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Singh N, Chaudhuri K, Nand P. Severe early aneurysmal degeneration of a Freestyle aortic root bioprosthesis in a patient with known genetic aortopathy. ANZ J Surg 2022; 93:1095-1096. [PMID: 36259718 DOI: 10.1111/ans.18126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 09/13/2022] [Accepted: 10/10/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Navneet Singh
- Green Lane Cardiothoracic Surgical Unit, Auckland City Hospital, Auckland, New Zealand
| | - Krish Chaudhuri
- Green Lane Cardiothoracic Surgical Unit, Auckland City Hospital, Auckland, New Zealand
| | - Parma Nand
- Green Lane Cardiothoracic Surgical Unit, Auckland City Hospital, Auckland, New Zealand
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2
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Casenghi M, Rubbio AP, Menicanti L, Bedogni F, Testa L. Durability of surgical and transcatheter aortic bioprostheses. A review of the literature. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 42:161-170. [DOI: 10.1016/j.carrev.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/07/2022] [Accepted: 03/07/2022] [Indexed: 11/03/2022]
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3
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Butany J, Schoen FJ. Cardiac valve replacement and related interventions. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00010-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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4
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Wojnarski CM, Moraca RJ. Commentary: Stentless valve for bicuspid aortic valve replacement: Some answers just lead to more questions. JTCVS OPEN 2021; 8:191-192. [PMID: 36004126 PMCID: PMC9390319 DOI: 10.1016/j.xjon.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Charles M. Wojnarski
- Address for reprints: Charles M. Wojnarski, MD, MS, Virginia Mason Medical Center, 1100 Ninth Ave, X3-CAR, Seattle, WA 98101.
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5
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Benedetto U, Sinha S, Dimagli A, Dixon L, Stoica S, Cocomello L, Quarto C, Angelini GD, Dandekar U, Caputo M. Aortic valve neocuspidization with autologous pericardium in adult patients: UK experience and meta-analytic comparison with other aortic valve substitutes. Eur J Cardiothorac Surg 2021; 60:34-46. [PMID: 33517391 DOI: 10.1093/ejcts/ezaa472] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/30/2020] [Accepted: 11/25/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES We sought to provide further evidence on the safety and efficacy of aortic valve neocuspidization (AVNeo) using autologous pericardium in adult patients with aortic valve disease by reporting clinical and echocardiographic results from the first UK experience and performing a meta-analytic comparison with other biological valve substitutes. METHODS We reported clinical and echocardiographic outcomes of 55 patients (mean age 58 ± 15 years) undergoing AVNeo with autologous pericardium in 2 UK centres from 2018 to 2020. These results were included in a meta-analytic comparison between series on AVNeo (7 studies, 1205 patients, mean weighted follow-up 3.6 years) versus Trifecta (10 studies, 8705 patients, 3.8 years), Magna Ease (3 studies, 3137 patients, 4.1 years), Freedom Solo (4 studies, 1869 patients, 4.4 years), Freestyle (4 studies, 4307 patients, 7 years), Mitroflow (4 studies, 4760 patients, 4.1 years) and autograft aortic valve (7 papers, 3839 patients, 9.1 years). RESULTS In the present series no patients required intraoperative conversion. After mean follow-up of 12.5 ± 0.9 months, 3 patients presented with endocarditis and 1 required reintervention. The remaining patients had absent or mild aortic valve insufficiency with very low peak and mean transvalvular gradients (16 ± 3.7 and 9 ± 2.2 mmHg, respectively). Meta-analytic estimates showed non-significant difference between AVNeo and all but Magna Ease valves with regards to structural valve degeneration, reintervention and endocarditis. When compared Magna Ease valve, AVNeo and other valve substitutes showed an excess of valve-related events. CONCLUSIONS AVNeo is safe, associated with excellent haemodynamic profile. Its midterm risk of valve-related events is comparable to most biological valve substitutes. Magna Ease is potentially the best biological choice as far as risk of reintervention is concerned.
