Accepted: 12/05/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Pavan Atluri
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa
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Zhou Y, Zhang L, Hua K, Zhang J, Yang X. The benefit of fibrosa layer stripping technique during minimally invasive aortic valve replacement for calcified aortic valve stenosis-A randomized controlled trial. J Card Surg 2020; 36:466-474. [PMID: 33314388 DOI: 10.1111/jocs.15215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/01/2020] [Accepted: 10/29/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Fibrosa layer stripping (FLS) technique is a new approach to remove the calcified aortic valve. In this study, we aimed to assess the effectiveness of the FLS technique by comparing it with the conventional technique in minimally invasive aortic valve replacement (MIAVR). METHODS A prospective, single-center, randomized controlled trial was conducted at Beijing Anzhen Hospital. Seventy patients diagnosed with severe calcific aortic stenosis were randomly assigned to undergo FLS (n = 35) or conventional (n = 35) technique to debride calcified aortic valve. Preoperative profile, procedural parameters, and postoperative outcomes were analyzed. RESULTS No significant difference was observed in the preoperative profile between the two groups. Compared with the conventional technique, the FLS technique had a significantly higher indexed effective orifice area and lower mean gradient. Moreover, the FLS technique was associated with significantly reduced aortic cross-clamp time (41 [38-44] vs. 56 [51-60] min, p < .001), cardiopulmonary bypass (CPB) time (63 [56-69] vs. 81 [75-84] min, p < .001), and operative time (148 [141-156] vs. 173 [169-180] min, p < .001). Lastly, the length of intensive care unit stay (1.2 ± 0.4 vs. 1.5 ± 0.8 days, p = .041) and hospital stay (5.3 ± 0.6 vs. 6.0 ± 1.4 days, p = .020) was significantly reduced in the FLS group compared with those in the conventional group. CONCLUSIONS FLS technique is effective in removing calcified tissue during MIAVR and is associated with shorter cross-clamp time and CPB time, and better hemodynamic performance than the conventional technique.
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Affiliation(s)
- Yuan Zhou
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Liang Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Kun Hua
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jinwei Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiubin Yang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Affonso da Costa FD. Commentary: Prosthesis-patient mismatch, the controversy goes on. J Thorac Cardiovasc Surg 2020; 164:833-834. [PMID: 33309085 DOI: 10.1016/j.jtcvs.2020.11.012] [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: 11/02/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 10/23/2022]
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Moront MG, Sabik JF, Reardon MJ, Dagenais F, Lange R, Walther T, Kerendi F, Klautz RJM. Sizing Strategy and Implant Considerations for the Avalus Valve. Ann Thorac Surg 2020; 110:e551-e553. [PMID: 32540438 DOI: 10.1016/j.athoracsur.2020.04.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/18/2020] [Indexed: 10/24/2022]
Abstract
Hemodynamic performance of the Avalus valve through 3 years after implant is comparable to that of contemporary surgical bioprostheses. Many variables affect hemodynamic outcomes, including surgical technique. This article describes our experience with the Avalus bioprosthesis and strategies to achieve optimal hemodynamic performance.
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Affiliation(s)
- Michael G Moront
- Department of Cardiothoracic Surgery, ProMedica Toledo Hospital, Toledo, Ohio.
