1
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Jasinski M, Plonek T, Gocol R, Pysz P, Hudziak D, Wenzel-Jasinska I, Kansy A, Deja M. Bicuspid aortic valve repair with external or subcommissural annuloplasty-echocardiographic prospective trial. J Card Surg 2021; 37:526-531. [PMID: 34821415 DOI: 10.1111/jocs.16154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 10/16/2021] [Accepted: 10/20/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The incompetent bicuspid aortic valve (BAV) can be repaired using various techniques. This study presents a prospective comparison of external and subcommissural aortic annuloplasty. METHODS Fifty consecutive patients (38 males, age: 43.9 ± 15.8 years) with BAV insufficiency with or without aortic dilatation underwent valve repair in a single institution. They were prospectively allocated to one of two groups based on the aortic annulus stabilization technique: 25 patients were operated on using the subcommissural annuloplasty (SCA) and 25 using the external complete annuloplasty (EA). Transthoracic echocardiography was performed in all patients before the operation and 1 and 3 years after the operation. Moreover, mortality and morbidity at 7 years were evaluated. RESULTS In prospective echocardiographic comparison, EA was associated with smaller diameter of the aortic annulus (24.1 ± 2.6 mm vs. 25.8±2.1 mm, p < .05) and lower mean and peak transvalvular gradients (7 ± 4 mmHg vs. 13 ± 4 mmHg, p = .02 and 15.3 ± 9.7 mmHg vs. 20.7 ± 5.6 mmHg, p = .03, respectively). No patients died or required reoperation due to recurrent insufficiency at 6,81 (interquartile range-0,17) years after the operation. The Kaplan-Meier actuarial freedom from aortic regurgitation (AR) grade ≥2 or gradient > 20 mmHg at 35.1 ± 3.6 months years was 96% (24 out of 25) for patients who had external annuloplasty and amounted to 76% (19 out of 25) for those who had SCA, p = .05). CONCLUSIONS External annuloplasty performed during repair of the BAV is associated with better hemodynamics at medium-term follow-up compared to SCA.
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Affiliation(s)
- Marek Jasinski
- Department of Cardiothoracic Surgery, Wroclaw Medical University, Wroclaw, Poland.,Department of Cardiac Surgery, Children's Memorial Pediatric Health Institute, Warsaw, Poland
| | - Tomasz Plonek
- Department of Cardiothoracic Surgery, Wroclaw Medical University, Wroclaw, Poland.,Department Cardiac Surgery, Thorax Centrum Twente, Enschede, The Netherlands
| | - Radoslaw Gocol
- Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland
| | - Piotr Pysz
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Damian Hudziak
- Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland
| | | | - Andrzej Kansy
- Department of Cardiac Surgery, Children's Memorial Pediatric Health Institute, Warsaw, Poland
| | - Marek Deja
- Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland
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2
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Hou Q, Liu G, Liu N, Zhang H, Qu Z, Zhang H, Li H, Pan Y, Qiao A. Effect of Valve Height on the Opening and Closing Performance of the Aortic Valve Under Aortic Root Dilatation. Front Physiol 2021; 12:697502. [PMID: 34526908 PMCID: PMC8435789 DOI: 10.3389/fphys.2021.697502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/04/2021] [Indexed: 12/13/2022] Open
Abstract
Patients with aortic valve disease can suffer from valve insufficiency after valve repair surgery due to aortic root dilatation. The paper investigates the effect of valve height (Hv) on the aortic valve opening and closing in order to select the appropriate range of Hv for smoother blood flow through the aortic valve and valve closure completely in the case of continuous aortic root dilatation. A total of 20 parameterized three-dimensional models of the aortic root were constructed following clinical surgical guidance. Aortic annulus diameter (DAA) was separately set to 26, 27, 28, 29, and 30 mm to simulate aortic root dilatation. HV value was separately set to 13.5, 14, 14.5, and 15 mm to simulate aortic valve alterations in surgery. Time-varying pressure loads were applied to the valve, vessel wall of the ascending aorta, and left ventricle. Then, finite element analysis software was employed to simulate the movement and mechanics of the aortic root. The feasible design range of the valve size was evaluated using maximum stress, geometric orifice area (GOA), and leaflet contact force. The results show that the valve was incompletely closed when HV was 13.5 mm and DAA was 29 or 30 mm. The GOA of the valve was small when HV was 15 mm and DAA was 26 or 27 mm. The corresponding values of the other models were within the normal range. Compared with the model with an HV of 14 mm, the model with an HV of 14.5 mm could effectively reduce maximum stress and had relatively larger GOA and less change in contact force. As a result, valve height affects the performance of aortic valve opening and closing. Smaller HV is adapted to smaller DAA and vice versa. When HV is 14.5 mm, the valve is well adapted to the dilatation of the aortic root to enhance repair durability. Therefore, more attention should be paid to HV in surgical planning.
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Affiliation(s)
- Qianwen Hou
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China.,Intelligent Physiological Measurement and Clinical Translation, Beijing International Base for Scientific and Technological Cooperation, Beijing, China
| | - Guimei Liu
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China.,Intelligent Physiological Measurement and Clinical Translation, Beijing International Base for Scientific and Technological Cooperation, Beijing, China
| | - Ning Liu
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China.,Intelligent Physiological Measurement and Clinical Translation, Beijing International Base for Scientific and Technological Cooperation, Beijing, China
| | - Honghui Zhang
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China.,Intelligent Physiological Measurement and Clinical Translation, Beijing International Base for Scientific and Technological Cooperation, Beijing, China
| | - Zhuoran Qu
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China.,Intelligent Physiological Measurement and Clinical Translation, Beijing International Base for Scientific and Technological Cooperation, Beijing, China
| | - Hanbing Zhang
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China.,Intelligent Physiological Measurement and Clinical Translation, Beijing International Base for Scientific and Technological Cooperation, Beijing, China
| | - Hui Li
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China.,Intelligent Physiological Measurement and Clinical Translation, Beijing International Base for Scientific and Technological Cooperation, Beijing, China
| | - Youlian Pan
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China.,Intelligent Physiological Measurement and Clinical Translation, Beijing International Base for Scientific and Technological Cooperation, Beijing, China
| | - Aike Qiao
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China.,Intelligent Physiological Measurement and Clinical Translation, Beijing International Base for Scientific and Technological Cooperation, Beijing, China
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3
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Mistirian AA, Yates MT, Lawrence DR. Alternative and Safe Technique to Tie Down a Biologic Aortic Valve in Small Aortic Roots. Ann Thorac Surg 2021; 112:e147-e148. [PMID: 33667461 DOI: 10.1016/j.athoracsur.2020.12.091] [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: 09/26/2020] [Revised: 12/05/2020] [Accepted: 12/22/2020] [Indexed: 11/29/2022]
Abstract
Biologic aortic valves are constructed with 3 stents corresponding to the commissures, which sit in the aortic root. When implanted using interrupted sutures, these stents may make the valve difficult to tie down safely in patients with small, calcified aortic roots. We present an easily reproducible technique to make this valve tie down safer.