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Affiliation(s)
- Umberto Benedetto
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol, UK
| | - Shubhra Sinha
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol, UK
| | - Arnaldo Dimagli
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol, UK
| | - Lauren Dixon
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol, UK
| | - Serban Stoica
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol, UK
| | - Lucia Cocomello
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol, UK
| | - Cesare Quarto
- Department of Cardiothoracic Surgery, Royal Brompton Harefield NHS Trust, London, UK
| | - Gianni D Angelini
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol, UK
| | - Uday Dandekar
- Department of Cardiothoracic Surgery, University Hospital Coventry Warwickshire NHS Trust, Coventry, West Midlands, UK
| | - Massimo Caputo
- Bristol Heart Institute, Translational Health Sciences, University of Bristol, Bristol, UK
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6
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Abstract
Aortic stenosis is the most common valvular disease requiring valve replacement. Valve replacement therapies have undergone progressive evolution since the 1960s. Over the last 20 years, transcatheter aortic valve replacement has radically transformed the care of aortic stenosis, such that it is now the treatment of choice for many, particularly elderly, patients. This review provides an overview of the pathophysiology, presentation, diagnosis, indications for intervention, and current therapeutic options for aortic stenosis.
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Affiliation(s)
- Marko T Boskovski
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA
| | - Thomas G Gleason
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA
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7
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Rasmussen K, Rokey R, Rolak SC, Zhong C, Braxton JH, Hashimoto K. Repeat Pregnancy after Prior Aortic Valve-in-Valve Replacement: A Cautionary Tale. Clin Med Res 2020; 18:153-160. [PMID: 32878905 PMCID: PMC7735452 DOI: 10.3121/cmr.2020.1554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 06/02/2020] [Accepted: 06/23/2020] [Indexed: 11/18/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) within a severely stenotic native aortic valve or previously placed surgical biologic aortic valve replacement (SAVR) is a rare occurrence in pregnant patients. The short- and long-term procedural outcomes for future pregnancies in these women or any woman of child bearing age who have received prior TAVR or TAVR in SAVR, are unknown. We describe the first result of a repeat pregnancy outcome in a woman with a history of prior TAVR in SAVR. Both maternal and fetal outcomes were favorable, but maternal cardiac complications observed in the third trimester emphasize our concerns regarding risk for cardiac complications in subsequent pregnancies in patients with a prior TAVR in SAVR. Despite the maternal complications that occurred during repeat pregnancy in this patient, a successful pregnancy outcome reaffirms our recommendation to utilize a multidisciplinary team for pregnancy management in patients with prior TAVR or TAVR in SAVR and to help in the management of any cardiac complications that may occur during or shortly after pregnancy.
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Affiliation(s)
- Kelly Rasmussen
- Cardiology Department, Marshfield Medical Center, Marshfield, WI USA
| | - Roxann Rokey
- Clinical Research Center, Marshfield Clinic Research Institute, Marshfield, WI USA
| | - Stacey C Rolak
- University of Wisconsin, School of Medicine and Public Health, Madison, WI USA
| | - Chuyang Zhong
- Department of Internal Medicine, Marshfield Medical Center, Marshfield, WI USA
| | - John H Braxton
- Department of Surgery, Billings Clinic, Billings, MT USA
| | - Kazumasa Hashimoto
- Obstetrics and Gynecology Department, Marshfield Medical Center, Marshfield, WI USA
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8
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Zeng BQ, Yu SQ, Chen Y, Zhai W, Liu B, Zhan SY, Sun F. [Safety of biological valves for aortic valve replacement: A systematic review and meta-analysis]. JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2020; 52:547-556. [PMID: 32541991 DOI: 10.19723/j.issn.1671-167x.2020.