| | - Joseph F Sabik
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Michael J Reardon
- Department of Cardiovascular Surgery, DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Francois Dagenais
- Department of Cardiac Surgery, University Institute of Cardiology and Pulmonology of Quebec (IUCPQ), University of Laval, Québec, Canada
| | - Rüdiger Lange
- Department of Cardiovascular Surgery and the INSURE-Institute for Translational Cardiac Surgery, German Heart Centre Munich, Munich, Germany
| | - Thomas Walther
- Department of Cardiac, Thoracic, and Thoracic Vascular Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Faraz Kerendi
- Division of Cardiac Surgery, Heart Hospital of Austin, Austin, Texas
| | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
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10
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Lipiski M, Eberhard M, Fleischmann T, Halvachizadeh S, Kolb B, Maisano F, Sauer M, Falk V, Emmert MY, Alkadhi H, Cesarovic N. Computed Tomography-based evaluation of porcine cardiac dimensions to assist in pre-study planning and optimized model selection for pre-clinical research. Sci Rep 2020; 10:6020. [PMID: 32265478 PMCID: PMC7138799 DOI: 10.1038/s41598-020-63044-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 03/24/2020] [Indexed: 12/25/2022] Open
Abstract
The pig (Sus Scrofa Domestica) is an accepted model for preclinical evaluation of prosthetic heart valves and trans-catheter implantation techniques. Understanding porcine cardiac dimensions through three-dimensional computed tomography (CT), increases preclinical study success, leading to higher cost efficiency and to the observance of the obligation to the 3 R principles. Cardiac CT images of twenty-four Swiss large white pigs were segmented; aortic root, mitral valve, pulmonary trunk, tricuspid valve, as well as the aorto-mitral angle and left atrial height were analyzed. Correlation coefficient (r) was calculated in relation to body weight. In Swiss large white pigs, valvular dimensions, length of the pulmonary artery and ascending aorta as well as left atrial height correlate with body weight. Coronary ostia heights and aorto-mitral angle size can be neglected in animal size selection; no changes were found for either of the two parameters with increasing body weight.
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Affiliation(s)
- Miriam Lipiski
- Division of Surgical Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Matthias Eberhard
- Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Thea Fleischmann
- Division of Surgical Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Beate Kolb
- Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Francesco Maisano
- Department of Cardiac Surgery, University Heart Center Zurich, Zurich, Switzerland
| | - Mareike Sauer
- Division of Surgical Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Volkmar Falk
- Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Berlin, Germany.,Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Maximilian Y Emmert
- Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, Berlin, Germany
| | - Hatem Alkadhi
- Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Nikola Cesarovic
- Division of Surgical Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
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Tasca G, Lucherini F, Romagnoni C, Jaworek M, Redaelli A, Antona C, Vismara R. Effect of the valve design on pressure drop, pressure recovery, and spatial positioning of vena contracta. Int J Artif Organs 2020; 43:468-475. [PMID: 31894714 DOI: 10.1177/0391398819896582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Bioprostheses are complex structures and yield a very complex fluid dynamics. Hence, it can be hypothesized that prosthesis structural characteristics affect the position of the vena contracta and, consequently, influences the pattern and the extent of pressure recovery downstream from the vena contracta. MATERIALS AND METHODS The study was performed on pericardial aortic prostheses, specifically Crown 21 and 23 (LivaNova PLC, UK), Trifecta 19 and 21 (Edwards Lifescience, USA), and Magna 19 and 21(Abbott, USA), tested in an "ad hoc" devised steady flow loop circuit at four flow rates (10, 15, 20, and 25 L/min). Fluid dynamic quantities were obtained by direct pressure measurement and Doppler interrogation. RESULTS Pressure drop at 25 L/min flow rate was 26.5 ± 0.3 mm Hg and 14.9 ± 0.1 mm Hg for the Trifecta 19 and 21, 37.1 ± 1.0 mm Hg and 27.3 ± 0.4 mm Hg for the Magna 19 and 21, and 36.6 ± 1.0 mm Hg and 22.7 ± 0.1 mm Hg for Crown 21 and 23, respectively. The vena contracta was shorter for Trifecta compared with the Magna and the Crown in which it developed further downstream and as far as 1 cm from the valve leaflets fringes. The pressure recovery was 54% ± 1% for Trifecta 21, 39% ± 1% for Magna 21, and 41% ± 2% for Crown 23 with different patterns. CONCLUSION The design of bioprosthesis affects pressure recovery and the position of the vena contracta. The different patterns of pressure recovery might have clinical impact.
