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Anaraki KT, Zahed Z, Javid RN, Shafiei S, Beiranvandi F, Kahrizsangi NG, Golafshan F, Arzhangzade A, Kojuri J, Almassian S, Hadi R, Gholizadeh P, Kazeminava F. Immune response following transcatheter aortic valve procedure. Vascul Pharmacol 2024; 154:107283. [PMID: 38340884 DOI: 10.1016/j.vph.2024.107283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/25/2024] [Accepted: 02/07/2024] [Indexed: 02/12/2024]
Abstract
Aortic valve stenosis is the most common type of heart valve disease in the United States and Europe and calcific aortic stenosis (AS) affects 2-7% of people aged 65 years and older. Aortic valve replacement (AVR) is the only effective treatment for individuals with this condition. Transcatheter Aortic Valve Replacement (TAVR) has been widely accepted as a minimally invasive therapeutic approach for addressing symptomatic AS in patients who are considered to have a high risk for traditional surgical intervention. TAVR procedure may have a paradoxical effect on the immune system and inflammatory status. A major portion of these immune responses is regulated by activating or inhibiting inflammatory monocytes and the complement system with subsequent changes in inflammatory cytokines. TAVR has the potential to induce various concurrent exposures, including disruption of the native valve, hemodynamic changes, antigenicity of the bioprosthesis, and vascular damage, which finally lead to the development of inflammation. On the other hand, it is important to acknowledge that TAVR may also have anti-inflammatory effects by helping in the resolution of stenosis.The inflammation and immune response following TAVR are complex processes that significantly impact procedural outcomes and patient well-being. Understanding the underlying mechanisms, identifying biomarkers of inflammation, and exploring therapeutic interventions to modulate these responses are crucial for optimizing TAVR outcomes. Further research is warranted to elucidate the precise immunological dynamics and develop tailored strategies to attenuate inflammation and enhance post-TAVR healing while minimizing complications.
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Affiliation(s)
- Kasra Talebi Anaraki
- Department of Cardiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Zahed
- Department of Medical Sciences, Ardabil University of Medical Sciences, Ardabil, Iran
| | | | - Sasan Shafiei
- Department of Cardiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fereshteh Beiranvandi
- Department of Cardiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Faraz Golafshan
- Department of Cardiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Arzhangzade
- Department of Cardiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Javad Kojuri
- Department of Cardiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Samin Almassian
- Heart Valve Disease Research Center, Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Raha Hadi
- Department of Chemistry, Faculty of Basic Science, University of Mohaghegh Ardabili, Ardabil, Iran
| | - Pourya Gholizadeh
- Zoonoses Research Center, Ardabil University of Medical Sciences, Ardabil, Iran; Digestive Disease Research Center, Ardabil University of Medical Sciences, Ardabil, Iran.
| | - Fahimeh Kazeminava
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
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Yang T, Zhu G, Cai L, Yeo JH, Mao Y, Yang J. A benchmark study of convolutional neural networks in fully automatic segmentation of aortic root. Front Bioeng Biotechnol 2023; 11:1171868. [PMID: 37397959 PMCID: PMC10311214 DOI: 10.3389/fbioe.2023.1171868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/06/2023] [Indexed: 07/04/2023] Open
Abstract
Recent clinical studies have suggested that introducing 3D patient-specific aortic root models into the pre-operative assessment procedure of transcatheter aortic valve replacement (TAVR) would reduce the incident rate of peri-operative complications. Tradition manual segmentation is labor-intensive and low-efficient, which cannot meet the clinical demands of processing large data volumes. Recent developments in machine learning provided a viable way for accurate and efficient medical image segmentation for 3D patient-specific models automatically. This study quantitively evaluated the auto segmentation quality and efficiency of the four popular segmentation-dedicated three-dimensional (3D) convolutional neural network (CNN) architectures, including 3D UNet, VNet, 3D Res-UNet and SegResNet. All the CNNs were implemented in PyTorch platform, and low-dose CTA image sets of 98 anonymized patients were retrospectively selected from the database for training and testing of the CNNs. The results showed that despite all four 3D CNNs having similar recall, Dice similarity coefficient (DSC), and Jaccard index on the segmentation of the aortic root, the Hausdorff distance (HD) of the segmentation results from 3D Res-UNet is 8.56 ± 2.28, which is only 9.8% higher than that of VNet, but 25.5% and 86.4% lower than that of 3D UNet and SegResNet, respectively. In addition, 3D Res-UNet and VNet also performed better in the 3D deviation location of interest analysis focusing on the aortic valve and the bottom of the aortic root. Although 3D Res-UNet and VNet are evenly matched in the aspect of classical segmentation quality evaluation metrics and 3D deviation location of interest analysis, 3D Res-UNet is the most efficient CNN architecture with an average segmentation time of 0.10 ± 0.04 s, which is 91.2%, 95.3% and 64.3% faster than 3D UNet, VNet and SegResNet, respectively. The results from this study suggested that 3D Res-UNet is a suitable candidate for accurate and fast automatic aortic root segmentation for pre-operative assessment of TAVR.
