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Macé LG, Fringand T, Cheylan I, Sabatier L, Meille L, Lenoir M, Favier J. Three-dimensional modelling of aortic leaflet coaptation and load-bearing surfaces: in silico design of aortic valve neocuspidizations. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 39:ivae108. [PMID: 38830038 PMCID: PMC11246164 DOI: 10.1093/icvts/ivae108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 04/30/2024] [Accepted: 05/30/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVES Three-dimensional (3D) modelling of aortic leaflets remains difficult due to insufficient resolution of medical imaging. We aimed to model the coaptation and load-bearing surfaces of the aortic leaflets and adapt this workflow to aid in the design of aortic valve neocuspidizations. METHODS Geometric morphometrics, using landmarks and semilandmarks, was applied to the geometric determinants of the aortic leaflets from computed tomography, followed by an isogeometric analysis using Non-Uniform Rational Basis Splines (NURBS). Ten aortic valve models were generated, measuring determinants of leaflet geometry defined as 3D NURBS curves, and leaflet coaptation and load-bearing surfaces were defined as 3D NURBS surfaces. Neocuspidizations were obtained by either shifting the upper central coaptation landmark towards the sinotubular junction or using parametric neo-landmarks placed on a centreline drawn between the centroid of the aortic root base and centroid of a circle circumscribing the 3 upper commissural landmarks. RESULTS The ratio of the leaflet free margin length to the geometric height was 1.83, whereas the ratio of the commissural coaptation height to the central coaptation height was 1.93. The median coaptation surface was 137 mm2 (IQR 58) and the median load-bearing surface was 203 mm2 (60) per leaflet. Neocuspidization multiplied the central coaptation height by 3.7 and the coaptation surfaces by 1.97 and 1.92 using the native coaptation axis and centroid coaptation axis, respectively. CONCLUSIONS Geometric morphometrics reliably defined the coaptation and load-bearing surfaces of aortic leaflets, enabling an experimental 3D design for the in silico neocuspidization of aortic valves.
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Affiliation(s)
- Loïc Georges Macé
- Department of Cardiac Surgery, La Timone Hospital, AP-HM, Aix Marseille Univ, Marseille, France
- Aix Marseille Univ, CNRS, Centrale Med, M2P2, Marseille, France
| | - Tom Fringand
- Aix Marseille Univ, CNRS, Centrale Med, M2P2, Marseille, France
| | | | | | - Laurent Meille
- Cardiovascular Department, Clinique Rhône Durance, Avignon, France
| | - Marien Lenoir
- Department of Cardiac Surgery, La Timone Hospital, AP-HM, Aix Marseille Univ, Marseille, France
- Aix Marseille Univ, CNRS, Centrale Med, M2P2, Marseille, France
| | - Julien Favier
- Aix Marseille Univ, CNRS, Centrale Med, M2P2, Marseille, France
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Mokryk I, Batsak B, Nechai I, Stetsyuk I, Todurov B. A personalized aortic valve replacement using computed tomography-guided aortic valve neocuspidization. Analysis of mid-term results compared to standard Ozaki technique. J Cardiovasc Comput Tomogr 2024; 18:345-351. [PMID: 38553401 DOI: 10.1016/j.jcct.2024.03.013] [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: 01/23/2024] [Revised: 03/06/2024] [Accepted: 03/22/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND The original Ozaki technique involves sizing the neovalve cusps during cross-clamp. It leads to prolonging the ischemic time compared to standard surgical AVR. Measurements taken on the collapsed Aortic Root (AR) may also be inaccurate. We use preoperative Computed Tomography (CT) to perform more accurate sizing in physiological conditions and shorten the ischemic time. This study analyzes the results of the CT-guided Aortic Valve Neocuspidization (AVNeo) compared with the Ozaki technique. METHODS The validity of the concept was evaluated ex vivo. Experimental valves underwent geometric, CT, and hydrodynamic controls. In the clinical phase of the study, we prospectively analyzed patients who received CT-guided AVNeo (N = 7, Group 1). The control group enrolled patients who were operated on after the standard AVNeo technique (N = 15, Group 2). RESULTS In Group 1, Aortic Cross-Clamp (70.3 ± 17.0 vs. 91 ± 21.3 min, ρ = 0.026) and Bypass times (92.9 ± 21.0 vs. 123 ± 24.8 min, ρ = 0.011) were significantly shorter. At discharge, the peak (11.7 ± 2.75 vs. 15.4 ± 4.66 mm Hg, ρ = 0.032) and mean Aortic Valve (AV) gradient (6.29 ± 1.25 vs. 7.87 ± 2.33 mm Hg, ρ = 0.052) were lower in Group 1. Only one patient in Group 2 had Aortic Insufficiency (AI) greater than mild. The mean follow-up was 49.6 ± 6.9 months in both groups. There were no late deaths or any valve-related events detected in any patient. EchoCG revealed that peak (10.0 ± 2.65 vs. 12.6 ± 4.05 mm Hg, ρ = 0.090) and mean AV gradient (5.14 ± 1.35 vs. 6.73 ± 2.25 mm Hg, ρ = 0.054) also were lower in Group 1. AI indexes were stable in both Groups. CONCLUSIONS CT-guided AVNeo is an example of personalized medicine in the surgical treatment of heart valve pathology. It allows the development of a biological AV that adapts to the patient's anatomy, shortens ischemic time, and results in better hemodynamics. A more significant number of clinical observations and longer follow-up are warranted to prove the viability of the concept.
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Affiliation(s)
- Igor Mokryk
- Department of Adult Cardiac Surgery, Heart Institute, Kyiv, Ukraine.
| | - Bogdan Batsak
- University Clinic of Taras Shevchenko National University, Kyiv, Ukraine
| | - Illia Nechai
- Department of Adult Cardiac Surgery, Heart Institute, Kyiv, Ukraine.
| | - Ihor Stetsyuk
- Department of Adult Cardiac Surgery, Heart Institute, Kyiv, Ukraine
| | - Borys Todurov
- Department of Adult Cardiac Surgery, Heart Institute, Kyiv, Ukraine
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Frankel WC, Robinson JA, Roselli EE, Unai S, Tretter JT, Fuller S, Nelson JS, Ghobrial J, Svensson LG, Pettersson GB, Najm HK, Karamlou T. Lifetime Management of Adolescents and Young Adults with Congenital Aortic Valve Disease. Ann Thorac Surg 2024:S0003-4975(24)00461-2. [PMID: 38871162 DOI: 10.1016/j.athoracsur.2024.04.038] [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: 11/15/2023] [Revised: 03/26/2024] [Accepted: 04/24/2024] [Indexed: 06/15/2024]
Abstract
In this invited expert review, we focus on evolving lifetime management strategies for adolescents and young adults with congenital aortic valve disease, acknowledging that these patients often require multiple interventions during their lifetime. Our goal is to preserve the native aortic valve when feasible. Leveraging advanced multimodality imaging, a detailed assessment of the aortic valve and root complex can be obtained, and a surgically approach tailored to an individual patient's anatomy and pathology can be used. In turn, aortic valve repair and reconstruction can be offered to a greater number of patients, either as a definitive strategy or as a component of a staged strategy to delay the need for aortic valve replacement until later in life when more options are available.
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Affiliation(s)
- William C Frankel
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Justin A Robinson
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eric E Roselli
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Shinya Unai
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Justin T Tretter
- Department of Pediatric Cardiology, Heart, Vascular and Thoracic Institute, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Stephanie Fuller
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jennifer S Nelson
- Division of Cardiovascular Surgery, Department of Cardiovascular Services, Nemours Children's Hospital, Orlando, Florida
| | - Joanna Ghobrial
- Department of Pediatric Cardiology, Heart, Vascular and Thoracic Institute, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Gösta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Hani K Najm
- Division of Pediatric Cardiac Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Tara Karamlou
- Division of Pediatric Cardiac Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic Children's Hospital, Cleveland, Ohio.
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Prinzing A, Boehm J, Burri M, Schreyer J, Lange R, Krane M. Midterm results after aortic valve neocuspidization. JTCVS Tech 2024; 25:35-42. [PMID: 38899113 PMCID: PMC11184442 DOI: 10.1016/j.xjtc.2024.02.011] [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: 11/06/2023] [Revised: 01/21/2024] [Accepted: 02/11/2024] [Indexed: 06/21/2024] Open
Abstract
Objectives Aortic valve neocuspidization with autologous pericardium is gaining increasing attention as a surgical treatment option for aortic valve disease. However, little is known about midterm durability and valve-related events. Methods Patients undergoing aortic valve neocuspidization between 2016 and 2021 were included. Transthoracic echocardiography was performed before the operation, at discharge, and annually thereafter. Data were analyzed for incidences of structural valve deterioration, bioprosthetic valve failure, survival, freedom from reoperation, and hemodynamic performance. Results A total of 162 patients underwent aortic valve neocuspidization (mean age, 52.6 ± 16.6 years; range, 13-78 years); 114 (70.4%) were male. A total of 132 patients presented with a bicuspid aortic valve (81.5%) and 126 patients presented with aortic valve stenosis (77.8%). Concomitant procedures were performed in 63 patients (38.9%). Mean follow-up was 3.5 ± 1.2 years. At discharge, peak and mean pressure gradients were 15.6 ± 7.2 mm Hg and 8.4 ± 3.7 mm Hg, respectively, with a mean effective orifice area of 2.4 ± 0.8 cm2. After 5 years, peak and mean pressure gradients were 14.5 ± 4.6 mm Hg and 7.5 ± 2.2 mm Hg, respectively, with a mean effective orifice area of 2.3 ± 0.8 cm2. At 5 years, cumulative incidences of moderate and severe structural valve deterioration and bioprosthetic valve failure were 9.82% ± 3.87%, 6.96% ± 3.71%, and 12.1% ± 4.12%, respectively. Survival was 97.3% ± 1.4%, and freedom from reoperation was 91.3% ± 2.4%. Conclusions Aortic valve neocuspidization accomplishes low pressure gradients early after initial surgery and during follow-up. Survival in this young patient population is excellent. The main reason for reoperation is endocarditis, and rates for structural valve degeneration are low.
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Affiliation(s)
- Anatol Prinzing
- Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, School of Medicine & Health, Technical University of Munich, Munich, Germany
| | - Johannes Boehm
- Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, School of Medicine & Health, Technical University of Munich, Munich, Germany
| | - Melchior Burri
- Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, School of Medicine & Health, Technical University of Munich, Munich, Germany
| | - Julia Schreyer
- Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, School of Medicine & Health, Technical University of Munich, Munich, Germany
| | - Rüdiger Lange
- Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, School of Medicine & Health, Technical University of Munich, Munich, Germany
| | - Markus Krane
- Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, School of Medicine & Health, Technical University of Munich, Munich, Germany
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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Dittfeld C, Bähring S, Welzel C, Jannasch A, Matschke K, Tugtekin SM, Alexiou K. Tissue requirements for the application of aortic valve neocuspidization - appropriate pericardium properties and homogeneity? JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2024; 35:26. [PMID: 38683259 PMCID: PMC11058761 DOI: 10.1007/s10856-024-06790-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 03/05/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVE Aortic valve neocuspidization (AVNeo) using autologous pericardium is a promising technique. Expected advantages are reduced immune response, appropriate biomechanics and lower treatment expenses. Nevertheless, autologous pericardium can be affected by patient's age and comorbidities. Usually, glutaraldehyde (GA) - fixed bovine pericardium is the basic material for aortic valve prostheses, easy available and carefully pre-examined in a standardized fabrication process. Aim of the study is the verification of autologous pericardial tissue homogeneity by analysing tissue thickness, biomechanics and extracellular matrix (ECM) composition. METHODS Segments of human GA-fixed pericardium selected by the surgeon based on visual criteria for cusp pre-cut and remaining after surgical AV replacement were investigated in comparison to bovine standard tissue treated equivalently. Pericardium sampling was performed at up to three positions of each sutured cusp for histological or biomechanical analysis, according to tissue availability. RESULTS AND CONCLUSIONS Human pericardia exhibited a higher heterogeneity in collagen content, density of vessel structures and elastic moduli. Thickness, vessel density and collagen and elastin content differed significantly between the species. In contrast, significant interindividual differences were detected in most properties investigated for human pericardial samples but only for tissue thickness in bovine tissues. Higher heterogeneity of human pericardium, differing vessel and collagen content compared to bovine state-of-the-art material might be detrimental for long term AV functionality or deterioration and have to be intensely investigated in patients follow up after autologous cusp replacement.