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Affiliation(s)
- Giordano Tasca
- Cardiac Surgery Unit, Heart Health Center, King Saud Medical City, Riyadh, Kingdom of Saudi Arabia
- Department of Electronic, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Federico Lucherini
- Department of Electronic, Information and Bioengineering, Politecnico di Milano, Milan, Italy
- ForCardio.lab, Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
| | - Claudia Romagnoni
- ForCardio.lab, Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
- Cardiovascular Surgery Department, "L. Sacco" Hospital, Università degli Studi di Milano, Milan, Italy
| | - Michal Jaworek
- Department of Electronic, Information and Bioengineering, Politecnico di Milano, Milan, Italy
- ForCardio.lab, Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
| | - Alberto Redaelli
- Department of Electronic, Information and Bioengineering, Politecnico di Milano, Milan, Italy
- ForCardio.lab, Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
| | - Carlo Antona
- ForCardio.lab, Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
- Cardiovascular Surgery Department, "L. Sacco" Hospital, Università degli Studi di Milano, Milan, Italy
| | - Riccardo Vismara
- Department of Electronic, Information and Bioengineering, Politecnico di Milano, Milan, Italy
- ForCardio.lab, Fondazione per la Ricerca in Cardiochirurgia ONLUS, Milan, Italy
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Mehdiani A, Sorokin VA, Sule J, Smiris K, Stadnik D, Lichtenberg A, Blehm A. Mid-term single-center outcomes of BioIntegral compared to Freestyle aortic conduit implantation. THE JOURNAL OF CARDIOVASCULAR SURGERY 2019; 61:512-519. [PMID: 31815376 DOI: 10.23736/s0021-9509.19.11098-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Full aortic root replacement with biological conduit has limited options. This non-randomized cohort study aims to compare mid-term clinical and hemodynamic results of the BioIntegral (BI) composite biological versus the stentless Freestyle (FS) conduits in patients undergoing full aortic root replacement. METHODS From February 2013 to July 2017, 265 patients underwent aortic root replacement at a single institution (202 BI, 65 FS). Preoperative, intraoperative and postoperative parameters, complications including stroke, myocardial infarction (MI), endocarditis and reoperation were studied. Hemodynamic performance of both conduits was analyzed by echocardiography. Target endpoints were 30-day mortality, two-year survival, two-year freedom from major adverse valve-related and cardiovascular events. RESULTS Wider BI conduits were used (BI 27±2 vs. FS 25±2 mm, P<0.0001). The BI group had shorter cardiopulmonary bypass (BI 165±67 vs. FS 200±78 min, P<0.0001) and cross-clamp (BI 102±36 vs. FS 122±40 min, P=0.001) times. Thirty-day mortality was similar in both groups. There were fewer conduit-related reoperations in the BI group (BI 0% vs. FS 3%, P=0.012) but higher postoperative atrial fibrillation (BI 31% vs. FS 17%, P=0.025). No significant differences were observed for stroke (BI 5% vs. FS 10%, P=0.947), MI (BI 3% vs. FS 4%, P=0.583), or infective endocarditis (BI 0% vs. FS 2%, P=0.077). No significant hemodynamic differences were evident on follow-up echocardiography while an improved overall survival trend was seen in the BI group (P=0.062). CONCLUSIONS FS and BI provide comparable clinical mid-term results and hemodynamic parameters. Simplified implantation technique providing shorter cardiopulmonary bypass and operation times are advantageous for BI.
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Affiliation(s)
- Arash Mehdiani
- Department of Cardiovascular Surgery, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Vitaly A Sorokin
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore - .,Department of Cardiac, Thoracic, and Vascular Surgery, National University Hospital, National University Health System, Singapore
| | - Jai Sule
- Department of Cardiac, Thoracic, and Vascular Surgery, National University Hospital, National University Health System, Singapore
| | - Konstantinos Smiris
- Department of Cardiovascular Surgery, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Dmytro Stadnik
- Department of Cardiovascular Surgery, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Artur Lichtenberg
- Department of Cardiovascular Surgery, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Alexander Blehm
- Department of Cardiovascular Surgery, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
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13
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Chang HW, Kim WS, Ahn JH, Carriere KC, Jeong DS, Cho YH, Sung K, Park PW. Late clinical outcomes of aortic valve replacement with Carpentier-Edwards pericardial valves. J Thorac Dis 2019; 11:5372-5381. [PMID: 32030255 DOI: 10.21037/jtd.2019.11.65] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The present study aimed to compare the long-term clinical and hemodynamic outcomes of aortic valve replacement using Carpentier-Edwards Perimount (Perimount) or Perimount Magna (Magna) valves. Methods We enrolled 430 patients who underwent aortic valve replacements with Perimount (n=58) or Magna (n=372) valves [1998-2013]. Multivariable and inverse probability of treatment weight (IPTW) analyses were performed. Results Before IPTW analysis, the overall 8-year survival rate differed significantly between the groups [Perimount 90%±4% vs. Magna 76%±4%; P=0.02; hazard ratio (HR): 0.37 for the Perimount group; 95% confidence interval (CI): 0.17-0.83]. Multivariable analysis of the overall survival identified Perimount valve use as a protective factor (P=0.009; HR: 0.32; 95% CI: 0.14-0.75). Independent risk factors of overall survival were older age, male sex, higher preoperative left ventricular mass index, lower ejection fraction, lower aortic valve pressure gradient, and lower haemoglobin. After applying IPTW, overall survival was again found to be significantly longer in the Perimount group (P=0.04; HR: 0.43; 95% CI: 0.20-0.93). Event-free survival was also better in the Perimount group (P=0.006; HR: 0.38; 95% CI: 0.19-0.75). However, the Magna group had significantly lower aortic valve pressure gradients at one year and five years postoperative. Conclusions Although Magna use led to decreased aortic valve pressure gradients at follow-up, overall and event-free survival rates were significantly better with use of the Perimount valve. Additional and larger studies are needed to confirm these results.