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Affiliation(s)
- Tingting Yang
- School of Energy and Power Engineering, Xi’an Jiaotong University, Xi’an, China
| | - Guangyu Zhu
- School of Energy and Power Engineering, Xi’an Jiaotong University, Xi’an, China
| | - Li Cai
- School of Mathematics and Statistics, Northwestern Polytechnical University, Xi’an, China
| | - Joon Hock Yeo
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Yu Mao
- Department of Cardiac Surgery, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Jian Yang
- Department of Cardiac Surgery, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
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Chen X, Yu T, Kong Q, Kuang D, Xu H, Zhao Z, Yang L, Li G, Fan H, Wang Y. Functional non-glutaraldehyde treated porcine pericardium for anti-coagulation, anti-calcification, and endothelial proliferation bioprosthetic heart valves. JOURNAL OF LEATHER SCIENCE AND ENGINEERING 2022. [DOI: 10.1186/s42825-022-00098-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
AbstractIn the last decade, the number of transcatheter heart valve replacement for severe heart valve disease has increased exponentially. Although the bioprosthetic artificial heart valve (BHV) has similar fluid dynamics performance to the original heart valve compared with mechanical heart valve so that there is no need to take long-term anticoagulant drugs to prevent thromboembolism, transcatheter BHV replacement are still at risk for thrombosis during the first few months according to the clinical data. However, the use of antithrombotic drugs can also increase the risk of bleeding. Therefore, it is particularly important to improve the anticoagulant properties for the BHV itself. In this work, a kind of non-glutaraldehyde cross-linked BHV material with excellent antithrombotic ability has been prepared from carboxylated oxazolidine treated porcine pericardium (consisting of collagen, elastin and glycoprotein) with the further graft of the anticoagulant heparin sodium via hydrophilic modified chitosan. Along with the similar mechanical properties and collagen stability comparable to the glutaraldehyde cross-linked porcine pericardium (PP), these functional non-glutaraldehyde cross-linked PPs exhibit better biocompatibility, promoted endothelial proliferation and superior anti-calcification ability. More importantly, excellent anticoagulant activity can be observed in the hematological experiments in vivo and in vitro. In summary, these excellent performances make these functional non-glutaraldehyde cross-linked PPs great potentialities in the BHV applications.
Graphical abstract
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Parekh A, Sengupta V, Hunyadi V, Ianitelli M, Zainea M. Aortic Valve Leaflet Rupture Causing Delayed Left Main Coronary Ostial Obstruction During Valvuloplasty Preceding TAVR. JACC Case Rep 2021; 3:1822-1827. [PMID: 34917962 PMCID: PMC8642731 DOI: 10.1016/j.jaccas.2021.09.022] [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: 07/12/2021] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 02/06/2023]
Abstract
A 69-year-old man with mediastinal radiation history underwent balloon valvuloplasty before transcatheter aortic valve replacement, which caused aortic leaflet rupture leading to unstable severe aortic regurgitation and subsequent left main ostial obstruction. A balloon-expanding valve was implanted to capture the ruptured leaflet and a left main stent was placed. (Level of Difficulty: Advanced.)
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Affiliation(s)
- Akarsh Parekh
- Department of Cardiovascular Medicine, McLaren Macomb Medical Center, Mount Clemens, Michigan, USA
- Michigan State University, East Lansing, Michigan, USA
- Address for correspondence: Dr Akarsh Parekh, McLaren Macomb Medical Center, Cardiovascular Medicine, 1000 Harrington Street, Mount Clemens, Michigan 48043, USA.