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Affiliation(s)
- Claudia Dittfeld
- Department of Cardiac Surgery, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Heart Centre Dresden, Dresden, Germany.
| | - Sophia Bähring
- Department of Cardiac Surgery, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Heart Centre Dresden, Dresden, Germany
| | - Cindy Welzel
- Department of Cardiac Surgery, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Heart Centre Dresden, Dresden, Germany
| | - Anett Jannasch
- Department of Cardiac Surgery, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Heart Centre Dresden, Dresden, Germany
| | - Klaus Matschke
- Department of Cardiac Surgery, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Heart Centre Dresden, Dresden, Germany
| | - Sems-Malte Tugtekin
- Department of Cardiac Surgery, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Heart Centre Dresden, Dresden, Germany
| | - Konstantin Alexiou
- Department of Cardiac Surgery, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Heart Centre Dresden, Dresden, Germany
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Ogami T, Dufendach KA, Imran M, Thoma FW, Bonatti JO, Yoon PD, Kaczorowski DJ, Sultan I, Morell VO, Chu D. Midterm Outcomes After Aortic Valve Neocuspidization (Ozaki Procedure) in Adults. Ann Thorac Surg 2024; 117:789-795. [PMID: 38216078 DOI: 10.1016/j.athoracsur.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/21/2023] [Accepted: 12/19/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Trileaflet aortic valve neocuspidization (AVN) using autologous pericardium (Ozaki procedure) is an emerging surgical treatment option for aortic valve diseases. Although excellent results have been reported from Japan, data pertaining to its use in the United States are sparse. METHODS All adult patients who underwent AVN (AVN group) or surgical aortic valve replacement (SAVR) with a bioprosthetic valve (SAVR group) between 2015 and 2022 were identified. Propensity score matching was used to adjust the baseline characteristics between the 2 groups. RESULTS A total of 101 patients underwent AVN, and 1816 patients underwent SAVR with a bioprosthetic valve. None in the AVN group required conversion to SAVR. Before matching, mean age in the AVN group was 68.5 ± 8.8 years, and 56 patients (55.4%) underwent concomitant procedures. Preoperatively, 3 (3%) had endocarditis. Bicuspid valve was observed in 38 (38.4%). None died at 30 days in the AVN group. The median follow-up duration was 3.2 years. After propensity score matching, the expected survival and freedom from at least moderate aortic regurgitation at 5 years was 91.7% ± 3.1% and 97.6% ± 1.7%, respectively. Propensity score matching yielded 77 patients in each group. The Kaplan-Meier curve demonstrated equivalent survival at 5 years between the 2 groups (P = .95). Additionally, freedom from at least moderate aortic regurgitation was comparable at 5 years (P = .23). CONCLUSIONS AVN can be safely performed for a variety of aortic valve diseases, with or without concomitant operations. AVN demonstrated similar midterm outcomes compared with SAVR with a bioprosthetic valve in the United States adult population.
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Affiliation(s)
- Takuya Ogami
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Keith A Dufendach
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Mahnoor Imran
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Floyd W Thoma
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Johannes O Bonatti
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Pyongsoo D Yoon
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - David J Kaczorowski
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Victor O Morell
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Danny Chu
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Section of Cardiac Surgery, Surgery Service Line, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
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Kalezi ZE, Simbila AN, Mongella S, Nkya D, Sharau G, Shonyela F, Mlawi V, Majani N. Outcomes post Ozaki procedure among children with aortic valve disease at Jakaya Kikwete Cardiac Institute, Dar es Salaam, Tanzania: a retrospective descriptive study. BMC Cardiovasc Disord 2024; 24:163. [PMID: 38504187 PMCID: PMC10949633 DOI: 10.1186/s12872-024-03829-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 03/04/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Aortic valve reconstruction using glutaraldehyde-treated autologous pericardium, also called Ozaki procedure, is a surgical procedure for patients with aortic valve disease. Gratifying results have been reported in adult patients, however, limited published data is available in paediatric population. This study looked at clinical characteristics and early outcomes of children who underwent Ozaki procedure at our Institute. METHODS This was a retrospective descriptive study conducted on children who underwent aortic valve reconstruction at Jakaya Kikwete Cardiac Institute (JKCI) from January 2019 through December 2022. Medical records of these children were reviewed to extract data on demographics, clinical characteristics, redo surgical interventions and survival. RESULTS A total of 10 children underwent Ozaki procedure during the study period. Eight children had severe aortic regurgitation while 2 had severe aortic stenosis preoperatively. All children had either none or trivial aortic regurgitation immediately after surgery. None of them had redone operations throughout the follow-up period. There was no in-hospital mortality, however, one child died one-year after surgery. The mean follow-up period was 1.6 years with the longest follow-up time of 4 years. CONCLUSION Ozaki procedure showed encouraging early results among children with aortic valve disease who underwent surgical repair by this technique. Future studies with larger sample sizes and longer follow up periods to evaluate long-term results in this population are recommended.
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Affiliation(s)
- Zawadi Edward Kalezi
- Department of Paediatric cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania.
| | - Alphonce Nsabi Simbila
- Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Stella Mongella
- Department of Paediatric cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Deogratias Nkya
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Godwin Sharau
- Department of Paediatric cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Felix Shonyela
- Department of Paediatric cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Vivienne Mlawi
- Department of Paediatric cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
| | - Naizihijwa Majani
- Department of Paediatric cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 65141, Dar es Salaam, Tanzania
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Saisho H, Geisler I, Scharfschwerdt M, Sadat N, Zhang X, Puehler T, Ensminger S, Fujita B, Aboud A. Ex vivo evaluation of 3 different right ventricular outflow tract substitutes. Eur J Cardiothorac Surg 2024; 65:ezae081. [PMID: 38479833 DOI: 10.1093/ejcts/ezae081] [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: 09/11/2023] [Revised: 02/22/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVES The Ross procedure represents an excellent treatment option in younger patients with aortic stenosis but is limited by poor availability of homografts. In this study, we investigated the hydrodynamic performance of 3 different types of right ventricular outflow tract replacement with pericardium or synthetic material. METHODS Three different types of valved conduits were constructed using pericardium and/or synthetic material (Group PEPE: pericardial cusps and pericardial conduit, Group PEPR: pericardial cusps and Dacron conduit, Group PRPR: expanded polytetrafluoroethylene cusps and Dacron conduit). The conduits were designed according to the Ozaki method. Their hydrodynamic performance (effective orifice area, mean pressure gradient and leakage volume) were evaluated in a mock circulation loop at different hydrodynamic conditions. RESULTS Hydrodynamic assessment showed significantly larger effective orifice area of PEPE and PEPR compared to PRPR under all conditions and there were no significant differences between PEPE and PEPR [for condition 2: PEPE 2.43 (2.35-2.54) cm2, PEPR: 2.42 (2.4-2.5) cm2, PRPR: 2.08 (1.97-2.21) cm2, adjusted pairwise comparisons: PEPE versus PEPR: P = 0.80, PEPE versus PRPR: P < 0.001, PEPR versus PRPR: P < 0.001]. Mean pressure gradient was significantly lower for PEPE and PEPR compared with PRPR, whereas no significant differences were seen between PEPE and PEPR. Leakage volume was significantly lower for PEPE and PEPR compared with PRPR under all conditions while leakage was similar between PEPE and PEPR. CONCLUSIONS Pulmonary graft reconstruction with pericardium cusps showed superior hydrodynamic performance compared with polytetrafluoroethylene cusps. Our results suggest that it could be considered as an alternative substitute for right ventricular outflow tract replacement during the Ross procedure.
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Affiliation(s)
- Hiroyuki Saisho
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein, Lübeck, Germany
| | - Ioana Geisler
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein, Lübeck, Germany
| | - Michael Scharfschwerdt
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein, Lübeck, Germany
| | - Najla Sadat
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein, Lübeck, Germany
| | - Xiling Zhang
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein, Lübeck, Germany
| | - Thomas Puehler
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein, Lübeck, Germany
- DZHK (German Center for cardiovascular research), Partner Site Hamburg/Kiel/Luebeck, Germany
| | - Stephan Ensminger
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein, Lübeck, Germany
- DZHK (German Center for cardiovascular research), Partner Site Hamburg/Kiel/Luebeck, Germany
| | - Buntaro Fujita
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein, Lübeck, Germany
- DZHK (German Center for cardiovascular research), Partner Site Hamburg/Kiel/Luebeck, Germany
| | - Anas Aboud
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein, Lübeck, Germany
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Manchester EL, Pirola S, Pirola S, Mastroiacovo G, Polvani G, Pontone G, Xu XY. Aortic valve neocuspidization and bioprosthetic valves: Evaluating turbulence haemodynamics. Comput Biol Med 2024; 171:108123. [PMID: 38354498 DOI: 10.1016/j.compbiomed.2024.108123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/05/2024] [Accepted: 02/04/2024] [Indexed: 02/16/2024]
Abstract
Aortic valve disease is often treated with bioprosthetic valves. An alternative treatment is aortic valve neocuspidization which is a relatively new reparative procedure whereby the three aortic cusps are replaced with patient pericardium or bovine tissues. Recent research indicates that aortic blood flow is disturbed, and turbulence effects have yet to be evaluated in either bioprosthetic or aortic valve neocuspidization valve types in patient-specific settings. The aim of this study is to better understand turbulence production in the aorta and evaluate its effects on laminar and turbulent wall shear stress. Four patients with aortic valve disease were treated with either bioprosthetic valves (n=2) or aortic valve neocuspidization valvular repair (n=2). Aortic geometries were segmented from magnetic resonance images (MRI), and 4D flow MRI was used to derive physiological inlet and outlet boundary conditions. Pulsatile large-eddy simulations were performed to capture the full range of laminar, transitional and turbulence characteristics in the aorta. Turbulence was produced in all aortas with highest levels occurring during systolic deceleration. In the ascending aorta, turbulence production is attributed to a combination of valvular skew, valvular eccentricity, and ascending aortic dilation. In the proximal descending thoracic aorta, turbulence production is dependent on the type of arch-descending aorta connection (e.g., a narrowing or sharp bend) which induces flow separation. Laminar and turbulent wall shear stresses are of similar magnitude throughout late systolic deceleration and diastole, although turbulent wall shear stress magnitudes exceed laminar wall shear stresses between 27.3% and 61.1% of the cardiac cycle. This emphasises the significance of including turbulent wall shear stress to improve our comprehension of progressive arterial wall diseases. The findings of this study recommend that aortic valve treatments should prioritise minimising valvular eccentricity and skew in order to mitigate turbulence generation.
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Affiliation(s)
- Emily Louise Manchester
- Department of Chemical Engineering, Imperial College London, London, United Kingdom; Department of Fluids and Environment, The University of Manchester, Manchester, United Kingdom.
| | - Selene Pirola
- Department of Chemical Engineering, Imperial College London, London, United Kingdom; Department of BioMechanical Engineering, Delft University of Technology, Delft, Netherlands.
| | - Sergio Pirola
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Giorgio Mastroiacovo
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Gianluca Polvani
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Gianluca Pontone
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy; Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Xiao Yun Xu
- Department of Chemical Engineering, Imperial College London, London, United Kingdom.
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10
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Hassanabad AF, Kim T, Adams C. A rare and unique case: aortic valve replacement in a young adult with a stenotic unicommissural unicuspid aortic valve. Future Cardiol 2024; 20:5-10. [PMID: 38189260 DOI: 10.2217/fca-2022-0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 10/12/2023] [Indexed: 01/09/2024] Open
Abstract
Unicuspid aortic valve (UAV) is a rare congenital cardiac anomaly. There are two forms of UAV, including unicuspid acommissural and unicuspid unicommissural. Definitive management for UAV is surgical intervention, but due to the rarity of UAV, the long-term surgical outcomes as well as overall prognosis are not known. Here, we present the case of a 19-year-old patient who was found to have a UAV prenatally and underwent a mechanical aortic valve replacement through an upper hemi-sternotomy due to elevated aortic stenosis gradients and presence of symptoms.
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Affiliation(s)
| | - Tiffany Kim
- Section of Cardiac Surgery, Libin Cardiovascular Institute, Calgary, Canada
| | - Corey Adams
- Section of Cardiac Surgery, Libin Cardiovascular Institute, Calgary, Canada
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11
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Patel V, Unai S, Moore R, Layoun H, Harb S, Tong MZ, Karamlou T, Najm HK, Svensson LG, Rajeswaran J, Blackstone EH, Pettersson GB. The Ozaki Procedure: Standardized Protocol Adoption of a Complex Innovative Procedure. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2024; 8:100217. [PMID: 38283567 PMCID: PMC10818143 DOI: 10.1016/j.shj.2023.100217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/30/2023] [Accepted: 08/10/2023] [Indexed: 01/30/2024]
Abstract
Background The Ozaki procedure using autologous pericardium is an interesting but complex alternative for aortic valve replacement. We present a standardized approach to minimize the learning curve and confirm reproducibility. Methods After careful preparation, from May 2015 to February 2021, an Ozaki procedure was performed on 46 patients age 51 ± 14 years. Seven had unicuspid (15%), 29 bicuspid (63%), and 10 tricuspid (22%) aortic valves, and 2 patients had endocarditis. Endpoints were operative learning curves, perioperative outcomes, intermediate-term valve hemodynamics, reintervention, health-related quality of life (MacNew Heart Disease Health-Related Quality of Life questionnaire), and mortality. Results Cardiopulmonary bypass and aortic clamp times decreased from 145 to 125 minutes and 120 to 100 minutes, respectively, over the first 20 cases, reflecting the learning curve. There was no major perioperative morbidity or mortality. Median postoperative stay was 6.9 days. Aortic regurgitation was mild or less in all but 2 patients who developed moderate aortic regurgitation. Mean aortic valve gradient was 7.9 mmHg postoperatively, 9.2 mmHg by 6 months, and constant thereafter. Left ventricular ejection fraction was 58% preoperatively, 60% at 6 months, and remained stable thereafter. One patient developed infective endocarditis 7 months postoperatively, failed medical management, and underwent valve replacement at 14 months. Two-year survival was 96%, with 1 noncardiac death at 16 months. Health-related quality of life in mental, physical, and emotional domains was better than matched norms, global 6.2 vs. 5.0 (p < 0.0001). Conclusions Using a well-prepared standardized approach, the Ozaki procedure is reproducible with a short learning curve, excellent hemodynamic performance, and good quality of life.