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To provide a comprehensive and contemporary overview of the long-term safety outcomes after aortic valve replacements (AVR) with conventional biological heart valve (stented or stentless). METHODS English databases (Medline, Embase, Web of Science, CENTRAL, and ClinicalTrial.gov) and Chinese databases (CNKI, VIP, WanFang, and SinoMed) were searched systemically from January 1, 2000 to January 26, 2019. Eligible randomized controlled trials, non-randomized clinical trials, cohort studies (retrospective or prospective), and unselected case series were included. Strict screening of the obtained literature was conducted to extract relevant data by two reviewers. Other inclusion criteria were studied reporting on outcomes of AVR with biological valves (stented or stentless), with or without coronary artery bypass grafting (CABG) or valve repair procedure, with mean follow-up length equal to or longer than 5 years. We excluded studies that reported only a specific patient group (e.g., patients with renal failure, or pregnancy), without the report of biological valve type, or with study population size less than 100. The meta-analysis was performed using Stata 14.0 software. RESULTS In this study, 53 papers (in total 57 study groups) involving 47 803 patients were included. (1) The all-cause mortality was 6.33/100 patient-years (95%CI: 5.85-6.84). Subgroup analysis showed that the mortality rates of porcine and bovine valve prostheses were 5.69/100 patient-years (95%CI: 5.05-6.41) and 7.29/100 patient-years (95%CI: 6.53-8.13), respectively. The all-cause mortality rates for stented and stentless valve were 6.69/100 patient-years (95%CI: 6.12-7.30) and 5.21/100 patient-years (95%CI: 4.43-6.14), respectively. (2) The incidence rate of thromboembolism was 1.16/100 patient-years (95%CI: 0.96-1.40), the incidence rate of permanent pacemaker (PPM) implantation was 1.08/100 patient-years (95%CI: 0.75-1.54), the incidence rate of stroke was 0.74/100 patient-years (95%CI: 0.51-1.06), the incidence rate of structural valve dysfunction (SVD) was 0.73/100 patient-years (95%CI: 0.59-0.91), the incidence rate of major bleeding was 0.52/100 patient-years (95%CI: 0.41-0.65), the incidence rate of endocarditis was 0.38/100 patient-years (95%CI: 0.33-0.44), and the incidence rate of non-structural valve dysfunction (NSVD) was 0.20/100 patient-years (95%CI: 0.13-0.31). The total reoperation rate for biological aortic valve was 0.77/100 patient-years (95%CI: 0.65-0.91), and the SVD related reoperation rate was 0.46/100 patient-years (95%CI: 0.36-0.58). CONCLUSION The all-cause mortality for conventional biological AVR was 6.33/100 patient-years. Thromboembolism, PPM implantation, reoperation, stroke, and SVD were major long term complications.
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Affiliation(s)
- B Q Zeng
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - S Q Yu
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - Y Chen
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - W Zhai
- Beijing Center for ADR Monitoring, Beijing 100024, China
| | - B Liu
- Beijing Center for ADR Monitoring, Beijing 100024, China
| | - S Y Zhan
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - F Sun
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
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9
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Stefanelli G, Pirro F, Macchione A, Bellisario A, Weltert L. Long-term follow-up after Bentall operation using a stentless Shelhigh NR-2000 bio-conduit. J Card Surg 2020; 35:988-995. [PMID: 32176376 DOI: 10.1111/jocs.14510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND To analyze the long-term results after Bentall operation using the stentless Shelhigh No-React (NR)-2000 bio-root prosthesis. MATERIAL From 2004 to 2008, 26 consecutive, nonselected patients (mean age at surgery: 67 ± 9 years) underwent a Bentall operation using a stentless Shelhigh valved conduit at our institution. Mean preoperative Logistic-EuroSCORE was 17.1 ± 12.9. The mean size of the aortic root was 53.2 ± 5 mm. The mean preoperative ejection fraction was 55 ± 7.4%. Three patients had a bicuspid valve. One patient with acute endocarditis and one patient with type A aortic dissection were operated on an emergency. Three patients (11.54%) had a previous cardiac operation. The Button-Bentall technique was used in all cases. Seven patients (26.92%) received an associated procedure. The mean size of the implanted prosthesis was 26.1 ± 2.2. Follow-up ranged between 6 and 174 months (mean 93.4 ± 59.1 months). Primary endpoints consisted of early and late mortality, freedom from acute endocarditis, freedom from structural valve deterioration, and freedom from valve-related-reoperation. RESULTS Two patients died in hospital, while 10 patients died during follow-up time, of which three for cardiac causes (12.5%). Overall survival probability was 52.9% at 15 years. Freedom from acute endocarditis was 95.7% at 5 and 15 years. Freedom from severe aortic incompetence due to structural deterioration was 100% at 5 and 10 years, 90.9% at 15 years. The mean aortic gradient at follow-up was 11.4 ± 5 mm Hg. Freedom from valve-related reoperation was 100% at 5 and 10 years, 90.9% at 15 years. CONCLUSIONS In our experience, Bentall's operation using the Shelhigh NR-2000 stentless bio-conduit provided satisfactory early and long-term results. However, our findings are not consistent with unfavorable long-term outcomes following the implantation of this device reported by other authors.