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Affiliation(s)
- Hyoung Woo Chang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Wook Sung Kim
- Department of Thoracic and Cardiovascular Surgery, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joong Hyun Ahn
- Bioinformatics Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Keumhee C Carriere
- Bioinformatics Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Dong Seop Jeong
- Department of Thoracic and Cardiovascular Surgery, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yang Hyun Cho
- Department of Thoracic and Cardiovascular Surgery, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kiick Sung
- Department of Thoracic and Cardiovascular Surgery, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Pyo Won Park
- Department of Thoracic and Cardiovascular Surgery, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Caporali E, Bonato R, Klersy C, Ferrari E. Hemodynamic performance and clinical outcome of pericardial Perimount Magna and Porcine Hancock‐II valves in aortic position. J Card Surg 2019; 34:1055-1061. [DOI: 10.1111/jocs.14212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Elena Caporali
- Department of Cardiac SurgeryCardiocentro Ticino Lugano Switzerland
| | - Riccardo Bonato
- Department of Cardiac SurgeryCardiocentro Ticino Lugano Switzerland
| | - Catherine Klersy
- Clinical Epidemiology and BiometryIRCCS Fondazione Policlinico San Matteo Pavia Italy
| | - Enrico Ferrari
- Department of Cardiac SurgeryCardiocentro Ticino Lugano Switzerland
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15
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Kaneyuki D, Nakajima H, Asakura T, Yoshitake A, Tokunaga C, Tochii M, Hayashi J, Takazawa A, Izumida H, Iguchi A. Early First-Generation Trifecta Valve Failure: A Case Series and a Review of the Literature. Ann Thorac Surg 2019; 109:86-92. [PMID: 31336064 DOI: 10.1016/j.athoracsur.2019.05.073] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 05/16/2019] [Accepted: 05/21/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND The Trifecta valve (Abbott, St Paul, MN) has excellent hemodynamic performance with acceptable rates of freedom from structural valve degeneration. However, some recent studies have reported early Trifecta valve failure. Here, we report a case series of seven Trifecta valve failures with a review of the literature. METHODS Of 107 implantations of Trifecta bioprostheses between 2012 and 2014, we encountered seven Trifecta valve failures (6.5%). Failure of a 19-mm Trifecta valve occurred in 1 patient, failure of a 21-mm Trifecta valve occurred in 5 patients, and failure of a 23-mm Trifecta valve occurred in 1 patient. The mean duration of valve durability was 51 ± 16 months. The mean effective orifice area index on the first echocardiogram after Trifecta valve implantation was 0.96 ± 0.26. The mode of presentation was prosthetic valve stenosis in 3 patients and severe aortic regurgitation in 4 patients. RESULTS Six patients underwent redo surgical aortic valve replacement. The common pathologic findings were circumferential pannus formation with noncoronary cusp tear and leaflet calcification. The rates of preoperative end-renal stage disease and postoperative prosthesis-patient mismatch were higher in patients with Trifecta valve failure. The incidence of early Trifecta valve failure was 3.1% at 48 months and 13.1% at 72 months. CONCLUSIONS In our experience, early Trifecta valve failure was caused by cusp tears or leaflet calcification. Patients with end-renal stage disease and prosthesis-patient mismatch should be closely followed. Some patients with cusp tears may require urgent surgery.