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Affiliation(s)
- Alina A Mistirian
- Department of Cardiac Surgery, St Bartholomew's Hospital, London, United Kingdom
| | - Martin T Yates
- Department of Cardiac Surgery, St Bartholomew's Hospital, London, United Kingdom
| | - David R Lawrence
- Department of Cardiac Surgery, St Bartholomew's Hospital, London, United Kingdom.
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4
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Ali A, Dodou D, Smit G, Rink R, Breedveld P. Stabilizing interventional instruments in the cardiovascular system: A classification of mechanisms. Med Eng Phys 2021; 89:22-32. [PMID: 33608122 DOI: 10.1016/j.medengphy.2021.01.004] [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: 05/04/2020] [Revised: 01/11/2021] [Accepted: 01/17/2021] [Indexed: 10/22/2022]
Abstract
Positioning and stabilizing a catheter at the required location inside a vessel or the heart is a complicated task in interventional cardiology. In this review we provide a structured classification of catheter stabilization mechanisms to systematically assess their challenges during cardiac interventions. Commercially available, patented, and experimental prototypes of catheters were classified with respect to their stabilizing mechanisms. Subsequently, the classification was used to define requirements for future cardiac catheters and persisting challenges in catheter stabilization. The classification showed that there are two main stabilization mechanisms: surface-based and volume-based. Surface-based mechanisms apply attachment through surface anchoring, while volume-based mechanisms make use of locking through shape or force against the vessel or cardiac wall. The classification provides insight into existing catheter stabilization mechanisms and can possibly be used as a tool for future design of catheter stabilization mechanisms to keep the catheter at a specific location during an intervention. Additionally, insight into the requirements and challenges for catheter stabilization inside the heart and vasculature can lead to the development of more dedicated systems in the future, allowing for intervention- and patient-specific instrument manipulation.
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Affiliation(s)
- Awaz Ali
- PhD candidate at TU Delft, Delft University of Technology, Faculty of Mechanical, Maritime and Materials Engineering, Department of BioMechanical Engineering, Delft, Zuid-Holland, the Netherlands.
| | - Dimitra Dodou
- Associate Professor Bio-Mechanical Engineering at TU Delft, Delft University of Technology, Faculty of Mechanical, Maritime and Materials Engineering, Department of BioMechanical Engineering, Delft, Zuid-Holland, the Netherlands.
| | - Gerwin Smit
- Assistant Professor Bio-Mechanical Engineering at TU Delft, Delft University of Technology, Faculty of Mechanical, Maritime and Materials Engineering, Department of BioMechanical Engineering, Delft, Zuid-Holland, the Netherlands.
| | - Ruben Rink
- Student Bio-Mechanical Engineering at TU Delft, Delft University of Technology, Faculty of Mechanical, Maritime and Materials Engineering, Department of BioMechanical Engineering, Delft, Zuid-Holland, the Netherlands.
| | - Paul Breedveld
- Professor Bio-Mechanical Engineering at TU Delft, Delft University of Technology, Faculty of Mechanical, Maritime and Materials Engineering, Department of BioMechanical Engineering, Delft, Zuid-Holland, the Netherlands.
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5
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Aranda-Michel E, Bianco V, Dufendach K, Kilic A, Habertheuer A, Humar R, Navid F, Wang Y, Sultan I. Midterm outcomes of subcoronary stentless porcine valve versus stented aortic valve replacement. J Card Surg 2020; 35:2950-2956. [PMID: 32789931 DOI: 10.1111/jocs.14943] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/20/2020] [Accepted: 07/30/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Stentless porcine xenografts are versatile bioprosthetic valves with the advantage of improved hemodynamics that mimic the function of the native aortic valve. However, these bioprostheses are challenging to implant in the subcoronary position. METHODS All consecutive patients who underwent a bioprosthetic aortic valve replacement (AVR) were included from our institutional database. Cox regression analysis was preformed to determine significant predictors for mid term mortality as well as all cause, cardiac, and heart failure readmission. RESULTS Patients in the subcoronary stentless group were older and more likely to be female and were likely to have a higher Society of Thoracic Surgery risk of mortality. Survival was superior in the stented AVR cohort at 30-days (96.4% vs 90.5%; P < .001), 1-year (90.5% vs 71.6%; P < .001), and 5-year (74.5% vs 56.9%; P < .001) follow up. Acute kidney injury (16.22% vs 5.22%; P < .001) and blood product transfusion (70.27% vs 44.0%; P < .001) were higher in the stentless group. Multivariable analysis revealed subcoronary stentless implantation as a significant independent risk factor for mortality (hazards ratio: 1.92 [1.35,2.72]; P < .001). CONCLUSION Stentless porcine xenograft implantation with the Freestyle bioprosthetic in the subcoronary position can be successfully performed in select patients, but its use is associated with increased perioperative morbidity and mortality affecting midterm outcomes. Individual patient selection and surgeon experience are important to ensure favorable outcomes.
