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Tong Q, Cai J, Wang Z, Sun Y, Liang X, Xu Q, Mahamoud OA, Qian Y, Qian Z. Recent Advances in the Modification and Improvement of Bioprosthetic Heart Valves. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2024; 20:e2309844. [PMID: 38279610 DOI: 10.1002/smll.202309844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/10/2023] [Indexed: 01/28/2024]
Abstract
Valvular heart disease (VHD) has become a burden and a growing public health problem in humans, causing significant morbidity and mortality worldwide. An increasing number of patients with severe VHD need to undergo heart valve replacement surgery, and artificial heart valves are in high demand. However, allogeneic valves from donors are lacking and cannot meet clinical practice needs. A mechanical heart valve can activate the coagulation pathway after contact with blood after implantation in the cardiovascular system, leading to thrombosis. Therefore, bioprosthetic heart valves (BHVs) are still a promising way to solve this problem. However, there are still challenges in the use of BHVs. For example, their longevity is still unsatisfactory due to the defects, such as thrombosis, structural valve degeneration, calcification, insufficient re-endothelialization, and the inflammatory response. Therefore, strategies and methods are needed to effectively improve the biocompatibility and longevity of BHVs. This review describes the recent research advances in BHVs and strategies to improve their biocompatibility and longevity.
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Affiliation(s)
- Qi Tong
- Department of Cardiovascular Surgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, #37 Guoxue Alley, Chengdu, Sichuan, 610041, P. R. China
| | - Jie Cai
- Department of Cardiovascular Surgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, #37 Guoxue Alley, Chengdu, Sichuan, 610041, P. R. China
| | - Zhengjie Wang
- Department of Cardiovascular Surgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, #37 Guoxue Alley, Chengdu, Sichuan, 610041, P. R. China
| | - Yiren Sun
- Department of Cardiovascular Surgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, #37 Guoxue Alley, Chengdu, Sichuan, 610041, P. R. China
| | - Xuyue Liang
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, #37 Guoxue Alley, Chengdu, Sichuan, 610041, P. R. China
| | - Qiyue Xu
- School of Basic Medicine, Mudanjiang Medical University, Mudanjiang, Heilongjiang, 157011, P. R. China
| | - Oumar Abdel Mahamoud
- Department of Cardiovascular Surgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, #37 Guoxue Alley, Chengdu, Sichuan, 610041, P. R. China
| | - Yongjun Qian
- Department of Cardiovascular Surgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, #37 Guoxue Alley, Chengdu, Sichuan, 610041, P. R. China
| | - Zhiyong Qian
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, #37 Guoxue Alley, Chengdu, Sichuan, 610041, P. R. China
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Thong EHE, Kong WKF, Poh KK, Wong R, Chai P, Sia CH. Multimodal Cardiac Imaging in the Assessment of Patients Who Have Suffered a Cardioembolic Stroke: A Review. J Cardiovasc Dev Dis 2023; 11:13. [PMID: 38248883 PMCID: PMC10816708 DOI: 10.3390/jcdd11010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/21/2023] [Accepted: 12/27/2023] [Indexed: 01/23/2024] Open
Abstract
Cardioembolic strokes account for 20-25% of all ischaemic strokes, with their incidence increasing with age. Cardiac imaging plays a crucial role in identifying cardioembolic causes of stroke, with early and accurate identification affecting treatment, preventing recurrence, and reducing stroke incidence. Echocardiography serves as the mainstay of cardiac evaluation. Transthoracic echocardiography (TTE) is the first line in the basic evaluation of structural heart disorders, valvular disease, vegetations, and intraventricular thrombus. It can be used to measure chamber size and systolic/diastolic function. Trans-oesophageal echocardiography (TOE) yields better results in identifying potential cardioembolic sources of stroke and should be strongly considered, especially if TTE does not yield adequate results. Cardiac computed tomography and cardiac magnetic resonance imaging provide better soft tissue characterisation, high-grade anatomical information, spatial and temporal visualisation, and image reconstruction in multiple planes, especially with contrast. These techniques are useful in cases of inconclusive echocardiograms and can be used to detect and characterise valvular lesions, thrombi, fibrosis, cardiomyopathies, and aortic plaques. Nuclear imaging is not routinely used, but it can be used to assess left-ventricular perfusion, function, and dimensions and may be useful in cases of infective endocarditis. Its use should be considered on a case-by-case basis. The accuracy of each imaging modality depends on the likely source of cardioembolism, and the choice of imaging approach should be tailored to individual patients.
