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Tsukada T, Suzuki Y, Mathis BJ, Sato K, Kawamata T, Imai A, Nakajima T, Kaminishi Y, Kato H, Sakamoto H, Hiramatsu Y. Aortic valve area index values of Trifecta implants correlate with energy loss and increased valve stress. J Artif Organs 2024:10.1007/s10047-024-01453-z. [PMID: 38916826 DOI: 10.1007/s10047-024-01453-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/16/2024] [Indexed: 06/26/2024]
Abstract
Biological valves are becoming more frequently used in aortic valve replacement. While several reports have evaluated the performance of biological valves, echocardiography studies during exercise stress remain scarce. Furthermore, no current reports compare rate changes in the aortic valve area of biological valves under increased exercise load. Here, we performed exercise stress echocardiography in patients after AVR with Trifecta or Inspiris valves and compared the rates of change in aortic valve areas (AVA). In addition, hydrodynamic analysis at rest was conducted with four-dimensional flow magnetic resonance imaging (4D-flow MRI). Exercise stress echocardiography was performed in seven Trifecta and seven Inspiris patients who underwent AVR at our hospital while 4D flow MRI was performed in all but two Trifecta cases. Comparing the percentage change in AVA when loaded to 25 W versus at rest, Trifecta was greater than Inspiris (28.7 ± 36.0 vs - 0.8 ± 12.4%). The smaller AVA at rest was considered causative for this. Meanwhile, Trifecta systolic energy loss in the prosthetic valve segment on 4D-flow MRI (97.5 ± 35.9 vs 52.7 ± 25.3 mW) was higher than Inspiris. The opening of the Trifecta valve was considered to be restricted at rest and this may reflect the current reports of early valve degradation requiring reoperation. Taken together, we observed that the Trifecta design may promote faster wear due to higher valve stress.
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Affiliation(s)
- Toru Tsukada
- Department of Cardiovascular Surgery, University of Tsukuba Institute of Medicine, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yasuyuki Suzuki
- Department of Cardiovascular Surgery, University of Tsukuba Institute of Medicine, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Bryan J Mathis
- Department of Cardiovascular Surgery, University of Tsukuba Institute of Medicine, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Kimi Sato
- Department of Cardiology, University of Tsukuba Institute of Medicine, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Takeshi Kawamata
- Department of Cardiovascular Surgery, University of Tsukuba Institute of Medicine, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Akito Imai
- Department of Cardiovascular Surgery, University of Tsukuba Institute of Medicine, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Tomomi Nakajima
- Department of Cardiovascular Surgery, University of Tsukuba Institute of Medicine, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yuichiro Kaminishi
- Department of Cardiovascular Surgery, University of Tsukuba Institute of Medicine, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hideyuki Kato
- Department of Cardiovascular Surgery, University of Tsukuba Institute of Medicine, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hiroaki Sakamoto
- Department of Cardiovascular Surgery, University of Tsukuba Institute of Medicine, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yuji Hiramatsu
- Department of Cardiovascular Surgery, University of Tsukuba Institute of Medicine, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
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Tnay TD, Shell D, Lui A. Review of bioprosthetic structural valve deterioration: Patient or valve? J Card Surg 2022; 37:5243-5253. [PMID: 36317394 DOI: 10.1111/jocs.17081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/22/2022] [Accepted: 09/17/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND With guidelines progressively recommending bioprosthetic aortic valves in younger patients, a greater emphasis is placed on structural valve deterioration (SVD) as an important clinical endpoint for both transcatheter and surgically implanted valves. However, SVD of bioprosthetic valves is a complex entity with varying definitions in the literature and a multifaceted pathogenesis. AIM This review first aims to establish the most updated definitions of SVD as per the literature. We then explore the patient- and valve-related factors that play the greatest roles in facilitating early SVD. METHODS A PubMed literature review was conducted to identify the relevant research in this field within the past two decades. CONCLUSION Increasing rates of obesity and metabolic syndrome pose a significant risk to the longevity of bioprosthetic valves. Additionally, externally mounted valves have proven to sacrifice durability for superior haemodynamics. Bioprosthetic SVD continues to be a multifactorial issue that will require various patient- and valve-related factors to be addressed.