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Affiliation(s)
- Viral Patel
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shinya Unai
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ryan Moore
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Habib Layoun
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Serge Harb
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael Z.Y. Tong
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Tara Karamlou
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hani K. Najm
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lars G. Svensson
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jeevanantham Rajeswaran
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Eugene H. Blackstone
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gösta B. Pettersson
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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12
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Pirola S, Pirola S, Mastroiacovo G, Bonomi A, Manchester EL, Fisichella SM, Maragna R, Baggiano A, Mushtaq S, Muscogiuri G, Guglielmo M, Yun Xu X, Pontone G, Polvani G. Does the AVNeo valve reduce wall stress on the aortic wall? A cardiac magnetic resonance analysis with 4D-flow for the evaluation of aortic valve replacement with the Ozaki technique. Eur J Cardiothorac Surg 2023; 64:ezad299. [PMID: 37656941 DOI: 10.1093/ejcts/ezad299] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/15/2023] [Accepted: 08/31/2023] [Indexed: 09/03/2023] Open
Abstract
OBJECTIVES Aortic valve neocuspidalization aims to replace the 3 aortic cusps with autologous pericardium pre-treated with glutaraldehyde, and it is a surgical alternative to the classical aortic valve replacement (AVR). Image-based patient-specific computational fluid dynamics allows the derivation of shear stress on the aortic wall [wall shear stress (WSS)]. Previous studies support a potential link between increased WSS and histological alterations of the aortic wall. The aim of this study is to compare the WSS of the ascending aorta in patients undergoing aortic valve neocuspidalization versus AVR with biological prostheses. METHODS This is a prospective nonrandomized clinical trial. Each patient underwent a 4D-flow cardiac magnetic resonance scan after surgery, which informed patient-specific computational fluid dynamics models to evaluate WSS at the ascending aortic wall. The adjusted variables were calculated by summing the residuals obtained from a multivariate linear model (with ejection fraction and left ventricle outflow tract-aorta angle as covariates) to the mean of the variables. RESULTS Ten patients treated with aortic valve neocuspidalization were enrolled and compared with 10 AVR patients. The aortic valve neocuspidalization group showed a significantly lower WSS in the outer curvature segments of the proximal and distal ascending aorta as compared to AVR patients (P = 0.0179 and 0.0412, respectively). WSS levels remained significantly lower along the outer curvature of the proximal aorta in the aortic valve neocuspidalization population, even after adjusting the WSS for the ejection fraction and the left ventricle outflow tract-aorta angle [2.44 Pa (2.17-3.01) vs 1.94 Pa (1.72-2.01), P = 0.02]. CONCLUSIONS Aortic valve neocuspidalization hemodynamical features are potentially associated with a lower WSS in the ascending aorta as compared to commercially available bioprosthetic valves.
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Affiliation(s)
- Sergio Pirola
- Department of Cardiovascular Surgery, IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - Selene Pirola
- Institute of Clinical Sciences, Imperial College London, London, UK
- Department of BioMechanical Engineering, TU Delft, Delft, Netherlands
| | - Giorgio Mastroiacovo
- Department of Cardiovascular Surgery, IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - Alice Bonomi
- Department of Biostatistics, IRCCS Centro Cardiologico Monzino, Milan, Italy
| | | | | | - Riccardo Maragna
- Department of Cardiac imaging, IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - Andrea Baggiano
- Department of Cardiac imaging, IRCCS Centro Cardiologico Monzino, Milan, Italy
- Department of Cardiovascular Sciences and Community Health, University of Milan, Milan, Italy
| | | | - Giuseppe Muscogiuri
- Department of Radiology, IRCCS Istituto Auxologico Italiano, San Luca Hospital, Milan, Italy
| | - Marco Guglielmo
- Department of Cardiology, Division of Heart and Lungs, Utrecht University, Utrecht University Medical Center, Utrecht, Netherlands
| | - Xiao Yun Xu
- Department of Chemical Engineering, Imperial College London, UK
| | - Gianluca Pontone
- Department of Cardiac imaging, IRCCS Centro Cardiologico Monzino, Milan, Italy
| | - Gianluca Polvani
- Department of Cardiovascular Surgery, IRCCS Centro Cardiologico Monzino, Milan, Italy
- Department of Surgical and Dental Biomedical Sciences, University of Milan, Italy
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13
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Lansakara M, Unai S, Ozaki S. Ozaki procedure-re-construction of aortic valve leaflets using autologous pericardial tissue: a review. Indian J Thorac Cardiovasc Surg 2023; 39:260-269. [PMID: 38093925 PMCID: PMC10713953 DOI: 10.1007/s12055-023-01635-z] [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: 09/19/2023] [Revised: 10/12/2023] [Accepted: 10/23/2023] [Indexed: 12/17/2023] Open
Abstract
The Ozaki procedure has emerged as a valuable option for treating various aortic valve pathologies. This review article delves into the intricacies of this innovative surgical approach by exploring its adaptation to the complex anatomy and physiology of the aortic root. The diverse etiologies of aortic valve diseases, ranging from congenital anomalies to degenerative changes, make treatment selection a complex challenge. Aortic valve replacement has traditionally been the gold standard, but emerging evidence supports valve repair techniques, emphasizing the importance of preserving native tissue. Nevertheless, issues like lifelong anticoagulation with mechanical valves and patient-prosthetic mismatch remain. The Ozaki procedure offers a compelling alternative by utilizing autologous pericardium or a tissue substitute to construct new aortic valve leaflets. This technique, standardized by Dr. Ozaki in 2007, provides a customizable and adaptable solution. The article highlights the anatomy of the aortic root, emphasizing the critical role of the sinus of Valsalva and interleaflet triangles in maintaining proper valve function. The procedure's unique adaptation to aortic root dynamics allows for reduced mechanical stress during systole and diastole, mimicking the natural valve's behavior. Furthermore, Ozaki leaflets exhibit promising hemodynamics and reduced risks of complications, such as permanent pacemaker implantation and patient-prosthetic mismatch. The use of autologous pericardium in the Ozaki procedure presents advantages, including enhanced tissue strength, minimal immunogenicity, and reduced risk of immune-mediated calcification. These factors contribute to the longevity and resilience of the reconstructed valve. This comprehensive review aims to shed light on the procedure's intricacies, its alignment with aortic root anatomy and physiology, and its potential as a valuable tool in the armamentarium of aortic surgeons.
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Affiliation(s)
| | - Shinya Unai
- The Peter and Elizabeth C. Tower and Family Endowed Chair in Cardiothoracic Research, Aortic Valve Center, Heart Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Ave., Desk J4-1, Cleveland, OH 44915 USA
| | - Shigeyuki Ozaki
- Department of Cardiovascular Surgery, Toho University Ohashi Hospital, 2-17-6 Ohashi, Meguro-Ku, Tokyo, 153-8515 Japan
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14
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Mylonas KS, Angouras DC. Bioprosthetic Valves for Lifetime Management of Aortic Stenosis: Pearls and Pitfalls. J Clin Med 2023; 12:7063. [PMID: 38002679 PMCID: PMC10672358 DOI: 10.3390/jcm12227063] [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: 09/10/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023] Open
Abstract
This review explores the use of bioprosthetic valves for the lifetime management of patients with aortic stenosis, considering recent advancements in surgical (SAV) and transcatheter bioprostheses (TAV). We examine the strengths and challenges of each approach and their long-term implications. We highlight differences among surgical bioprostheses regarding durability and consider novel surgical valves such as the Inspiris Resilia, Intuity rapid deployment, and Perceval sutureless bioprostheses. The impact of hemodynamics on the performance and durability of these prostheses is discussed, as well as the benefits and considerations of aortic root enlargement during Surgical Aortic Valve Replacement (SAVR). Alternative surgical methods like the Ross procedure and the Ozaki technique are also considered. Addressing bioprosthesis failure, we compare TAV-in-SAV with redo SAVR. Challenges with TAVR, such as TAV explantation and considerations for coronary circulation, are outlined. Finally, we explore the potential challenges and limitations of several clinical strategies, including the TAVR-first approach, in the context of aortic stenosis lifetime management. This concise review provides a snapshot of the current landscape in aortic bioprostheses for physicians and surgeons.
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Affiliation(s)
| | - Dimitrios C. Angouras
- Department of Cardiac Surgery, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 15772 Athens, Greece;
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15
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Geuens L, Van Hoof L, Van De Bruaene A, Rega F, Meuris B, Verbrugghe P. Aortic valve replacement in non-elderly: the gap between reality, guidelines and evidence. Eur J Cardiothorac Surg 2023; 64:ezad318. [PMID: 37756688 DOI: 10.1093/ejcts/ezad318] [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: 01/31/2023] [Revised: 08/22/2023] [Accepted: 09/24/2023] [Indexed: 09/29/2023] Open
Abstract
OBJECTIVES There are several treatment options for non-elderly adults (18-60 years) in need of aortic valve replacement (AVR): a mechanical or biological substitute, a homograft, the Ross procedure or nowadays even transcatheter aortic valve replacement. This study evaluated the current opinions and practices of cardiac surgeons and cardiologists concerning AVR strategies in this patient group. METHODS A 43-item online survey was sent out to several scientific organizations, individual cardiac surgeons, cardiologists and residents/fellows worldwide. RESULTS Two hundred twenty-two physicians from 33 different countries answered the survey. The UK (24%), Belgium (23%) and North America (22%) are best represented. A mechanical valve is the most frequently used substitute in non-elderly. With increasing patient age, the popularity of a biological valve increases. Transcatheter aortic valve replacement and the Ross procedure are each used in <10% of this cohort. Only 12% of the cardiac surgeons has experience with the Ross surgery. In 23%, the patient seems not to be involved in the decision on the type of valve substitute. CONCLUSIONS The preferred surgical treatment for non-elderly patients in need of AVR differs widely. To enable a shared decision-making process including patient preferences, there is more need for collaboration between cardiac departments, as well as education and scientific research about patient-centred outcomes of the different AVR techniques.
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Affiliation(s)
- Lise Geuens
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Lucas Van Hoof
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | | | - Filip Rega
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Bart Meuris
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Peter Verbrugghe
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
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16
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Jia S, Han J, Jiang W, Zhang H. Triple valve repair for a patient with complex rheumatic-heart valvular disease: A case report. Asian J Surg 2023; 46:5043-5045. [PMID: 37597989 DOI: 10.1016/j.asjsur.2023.06.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/09/2023] [Indexed: 08/21/2023] Open
Affiliation(s)
- Songhao Jia
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jie Han
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wenjian Jiang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
| | - Hongjia Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
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17
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Mikami T, Uchiyama H, Maeda T, Nakashima S, Satoshi M, Taku S, Araki E. A Case of Severe Aortic Stenosis after Aortic Valve Neocuspidization Using Autologous Pericardium (Ozaki Procedure). Ann Thorac Cardiovasc Surg 2023; 29:261-265. [PMID: 35321992 PMCID: PMC10587478 DOI: 10.5761/atcs.cr.21-00269] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/03/2022] [Indexed: 11/16/2022] Open
Abstract
A 56-year-old man with a history of left nephrectomy for Wilms' tumor on chronic hemodialysis underwent aortic valve neocuspidization using autologous pericardium (Ozaki procedure) for aortic stenosis (AS) due to a bicuspid aortic valve 6 years ago. The AS gradually progressed and a decrease in the left ventricular ejection fraction was observed. Because of this, we decided to perform reoperative aortic valve replacement using a mechanical valve. Intraoperative findings showed severe calcification at the site where the autologous pericardium was sutured to the annulus. However, the degeneration of the valve leaflets themselves was mild. While excellent mid-term results have been reported for the Ozaki procedure, the long-term results are still unclear. In this case, the annulus was severely calcified, which reduced the mobility of the leaflet. We report the first case of AS progression requiring reoperation in the long-term period after the Ozaki procedure.
