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Hecht S, Zenses AS, Bernard J, Tastet L, Côté N, de Freitas Campos Guimarães L, Paradis JM, Beaudoin J, O’Connor K, Bernier M, Dumont E, Kalavrouziotis D, Delarochellière R, Mohammadi S, Clavel MA, Rodés-Cabau J, Salaun E, Pibarot P. Hemodynamic and Clinical Outcomes in Redo-Surgical Aortic Valve Replacement vs. Transcatheter Valve-in-Valve. STRUCTURAL HEART 2022. [DOI: 10.1016/j.shj.2022.100106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Okutucu S, Niazi AK, Oliveira D, Fatihoglu SG, Oto A. A systematic review on durability and structural valve deterioration in TAVR and surgical AVR. Acta Cardiol 2021; 76:921-932. [PMID: 33302806 DOI: 10.1080/00015385.2020.1858250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Mechanical valves and bioprosthetic heart valves are widely used for aortic valve replacement (AVR). Mechanical valves are associated with risk of bleeding because of oral anticoagulation, while the durability and structural valve deterioration (SVD) represent the main limitation of the bioprosthetic heart valves. The implantation of bioprosthetic heart valves is increasing precipitously due aging population, and the widespread use of transcatheter aortic valve replacement (TAVR). TAVR has become the standard treatment for intermediate or high surgical risk patients and a reasonable alternative to surgery for low risk patients with symptomatic severe aortic stenosis. Moreover, TAVR is increasingly being used for younger and lower-risk patients with longer life expectancy; therefore it is important to ensure the valve durability for long-term transcatheter aortic valves. Although the results of mid-term durability of the transcatheter heart valves are encouraging, their long-term durability remains largely unknown. This review summarises the definitions, mechanisms, risk factors and assessment of SVD; overviews available data on surgical bioprosthetic and transcatheter heart valves durability.
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Affiliation(s)
- Sercan Okutucu
- Department of Cardiology, Memorial Ankara Hospital, Ankara, Turkey
| | - Attaullah Khan Niazi
- Department of Cardiovascular Surgery, Shalamar Medical & Dental College, Lahore, Pakistan
| | - Dinaldo Oliveira
- Department of Cardiology, Federal University of Pernambuco, Recife, Brazil
| | | | - Ali Oto
- Department of Cardiology, Memorial Ankara Hospital, Ankara, Turkey
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Lunardi M, Mylotte D. Surgical or Transcatheter Aortic Valve Replacement in Patients With Chronic Kidney Disease: Does Renal Impairment Matter? JACC Cardiovasc Interv 2021; 14:2006-2009. [PMID: 34556274 DOI: 10.1016/j.jcin.2021.08.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Mattia Lunardi
- Department of Cardiology, Galway University Hospital, National University of Ireland Galway, Galway, Ireland
| | - Darren Mylotte
- Department of Cardiology, Galway University Hospital, National University of Ireland Galway, Galway, Ireland.
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Fuller SM, Borisuk MJ, Sleeper LA, Bacha E, Burchill L, Guleserian K, Ilbawi M, Razzouk A, Shinkawa T, Lu M, Baird CW. Mortality and Reoperation Risk After Bioprosthetic Aortic Valve Replacement in Young Adults With Congenital Heart Disease. Semin Thorac Cardiovasc Surg 2021; 33:1081-1092. [PMID: 34174404 DOI: 10.1053/j.semtcvs.2021.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 11/11/2022]
Abstract
Bioprosthetic aortic valve replacement (bAVR) in patients with congenital heart disease is challenging due to age, size and complexity. Our objective was to assess survival and identify predictors of re-operation. Data were retrospectively collected for 314 patients undergoing bAVR at 8 centers from 2000-2014. Kaplan-Meier estimation of time to re-operation and Cox regression were utilized. Average age was 45.2 years (IQR 17.8-71.1) and 30% were <21. Indications were stenosis (48%), regurgitation (28%) and mixed (18%). Twenty-eight (9%) underwent prior AVR. Median valve size was 23mm (IQR 21, 25). Implanted valves included CE (Carpentier-Edwards) Perimount (47%), CE Magna/Magna Ease (29%), Sorin Mitroflow (9%), St Jude (2%) and other (13%). Median follow-up was 2.9 (IQR 1.2, 5.7) years. Overall, 11% required re-operation, 35% of whom had a Mitroflow and 65% were <21 years old. Time to re-operation varied among valve type (p=0.020). Crude 3-year rate was 20% in patients ≤21. Smaller valve size indexed to BSA was associated with re-operation (21.7 vs. 23.5 mm/m2). Predictors of reintervention by multivariable analysis were younger age (29% increase in hazard per 5-year decrease, p<0.001), Mitroflow (HR=4 to 8 versus other valves), and smaller valve size (20% increase in hazard per 1 mm decrease, p=0.002). The overall 1, 3 and 5-year survival rates were 94%, 90% and 85% without differences by valve (p=0.19). A concerning reduction in 5-year survival after bAVR is shown. Re-operation is common and varies by age and valve type. Further research is needed to guide valve choice and improve survival.