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Affiliation(s)
- Daisuke Kaneyuki
- Division of Cardiovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan.
| | - Hiroyuki Nakajima
- Division of Cardiovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Toshihisa Asakura
- Division of Cardiovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Akihiro Yoshitake
- Division of Cardiovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Chiho Tokunaga
- Division of Cardiovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Masato Tochii
- Division of Cardiovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Jun Hayashi
- Division of Cardiovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Akitoshi Takazawa
- Division of Cardiovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Hiroaki Izumida
- Division of Cardiovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Atsushi Iguchi
- Division of Cardiovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan
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16
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Xiong TY, Li YJ, Feng Y, Liao YB, Zhao ZG, Mylotte D, Wei X, Xu YN, Peng Y, Wei JF, Zheng MX, Zhou X, Meng W, Piazza N, Chen M. Understanding the Interaction Between Transcatheter Aortic Valve Prostheses and Supra-Annular Structures From Post-Implant Stent Geometry. JACC Cardiovasc Interv 2019; 12:1164-1171. [DOI: 10.1016/j.jcin.2019.02.051] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 02/11/2019] [Accepted: 02/14/2019] [Indexed: 11/29/2022]
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17
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Bilkhu R, Jahangiri M, Otto CM. Patient-prosthesis mismatch following aortic valve replacement. Heart 2019; 105:s28-s33. [DOI: 10.1136/heartjnl-2018-313515] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 10/01/2018] [Accepted: 10/14/2018] [Indexed: 01/12/2023] Open
Abstract
Patient-prosthesis mismatch (PPM) occurs when an implanted prosthetic valve is too small for the patient; severe PPM is defined as an indexed effective orifice area (iEOA) <0.65 cm2/m2 following aortic valve replacement (AVR). This review examines articles from the past 10 years addressing the prevalence, outcomes and options for prevention and treatment of PPM after AVR. Prevalence of PPM ranges from 8% to almost 80% in individual studies. PPM is thought to have an impact on mortality, mainly in patients with severe PPM, although severe PPM accounts for only 10–15% of cases. Outcomes of patients with moderate PPM are not significantly different to those without PPM. PPM is associated with higher rates of perioperative stroke and renal failure and lack of left ventricular mass regression. Predictors include female sex, older age, hypertension, diabetes, renal failure and higher surgical risk score. PPM may be a marker of comorbidity rather than a risk factor for adverse outcomes. PPM should be suspected in patients with persistent cardiac symptoms after AVR when there is high prosthetic valve velocity or gradient and a small calculated effective orifice area. After exclusion of other causes of increased transvalvular gradient, re-intervention may be considered if symptoms persist and are unresponsive to medical therapy. However, this decision needs to consider the available options to relieve PPM and whether expected benefits justify the risk of intervention. The only effective intervention is redo surgery with implantation of a larger valve and/or annular enlargement. Therefore, focus needs to be on prevention.
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18
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Should the risk of a permanent pacemaker be considered when choosing a procedure for aortic stenosis? J Thorac Cardiovasc Surg 2017; 154:1566-1567. [DOI: 10.1016/j.jtcvs.2017.07.006] [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: 07/04/2017] [Accepted: 07/10/2017] [Indexed: 11/19/2022]
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19
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Early trifecta valve failure: Warning shot or unfair scrutiny? J Thorac Cardiovasc Surg 2017; 154:1241-1242. [DOI: 10.1016/j.jtcvs.2017.06.033] [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: 06/14/2017] [Accepted: 06/14/2017] [Indexed: 11/19/2022]
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20
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Goldman S. Bigger valve size is not always better. J Thorac Cardiovasc Surg 2017; 154:820-821. [PMID: 28826150 DOI: 10.1016/j.jtcvs.2017.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 05/08/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Scott Goldman
- Division of Cardiovascular Surgery, Lankenau Hospital, Wynnewood, Pa
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21
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Invited Commentary. Ann Thorac Surg 2017; 103:1876-1877. [DOI: 10.1016/j.athoracsur.2016.11.008] [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: 10/24/2016] [Revised: 10/24/2016] [Accepted: 11/08/2016] [Indexed: 11/21/2022]
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