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Bavaria JE, Mumtaz MA, Griffith B, Svensson LG, Pibarot P, Borger MA, Thourani VH, Blackstone EH, Puskas JD. Five-Year Outcomes After Bicuspid Aortic Valve Replacement With a Novel Tissue Bioprosthesis. Ann Thorac Surg 2024; 118:173-179. [PMID: 38135262 DOI: 10.1016/j.athoracsur.2023.11.036] [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: 07/28/2023] [Revised: 11/20/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND This study investigated the safety and effectiveness of surgical aortic valve replacement with RESILIA tissue (Edwards Lifesciences) through 5 years in patients with native bicuspid aortic valves. Outcomes were compared with those for patients with tricuspid aortic valves. METHODS Of 689 patients from the COMMENCE (ProspeCtive, nOn-randoMized, MulticENter) trial who received the study valve, 645 had documented native valve morphology and core laboratory-evaluable echocardiograms from any postoperative visit, which were used to model hemodynamic outcomes over 5 years. Linear mixed-effects models were used to estimate longitudinal changes in mean gradient and effective orifice area. RESULTS Patients with native bicuspid aortic valves (n = 214) were more than a decade younger than those with tricuspid aortic valves (n = 458; 59.8 ± 12.4 years vs 70.2 ± 9.5 years; P < .001). The bicuspid aortic valve cohort exhibited no structural valve deterioration over 5 years, and rates of paravalvular leak and transvalvular regurgitation were low (0.7% and 2.9%, respectively [all mild] at 5 years). These outcomes mirrored those in patients with native tricuspid aortic valves. The model-estimated postoperative mean gradient and effective orifice area, as well as the rate of change of these outcomes, adjusted for age, body surface area, and bioprosthesis size, did not differ between the 2 cohorts. CONCLUSIONS Among patients with bicuspid aortic valves, RESILIA tissue valves demonstrated excellent outcomes to 5 years, including no structural valve deterioration and very low rates of paravalvular and transvalvular regurgitation. These results are encouraging for RESILIA tissue durability in young patients.
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Affiliation(s)
- Joseph E Bavaria
- Department of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Mubashir A Mumtaz
- Department of Cardiovascular and Thoracic Surgery, UPMC Central Pennsylvania, Harrisburg, Pennsylvania
| | - Bartley Griffith
- Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Philippe Pibarot
- Department of Cardiology, Québec Heart and Lung Institute, Laval University, Quebec, Canada
| | - Michael A Borger
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - John D Puskas
- Department of Cardiovascular Surgery, Mount Sinai Morningside, New York, New York
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Sef D, Thet MS, Klokocovnik T, Luthra S. Early and mid-term outcomes after aortic valve replacement using a novel tissue bioprosthesis: a systematic review. Eur J Cardiothorac Surg 2024; 65:ezae045. [PMID: 38331412 DOI: 10.1093/ejcts/ezae045] [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: 12/02/2023] [Revised: 01/14/2024] [Accepted: 02/05/2024] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVES While current data show a clear trend towards the use of bioprosthetic valves during aortic valve replacement (AVR), durability of bioprosthetic valves remains the most important concern. We conducted a 1st systematic review of all available evidence that analysed early and mid-term outcomes after AVR using the Inspiris RESILIA™ bioprosthesis. METHODS A systematic literature search was performed to identify all relevant studies evaluating early and mid-term outcomes after AVR using the Inspiris RESILIA bioprosthesis and including at least 20 patients with no restriction on the publication date. Subgroup meta-analysis was performed to compare Inspiris RESILIA and PERIMOUNT Magna Ease bioprosthesis and to pool the early postoperative mortality and stroke rates. RESULTS A total of 416 studies were identified, of which 15 studies met the eligibility criteria. The studies included a total of 3202 patients with an average follow-up of up to 5.3 years. The average age of patients across the studies was 52.2-75.1 years. Isolated AVR was performed in 39.0-86.4% of patients. In-hospital or 30-day postoperative mortality was 0-2.8%. At the mid-term follow-up, freedom from all-cause mortality was up to 85.4%. Among studies with mid-term follow-up, trace/mild paravalvular leak was detected in 0-3.0%, while major paravalvular leak was found only in up to 2.0% of patients. No statistically significant differences in terms of mortality (P = 0.98, odds ratio 1.02, 95% confidence interval 0.36-2.83) and stroke (P = 0.98, odds ratio 1.01, 95% confidence interval 0.38-2.73) between the Inspiris RESILIA bioprosthesis and PERIMOUNT Magna Ease bioprosthesis were observed in the subgroup meta-analysis. CONCLUSIONS Mid-term data on the safety and haemodynamic performance of the novel aortic bioprosthesis are encouraging. Further comparative studies with other bioprostheses and longer follow-up are still required to endorse durability and safety of the novel bioprosthesis.
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Affiliation(s)
- Davorin Sef
- Department of Cardiac Surgery, University Hospitals of Leicester, Leicester, UK
| | - Myat Soe Thet
- Faculty of Medicine, Department of Surgery and Cancer, Imperial College London & Imperial College Healthcare NHS Trust, London, UK
| | | | - Suvitesh Luthra
- Department of Cardiac Surgery, Wessex Cardiothoracic Centre, University Hospital of Southampton, Southampton, UK
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Sadipour M, Azadani AN. The Measurement of Bovine Pericardium Density and Its Implications on Leaflet Stress Distribution in Bioprosthetic Heart Valves. Cardiovasc Eng Technol 2023; 14:853-861. [PMID: 37932655 DOI: 10.1007/s13239-023-00692-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 10/18/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE Bioprosthetic Heart Valves (BHVs) are widely used in clinical practice, showing promising outcomes. Computational modeling offers a valuable tool for quantitatively characterizing BHVs. To ensure the accuracy of computational models, it is crucial to consider precise leaflet properties, including mechanical properties and density. Bovine pericardium (BP) serves as a common material for BHV leaflets. Previous computational studies often assume BP density to approximate that of water or blood. Given that BP leaflets undergo various treatments, such as tissue fixation and anti-calcification, this study aims to measure the density of BP used in BHVs and assess its impact on leaflet stress distribution. METHODS Eight square BP samples were laser cut from Edwards BP patches and their density was determined. Specimen weight was measured using an A&D Analytical Balance, while volume was assessed through high-resolution imaging. Additionally, finite element models resembling a BHV, like the Carpentier-Edwards PERIMOUNT Magna, were constructed in ABAQUS. RESULTS The average density of the BP samples was found to be 1,410 kg/m3. During the acceleration phase of a cardiac cycle, the maximum stress reached 1.89 MPa for a density of 1,410 kg/m3 and 2.47 MPa for a density of 1,000 kg/m3 (a 30.7% difference). In the deceleration phase, the maximum stress reached 713 kPa and 669 kPa, respectively. CONCLUSION Leaflet stress distribution and motion in BHVs are influenced by density variations. Establishing an accurate density value for BHV leaflets is imperative for enhancing the computational models, which can ultimately contribute to improved BHV design and outcomes.
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Affiliation(s)
- Masod Sadipour
- Department of Mechanical and Materials Engineering, University of Denver, 2155 E. Wesley Ave #439, Denver, CO, 80208, USA
| | - Ali N Azadani
- Department of Mechanical and Materials Engineering, University of Denver, 2155 E. Wesley Ave #439, Denver, CO, 80208, USA.
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Meuris B, Roussel JC, Borger MA, Siepe M, Stefano P, Laufer G, Langanay T, Theron A, Grabenwöger M, Binder K, Demers P, Pessotto R, van Leeuwen W, Bourguignon T, Canovas S, Mariscalco G, Coscioni E, Dagenais F, Wendler O, Polvani G, Eden M, Botta B, Bramlage P, De Paulis R. Durability of bioprosthetic aortic valve replacement in patients under the age of 60 years - 1-year follow-up from the prospective INDURE registry. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 37:ivad115. [PMID: 37462612 PMCID: PMC10576637 DOI: 10.1093/icvts/ivad115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/16/2023] [Accepted: 07/01/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVES We report 1-year safety and clinical outcomes in patients <60 years undergoing bioprosthetic surgical aortic valve intervention. METHODS The INSPIRIS RESILIA Durability Registry is a prospective, multicentre registry to assess clinical outcomes of patients <60 years. Patients with planned SAVR with or without concomitant replacement of the ascending aorta and/or coronary bypass surgery were included. Time-related valve safety, haemodynamic performance and quality of life (QoL) at 1 year were assessed. RESULTS A total of 421 patients were documented with a mean age of 53.5 years, 76.5% being male and 27.2% in NYHA class III/IV. Outcomes within 30 days included cardiovascular-related mortality (0.7%), time-related valve safety (VARC-2; 5.8%), thromboembolic events (1.7%), valve-related life-threatening bleeding (VARC-2; 4.3%) and permanent pacemaker implantation (3.8%). QoL was significantly increased at 6 months and sustained at 1 year. Freedom from all-cause mortality at 1 year was 98.3% (95% confidence interval 97.1; 99.6) and 81.8% were NYHA I versus 21.9% at baseline. No patient developed structural valve deterioration stage 3 (VARC-3). The mean aortic pressure gradient was 12.6 mmHg at 1 year and the effective orifice area was 1.9 cm2. CONCLUSIONS The 1-year data from the INSPIRIS RESILIA valve demonstrate good safety and excellent haemodynamic performance as well as an early QoL improvement. CLINICAL TRIAL REGISTRATION clinicaltrials.gov: NCT03666741.