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Affiliation(s)
- Edgar Aranda-Michel
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Valentino Bianco
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Keith Dufendach
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Arman Kilic
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.,Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Andreas Habertheuer
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rishab Humar
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Forozan Navid
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.,Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Yisi Wang
- 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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6
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Amadeo F, Barbuto M, Bernava G, Savini N, Brioschi M, Rizzi S, Banfi C, Polvani G, Pesce M. Culture Into Perfusion-Assisted Bioreactor Promotes Valve-Like Tissue Maturation of Recellularized Pericardial Membrane. Front Cardiovasc Med 2020; 7:80. [PMID: 32478099 PMCID: PMC7235194 DOI: 10.3389/fcvm.2020.00080] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/15/2020] [Indexed: 11/13/2022] Open
Abstract
Derivation of tissue-engineered valve replacements is a strategy to overcome the limitations of the current valve prostheses, mechanical, or biological. In an effort to set living pericardial material for aortic valve reconstruction, we have previously assessed the efficiency of a recellularization strategy based on a perfusion system enabling mass transport and homogenous distribution of aortic valve-derived "interstitial" cells inside decellularized pericardial material. In the present report, we show that alternate perfusion promoted a rapid growth of valve cells inside the pericardial material and the activity of a proliferation-supporting pathway, likely controlled by the YAP transcription factor, a crucial component of the Hippo-dependent signaling cascade, especially between 3 and 14 days of culture. Quantitative mass spectrometry analysis of protein content in the tissue constructs showed deposition of valve proteins in the decellularized pericardium with a high variability at day 14 and a reproducible tissue maturation at 21 days. These results represent a step forward in the definition of strategies to produce a fully engineered tissue for replacing the calcified leaflets of failing aortic valves.
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Affiliation(s)
- Francesco Amadeo
- Unità di Ingegneria Tissutale Cardiovascolare, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Marianna Barbuto
- Unità di Ingegneria Tissutale Cardiovascolare, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Giacomo Bernava
- Unità di Ingegneria Tissutale Cardiovascolare, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Nicla Savini
- Unità di Ingegneria Tissutale Cardiovascolare, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Maura Brioschi
- Unità di Proteomica, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Stefano Rizzi
- Unità di Ingegneria Tissutale Cardiovascolare, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Cristina Banfi
- Unità di Proteomica, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Gianluca Polvani
- Dipartimento di Scienze Cliniche e di Comunità, Università degli studi di Milano, Milan, Italy
| | - Maurizio Pesce
- Unità di Ingegneria Tissutale Cardiovascolare, Centro Cardiologico Monzino, IRCCS, Milan, Italy
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7
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Harky A, Suen MMY, Wong CHM, Maaliki AR, Bashir M. Bioprosthetic Aortic Valve Replacement in <50 Years Old Patients - Where is the Evidence? Braz J Cardiovasc Surg 2019; 34:729-738. [PMID: 31112031 PMCID: PMC6894029 DOI: 10.21470/1678-9741-2018-0374] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Aortic valve disease is one of the most common valvular heart diseases in the cardiovascular category. Surgical replacement of the diseased aortic valve remains the definitive intervention for most diseases. There is a clear consensus that in young patients who require aortic valve replacement, a mechanical prosthesis is the preferred choice due to its durable prosthesis without fear of wear and tear over time. However, this comes at the expense of increased risk of bleeding and thromboembolic events; in addition, there is a lack of strict evidence in using bioprosthesis in patients younger than 50 years. The objective of this review article is to assess the current evidence behind using bioprosthetic aortic valve in this young cohort.
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Affiliation(s)
- Amer Harky
- Liverpool Heart and Chest Hospital Department of Cardiothoracic Surgery Liverpool UK Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Michael Man Yuen Suen
- The Chinese University of Hong Kong Faculty of Medicine Hong Kong China Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Chris Ho Ming Wong
- The Chinese University of Hong Kong Faculty of Medicine Hong Kong China Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Abdul Rahman Maaliki
- Manchester Royal Infirmary Manchester UK Manchester Royal Infirmary, Oxford Road, Manchester, UK
| | - Mohamad Bashir
- Manchester Royal Infirmary Manchester UK Manchester Royal Infirmary, Oxford Road, Manchester, UK
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8
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Andreas M, Russo M, Kuwata S, Cesarovic N, Wang C, Guidotti A, Lipiski M, Rankin JS, Regar E, Taramasso M, Maisano F, Weber A. Transcatheter aortic valve-in-ring implantation: feasibility in an acute, preclinical, pilot trial. Interact Cardiovasc Thorac Surg 2019; 28:908-915. [PMID: 30649330 DOI: 10.1093/icvts/ivy341] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/24/2018] [Accepted: 11/15/2018] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The HAART ring device has been introduced as a novel strategy to facilitate aortic valve repair. This rigid, elliptical device aims to restore normal leaflet configuration and to provide annular stabilization in the setting of aortic regurgitation. The goal of this preclinical study is to evaluate the in vivo feasibility of 'aortic valve-in-ring' transcatheter aortic valve replacement (TAVR). METHODS Six animals {landrace pigs, 87.6 [standard deviation (SD) 4.5] kg} underwent HAART ring implantation (5 cases #19 mm and 1 case #21 mm) via full sternotomy with cardiopulmonary bypass. Seven transfemoral TAVR implantations were performed with the Medtronic EvolutR prosthesis to assess the sizing and outcome (5 cases #23 mm, 1 case #26 mm and 1 case #29 mm). RESULTS TAVR implantation was successful in 6 of 7 attempts. Post-dilatation was performed in 1 case without damage of the ring or the valve. One embolization occurred due to oversizing (EvolutR valve 29 mm in HAART ring 19 mm). No clinically relevant postimplantation gradient [7.6 (SD 4.0) mmHg] or regurgitation was detected by invasive and echocardiographic measurements. Postoperative computed tomography scans revealed good device configuration. CONCLUSIONS Transcatheter aortic valve-in-ring implantation of a self-expandable TAVR into a rigid aortic annuloplasty ring after aortic valve repair appears feasible. Proper sizing and correct depth of implantation are crucial.