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Affiliation(s)
- Stephanie M Fuller
- Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania..
| | - Michele J Borisuk
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Lynn A Sleeper
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Emile Bacha
- Division of Cardiac, Thoracic and Vascular Surgery, New York Presbyterian/Morgan Stanley Children's Hospital-Columbia/Komansky Weill-Cornell, New York, New York
| | - Luke Burchill
- Department of Medicine, University of Melbourne Royal Melbourne Hospital, Melbourne, New Zealand
| | - Kristine Guleserian
- Division of Cardiothoracic Surgery, Nicklaus Children's Hospital, Miami, Florida
| | - Michel Ilbawi
- Division of Pediatric Cardiac Surgery, Advocate Children's Hospital, Oak Lawn, Illinois
| | - Anees Razzouk
- Department of Cardiovascular and Thoracic Surgery, Loma Linda University Hospital, Loma Linda, California
| | - Takeshi Shinkawa
- Department of Cardiac Surgery, Tokyo Women's Medical University, Tokyo, JAPAN
| | - Minmin Lu
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Christopher W Baird
- Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
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Edlinger C, Bannehr M, Wernly B, Kücken T, Okamoto M, Lichtenauer M, Hähnel V, Reiners D, Neuss M, Butter C. Direct Flow Medical vs. Edwards Sapien 3 Prosthesis: A Propensity Matched Comparison on Intermediate Safety and Mortality. Front Cardiovasc Med 2021; 8:671719. [PMID: 34222370 PMCID: PMC8249849 DOI: 10.3389/fcvm.2021.671719] [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: 02/24/2021] [Accepted: 05/24/2021] [Indexed: 11/24/2022] Open
Abstract
Aims: To compare intermediate performance and mortality rates in patients, who underwent transcatheter aortic valve implantation (TAVI) with two different types of prostheses: Edwards Sapien 3 (ES3) and Direct Flow Medical (DFM). Methods and Results: 42 consecutive patients implanted with a DFM prosthesis for severe aortic stenosis were matched 1:1 with an equal number of patients, who received an ES3 during the same period. Primary endpoint was mortality. MACE, as a composite of all-cause death, stroke, and re-do-procedure (valve-in-valve), was defined as secondary endpoint. Moreover, we compared NYHA class, NT-proBNP-levels and the extent of restenosis. Patients were followed for 2 years. DFM patients showed echocardiographic elevated mean pressure gradients compared to ES3 patients before discharge (11.2 mmHg ± 5.3 vs. 3.5 mmHg ± 2.7; p < 0.001) and upon 6-months follow-up (20.3 mmHg ± 8.8 vs. 12.3 mmHg ± 4.4; p < 0.001). ES3 candidates showed superior NYHA class at follow-up (p = 0.001). Kaplan-Meier analysis revealed significantly worse survival in patients receiving a DFM prosthesis compared to ES3 (Breslow p = 0.020). MACE occurred more often in DFM patients compared to ES3 (Breslow p = 0.006). Conclusions: Patients receiving DFM valve prostheses showed worse survival and higher rates in MACE compared to ES3. Prosthesis performance regarding mean pressure gradients and patients' NYHA class also favored ES3.