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Affiliation(s)
- Bart Meuris
- Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | | | - Michael A Borger
- Department for Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Matthias Siepe
- Department of Cardiovascular Surgery, University Heart Center, University Hospital Freiburg, Freiburg, Germany
- Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
- Department of Cardiac Surgery, University Hospital Bern, University of Bern, Switzerland
| | - Pierluigi Stefano
- Division of Cardiac Surgery, Careggi University Hospital, Florence, Italy
| | - Günther Laufer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Thierry Langanay
- Thoracic and Cardiovascular Surgery, Rennes University Hospital Center, Rennes, France
| | - Alexis Theron
- Cardio-Thoracic Surgery Department, Hospital de la Timone, Marseille, France
| | - Martin Grabenwöger
- Department of Cardiovascular Surgery, HZH Heart Center Hietzing, Austria
| | - Konrad Binder
- Heart Center University St. Pölten, St. Pölten, Austria
| | - Philippe Demers
- Department of surgery, Montreal Heart Institute, University of Montreal, Montreal, Canada
| | - Renzo Pessotto
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Wouter van Leeuwen
- Cardio-Thoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Thierry Bourguignon
- Department of Cardiology and Cardiac Surgery, Tours University Hospital, Tours, France
| | - Sergio Canovas
- Cardiovascular Surgery Department, Hospital University Virgen de la Arrixaca, Murcia, Spain
| | - Giovanni Mariscalco
- National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, England
| | - Enrico Coscioni
- Division of Cardiac Surgery, University Hospital San Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | | | - Olaf Wendler
- Department of Cardiothoracic Surgery, King’s College Hospital NHS Foundation Trust, London, UK
| | - Gianluca Polvani
- Department of Cardiovascular Surgery, Cardiology Center Monzino, Milan, Italy
| | - Matthias Eden
- Department for Internal Medicine III, Molecular Cardiology and Angiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Beate Botta
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
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Beaver T, Bavaria JE, Griffith B, Svensson LG, Pibarot P, Borger MA, Sharaf OM, Heimansohn DA, Thourani VH, Blackstone EH, Puskas JD. Seven-year outcomes following aortic valve replacement with a novel tissue bioprosthesis. J Thorac Cardiovasc Surg 2023:S0022-5223(23)00873-5. [PMID: 37778503 DOI: 10.1016/j.jtcvs.2023.09.047] [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: 07/09/2023] [Revised: 09/07/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE As bioprosthetic aortic valve replacement (AVR) extends to younger cohorts, tissue durability is of paramount importance. We report 7-year outcomes from an AVR bioprosthesis utilizing novel tissue. METHODS This was an international investigational device exemption trial for novel AVR with annual follow-up and a subset re-consented at 5 years for extended 10-year follow-up. Safety end points and echocardiographic measurements were adjudicated by an independent clinical events committee and by a dedicated core laboratory, respectively. RESULTS Between January 2013 and March 2016, 689 patients underwent AVR with the study valve. Mean age was 66.9 ± 11.6 years, Society of Thoracic Surgeons risk score was 2.0% ± 1.8%, and 74.3% of patients were New York Heart Association functional class II and III. Five-year follow-up was completed by 512 patients, and 225 re-consented for extended follow-up. Follow-up duration was 5.3 ± 2.2 years (3665.6 patient-years), and 194 and 195 patients completed 6- and 7-year follow-ups, respectively. One-, 5-, and 7-year freedom from all-cause mortality was 97.7%, 89.4%, and 85.4%, respectively. Freedom from structural valve deterioration at 7 years was 99.3%. At 7 years, effective orifice area and mean gradients were 1.82 ± 0.57 cm2 (n = 153), and 9.4 ± 4.5 mm Hg (n = 157), respectively. At 7 years, predominantly none (96.8% [152 out of 157]) or trivial/trace (2.5% [4 out of 157]) paravalvular regurgitation and none (84.7% [133 out of 157]) or trivial/trace (11.5% [18 out of 157]) transvalvular regurgitation were observed. CONCLUSIONS We report the longest surgical AVR follow-up with novel tissue in an investigational device exemption trial utilizing an independent clinical events committee and an echocardiography core laboratory. This tissue demonstrates excellent outcomes through 7 years and is the benchmark for future surgical and transcatheter prostheses.
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Affiliation(s)
- Thomas Beaver
- Division of Cardiovascular Surgery, University of Florida Health, Gainesville, Fla.
| | - Joseph E Bavaria
- Department of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Bartley Griffith
- Department of Surgery, University of Maryland Medical Center, Baltimore, Md
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Philippe Pibarot
- Department of Cardiology, Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada
| | - Michael A Borger
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Omar M Sharaf
- Division of Cardiovascular Surgery, University of Florida Health, Gainesville, Fla
| | | | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Ga
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - John D Puskas
- Department of Cardiovascular Surgery, Mount Sinai Morningside, New York, NY
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Porto A, Stolpe G, Badaoui R, Boudouresques V, Deutsch C, Amanatiou C, Riberi A, Gariboldi V, Collart F, Theron A. One-year clinical outcomes following Edwards INSPIRIS RESILIA aortic valve implantation in 487 young patients with severe aortic stenosis: a single-center experience. Front Cardiovasc Med 2023; 10:1196447. [PMID: 37600038 PMCID: PMC10435896 DOI: 10.3389/fcvm.2023.1196447] [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: 03/29/2023] [Accepted: 06/26/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction The use of an aortic bioprosthesis is on the rise in younger patients with severe aortic stenosis despite the risk of accelerated structural valve degeneration (SVD). In the search for an optimal valve substitute that would not be prone to SVD, the INSPIRIS bioprosthesis represents a promising solution to lowering the risk of SVD. Here, we report the 1-year outcomes of the INSPIRIS RESILIA aortic bioprosthesis in a population of young patients who underwent aortic valve replacement. Methods In this prospective single-center study, we included all consecutive patients receiving INSPIRIS RESILIA bioprosthesis between June 2017 and July 2021. Patients with isolated severe aortic regurgitation were excluded. Clinical assessment and transthoracic echocardiography were performed preoperatively and at 1 year post-operatively. The primary outcome was overall mortality at one year. Results A total of 487 patients were included. The mean age was 58.2 ± 11.5 years, 75.2% were men. Most of the interventions were elective, with a mean EuroSCORE II of 4.8 ± 7.9. The valve annulus size in most cases was either 23 mm or 25 mm. Overall mortality at 1-year was 4.1%. At 1-year, 7 patients (1.4%) had a stroke, 4 patients (0.8%) had a myocardial infarction, and 20 patients (4.1%) were hospitalized for congestive heart failure. The Kaplan-Meier estimated survival rates and survival without major adverse cardiac events at 1-year were 96.4% and 96.7%, respectively. At 1-year follow-up, 10 patients (2.1%) had endocarditis and 1 patient (0.2%) had partial prosthetic thrombosis. Pacemaker implantation at 1-year post-operative was necessary in 27 patients (5.5%). Severe patient prosthesis mismatch and severe intra valvular regurgitation were 1.2% and 0.6%, respectively. The Kaplan-Meier estimated survival rates at 1-year of no infective endocarditis preoperative and infective endocarditis preoperative were 97.9 ± 0.7% and 89.5 ± 3.3%, respectively (P < 0.001). Excluding endocarditis-related complication, no structural valve deterioration and no valve failure requiring redo surgery were reported. Conclusion This is the largest single-center descriptive study of the 1-year outcomes after INSPIRIS RESILIA bioprosthesis implantation. The EDWARDS INSPIRIS RESILIA bioprosthesis provides encouraging clinical outcomes with an excellent 1- year survival rates and good hemodynamic performance. Long-term studies are mandatory to assess valve durability.
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Affiliation(s)
- Alizee Porto
- Department of Cardiac Surgery, APHM, Timone Hospital, Marseille, France
| | - Gregoire Stolpe
- Department of Cardiac Surgery, APHM, Timone Hospital, Marseille, France
| | - Rita Badaoui
- Department of Cardiac Surgery, APHM, Timone Hospital, Marseille, France
| | | | - Cornelia Deutsch
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Cecile Amanatiou
- Department of Cardiac Surgery, APHM, Timone Hospital, Marseille, France
| | - Alberto Riberi
- Department of Cardiac Surgery, APHM, Timone Hospital, Marseille, France
| | - Vlad Gariboldi
- Department of Cardiac Surgery, APHM, Timone Hospital, Marseille, France
| | - Frédéric Collart
- Department of Cardiac Surgery, APHM, Timone Hospital, Marseille, France
| | - Alexis Theron
- Department of Cardiac Surgery, APHM, Timone Hospital, Marseille, France
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Bernard J, Georges G, Hecht S, Pibarot P, Clavel MA, Babaki S, Kalavrouziotis D, Mohammadi S. Mid-term clinical and echocardiographic results of the INSPIRIS RESILIA aortic valve: a retrospective comparison to the Magna Ease. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 37:ivad117. [PMID: 37462610 PMCID: PMC10386877 DOI: 10.1093/icvts/ivad117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/12/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVES The INSPIRIS aortic valve combines the RESILIA proprietary tissue preservation process and an expandable stent frame to benefit future transcatheter valve-in-valve procedures. As the INSPIRIS valve became commercially available in 2017, mid-term outcome reports are scarce. We aimed to evaluate mid-term safety and echocardiographic performance of the INSPIRIS valve in comparison to its predecessor, the Carpentier Edwards Perimount Magna Ease (ME). METHODS This study was a retrospective single-centre study. Clinical results included early postoperative outcomes, mid-term mortality and readmission for cardiovascular cause or stroke. Echocardiographic follow-up (FU) was performed at discharge and 1-3, 6, 12 and 24 months. Clinical end point analyses were accomplished with a propensity score matching analysis and FU echocardiographic data comparisons using pairwise analyses and linear mixed-effect models. RESULTS We included 953 patients who received an INSPIRIS (n = 488) or ME (n = 463) bioprosthesis between January 2018 and July 2021. In the matched population (n = 217 per group), no significant difference in short-term outcomes was observed, survival was similar at 30 months (INSPIRIS: 94% vs ME: 91%, P = 0.89), but freedom from readmission was higher in the INSPIRIS group (94% vs 86%, P = 0.014). INSPIRIS valves had a lower gradient at discharge (∼10 vs 14 mmHg, P < 0.001), 1-3 months (∼10 vs 12 mmHg, P < 0.001) and 24 months (∼11 vs 17 mmHg, P < 0.001) in paired analyses and significantly lower evolution of mean transvalvular gradients compared to ME. CONCLUSIONS This study represents the largest comparative evaluation of the INSPIRIS to the ME valves, which demonstrated safe clinical outcomes and favourable haemodynamic performance at 2 years. Long-term FU is underway.
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Affiliation(s)
- Jérémy Bernard
- Cardiology Division, Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval/Quebec Heart and Lung Institute - Laval University, Quebec, QC, Canada
| | - Gabriel Georges
- Cardiac Surgery Division, Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval/Quebec Heart and Lung Institute - Laval University, Quebec, QC, Canada
| | - Sébastien Hecht
- Cardiology Division, Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval/Quebec Heart and Lung Institute - Laval University, Quebec, QC, Canada
| | - Philippe Pibarot
- Cardiology Division, Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval/Quebec Heart and Lung Institute - Laval University, Quebec, QC, Canada
| | - Marie-Annick Clavel
- Cardiology Division, Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval/Quebec Heart and Lung Institute - Laval University, Quebec, QC, Canada
| | - Shervin Babaki
- Research Division, Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval/Quebec Heart and Lung Institute - Laval University, Quebec, QC, Canada
| | - Dimitri Kalavrouziotis
- Cardiac Surgery Division, Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval/Quebec Heart and Lung Institute - Laval University, Quebec, QC, Canada
| | - Siamak Mohammadi
- Cardiac Surgery Division, Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval/Quebec Heart and Lung Institute - Laval University, Quebec, QC, Canada
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Bartus K, Bavaria JE, Thourani VH, Xu K, Keuffel EL. Structural hemodynamic valve deterioration durability of RESILIA-tissue versus contemporary aortic bioprostheses. J Comp Eff Res 2023; 12:e220180. [PMID: 36691718 PMCID: PMC10288964 DOI: 10.2217/cer-2022-0180] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 01/03/2023] [Indexed: 01/25/2023] Open
Abstract
Aim: Durability of aortic valve replacement is becoming increasingly important. Aortic bioprostheses with RESILIA tissue have demonstrated outstanding outcomes thus far, but only in single-arm studies. Methods: We compared structural valve deterioration (SVD)-related hemodynamic valve deterioration (HVD) of grade ≥2 of RESILIA tissue valves from the COMMENCE trial (n = 689) to those from the PARTNER 2A contemporary AVR arm (n = 936) based upon annual core laboratory echocardiograms through 5 years of follow-up. Results: SVD-related HVD in the COMMENCE and PARTNER 2A cohorts were 1.8 versus 3.5%, respectively (one-sided 95% lower-bound hazard ratio of 0.92; p = 0.07). In propensity-matched cohorts (n = 239), these outcomes were 1.0 versus 4.8%, respectively (one-sided 95% lower-bound hazard ratio of 1.15; p = 0.03). Conclusion: RESILIA tissue-based AVR exhibited reduced SVD-related HVD compared with a contemporary AVR cohort devoid of RESILIA tissue.