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Affiliation(s)
- Martin Andreas
- Department of Cardiac Surgery, University Heart Center, Universitaetsspital Zurich, University of Zurich, Zurich, Switzerland.,Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Marco Russo
- Department of Cardiac Surgery, University Heart Center, Universitaetsspital Zurich, University of Zurich, Zurich, Switzerland.,Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Shingo Kuwata
- Department of Cardiac Surgery, University Heart Center, Universitaetsspital Zurich, University of Zurich, Zurich, Switzerland
| | - Nikola Cesarovic
- Division of Surgical Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Changtian Wang
- Department of Cardiac Surgery, University Heart Center, Universitaetsspital Zurich, University of Zurich, Zurich, Switzerland
| | - Andrea Guidotti
- Department of Cardiac Surgery, University Heart Center, Universitaetsspital Zurich, University of Zurich, Zurich, Switzerland
| | - Miriam Lipiski
- Division of Surgical Research, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - J Scott Rankin
- Division of Cardiothoracic Surgery, West Virginia University, Morgantown, WV, USA
| | - Evelyn Regar
- Department of Cardiac Surgery, University Heart Center, Universitaetsspital Zurich, University of Zurich, Zurich, Switzerland
| | - Maurizio Taramasso
- Department of Cardiac Surgery, University Heart Center, Universitaetsspital Zurich, University of Zurich, Zurich, Switzerland
| | - Francesco Maisano
- Department of Cardiac Surgery, University Heart Center, Universitaetsspital Zurich, University of Zurich, Zurich, Switzerland
| | - Alberto Weber
- Department of Cardiac Surgery, University Heart Center, Universitaetsspital Zurich, University of Zurich, Zurich, Switzerland
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9
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Freedman BR, Mooney DJ. Biomaterials to Mimic and Heal Connective Tissues. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2019; 31:e1806695. [PMID: 30908806 PMCID: PMC6504615 DOI: 10.1002/adma.201806695] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/27/2019] [Indexed: 05/11/2023]
Abstract
Connective tissue is one of the four major types of animal tissue and plays essential roles throughout the human body. Genetic factors, aging, and trauma all contribute to connective tissue dysfunction and motivate the need for strategies to promote healing and regeneration. The goal here is to link a fundamental understanding of connective tissues and their multiscale properties to better inform the design and translation of novel biomaterials to promote their regeneration. Major clinical problems in adipose tissue, cartilage, dermis, and tendon are discussed that inspire the need to replace native connective tissue with biomaterials. Then, multiscale structure-function relationships in native soft connective tissues that may be used to guide material design are detailed. Several biomaterials strategies to improve healing of these tissues that incorporate biologics and are biologic-free are reviewed. Finally, important guidance documents and standards (ASTM, FDA, and EMA) that are important to consider for translating new biomaterials into clinical practice are highligted.
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Affiliation(s)
- Benjamin R Freedman
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, 02115, USA
| | - David J Mooney
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, 02115, USA
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10
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Fatima B, Mohananey D, Khan FW, Jobanputra Y, Tummala R, Banerjee K, Krishnaswamy A, Mick S, Tuzcu EM, Blackstone E, Svensson L, Kapadia S. Durability Data for Bioprosthetic Surgical Aortic Valve. JAMA Cardiol 2019; 4:71-80. [DOI: 10.1001/jamacardio.2018.4045] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Benish Fatima
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Divyanshu Mohananey
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Fazal W. Khan
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Yash Jobanputra
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ramyashree Tummala
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kinjal Banerjee
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Stephanie Mick
- Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - E. Murat Tuzcu
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eugene Blackstone
- Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lars Svensson
- Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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11
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Activation of human aortic valve interstitial cells by local stiffness involves YAP-dependent transcriptional signaling. Biomaterials 2018; 181:268-279. [DOI: 10.1016/j.biomaterials.2018.07.033] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 07/23/2018] [Accepted: 07/23/2018] [Indexed: 12/15/2022]
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12
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Gillis K, Bala G, Roosens B, Hernot S, Remory I, Scheirlynck E, Geers J, Droogmans S, Cosyns B. Clinical validation of an ultrasound quantification score for aortic valve calcifications. Int J Cardiol 2018; 252:68-71. [PMID: 29249440 DOI: 10.1016/j.ijcard.2017.07.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/01/2017] [Accepted: 07/10/2017] [Indexed: 01/17/2023]
Affiliation(s)
- Kris Gillis
- Centrum voor Hart- en Vaatziekten (CHVZ), UZ Brussel, Laarbeeklaan 101, 1090 Jette, Belgium; In vivo Cellular and Molecular Imaging laboratory (ICMI), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Building K, Laarbeeklaan 103, 1090 Jette, Belgium.