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Affiliation(s)
| | - William K. F. Kong
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
| | - Kian-Keong Poh
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
| | - Raymond Wong
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
| | - Ping Chai
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
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Vermes E, Iacuzio L, Maréchaux S, Levy F, Loardi C, Tribouilloy C. Is there a role for cardiovascular magnetic resonance imaging in the assessment of biological aortic valves? Front Cardiovasc Med 2023; 10:1250576. [PMID: 38124892 PMCID: PMC10730731 DOI: 10.3389/fcvm.2023.1250576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Patients with biological aortic valves (following either surgical aortic valve replacement [SAVR] or trans catheter aortic valve implantation [TAVI]) require lifelong follow-up with an imaging modality to assess prosthetic valve function and dysfunction. Echocardiography is currently the first-line imaging modality to assess biological aortic valves. In this review, we discuss the potential role of cardiac magnetic resonance imaging (CMR) as an additional imaging modality in situations of inconclusive or equivocal echocardiography. Planimetry of the prosthetic orifice can theoretically be measured, as well as the effective orifice area, with potential limitations, such as CMR valve-related artefacts and calcifications in degenerated prostheses. The true benefit of CMR is its ability to accurately quantify aortic regurgitation (paravalvular and intra-valvular) with a direct and reproducible method independent of regurgitant jet morphology to accurately assess reverse remodelling and non-invasively detect focal and interstitial diffuse myocardial fibrosis. Following SAVR or TAVI for aortic stenosis, interstitial diffuse fibrosis can regress, accompanied by structural and functional improvement that CMR can accurately assess.
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Affiliation(s)
- Emmanuelle Vermes
- Department of Cardiology, Amiens University Hospital, Amiens, France
| | - Laura Iacuzio
- Department of Cardiology, Centre Cardio-Thoracique de Monaco, Monaco City, Monaco
| | - Sylvestre Maréchaux
- GCS-Groupement des Hôpitaux de l’Institut Catholique de Lille/Lille Catholic Hospitals, Heart Valve Center, Cardiology Department, ETHICS EA 7446, Lille Catholic University, Lille, France
| | - Franck Levy
- Department of Cardiology, Centre Cardio-Thoracique de Monaco, Monaco City, Monaco
| | - Claudia Loardi
- Department of Thoracic Surgery, Tours University Hospital, Tours, France
| | - Christophe Tribouilloy
- Department of Cardiology, Amiens University Hospital, Amiens, France
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
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4
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Fazzari F, Baggiano A, Fusini L, Ghulam Ali S, Gripari P, Junod D, Mancini ME, Maragna R, Mushtaq S, Pontone G, Pepi M, Muratori M. Early Biological Valve Failure: Structural Valve Degeneration, Thrombosis, or Endocarditis? J Clin Med 2023; 12:5740. [PMID: 37685807 PMCID: PMC10488994 DOI: 10.3390/jcm12175740] [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: 07/28/2023] [Revised: 08/24/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
Biological valve failure (BVF) is an inevitable condition that compromises the durability of biological heart valves (BHVs). It stems from various causes, including rejection, thrombosis, and endocarditis, leading to a critical state of valve dysfunction. Echocardiography, cardiac computed tomography, cardiac magnetic resonance, and nuclear imaging play pivotal roles in the diagnostic multimodality workup of BVF. By providing a comprehensive overview of the pathophysiology of BVF and the diagnostic approaches in different clinical scenarios, this review aims to aid clinicians in their decision-making process. The significance of early detection and appropriate management of BVF cannot be overstated, as these directly impact patients' prognosis and their overall quality of life. Ensuring timely intervention and tailored treatments will not only improve outcomes but also alleviate the burden of this condition on patients' life. By prioritizing comprehensive assessments and adopting the latest advancements in diagnostic technology, medical professionals can significantly enhance their ability to manage BVF effectively.
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Affiliation(s)
- Fabio Fazzari
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138 Milan, Italy; (A.B.); (L.F.); (S.G.A.); (P.G.); (D.J.); (M.E.M.); (R.M.); (S.M.); (G.P.); (M.P.); (M.M.)
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5
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Kumar T, Singh A, Thakre S, Acharya S, Shukla S, Kumar S. Scientific Evolution of Artificial Heart Valves: A Narrative Review. Cureus 2023; 15:e42131. [PMID: 37602004 PMCID: PMC10438674 DOI: 10.7759/cureus.42131] [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: 07/08/2023] [Accepted: 07/19/2023] [Indexed: 08/22/2023] Open
Abstract
Cardiovascular disorders have always been the top contributors to the number of mortality occurring worldwide. But the last few decades have seen a drop in those numbers as the lives of millions of people have been saved due to ground-breaking advances in both therapeutic and surgical treatment modalities. Achieving this level of scientific glory in cardiology was a challenging feat. The credit goes to the scientists and physicians of the previous century who, despite their time's technological limitations, made discoveries and laid a solid foundation for modern medicine. Valvular complications are a major part of the global burden of cardiac diseases. The ongoing development of heart valve replacements remains a fascinating subject, as it continues to progress. Valve replacements comprise either mechanical heart valves or bioprosthetic heart valves. Both types of valves have their merits and demerits; their usage depends mostly on individual patient requirements. This article aims to review the evolution of the implantation of heart valves, and it is the objective of this article to give credit to scientists and physicians for their contributions. The article highlights the research gaps in finding more durable materials and the scope of further research in creating a heart valve that can be universally used for better patient outcomes.