| | - Vivek Sengupta
- Department of Cardiovascular Medicine, McLaren Macomb Medical Center, Mount Clemens, Michigan, USA
- Michigan State University, East Lansing, Michigan, USA
| | - Victor Hunyadi
- Department of Cardiovascular Medicine, McLaren Macomb Medical Center, Mount Clemens, Michigan, USA
- Michigan State University, East Lansing, Michigan, USA
| | - Melissa Ianitelli
- Department of Cardiovascular Medicine, McLaren Macomb Medical Center, Mount Clemens, Michigan, USA
- Michigan State University, East Lansing, Michigan, USA
| | - Mark Zainea
- Department of Cardiovascular Medicine, McLaren Macomb Medical Center, Mount Clemens, Michigan, USA
- Wayne State University, Detroit, Michigan, USA
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Wahl S. Cardiac Surgery: Beyond Conventional Sternotomy With Cardiopulmonary Bypass. Crit Care Nurse 2020; 40:66-73. [PMID: 32006037 DOI: 10.4037/ccn2020258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Minimally invasive cardiac surgery options, which originated with off-pump coronary artery bypass grafting and aortic valve procedures, continue to evolve in order to address complex conditions, including those requiring mitral and tricuspid valve repair. Although these procedures are primarily indicated for high-risk patient populations, favorable patient outcomes have resulted in recommendations being expanded to include intermediate-risk groups. This article increases nursing-related knowledge of minimally invasive cardiac procedures, providing an overview of current minimally invasive cardiac surgeries and their associated risks and benefits.
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Affiliation(s)
- Sharon Wahl
- Sharon Wahl is a clinical nurse specialist at Abbott Northwestern Hospital, Minneapolis, Minnesota
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Yousif N, Subbramaniyam S, Thevan B, Amin M, Sulaibikh L, Bukamal N, Tareif H, Shivappa S, Amin H, Noor HA. Transcatheter Aortic Valve Implantation: Bahrain Experience. J Saudi Heart Assoc 2020; 32:434-439. [PMID: 33299788 PMCID: PMC7721461 DOI: 10.37616/2212-5043.1143] [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: 07/01/2020] [Revised: 09/14/2020] [Accepted: 09/14/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is a minimally invasive procedure that is considered a good alternative to surgical aortic valve replacement (sAVR) in selected patients. Our aim is to determine the baseline, procedural characteristics and one-year clinical outcomes of our TAVI registry. METHODS This study is a retrospective observational analysis of a prospectively designed cohort comprising 81 consecutive patients treated at Mohammed bin Khalifa Cardiac Centre (MKCC) who were enrolled in Bahrain TAVI registry from February 2014 to February 2019. The clinical endpoints were defined according to the updated Valve Academic Research Consortium-2 (VARC-2) consensus document. RESULTS Out of the 81 patients included in our study, there were 37 (45.7%) males. The mean age was 76.4 ± 8.9 years with a mean Logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE II) of 4.1 ± 2.5 and a mean Society of Thoracic Surgery (STS) Risk Score of 4.2 ± 3.5. Evolute-R valve was used for 36 (44.4%) patients, Edward Sapien for 26 patients (32.1%), and Core valve for 19 patients (23.5%). At one year follow up, all-cause death was reported in three (3.7%) patients; none of them was cardiovascular mortality. As per VARC-II criteria, no cases fulfilled the criteria of valve dysfunction but TAVI-related complications (i.e., TAV-in-TAV deployment) were reported in four (4.9%) cases. One (1.2%) case of major bleeding was encountered but no patient experienced life-threatening bleeding. Major vascular complications were documented in two patients (2.5%) only. Significant Acute Kidney Injury (AKI) occurred in two (2.5%) patients, both classified as stage-2 but no one deteriorated to stage-3 or hemodialysis. Seven (8.6%) patients required permanent pacemakers, and all were implanted during the index admission for TAVI. One patient (1.2%) had stroke and all survivors completed one-year follow up. CONCLUSION The TAVI program in Bahrain is encouraging and corresponds to the finest international centers outcomes in terms of procedural success and complications rate.