| | - Gezim Bala
- Centrum voor Hart- en Vaatziekten (CHVZ), UZ Brussel, Laarbeeklaan 101, 1090 Jette, Belgium; In vivo Cellular and Molecular Imaging laboratory (ICMI), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Building K, Laarbeeklaan 103, 1090 Jette, Belgium
| | - Bram Roosens
- Centrum voor Hart- en Vaatziekten (CHVZ), UZ Brussel, Laarbeeklaan 101, 1090 Jette, Belgium; In vivo Cellular and Molecular Imaging laboratory (ICMI), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Building K, Laarbeeklaan 103, 1090 Jette, Belgium
| | - Sophie Hernot
- In vivo Cellular and Molecular Imaging laboratory (ICMI), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Building K, Laarbeeklaan 103, 1090 Jette, Belgium
| | - Isabel Remory
- In vivo Cellular and Molecular Imaging laboratory (ICMI), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Building K, Laarbeeklaan 103, 1090 Jette, Belgium
| | - Esther Scheirlynck
- Centrum voor Hart- en Vaatziekten (CHVZ), UZ Brussel, Laarbeeklaan 101, 1090 Jette, Belgium; In vivo Cellular and Molecular Imaging laboratory (ICMI), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Building K, Laarbeeklaan 103, 1090 Jette, Belgium
| | - Jolien Geers
- Centrum voor Hart- en Vaatziekten (CHVZ), UZ Brussel, Laarbeeklaan 101, 1090 Jette, Belgium; In vivo Cellular and Molecular Imaging laboratory (ICMI), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Building K, Laarbeeklaan 103, 1090 Jette, Belgium
| | - Steven Droogmans
- Centrum voor Hart- en Vaatziekten (CHVZ), UZ Brussel, Laarbeeklaan 101, 1090 Jette, Belgium; In vivo Cellular and Molecular Imaging laboratory (ICMI), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Building K, Laarbeeklaan 103, 1090 Jette, Belgium
| | - Bernard Cosyns
- Centrum voor Hart- en Vaatziekten (CHVZ), UZ Brussel, Laarbeeklaan 101, 1090 Jette, Belgium; In vivo Cellular and Molecular Imaging laboratory (ICMI), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Building K, Laarbeeklaan 103, 1090 Jette, Belgium
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13
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Santoro R, Venkateswaran S, Amadeo F, Zhang R, Brioschi M, Callanan A, Agrifoglio M, Banfi C, Bradley M, Pesce M. Acrylate-based materials for heart valve scaffold engineering. Biomater Sci 2018; 6:154-167. [PMID: 29148548 DOI: 10.1039/c7bm00854f] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Calcific aortic valve disease (CAVD) is the most frequent cardiac valve pathology. Its standard treatment consists of surgical replacement either with mechanical (metal made) or biological (animal tissue made) valve prostheses, both of which have glaring deficiencies. In the search for novel materials to manufacture artificial valve tissue, we have conducted a high-throughput screening with subsequent up-scaling to identify non-degradable polymer substrates that promote valve interstitial cells (VICs) adherence/growth and, at the same time, prevent their evolution toward a pro-calcific phenotype. Here, we provide evidence that one of the two identified 'hit' polymers, poly(methoxyethylmethacrylate-co-diethylaminoethylmethacrylate), provided robust VICs adhesion and maintained the healthy VICs phenotype without inducing pro-osteogenic differentiation. This ability was also maintained when the polymer was used to coat a non-woven poly-caprolactone (PCL) scaffold using a novel solvent coating procedure, followed by bioreactor-assisted VICs seeding. Since we observed that VICs had an increased secretion of the elastin-maturing component MFAP4 in addition to other valve-specific extracellular matrix components, we conclude that valve implants constructed with this polyacrylate will drive the biological response of human valve-specific cells.
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Affiliation(s)
- Rosaria Santoro
- Unità di Ingegneria Tissutale Cardiovascolare, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
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14
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Quantitative Characterization of Aortic Valve Endothelial Cell Viability and Morphology In Situ Under Cyclic Stretch. Cardiovasc Eng Technol 2018; 10:173-180. [PMID: 30141125 DOI: 10.1007/s13239-018-00375-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/17/2018] [Indexed: 10/28/2022]
Abstract
Current protocols for mechanical preconditioning of tissue engineered heart valves have focused on application of pressure, flexure and fluid flow to stimulate collagen production, ECM remodeling and improving mechanical performance. The aim of this study was to determine if mechanical preconditioning with cyclic stretch could promote an intact endothelium that resembled the viability and morphology of a native valve. Confocal laser scanning microscopy was used to image endothelial cells on aortic valve strips subjected to static incubation or physiological strain regimens. An automated image analysis program was designed and implemented to detect and analyze live and dead cells in images captured of a live aortic valve endothelium. The images were preprocessed, segmented, and quantitatively analyzed for live/dead cell ratio, minimum neighbor distance and circularity. Significant differences in live/dead cellular ratio and the minimum distance between cells were observed between static and strained endothelia, indicating that cyclic strain is an important stimulus for maintaining a healthy endothelium. In conclusion, in vitro application of physiological levels of cyclic strain to tissue engineered heart valves seeded with autologous endothelial cells would be advantageous.
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15
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Amadeo F, Boschetti F, Polvani G, Banfi C, Pesce M, Santoro R. Aortic valve cell seeding into decellularized animal pericardium by perfusion-assisted bioreactor. J Tissue Eng Regen Med 2018; 12:1481-1493. [PMID: 29702745 DOI: 10.1002/term.2680] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 02/28/2018] [Accepted: 04/16/2018] [Indexed: 12/19/2022]
Abstract
Animal-derived pericardium is the elective tissue employed in manufacturing heart valve prostheses. The preparation of this tissue for biological valve production consists of fixation with aldehydes, which reduces, but not eliminates, the xenoantigens and the donor cellular material. As a consequence, especially in patients below 65-70 years of age, the employment of valve substitutes contaning pericardium is not indicated due to progressive calcification that causes tissue degeneration and recurrence of valve insufficiency. Decellularization with ionic or nonionic detergents has been proposed as an alternative procedure to prepare aldehyde- or xenoantigen-free pericardium for biological valve manufacturing. In the present contribution, we optimized a decellularization procedure that is permissive for seeding and culturing valve competent cells able to colonize and reconstitute a valve-like tissue. A high-efficiency cellularization was achieved by forcing cell penetration inside the pericardium matrix using a perfusion bioreactor. Because the decellularization procedure was found not to alter the collagen composition of the pericardial matrix and cells seeded in the tissue constructs consistently grew and acquired the phenotype of "quiescent" valve interstitial cells, our investigation sets a novel standard in pericardium application for tissue engineering of "living" valve implants.
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Affiliation(s)
- Francesco Amadeo
- Unità di Ingegneria Tissutale Cardiovascolare, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - Gianluca Polvani
- Dipartimento di Scienze Cliniche e di Comunità, Università di Milano, Milan, Italy
| | - Cristina Banfi
- Unità di Proteomica, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Maurizio Pesce
- Unità di Ingegneria Tissutale Cardiovascolare, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Rosaria Santoro
- Unità di Ingegneria Tissutale Cardiovascolare, Centro Cardiologico Monzino IRCCS, Milan, Italy
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Liberski A, Ayad N, Wojciechowska D, Kot R, Vo DM, Aibibu D, Hoffmann G, Cherif C, Grobelny-Mayer K, Snycerski M, Goldmann H. Weaving for heart valve tissue engineering. Biotechnol Adv 2017; 35:633-656. [DOI: 10.1016/j.biotechadv.2017.07.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 07/30/2017] [Accepted: 07/31/2017] [Indexed: 10/19/2022]
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17
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David TE. Aortic Valve Replacement in Children and Young Adults. J Am Coll Cardiol 2016; 67:2871-3. [PMID: 27311526 DOI: 10.1016/j.jacc.2016.04.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 04/06/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Tirone E David
- Division of Cardiac Surgery of the Peter Munk Cardiac Centre at Toronto General Hospital and the University of Toronto, Toronto, Ontario, Canada.