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Affiliation(s)
- Tanishq Kumar
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Arihant Singh
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Swedaj Thakre
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sourya Acharya
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Samarth Shukla
- Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sunil Kumar
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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6
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Prosthetic valve thrombosis: literature review and two case reports. COR ET VASA 2023. [DOI: 10.33678/cor.2022.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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7
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Aziminia N, Nitsche C, Mravljak R, Bennett J, Thornton GD, Treibel TA. Heart failure and excess mortality after aortic valve replacement in aortic stenosis. Expert Rev Cardiovasc Ther 2023; 21:193-210. [PMID: 36877090 PMCID: PMC10069375 DOI: 10.1080/14779072.2023.2186853] [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: 12/07/2022] [Accepted: 02/28/2023] [Indexed: 03/07/2023]
Abstract
INTRODUCTION In aortic stenosis (AS), the heart transitions from adaptive compensation to an AS cardiomyopathy and eventually leads to decompensation with heart failure. Better understanding of the underpinning pathophysiological mechanisms is required in order to inform strategies to prevent decompensation. AREAS COVERED In this review, we therefore aim to appraise the current pathophysiological understanding of adaptive and maladaptive processes in AS, appraise potential avenues of adjunctive therapy before or after AVR and highlight areas of further research in the management of heart failure post AVR. EXPERT OPINION Tailored strategies for the timing of intervention accounting for individual patient's response to the afterload insult are underway, and promise to guide better management in the future. Further clinical trials of adjunctive pharmacological and device therapy to either cardioprotect prior to intervention or promote reverse remodeling and recovery after intervention are needed to mitigate the risk of heart failure and excess mortality.
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Affiliation(s)
- Nikoo Aziminia
- Institute of Cardiovascular Science, University College London, London, England
- Barts Heart Centre, London, England
| | - Christian Nitsche
- Institute of Cardiovascular Science, University College London, London, England
- Barts Heart Centre, London, England
| | | | - Jonathan Bennett
- Institute of Cardiovascular Science, University College London, London, England
- Barts Heart Centre, London, England
| | - George D Thornton
- Institute of Cardiovascular Science, University College London, London, England
- Barts Heart Centre, London, England
| | - Thomas A Treibel
- Institute of Cardiovascular Science, University College London, London, England
- Barts Heart Centre, London, England
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8
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Bailoor S, Seo JH, Dasi L, Schena S, Mittal R. Towards Longitudinal Monitoring of Leaflet Mobility in Prosthetic Aortic Valves via In-Situ Pressure Sensors: In-Silico Modeling and Analysis. Cardiovasc Eng Technol 2023; 14:25-36. [PMID: 35668222 DOI: 10.1007/s13239-022-00635-1] [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: 10/28/2021] [Accepted: 05/18/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Transcatheter aortic valves (TAVs) are susceptible to leaflet thrombosis which may lead to thromboembolic events, and early detection and intervention are believed to be the key to avoiding such adverse outcomes. An embedded sensor system installed on the valve stent, coupled with an appropriate machine learning-based continuous monitoring algorithm can facilitate early detection to predict severity of reduced leaflet motion (RLM) and avoid adverse outcomes. METHODS We present a data-driven, in silico, proof-of-concept analysis of a pressure microsensor based system for quantifying RLM in TAVs. We generate a dataset of 21 high-fidelity transvalvular flow simulations with healthy and mildly stenotic TAVs to train a logistic regression model to correlate individual leaflet mobility in each simulation with principal components of corresponding hemodynamic pressure recorded at strategic locations of the TAV stent. A separate test dataset of 7 simulations is also generated for prospective assessment of model performance. RESULTS An array of 6 sensors embedded on the TAV stent, with two sensors tracking individual leaflet, successfully correlates leaflet mobility with recorded pressure. The sensors are placed along leaflet centerlines, one in the sinus, and the other at the sino-tubular junction. The regression model is tuned using cross-validation to achieve high accuracy on both training (R2 = 0.93) and test (R2 = 0.77) sets. CONCLUSION Discrete blood pressure recordings on TAV stents can be successfully correlated with individual leaflet mobility. Further development of this technology can enable longitudinal monitoring of TAVs and early detection of valve failure.