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Affiliation(s)
- Takuma Mikami
- Department of Cardiovascular Surgery, Sapporo Central Hospital, Sapporo, Hokkaido, Japan
| | - Hiroki Uchiyama
- Department of Cardiovascular Surgery, Sapporo Central Hospital, Sapporo, Hokkaido, Japan
| | - Toshiyuki Maeda
- Department of Cardiovascular Surgery, Sapporo Central Hospital, Sapporo, Hokkaido, Japan
| | - Shinji Nakashima
- Department of Cardiovascular Surgery, Sapporo Central Hospital, Sapporo, Hokkaido, Japan
| | - Muraki Satoshi
- Department of Cardiovascular Surgery, Sapporo Central Hospital, Sapporo, Hokkaido, Japan
| | - Sakurada Taku
- Department of Cardiovascular Surgery, Sapporo Central Hospital, Sapporo, Hokkaido, Japan
| | - Eiji Araki
- Department of Cardiovascular Surgery, Sapporo Central Hospital, Sapporo, Hokkaido, Japan
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18
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Bazylev V, Tungusov D, Mikulyak A. Predictors of Mid-Term AVNeo Insufficiency. Braz J Cardiovasc Surg 2023; 38:e20220370. [PMID: 37797236 PMCID: PMC10549767 DOI: 10.21470/1678-9741-2022-0370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/15/2023] [Indexed: 10/07/2023] Open
Abstract
INTRODUCTION Aortic stenosis (AS) is the most common valvular heart disease and the most common indication for aortic valve replacement in adults. Aortic valve neocuspidization (AVNeo) with fixed autologous pericardium, also known as the Ozaki procedure, is a possible alternative treatment of AS. Autopericardial valves save the dynamics and physiological anatomy of the aortic root, however, the service life of autopericardial leaflets is limited. There is no data about factors that may influence the development of AVNeo insufficiency. Here, we assessed the effect of autopericardial leaflet symmetry on the development of aortic insufficiency after Ozaki procedure. METHODS This study included 381 patients with AS who underwent Ozaki procedure. Patients were divided into group 1 (171 patients with symmetric aortic root) and group 2 (210 patients with asymmetric aortic root). RESULTS The maximum observation period was up to 65 months. Sixteen cases of aortic insufficiency were detected in group 1, and 33 cases were detected in group 2. Based on the results of Cox regression, the predictors of aortic insufficiency in the late postoperative period are age and asymmetry of neocusps. According to results of Kaplan-Meier analysis, insufficiency of AVNeo in the maximum follow-up period after surgical correction of AS for group 1 patients was significantly lower than for group 2 patients (P=0.006). CONCLUSION Asymmetric neocusps increase the risk of aortic insufficiency in the mid-term period after Ozaki procedure. And the older the patients at the time of surgery, the less likely they develop AVNeo insufficiency.
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Affiliation(s)
- Vladlen Bazylev
- Federal Center for Cardiovascular Surgery (Penza), Ministry of
Health of the Russian Federation, Penza, Russian Federation
| | - Dmitry Tungusov
- Federal Center for Cardiovascular Surgery (Penza), Ministry of
Health of the Russian Federation, Penza, Russian Federation
| | - Artur Mikulyak
- Federal Center for Cardiovascular Surgery (Penza), Ministry of
Health of the Russian Federation, Penza, Russian Federation
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19
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Lee KFL, Mak KLT, Chen Q, Yam N. Early aortic valve neocuspidization failure due to xenograft leaflet tear in a young adult. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 37:ivad165. [PMID: 37812218 PMCID: PMC10576632 DOI: 10.1093/icvts/ivad165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/04/2023] [Accepted: 10/06/2023] [Indexed: 10/10/2023]
Abstract
Aortic valve neocuspidization, initially described by Ozaki and colleagues, has become an increasingly popular treatment approach for aortic valve disease in both adult and paediatric populations. We report a case of an 18-year-old man with severe aortic regurgitation who underwent the Ozaki procedure using photo-oxidized bovine pericardium. Around 5 weeks after the surgery, he developed early symptomatic valve failure due to multiple leaflet tears requiring urgent reoperation.
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Affiliation(s)
- Kwok Fai Lucius Lee
- Department of Paediatric Cardiothoracic Surgery, Hong Kong Children's Hospital, Hong Kong, China
| | - Ka Lun Tony Mak
- Department of Paediatric Cardiothoracic Surgery, Hong Kong Children's Hospital, Hong Kong, China
| | - Qiang Chen
- Department of Paediatric Cardiothoracic Surgery, Hong Kong Children's Hospital, Hong Kong, China
| | - Nicholson Yam
- Department of Paediatric Cardiothoracic Surgery, Hong Kong Children's Hospital, Hong Kong, China
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20
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Nappi F, Schoell T, Spadaccio C, Acar C, da Costa FDA. A Literature Review on the Use of Aortic Allografts in Modern Cardiac Surgery for the Treatment of Infective Endocarditis: Is There Clear Evidence or Is It Merely a Perception? Life (Basel) 2023; 13:1980. [PMID: 37895362 PMCID: PMC10608498 DOI: 10.3390/life13101980] [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: 08/21/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023] Open
Abstract
Infective valve endocarditis is caused by different pathogens and 60% of those involve the aortic valve with valve failure. Although S. aureus is recognized as the most frequently isolated causative bacterium associated with IE in high-income countries, Gram-positive cocci nevertheless play a crucial role in promoting infection in relation to their adhesive matrix molecules. The presence of pili on the surface of Gram-positive bacteria such as in different strains of Enterococcus faecalis and Streptococcus spp., grants these causative pathogens a great offensive capacity due to the formation of biofilms and resistance to antibiotics. The indications and timing of surgery in endocarditis are debated as well as the choice of the ideal valve substitute to replace the diseased valve(s) when repair is not possible. We reviewed the literature and elaborated a systematic approach to endocarditis management based on clinical, microbiological, and anatomopathological variables known to affect postoperative outcomes with the aim to stratify the patients and orient decision making. From this review emerges significant findings on the risk of infection in the allograft used in patients with endocarditis and no endocarditis etiology suggesting that the use of allografts has proved safety and effectiveness in patients with both pathologies.
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Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord, 93200 Saint-Denis, France;
| | - Thibaut Schoell
- Department of Cardiac Surgery, Centre Cardiologique du Nord, 93200 Saint-Denis, France;
| | - Cristiano Spadaccio
- Cardiothoracic Surgery, Lancashire Cardiac Center, Blackpool Victoria Hospital, Blackpool FY3 8NP, UK;
| | - Christophe Acar
- Department of Cardiothoracic Surgery, Hôpital Pitié-Salpêtrière, Boulevard de Hôpital 47-83, 75013 Paris, France;
| | - Francisco Diniz Affonso da Costa
- Department of Cardiovascular Surgery, Instituto de Neurologia e Cardiologia de Curitiba—INC Cardio, Curitiba 81210-310, Parana, Brazil;
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21
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Iaccarino A, Barbone A, Basciu A, Cuko E, Droandi G, Galbiati D, Romano G, Citterio E, Fumero A, Scarfò I, Manzo R, La Canna G, Torracca L. Surgical Challenges in Infective Endocarditis: State of the Art. J Clin Med 2023; 12:5891. [PMID: 37762834 PMCID: PMC10532218 DOI: 10.3390/jcm12185891] [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: 07/20/2023] [Revised: 08/24/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
Infective endocarditis (IE) is still a life-threatening disease with frequent lethal outcomes despite the profound changes in its clinical, microbiological, imaging, and therapeutic profiles. Nowadays, the scenario for IE has changed since rheumatic fever has declined, but on the other hand, multiple aspects, such as elderly populations, cardiovascular device implantation procedures, and better use of multiple imaging modalities and multidisciplinary care, have increased, leading to escalations in diagnosis. Since the ESC and AHA Guidelines have been released, specific aspects of diagnostic and therapeutic management have been clarified to provide better and faster diagnosis and prognosis. Surgical treatment is required in approximately half of patients with IE in order to avoid progressive heart failure, irreversible structural damage in the case of uncontrolled infection, and the prevention of embolism. The timing of surgery has been one of the main aspects discussed, identifying cases in which surgery needs to be performed on an emergency (within 24 h) or urgent (within 7 days) basis, irrespective of the duration of antibiotic treatment, or cases where surgery can be postponed to allow a brief period of antibiotic treatment under careful clinical and echocardiographic observation. Mainly, guidelines put emphasis on the importance of an endocarditis team in the handling of systemic complications and how they affect the timing of surgery and perioperative management. Neurological complications, acute renal failure, splenic or musculoskeletal manifestations, or infections determined by multiresistant microorganisms or fungi can affect long-term prognosis and survival. Not to be outdone, anatomical and surgical factors, such as the presence of native or prosthetic valve endocarditis, a repair strategy when feasible, anatomical extension and disruption in the case of an annular abscess (mitral valve annulus, aortic mitral curtain, aortic root, and annulus), and the choice of prosthesis and conduits, can be equally crucial. It can be hard for surgeons to maneuver between correct pre-operative planning and facing unexpected obstacles during intraoperative management. The aim of this review is to provide an overview and analysis of a broad spectrum of specific surgical scenarios and how their challenging management can be essential to ensure better outcomes and prognoses.
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Affiliation(s)
- Alessandra Iaccarino
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.B.); (A.B.); (E.C.); (G.D.); (D.G.); (G.R.); (E.C.); (A.F.); (L.T.)
| | - Alessandro Barbone
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.B.); (A.B.); (E.C.); (G.D.); (D.G.); (G.R.); (E.C.); (A.F.); (L.T.)
| | - Alessio Basciu
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.B.); (A.B.); (E.C.); (G.D.); (D.G.); (G.R.); (E.C.); (A.F.); (L.T.)
| | - Enea Cuko
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.B.); (A.B.); (E.C.); (G.D.); (D.G.); (G.R.); (E.C.); (A.F.); (L.T.)
| | - Ginevra Droandi
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.B.); (A.B.); (E.C.); (G.D.); (D.G.); (G.R.); (E.C.); (A.F.); (L.T.)
| | - Denise Galbiati
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.B.); (A.B.); (E.C.); (G.D.); (D.G.); (G.R.); (E.C.); (A.F.); (L.T.)
| | - Giorgio Romano
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.B.); (A.B.); (E.C.); (G.D.); (D.G.); (G.R.); (E.C.); (A.F.); (L.T.)
| | - Enrico Citterio
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.B.); (A.B.); (E.C.); (G.D.); (D.G.); (G.R.); (E.C.); (A.F.); (L.T.)
| | - Andrea Fumero
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.B.); (A.B.); (E.C.); (G.D.); (D.G.); (G.R.); (E.C.); (A.F.); (L.T.)
| | - Iside Scarfò
- Cardiovascular Department, Applied Diagnostic Echocardiography of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (I.S.); (R.M.); (G.L.C.)
| | - Rossella Manzo
- Cardiovascular Department, Applied Diagnostic Echocardiography of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (I.S.); (R.M.); (G.L.C.)
| | - Giovanni La Canna
- Cardiovascular Department, Applied Diagnostic Echocardiography of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (I.S.); (R.M.); (G.L.C.)
| | - Lucia Torracca
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.B.); (A.B.); (E.C.); (G.D.); (D.G.); (G.R.); (E.C.); (A.F.); (L.T.)
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22
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Notenboom ML, Schuermans A, Etnel JRG, Veen KM, van de Woestijne PC, Rega FR, Helbing WA, Bogers AJJC, Takkenberg JJM. Paediatric aortic valve replacement: a meta-analysis and microsimulation study. Eur Heart J 2023; 44:3231-3246. [PMID: 37366156 PMCID: PMC10482570 DOI: 10.1093/eurheartj/ehad370] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 04/21/2023] [Accepted: 05/24/2023] [Indexed: 06/28/2023] Open
Abstract
AIMS To support decision-making in children undergoing aortic valve replacement (AVR), by providing a comprehensive overview of published outcomes after paediatric AVR, and microsimulation-based age-specific estimates of outcome with different valve substitutes. METHODS AND RESULTS A systematic review of published literature reporting clinical outcome after paediatric AVR (mean age <18 years) published between 1/1/1990 and 11/08/2021 was conducted. Publications reporting outcome after paediatric Ross procedure, mechanical AVR (mAVR), homograft AVR (hAVR), and/or bioprosthetic AVR were considered for inclusion. Early risks (<30d), late event rates (>30d) and time-to-event data were pooled and entered into a microsimulation model. Sixty-eight studies, of which one prospective and 67 retrospective cohort studies, were included, encompassing a total of 5259 patients (37 435 patient-years; median follow-up: 5.9 years; range 1-21 years). Pooled mean age for the Ross procedure, mAVR, and hAVR was 9.2 ± 5.6, 13.0 ± 3.4, and 8.4 ± 5.4 years, respectively. Pooled early mortality for the Ross procedure, mAVR, and hAVR was 3.7% (95% CI, 3.0%-4.7%), 7.0% (5.1%-9.6%), and 10.6% (6.6%-17.0%), respectively, and late mortality rate was 0.5%/year (0.4%-0.7%/year), 1.0%/year (0.6%-1.5%/year), and 1.4%/year (0.8%-2.5%/year), respectively. Microsimulation-based mean life-expectancy in the first 20 years was 18.9 years (18.6-19.1 years) after Ross (relative life-expectancy: 94.8%) and 17.0 years (16.5-17.6 years) after mAVR (relative life-expectancy: 86.3%). Microsimulation-based 20-year risk of aortic valve reintervention was 42.0% (95% CI: 39.6%-44.6%) after Ross and 17.8% (95% CI: 17.0%-19.4%) after mAVR. CONCLUSION Results of paediatric AVR are currently suboptimal with substantial mortality especially in the very young with considerable reintervention hazards for all valve substitutes, but the Ross procedure provides a survival benefit over mAVR. Pros and cons of substitutes should be carefully weighed during paediatric valve selection.