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Affiliation(s)
- Trevor D Tnay
- Department of Cardiothoracic Surgery, St Vincent's Hospital - Melbourne St Vincent's Health Australia, Melbourne, Australia
| | - Daniel Shell
- Department of Cardiothoracic Surgery, St Vincent's Hospital - Melbourne St Vincent's Health Australia, Melbourne, Australia
| | - Adrienne Lui
- Department of Cardiothoracic Surgery, St Vincent's Hospital - Melbourne St Vincent's Health Australia, Melbourne, Australia
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Joury A, Duran A, Stewart M, Gilliland YE, Spindel SM, Qamruddin S. Prosthesis-patient mismatch following aortic and mitral valves replacement – A comprehensive review. Prog Cardiovasc Dis 2022; 72:84-92. [PMID: 35235847 DOI: 10.1016/j.pcad.2022.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Abdulaziz Joury
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA, United States of America; King Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia.
| | - Antonio Duran
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA, United States of America; Ochsner Clinical School, New Orleans, LA, United States of America.
| | - Merrill Stewart
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA, United States of America; Ochsner Clinical School, New Orleans, LA, United States of America.
| | - Yvonne E Gilliland
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA, United States of America; Ochsner Clinical School, New Orleans, LA, United States of America
| | - Stephen M Spindel
- Ochsner Clinical School, New Orleans, LA, United States of America; Division of Cardiothoracic Surgery, Ochsner Medical Center, New Orleans, LA, United States of America.
| | - Salima Qamruddin
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA, United States of America; Ochsner Clinical School, New Orleans, LA, United States of America.
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Early Hemodynamics after Aortic Valve Replacement. ACTA ACUST UNITED AC 2020; 56:medicina56120674. [PMID: 33297308 PMCID: PMC7762237 DOI: 10.3390/medicina56120674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/02/2020] [Accepted: 12/04/2020] [Indexed: 11/16/2022]
Abstract
Background and objectives: The aims of this study were to investigate changes in the hemodynamics associated with different types of aortic prostheses and to evaluate patient-prosthesis mismatch (PPM) at rest and after exercise. Materials and Methods: We retrospectively analyzed 150 patients who presented with indications for aortic valve replacement (AVR) with/without concomitant surgery from March 2019 to January 2020. The study population included 90 (60%) men and 60 (40%) women (mean age, 67.33 ± 10.22 years; range, 37-88 years). Echocardiography data such as peak and mean transprosthetic pressure gradients (Gmax, Gmean), velocity (V), effective orifice area (EOA), and indexed EOA (iEOA) were derived at rest and after exercise at baseline and before discharge. The study patients performed the six-minute walk test (6MWT) on the 5th-7th postoperative day. Results: Stented tissue valves showed excellent performance at rest and after exercise in comparison with mechanical valves, which showed favorable hemodynamics at rest only. At the time of discharge, moderate PPM was observed in 7/74 patients (9.5%) at rest and 5/98 (3.3%) patients after exercise. None of the patients showed severe PPM. EOA and iEOA were not significantly different between the groups. However, the stented group showed more pronounced changes in EOA and iEOA after exercise, whereas the changes in the mechanical valve group did not reach significance. Conclusions: In the early postoperative period, mechanical valves and stented valves showed favorable resting hemodynamics. The PPM rate measured after exercise was lower than that at rest.
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Owais T, El Garhy M, Secknus MA, Kuntze T. Implantation of Perceval in Trifecta ring: A new perspective. J Cardiol Cases 2019; 20:172-173. [PMID: 31719938 DOI: 10.1016/j.jccase.2019.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 06/28/2019] [Accepted: 07/28/2019] [Indexed: 10/26/2022] Open
Abstract
We report a case of a 67-year-old woman who underwent an aortic valve replacement with a 23-mm Trifecta prosthesis (St. Jude Medical, St. Paul, MN, USA). We implanted Perceval S (LenoNova, London, UK) after resecting the degenerated leaflets three years later after the first operation. This strategy enabled us to reduce the ischemic time and hence simplify the surgical procedure in addition to providing excellent postoperative hemodynamics. <Learning objective: The Perceval sutureless valve implantation in Trifecta ring is a feasible alternative to transcatheter aortic valve implantation in specific situations.>.