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Affiliation(s)
| | - Fabrizio Pirro
- Department of Cardiac Surgery, Hesperia Hospital, Modena, Italy
| | | | | | - Luca Weltert
- Department of Cardiac Surgery, European Hospital, Rome, Italy
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10
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Influence of Age on Longevity of a Stentless Aortic Valve. Ann Thorac Surg 2019; 110:500-507. [PMID: 31877296 DOI: 10.1016/j.athoracsur.2019.10.085] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 10/24/2019] [Accepted: 10/28/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND The longevity of a stentless valve in a younger population (20-60 years old) is unknown. METHODS From 1992 to 2015, 1947 patients underwent aortic valve/root replacement for aortic stenosis, insufficiency, root aneurysm, or aortic dissection with stentless bioprostheses (median size, 26 mm). At operation 105 patients were <40 years old, 528 were 40 to 59, 860 were 60 to 74, and 454 were ≥75 years. The data were obtained through chart review, administered surveys, and the National Death Index. RESULTS The 30-day mortality rate was 2.6%. During follow-up 807 patients (41%) died before reoperation, 993 (51%) were alive without reoperations because of deterioration, and 113 patients (5.8%) underwent reoperation for structural valve deterioration. After adjusting death and reoperation for non-structural valve deterioration causes as competing risks, the cumulative incidence of reoperation was significantly different between the younger groups (<40, 40-59) and the older groups (60-74, ≥75; P < .0001) but not inside the younger (<40 vs 40-59) or older (60-74 vs ≥75) group. The significant hazard ratio of reoperation for <40 versus ≥75 years of age was 12, <40 versus 60 to 74 was 4, 40 to 59 versus 60 to 74 was 3, and 40 to 59 versus ≥75 was 9 (P ≤ .01). The 10- and 15-year survival in the entire cohort was 53% and 29%, respectively. CONCLUSIONS The stentless aortic valve provides satisfactory durability as a conduit for aortic valve/root replacement for patients who prefer a bioprosthesis. However it should be judiciously considered for patients younger than 60 years because of an increased incidence of reoperation for structural valve deterioration.
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11
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Gennari M, Giambuzzi I, Polvani G, Agrifoglio M. TAVI-in-homograft (TiH): open transcatheter aortic valve replacement in calcified aortic homograft case reports. J Cardiothorac Surg 2019; 14:208. [PMID: 31775822 PMCID: PMC6881997 DOI: 10.1186/s13019-019-1036-2] [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: 09/05/2019] [Accepted: 11/18/2019] [Indexed: 11/17/2022] Open
Abstract
Background Redo surgery in patient who underwent aortic valve replacement with an aortic homograft can result technically challenging because of the massive calcification of the conduit. Case presentation We present a case of a patient who underwent open surgery on cardiopulmonary bypass assistance to implant a standard transcatheter aortic bioprosthesis through aortotomy in an off-label procedure and we discuss its safety and feasibility. Conclusions The combination of open cardiac surgery and open trans-aortic implant of a transcatheter prosthesis may reduce the surgical risk shrinking the technical difficulties that the implantation of a standard surgical prosthesis would have given.
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Affiliation(s)
- Marco Gennari
- Centro Cardiologico Monzino IRCCS, Via Parea 4 - 20138, Milan, Italy.
| | - Ilaria Giambuzzi
- Centro Cardiologico Monzino IRCCS, Via Parea 4 - 20138, Milan, Italy
| | - Gianluca Polvani
- Centro Cardiologico Monzino IRCCS, Via Parea 4 - 20138, Milan, Italy.,Department of Cardiovascular Sciences and Community Health, University of Milan, Milan, Italy
| | - Marco Agrifoglio
- Centro Cardiologico Monzino IRCCS, Via Parea 4 - 20138, Milan, Italy.,Department of Cardiovascular Sciences and Community Health, University of Milan, Milan, Italy
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12
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Zhong C, Rokey R, Rolak S, Mesa J. Pregnancy and transcatheter aortic valve replacement in a severely stenotic Freestyle full aortic root stentless bioprosthesis. Catheter Cardiovasc Interv 2019; 95:1225-1229. [PMID: 31483554 DOI: 10.1002/ccd.28481] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/26/2019] [Accepted: 08/20/2019] [Indexed: 12/22/2022]
Abstract
Symptomatic degenerative prosthetic aortic valve stenosis during pregnancy represents a significant risk to both mother and fetus, and until recently, surgical aortic valve replacement (SAVR) during pregnancy was often the only choice for women opting to continue pregnancy. However, symptomatic severe stenosis in a pregnant woman with a degenerated full aortic root Freestyle stentless bioprosthesis (FSB) and reimplanted coronary arteries presents additional complexities that require an alternative surgical approach. In this case report, we describe the first successful transcatheter aortic valve replacement (TAVR) in SAVR for a severely stenotic degenerative FSB in a pregnant woman and subsequent delivery of a healthy infant several months later. TAVR in SAVR of a severely stenotic aortic FSB should be considered as a surgical option in symptomatic pregnant women. Short-term and long-term implications for future pregnancy should be discussed by a multidisciplinary team and with the patient.