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Affiliation(s)
- Krzysztof Bartus
- Department of Cardiovascular Surgery & Transplantology, Jagiellonian University Medical College, Institute of Cardiology, John Paul II Hospital, Krakow, Poland
| | - Joseph E Bavaria
- Department of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, GA, USA
| | - Ke Xu
- Edwards Lifesciences, Irvine, CA, USA
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Carapinha JL, Iliescu VA, Dorobantu LF, Turcu-Stiolica A, Deckert J, White A, Salem A, Parasca C. Budget impact analysis of a bovine pericardial aortic bioprosthesis versus mechanical aortic valve replacement in adult patients with aortic stenosis in Romania. J Med Econ 2023; 26:998-1008. [PMID: 37505934 DOI: 10.1080/13696998.2023.2242188] [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: 04/11/2023] [Revised: 07/15/2023] [Accepted: 07/25/2023] [Indexed: 07/30/2023]
Abstract
AIMS An analysis of the budget impact of using a bovine pericardial aortic bioprosthesis (BPAB) or a mechanical valve (MV) in aortic stenosis (AS) patients in Romania. MATERIALS AND METHODS A decision-tree with a partitioned survival model was used to predict the financial outcomes of using either a BPAB (the Carpentier-Edwards Perimount Magna Ease Valve) or MV in aortic valve replacement (AVR) procedure over a 5-year period. The budget impact of various resource consumption including disabling strokes, reoperations, minor thromboembolic events, major bleeding, endocarditis, anticoagulation treatment and monitoring, and echocardiogram assessments were compared for both types of valves. One-way sensitivity analyses (OWSA) were conducted on the input costs and probabilities. RESULTS The use of BPAB compared to MV approaches budget neutrality due to incremental savings year-on-year. The initial surgical procedure and reoperation costs for BPAB are offset by savings in acenocoumarol use, disabling strokes, major bleeding, minor thromboembolic events, and anticoagulation complications. The cost of the initial procedure per patient is 460 euros higher for a BPAB due to the higher valve acquisition cost, although this is partially offset by a shorter hospital stay. The OWSA shows that the total procedure costs, including the hospital stay, are the primary cost drivers in the model. LIMITATIONS Results are limited by cost data aggregation in the DRG system, exclusion of costs for consumables and capital equipment use, possible underestimation of outpatient complication costs, age-related variations of event rates, and valve durability. CONCLUSIONS Adopting BPAB as a treatment option for AS patients in Romania can lead to cost savings and long-term economic benefits. By mitigating procedure costs and increasing anticoagulation treatment costs, BPAB offers a budget-neutral option that can help healthcare providers, policymakers, and patients alike manage the growing burden of AS in Romania.
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Affiliation(s)
- João L Carapinha
- Northeastern University School of Pharmacy, Boston, United States of America
- Syenza, Anaheim, United States of America
| | - Vlad A Iliescu
- University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | | | | | | | | | - Adham Salem
- Edwards Lifesciences, Dubai, United Arab Emirates
| | - Catalina Parasca
- "Prof. Dr. C.C. Iliescu" Institute for Cardiovascular Diseases, Bucharest, Romania
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10
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Keuffel EL, Reifenberger M, Marfo G, Nguyen TC. Long-run savings associated with surgical aortic valve replacement using a RESILIA tissue bioprosthetic valve versus a mechanical valve. J Med Econ 2023; 26:120-127. [PMID: 36524536 DOI: 10.1080/13696998.2022.2159662] [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: 12/23/2022]
Abstract
BACKGROUND Prior economic analyses demonstrate that legacy tissue valves are associated with substantial financial savings over the long run after a surgical aortic valve replacement (SAVR). Bioprostheses with RESILIA tissue reduce calcification, the primary cause of structural valve deterioration (SVD), and have demonstrated promising pre-clinical and 5-year clinical results. This economic evaluation quantifies the expected long-run savings of bioprosthetic valves with RESILIA tissue relative to mechanical valves given 5-year clinical results and expected performance through year 15. METHODS Simulation models estimated disease progression across two hypothetical SAVR cohorts (tissue vs. mechanical) of 10,000 patients in the US over 15 years. One comparison evaluated RESILIA tissue valves relative to mechanical valves. The other compared legacy SAVR tissue and mechanical valves. Health outcome probabilities and costs were based on literature and expert opinion. Incidence rates of health outcomes associated with mechanical valve were calculated using relative risks of expected outcomes in tissue valve versus mechanical valve patients. The comparisons also accounted for anti-coagulation monitoring in both cohorts. Savings estimates are based on US healthcare costs and do not yet account for the premium associated use of RESILIA relative to a standard tissue valve. RESULTS Relative to mechanical SAVR, the median net discounted savings for a patient receiving SAVR with a RESILIA tissue valve is $20,744 ($US, 2020; 95% CI = $15,835-$26,655) over a 15-year horizon. While 30-day and 1-year savings were not significant, expected savings after 5 years are $9,110 (95% CI = $6,634-$11,969). Net savings for RESILIA SAVR valves were approximately 30-50% larger than savings anticipated using legacy tissue SAVR valves. CONCLUSION RESILIA tissue valves are associated with lower health expenditures relative to mechanical valves.
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Affiliation(s)
- Eric L Keuffel
- Health Economics, Health Finance & Access Initiative, Ardmore, PA, USA
| | | | - Godfred Marfo
- Health Economics, Edwards Life Sciences, Irvine, CA, USA
| | - Tom C Nguyen
- Department of Cardiothoracic Surgery, University of California San Francisco, San Francisco, CA, USA
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11
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Hemodynamic performance of INSPIRIS RESILIA aortic bioprosthesis for severe aortic stenosis: 2-year follow-up in Japanese cohort. J Artif Organs 2022; 25:323-328. [DOI: 10.1007/s10047-022-01316-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/24/2022] [Indexed: 10/19/2022]
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12
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Bavaria JE, Griffith B, Heimansohn DA, Rozanski J, Johnston DR, Bartus K, Girardi LN, Beaver T, Takayama H, Mumtaz MA, Rosengart TK, Starnes V, Timek TA, Boateng P, Ryan W, Cornwell LD, Blackstone EH, Borger MA, Pibarot P, Thourani VH, Svensson LG, Puskas JD. Five-year Outcomes of the COMMENCE Trial Investigating Aortic Valve Replacement with RESILIA Tissue. Ann Thorac Surg 2022; 115:1429-1436. [DOI: 10.1016/j.athoracsur.2021.12.058] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 11/19/2021] [Accepted: 12/01/2021] [Indexed: 11/29/2022]
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13
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OUP accepted manuscript. Eur Heart J 2022; 43:2729-2750. [DOI: 10.1093/eurheartj/ehac105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 02/22/2022] [Accepted: 02/01/2022] [Indexed: 11/12/2022] Open
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14
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Carapinha JL, Al-Omar HA, Aluthman U, Albacker TB, Arafat A, Algarni K, Martí-Sánchez B. Budget impact analysis of a bioprosthetic valve with a novel tissue versus mechanical aortic valve replacement in patients older than 65 years with aortic stenosis in Saudi Arabia. J Med Econ 2022; 25:1149-1157. [PMID: 36201747 DOI: 10.1080/13696998.2022.2133320] [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: 10/24/2022]
Abstract
AIMS A budget impact analysis (BIA) comparing bioprosthetic valves with RESILIA tissue and mechanical valves in aortic stenosis (AS) patients > 65 years in the public and private sectors of Saudi Arabia. MATERIALS AND METHODS A decision-tree with a partitioned survival model was adapted to estimate the financial consequences of either a RESILIA tissue valve or a mechanical valve in aortic valve replacement (AVR) procedures up to 5 years. The budget impact of resource consumption for both valve types was compared and included disabling strokes, reoperations, minor thromboembolic events, major bleeding, endocarditis, anticoagulation treatment and monitoring, and echocardiogram assessments. One-way sensitivity analyses (OWSA) were performed on cost and probability inputs. RESULTS RESILIA tissue valves versus mechanical valves are overall budget saving commencing in Year 1 and savings gradually increase year-on-year. The higher costs of the initial procedure, reoperation, and additional monitoring (echocardiogram tests and visits) associated with RESILIA tissue valves are offset by savings in warfarin use, disabling strokes, major bleeding, and anticoagulation complications. The cost per initial procedure per patient is SAR795 higher for a RESILIA tissue valve reflecting the higher valve acquisition cost, which is partially offset by a shorter hospital stay. The OWSA suggests that total procedure costs of each valve, including the hospital stay, are the main cost drivers in the model. LIMITATIONS The variability of cost inputs and the presence of multiple payers with multiple costing data is a key challenge in Saudi Arabia. Budget impact results may, therefore, change if repeated per AVR center and may also be impacted by the long-term durability of RESILIA tissue valves. CONCLUSIONS An AVR in patients > 65 years with a RESILIA tissue valve is budget-saving from the first year in Saudi Arabia. Patients, payers, providers and policymakers may benefit economically from increased implantation of RESILIA tissue valves.
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Affiliation(s)
- João L Carapinha
- School of Pharmacy, Northeastern University, Boston, MA, USA
- Syenza, Anaheim, CA, USA
| | - Hussain A Al-Omar
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Uthman Aluthman
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Turki B Albacker
- Cardiac Sciences Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- King Fahad Cardiac Center, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Amr Arafat
- Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
- Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt
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15
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Chen J, Lv M, Lu Y, Fu J, Guo Y, Tao L, Zhou X, Gu T, Wei L, Hong T, Wang C. Two-Year Clinical Follow-Up Assessment of the Novel Cingular Surgical Bovine Pericardial Valve. Front Cardiovasc Med 2021; 8:736877. [PMID: 34966792 PMCID: PMC8711235 DOI: 10.3389/fcvm.2021.736877] [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: 07/06/2021] [Accepted: 10/25/2021] [Indexed: 02/05/2023] Open
Abstract
Objectives: To evaluate the 2-year clinical safety and hemodynamic outcomes of the Cingular bovine pericardial bioprosthesis. Methods: A prospective, multicenter, single-arm trial was conducted in patients who required aortic or mitral valve replacement. From March 2016 to October 2017, 197 patients were implanted with the Cingular bovine pericardial valve at five sites in China. The clinical outcomes and hemodynamic performance were assessed through a 2-year follow-up. Clinical safety events were reviewed by an independent clinical events committee, and echocardiographic data were assessed by an independent core laboratory. Results: The mean age was 66.9 ± 4.9 years. The 2-year survival rate was 96.4%. A complete 2-year clinical follow-up was achieved in 189 of 190 survivors. No case of structural valve deterioration, major perivalvular leak, prosthetic valve endocarditis, or valve-related reoperation was seen. For the aortic valve, the mean pressure gradient observed was 12.5 ± 4.0 mm Hg, and the effective orifice area (EOA) was 2.0 ± 0.3 cm2. For the smaller size aortic valves, 19 mm and 21 mm, respective mean EOA values of 1.7 ± 0.2 cm2 and 1.8 ± 0.2 cm2 were found. The values for mean pressure gradient and mean EOA for mitral bioprostheses were 4.0 ± 1.4 mm Hg and 2.2 ± 0.3 cm2, respectively. There was no significant change between 1-year and 2-year hemodynamic performance. Conclusions: The Cingular bovine pericardial valve showed favorable clinical safety and hemodynamic outcomes over a 2-year follow-up. Further follow-up is required to validate the long-term durability.