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Affiliation(s)
- Tamer Owais
- Heart Centre, Zentralklinik Bad Berka, Bad Berka, Germany.,Department of Cardiothoracic Surgery, Cairo University, Cairo, Egypt
| | - Mohammad El Garhy
- Heart Centre, Zentralklinik Bad Berka, Bad Berka, Germany.,Department of Cardiology, Minia University, Minia, Egypt
| | | | - Thomas Kuntze
- Heart Centre, Zentralklinik Bad Berka, Bad Berka, Germany
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Stock S, Lohmann I, Hanke T, Stierle U, Richardt D, Tsvelodub S, Sievers HH. Rest and exercise haemodynamics in patients with one of two stented bioprostheses and in healthy controls with small aortic annuli. Interact Cardiovasc Thorac Surg 2018; 26:425-430. [PMID: 29095979 DOI: 10.1093/icvts/ivx356] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 10/03/2017] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Because bioprosthetic aortic valve replacement remains one of the most frequent cardiac surgical procedures, it is necessary to study patient haemodynamics in more detail. Until now, a few studies assessed haemodynamics during exercise, but none with special regard to small aortic annuli. We compared patients who had the differently designed bioprostheses, Trifecta and Perimount Magna Ease (PME), size ≤ 23 mm, and a healthy control group during rest and exercise. METHODS We determined the mean transvalvular gradient, the effective orifice area (EOA) and the EOA index during rest and exercise using transthoracic echocardiography in 35 patients with the Trifecta (mean age 71.4 years, follow-up 1 year, labelled valve size 21.7 mm), in 16 patients with the PME (mean age 66.2 years, follow-up 2.6 years, labelled valve size 21.6 mm) and in 25 healthy persons. The parameters derived were summarized in a simplified Valve Academic Research Consortium-2 classification to determine prosthetic valve dysfunction. RESULTS When we compared the Trifecta and the PME, a significant superiority of the Trifecta was seen at rest in mean transvalvular gradient (7.96 vs 12.19 mmHg) and EOA (1.57 vs 1.48 cm2), during exercise in all parameters (mean transvalvular gradient 11.06 vs 19.2 mmHg, EOA 1.77 vs 1.26 cm2, EOA index 0.96 vs 0.67 cm2/m2). The Trifecta showed a physiological increase in the EOA index during exercise. Exercise led to a shift to better simplified Valve Academic Research Consortium-2 categories in the Trifecta and to worse in the PME group. CONCLUSIONS This study reveals the haemodynamic superiority of the Trifecta to the PME. Especially in small aortic annuli, this difference might have some relevance for clinical and research issues.
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Affiliation(s)
- Sina Stock
- Department of Cardiac and Thoracic Vascular Surgery, University of Luebeck, Luebeck, Germany
| | - Inga Lohmann
- Department of Cardiac and Thoracic Vascular Surgery, University of Luebeck, Luebeck, Germany
| | - Thorsten Hanke
- Department of Cardiac and Thoracic Vascular Surgery, University of Luebeck, Luebeck, Germany
| | - Ulrich Stierle
- Department of Cardiac and Thoracic Vascular Surgery, University of Luebeck, Luebeck, Germany
| | - Doreen Richardt
- Department of Cardiac and Thoracic Vascular Surgery, University of Luebeck, Luebeck, Germany
| | - Stanislav Tsvelodub
- Department of Cardiac and Thoracic Vascular Surgery, University of Luebeck, Luebeck, Germany
| | - Hans-Hinrich Sievers
- Department of Cardiac and Thoracic Vascular Surgery, University of Luebeck, Luebeck, Germany
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Ito H, Mizumoto T, Shomura Y, Sawada Y, Kajiyama K, Shimpo H. The impact of global left ventricular afterload on left ventricular reverse remodeling after aortic valve replacement. J Card Surg 2017; 32:530-536. [DOI: 10.1111/jocs.13190] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Hisato Ito
- Department of Cardiothoracic Surgery; Anjo Kosei Hospital; 28 Higashi-Hirokute Anjo City Aichi 446-8602 Japan