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Affiliation(s)
- Chuyang Zhong
- Department of Internal Medicine, Marshfield Medical Center-Marshfield, Marshfield, Wisconsin
| | - Roxann Rokey
- Clinical Research Center, Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | - Stacey Rolak
- University of Wisconsin, School of Medicine and Public Health, Madison, Wisconsin
| | - Juan Mesa
- Cardiology Department, Marshfield Medical Center-Marshfield, Marshfield, Wisconsin
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13
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Watanabe Y, Naganuma T, Kitanaka Y, Nakamura S. Thromboembolic acute myocardial infarction after aortic valve replacement using the Freestyle stentless aortic bioprosthesis with subcoronary valve replacement. Eur J Cardiothorac Surg 2019; 55:587-589. [PMID: 30107540 DOI: 10.1093/ejcts/ezy283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/13/2018] [Accepted: 07/18/2018] [Indexed: 11/12/2022] Open
Abstract
A 70-year-old woman with substernal chest pain lasting 2.5 h presented to the emergency department of our hospital. She had a history of aortic valve replacement with the Freestyle stentless aortic bioprosthesis for severe aortic regurgitation 7 years ago. The initial electrocardiogram showed sinus rhythm at a rate of 71 bpm with ST-segment slight elevation in leads II, III and aVF. She was diagnosed as having acute coronary syndrome and was referred for an urgent catheterization. Urgent coronary angiography revealed total occlusion in the distal segment of the right coronary artery. Furthermore, a cavity was revealed around the aortic annulus by the contrast leaked from the ostium of the right coronary artery during angiography. Contrast-enhanced computed tomography showed an enhanced cavity between the native aortic wall and the bioprosthesis and the defect in the cavity. We diagnosed the incompetence of the bioprosthesis and decided to perform repeat aortic valve replacement. During surgery, the presence of a thrombus was confirmed in the cavity. The finding indicated that this embolic event was due to the thrombus from the cavity.
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Affiliation(s)
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Yosuke Kitanaka
- Department of Cardiovascular Surgery, New Tokyo Hospital, Chiba, Japan
| | - Sunao Nakamura
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
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14
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Patel HJ. Look at the Valve but Listen to the Patient. Circ Cardiovasc Qual Outcomes 2019; 12:e005498. [PMID: 30760005 DOI: 10.1161/circoutcomes.119.005498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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15
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Dvir D, Bourguignon T, Otto CM, Hahn RT, Rosenhek R, Webb JG, Treede H, Sarano ME, Feldman T, Wijeysundera HC, Topilsky Y, Aupart M, Reardon MJ, Mackensen GB, Szeto WY, Kornowski R, Gammie JS, Yoganathan AP, Arbel Y, Borger MA, Simonato M, Reisman M, Makkar RR, Abizaid A, McCabe JM, Dahle G, Aldea GS, Leipsic J, Pibarot P, Moat NE, Mack MJ, Kappetein AP, Leon MB. Standardized Definition of Structural Valve Degeneration for Surgical and Transcatheter Bioprosthetic Aortic Valves. Circulation 2018; 137:388-399. [DOI: 10.1161/circulationaha.117.030729] [Citation(s) in RCA: 260] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Bioprostheses are prone to structural valve degeneration, resulting in limited long-term durability. A significant challenge when comparing the durability of different types of bioprostheses is the lack of a standardized terminology for the definition of a degenerated valve. This issue becomes especially important when we try to compare the degeneration rate of surgically inserted and transcatheter bioprosthetic valves. This document, by the VIVID (Valve-in-Valve International Data), proposes practical and standardized definitions of valve degeneration and provides recommendations for the timing of clinical and imaging follow-up assessments accordingly. Its goal is to improve the quality of research and clinical care for patients with deteriorated bioprostheses by providing objective and strict criteria that can be utilized in future clinical trials. We hope that the adoption of these criteria by both the cardiological and surgical communities will lead to improved comparability and interpretation of durability analyses.