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Affiliation(s)
- Christoph Edlinger
- Department of Cardiology, Heart Center Brandenburg, Bernau/Berlin, Germany.,Brandenburg Medical School (MHB) "Theodor Fontane", Neuruppin, Germany.,Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria.,Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
| | - Marwin Bannehr
- Department of Cardiology, Heart Center Brandenburg, Bernau/Berlin, Germany.,Brandenburg Medical School (MHB) "Theodor Fontane", Neuruppin, Germany.,Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
| | - Bernhard Wernly
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria.,Department of Anaesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Tanja Kücken
- Department of Cardiology, Heart Center Brandenburg, Bernau/Berlin, Germany.,Brandenburg Medical School (MHB) "Theodor Fontane", Neuruppin, Germany.,Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
| | - Maki Okamoto
- Department of Cardiology, Heart Center Brandenburg, Bernau/Berlin, Germany.,Brandenburg Medical School (MHB) "Theodor Fontane", Neuruppin, Germany.,Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
| | - Michael Lichtenauer
- Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Valentin Hähnel
- Department of Cardiology, Heart Center Brandenburg, Bernau/Berlin, Germany.,Brandenburg Medical School (MHB) "Theodor Fontane", Neuruppin, Germany.,Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
| | - David Reiners
- Department of Cardiology, Heart Center Brandenburg, Bernau/Berlin, Germany.,Brandenburg Medical School (MHB) "Theodor Fontane", Neuruppin, Germany.,Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
| | - Michael Neuss
- Department of Cardiology, Heart Center Brandenburg, Bernau/Berlin, Germany.,Brandenburg Medical School (MHB) "Theodor Fontane", Neuruppin, Germany.,Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg, Bernau/Berlin, Germany.,Brandenburg Medical School (MHB) "Theodor Fontane", Neuruppin, Germany.,Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
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Henning RJ. The current diagnosis and treatment of patients with aortic valve stenosis. Future Cardiol 2021; 17:1143-1160. [PMID: 33728942 DOI: 10.2217/fca-2020-0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aortic valve stenosis (AS) is the third most frequent cardiovascular abnormality after coronary artery disease and hypertension. A bicuspid aortic valve is the most common cause for AS until seventh decade and calcific valve degeneration is responsible thereafter. In symptomatic patients, The risk of death increases from ≤1%/year to 2%/month. An echo valve area ≤1 cm2, peak transaortic velocity ≥4 m/s, mean valve gradient ≥40 mmHg and/or computerized tomography valve calcium score >2000 Agatston units (AU) for males or more than 1200 AU for females indicate severe AS. AS stages and management are discussed. Valve replacement is based on surgical risk, valve durability/hemodynamics, need for anticoagulation and patient preferences. EuroSCORE ≥20%, Society of Thoracic Surgeons Predicted Risk of Mortality ≥8% and co-morbidities indicate high surgical risk. Surgery is recommended for low-intermediate risk patients. Transcatheter aortic valve implantation is an alternative in older patients at low, intermediate, high or prohibitive risk. Transaortic valve implantation/replacement trials are summarized.
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Ameer OZ, Salman IM, Alwadi AY, Ouban A, Abu-Owaimer FM, AlSharari SD, Bukhari IA. Regional functional and structural abnormalities within the aorta as a potential driver of vascular disease in metabolic syndrome. Exp Physiol 2021; 106:771-788. [PMID: 33450088 DOI: 10.1113/ep089213] [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: 10/25/2020] [Accepted: 01/06/2021] [Indexed: 12/11/2022]
Abstract
NEW FINDINGS What is the central question of this study? Is aortic dysfunction, a significant contributor to cardiovascular disease in metabolic syndrome, expressed uniformly across both the thoracic and abdominal aorta? What is the main finding and its importance? Our study shows that, in the setting of metabolic syndrome, functional and structural deficits in the aorta are differentially expressed along its length, with the abdominal portion displaying more extensive vascular abnormalities. It is, therefore, likely that early interventional strategies targeting the abdominal aorta might alleviate cardiovascular pathologies driven by the metabolic syndrome. ABSTRACT The extent of vascular dysfunction associated with metabolic syndrome might vary along the length of the aorta. In this study, we investigated regional functional and structural changes in the thoracic and abdominal aorta of a rat model of metabolic syndrome, namely, high-fat diet (HFD) streptozotocin-induced diabetes mellitus (HFD-D). Four-week-old male Wistar albino rats were fed with either HFD or control diet (CD) for 10 weeks. At week 6, 40 mg/kg streptozotocin and its vehicle were injected i.p. into HFD and CD groups, respectively. At the end of the feeding period, rats were euthanised and aortic segments collected for assessment of vascular functional responses and histomorphometry. Tail-cuff systolic blood pressures (154 ± 6 vs. 110 ± 4 mmHg) and areas under the curve for oral glucose and i.p. insulin tolerance tests were greater in HFD-D versus CD rats. Abdominal aortic vasoconstriction in response to noradrenaline and KCl was greater in HFD-D compared with CD rats. Thoracic vasoconstrictor responses to noradrenaline, but not KCl, were greater in the HFD-D group. Abdominal, but not thoracic, endothelium-dependent vasorelaxation in response to acetylcholine was blunted in HFD-D relative to CD rats; however, nitric oxide-dependent vasorelaxation in HFD-D rats was impaired in both thoracic and abdominal segments. The abdominal aorta of HFD-D rats showed deranged interlamellar spacing and increased lipid plaque deposition. In conclusion, vascular dysfunction in metabolic syndrome is expressed differentially along the length of the aorta, with the abdominal aorta exhibiting increased susceptibility to vasoconstrictors and greater deficits in endothelium-dependent relaxation. These vascular functional abnormalities could potentially underlie the development of hypertensive cardiovascular disease associated with the metabolic syndrome.