- Department of Thoracic and Cardiovascular Surgery; Mie University; 2-174 Edobashi Tsu Mie 514-8507 Japan
| | - Toru Mizumoto
- Department of Cardiothoracic Surgery; Anjo Kosei Hospital; 28 Higashi-Hirokute Anjo City Aichi 446-8602 Japan
| | - Yu Shomura
- Department of Cardiothoracic Surgery; Anjo Kosei Hospital; 28 Higashi-Hirokute Anjo City Aichi 446-8602 Japan
| | - Yasuhiro Sawada
- Department of Cardiothoracic Surgery; Anjo Kosei Hospital; 28 Higashi-Hirokute Anjo City Aichi 446-8602 Japan
| | - Ko Kajiyama
- Department of Cardiothoracic Surgery; Anjo Kosei Hospital; 28 Higashi-Hirokute Anjo City Aichi 446-8602 Japan
| | - Hideto Shimpo
- Department of Thoracic and Cardiovascular Surgery; Mie University; 2-174 Edobashi Tsu Mie 514-8507 Japan
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8
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Hegazy YY, Rayan A, Bauer S, Keshk N, Bauer K, Ennker I, Ennker J. Current indications for stentless aortic bioprostheses. Asian Cardiovasc Thorac Ann 2017; 26:19-27. [PMID: 28699388 DOI: 10.1177/0218492317721411] [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: 11/16/2022]
Abstract
The best aortic prostheses have been debated for decades. The introduction of stentless aortic bioprostheses was aimed at improving hemodynamics and potentially the durability of aortic bioprostheses. Despite the good short- and long-term outcomes after implantation of stentless aortic bioprostheses, their use remains limited owing to the technically demanding implantation techniques. Nevertheless, stentless aortic bioprostheses might be of special benefit in certain indications, where they could be a valuable addition to the surgical armamentarium.
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Affiliation(s)
- Yasser Y Hegazy
- 1 Department of Cardiac Surgery, Heart Institute Lahr/Baden, Lahr, Germany.,2 Department of Cardio-Thoracic Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Amr Rayan
- 1 Department of Cardiac Surgery, Heart Institute Lahr/Baden, Lahr, Germany.,2 Department of Cardio-Thoracic Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Stefan Bauer
- 1 Department of Cardiac Surgery, Heart Institute Lahr/Baden, Lahr, Germany
| | - Noha Keshk
- 1 Department of Cardiac Surgery, Heart Institute Lahr/Baden, Lahr, Germany
| | - Kerstin Bauer
- 1 Department of Cardiac Surgery, Heart Institute Lahr/Baden, Lahr, Germany
| | - Ina Ennker
- 3 Department of Plastic-, Aesthetic-, Hand- and Reconstructive Surgery, Hannover Medical School, Hannover, Germany
| | - Jürgen Ennker
- 1 Department of Cardiac Surgery, Heart Institute Lahr/Baden, Lahr, Germany.,4 Faculty of Health, School of Medicine, University of Witten Herdecke, Witten, Germany
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Lehmann S, Meyer A, Schroeter T, Uhlemann M, Fischer J, Leontyev S, Garbade J, Holzhey D, Misfeld M, Mohr FW. Midterm Durability and Hemodynamic Performance of a Third-Generation Bovine Pericardial Prosthetic Aortic Valve: The Leipzig Experience. Ann Thorac Surg 2017; 103:1933-1939. [DOI: 10.1016/j.athoracsur.2016.09.073] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 08/28/2016] [Accepted: 09/12/2016] [Indexed: 11/28/2022]
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10
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Management of small aortic annulus in the era of sutureless valves: A comparative study among different biological options. J Thorac Cardiovasc Surg 2016; 152:1019-28. [DOI: 10.1016/j.jtcvs.2016.06.058] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 06/21/2016] [Accepted: 06/24/2016] [Indexed: 11/21/2022]
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Bach DS, Patel HJ, Kolias TJ, Deeb GM. Randomized comparison of exercise haemodynamics of Freestyle, Magna Ease and Trifecta bioprostheses after aortic valve replacement for severe aortic stenosis. Eur J Cardiothorac Surg 2016; 50:361-7. [DOI: 10.1093/ejcts/ezv493] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 12/22/2015] [Indexed: 11/13/2022] Open
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