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Affiliation(s)
- Danny Dvir
- University of Washington Medical Center, Seattle (D.D., C.M.O., G.B.M., M.R., J.M.M., G.S.A.)
| | | | - Catherine M. Otto
- University of Washington Medical Center, Seattle (D.D., C.M.O., G.B.M., M.R., J.M.M., G.S.A.)
| | - Rebecca T. Hahn
- Columbia University Medical Center, New York (R.T.H., M.A.B., M.B.L.)
| | | | - John G. Webb
- St Paul’s Hospital, Vancouver, British Columbia, Canada (J.G.W., M.S., J.L.)
| | | | | | - Ted Feldman
- NorthShore University HealthSystem, Evanston, IL (T.F.)
| | | | - Yan Topilsky
- Tel Aviv Sourasky Medical Center, Israel (Y.T., Y.A.)
| | | | | | - G. Burkhard Mackensen
- University of Washington Medical Center, Seattle (D.D., C.M.O., G.B.M., M.R., J.M.M., G.S.A.)
| | | | - Ran Kornowski
- Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Israel (R.K.)
| | - James S. Gammie
- University of Maryland School of Medicine, Baltimore (J.S.G.)
| | - Ajit P. Yoganathan
- Georgia Institute of Technology and Emory University, Atlanta, GA (A.P.Y.)
| | - Yaron Arbel
- Tel Aviv Sourasky Medical Center, Israel (Y.T., Y.A.)
| | - Michael A. Borger
- Columbia University Medical Center, New York (R.T.H., M.A.B., M.B.L.)
| | - Matheus Simonato
- St Paul’s Hospital, Vancouver, British Columbia, Canada (J.G.W., M.S., J.L.)
| | - Mark Reisman
- University of Washington Medical Center, Seattle (D.D., C.M.O., G.B.M., M.R., J.M.M., G.S.A.)
| | - Raj R. Makkar
- Cedars-Sinai Medical Center, Los Angeles, CA (R.R.M.)
| | | | - James M. McCabe
- University of Washington Medical Center, Seattle (D.D., C.M.O., G.B.M., M.R., J.M.M., G.S.A.)
| | - Gry Dahle
- Rikshospitalet-Radiumhospitalet Medical Center, Oslo, Norway (G.D.)
| | - Gabriel S. Aldea
- University of Washington Medical Center, Seattle (D.D., C.M.O., G.B.M., M.R., J.M.M., G.S.A.)
| | - Jonathon Leipsic
- St Paul’s Hospital, Vancouver, British Columbia, Canada (J.G.W., M.S., J.L.)
| | | | - Neil E. Moat
- Royal Brompton Hospital, London, United Kingdom (N.E.M.)
| | | | | | - Martin B. Leon
- Columbia University Medical Center, New York (R.T.H., M.A.B., M.B.L.)
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16
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Guihaire J, Kloeckner M, Deleuze P. Exclusion of Complex Paraannular Aortic Abscess With the Freestyle Xenograft. Ann Thorac Surg 2017; 102:e373-5. [PMID: 27645988 DOI: 10.1016/j.athoracsur.2016.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 04/04/2016] [Accepted: 04/06/2016] [Indexed: 11/17/2022]
Abstract
Destructive aortic valve endocarditis is a serious condition that can result in aortoventricular disjunction. The appropriate surgical approach for severe excavating lesions remains a matter of debate. Homografts, prosthetic valves associated with a pericardial patch for annulus repair, and prosthetic valve conduits can be used. We report the technical issue of subcoronary inclusion of the full root Freestyle xenograft for complicated aortic endocarditis extending to the left ventricular outflow tract.