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18
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Everett RJ, Newby DE, Jabbour A, Fayad ZA, Dweck MR. The Role of Imaging in Aortic Valve Disease. CURRENT CARDIOVASCULAR IMAGING REPORTS 2016; 9:21. [PMID: 27375833 PMCID: PMC4896976 DOI: 10.1007/s12410-016-9383-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Aortic valve disease is the most common form of heart valve disease in developed countries. Imaging remains central to the diagnosis and risk stratification of patients with both aortic stenosis and regurgitation and has traditionally been performed with echocardiography. Indeed, echocardiography remains the cornerstone of aortic valve imaging as it is cheap, widely available and provides critical information concerning valve hemodynamics and ventricular function. RECENT FINDINGS Whilst diagnostic in the vast majority of patients, echocardiography has certain limitations including operator variability, potential for measurement errors and internal inconsistencies in severity grading. In particular, low-gradient severe aortic stenosis is common and challenging to diagnose. Aortic valve imaging may therefore be improved with alternative and complimentary multimodality approaches. SUMMARY This review investigates established and novel techniques for imaging both the aortic valve and the myocardial remodelling response including echocardiography, computed tomography, cardiovascular magnetic resonance and positron emission tomography. Moreover, we examine how the complementary information provided by each modality may be used in both future clinical practice and the research arena.
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Affiliation(s)
- Russell J. Everett
- />BHF/Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, EH16 4SB Edinburgh, UK
| | - David E. Newby
- />BHF/Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, EH16 4SB Edinburgh, UK
| | | | - Zahi A. Fayad
- />Icahn School of Medicine at Mount Sinai, New York, USA
| | - Marc R. Dweck
- />BHF/Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building, 49 Little France Crescent, EH16 4SB Edinburgh, UK
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19
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Abstract
BACKGROUND Surgical correction was the treatment of choice for pulmonary stenosis until three decades ago, when balloon valvuloplasty was implemented. The natural history of surgically relieved pulmonary stenosis has been considered benign but is actually unknown, as is the need for re-intervention. The objective of this study was to investigate the morbidity and mortality of patients with surgically treated pulmonary stenosis operated at Aarhus University Hospital between 1957 and 2000. RESULTS The total study population included 80 patients. In-hospital mortality was 2/80 (2.5%), and an additional four patients died after hospital discharge; therefore, the long-term mortality was 5%. The maximum follow-up period was 57 years, with a median of 33 years. In all, 16 patients (20%) required at least one re-intervention. Pulmonary valve replacement due to pulmonary regurgitation was the most common re-intervention (67%). Freedom from re-intervention decreased >20 years after the initial repair. In addition, 45% of patients had moderate/severe pulmonary regurgitation, 38% had some degree of right ventricular dilatation, and 40% had some degree of tricuspid regurgitation, which did not require re-intervention at the present stage. CONCLUSION Surgical relief for pulmonary stenosis is efficient in relieving outflow obstruction; however, this efficiency is achieved at the cost of pulmonary regurgitation, leading to right ventricular dilatation and tricuspid regurgitation. When required, pulmonary valve replacement is performed most frequently >20 years after the initial surgery. Lifelong follow-up of patients treated surgically for pulmonary stenosis is emphasised in this group of patients, who might otherwise consider themselves cured.
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Gillis K, Bala G, Roosens B, Remory I, Hernot S, Droogmans S, Cosyns B. Quantification of Calcium Amount in a New Experimental Model: A Comparison between Ultrasound and Computed Tomography. PLoS One 2016; 11:e0148904. [PMID: 26859304 PMCID: PMC4747484 DOI: 10.1371/journal.pone.0148904] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 01/24/2016] [Indexed: 11/18/2022] Open
Abstract
Purpose Calcification is an important prognostic factor in aortic valve stenosis. However, there is no ultrasound (US) method available to accurately quantify calcification in this setting to date. We aimed to validate a new US method for measuring the amount of calcium in an in vitro model, and compare it to computed tomography (CT), the current imaging gold standard. Materials and Methods An agar phantom (2% agar) was made, containing 9 different amounts of calcium-hydroxyapatite Ca5(PO4)3OH (2 to 50mg). The phantoms were imaged with micro-CT and US (10 MHz probe). The calcium area (areacalcium) and its maximum pixel value (PVmax) were obtained. These values were summed to calculate CT and US calcium scores (∑(areacalcium × PVmax)) and volumes (∑areacalcium). Both US- and CT-calcium scores were compared with the calcium amounts, and with each other. Results Both calcium scores correlated significantly with the calcium amount (R2 = 0.9788, p<0.0001 and R2 = 0.8154, p<0.0001 for CT and US respectively). Furthermore, there was a significant correlation between US and CT for calcium volumes (R2 = 0.7392, p<0.0001) and scores (R2 = 0.7391, p<0.0001). Conclusion We developed a new US method that accurately quantifies the amount of calcium in an in vitro model. Moreover it is strongly correlated with CT.