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Affiliation(s)
- Maximiliaan L Notenboom
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Erasmus MC, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Zuid-Holland, The Netherlands
| | - Art Schuermans
- Department of Cardiac Surgery, University Hospitals Leuven, UZ Leuven Gasthuisberg, Herestraat 49, 3000, Leuven, Flanders, Belgium
- Cardiovascular Research Center, Massachusetts General Hospital, 149 13th Street, 4th floor, Boston, MA 02129, USA
- Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Merkin Building, 415 Main St., Cambridge, MA 02142, USA
| | - Jonathan R G Etnel
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Erasmus MC, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Zuid-Holland, The Netherlands
| | - Kevin M Veen
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Erasmus MC, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Zuid-Holland, The Netherlands
| | - Pieter C van de Woestijne
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Erasmus MC, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Zuid-Holland, The Netherlands
| | - Filip R Rega
- Department of Cardiac Surgery, University Hospitals Leuven, UZ Leuven Gasthuisberg, Herestraat 49, 3000, Leuven, Flanders, Belgium
| | - Willem A Helbing
- Department of Paediatrics, Division of Paediatric Cardiology, Erasmus MC-Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, Zuid-Holland, The Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Erasmus MC, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Zuid-Holland, The Netherlands
| | - Johanna J M Takkenberg
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Erasmus MC, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Zuid-Holland, The Netherlands
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23
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Yilmaz M, Pamuk U, Gursu HA, Atalay A. Urgent aortic valve neocuspidization using the Ozaki procedure in an infant with native aortic valve endocarditis. Cardiol Young 2023; 33:1462-1464. [PMID: 36651088 DOI: 10.1017/s1047951122004267] [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] [Indexed: 01/19/2023]
Abstract
Native valve aortic endocarditis is rarely seen in the paediatric population. Although, the first-line of treatment is medical, surgical intervention may be indicated in patients with unrepairable valvular and subvalvular disease. Recently, the aortic valve neocuspidization (AVNeo) procedure has gained popularity both in adult and children in whom other repair techniques are not feasible. In this case report, we present an urgent aortic valve replacement using the AVNeo technique in a critically ill infant with a small annulus, severe left ventricular outflow tract stenosis, and severe aortic regurgitation.
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Affiliation(s)
- Mustafa Yilmaz
- Department of Pediatric Cardiovascular Surgery, Ankara City Hospital, Cankaya, Turkey
| | - Utku Pamuk
- Department of Pediatric Cardiology, Ankara City Hospital, Cankaya, Turkey
| | - Hazım Alper Gursu
- Department of Pediatric Cardiology, Ankara City Hospital, Cankaya, Turkey
| | - Atakan Atalay
- Department of Pediatric Cardiovascular Surgery, Ankara City Hospital, Cankaya, Turkey
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24
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Li RL, Sun M, Russ JB, Pousse PL, Kossar AP, Gibson I, Paschalides C, Herschman AR, Abyaneh MH, Ferrari G, Bacha E, Waisman H, Vedula V, Kysar JW, Kalfa D. In Vitro Proof of Concept of a First-Generation Growth-Accommodating Heart Valved Conduit for Pediatric Use. Macromol Biosci 2023; 23:e2300011. [PMID: 36905285 PMCID: PMC10363995 DOI: 10.1002/mabi.202300011] [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: 01/11/2023] [Revised: 02/27/2023] [Indexed: 03/12/2023]
Abstract
Currently available heart valve prostheses have no growth potential, requiring children with heart valve diseases to endure multiple valve replacement surgeries with compounding risks. This study demonstrates the in vitro proof of concept of a biostable polymeric trileaflet valved conduit designed for surgical implantation and subsequent expansion via transcatheter balloon dilation to accommodate the growth of pediatric patients and delay or avoid repeated open-heart surgeries. The valved conduit is formed via dip molding using a polydimethylsiloxane-based polyurethane, a biocompatible material shown here to be capable of permanent stretching under mechanical loading. The valve leaflets are designed with an increased coaptation area to preserve valve competence at expanded diameters. Four 22 mm diameter valved conduits are tested in vitro for hydrodynamics, balloon dilated to new permanent diameters of 23.26 ± 0.38 mm, and then tested again. Upon further dilation, two valved conduits sustain leaflet tears, while the two surviving devices reach final diameters of 24.38 ± 0.19 mm. After each successful dilation, the valved conduits show increased effective orifice areas and decreased transvalvular pressure differentials while maintaining low regurgitation. These results demonstrate concept feasibility and motivate further development of a polymeric balloon-expandable device to replace valves in children and avoid reoperations.
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Affiliation(s)
- Richard L Li
- Department of Surgery, Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, New-York Presbyterian - Morgan Stanley Children's Hospital, Columbia University Medical Center, 3959 Broadway, CHN-274, New York, NY, 10032, USA
- Department of Mechanical Engineering, Fu Foundation School of Engineering and Applied Science, Columbia University, 220 Mudd Building, 500 W. 120th Street, New York, NY, 10027, USA
| | - Mingze Sun
- Department of Surgery, Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, New-York Presbyterian - Morgan Stanley Children's Hospital, Columbia University Medical Center, 3959 Broadway, CHN-274, New York, NY, 10032, USA
| | - Jonathan B Russ
- Department of Civil Engineering and Engineering Mechanics, Fu Foundation School of Engineering and Applied Science, Columbia University, 610 Mudd Building, 500 W. 120th Street, New York, NY, 10027, USA
| | - Pierre-Louis Pousse
- Department of Surgery, Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, New-York Presbyterian - Morgan Stanley Children's Hospital, Columbia University Medical Center, 3959 Broadway, CHN-274, New York, NY, 10032, USA
| | - Alexander P Kossar
- Department of Surgery, Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, New-York Presbyterian - Morgan Stanley Children's Hospital, Columbia University Medical Center, 3959 Broadway, CHN-274, New York, NY, 10032, USA
| | - Isabel Gibson
- Department of Surgery, Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, New-York Presbyterian - Morgan Stanley Children's Hospital, Columbia University Medical Center, 3959 Broadway, CHN-274, New York, NY, 10032, USA
| | - Costas Paschalides
- Department of Mechanical Engineering, Fu Foundation School of Engineering and Applied Science, Columbia University, 220 Mudd Building, 500 W. 120th Street, New York, NY, 10027, USA
| | - Abigail R Herschman
- Department of Surgery, Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, New-York Presbyterian - Morgan Stanley Children's Hospital, Columbia University Medical Center, 3959 Broadway, CHN-274, New York, NY, 10032, USA
- Department of Mechanical Engineering, Fu Foundation School of Engineering and Applied Science, Columbia University, 220 Mudd Building, 500 W. 120th Street, New York, NY, 10027, USA
| | - Maryam H Abyaneh
- Department of Surgery, Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, New-York Presbyterian - Morgan Stanley Children's Hospital, Columbia University Medical Center, 3959 Broadway, CHN-274, New York, NY, 10032, USA
| | - Giovanni Ferrari
- Department of Surgery, Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, New-York Presbyterian - Morgan Stanley Children's Hospital, Columbia University Medical Center, 3959 Broadway, CHN-274, New York, NY, 10032, USA
| | - Emile Bacha
- Department of Surgery, Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, New-York Presbyterian - Morgan Stanley Children's Hospital, Columbia University Medical Center, 3959 Broadway, CHN-274, New York, NY, 10032, USA
| | - Haim Waisman
- Department of Civil Engineering and Engineering Mechanics, Fu Foundation School of Engineering and Applied Science, Columbia University, 610 Mudd Building, 500 W. 120th Street, New York, NY, 10027, USA
| | - Vijay Vedula
- Department of Mechanical Engineering, Fu Foundation School of Engineering and Applied Science, Columbia University, 220 Mudd Building, 500 W. 120th Street, New York, NY, 10027, USA
| | - Jeffrey W Kysar
- Department of Mechanical Engineering, Fu Foundation School of Engineering and Applied Science, Columbia University, 220 Mudd Building, 500 W. 120th Street, New York, NY, 10027, USA
- Department of Otolaryngology-Head and Neck Surgery, Columbia University Medical Center, 3959 Broadway, 5th Floor, New York, NY, 10032, USA
| | - David Kalfa
- Department of Surgery, Division of Cardiac, Thoracic and Vascular Surgery, Section of Pediatric and Congenital Cardiac Surgery, New-York Presbyterian - Morgan Stanley Children's Hospital, Columbia University Medical Center, 3959 Broadway, CHN-274, New York, NY, 10032, USA
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25
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Haranal M, Sivalingam S. Aortic valve repair in the pediatric population: emerging role of aortic valve neocuspidization (AVNeo procedure). Indian J Thorac Cardiovasc Surg 2023; 39:262-270. [PMID: 37124595 PMCID: PMC10140244 DOI: 10.1007/s12055-023-01473-z] [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: 08/23/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/27/2023] Open
Abstract
Management of aortic valve diseases in children is challenging owing to the quality and quantity of the native tissue for repair, limitations in the currently available biological materials to supplement the repair and to achieve a long-lasting durable repair in an annulus where there is still growth potential. The aortic valve neocuspidization (AVNeo) procedure has emerged as a versatile alternative strategy in the armamentarium of pediatric aortic valve reconstructions that are currently available. In this review article, the focus of the discussion will be on the various aortic valve repair procedures in the pediatric population, with a special emphasis on the emerging role of AVNeo procedure in pediatrics and its outcomes.
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Affiliation(s)
- Maruti Haranal
- Department of Pediatric Cardiac Surgery, U N Mehta Institute of Cardiology and Research, Ahmedabad, Gujarat India
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26
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Singh H, Halder V, Sangdup T, Aggarwal H, Bansal V. Trileaflet pulmonary valve reconstruction with the Ozaki technique in an adult patient of tetralogy of Fallot with absent pulmonary valve. Indian J Thorac Cardiovasc Surg 2023; 39:282-285. [PMID: 37124599 PMCID: PMC10140211 DOI: 10.1007/s12055-022-01469-1] [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: 10/25/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 01/30/2023] Open
Abstract
Pulmonary valve interventions are one of the most common cardiac interventions that are being performed in patients with a wide variety of congenital heart diseases, more so in adults with congenital heart disease. Despite the introduction of various different reconstructive techniques and conduits, the ideal option still remains elusive. Lack of growth and re-operation for conduit replacement remains an Achilles heel in such conduits. So, surgeons have constantly tried to evolve surgical techniques that would obviate their use and allow age-related growth. The Ozaki procedure has proven to be technically reproducible and have excellent mid-term results in the aortic position in adults. Extending the same principle for reconstruction of the pulmonary valve can prove to be a reasonable alternative. Supplementary Information The online version contains supplementary material available at 10.1007/s12055-022-01469-1.
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Affiliation(s)
- Harkant Singh
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikram Halder
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Tsering Sangdup
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Hiteshi Aggarwal
- Department of Anesthesia, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vidur Bansal
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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27
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Brega C, Albertini A. Aortic Root Surgery in Adults: An Unsolved Problem. AORTA (STAMFORD, CONN.) 2023; 11:29-35. [PMID: 36848909 PMCID: PMC9970757 DOI: 10.1055/s-0042-1757949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Nowadays, despite the rapid advancements in interventional cardiology, open surgery still deals with aortic root diseases, to assure the best "ad hoc" treatment. In case of middle-aged adult patients, the optimal operation still represents a matter of debate. A review of the last 10-year literature was conducted, focusing on patients below 65 to 70 years of age. Because of the small sample and the heterogeneity of the papers, no metanalysis was possible. Bentall-de Bono procedure, valve sparing, and Ross operations are the surgical options currently available. The main issues in the Bentall - de Bono operation are lifelong anticoagulation therapy and cavitation in case of mechanical prosthesis implantation and structural valve degeneration in case of biological Bentall. As transcatheter procedures are currently performed as valve in valve, biological prosthesis may be preferable, if the diameter may prevent postoperative high gradients. Conservative techniques, such as remodeling and reimplantation, preferred in the young, guarantee physiologic aortic root dynamics and impose surgical analysis of the aortic root structures to get a durable result. The Ross operation, which shows excellent performance, involves autologous pulmonary valve implantation and is performed only in experienced and high-volume centers. Due to its technical difficulty, it requires a steep learning curve and presents some limitations in specific aortic valve diseases. All three have advantages and downsides, and no ideal solution has still been reported.
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Affiliation(s)
- Carlotta Brega
- Department of Cardiovascular Surgery, GVM Care and Research, Cotignola, RA, Italy,Address for correspondence Carlotta Brega, MD Maria Cecilia Hospital, GVM Care and ResearchVia Corriera 1, 48033 Cotignola, RAItaly
| | - Alberto Albertini
- Department of Cardiovascular Surgery, GVM Care and Research, Cotignola, RA, Italy
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28
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Stoica S, Beard C, Takkenberg JJM, Mokhles MM, Turner M, Pepper J, Hopewell-Kelly N, Benedetto U, Nashef SAM, El-Hamamsy I, Skillington P, Glauber M, De Paulis R, Tseng E, Meuris B, Sitges M, Delgado V, Krane M, Kostolny M, Pufulete M. Formal consensus study on surgery to replace the aortic valve in adults aged 18-60 years. Heart 2023; 109:857-865. [PMID: 36849232 DOI: 10.1136/heartjnl-2022-321740] [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: 08/29/2022] [Accepted: 12/12/2022] [Indexed: 03/01/2023] Open
Abstract
OBJECTIVE There is uncertainty about surgical procedures for adult patients aged 18-60 years undergoing aortic valve replacement (AVR). Options include conventional AVR (mechanical, mAVR; tissue, tAVR), the pulmonary autograft (Ross) and aortic valve neocuspidisation (Ozaki). Transcatheter treatment may be an option for selected patients. We used formal consensus methodology to make recommendations about the suitability of each procedure. METHODS A working group, supported by a patient advisory group, developed a list of clinical scenarios across seven domains (anatomy, presentation, cardiac/non-cardiac comorbidities, concurrent treatments, lifestyle, preferences). A consensus group of 12 clinicians rated the appropriateness of each surgical procedure for each scenario on a 9-point Likert scale on two separate occasions (before and after a 1-day meeting). RESULTS There was a consensus that each procedure was appropriate (A) or inappropriate (I) for all clinical scenarios as follows: mAVR: total 76% (57% A, 19% I); tAVR: total 68% (68% A, 0% I); Ross: total 66% (39% A, 27% I); Ozaki: total 31% (3% A, 28% I). The remainder of percentages to 100% reflects the degree of uncertainty. There was a consensus that transcatheter aortic valve implantation is appropriate for 5 of 68 (7%) of all clinical scenarios (including frailty, prohibitive surgical risk and very limited life span). CONCLUSIONS Evidence-based expert opinion emerging from a formal consensus process indicates that besides conventional AVR options, there is a high degree of certainty about the suitability of the Ross procedure in patients aged 18-60 years. Future clinical guidelines should include the option of the Ross procedure in aortic prosthetic valve selection.