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Affiliation(s)
- Jinmiao Chen
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Minzhi Lv
- Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuntao Lu
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jiahui Fu
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yingqiang Guo
- Department of Cardiac Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Liang Tao
- Department of Cardiac Surgery, Wuhan Asia Heart Hospital, Wuhan, China
| | - Xinmin Zhou
- Department of Cardiac Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Tianxiang Gu
- Department of Cardiac Surgery, The First Hospital of China Medical University, Changchun, China
| | - Lai Wei
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tao Hong
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chunsheng Wang
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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16
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Johnston DR, Griffith BP, Puskas JD, Bavaria JE, Svensson LG, Blackstone EH, Gammie JS, Heimansohn DA, Sadowski J, Bartus K, Rozanski J, Bilewskai A, Rosengart T, Girardi LN, Klodell CT, Mumtaz MA, Takayama H, Halkos M, Starnes V, Boateng P, Timek TA, Ryan W, Omer S, Smith CR. Intermediate-term outcomes of aortic valve replacement using a bioprosthesis with a novel tissue. J Thorac Cardiovasc Surg 2021; 162:1478-1485. [DOI: 10.1016/j.jtcvs.2020.01.095] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 12/30/2019] [Accepted: 01/17/2020] [Indexed: 01/28/2023]
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17
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Makkar RR, Yoon SH, Chakravarty T, Kapadia SR, Krishnaswamy A, Shah PB, Kaneko T, Skipper ER, Rinaldi M, Babaliaros V, Vemulapalli S, Trento A, Cheng W, Kodali S, Mack MJ, Leon MB, Thourani VH. Association Between Transcatheter Aortic Valve Replacement for Bicuspid vs Tricuspid Aortic Stenosis and Mortality or Stroke Among Patients at Low Surgical Risk. JAMA 2021; 326:1034-1044. [PMID: 34546301 PMCID: PMC8456392 DOI: 10.1001/jama.2021.13346] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE There are limited data on outcomes of transcatheter aortic valve replacement (TAVR) for bicuspid aortic stenosis in patients at low surgical risk. OBJECTIVE To compare the outcomes of TAVR with a balloon-expandable valve for bicuspid vs tricuspid aortic stenosis in patients who are at low surgical risk. DESIGN, SETTING, AND PARTICIPANTS Registry-based cohort study of patients undergoing TAVR at 684 US centers. Participants were enrolled in the Society of Thoracic Surgeons (STS)/American College of Cardiology Transcatheter Valve Therapies Registry from June 2015 to October 2020. Among 159 661 patients (7058 bicuspid, 152 603 tricuspid), 37 660 patients (3243 bicuspid and 34 417 tricuspid) who were at low surgical risk (defined as STS risk score <3%) were included in the analysis. EXPOSURES TAVR for bicuspid vs tricuspid aortic stenosis. MAIN OUTCOMES AND MEASURES Coprimary outcomes were 30-day and 1-year mortality and stroke. Secondary outcomes included procedural complications and valve hemodynamics. RESULTS Among 159 661 patients (7058 bicuspid; 152 603 tricuspid), 3168 propensity-matched pairs of patients with bicuspid and tricuspid aortic stenosis at low surgical risk were analyzed (mean age, 69 years; 69.8% men; mean [SD] STS-predicted risk of mortality, 1.7% [0.6%] for bicuspid and 1.7% [0.7%] for tricuspid). There was no significant difference between the bicuspid and tricuspid groups' rates of death at 30 days (0.9% vs 0.8%; hazard ratio [HR], 1.18 [95% CI, 0.68-2.03]; P = .55) and at 1 year (4.6% vs 6.6%; HR, 0.75 [95% CI, 0.55-1.02]; P = .06) or stroke at 30 days (1.4% vs 1.2%; HR, 1.14 [95% CI, 0.73-1.78]; P = .55) and at 1 year (2.0% vs 2.1%; HR 1.03 [95% CI, 0.69-1.53]; P = .89).There were no significant differences between the bicuspid and tricuspid groups in procedural complications, valve hemodynamics (aortic valve gradient: 13.2 mm Hg vs 13.5 mm Hg; absolute risk difference [RD], 0.3 mm Hg [95% CI, -0.9 to 0.3 mm Hg]), and moderate or severe paravalvular leak (3.4% vs 2.1%; absolute RD, 1.3% [95% CI, -0.6% to 3.2%]). CONCLUSIONS AND RELEVANCE In this preliminary, registry-based study of propensity-matched patients at low surgical risk who had undergone TAVR for aortic stenosis, patients treated for bicuspid vs tricuspid aortic stenosis had no significant difference in mortality or stroke at 30 days or 1 year. Because of the potential for selection bias and absence of a control group treated surgically for bicuspid aortic stenosis, randomized trials are needed to adequately assess the efficacy and safety of transcatheter aortic valve replacement for bicuspid aortic stenosis in patients at low surgical risk.
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Affiliation(s)
- Raj R. Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Sung-Han Yoon
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Tarun Chakravarty
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | | | | | | | | | - Eric R. Skipper
- Sanger Heart and Vascular Institute, Carolinas Medical Center, Charlotte, North Carolina
| | - Michael Rinaldi
- Sanger Heart and Vascular Institute, Carolinas Medical Center, Charlotte, North Carolina
| | | | | | - Alfredo Trento
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Wen Cheng
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
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18
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Liebrich M, Charitos EI, Dingemann C, Roser D, Seeburger J, Hemmer W, Voth V. The reinforced full-root technique for the Ross operation: surgical considerations and operative insights. Ann Cardiothorac Surg 2021; 10:485-490. [PMID: 34422560 DOI: 10.21037/acs-2020-rp-22] [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: 10/15/2020] [Accepted: 05/12/2021] [Indexed: 11/06/2022]
Abstract
Background Surgical treatment of young and middle-aged patients suffering from aortic valve disease remains an unresolved issue due to the limited durability of bioprosthetic heart valve replacements and the valve-related morbidity of patients with mechanical valve substitutes. Theoretically, the "living valve" principle of the Ross operation may represent a potentially viable solution to this dilemma. In this paper, we report on the surgical techniques of the Ross procedure and present long-term post-operative outcomes using the reinforced full-root technique. Methods From 1995 to 2020, a total of 832 consecutive patients (mean age, 43.4±13.7 years; 617 males) underwent a Ross operation using the full-root technique. Patients were prospectively monitored with clinical and echocardiographic follow-up. Total follow-up was 9,046 patients-years and was 92% complete. Mean-follow-up was 10.9±6.9 years (range, 0-24.9 years). Results Survival at twenty years was 92% (95% CI: 90-94%). Freedom from autograft or right ventricle to pulmonary artery connection reoperation at twenty years was 79% (95% CI: 74-85%). Eighty-nine pulmonary autograft reoperations had to be performed in eighty patients; salvage of the pulmonary autograft could be performed in forty-six of them. Fifty-seven patients required sixty-three reoperations on the right ventricle to pulmonary artery connection. Major cerebral bleeding occurred in one patient and neurological events in seventeen patients, respectively. Conclusions Over a follow-up interval of up to twenty-five years, the Ross operation with the reinforced full-root technique demonstrated excellent survival in young and middle-aged patients. The rate of pulmonary autograft and right ventricular outflow graft reoperations were low in this patient subset. Therefore, the Ross operation with the reinforced full-root technique represents an enduring and valid treatment option in young and middle-aged patients suffering from aortic valve disease.
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Affiliation(s)
| | | | | | - Detlef Roser
- Sana Cardiac Surgery Stuttgart, Stuttgart, Germany
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19
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Sievers HH, Ensminger S. Update on the German Ross Registry. Ann Cardiothorac Surg 2021; 10:515-517. [PMID: 34422565 DOI: 10.21037/acs-2020-rp-154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 02/15/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Hans-Hinrich Sievers
- Department of Cardiac and Thoracic Vascular Surgery, University Heart Center Lübeck, University Hospital of Schleswig Holstein, Lübeck, Germany
| | - Stephan Ensminger
- Department of Cardiac and Thoracic Vascular Surgery, University Heart Center Lübeck, University Hospital of Schleswig Holstein, Lübeck, Germany
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20
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Kim W, Hwang HY, Kang Y, Kim JS, Sohn SH, Choi JW, Kim KH. Comparative analysis of structural valve deterioration and long-term clinical outcomes after bovine pericardial versus porcine bioprosthetic mitral valve replacement. J Thorac Dis 2021; 13:3969-3978. [PMID: 34422327 PMCID: PMC8339742 DOI: 10.21037/jtd-21-281] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/21/2021] [Indexed: 11/11/2022]
Abstract
Background This study aimed to compare long-term outcomes, including durability, after bovine pericardial valve replacement with those after porcine mitral valve replacement (MVR). Methods We enrolled 309 patients who underwent MV replacement (mean age: 65.8±11.5 years; 68.9% females) with Carpentier-Edwards PERIMOUNT bovine pericardial valves (bovine MVR group, n=241) or Hancock II porcine bioprosthesis (porcine MVR group, n=68). The mean clinical and echocardiographic follow-up durations were 81.4±60.0 and 57.8±53.3 months, respectively. Structural valve deterioration (SVD) was defined as prosthetic mitral valve (MV) regurgitation or stenosis of greater than moderate degree combined with a motion limitation, tear, or perforation of prosthetic valve leaflet on follow-up echocardiography. Propensity score (PS)-adjusted multivariable analyses were performed. Results Thirty-day mortality rate was 6.4% (20/309 patients). SVD occurred in 50 patients (33 and 17 patients in the bovine and porcine MV replacement groups, respectively). Cumulative incidences of SVD at 5, 10, and 15 years were 3.2%, 15.9%, and 32.4%, respectively, in the bovine MVR group and 1.9%, 15.3%, and 41.7%, respectively, in the porcine MVR group. Cumulative incidences of SVD in the two groups were not different in competing risk analysis (P=0.23). Other clinical outcomes including overall survival and cumulative incidences of cardiac death and MV-related events were not statistically significantly different between the groups in PS-adjusted multivariable analyses. Conclusions Long-term clinical outcomes including SVD were not different between the bovine and porcine bioprosthesis MVR groups during average 7 years of clinical follow-up after MVR.