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Affiliation(s)
- Kris Gillis
- In vivo Cellular and Molecular Imaging (ICMI) laboratory, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Centrum voor Hart- en Vaatziekten (CHVZ), Department of Cardiology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussel, Belgium
- * E-mail:
| | - Gezim Bala
- In vivo Cellular and Molecular Imaging (ICMI) laboratory, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Centrum voor Hart- en Vaatziekten (CHVZ), Department of Cardiology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussel, Belgium
| | - Bram Roosens
- In vivo Cellular and Molecular Imaging (ICMI) laboratory, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Centrum voor Hart- en Vaatziekten (CHVZ), Department of Cardiology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussel, Belgium
| | - Isabel Remory
- In vivo Cellular and Molecular Imaging (ICMI) laboratory, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Sophie Hernot
- In vivo Cellular and Molecular Imaging (ICMI) laboratory, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Steven Droogmans
- In vivo Cellular and Molecular Imaging (ICMI) laboratory, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Centrum voor Hart- en Vaatziekten (CHVZ), Department of Cardiology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussel, Belgium
| | - Bernard Cosyns
- In vivo Cellular and Molecular Imaging (ICMI) laboratory, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Centrum voor Hart- en Vaatziekten (CHVZ), Department of Cardiology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussel, Belgium
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21
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Mazzitelli D, Stamm C, Rankin JS, Pfeiffer S, Fischlein T, Pirk J, Choi YH, Detter C, Kroll J, Beyersdorf F, Shrestha M, Schreiber C, Lange R. Leaflet reconstructive techniques for aortic valve repair. Ann Thorac Surg 2014; 98:2053-60. [PMID: 25468084 DOI: 10.1016/j.athoracsur.2014.06.052] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 05/30/2014] [Accepted: 06/09/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Refining leaflet reconstruction has become a primary issue in aortic valve repair. This descriptive analysis reviews leaflet pathology, repair techniques, and early results in a prospective regulatory trial of aortic valve repair. METHODS Sixty-five patients underwent valve repair for predominant moderate to severe aortic insufficiency (AI). The mean age was 63 ± 13 years, and 69% of the patients were male. Ascending aortic/root replacement was required in 62%. As a first step, ring annuloplasty was performed, and then leaflet repair included leaflet plication for prolapse, nodular unfolding, double pericardial patching of commissural defects or holes, complete pericardial leaflet replacement, leaflet extension, and Gore-Tex reinforcement. Leaflet techniques and causes of adverse outcomes were evaluated. RESULTS The follow-up time was 2-years maximal and 0.9 years mean, with a survival of 97%. Eighty percent of patients required repair of leaflet defects: leaflet prolapse (52/65-80%), ruptured commissures (6/65-9%), leaflet holes (4/65-6%), and nodular retraction (6/65-9%). The average preoperative AI grade of 2.9 ± 0.8 fell to 0.7 ± 0.7 (p < 0.0001). Three patients (4.6%) required interval valve replacement because of (1) suture untying, (2) iatrogenic leaflet tear, or (3) diphtheroid endocarditis. Five other patients experienced grade 2 or grade 3 AI: probable suture untying in 1 patient, ineffective leaflet extensions in 2 patients, and unsuccessful Gore-Tex reinforcements in 2 patients. Two patients with single pericardial leaflet replacements and all those with double pericardial reconstructions did well. CONCLUSIONS Leaflet defects are common in patients with moderate to severe AI. Leaflet plication, nodular unfolding, and double pericardial patching performed well. Gore-Tex and leaflet extension seemed less satisfactory. Standardization and experience with leaflet reconstruction will be important for optimizing the outcomes of aortic valve repair.
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Affiliation(s)
| | | | | | | | | | - Jan Pirk
- Institute for Clinical and Experimental Medicine, Prague, Czechoslovakia
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Parolari A, Songia P, Myasoedova V, Poggio P. Re: development of a next-generation tissue valve using a glutaraldehyde-fixed porcine aortic valve treated with decellularization, α-galactosidase, space filler, organic solvent and detoxification. Eur J Cardiothorac Surg 2014; 48:114. [PMID: 25385220 DOI: 10.1093/ejcts/ezu432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Alessandro Parolari
- Unit for Clinical Research in Atherothrombosis, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Paola Songia
- Unit for the Study of Aortic, Valvular and Coronary Pathologies, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Veronika Myasoedova
- Unit for Clinical Research in Atherothrombosis, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Paolo Poggio
- Unit for the Study of Aortic, Valvular and Coronary Pathologies, Centro Cardiologico Monzino IRCCS, Milan, Italy
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Panduranga P, El-Deeb M, Jha C. Mechanical Prosthetic Valves and Pregnancy: A therapeutic dilemma of anticoagulation. Sultan Qaboos Univ Med J 2014; 14:e448-e454. [PMID: 25364545 PMCID: PMC4205054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 04/27/2014] [Accepted: 05/08/2014] [Indexed: 06/04/2023] Open
Abstract
Choosing the best anticoagulant therapy for a pregnant patient with a mechanical prosthetic valve is controversial and the published international guidelines contain no clear-cut consensus on the best approach. This is due to the fact that there is presently no anticoagulant which can reliably decrease thromboembolic events while avoiding damage to the fetus. Current treatments include either continuing oral warfarin or substituting warfarin for subcutaneous unfractionated heparin or low-molecular-weight heparin (LMWH) in the first trimester (6-12 weeks) or at any point throughout the pregnancy. However, LMWH, while widely-prescribed, requires close monitoring of the blood anti-factor Xa levels. Unfortunately, facilities for such monitoring are not universally available, such as within hospitals in developing countries. This review evaluates the leading international guidelines concerning anticoagulant therapy in pregnant patients with mechanical prosthetic valves as well as proposing a simplified guideline which may be more relevant to hospitals in this region.