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Affiliation(s)
- Omar Z Ameer
- College of Pharmacy, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | - Ibrahim M Salman
- College of Pharmacy, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | - Aiman Y Alwadi
- College of Pharmacy, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | - Abderrahman Ouban
- College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia
| | | | - Shakir D AlSharari
- College of Pharmacy, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Ishfaq A Bukhari
- College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
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Schussler O, Lila N, Grau J, Ruel M, Lecarpentier Y, Carpentier A. Possible Link Between the ABO Blood Group of Bioprosthesis Recipients and Specific Types of Structural Degeneration. J Am Heart Assoc 2020; 9:e015909. [PMID: 32698708 PMCID: PMC7792238 DOI: 10.1161/jaha.119.015909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background Pigs/bovines share common antigens with humans: α-Gal, present in all pigs/bovines close to the human B-antigen; and AH-histo-blood-group antigen, identical to human AH-antigen and present only in some animals. We investigate the possible impact of patients' ABO blood group on bioprosthesis structural valve degeneration (SVD) through calcification/pannus/tears/perforations for patients ≤60 years at implantation. Methods and Results This was a single-center study (Paris, France) that included all degenerative bioprostheses explanted between 1985 and 1998, mostly porcine bioprostheses (Carpentier-Edwards second/third porcine bioprostheses) and some bovine bioprostheses. For the period 1998 to 2014, only porcine bioprostheses with longevity ≥13 years were included (total follow-up ≥29 years). Except for blood groups, important predictive factors for SVD were prospectively collected (age at implantation/longevity/number/site/sex/SVD types) and analyzed using logistic regression. All variables were available for 500 explanted porcine bioprostheses. By multivariate analyses, the A group was associated with an increased risk of: tears (odds ratio[OR], 1.61; P=0.026); pannus (OR, 1.5; P=0.054), pannus with tears (OR, 1.73; P=0.037), and tendency for lower risk of: calcifications (OR, 0.63; P=0.087) or isolated calcification (OR, 0.67; P=0.17). A-antigen was associated with lower risk of perforations (OR 0.56; P=0.087). B-group patients had an increased risk of: perforations (OR, 1.73; P=0.043); having a pannus that was calcified (OR, 3.0, P=0.025). B-antigen was associated with a propensity for calcifications in general (OR, 1.34; P=0.25). Conclusions Patient's ABO blood group is associated with specific SVD types. We hypothesize that carbohydrate antigens, which may or may not be common to patient and animal bioprosthetic tissue, will determine a patient's specific immunoreactivity with respect to xenograft tissue and thus bioprosthesis outcome in terms of SVD.
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Affiliation(s)
- Olivier Schussler
- Deparments of Cardiovascular Surgery and Cardiovascular Research Laboratory Geneva University Hospitals and Faculty of Medicine Geneva Switzerland.,Service de Chirurgie Thoracique Hôpitaux Universitaire de StrasbourgParis University Paris France
| | - Nermine Lila
- Biosurgical Research Lab (Carpentier Foundation) APHPGeorges PompidouEuropean Georges Pompidou Hospital Paris France
| | - Juan Grau
- Department of Epidemiology Ottawa Heart InstituteUniversity of Ottawa Ontario Canada
| | - Marc Ruel
- Department of Epidemiology Ottawa Heart InstituteUniversity of Ottawa Ontario Canada
| | - Yves Lecarpentier
- Centre de Recherche Clinique Grand Hôpital de l'Est Francilien (GHEF) Meaux France
| | - Alain Carpentier
- Biosurgical Research Lab (Carpentier Foundation) APHPGeorges PompidouEuropean Georges Pompidou Hospital Paris France.,Division of Cardiac Surgery and Research Laboratory European HospitalEuropean Georges Pompidou Hospital Paris France
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