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Affiliation(s)
- Shantanu Bailoor
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Jung-Hee Seo
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Lakshmi Dasi
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Stefano Schena
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Rajat Mittal
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, USA.
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9
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Loerakker S, Humphrey JD. Computer Model-Driven Design in Cardiovascular Regenerative Medicine. Ann Biomed Eng 2023; 51:45-57. [PMID: 35974236 PMCID: PMC9832109 DOI: 10.1007/s10439-022-03037-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/20/2022] [Indexed: 01/28/2023]
Abstract
Continuing advances in genomics, molecular and cellular mechanobiology and immunobiology, including transcriptomics and proteomics, and biomechanics increasingly reveal the complexity underlying native tissue and organ structure and function. Identifying methods to repair, regenerate, or replace vital tissues and organs remains one of the greatest challenges of modern biomedical engineering, one that deserves our very best effort. Notwithstanding the continuing need for improving standard methods of investigation, including cell, organoid, and tissue culture, biomaterials development and fabrication, animal models, and clinical research, it is increasingly evident that modern computational methods should play increasingly greater roles in advancing the basic science, bioengineering, and clinical application of regenerative medicine. This brief review focuses on the development and application of computational models of tissue and organ mechanobiology and mechanics for purposes of designing tissue engineered constructs and understanding their development in vitro and in situ. Although the basic approaches are general, for illustrative purposes we describe two recent examples from cardiovascular medicine-tissue engineered heart valves (TEHVs) and tissue engineered vascular grafts (TEVGs)-to highlight current methods of approach as well as continuing needs.
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Affiliation(s)
- Sandra Loerakker
- Department of Biomedical Engineering and Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Jay D Humphrey
- Department of Biomedical Engineering and Vascular Biology & Therapeutics Program, Yale University and Yale School of Medicine, New Haven, CT, USA.
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10
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Tandon R, Sondh M, Gupta R, Sachdeva S. Retrospective Observational Analysis of Outcomes After Surgical Valve Replacement: A 15 Years' Experience in a Tertiary Care Hospital. JOURNAL OF THE INDIAN ACADEMY OF ECHOCARDIOGRAPHY & CARDIOVASCULAR IMAGING 2023. [DOI: 10.4103/jiae.jiae_46_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
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11
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Raman J, Bhaskar J, Newcomb A. Leaflet Immobility and Hypo-Attenuated Leaflet Thrombosis (HALT)-Under-Recognised Complications of Bioprosthetic Valve Replacements. Heart Lung Circ 2022; 31:1049-1050. [PMID: 35870828 DOI: 10.1016/j.hlc.2022.06.663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Jai Raman
- University of Melbourne, Melbourne, Vic, Australia; St Vincent's Hospital, Melbourne, Vic, Australia; Austin Health, Melbourne, Vic, Australia.
| | - Jay Bhaskar
- St Vincent's Hospital, Melbourne, Vic, Australia; Austin Health, Melbourne, Vic, Australia
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12
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Nappi F, Avtaar Singh SS, Nappi P, Fiore A. Biomechanics of Transcatheter Aortic Valve Implant. Bioengineering (Basel) 2022; 9:bioengineering9070299. [PMID: 35877350 PMCID: PMC9312295 DOI: 10.3390/bioengineering9070299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 11/16/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has grown exponentially within the cardiology and cardiac surgical spheres. It has now become a routine approach for treating aortic stenosis. Several concerns have been raised about TAVI in comparison to conventional surgical aortic valve replacement (SAVR). The primary concerns regard the longevity of the valves. Several factors have been identified which may predict poor outcomes following TAVI. To this end, the lesser-used finite element analysis (FEA) was used to quantify the properties of calcifications which affect TAVI valves. This method can also be used in conjunction with other integrated software to ascertain the functionality of these valves. Other imaging modalities such as multi-detector row computed tomography (MDCT) are now widely available, which can accurately size aortic valve annuli. This may help reduce the incidence of paravalvular leaks and regurgitation which may necessitate further intervention. Structural valve degeneration (SVD) remains a key factor, with varying results from current studies. The true incidence of SVD in TAVI compared to SAVR remains unclear due to the lack of long-term data. It is now widely accepted that both are part of the armamentarium and are not mutually exclusive. Decision making in terms of appropriate interventions should be undertaken via shared decision making involving heart teams.