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Affiliation(s)
- Julien Guihaire
- Department of Adult Cardiac Surgery, Marie Lannelongue Hospital, University of Paris Sud, Le Plessis Robinson, France.
| | - Martin Kloeckner
- Department of Adult Cardiac Surgery, Marie Lannelongue Hospital, University of Paris Sud, Le Plessis Robinson, France
| | - Philippe Deleuze
- Department of Adult Cardiac Surgery, Marie Lannelongue Hospital, University of Paris Sud, Le Plessis Robinson, France
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17
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Foroutan F, Guyatt GH, O'Brien K, Bain E, Stein M, Bhagra S, Sit D, Kamran R, Chang Y, Devji T, Mir H, Manja V, Schofield T, Siemieniuk RA, Agoritsas T, Bagur R, Otto CM, Vandvik PO. Prognosis after surgical replacement with a bioprosthetic aortic valve in patients with severe symptomatic aortic stenosis: systematic review of observational studies. BMJ 2016; 354:i5065. [PMID: 27683072 PMCID: PMC5040922 DOI: 10.1136/bmj.i5065] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To determine the frequency of survival, stroke, atrial fibrillation, structural valve deterioration, and length of hospital stay after surgical replacement of an aortic valve (SAVR) with a bioprosthetic valve in patients with severe symptomatic aortic stenosis. DESIGN Systematic review and meta-analysis of observational studies. DATA SOURCES Medline, Embase, PubMed (non-Medline records only), Cochrane Database of Systematic Reviews, and Cochrane CENTRAL from 2002 to June 2016. STUDY SELECTION Eligible observational studies followed patients after SAVR with a bioprosthetic valve for at least two years. METHODS Reviewers, independently and in duplicate, evaluated study eligibility, extracted data, and assessed risk of bias for patient important outcomes. We used the GRADE system to quantify absolute effects and quality of evidence. Published survival curves provided data for survival and freedom from structural valve deterioration, and random effect models provided the framework for estimates of pooled incidence rates of stroke, atrial fibrillation, and length of hospital stay. RESULTS In patients undergoing SAVR with a bioprosthetic valve, median survival was 16 years in those aged 65 or less, 12 years in those aged 65 to 75, seven years in those aged 75 to 85, and six years in those aged more than 85. The incidence rate of stroke was 0.25 per 100 patient years (95% confidence interval 0.06 to 0.54) and atrial fibrillation 2.90 per 100 patient years (1.78 to 4.79). Post-SAVR, freedom from structural valve deterioration was 94.0% at 10 years, 81.7% at 15 years, and 52% at 20 years, and mean length of hospital stay was 12 days (95% confidence interval 9 to 15). CONCLUSION Patients with severe symptomatic aortic stenosis undergoing SAVR with a bioprosthetic valve can expect only slightly lower survival than those without aortic stenosis, and a low incidence of stroke and, up to 10 years, of structural valve deterioration. The rate of deterioration increases rapidly after 10 years, and particularly after 15 years.
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Affiliation(s)
- Farid Foroutan
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada L8S 4L8 Heart Failure/Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Gordon H Guyatt
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada L8S 4L8
| | - Kathleen O'Brien
- Heart Failure/Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Eva Bain
- Heart Failure/Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Madeleine Stein
- Heart Failure/Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Sai Bhagra
- Heart Failure/Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Daegan Sit
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada L8S 4L8
| | - Rakhshan Kamran
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada L8S 4L8
| | - Yaping Chang
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada L8S 4L8
| | - Tahira Devji
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada L8S 4L8
| | - Hassan Mir
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada L8S 4L8
| | - Veena Manja
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada L8S 4L8 Department of Internal Medicine, State University of New York at Buffalo, Buffalo, USA VA WNY Health Care System at Buffalo, Department of Veterans Affairs, USA
| | - Toni Schofield
- Heart Failure/Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Reed A Siemieniuk
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada L8S 4L8 Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Thomas Agoritsas
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada L8S 4L8 Division of General Internal Medicine, and Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Rodrigo Bagur
- Division of Cardiology, London Health Sciences Centre and Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada N6A 5W9
| | - Catherine M Otto
- Division of Cardiology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Per O Vandvik
- Department of Internal Medicine, Innlandet Hospital Trust-division Gjøvik, Norway Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway
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18
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Huygens SA, Mokhles MM, Hanif M, Bekkers JA, Bogers AJJC, Rutten-van Mölken MPMH, Takkenberg JJM. Contemporary outcomes after surgical aortic valve replacement with bioprostheses and allografts: a systematic review and meta-analysis. Eur J Cardiothorac Surg 2016; 50:605-616. [PMID: 27026750 PMCID: PMC5052462 DOI: 10.1093/ejcts/ezw101] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/17/2016] [Accepted: 02/26/2016] [Indexed: 11/14/2022] Open