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Affiliation(s)
- Woojung Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho Young Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoonjin Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Seong Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Suk Ho Sohn
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae Woong Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyung Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Chemtob RA, Sale S, Wyler D, Mehta A, Hauser M, Wallace L, Soltesz E, Wierup P, Roselli EE, Svensson LG, Johnston DR. Postpump Aortic Insufficiency Is Transient After Valve Replacement with a Novel Prosthesis. J Am Soc Echocardiogr 2021; 34:1017-1019. [PMID: 33991599 DOI: 10.1016/j.echo.2021.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 04/22/2021] [Accepted: 04/22/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Raphaelle A Chemtob
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Shiva Sale
- Department of Thoracic and Cardiovascular Anesthesiology, Cleveland Clinic, Cleveland, Ohio
| | - Daniel Wyler
- Department of Anesthesiology, University Hospitals, Cleveland, Ohio
| | - Anand Mehta
- Department of Thoracic and Cardiovascular Anesthesiology, Cleveland Clinic, Cleveland, Ohio
| | - Michael Hauser
- Department of Thoracic and Cardiovascular Anesthesiology, Cleveland Clinic, Cleveland, Ohio
| | - Lee Wallace
- Department of Thoracic and Cardiovascular Anesthesiology, Cleveland Clinic, Cleveland, Ohio
| | - Edward Soltesz
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio; Aortic Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Per Wierup
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio; Aortic Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eric E Roselli
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio; Aortic Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio; Aortic Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Douglas R Johnston
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio; Aortic Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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22
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Balmforth D, Dimagli A, Benedetto U, Uppal R. Fifty years of the pericardial valve: Long-term results in the aortic position. J Card Surg 2021; 36:2865-2875. [PMID: 33982282 DOI: 10.1111/jocs.15604] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/23/2021] [Accepted: 04/18/2021] [Indexed: 11/26/2022]
Abstract
It is now 50 years since the development of the first pericardial valve in 1971. In this time significant progress has been made in refining valve design aimed at improving the longevity of the prostheses. This article reviews the current literature regarding the longevity of pericardial heart valves in the aortic position. Side by side comparisons of freedom from structural valve degeneration are made for the valves most commonly used in clinical practice today, including stented, stentless, and sutureless valves. Strategies to reduce structural valve degeneration are also discussed including methods of tissue fixation and anti-calcification, ways to minimise mechanical stress on the valve, and the role of patient prosthesis mismatch.
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Affiliation(s)
| | | | | | - Rakesh Uppal
- Barts Heart Centre, St Bartholomew's Hospital, London, UK
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23
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The First 100 Cases of Two Innovations Combined: Video-Assisted Minimally Invasive Aortic Valve Replacement Through Right Anterior Mini-Thoracotomy Using a Novel Aortic Prosthesis. Adv Ther 2021; 38:2435-2446. [PMID: 33788152 PMCID: PMC8010499 DOI: 10.1007/s12325-021-01705-x] [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: 02/17/2021] [Accepted: 03/10/2021] [Indexed: 11/25/2022]
Abstract
Introduction Aortic valve replacement (AVR) via right anterior mini-thoracotomy (RAMT) is less traumatic than via other surgical routes; using a novel aortic valve may confer long-term resistance against valve deterioration, and thus be useful in younger, more active patients. Here we aim to validate using the INSPIRIS RESILIA valve with minimally invasive RAMT. Methods Between April 2017 and June 2019, 100 patients underwent video-assisted minimally invasive AVR by RAMT, using the INSPIRIS RESILIA aortic valve. Cannulation for cardiopulmonary bypass (CPB) was through femoral vessels. Clinical data were prospectively entered into our institutional database. Results Cardiopulmonary bypass (CPB) and cross-clamping times were 79 ± 38 and 41 ± 17 min. Surgical access was successful in 100% of cases. There were no cases of intraoperative mortality, 30-day mortality, cerebrovascular events, rethoracotomy for bleeding, valve-related reoperation, right internal mammary artery injury, or conversion to sternotomy. Intensive care and hospital stays were 2 ± 1 and 6 ± 3 days, respectively. One patient had a pacemaker fitted. Postoperative dialysis was necessary in one patient. Trace to mild aortic valve regurgitation occurred in two patients. No structural valve deterioration (SVD) and paravalvular leak were seen. At 1-year follow-up mean effective orifice area (EOA) was 1.8 ± 0.1 cm2, peak gradient was 22.1 ± 3.1 mmHg, and mean gradient was 11.5 ± 2.3 mmHg. Conclusion Our preliminary experience suggests that RAMT for AVR using the INSPIRIS RESILIA aortic valve is safe, effective, and reproducible. Larger studies are needed to evaluate the long-term efficacy and durability of this new valve.
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Abstract
Aortic stenosis is the most common valvular disease requiring valve replacement. Valve replacement therapies have undergone progressive evolution since the 1960s. Over the last 20 years, transcatheter aortic valve replacement has radically transformed the care of aortic stenosis, such that it is now the treatment of choice for many, particularly elderly, patients. This review provides an overview of the pathophysiology, presentation, diagnosis, indications for intervention, and current therapeutic options for aortic stenosis.
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Affiliation(s)
- Marko T Boskovski
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA
| | - Thomas G Gleason
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA
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Tod TJ, Gohres RA, Torky M, Wright GA, Lamberigts M, Flameng W, Meuris B. Influence of Tissue Technology on Pannus Formation on Bioprosthetic Heart Valves. Cardiovasc Eng Technol 2021; 12:418-425. [PMID: 33880722 DOI: 10.1007/s13239-021-00530-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/03/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Bioprosthetic heart valves have several modes of failure. Tissue degeneration and calcification are the major modes of failure with the highest focus of attention, however pannus formation can also be problematic. We studied the effect of a new tissue technology with the absence of any glutaraldehyde-based storage solution and a stable aldehyde capping process on pannus formation. METHODS Using a juvenile sheep model of mitral valve replacement, valves with the new tissue technology were compared to control valves with contemporary bovine pericardial tissue, regarding pannus formation. Valves were implanted for either a 5- or 8-month period. Explanted valves were examined macroscopically and histologically. Histological observations were made by an independent pathologist, blinded to group identity. RESULTS Pannus area measured macroscopically on the test valves was significantly lower than the pannus on the control tissue. This was confirmed on the histological samples, where the total pannus overgrowth was significantly lower in the test group compared to the control. CONCLUSION The new tissue technology leads to less pannus formation. This may beneficially influence both short- and long-term valve behavior of bioprosthetic valves.
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Affiliation(s)
- Tara J Tod
- Tissue Research, Edwards Lifesciences, Irvine, CA, USA
| | | | - Mohammed Torky
- Cardiothoracic Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Marie Lamberigts
- Cardiac Surgery, Department of Cardiovascular Sciences, University Hospitals Leuven, Leuven, Belgium.
| | - Willem Flameng
- Cardiac Surgery, Department of Cardiovascular Sciences, University Hospitals Leuven, Leuven, Belgium
| | - Bart Meuris
- Cardiac Surgery, Department of Cardiovascular Sciences, University Hospitals Leuven, Leuven, Belgium
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Bakhtiary F, Ahmad AES, Autschbach R, Benedikt P, Bonaros N, Borger M, Dewald O, Feyrer R, Geißler HJ, Grünenfelder J, Lam KY, Leyh R, Liebold A, Czesla M, Mehdiani A, Pollari F, Salamate S, Strauch J, Vötsch A, Weber A, Wendt D, Botta B, Bramlage P, Zierer A. Impact of pre-existing comorbidities on outcomes of patients undergoing surgical aortic valve replacement - rationale and design of the international IMPACT registry. J Cardiothorac Surg 2021; 16:51. [PMID: 33766089 PMCID: PMC7993500 DOI: 10.1186/s13019-021-01434-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 03/16/2021] [Indexed: 11/18/2022] Open
Abstract
Background Degenerative aortic valve disease accounts for 10–20% of all cardiac surgical procedures. The impact of pre-existing comorbidities on the outcome of patients undergoing surgical aortic valve replacement (SAVR) needs further research. Methods The IMPACT registry is a non-interventional, prospective, open-label, multicenter, international registry with a follow-up of 5 years to assess the impact of pre-existing comorbidities of patients undergoing SAVR with the INSPIRIS RESILIA aortic valve on outcomes. IMPACT will be conducted across 25 sites in Austria, Germany, The Netherlands and Switzerland and intends to enroll approximately 500 patients. Patients will be included if they are at least 18 years of age and are scheduled to undergo SAVR with the INSPIRIS RESILIA Aortic Valve with or without concomitant ascending aortic root replacement and/or coronary bypass surgery. The primary objective is to determine all-cause mortality at 1, 3, and 5 years post SAVR. Secondary objectives include cardiac-related and valve-related mortality and structural valve deterioration including hemodynamics and durability, valve performance and further clinical outcomes in the overall study population and in specific patient subgroups characterized by the presence of chronic kidney disease, hypertension, metabolic syndrome and/or chronic inflammation. Discussion IMPACT is a prospective, multicenter European registry, which will provide much-needed data on the impact of pre-existing comorbidities on patient outcomes and prosthetic valve performance, and in particular the performance of the INSPIRIS RESILIA, in a real-world setting. The findings of this study may help to support and expand appropriate patient selection for treatment with bioprostheses. Trial registration ClinicalTrials.gov identifier: NCT04053088.
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Affiliation(s)
- Farhad Bakhtiary
- Division of Cardiac Surgery, Heart Center Siegburg-Wuppertal, University Witten-Herdecke, Ringstr. 49, 53721, Siegburg, Germany.
| | - Ali El-Sayed Ahmad
- Division of Cardiac Surgery, Heart Center Siegburg-Wuppertal, University Witten-Herdecke, Ringstr. 49, 53721, Siegburg, Germany
| | | | - Peter Benedikt
- Kepler University Hospital Linz, Linz; and Hospital Wels-Grieskirchen, Wels, Austria
| | | | | | | | | | - Hans-Joachim Geißler
- Kepler University Hospital Linz, Linz; and Hospital Wels-Grieskirchen, Wels, Austria
| | | | - Ka Yan Lam
- Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Rainer Leyh
- University Hospital Wuerzburg, Wuerzburg, Germany
| | | | | | | | - Francesco Pollari
- Cardiac Surgery, Klinikum Nürnberg - Paracelsus Medical University, Nuremberg, Germany
| | - Saad Salamate
- Division of Cardiac Surgery, Heart Center Siegburg-Wuppertal, University Witten-Herdecke, Ringstr. 49, 53721, Siegburg, Germany
| | | | - Andreas Vötsch
- Department of Cardiovascular and Endovascular Surgery, Paracelsus Medical University, Salzburg, Austria
| | | | | | - Beate Botta
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Andreas Zierer
- Kepler University Hospital Linz, Linz; and Hospital Wels-Grieskirchen, Wels, Austria
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Long-Term Outcomes of Patients Undergoing the Ross Procedure. J Am Coll Cardiol 2021; 77:1412-1422. [DOI: 10.1016/j.jacc.2021.01.034] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 11/19/2022]
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Tamagnini G, Bourguignon T, Rega F, Verbrugghe P, Lamberigts M, Langenaeken T, Meuris B. Device profile of the Inspiris Resilia valve for aortic valve replacement: overview of its safety and efficacy. Expert Rev Med Devices 2021; 18:239-244. [PMID: 33583313 DOI: 10.1080/17434440.2021.1886921] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The Inspiris Resilia tissue valve was recently introduced into clinical practice. This review summarizes the pre-clinical and clinical studies leading to this new bioprosthesis. AREAS COVERED The novel Resilia tissue was tested extensively in a large animal model. The clinical use of the tissue started in 2011 with the European Feasibility study, followed by a North-American multi-center study. Since 2017, the Inspiris Resilia valve has been in full commercial use. Further prospective evaluations and registries are ongoing. EXPERT OPINION The Inspiris Resilia valve was clinically introduced after pre-clinical tests revealed superiority compared to contemporary therapy such as the Perimount valve. Prospective long-term follow-up studies on Resilia are ongoing since 2011 and reveal no major complications. Full 5-year data show no signs of early degeneration, but longer follow-up is certainly still needed. Several prospective registries are actively monitoring the outcome with the Inspiris Resilia valve now. The novel tissue, designed to mitigate calcification and increase durability, together with the expandable stent, facilitating potential future valve-in-valve (ViV) procedures, are the cutting-edge aspects. Clinical use in younger patients is currently ongoing: their follow-up and outcome will determine the added value of this valve.