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Affiliation(s)
- Serban Stoica
- Cardiothoracic Surgery, Bristol Heart Institute, Bristol, UK
| | - Chloe Beard
- Cardiothoracic Surgery, Bristol Heart Institute, Bristol, UK
| | | | - Mostafa M Mokhles
- Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mark Turner
- Department of Cardiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - John Pepper
- Surgery, Royal Brompton Hospital, London, UK
| | - Noreen Hopewell-Kelly
- Health and Social Sciences, University of the West of England-Frenchay Campus, Bristol, UK
| | | | - Samer A M Nashef
- Cardiac Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | | | | | | | | | - Elaine Tseng
- University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Bart Meuris
- Cardiac Surgery, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - Marta Sitges
- Cardiology, Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - Markus Krane
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Martin Kostolny
- Cardiothoracic Unit, Great Ormond Street Hospital and Institute of Cardiovascular Science, University College London, London, UK
| | - Maria Pufulete
- Bristol Heart Institute, Bristol Medical School, University of Bristol, Bristol, UK
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29
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Feng Y, Zhang B, Li J, Yan W, Jia B, Wang S, Zhang H. Morphology Optimization of Leaflet for Surgical Reconstruction of the Aortic Valve: In Vitro Test and Simulation-Based DOE Study. J Cardiovasc Transl Res 2023; 16:177-191. [PMID: 35799087 DOI: 10.1007/s12265-022-10287-0] [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: 04/05/2022] [Accepted: 06/08/2022] [Indexed: 11/24/2022]
Abstract
This study was to evaluate the impact of leaflet trimming strategy on the hemodynamic behaviors of the aortic valve after reconstructive surgery, and give recommendations based on design of experiment (DOE) and in vitro studies. An in vitro hemodynamic test was performed on the simulated surgical model to quantify the efficacy of conventional reconstructive surgery. The very same computational model was built and verified, on which the full factorial DOE was carried out to summarize the correlations between leaflet trimming parameters and valve hemodynamic characteristics. Hemodynamic characteristics of the valve substitute were significantly associated with leaflet trimming parameters. The total regurgitant and transvalvular regurgitant of the valve substitute were reduced by 27.44% and 13.61% after optimization of the leaflet design. Synthetic use of in vitro tests and DOE study based on computational models helped improve outcomes of the reconstruction of aortic valve by reducing free edge length and increasing commissure height and leaflet height.
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Affiliation(s)
- Yong Feng
- Institute for Biomechanics, Department of Aeronautics and Astronautics, Fudan University, 200433, Shanghai, China
| | - Bowen Zhang
- Institute for Biomechanics, Department of Aeronautics and Astronautics, Fudan University, 200433, Shanghai, China
| | - Jianming Li
- Institute for Biomechanics, Department of Aeronautics and Astronautics, Fudan University, 200433, Shanghai, China
| | - Wentao Yan
- Institute for Biomechanics, Department of Aeronautics and Astronautics, Fudan University, 200433, Shanghai, China
| | - Bing Jia
- Department of Cardiothoracic Surgery, Children's Hospital of Fudan University, 201102, Shanghai, China
| | - Shengzhang Wang
- Institute for Biomechanics, Department of Aeronautics and Astronautics, Fudan University, 200433, Shanghai, China. .,Institute of Biomedical Engineering Technology, Academy of Engineering & Technology, Fudan University, 200433, Shanghai, China.
| | - Huifeng Zhang
- Department of Cardiothoracic Surgery, Children's Hospital of Fudan University, 201102, Shanghai, China.
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30
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Kobalava ZD, Kotova EO. [Global and national trends in the evolution of infective endocarditis]. KARDIOLOGIIA 2023; 63:3-11. [PMID: 36749195 DOI: 10.18087/cardio.2023.1.n2307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/28/2022] [Indexed: 02/08/2023]
Abstract
For the recent 20 years, substantial changes have occurred in all aspects of infectious endocarditis (IE), the evolution of risk factors, modernization of diagnostic methods, therapeutic and preventive approaches. The global trends are characterized by increased IE morbidity among people older than 65 who use intravenous psychoactive drugs. The epidemiological trend is represented by reduced roles of chronic rheumatic heart disease and congenital heart defects, increased proportion of IE associated with medical care, valve replacement, installation of intracardiac devices, and increased contribution of Staphylococcus spp. and Enterococcus spp. to the IE etiology. Additional visualization methods (fluorodeoxyglucose positron emission tomography with 18F-fludesoxyglucose (18F-FDG PET-CT), labeled white blood cell single-photon emission computed tomography (SPECT), and modernization of the etiological diagnostic algorithm for determining the true pathogen (immunochemistry, polymerase chain reaction, sequencing) also become increasingly important. The COVID-19 pandemic has also adversely contributed to the IE epidemiology. New prospects of treatment have emerged, such as bacteriophages, lysins, oral antibacterial therapy, minimally invasive surgical strategies (percutaneous mechanical aspiration), endovascular mechanical embolectomy. The physicians' compliance with clinical guidelines (CG) is low, which contributes to the high rate of adverse outcomes of IE, while simple adherence to the CG together with more frequent use of surgical treatment doubles survival. Systematic adherence to CG, timely prevention and implementation of the Endocarditis Team into practice play the decisive role in a favorable prognosis of dynamically changing IE. This article presents the authors' own data that confirm the evolutionary trends of current IE.
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Affiliation(s)
- Zh D Kobalava
- Russian University of Peoples' Friendship; Vinogradov Municipal Clinical Hospital
| | - E O Kotova
- Russian University of Peoples' Friendship; Vinogradov Municipal Clinical Hospital
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Fujita B, Ensminger S. In-vitro Evaluierung der Neokuspidalisierung nach Ozaki. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2023. [DOI: 10.1007/s00398-022-00553-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Unai S, Ozaki S, Johnston DR, Saito T, Rajeswaran J, Svensson LG, Blackstone EH, Pettersson GB. Aortic Valve Reconstruction With Autologous Pericardium Versus a Bioprosthesis: The Ozaki Procedure in Perspective. J Am Heart Assoc 2023; 12:e027391. [PMID: 36628965 PMCID: PMC9939068 DOI: 10.1161/jaha.122.027391] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background We assessed the Ozaki procedure, aortic valve reconstruction using autologous pericardium, with respect to its learning curve, hemodynamic performance, and durability compared with a stented bioprosthesis. Methods and Results From January 2007 to January 2016, 776 patients underwent an Ozaki procedure at Toho University Ohashi Medical Center. Learning curves, aortic regurgitation (AR), and peak gradient, assessed by serial echocardiograms, valve rereplacement, and survival were investigated. Valve performance and durability were compared with 627 1:1 propensity-matched patients receiving stented bovine pericardial valves implanted from 1982 to 2011 at Cleveland Clinic. Learning curves were observed for aortic clamp and cardiopulmonary bypass times, AR prevalence, and early mortality. Decreased aortic clamp time was observed over the first 300 cases. New surgeons performing parts of the procedure after case 400 resulted in a slight increase in aortic clamp and cardiopulmonary bypass times. Among matched patients, the Ozaki cohort had more AR than the PERIMOUNT cohort (severe AR at 1 and 6 years, 0.58% and 3.6% versus 0.45% and 1.0%, respectively; P[trend]=0.006), although with a steep learning curve. Peak gradient showed the opposite trend: 14 and 17 mm Hg for Ozaki and 24 and 28 mm Hg for PERIMOUNT at these times (P[trend]<0.001). Freedom from rereplacement was similar (P=0.491). Survival of the Ozaki cohort was 85% at 6 years. Conclusions Patients undergoing the Ozaki procedure had lower gradients but more recurrent AR than those receiving PERIMOUNT bioprostheses. Although recurrent AR is concerning, results confirm low risk and good midterm performance of the Ozaki procedure, supporting its continued use.
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Affiliation(s)
- Shinya Unai
- Department of Thoracic and Cardiovascular SurgeryHeart, Vascular, and Thoracic InstituteCleveland ClinicClevelandOH
| | - Shigeyuki Ozaki
- Department of Cardiovascular SurgeryToho University Ohashi Medical CenterTokyoJapan
| | - Douglas R. Johnston
- Department of Thoracic and Cardiovascular SurgeryHeart, Vascular, and Thoracic InstituteCleveland ClinicClevelandOH
| | - Tomohiro Saito
- Department of Cardiovascular SurgeryToho University Ohashi Medical CenterTokyoJapan
| | - Jeevanantham Rajeswaran
- Department of Quantitative Health SciencesLerner Research InstituteCleveland ClinicClevelandOH
| | - Lars G. Svensson
- Department of Thoracic and Cardiovascular SurgeryHeart, Vascular, and Thoracic InstituteCleveland ClinicClevelandOH
| | - Eugene H. Blackstone
- Department of Thoracic and Cardiovascular SurgeryHeart, Vascular, and Thoracic InstituteCleveland ClinicClevelandOH,Department of Quantitative Health SciencesLerner Research InstituteCleveland ClinicClevelandOH
| | - Gösta B. Pettersson
- Department of Thoracic and Cardiovascular SurgeryHeart, Vascular, and Thoracic InstituteCleveland ClinicClevelandOH
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Todurov B, Mokryk I, Batsak B, Ponych N. Computed tomography-guided aortic valve neocuspidization: details of preoperative assessment and surgical technique. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 36:ivac290. [PMID: 36802250 PMCID: PMC9972512 DOI: 10.1093/icvts/ivac290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/12/2022] [Accepted: 12/20/2022] [Indexed: 06/18/2023]
Abstract
The original Ozaki technique involves sizing and trimming the neovalve cusps during cross-clamp. It leads to prolongation of the ischaemic time, as compared to standard aortic valve replacement. We use preoperative computed tomography scanning of the patient's aortic root to develop personalized templates for each leaflet. With this method, autopericardial implants are prepared before the initiation of the bypass. It permits maximally adopting the procedure to the patient's individual anatomy and to shorten the cross-clamp time. We present a case of a computed tomography-guided aortic valve neocuspidization and concomitant coronary artery bypass grafting with excellent short-term results. We discuss the feasibility and technical details of the novel technique.
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Affiliation(s)
- Borys Todurov
- Department of Adult Cardiac Surgery, Heart Institute, Kyiv, Ukraine
| | - Igor Mokryk
- Corresponding author. Department of Adult Cardiac Surgery, Heart Institute, Str. Bratyslavska 5A, Kyiv 02660, Ukraine. Tel: +380-504710444; e-mail: (I. Mokryk)
| | - Bogdan Batsak
- University Clinic of Taras Shevchenko National University, Kyiv, Ukraine
| | - Nataliya Ponych
- Department of Adult Cardiac Surgery, Heart Institute, Kyiv, Ukraine
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Sassis L, Kefala-Karli P, Cucchi I, Kouremenos I, Demosthenous M, Diplaris K. Valve Repair in Aortic Insufficiency: A State-of-the-art Review. Curr Cardiol Rev 2023; 19:e270422204131. [PMID: 35490315 PMCID: PMC10201877 DOI: 10.2174/1573403x18666220427120235] [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: 01/22/2022] [Revised: 03/02/2022] [Accepted: 03/09/2022] [Indexed: 02/08/2023] Open
Abstract
Aortic valve insufficiency (AI) describes the pathology of blood leaking through the aortic valve to the left ventricle during diastole and is classified as mild, moderate or severe according to the volume of regurgitating blood. Intervention is required in severe AI when the patient is symptomatic or when the left ventricular function is impaired. Aortic valve replacement has been considered the gold standard for decades for these patients, but several repair techniques have recently emerged that offer exceptional stability and long-term outcomes. The appropriate method of repair is selected based on the mechanism of AI and each patient's anatomic variations. This review aims to describe different pathologies of AI based on its anatomy, along with the different surgical techniques of aortic repair and their reported results.