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Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord, 93200 Saint-Denis, France
- Correspondence: ; Tel.: +33-149334104; Fax: +33-149334119
| | | | - Pierluigi Nappi
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy;
| | - Antonio Fiore
- Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, 94000 Creteil, France;
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13
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Hermans LHL, Van Kelle MAJ, Oomen PJA, Lopata R.GP, Loerakker S, Bouten CVC. Scaffold Geometry-Imposed Anisotropic Mechanical Loading Guides the Evolution of the Mechanical State of Engineered Cardiovascular Tissues in vitro. Front Bioeng Biotechnol 2022; 10:796452. [PMID: 35252127 PMCID: PMC8888825 DOI: 10.3389/fbioe.2022.796452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 01/28/2022] [Indexed: 11/13/2022] Open
Abstract
Cardiovascular tissue engineering is a promising approach to develop grafts that, in contrast to current replacement grafts, have the capacity to grow and remodel like native tissues. This approach largely depends on cell-driven tissue growth and remodeling, which are highly complex processes that are difficult to control inside the scaffolds used for tissue engineering. For several tissue engineering approaches, adverse tissue growth and remodeling outcomes were reported, such as aneurysm formation in vascular grafts, and leaflet retraction in heart valve grafts. It is increasingly recognized that the outcome of tissue growth and remodeling, either physiological or pathological, depends at least partly on the establishment of a homeostatic mechanical state, where one or more mechanical quantities in a tissue are maintained in equilibrium. To design long-term functioning tissue engineering strategies, understanding how scaffold parameters such as geometry affect the mechanical state of a construct, and how this state guides tissue growth and remodeling, is therefore crucial. Here, we studied how anisotropic versus isotropic mechanical loading—as imposed by initial scaffold geometry—influences tissue growth, remodeling, and the evolution of the mechanical state and geometry of tissue-engineered cardiovascular constructs in vitro. Using a custom-built bioreactor platform and nondestructive mechanical testing, we monitored the mechanical and geometric changes of elliptical and circular, vascular cell-seeded, polycaprolactone-bisurea scaffolds during 14 days of dynamic loading. The elliptical and circular scaffold geometries were designed using finite element analysis, to induce anisotropic and isotropic dynamic loading, respectively, with similar maximum stretch when cultured in the bioreactor platform. We found that the initial scaffold geometry-induced (an)isotropic loading of the engineered constructs differentially dictated the evolution of their mechanical state and geometry over time, as well as their final structural organization. These findings demonstrate that controlling the initial mechanical state of tissue-engineered constructs via scaffold geometry can be used to influence tissue growth and remodeling and determine tissue outcomes.
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Affiliation(s)
- L. H. L. Hermans
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
- Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, Netherlands
| | - M. A. J. Van Kelle
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
- Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, Netherlands
| | - P. J. A. Oomen
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
- Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, Netherlands
| | - R .G. P. Lopata
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - S. Loerakker
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
- Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, Netherlands
- *Correspondence: S. Loerakker,
| | - C. V. C. Bouten
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
- Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, Netherlands
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14
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Martín M, Cuevas J, Cigarrán H, Calvo J, Morís C. Transcatheter Aortic Valve Implantation and Subclinical and Clinical Leaflet Thrombosis: Multimodality Imaging for Diagnosis and Risk Stratification. Eur Cardiol 2021; 16:e35. [PMID: 34721669 PMCID: PMC8546909 DOI: 10.15420/ecr.2021.09] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 07/09/2021] [Indexed: 12/31/2022] Open
Abstract
In recent years, the phenomenon of subclinical leaflet thrombosis (SLT) in patients who have undergone transcatheter aortic valve implantation has become increasingly relevant. Hypo-attenuating leaflet thickening and hypo-attenuation affecting motion diagnosed by CT are the hallmarks of SLT, and their incidence varies depending on the intensity of screening. Whether these phenomena are a surrogate for leaflet thrombosis reducing valve durability and increasing the risk of stroke is still a matter of debate. Uncertainty remains over the optimal antithrombotic therapy after TAVI and the best treatment strategy is still not confirmed. Ongoing and future trials will provide more evidence about the best strategy for the prevention and treatment of SLT.
