Early Postoperative Bioprosthetic Valve Calcification

Enhancing Adhesion of Fibrin-Based Hydrogel to Polythioether Polymer Surfaces

The development of stable (bio)hybrid constructs composed of scaffolds and (bio)matrices is a major challenge in the field of tissue engineering. In the present work, the adhesion of fibrin-based hydrogels to the surface of polythioether-based polymers relevant to the 3D printing of polymer scaffolds produced by thiol-ene click chemistry was investigated. Adhesion properties were characterized by single-lap tensile shear testing. Both the sample preparation and the test method were optimized for the analysis of fibrin gel bonding to the polythioether surface. Our experimental results show that even without further modification, an adhesion between the fibrin hydrogel and polythioether is substantial, with an adhesion strength of 4.9 ± 1.0 kPa. To further improve the bonding, linear functional poly(N-vinylpyrrolidone-co-glycidyl methacrylate) (PVP-co-GMA) copolymers were used that are known for covalently binding to fibrin. The maximum adhesion strength in our study was found to be 18.4 ± 3.4 kPa. The pure PVP-co-GMA copolymers also demonstrate covalent binding to the thiol-ene-based polymers with a maximum adhesion strength of 32.2 ± 2.7 kPa. Therefore, compared to pure fibrin, the presence of copolymer coating both on the polythioether surface and in the fibrin gel led to a significant increase of the adhesion strength by a factor of 1.6.

Longitudinal Hemodynamics of Aortic Bioprosthetic Valve in Hemodialysis Patients

We examined the hemodynamic profile of bioprosthetic aortic valves in patients on hemodialysis (HD), longitudinally, and assess the incidence of adverse changes detected by echocardiography. Of 1,146 consecutive patients with severe aortic stenosis who underwent bioprosthetic aortic valve replacement (AVR), 148 patients had end-stage renal disease requiring HD. Each patient on HD was matched one-to-one with a non-HD patient on the basis of propensity scores. The mean follow-up period was 3.3 years for the HD group and 5.9 years for the non-HD group. Follow-up information was available for 95.2%. Postoperative trends of valve hemodynamics derived from linear mixed-effect models showed significant group vs time interactions between the two groups. Stable hemodynamics was consistently observed in the non-HD group, whereas the HD group showed a decrease of -0.06 cm²/y (95% confidence interval (CI), -0.10 to -0.02) in effective orifice area, an increase of 0.8 mm Hg/year (95% CI, 0.4-1.1) in mean pressure gradient, and an increase of 0.08 m/s/year (95%CI, 0.02-0.13) in peak velocity. Cumulative incidence function of SVD more than stage 2 was significantly higher in the HD group (13.1% vs 3.1% at 5 years, Gray test p = 0.01). In a multivariable Fine-Gray analysis, diabetes was independently associated with SVD more than stage 2 in the HD group (subhazard ratio, 1.91; 95% CI, 1.25-2.89; p = 0.02). Survival free-from stenotic-type SVD was significantly lower in HD patients undergoing bioprosthetic AVR. Diabetes was independently associated with postoperative stenotic-type SVD in HD patients.

Outcomes of Redo Transcatheter Aortic Valve Implantation for Structural Valve Degeneration of Transcatheter Aortic Valve

Background: The outcome of redo transcatheter aortic valve (TAV) implantation (TAVI) is unknown for TAV structural valve degeneration (SVD). This paper reports the initial results of redo TAVI for TAV-SVD in Japanese patients. Methods and Results: Of 630 consecutive patients, 6 (1.0%) underwent redo TAVI for TAV-SVD (689-1,932 days after the first TAVI). The first TAV were 23-mm balloon-expandable valves (BEV, n=5) and a 26-mm self-expandable valve (SEV, n=1). All patients underwent multidetector computed tomography (MDCT) before redo TAVI, which showed first-TAV under-expansion (range, 19.1-21.0 mm) compared with the label size. Two BEV and 4 SEV were successfully implanted as second TAV, without moderate/severe regurgitation or 30-day mortality. One of 2 patients with a BEV-inside-BEV implantation had a high transvalvular mean pressure gradient post-procedurally (34 mmHg) and required surgical valve replacement 248 days after the redo TAVI. This, however, was unnoted in patients with SEV implantation during redo TAVI. Planned coronary artery bypass grafting was concomitantly performed in 1 patient with a small sino-tubular junction and SEV-inside-SEV implantation because of the risk of coronary malperfusion caused by the first TAV leaflets. Five of the 6 patients survived during the follow-up period (range, 285-1,503 days). Conclusions: Redo TAVI for TAV-SVD appears safe and feasible, while specific strategies based on MDCT and device selection seem important for better outcomes.

Early onset of prosthesis failure after aortic valve replacement

We report an unusual case of a 78-year-old male who underwent an aortic valve replacement with a 21 mm Labcor tissue porcine aortic valve due to symptomatic aortic stenosis of his native valve. Only 3 months after an uncomplicated postoperative course, on a routine follow-up, transthoracic echo showed restrictive motion of the non-coronary cusp, incomplete closure of the coaptation line and severe aortic regurgitation. The patient was scheduled for a new operation during which the previous prosthetic valve was explanted and a different model was used.