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Affiliation(s)
| | | | - Irene Cucchi
- University of Nicosia, School of Medicine, Nicosia, Cyprus
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Mylonas KS, Tasoudis PT, Pavlopoulos D, Kanakis M, Stavridis GT, Avgerinos DV. Aortic valve neocuspidization using the Ozaki technique: A meta-analysis of reconstructed patient-level data. Am Heart J 2023; 255:1-11. [PMID: 36115391 DOI: 10.1016/j.ahj.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/29/2022] [Accepted: 09/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Aortic valve neocuspidization using the Ozaki technique has shown promising results both in adults and children. METHODS A systematic search of the PubMed and Cochrane databases was performed up to November 13, 2021. Individual patient data were reconstructed and analyzed from the Kaplan-Meier curves of all eligible studies for time-to-event outcomes. RESULTS We included a total of 22 studies reporting on 1,891 patients that underwent Ozaki reconstruction. Mean age at the time of surgery was 43.2 ± 24.5 years (65 ± 12.3 years for adult patients and 12.3 ± 3.8 years for pediatric patients). The most common indication was aortic stenosis (46.4%, 95% CI 34.1-58.6). Mean cross-clamp and cardiopulmonary bypass duration were 106.8 ± 24.8 minutes and 135.2 ± 35.1 minutes, respectively. Permanent pacemaker was implanted in 0.7% (95% CI 0.4-1.2) of the patients. At discharge, mean effective orifice area was 2.1 ± 0.5 cm2/m2. At latest follow-up, peak gradient was 15.7 ± 7.4 mm Hg and only 0.25% (95% CI 0-2.3) had moderate aortic insufficiency. In-hospital mortality was 0.7% (95% CI 0.1-1.7). Late mortality was 1.9% during a mean follow-up of 38.1 ± 23.8 months. One-year, 3-year, and 5-year freedom from reoperation rates were 98.0 %, 97.0 % and 96.5%, respectively. More than half of the reoperations were due to infective endocarditis (51.5%, 95% CI 18.3-84.0). In our cohort, the risk of endocarditis per patient per year was 0.5%. CONCLUSIONS The midterm outcomes of the Ozaki procedure are excellent in terms of hemodynamics, survival, and freedom from reoperation. Acquiring long-term follow-up will help solidify this technique in the cardiac surgery armamentarium.
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Affiliation(s)
| | - Panagiotis T Tasoudis
- Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece
| | | | - Meletios Kanakis
- Department of Pediatric and Adult Congenital Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
| | - George T Stavridis
- Department of Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
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Yousef S, Serna-Gallegos D, Brown JA, Ogami T, Wang Y, Thoma FW, Chu D, Bonatti J, Kaczorowski D, Yoon P, Sultan I. Outcomes of Root Enlargement Vs Root Replacement for Aortic Stenosis. Ann Thorac Surg 2022; 115:1180-1187. [PMID: 36584836 DOI: 10.1016/j.athoracsur.2022.12.027] [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: 09/20/2022] [Revised: 12/14/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Stentless aortic root replacement (ARR) and aortic root enlargement (ARE) are established strategies to avoid prosthesis-patient mismatch in patients with aortic stenosis (AS) and small annuli. We sought to compare outcomes of these 2 procedures. METHODS This was an observational study using an institutional database of aortic valve replacements from 2010 to 2021. The study compared patients who underwent ARE vs ARR for AS. Those with endocarditis or aortic aneurysms were excluded. Postoperative outcomes were compared between groups. Kaplan-Meier survival estimation and multivariable Cox regression for survival were performed. Cumulative incidence functions were generated for all-cause readmissions. RESULTS A total of 533 patients underwent either ARE or ARR for AS. Of these, 193 (36.2%) underwent ARE and 340 (63.8%) underwent ARR with a stentless xenograft. There were no significant differences in operative mortality, stroke, length of stay, or new-onset renal failure requiring dialysis. There were also no significant differences in aortic valve reintervention rates (3.1% vs 1.8%; P = .314). Patients in the ARR group had larger valves implanted, larger indexed effective orifice areas, lower rates of prosthesis-patient mismatch, and lower transprosthetic gradients (P < .001). Median follow-up was 5.02 (2.70-7.8) years. Kaplan-Meier survival estimates were comparable, and on multivariable Cox regression, ARR vs ARE was not significantly associated with an increased hazard of death (hazard ratio, 1.00; 95% CI, 0.69-1.45; P = .996). Cumulative incidence estimates for all-cause readmissions were also comparable between groups. CONCLUSIONS ARE and stentless xenograft ARR for AS were associated with comparable postoperative complications, aortic valve reinterventions, freedom from readmission, and 5-year survival.
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Affiliation(s)
- Sarah Yousef
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Derek Serna-Gallegos
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - James A Brown
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Takuya Ogami
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yisi Wang
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Floyd W Thoma
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Danny Chu
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Johannes Bonatti
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - David Kaczorowski
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Pyongsoo Yoon
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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Jaswal V, Bansal V, Chakraborty NS, Rohit MK, Thingnam SKS. "Y" incision and rectangular patch enlargement of aortic annulus and valve reconstruction with autologous pericardium in congenital aortic stenosis. J Card Surg 2022; 37:5564-5566. [PMID: 36345693 DOI: 10.1111/jocs.17127] [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: 10/05/2022] [Accepted: 10/24/2022] [Indexed: 11/10/2022]
Abstract
Surgical aortic valve replacement in children who have undergone prior balloon or surgical valvuloplasty or both is a formidable challenge. The aortic annulus is small, there is no ideal prosthesis and lifelong anticoagulation is highly undesirable. A "Y" incision and rectangular patch enlargement of the aortic annulus introduced by Dr. Bo Yang in 2020 combined with aortic valve reconstruction introduced by Dr. Shigeyuki Ozaki in 2011, is feasible, as described in this case.
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Affiliation(s)
- Vivek Jaswal
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vidur Bansal
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nirupam Sekhar Chakraborty
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manoj Kumar Rohit
- Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shyam Kumar Singh Thingnam
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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38
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Jubouri M, Tan SZCP, Mohammed I, Bashir M. Aortic valve neocuspidization using autologous versus bovine pericardium: Ozaki versus Batista. J Card Surg 2022; 37:5207-5209. [PMID: 36150150 DOI: 10.1111/jocs.16847] [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: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND The average living age of the population is constantly increasing and so is the incidence and prevalence of aortic valve disease. Surgical aortic valve replacement (SAVR) is the current gold standard treatment. Nevertheless, the use of prosthetic valves in SAVR is associated with issues that impact patients' quality of life. Aortic valve neocuspidization (AV Neo) offers a means to solve this dilemma by minimizing foreign valve tissue. AV Neo can either be performed using glutaraldehyde-treated autologous pericardium (Ozaki procedure) or bovine pericardium (Batista procedure). AIMS This commentary aims to discuss the recent study by Chan and colleagues which highlighted the surgical approach, clinical outcomes, and limitations of the Ozaki procedure, and compare this to the Batista procedure. METHODS A comprehensive literature search was performed using multiple electronic databases including PubMed, Ovid, Embase, and Scopus to collate the relevant research evidence. RESULTS Although the Ozaki procedure can achieve favorable results whilst mainly avoiding the need for life-long oral anticoagulation with mechanical valves, it still has several limitations that may hinder results. AV Neo using glutaraldehyde-treated bovine pericardium, developed by pioneer cardiac surgeon Dr. Randas J. Vilela Batista, yields superior clinical outcomes to Ozaki's, including excellent survival, lower complications, and minimal need for reoperation as well as shorter operative times. CONCLUSION AV Neo offers a means to perform SAVR whilst escaping the prosthetic valve issues. However, the Batista procedure has shown beyond doubt that it can be considered the superior approach for AV Neo over the Ozaki procedure.
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Affiliation(s)
- Matti Jubouri
- Hull York Medical School, University of York, York, UK
| | - Sven Z C P Tan
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Idhrees Mohammed
- Institute of Cardiac and Aortic Disorders (ICAD), SRM Institutes for Medical Science (SIMS Hospital), Chennai, Tamil Nadu, India
| | - Mohamad Bashir
- Vascular & Endovascular Surgery, Velindre University NHS Trust, Health Education & Improvement Wales (HEIW), Cardiff, UK
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Chan J, Basu A, Di Scenza G, Bartlett J, Fan KS, Oo S, Harky A. Understanding aortic valve repair through Ozaki procedure: A review of literature evidence. J Card Surg 2022; 37:5202-5206. [PMID: 36150152 DOI: 10.1111/jocs.16846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 07/06/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Aortic valve neocuspidization (AV Neo) using glutaraldehyde-treated autologous pericardium was first reported by Ozaki et al. in 2007. This technique has become an alternative to tissue and mechanical valve in selected patients as long-term anticoagulation is not required and shows promising midterm results and durability. METHOD A comprehensive search was performed on the major database using the search terms "Ozaki technique" AND "Aortic Valve Neocuspidization" AND "AV Neocuspidization" AND "Autologous pericardium" AND "glutaraldehyde-treated autologous pericardium." Articles up to August 1st, 2021 were included in this study. RESULTS A total of nine studies with a total of 1342 patients were included. The mean age was 67.36 and 54.23% were male. 66.32% and 23.92% of patients had aortic stenosis and aortic regurgitation, respectively. 66% of patients had a native tricuspid aortic valve (AV) and 31.37% of patients' native AV was bicuspid. Three studies reported their experience performing AV Neo via ministernotomy. CONCLUSION AV Neo can be a suitable alternative to surgical AV replacement in selected patients. The short- and midterm outcomes are comparable without the need for long-term oral anticoagulation. Long-term follow-up data are required for this novel approach to be widely adopted.