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Affiliation(s)
| | | | - Chitra Jha
- Obstetrics & Gynaecology, Royal Hospital, Muscat, Oman
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Pan Y, Qiao A, Dong N. Fluid-structure interaction simulation of aortic valve closure with various sinotubular junction and sinus diameters. Ann Biomed Eng 2014; 43:1363-9. [PMID: 25224079 DOI: 10.1007/s10439-014-1120-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 09/10/2014] [Indexed: 12/22/2022]
Abstract
This study was designed to investigate the effect of sinotubular junction and sinus diameters on aortic valve closure to prevent the regurgitation of blood from the aorta into the left ventricle during ventricular diastole. The 2-dimensional geometry of a base aortic valve was reconstructed using the geometric constraints and modeling dimensions suggested by literature as the reference model A (aortic annulus diameter (DAA) = 26, diameters of sinotubular junction (DSTJ) = 26, sinus diameter (DS) = 40), and then the DSTJ and DS were modified to create five geometric models named as B (DSTJ = 31.2, DS = 40), C (DSTJ = 20.8, DS = 40), D (DSTJ = 26, DS = 48), E (DSTJ = 26, DS = 32) and F (DSTJ = 31.2, DS = 48) with different dimensions. Fluid structure interaction method was employed to simulate the movement and mechanics of aortic root. The performance of the aortic root was quantified in terms of blood flow velocity through aortic valve, annulus diameter as well as leaflet contact pressure. For comparison among A, B and C, the differences of annulus diameter and leaflet contact pressure do not exceed 5% with DSTJ increased by 1.2 times and decreased by 0.8 times. For comparison among A, D and E, annulus diameter was increased by 6.92% and decreased by 7.87%, and leaflet contact pressure was increased by 8.99% and decreased by 12.14% with DS increased by 1.2 times and decreased by 0.8 times. For comparison between A and F, annulus diameter was increased by 5.10%, and leaflet contact pressure was increased by 13.54% both with DSTJ and DS increased by 1.1 times. The results of leaflet contact pressure presented for all models were consistent with those of aortic annulus diameters. For the Ross operation involves replacing the diseased aortic valve, aortic valve closure function can be affected by various sinotubular junction and sinus diameter. Compared with the sinus diameters, sinotubular junction diameters have less effect on the performance of aortic valve closure, when the diameter difference is within a range of 20%. So surgical planning might give sinus diameter more consideration.
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Affiliation(s)
- Youlian Pan
- College of Life Science and Bio-Engineering, Beijing University of Technology, Beijing, 100124, China
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Iatrogenic Ascending Aorta Dissection during Diagnostic Coronary Angiography: Rare but Life-Threatening. Case Rep Cardiol 2014; 2014:809398. [PMID: 25028613 PMCID: PMC4083777 DOI: 10.1155/2014/809398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 06/05/2014] [Indexed: 11/21/2022] Open
Abstract
Dissection of the ascending aorta is a very rare but life-threatening complication during diagnostic
angiography. We present a case of an elderly woman who underwent an elective diagnostic coronary
angiography, complicated with an iatrogenic ascending aorta dissection that did not involve the
coronary arteries but originated 4 cm distal of the aortic valve. The patient developed cardiogenic
shock due to acute pericardial tamponade and so immediate, life-saving cardiac surgery with
implantation of a supracoronary graft was successfully performed. A biopsy from the excised aorta
showed loss of smooth muscle cells and accumulation of basophilic ground substance, clear features
of cystic media necrosis. This is believed to be the underlying cause of the dissection besides a nonselective injection of the right coronary artery.
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Mazzitelli D, Stamm C, Rankin JS, Nöbauer C, Pirk J, Meuris B, Crooke PS, Wagner A, Beavan LA, Griffin CD, Powers D, Nasseri B, Schreiber C, Hetzer R, Lange R. Hemodynamic outcomes of geometric ring annuloplasty for aortic valve repair: A 4-center pilot trial. J Thorac Cardiovasc Surg 2014; 148:168-75. [DOI: 10.1016/j.jtcvs.2013.08.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 08/05/2013] [Accepted: 08/11/2013] [Indexed: 10/26/2022]
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Andreas M, Wiedemann D, Seebacher G, Rath C, Aref T, Rosenhek R, Heinze G, Eigenbauer E, Simon P, Ruetzler K, Hiesmayr JM, Moritz A, Laufer G, Kocher A. The Ross procedure offers excellent survival compared with mechanical aortic valve replacement in a real-world setting. Eur J Cardiothorac Surg 2014; 46:409-13; discussion 413-4. [DOI: 10.1093/ejcts/ezt663] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Design Characteristics of a Three-Dimensional Geometric Aortic Valve Annuloplasty Ring. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2013; 8:364-70. [DOI: 10.1097/imi.0000000000000026] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective A full geometric annuloplasty ring could facilitate aortic valve repair. The purpose of this report was to document the design of such a ring using mathematical analyses of normal human aortic valve computed tomographic angiograms. Methods One-millimeter axial slices of high-resolution computed tomographic angiograms from 11 normal aortic roots were used to generate high-density x, y, and z coordinates of valve structures in Mathematica. Three-dimensional least squares regression analyses of leaflet-sinus coordinates were used to assess geometry of aortic valve and root structures. Results Normal valve geometry could be represented as three leaflet-sinus general ellipsoids nested within an elliptical aortic root. Minor-major diameter ratio of the valve base was 0.60 ± 0.07, and elliptical geometry extended vertically up the commissures. By contrast, leaflet-sinus horizontal circumferences were fairly circular (diameter ratios, 0.82–0.87), and the left coronary/noncoronary commissural post was located at the posterior base minor diameter-circumference junction, with the center of the right coronary leaflet opposite. Post location on the circumference was symmetrical, with a deviation of only ±2% to ±3% from 33.3% symmetry. Commissural posts flared outward by 5 to 10 degrees, and leaflet areas were statistically equivalent ( P > 0.10). From end diastole to midsystole, the aortic root became less elliptical (diameter ratio increased by 0.15), but root area expanded minimally (less than +5%). A one-piece rigid annuloplasty ring was designed with 2:3 base ellipticality, three 10-degree outwardly flaring symmetrical posts, and post height = base circumference/2π. Conclusions A three-dimensional aortic annuloplasty ring was designed that could prove useful for enhancing applicability and stability of aortic valve repair.
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Crooke PS, Beavan LA, Griffin CD, Mazzitelli D, Rankin JS. Design Characteristics of a Three-Dimensional Geometric Aortic Valve Annuloplasty Ring. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2013. [DOI: 10.1177/155698451300800508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Philip S. Crooke
- Department of Mathematics, Vanderbilt University, Nashville, TN USA
| | | | | | | | - J. Scott Rankin
- Department of Cardiac Surgery, Vanderbilt University, Nashville, TN USA
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