Abstract
Many observational studies have reported outcomes after surgical aortic valve replacement (AVR), but there are no recent systematic reviews and meta-analyses including all available bioprostheses and allografts. The objective of this study is to provide a comprehensive and up-to-date overview of the outcomes after AVR with bioprostheses and allografts reported in the last 15 years. We conducted a systematic literature review (PROSPERO register: CRD42015017041) of studies published between 2000–15. Inclusion criteria were observational studies or randomized controlled trials reporting on outcomes of AVR with bioprostheses (stented or stentless) or allografts, with or without coronary artery bypass grafting (CABG) or valve repair procedure, with study population size n ≥ 30 and mean follow-up length ≥5 years. Fifty-four bioprosthesis studies and 14 allograft studies were included, encompassing 55 712 and 3872 patients and 349 840 and 32 419 patient-years, respectively. We pooled early mortality risk and linearized occurrence rates of valve-related events, reintervention and late mortality in a random-effects model. Sensitivity, meta-regression and subgroup analyses were performed to investigate the influence of outliers on the pooled estimates and to explore sources of heterogeneity. Funnel plots were used to investigate publication bias. Pooled early mortality risks for bioprostheses and allografts were 4.99% (95% confidence interval [CI], 4.44–5.62) and 5.03% (95% CI, 3.61–7.01), respectively. The late mortality rate was 5.70%/patient-year (95% CI, 4.99–5.62) for bioprostheses and 1.68%/patient-year (95% CI, 1.23–2.28) for allografts. Pooled reintervention rates for bioprostheses and allografts were 0.75%/patient-year (95% CI, 0.61–0.91) and 1.87%/patient-year (95% CI, 1.52–2.31), respectively. There was substantial heterogeneity in most outcomes. Meta-regression analyses identified covariates that could explain the heterogeneity: implantation period, valve type, patient age, gender, pre-intervention New York Heart Association class III/IV, concomitant CABG, study design and follow-up length. There is possible publication bias in all outcomes. This comprehensive systematic review and meta-analysis provides an overview of the outcomes after AVR with bioprostheses and allografts reported during the last 15 years. The results of this study can support patients and doctors in the prosthetic valve choice and can be used in microsimulation models to predict patient outcomes and estimate the cost-effectiveness of AVR with bioprostheses or allografts compared with current and future heart valve prostheses.
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Affiliation(s)
- Simone A Huygens
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands .,Institute for Medical Technology Assessment, Erasmus University, Rotterdam, Netherlands.,Department of Health Policy and Management, Erasmus University, Rotterdam, Netherlands
| | - Mostafa M Mokhles
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Milad Hanif
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Jos A Bekkers
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Maureen P M H Rutten-van Mölken
- Institute for Medical Technology Assessment, Erasmus University, Rotterdam, Netherlands.,Department of Health Policy and Management, Erasmus University, Rotterdam, Netherlands
| | - Johanna J M Takkenberg
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
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19
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Frangois J, Cathenis K, Hamerlijnck R. When a Mechanical Valve Goes Freestyle: A Patient Tailored Valve-In-Valve Implantation. Acta Chir Belg 2015; 115:371-3. [PMID: 26560005 DOI: 10.1080/00015458.2015.11681131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In case of a redo operation after a full root replacement there are two possible options: replacing the entire root or performing a more conservative valve-in-valve implantation. Regarding the relatively high morbidity and mortality of a redo root replacement, the valve-in-valve implantation is the preferred choice if technically feasible. We present the case of a valve-in-valve implantation with a St. Jude mechanical valve in a Medtronic bioprosthesis in a 57-year old man. Follow-up echocardiography after 1 month showed a mean gradient of 17 mmHg and no paravalvular leakage. The combination of a St. Jude bileaflet mechanical valve implanted in a Freestyle root prosthesis has not been described. This case shows that patient tailored treatment with a St. Jude bileaflet mechanical valve in a Freestyle aortic root valve can be safely performed and might be the preferred choice for younger patients, if technically feasible.
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20
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Pepper J. Do stentless valves make a difference? J Thorac Cardiovasc Surg 2014; 148:1911-2. [PMID: 25444185 DOI: 10.1016/j.jtcvs.2014.09.019] [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: 09/11/2014] [Accepted: 09/12/2014] [Indexed: 11/30/2022]
Affiliation(s)
- John Pepper
- Department of Surgery, Royal Brompton Hospital, London, United Kingdom.
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