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Affiliation(s)
- G Tamagnini
- Department of Cardiovascular Surgery -, Villa Torri Hospital, GVM Care&Research, Bologna, Italy
| | - T Bourguignon
- Department of Cardiac Surgery, Tours University Hospital, Tours, France
| | - F Rega
- Department of Cardiovascular Diseases, Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - P Verbrugghe
- Department of Cardiovascular Diseases, Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - M Lamberigts
- Department of Cardiovascular Diseases, Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - T Langenaeken
- Department of Cardiovascular Diseases, Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Bart Meuris
- Department of Cardiovascular Diseases, Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
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Clark A, Malaisrie SC. Failed bioprosthetic valve approaches: Transcatheter aortic valve replacement approach. J Thorac Cardiovasc Surg 2021; 163:1795-1798. [PMID: 33685735 DOI: 10.1016/j.jtcvs.2020.12.148] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/11/2020] [Accepted: 12/22/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Aaron Clark
- Division of Cardiac Surgery, Department of Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine and Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - S Chris Malaisrie
- Division of Cardiac Surgery, Department of Surgery, Bluhm Cardiovascular Institute, Northwestern Medicine and Northwestern University Feinberg School of Medicine, Chicago, Ill.
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VAN DER MERWE J, CASSELMAN F. Minimally invasive surgical and transcatheter interventions for aortic valve incompetence: current concepts and future perspectives. THE JOURNAL OF CARDIOVASCULAR SURGERY 2021; 62:3-11. [DOI: 10.23736/s0021-9509.20.11516-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bartus K, Litwinowicz R, Bilewska A, Stapor M, Bochenek M, Rozanski J, Sadowski J, Filip G, Kusmierczyk M, Kapelak B. Final 5-year outcomes following aortic valve replacement with a RESILIA™ tissue bioprosthesis. Eur J Cardiothorac Surg 2020; 59:434-441. [PMID: 33141188 PMCID: PMC7850021 DOI: 10.1093/ejcts/ezaa311] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/15/2020] [Accepted: 07/23/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Long-term durability of bioprosthetic valves is predominantly limited by structural valve deterioration. RESILIA™ tissue has exhibited reduced calcification in pre-clinical and early clinical studies. This study evaluated the 5-year clinical and haemodynamic outcomes of an aortic valve with this tissue. METHODS This was a prospective, non-randomized, single-arm study of 133 patients implanted with a RESILIA aortic bioprosthesis between July 2011 and February 2013 at 2 sites in Poland. Clinical outcomes and haemodynamic performance were assessed annually for 5 years post-implant. Safety events were adjudicated by a Clinical Events Committee and echocardiographic data were assessed by an independent core laboratory. RESULTS Mean patient age was 65.3 ± 13.5 years, with 34 patients (25.6%) ≤60. The mean follow-up was 4.2 ± 1.5 years. Early (≤30 days) and late (>30 days) all-cause mortality were 2.3% (N = 3) and 3.2%/late patients-years (N = 18) respectively. Early events included thromboembolism in 3 patients (2.3%). Late valve-related events included endocarditis in 1 patient, which led to explant, and valve thrombosis in another patient. There were no events of structural valve deterioration throughout the study. At 5 years, mean gradient was 14.8 ± 7.6 mmHg and effective orifice area was 1.4 ± 0.5 cm2, a marked improvement over baseline values. All New York Heart Association class III patients and most class II patients at baseline had improved classifications at 5 years. CONCLUSIONS The bioprosthesis with RESILIA tissue demonstrated a good safety profile with excellent haemodynamic performance over 5 years of follow-up. These encouraging outcomes warrant additional investigation of this novel tissue. CLINICAL TRIAL REGISTRATION NUMBER NCT01651052.
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Affiliation(s)
- Krzysztof Bartus
- John Paul II Hospital, Krakow, Poland,Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Krakow, Poland
| | - Radoslaw Litwinowicz
- John Paul II Hospital, Krakow, Poland,Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Krakow, Poland,Corresponding author. Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Jagiellonian University, Pradnicka 80, 31-202 Krakow, Poland. Tel: +48-126-143075; e-mail: (R. Litwinowicz)
| | - Agata Bilewska
- Department of Cardiac Surgery and Transplantology, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
| | | | - Maciej Bochenek
- John Paul II Hospital, Krakow, Poland,Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Krakow, Poland,Department of Heart Transplantation and Mechanical Circulatory Support, Centre for Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Jacek Rozanski
- Department of Cardiac Surgery and Transplantology, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Jerzy Sadowski
- John Paul II Hospital, Krakow, Poland,Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Krakow, Poland
| | - Grzegorz Filip
- John Paul II Hospital, Krakow, Poland,Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Krakow, Poland
| | - Mariusz Kusmierczyk
- Department of Cardiac Surgery and Transplantology, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Boguslaw Kapelak
- John Paul II Hospital, Krakow, Poland,Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Krakow, Poland
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Izumi C, Eishi K, Ashihara K, Arita T, Otsuji Y, Kunihara T, Komiya T, Shibata T, Seo Y, Daimon M, Takanashi S, Tanaka H, Nakatani S, Ninami H, Nishi H, Hayashida K, Yaku H, Yamaguchi J, Yamamoto K, Watanabe H, Abe Y, Amaki M, Amano M, Obase K, Tabata M, Miura T, Miyake M, Murata M, Watanabe N, Akasaka T, Okita Y, Kimura T, Sawa Y, Yoshida K. JCS/JSCS/JATS/JSVS 2020 Guidelines on the Management of Valvular Heart Disease. Circ J 2020; 84:2037-2119. [DOI: 10.1253/circj.cj-20-0135] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kiyoyuki Eishi
- Division of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Kyomi Ashihara
- Department of Cardiology, Tokyo Women’s Medical University Hospital
| | - Takeshi Arita
- Division of Cardiovascular Medicine Heart & Neuro-Vascular Center, Fukuoka Wajiro
| | - Yutaka Otsuji
- Department of Cardiology, Hospital of University of Occupational and Environmental Health
| | - Takashi Kunihara
- Department of Cardiac Surgery, The Jikei University School of Medicine
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka City University Postgraduate of Medicine
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Masao Daimon
- Department of Clinical Laboratory/Cardiology, The University of Tokyo Hospital
| | | | | | - Satoshi Nakatani
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | - Hiroshi Ninami
- Department of Cardiac Surgery, Tokyo Women’s Medical University
| | - Hiroyuki Nishi
- Department of Cardiovascular Surgery, Osaka General Medical Center
| | | | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | | | - Kazuhiro Yamamoto
- Division of Cardiovascular Medicine, Endocrinology and Metabolism, Faculty of Medicine, Tottori University
| | | | - Yukio Abe
- Department of Cardiology, Osaka City General Hospital
| | - Makoto Amaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Masashi Amano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kikuko Obase
- Division of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center
| | - Takashi Miura
- Division of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | | | - Mitsushige Murata
- Department of Laboratory Medicine, Tokai University Hachioji Hospital
| | - Nozomi Watanabe
- Department of Cardiology, Miyazaki Medical Association Hospital
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Yutaka Okita
- Department of Cardiovascular Surgery, Takatsuki Hospital
| | - Takeshi Kimura
- Department of Cardiology, Kyoto University Graduate School of Medicine
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Kiyoshi Yoshida
- Department of Cardiology, Sakakibara Heart Institute of Okayama
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De Martino A, Falcetta G, Colli A. Early Valve Thrombosis in Surgical Aortic Bioprosthesis: Rare or Underestimated Event? J Am Coll Cardiol 2020; 76:1812. [PMID: 33032743 DOI: 10.1016/j.jacc.2020.06.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/18/2020] [Indexed: 10/23/2022]
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Vanneman MW, Dalia AA. Perioperative and Echocardiographic Considerations for the Inspiris Resilia Aortic Valve--Current and Future. J Cardiothorac Vasc Anesth 2020; 34:2807-2812. [DOI: 10.1053/j.jvca.2020.03.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 03/31/2020] [Indexed: 11/11/2022]
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Anwaruddin S, Desai N. Systematic Approach Toward Transcatheter Treatment of BAV Disease: One Size Does Not Fit All. J Am Coll Cardiol 2020; 76:1031-1033. [PMID: 32854837 DOI: 10.1016/j.jacc.2020.07.019] [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] [Received: 07/10/2020] [Accepted: 07/10/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Saif Anwaruddin
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Nimesh Desai
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Le Bars F, Tomasi J, Belhaj Soulami R, Colas F, Anselmi A, Verhoye JP. Long-term follow-up of the Shelhigh™ superstentless bioprosthesis aortic valve and valved conduit in a monocentric experience. THE JOURNAL OF CARDIOVASCULAR SURGERY 2020; 61:776-783. [PMID: 32558524 DOI: 10.23736/s0021-9509.20.11219-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The Shelhigh™ SuperStentless (Shelhigh, INC., Union, NJ, USA) is a stentless aortic valve bioprosthesis and aortic root valved conduit. In 2007, this device was recalled by FDA due to malfunction, and subsequently reintegrated by BioIntegral Surgical™ Few data are available over late durability of this device. We performed a long-term follow-up of Shelhigh™ devices implanted at our center. METHODS Between 2002 and 2007, 44 patients underwent aortic valve replacement with a Shelhigh™ device (40 aortic valve bioprosthesis and 4 valved conduit). We performed a clinical and echocardiographic follow-up (9.2 years±4.3). Standardized definitions of valve-related events were adopted. RESULTS At discharge, maximum and mean aortic gradients averaged 36.1±11.3 and 21.0±6.8 mmHg, respectively. The 30-days mortality was 2.3%. Over the follow-up period, 29 patients died (65.9%); 2 deaths were valve related. Overall survival at 1, 5 and 10 years was 97.7%, 85.8% and 54% respectively. At last echocardiography, average transvalvular gradients had remained globally stable in the population (33.6±12 and 20.4±10.5 mmHg). Eight (19%) structural valve deterioration (SVD) events were reported. Two (5%) non-structural valve dysfunction (NSVD) events occurred (periprosthetic leak). Two (5%) infectious endocarditis events and two (5%) valve thromboses were also deplored. Three (7%) patients required re-operation (2 due to SVD and 1 due to endocarditis). CONCLUSIONS The immediate hemodynamic performance of the Shelhigh™ aortic bioprostheses was unexpectedly suboptimal. Despite this, hemodynamic performance remained stable over time. Patients survival at follow-up was satisfactory, however, continued surveillance is necessary.