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Affiliation(s)
- María Martín
- Cardiology Department, University Hospital of Asturias Oviedo, Asturias, Spain
| | - Javier Cuevas
- Cardiology Department, University Hospital of Asturias Oviedo, Asturias, Spain
| | - Helena Cigarrán
- Radiology Department, University Hospital of Asturias Oviedo, Asturias, Spain
| | - Juan Calvo
- Radiology Department, University Hospital of Asturias Oviedo, Asturias, Spain
| | - César Morís
- Cardiology Department, University Hospital of Asturias Oviedo, Asturias, Spain
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15
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Woldendorp K, Doyle MP, Black D, Ng M, Keech A, Grieve SM, Bannon PG. Subclinical valve thrombosis in transcatheter aortic valve implantation: A systematic review and meta-analysis. J Thorac Cardiovasc Surg 2021; 162:1491-1499.e2. [DOI: 10.1016/j.jtcvs.2020.01.084] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 12/21/2019] [Accepted: 01/16/2020] [Indexed: 11/27/2022]
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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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Whitlock R, Belley-Cote E, Rega F, Chu MWA, McClure GR, Hronyecz H, Verbrugghe P, Devereaux PJ, Bangdiwala S, Eikelboom J, Brady K, Sharifulin R, Bogachev-Prokophiev A, Stoica S. Ross for Valve replacement In AduLts (REVIVAL) pilot trial: rationale and design of a randomised controlled trial. BMJ Open 2021; 11:e046198. [PMID: 34531204 PMCID: PMC8449981 DOI: 10.1136/bmjopen-2020-046198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION In non-elderly adults, aortic valve replacement (AVR) with conventional prostheses yield poor long-term outcomes. Recent publications suggest a benefit of the Ross procedure over conventional AVR and highlight the need for high-quality randomised controlled trial (RCTs) on the optimal AVR. We have initiated a pilot trial assess two feasibility criteria and one assumption: (1) evaluate the capacity to enrol six patients per centre per year in at least five international centre, (2) validate greater than 90% compliance with allocation and (3) to validate the proportion of mechanical (≥65%) vs biological (≤35%) valves in the conventional arm. METHODS AND ANALYSIS Ross for Valve replacement In AduLts (REVIVAL) is a multinational, expertise-based RCT in adults aged 18-60 years undergoing AVR, comparing the Ross procedure versus one of the alternative approaches (mechanical vs stented or stentless bioprosthesis). The feasibility objectives will be assessed after randomising 60 patients; we will then make a decision regarding whether to expand the trial with the current protocol. We will ultimately examine the impact of the Ross procedure as compared with conventional AVR in non-elderly adults on survival free of valve-related life-threatening complications (major bleeding, systemic thromboembolism, valve thrombosis and valve reoperation) over the duration of follow-up. The objectives of the pilot trial will be analysed using descriptive statistics. In the full trial, the intention-to-treat principle will guide all primary analyses. A time-to-event analysis will be performed and Kaplan-Meier survival curves with comparison between groups using a log rank test will be presented. ETHICS AND DISSEMINATION REVIVAL will answer whether non-elderly adults benefit from the Ross procedure over conventional valve replacement. The final results at major meetings, journals, regional seminars, hospital rounds and via the Reducing Global Perioperative Risk Multimedia Resource Centre. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Identifier: NCT03798782 PROTOCOL VERSION: January 29, 2019 (Final Version 1.0).
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Affiliation(s)
- Richard Whitlock
- Surgery, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Emilie Belley-Cote
- Medicine, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Filip Rega
- Department of Cardiac Surgery, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - Michael W A Chu
- Cardiac Surgery, University of Western Ontario Faculty of Health Sciences, London, Ontario, Canada
| | - Graham R McClure
- Surgery, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | | | - Peter Verbrugghe
- Department of Cardiac Surgery, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - P J Devereaux
- Medicine, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | | | - John Eikelboom
- Medicine, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Katheryn Brady
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Ravil Sharifulin
- FSBI National Medical Research Center named after E N Meshalkin, Novosibirsk, Novosibirskaâ, Russian Federation
| | | | - Serban Stoica
- Cardiac Surgery, Bristol Royal Hospital for Children, Bristol, UK
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18
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Ascione G, Denti P. Transcatheter Mitral Valve Replacement and Thrombosis: A Review. Front Cardiovasc Med 2021; 8:621258. [PMID: 34150861 PMCID: PMC8212998 DOI: 10.3389/fcvm.2021.621258] [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: 10/25/2020] [Accepted: 04/12/2021] [Indexed: 11/25/2022] Open
Abstract
Mitral regurgitation is the most prevalent form of moderate or severe valve disease in developed countries. Surgery represents the standard of care for symptomatic patients with severe mitral regurgitation, but up to 50% of patients are denied surgery because of high surgical risk. In this context, different transcatheter options have been developed to address this unmet need. Transcatheter mitral valve replacement (TMVR) is an emergent field representing an alternative option in high complex contexts when transcatheter mitral valve repair is not feasible or suboptimal due to anatomical issues. However, TMVR is burdened by some device-specific issues (device malposition, migration or embolization, left ventricular outflow tract obstruction, hemolysis, thrombosis, stroke). Here we discuss the thrombotic risk of TMVR and current evidence about anticoagulation therapy after TMVR.