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Affiliation(s)
- Jeremy Chan
- Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Ayan Basu
- Department of Medical Education, St George's University of London, London, UK
| | - Gabriela Di Scenza
- Department of Medical Education, St George's University of London, London, UK
| | - Jack Bartlett
- Department of Medical Education, Institute of Life Sciences, Swansea University Medical School, Swansea, Wales, UK
| | - Ka Siu Fan
- Department of Medical Education, St George's University of London, London, UK
| | - Shwe Oo
- Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
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40
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De Paulis R. Editorial: Looking for the best treatment ofbicuspid aortic valves. Interact Cardiovasc Thorac Surg 2022; 35:6760131. [PMID: 36226806 PMCID: PMC9583848 DOI: 10.1093/icvts/ivac253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ruggero De Paulis
- Corresponding author. Dept. of Cardiac Surgery, European Hospital, Via Portuense 700, 00149 Rome, Italy. Tel: +39-0665975224; e-mail: (R. De Paulis)
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Ohuchi H, Kawata M, Uemura H, Akagi T, Yao A, Senzaki H, Kasahara S, Ichikawa H, Motoki H, Syoda M, Sugiyama H, Tsutsui H, Inai K, Suzuki T, Sakamoto K, Tatebe S, Ishizu T, Shiina Y, Tateno S, Miyazaki A, Toh N, Sakamoto I, Izumi C, Mizuno Y, Kato A, Sagawa K, Ochiai R, Ichida F, Kimura T, Matsuda H, Niwa K. JCS 2022 Guideline on Management and Re-Interventional Therapy in Patients With Congenital Heart Disease Long-Term After Initial Repair. Circ J 2022; 86:1591-1690. [DOI: 10.1253/circj.cj-22-0134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hideo Ohuchi
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, National Cerebral and Cardiovascular Center
| | - Masaaki Kawata
- Division of Pediatric and Congenital Cardiovascular Surgery, Jichi Children’s Medical Center Tochigi
| | - Hideki Uemura
- Congenital Heart Disease Center, Nara Medical University
| | - Teiji Akagi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Atsushi Yao
- Division for Health Service Promotion, University of Tokyo
| | - Hideaki Senzaki
- Department of Pediatrics, International University of Health and Welfare
| | - Shingo Kasahara
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Hajime Ichikawa
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Morio Syoda
- Department of Cardiology, Tokyo Women’s Medical University
| | - Hisashi Sugiyama
- Department of Pediatric Cardiology, Seirei Hamamatsu General Hospital
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Kei Inai
- Department of Pediatric Cardiology and Adult Congenital Cardiology, Tokyo Women’s Medical University
| | - Takaaki Suzuki
- Department of Pediatric Cardiac Surgery, Saitama Medical University
| | | | - Syunsuke Tatebe
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Tomoko Ishizu
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
| | - Yumi Shiina
- Cardiovascular Center, St. Luke’s International Hospital
| | - Shigeru Tateno
- Department of Pediatrics, Chiba Kaihin Municipal Hospital
| | - Aya Miyazaki
- Division of Congenital Heart Disease, Department of Transition Medicine, Shizuoka General Hospital
| | - Norihisa Toh
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences
| | - Ichiro Sakamoto
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yoshiko Mizuno
- Faculty of Nursing, Tokyo University of Information Sciences
| | - Atsuko Kato
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Koichi Sagawa
- Department of Pediatric Cardiology, Fukuoka Children’s Hospital
| | - Ryota Ochiai
- Department of Adult Nursing, Yokohama City University
| | - Fukiko Ichida
- Department of Pediatrics, International University of Health and Welfare
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | | | - Koichiro Niwa
- Department of Cardiology, St. Luke’s International Hospital
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Saisho H, Scharfschwerdt M, Schaller T, Sadat N, Aboud A, Ensminger S, Fujita B. Ex vivo evaluation of the Ozaki procedure in comparison with the native aortic valve and prosthetic valves. Interact Cardiovasc Thorac Surg 2022; 35:6650697. [PMID: 35895002 PMCID: PMC9443990 DOI: 10.1093/icvts/ivac199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/14/2022] [Accepted: 07/26/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Hiroyuki Saisho
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein , Lübeck, Germany
- University of Lübeck , Lübeck, Germany
| | - Michael Scharfschwerdt
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein , Lübeck, Germany
- University of Lübeck , Lübeck, Germany
| | - Tim Schaller
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein , Lübeck, Germany
- University of Lübeck , Lübeck, Germany
| | - Najla Sadat
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein , Lübeck, Germany
- University of Lübeck , Lübeck, Germany
- DZHK (German Centre for Cardiovascular Research—Partner Site Hamburg/Kiel/Lübeck) , Germany
| | - Anas Aboud
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein , Lübeck, Germany
- University of Lübeck , Lübeck, Germany
| | - Stephan Ensminger
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein , Lübeck, Germany
- University of Lübeck , Lübeck, Germany
- DZHK (German Centre for Cardiovascular Research—Partner Site Hamburg/Kiel/Lübeck) , Germany
| | - Buntaro Fujita
- Department of Cardiac and Thoracic Vascular Surgery, University Hospital of Schleswig Holstein , Lübeck, Germany
- University of Lübeck , Lübeck, Germany
- DZHK (German Centre for Cardiovascular Research—Partner Site Hamburg/Kiel/Lübeck) , Germany
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43
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Boehm J, Vitanova K, Prinzing A, Krane M, Lange R. Aortic valve neocuspidization using autologous pericardium compared to surgical aortic valve replacement. J Card Surg 2022; 37:3110-3116. [DOI: 10.1111/jocs.16800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/05/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Johannes Boehm
- Department of Cardiovascular Surgery, German Heart Center Munich Technical University Munich Munich Germany
- Department of Cardiovascular Surgery, German Heart Center, Insure (Institute for Translational Cardiac Surgery) Technical University Munich Munich Germany
| | - Keti Vitanova
- Department of Cardiovascular Surgery, German Heart Center Munich Technical University Munich Munich Germany
- Department of Cardiovascular Surgery, German Heart Center, Insure (Institute for Translational Cardiac Surgery) Technical University Munich Munich Germany
| | - Anatol Prinzing
- Department of Cardiovascular Surgery, German Heart Center Munich Technical University Munich Munich Germany
- Department of Cardiovascular Surgery, German Heart Center, Insure (Institute for Translational Cardiac Surgery) Technical University Munich Munich Germany
| | - Markus Krane
- DZHK (German Center for Cardiovascular Research) Partner Site Munich Heart Alliance Munich Germany
- Divison of Cardiac Surgery Yale School of Medicine New Haven Connecticut USA
| | - Rüdiger Lange
- Department of Cardiovascular Surgery, German Heart Center Munich Technical University Munich Munich Germany
- Department of Cardiovascular Surgery, German Heart Center, Insure (Institute for Translational Cardiac Surgery) Technical University Munich Munich Germany
- DZHK (German Center for Cardiovascular Research) Partner Site Munich Heart Alliance Munich Germany
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44
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Bouhout I, Kalfa D, Shah A, Goldstone AB, Harrington J, Bacha E. Surgical Management of Complex Aortic Valve Disease in Young Adults: Repair, Replacement, and Future Alternatives. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2022; 25:28-37. [PMID: 35835514 DOI: 10.1053/j.pcsu.2022.04.002] [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: 10/27/2021] [Revised: 03/17/2022] [Accepted: 04/29/2022] [Indexed: 11/11/2022]
Abstract
The ideal aortic valve substitute in young adults remains unknown. Prosthetic valves are associated with a suboptimal survival and carry a significant risk of valve-related complications in young patients, mainly reinterventions with tissue valves and, thromboembolic events and major bleeding with mechanical prostheses. The Ross procedure is the only substitute that restores a survival curve similar to that of a matched general population, and permits a normal life without functional limitations. Though the risk of reintervention is the Achilles' heel of this procedure, it is very low in patients with aortic stenosis and can be mitigated in patients with aortic regurgitation by tailored surgical techniques. Finally, the Ozaki procedure and the transcatheter aortic valve implantation are seen by many as future alternatives but lack evidence and long-term follow-up in this specific patient population.
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Affiliation(s)
- Ismail Bouhout
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University, New York, New York
| | - David Kalfa
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University, New York, New York
| | - Amee Shah
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University, New York, New York
| | - Andrew B Goldstone
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University, New York, New York
| | - Jamie Harrington
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University, New York, New York
| | - Emile Bacha
- Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Columbia University, New York, New York.
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45
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Ross FJ, Joffe DC, Landsem LM, Latham GJ. The Year in Review: Anesthesia for Congenital Heart Disease 2021. Semin Cardiothorac Vasc Anesth 2022; 26:129-139. [PMID: 35616475 DOI: 10.1177/10892532221095038] [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: 11/17/2022]
Abstract
This review focuses on the literature published during the calendar year 2021 that is of interest to anesthesiologists taking care of children and adults with congenital heart disease. Four major themes are discussed, including cardiovascular disease in children with COVID-19, aortic valve repair and replacement, bleeding and coagulation, and enhanced recovery after surgery (ERAS).
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Affiliation(s)
- Faith J Ross
- Department of Anesthesiology and Pain Medicine, University of WashingtonSeattle Children's Hospital, Seattle, WA, USA
| | - Denise C Joffe
- Department of Anesthesiology and Pain Medicine, University of WashingtonSeattle Children's Hospital, Seattle, WA, USA
| | - Leah M Landsem
- Department of Anesthesiology and Pain Medicine, University of WashingtonSeattle Children's Hospital, Seattle, WA, USA
| | - Gregory J Latham
- Department of Anesthesiology and Pain Medicine, University of WashingtonSeattle Children's Hospital, Seattle, WA, USA
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46
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Diagnosis and Management of Infective Endocarditis in People Who Inject Drugs: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 79:2037-2057. [PMID: 35589166 DOI: 10.1016/j.jacc.2022.03.349] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 12/16/2022]
Abstract
The incidence of injection drug use-associated infective endocarditis has been increasing rapidly over the last decade. Patients with drug use-associated infective endocarditis present an increasingly common clinical challenge with poor long-term outcomes and high reinfection and readmission rates. Their care raises issues unique to this population, including antibiotic selection and administration, indications for and ethical issues surrounding surgical intervention, and importantly management of the underlying substance use disorder to minimize the risk of reinfection. Successful treatment of these patients requires a broad understanding of these concerns. A multidisciplinary, collaborative approach providing a holistic approach to treating both the acute infection along with effectively addressing substance use disorder is needed to improve short-term and longer-term outcomes.
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47
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Amabile A, Torregrossa G, Degife E, Geirsson A, Krane M. Aortic valve neocuspidization: Frequently asked technical questions. J Card Surg 2022; 37:2469-2474. [PMID: 35538554 DOI: 10.1111/jocs.16606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/21/2022] [Accepted: 04/01/2022] [Indexed: 11/29/2022]
Abstract
Since the first description by Professor Ozaki in 2011, more than 5500 aortic valve neocuspidization procedures have been performed worldwide, with promising short- and mid-term outcomes. We here report the nuances required to master this highly reproducible, standardized technique for the treatment of aortic valve disease.
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Affiliation(s)
- Andrea Amabile
- Department of Surgery, Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Gianluca Torregrossa
- Department of Cardiothoracic Surgery, Lankenau Heart Institute, Lankenau Medical Center, Main Line Health, Wynnewood, Pennsylvania, USA
| | - Ellelan Degife
- Department of Surgery, Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Arnar Geirsson
- Department of Surgery, Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Markus Krane
- Department of Surgery, Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
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48
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Kirov H, Caldonazo T, Doenst T. Treatment of valvular heart disease in young patients-"early evidence" versus "latest fashion". J Card Surg 2022; 37:2375-2377. [PMID: 35535022 DOI: 10.1111/jocs.16607] [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: 04/28/2022] [Accepted: 04/30/2022] [Indexed: 11/27/2022]
Abstract
Is the performance of locally manufactured mechanical valve prostheses relevant for modern cardiac surgery, in which mechanical valve replacement has become a rarity? This question comes to mind reading the article in this issue of the Journal demonstrating equal outcomes of the TTK Chitra tilting disk mechanical heart valve prostheses in comparison to the SJM bi-leaflet blockbuster. The evidence documenting efficacy of mechanical valve replacement stems from the early ages of cardiac surgery, but often demonstrates superior outcomes in terms of survival and hemodynamics. Yet, the latest fashion in the Western world consists biological choices in combination with new transcatheter techniques (valve in valve options) or the Ozaki or Ross procedures. As long-term results are often missing and documented advantages for mechanical valves stems from early evidence, the local emphasis of mechanical valve replacement may possibly result in superior individual prognoses compared to following the Western world's latest fashions. Individual patient information and decision making moves into focus.
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Affiliation(s)
- Hristo Kirov
- Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - Tulio Caldonazo
- Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
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49
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Dhingra NK, Verma S, Yanagawa B, Hibino M. Aortic valve neocuspidization and its technical nuance. J Card Surg 2022; 37:2475-2476. [PMID: 35535024 DOI: 10.1111/jocs.16604] [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: 05/01/2022] [Accepted: 05/02/2022] [Indexed: 11/29/2022]
Abstract
Aortic valve neocuspidization or Ozaki procedure represents an advanced surgical strategy for the management of patients with aortic valvulopathy. It has been shown to have clinical and hemodynamic outcomes that compare favorably with aortic valve replacement as it restores physiological aortic valve function and left ventricular remodeling. There are, however, a new set of issues including structural valve deterioration, leaflet tear/perforation, and need for reoperation. A keen understanding of the technical nuances involved with the Ozaki procedure may help in reducing the incidence of such adverse outcomes.
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Affiliation(s)
- Nitish K Dhingra
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Subodh Verma
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Bobby Yanagawa
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Makoto Hibino
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.,Division of Cardiac Surgery, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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50
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Corona S, Manganiello S, Pepi M, Tamborini G, Muratori M, Ali SG, Capra N, Naliato M, Alamanni F, Zanobini M. Bioprosthetic aortic valve replacement in patients aged 50 years old and younger: Structural valve deterioration at long-term follow-up. Retrospective study. Ann Med Surg (Lond) 2022; 77:103624. [PMID: 35637981 PMCID: PMC9142659 DOI: 10.1016/j.amsu.2022.103624] [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: 03/16/2022] [Revised: 04/10/2022] [Accepted: 04/10/2022] [Indexed: 11/27/2022] Open
Abstract
Background Structural valve deterioration (SVD) remains the major determinant of bioprosthesis durability. The aim of this study was to investigate the SVD incidence, predictors and outcomes in patients aged 50 years and younger after bioprosthetic aortic valve replacement (bAVR). Methods We retrospectively analyzed 73 consecutive patients ≤50 years old who underwent bioprosthetic AVR at our center between 2005 and 2015. Median age at surgery was 44 (interquartile range [IQR]: 39-47) years. Follow-up was 93.2% complete at a median time of 7.2 (IQR: 5.5-9.5) years. Cumulative follow-up was 545.5 valve-years. Bioprosthesis SVD was determined by strict echocardiographic assessment. Results The overall survival-rate at 10/15 years and freedom from SVD at 10/12.5 years were 89.6 ± 5.2%/81.5 ± 9.1% and 73.5 ± 8.2%/41.9 ± 18.9%, respectively. SVD occurred at a median time of 8.2 (IQR: 6.0-9.9) years after bAVR. Age was not found as an independent predictor for SVD at the multivariable model, despite a higher rate of SVD in the age group ≤30 years. Freedom from reoperation due to SVD at 10/15 years was 71.3 ± 14.1%/13.6 ± 12.3%. Reoperation was performed at a median time of 10.0 (IQR: 8.9-11.9) years since first bAVR and was associated with a 100% 12-month survival. Conclusions In our study, the rate and time of SVD occurrence were comparable to those of other studies' older age groups. Strict echocardiographic monitoring of valve performance is mandatory to set the appropriate timing of eventual reoperation. This attitude can improve outcomes of bAVR in younger patients.
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Key Words
- AVR, Aortic Valve Replacement
- Aortic valve replacement
- Bioprosthesis
- EF, Ejection Fraction
- LV, Left Ventricle
- NYHA, New York Heart Association
- PASP, Pulmonary Artery Systolic Pressure
- PPM, Prosthesis-Patient Mismatch
- Reoperation
- SVD, Structural Valve Deterioration
- Structural valve deterioration
- TAVR, Transcatheter Aortic Valve Replacement
- TTE, Transthoracic Echocardiography
- bAVR, bioprosthetic Aortic Valve Replacement
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Affiliation(s)
- Silvia Corona
- Department of Cardiac Surgery, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Sabrina Manganiello
- Department of Cardiac Surgery, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Mauro Pepi
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Gloria Tamborini
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Manuela Muratori
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Sarah Ghulam Ali
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Nicolò Capra
- Department of Biostatistics, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Moreno Naliato
- Department of Cardiac Surgery, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Francesco Alamanni
- Department of Cardiac Surgery, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Marco Zanobini
- Department of Cardiac Surgery, Centro Cardiologico Monzino, IRCCS, Milan, Italy
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