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Affiliation(s)
- Florent Le Bars
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital Center, Rennes, France
| | - Jacques Tomasi
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital Center, Rennes, France
| | - Reda Belhaj Soulami
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital Center, Rennes, France
| | - Fabrice Colas
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital Center, Rennes, France
| | - Amedeo Anselmi
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital Center, Rennes, France -
| | - Jean-Philippe Verhoye
- Division of Thoracic and Cardiovascular Surgery, Pontchaillou University Hospital Center, Rennes, France
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Moront MG, Sabik JF, Reardon MJ, Dagenais F, Lange R, Walther T, Kerendi F, Klautz RJM. Sizing Strategy and Implant Considerations for the Avalus Valve. Ann Thorac Surg 2020; 110:e551-e553. [PMID: 32540438 DOI: 10.1016/j.athoracsur.2020.04.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/18/2020] [Indexed: 10/24/2022]
Abstract
Hemodynamic performance of the Avalus valve through 3 years after implant is comparable to that of contemporary surgical bioprostheses. Many variables affect hemodynamic outcomes, including surgical technique. This article describes our experience with the Avalus bioprosthesis and strategies to achieve optimal hemodynamic performance.
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Affiliation(s)
- Michael G Moront
- Department of Cardiothoracic Surgery, ProMedica Toledo Hospital, Toledo, Ohio.
| | - Joseph F Sabik
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Michael J Reardon
- Department of Cardiovascular Surgery, DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Francois Dagenais
- Department of Cardiac Surgery, University Institute of Cardiology and Pulmonology of Quebec (IUCPQ), University of Laval, Québec, Canada
| | - Rüdiger Lange
- Department of Cardiovascular Surgery and the INSURE-Institute for Translational Cardiac Surgery, German Heart Centre Munich, Munich, Germany
| | - Thomas Walther
- Department of Cardiac, Thoracic, and Thoracic Vascular Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Faraz Kerendi
- Division of Cardiac Surgery, Heart Hospital of Austin, Austin, Texas
| | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
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Chen J, He C, Lv M, Guo Y, Tao L, Hong T, Wang C, Zhou X, Gu T, Wei L, Fu J, Wang Y, Shi Y. One-year outcome with a bovine pericardial valve. JTCVS OPEN 2020; 2:1-11. [PMID: 36003682 PMCID: PMC9390642 DOI: 10.1016/j.xjon.2020.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 03/24/2020] [Accepted: 04/07/2020] [Indexed: 11/18/2022]
Abstract
Objectives To evaluate the safety and effectiveness of a novel surgical bovine pericardial valve for aortic and mitral valve replacements. Methods Between March 2016 and October 2017, 197 patients (mean age, 66.9 ± 4.9 years; 40.6% were women) underwent aortic valve replacement and mitral valve replacement and were implanted with the Cingular bovine pericardial valve (Shanghai Cingular Biotech Corporation, Shanghai, China) in a prospective, multicenter, single-arm trial in China. A total of 161 aortic and 49 mitral prostheses were implanted. Patients were followed up to 1 year. The primary end point was the 1-year overall rate of valve-related complications, including thromboembolic event, valve thrombosis, major hemorrhage event, major perivalvular leak, and prosthetic valve endocarditis. Results The 1-year overall rate of valve-related complications was 0.5% (95% confidence interval, 0.1%-3.7%). The 1-year survival was 96.4%. The mean gradient and effective orifice area for aortic prostheses at 1 year postoperatively were 12.8 ± 4.4 mm Hg and 1.9 ± 0.3 cm2, respectively. Particularly, the mean gradients and effective orifice area for 19 mm and 21 mm sizes of aortic prostheses at 1 year were 17.0 ± 3.8 mm Hg and 1.6 ± 0.2 cm2, 13.1 ± 4.0 mm Hg and 1.8 ± 0.1 cm2, respectively. Patient–prosthesis mismatch occurred in only 1.3% patients for aortic valve implantation at 1 month. No structural valve deterioration and no endocarditis occurred. Conclusions The Cingular bovine pericardial valve was safe and effective for surgical aortic and mitral valve replacement. The 1-year rate of valve-related complications was very low. Early hemodynamic performance was excellent even for the small aortic root.
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Meuris B, Borger MA, Bourguignon T, Siepe M, Grabenwöger M, Laufer G, Binder K, Polvani G, Stefano P, Coscioni E, van Leeuwen W, Demers P, Dagenais F, Canovas S, Theron A, Langanay T, Roussel JC, Wendler O, Mariscalco G, Pessotto R, Botta B, Bramlage P, de Paulis R. Durability of bioprosthetic aortic valves in patients under the age of 60 years - rationale and design of the international INDURE registry. J Cardiothorac Surg 2020; 15:119. [PMID: 32460798 PMCID: PMC7251702 DOI: 10.1186/s13019-020-01155-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is an ever-growing number of patients requiring aortic valve replacement (AVR). Limited data is available on the long-term outcomes and structural integrity of bioprosthetic valves in younger patients undergoing surgical AVR. METHODS The INSPIRIS RESILIA Durability Registry (INDURE) is a prospective, open-label, multicentre, international registry with a follow-up of 5 years to assess clinical outcomes of patients younger than 60 years who undergo surgical AVR using the INSPIRIS RESILIA aortic valve. INDURE will be conducted across 20-22 sites in Europe and Canada and intends to enrol minimum of 400 patients. Patients will be included if they are scheduled to undergo AVR with or without concomitant root replacement and/or coronary bypass surgery. The primary objectives are to 1) determine VARC-2 defined time-related valve safety at one-year (depicted as freedom from events) and 2) determine freedom from stage 3 structural valve degeneration (SVD) presenting as morphological abnormalities and severe haemodynamic valve degeneration at 5 years. Secondary objectives include the assessment of the haemodynamic performance of the valve, all stages of SVD, potential valve-in-valve procedures, clinical outcomes (in terms of New York Heart Association [NYHA] function class and freedom from valve-related rehospitalisation) and change in patient quality-of-life. DISCUSSION INDURE is a prospective, multicentre registry in Europe and Canada, which will provide much needed data on the long-term performance of bioprosthetic valves in general and the INSPIRIS RESILIA valve in particular. The data may help to gather a deeper understanding of the longevity of bioprosthetic valves and may expand the use of bioprosthetic valves in patients under the age of 60 years. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03666741 (registration received September, 12th, 2018).
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Affiliation(s)
- Bart Meuris
- Cardiac Surgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | | | | | - Matthias Siepe
- Heart Center University of Freiburg, Freiburg and Bad Krozingen, Germany
| | | | | | - Konrad Binder
- Heart Center University St. Pölten, St. Pölten, Austria
| | | | | | - Enrico Coscioni
- University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | | | | | | | - Sergio Canovas
- Hospital University Virgen de la Arrixaca, Murcia, Spain
| | | | | | | | - Olaf Wendler
- King's College Hospital NHS Foundation Trust, London, UK
| | | | | | - Beate Botta
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
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Chivasso P, Bruno VD. Commentary: Surgical aortic valve bioprostheses are still around and looking good. J Thorac Cardiovasc Surg 2020; 162:1486-1487. [PMID: 32201000 DOI: 10.1016/j.jtcvs.2020.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 02/03/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Pierpaolo Chivasso
- Bristol Heart Institute, University Hospitals of Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Vito Domenico Bruno
- Translational Health Science Department, Bristol Medical School, Bristol, United Kingdom.
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Commentary: The future of a former valve: Inspiring, resilient, or both? J Thorac Cardiovasc Surg 2020; 162:1487-1488. [PMID: 32199658 DOI: 10.1016/j.jtcvs.2020.02.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 02/11/2020] [Indexed: 11/20/2022]
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42
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Hardman G, Dark JH. Commentary: The end of the beginning? J Thorac Cardiovasc Surg 2020; 162:1489-1490. [PMID: 32164948 DOI: 10.1016/j.jtcvs.2020.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Gillian Hardman
- Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle Upon Tyne, United Kingdom
| | - John H Dark
- Department of Cardiothoracic Surgery, Newcastle University, Newcastle Upon Tyne, United Kingdom.
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Podesser BK, De Paulis R. Implantability of a novel, pre-assembled aortic valved conduit with RESILIA™ tissue. THE JOURNAL OF CARDIOVASCULAR SURGERY 2019; 61:376-379. [PMID: 31815373 DOI: 10.23736/s0021-9509.19.11022-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Currently, the only commercial pre-assembled aortic valved conduits employ mechanical valves, requiring lifelong anticoagulation. Tissue-valved conduits that require assembly on the operating table are less standardized, require extensive experience for satisfactory results, and are limited in their longevity. The KONECT RESILIA™ Aortic Valved Conduit is a new tissue valved conduit that consists of a Carpentier-Edwards PERIMOUNT™ Magna Ease™ aortic valve stent, the novel RESILIA™ tissue leaflets, and a new DualFit sewing ring pre-assembled to a Terumo GelWeave Valsalva Graft™. RESILIA tissue is a bovine pericardial tissue that may offer superior anti-calcification properties compared to contemporary tissue valves; furthermore, it may be stored dry. METHODS We tested the handling and implantability of this new aortic valved conduit in 8 human cadaver hearts, as well as the valve removal potential without detaching the coronary ostia. RESULTS The KONECT RESILIA aortic valved conduit's handling and implantability was uniformly satisfactory. The valve inside the conduit could be easily surgically extracted, leaving the conduit and coronary ostia intact. CONCLUSIONS We found this first evaluation of the KONECT RESILIA Aortic Valved Conduit to be that it handled well and was easily implantable and extractable in a human cadaver model.