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Affiliation(s)
- Guido Ascione
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Denti
- Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
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19
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Shahim B, Malaisrie SC, George I, Thourani VH, Biviano AB, Russo MJ, Brown DL, Babaliaros V, Guyton RA, Kodali SK, Nazif TM, McCabe JM, Williams MR, Généreux P, Lu M, Yu X, Alu MC, Webb JG, Mack MJ, Leon MB, Kosmidou I. Atrial Fibrillation and Outcomes After Transcatheter or Surgical Aortic Valve Replacement (from the PARTNER 3 Trial). Am J Cardiol 2021; 148:116-123. [PMID: 33691183 DOI: 10.1016/j.amjcard.2021.02.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/10/2021] [Accepted: 02/19/2021] [Indexed: 11/30/2022]
Abstract
The prognostic impact of preexisting atrial fibrillation or flutter (AF) in low-risk patients with severe aortic stenosis treated with transcatheter (TAVR) or surgical aortic valve replacement (SAVR) remains unknown. In this sub-analysis of the PARTNER 3 trial of patients with severe aortic stenosis at low surgical risk randomized 1:1 to TAVR versus SAVR, clinical outcomes were analyzed at 2 years according to AF status. Among 948 patients included in the analysis (452 [47.7%] in the SAVR vs 496 [52.3%] in the TAVR arm), 168 (17.6%) patients had AF [88/452 (19.5%) and 80/496 (16.1%) treated with SAVR and TAVR, respectively]. At 2 years, patients with AF had higher unadjusted rates of the composite outcome of death, stroke or rehospitalization (21.2% vs 12.9%, p = 0.007) and rehospitalization alone (15.3% vs 9.4%, p = 0.03) but not all cause death (3.8% vs 2.6%, p = 0.45) or stroke (4.8% vs 2.6%, p = 0.12). In adjusted analyses, patients with AF had a higher risk for the composite outcome of death, stroke or rehospitalization (hazard ratio [HR] 1.80, 95% confidence interval [CI] 1.20-2.71, p = 0.0046) and rehospitalization alone (HR 1.8, 95% CI 0.12-2.9, p = 0.015), but not death or stroke. There was no interaction between treatment modality and AF on the composite outcome (Pinter = 0.83). In conclusion, preexisting AF in patients with severe AS at low surgical risk was associated with increased risk of the composite outcome of death, stroke or rehospitalization at 2 years, irrespective of treatment modality.
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Affiliation(s)
- Bahira Shahim
- Cardiovascular Research Foundation, New York, New York
| | - S Chris Malaisrie
- Division of Cardiac Surgery, Northwestern University, Chicago, Illinois
| | - Isaac George
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Vinod H Thourani
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia
| | - Angelo B Biviano
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Mark J Russo
- Division of Cardiac Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | | | | | - Susheel K Kodali
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Tamim M Nazif
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | | | | | - Philippe Généreux
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey
| | - Michael Lu
- Edwards Lifesciences, Irvine, California
| | - Xiao Yu
- Edwards Lifesciences, Irvine, California
| | - Maria C Alu
- Cardiovascular Research Foundation, New York, New York; NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - John G Webb
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | - Martin B Leon
- Cardiovascular Research Foundation, New York, New York; NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Ioanna Kosmidou
- Cardiovascular Research Foundation, New York, New York; NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York.
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20
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Percutaneous versus Surgical Intervention for Severe Aortic Valve Stenosis: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2021; 2021:3973924. [PMID: 34136565 PMCID: PMC8175165 DOI: 10.1155/2021/3973924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/04/2021] [Accepted: 05/14/2021] [Indexed: 11/18/2022]
Abstract
Aortic stenosis is a disease that is increasing in prevalence and manifests as decreased cardiac output, which if left untreated can result in heart failure and ultimately death. It is primarily a disease of the elderly who often have multiple comorbidities. The advent of transcatheter aortic valve therapies has changed the way we treat these conditions. However, long-term results of these therapies remain uncertain. Recently, there has been an increasing number of studies examining the role of both surgical aortic valve replacement and transcatheter aortic valve replacement. We therefore performed a systematic review using Ovid MEDLINE, Ovid Embase, and the Cochrane Library. Two investigators searched papers published between January 1, 2007, and to date using the following terms: "aortic valve stenosis," "aortic valve operation," and "transcatheter aortic valve therapy." Both strategies in aortic stenosis treatment highlighted specific indications alongside the pitfalls such as structural valve degeneration and valve thrombosis which have a bearing on clinical outcomes. We propose some recommendations to help clinicians in the decision-making process as technological improvements make both surgical and transcatheter therapies viable options for patients with aortic stenosis. Finally, we assess the role of finite element analysis in patient selection for aortic valve replacement. THVT and AVR-S are both useful tools in the armamentarium against aortic stenosis. The decision between the two treatment strategies should be best guided by a strong robust evidence base, ideally with a long-term follow-up. This is best performed by the heart team with the patient as the center of the discussion.