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Affiliation(s)
- Nooraldaem Yousif
- Department of Cardiology, Mohammed Bin Khalifa Cardiac Centre, Riffa, Bahrain
| | | | - Babu Thevan
- Department of Cardiology, Mohammed Bin Khalifa Cardiac Centre, Riffa, Bahrain
| | - Mohammad Amin
- Department of Cardiology, Mohammed Bin Khalifa Cardiac Centre, Riffa, Bahrain
| | - Leena Sulaibikh
- Department of Cardiology, Mohammed Bin Khalifa Cardiac Centre, Riffa, Bahrain
| | - Nazar Bukamal
- Department of Cardiac Anesthesia, Mohammed Bin Khalifa Cardiac Centre, Riffa, Bahrain
| | - Habib Tareif
- Department of Cardiac Surgery, Mohammed Bin Khalifa Cardiac Centre, Riffa, Bahrain
| | - Sadananda Shivappa
- Department of Cardiology, Mohammed Bin Khalifa Cardiac Centre, Riffa, Bahrain
| | - Haitham Amin
- Department of Cardiology, Mohammed Bin Khalifa Cardiac Centre, Riffa, Bahrain
| | - Husam A Noor
- Department of Cardiology, Mohammed Bin Khalifa Cardiac Centre, Riffa, Bahrain
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Heyden CM, El-Said HG, Moore JW, Guyon PW, Katheria AC, Ratnayaka K. Early experience with the Micro Plug Set for preterm patent ductus arteriosus closure. Catheter Cardiovasc Interv 2020; 96:1439-1444. [PMID: 32979038 DOI: 10.1002/ccd.29298] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/16/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVES We intend to describe early experience using a new, commercially available Micro Plug Set for preterm neonate and infant transcatheter patent ductus arteriosus (PDA) occlusion. BACKGROUND Transcatheter PDA occlusion in premature neonates and small infants is safe and effective. The procedure is early in its evolution. METHODS Procedural and short-term outcomes of preterm neonates and infants undergoing transcatheter PDA occlusion with a new, commercially available device were reviewed. RESULTS Eight preterm neonates and infants born at median 27 weeks gestation (23-36 weeks) underwent transcatheter PDA device closure with the Micro Plug Set. The device is short (2.5 mm) with a range of diameters (3, 4, 5, 6 mm) and delivered through a microcatheter. Procedures were performed at median 41 days of age (12-88 days) and at 1690 g (760-3,310 g). Transvenous PDA device occlusion was performed with fluoroscopic and echocardiography guidance. All procedures were successful with complete PDA occlusion. There were no procedural or short-term adverse events. CONCLUSIONS Preterm neonate and infant transcatheter PDA device closure with a new, commercially available short and microcatheter delivered device (Micro Plug Set) was safe and effective in a small, early series of patients.
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Affiliation(s)
- Caitlin M Heyden
- Division of Pediatric Cardiology, Rady Children's Hospital and UC San Diego School of Medicine, San Diego, California, USA
| | - Howaida G El-Said
- Division of Pediatric Cardiology, Rady Children's Hospital and UC San Diego School of Medicine, San Diego, California, USA
| | - John W Moore
- Division of Pediatric Cardiology, Rady Children's Hospital and UC San Diego School of Medicine, San Diego, California, USA
| | - Peter W Guyon
- Division of Pediatric Cardiology, Rady Children's Hospital and UC San Diego School of Medicine, San Diego, California, USA
| | - Anup C Katheria
- Department of Neonatology, Sharp Mary Birch Hospital for Women and Newborns, San Diego, California, USA
| | - Kanishka Ratnayaka
- Division of Pediatric Cardiology, Rady Children's Hospital and UC San Diego School of Medicine, San Diego, California, USA
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Amir A, Moore A, Carvalho G, Codère-Marayuma T, Schricker T, Villeneuve V, Hatzakorzian R. A Story of Migration of a Surgically Implanted Aortic Sutureless Valve. J Cardiothorac Vasc Anesth 2017; 32:464-466. [PMID: 29221975 DOI: 10.1053/j.jvca.2017.06.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Alexander Amir
- Department of Cardiac Anesthesia, McGill University Health Center, Glen Site, Royal Victoria Hospital, Montréal, Canada
| | - Albert Moore
- Department of Cardiac Anesthesia, McGill University Health Center, Glen Site, Royal Victoria Hospital, Montréal, Canada
| | - George Carvalho
- Department of Cardiac Anesthesia, McGill University Health Center, Glen Site, Royal Victoria Hospital, Montréal, Canada
| | - Takumi Codère-Marayuma
- Department of Cardiac Anesthesia, McGill University Health Center, Glen Site, Royal Victoria Hospital, Montréal, Canada
| | - Thomas Schricker
- Department of Cardiac Anesthesia, McGill University Health Center, Glen Site, Royal Victoria Hospital, Montréal, Canada
| | - Valerie Villeneuve
- Department of Cardiac Anesthesia, McGill University Health Center, Glen Site, Royal Victoria Hospital, Montréal, Canada
| | - Roupen Hatzakorzian
- Department of Cardiac Anesthesia, McGill University Health Center, Glen Site, Royal Victoria Hospital, Montréal, Canada; Department of Critical Care, McGill University Health Center, Glen Site, Royal Victoria Hospital, Montréal, Canada.
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