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Affiliation(s)
- Bruno K Podesser
- Center for Biomedical Research, Medical University of Vienna and Karl Landsteiner University St. Poelten, Vienna, Austria -
| | - Ruggero De Paulis
- Department of Cardiac Surgery, European Hospital of Rome, Rome, Italy
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44
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Pibarot P, Borger MA, Clavel MA, Griffith B, Bavaria JE, Svensson LG, Thourani VH. Study Design of the Prospective Non-Randomized Single-Arm Multicenter Evaluation of the Durability of Aortic Bioprosthetic Valves with RESILIA Tissue in Subjects under 65 Years Old (RESILIENCE Trial). STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2019. [DOI: 10.1080/24748706.2019.1686554] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Philippe Pibarot
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Université Laval, Quebec, Canada
| | - Michael A. Borger
- Leipzig Heart Center, University Clinic of Cardiac Surgery, Leipzig, Germany
| | - Marie-Annick Clavel
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Université Laval, Quebec, Canada
| | - Bartley Griffith
- Department of Surgery/Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Joseph E. Bavaria
- Department of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lars G. Svensson
- Cleveland Clinic, Chairman of Heart and Vascular Institute, Cleveland, Ohio, USA
| | - Vinod H. Thourani
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
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45
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Klautz RJM, Vriesendorp MD, Dagenais F, Labrousse L, Bapat V, Moront MG, Misfeld M, Gearhart E, Kappetein AP, Sabik JF. Antithrombotic therapy and bleeding events after aortic valve replacement with a novel bioprosthesis. J Thorac Cardiovasc Surg 2019; 161:66-75.e4. [PMID: 31864696 DOI: 10.1016/j.jtcvs.2019.10.095] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 10/16/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Several recent-generation surgical tissue valves have been found to have bleeding rates exceeding rates recommended by regulatory bodies. We explored bleeding events using data from the Pericardial Surgical Aortic Valve Replacement (PERIGON) Pivotal Trial for the Avalus valve (Medtronic, Minneapolis, Minn) to examine whether this end point remains relevant for the evaluation of bioprostheses. METHODS Patients (n = 1115) underwent aortic valve replacement. Bleeding and thromboembolic event episodes in patients within 3 years postimplant were analyzed for frequency, timing, and severity, focusing on patients taking antiplatelet/anticoagulant medications at the time of the event. Clinical and hemodynamic outcomes are also reported. RESULTS At 3 years, the Kaplan-Meier cumulative probability estimate of all-cause death was 7.2% (cardiac, 3.6%; valve-related, 1.1%). The Kaplan-Meier cumulative probability estimates of all and major hemorrhage were 8.7% and 5.2%, respectively. Ninety-nine bleeding events occurred in 86 patients: most occurred >30 days postsurgery. Among the 51 late major bleeds, in 5 cases the patients were taking anticoagulant/antiplatelet medication for prophylaxis after surgical aortic valve replacement at the time of the event, whereas the remaining patients were taking medications for other reasons. Age (hazard ratio, 1.035; 95% confidence interval, 1.004-1.068), peripheral vascular disease (hazard ratio, 2.135; 95% confidence interval, 1.106-4.122), renal dysfunction (hazard ratio, 1.920; 95% confidence interval, 1.055-3.494), and antithrombotic medication use at the time of the event (hazard ratio, 1.417; 95% confidence interval, 1.048-1.915) were associated with late bleeds (major and minor). CONCLUSIONS Overall clinical outcomes demonstrated low mortality and few complications except for major bleeding. Most bleeding events occurred >30 days after surgery and in patients taking antiplatelet and/or anticoagulation for indications other than postimplant prophylaxis.
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Affiliation(s)
- Robert J M Klautz
- Department of Cardio-Thoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
| | - Michiel D Vriesendorp
- Department of Cardio-Thoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Francois Dagenais
- Cardiac Surgery Service, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
| | - Louis Labrousse
- Cardiac and Vascular Surgery Service, University Hospital of Bordeaux, Bordeaux, France
| | - Vinayak Bapat
- Department of Cardiothoracic Surgery, Columbia University Medical Center, New York, NY
| | - Michael G Moront
- Department of Cardiothoracic Surgery, ProMedica Toledo Hospital, Toledo, Ohio
| | - Martin Misfeld
- University Clinic for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Elizabeth Gearhart
- Department of Biostatistics, Coronary and Structural Heart, Medtronic, Mounds View, Minn
| | - A Pieter Kappetein
- Thorax Center, Erasmus University Medical Center, and Office of Medical Affairs, Medtronic, Rotterdam, The Netherlands
| | - Joseph F Sabik
- Department of Surgery, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Liakopoulos OJ. Commentary: Two-year outcomes after surgical aortic valve replacement with a new bioprostheses-The data are still good! J Thorac Cardiovasc Surg 2019; 160:382-383. [PMID: 31635878 DOI: 10.1016/j.jtcvs.2019.08.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 08/30/2019] [Accepted: 08/31/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Oliver J Liakopoulos
- Department of Cardiothoracic Surgery, Heart Center, University of Cologne, Cologne, Germany.
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47
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Safety, efficacy, and hemodynamic performance of a stented bovine pericardial aortic valve bioprosthesis: Two-year analysis. J Thorac Cardiovasc Surg 2019; 160:371-381.e4. [PMID: 31590957 DOI: 10.1016/j.jtcvs.2019.07.132] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 06/14/2019] [Accepted: 07/08/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The study objectives were to evaluate the safety, efficacy, and hemodynamic performance of a novel stented bovine pericardial aortic valve bioprosthesis 2 years after implantation. METHODS The PERIcardial SurGical AOrtic Valve ReplacemeNT Pivotal Trial enrolled patients with symptomatic moderate/severe aortic stenosis or regurgitation at centers in Canada, Europe, and the United States. We report the outcomes and hemodynamic performance in patients with up to 2 years of follow-up. RESULTS A total of 1273 patients were enrolled, and 1110 underwent implantation. Among patients undergoing implantation, the mean age was 70.2 ± 8.9 years; 833 (75.0%) were male. Risk of mortality (Society of Thoracic Surgeons) was 2.0% ± 1.4%. At the time of analysis, 604 patients had completed the 2-year follow-up visit. Linearized late event rates were as follows: all death, 2.68%; valve-related death, 0.42%; valve thrombosis, 0.05%; endocarditis, 0.94%; thromboembolism, 1.68%; all hemorrhage, 2.94%; major hemorrhage, 1.99%; all paravalvular leak, 0.26%; and major paravalvular leak, 0.05% per patient-year. Mean 2-year aortic gradient and effective orifice area were 13.4 ± 5.0 mm Hg and 1.5 ± 0.37 cm2, respectively. Moderate and severe prosthesis-patient mismatch were observed in 43.5% and 34.8% of patients at 2 years, respectively. Improvement in New York Heart Association class compared with baseline was observed in 73.0% with moderate mismatch and 74.1% with severe mismatch. CONCLUSIONS The Avalus (Medtronic, Minneapolis, Minn) bovine pericardial valve demonstrates good clinical and safety outcomes at 2 years. Hemodynamic performance shows mean gradients comparable to currently available bovine pericardial aortic valves. There was no clinical impact of moderate to severe mismatch at 2 years. Further follow-up is required to evaluate midterm to long-term clinical outcome.
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Abstract
Aortic valve replacement has stood the test of time but is no longer an operation that is exclusively approached through a median sternotomy using only sutured prostheses. Currently, surgical aortic valve replacement can be performed through a number of minimally invasive approaches employing conventional mechanical or bioprostheses as well as sutureless valves. In either case, the direct surgical access allows inspection of the valve, complete excision of the diseased leaflets, and debridement of the annulus in a controlled and thorough manner under visual control. It can be employed to treat aortic valve pathologies of all natures and aetiologies. When compared with transcatheter valves in patients with a high or intermediate preoperative predictive risk, conventional surgery has not been shown to be inferior to transcatheter valve implants. As our understanding of sutureless valves and their applicability to minimally invasive surgery advances, the invasiveness and trauma of surgery can be reduced and outcomes can improve. This warrants further comparative trials comparing sutureless and transcatheter valves.
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Affiliation(s)
- Cristiano Spadaccio
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Agamemnon Street, Glasgow, G81 4DY, UK
| | - Khalid Alkhamees
- Department of Cardiac Surgery, Prince Sultan Cardiac Center Al Hassa, Prince Fawaz bin Abdulaziz St., Hofuf city, 31982, Saudi Arabia
| | - Nawwar Al-Attar
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Agamemnon Street, Glasgow, G81 4DY, UK
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49
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Edelman JJ, Khan JM, Rogers T, Shults C, Satler LF, Ben-Dor II, Waksman R, Thourani VH. Valve-in-Valve TAVR: State-of-the-Art Review. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 14:299-310. [DOI: 10.1177/1556984519858020] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
An increasing number of surgically implanted bioprostheses will require re-intervention for structural valve deterioration. Valve-in-valve transcatheter aortic valve replacement (ViV TAVR) has become an alternative to reoperative surgery, currently approved for high-risk and inoperable patients. Challenges to the technique include higher rates of prosthesis–patient mismatch and coronary obstruction, compared to native valve TAVR. Herein, we review results of ViV TAVR and novel techniques to overcome the aforementioned challenges.
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Affiliation(s)
- J. James Edelman
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University School of Medicine, Washington, DC, USA
| | - Jaffar M. Khan
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Christian Shults
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University School of Medicine, Washington, DC, USA
| | - Lowell F. Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - I. Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Vinod H. Thourani
- Department of Cardiac Surgery, MedStar Heart and Vascular Institute, Georgetown University School of Medicine, Washington, DC, USA
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50
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Bartus K, Litwinowicz R, Bilewska A, Stapor M, Bochenek M, Rozanski J, Sadowski J, Filip G, Kapelak B, Kusmierczyk M. Intermediate-term outcomes after aortic valve replacement with a novel RESILIA TM tissue bioprosthesis. J Thorac Dis 2019; 11:3039-3046. [PMID: 31463133 DOI: 10.21037/jtd.2019.07.33] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The durability of bioprosthetic heart valves is limited by structural valve deterioration (SVD) due to long-term calcification. A novel bioprosthetic tissue (RESILIATM) has been developed which, in preclinical studies, has shown reduced calcification. The purpose of this study was to evaluate the intermediate-term clinical outcomes and hemodynamic performance of this tissue. Methods A prospective, single-arm, observational trial was conducted in patients who required surgical aortic valve replacement (AVR). Between July 2011 and February 2013, 133 patients were implanted at two sites in Poland. Hemodynamic performance and clinical outcomes were assessed annually through 4 years of follow-up. All safety events were adjudicated by an independent Clinical Events Committee, and echocardiographic data were evaluated by a core laboratory. Results Patients were 65.3±13.5 years old and 26% were ≤60 years old. The average follow-up was 3.8±1.1 (median: 4.1; IQR, 4.0-4.3) years. Early (≤30 day) and late (>30 day) all-cause mortality rates were 2.3% (n=3) and 3.2% late patient-years (n=16), respectively. There were no cases of early or late SVD. There was one early case of major paravalvular leak (0.8%), and no late cases. At 4 years, the mean gradient was 14.5±7.4 mmHg and the effective orifice area was 1.6±0.4 cm2, both markedly improved from baseline. At 4 years, the New York Heart Association functional class had improved from baseline in 54.5% of patients. Conclusions The aortic bioprosthesis with novel RESILIATM tissue demonstrated excellent hemodynamic performance and safety outcomes over 4 years. Longer follow-up will be important to confirm the durability of this bioprosthesis.
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Affiliation(s)
- Krzysztof Bartus
- John Paul II Hospital, Krakow, Poland.,Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Krakow, Poland
| | - Radoslaw Litwinowicz
- John Paul II Hospital, Krakow, Poland.,Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Krakow, Poland
| | - Agata Bilewska
- Department of Cardiac Surgery and Transplantology, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
| | | | - Maciej Bochenek
- John Paul II Hospital, Krakow, Poland.,Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Krakow, Poland
| | - Jacek Rozanski
- Department of Cardiac Surgery and Transplantology, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Jerzy Sadowski
- John Paul II Hospital, Krakow, Poland.,Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Krakow, Poland
| | - Grzegorz Filip
- John Paul II Hospital, Krakow, Poland.,Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Krakow, Poland
| | - Boguslaw Kapelak
- John Paul II Hospital, Krakow, Poland.,Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Krakow, Poland
| | - Mariusz Kusmierczyk
- Department of Cardiac Surgery and Transplantology, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
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