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21
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Ng ACT, Holmes DR, Mack MJ, Delgado V, Makkar R, Blanke P, Leipsic JA, Leon MB, Bax JJ. Leaflet immobility and thrombosis in transcatheter aortic valve replacement. Eur Heart J 2021; 41:3184-3197. [PMID: 32930773 PMCID: PMC9186299 DOI: 10.1093/eurheartj/ehaa542] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/17/2020] [Accepted: 07/01/2020] [Indexed: 12/13/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has grown exponentially worldwide in the last decade. Due to the higher bleeding risks associated with oral anticoagulation and in patients undergoing TAVR, antiplatelet therapy is currently considered first-line antithrombotic treatment after TAVR. Recent studies suggest that some patients can develop subclinical transcatheter heart valve (THV) thrombosis after the procedure, whereby thrombus forms on the leaflets that can be a precursor to leaflet dysfunction. Compared with echocardiography, multidetector computed tomography is more sensitive at detecting THV thrombosis. Transcatheter heart valve thrombosis can occur while on dual antiplatelet therapy with aspirin and thienopyridine but significantly less with anticoagulation. This review summarizes the incidence and diagnostic criteria for THV thrombosis and discusses the pathophysiological mechanisms that may lead to thrombus formation, its natural history, potential clinical implications and treatment for these patients. ![]()
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Affiliation(s)
- Arnold C T Ng
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, Australia
| | - David R Holmes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Philipp Blanke
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonathon A Leipsic
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Martin B Leon
- Columbia University Medical Center, New York-Presbyterian Hospital, New York, NY, USA
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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22
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2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg 2021; 162:e183-e353. [PMID: 33972115 DOI: 10.1016/j.jtcvs.2021.04.002] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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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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24
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Gusdon AM, Farrokh S, Grotta JC. Antithrombotic Therapy for Stroke Patients with Cardiovascular Disease. Semin Neurol 2021; 41:365-387. [PMID: 33851394 DOI: 10.1055/s-0041-1726331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Prevention of ischemic stroke relies on the use of antithrombotic medications comprising antiplatelet agents and anticoagulation. Stroke risk is particularly high in patients with cardiovascular disease. This review will focus on the role of antithrombotic therapies in the context of different types of cardiovascular disease. We will discuss oral antiplatelet medications and both IV and parental anticoagulants. Different kinds of cardiovascular disease contribute to stroke via distinct pathophysiological mechanisms, and the optimal treatment for each varies accordingly. We will explore the mechanism of stroke and evidence for antithrombotic therapy in the following conditions: atrial fibrillation, prosthetic heart values (mechanical and bioprosthetic), aortic arch atherosclerosis, congestive heart failure (CHF), endocarditis (infective and nonbacterial thrombotic endocarditis), patent foramen ovale (PFO), left ventricular assist devices (LVAD), and extracorporeal membrane oxygenation (ECMO). While robust data exist for antithrombotic use in conditions such as atrial fibrillation, optimal treatment in many situations remains under active investigation.
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Affiliation(s)
- Aaron M Gusdon
- Department of Neurosurgery, UTHealth Neurosciences, McGovern School of Medicine, University of Texas Health Science Center, Houston, Texas
| | - Salia Farrokh
- Division of Neurocritical Care, Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - James C Grotta
- Mobile Stroke Unit, Memorial Hermann Hospital, Texas Medical Center, Houston
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25
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Mustafa A, Thomas T, Murdock R, Congello S. Modified fibrinolytic therapy as treatment of mechanical aortic valve thrombosis. SAGE Open Med Case Rep 2021; 9:2050313X21999202. [PMID: 33796313 PMCID: PMC7975491 DOI: 10.1177/2050313x21999202] [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: 01/29/2021] [Accepted: 02/05/2021] [Indexed: 11/15/2022] Open
Abstract
Prosthetic valve thrombosis is a rare phenomenon with limited treatment options. Current
management choices include anticoagulation with or without fibrinolysis or surgical valve
replacement for appropriate candidates. We report an alternative fibrinolytic and
anticoagulation regimen resulting in successful treatment of a patient presenting with
mechanical aortic valve thrombosis.
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Affiliation(s)
- Ala Mustafa
- Internal Medicine Department, MercyOne North Iowa Medical Center, Mason City, IA, USA
| | - Todd Thomas
- Cardiology Department, MercyOne North Iowa Medical Center, Mason City, IA, USA
| | - Robert Murdock
- Cardiology Department, MercyOne North Iowa Medical Center, Mason City, IA, USA
| | - Samuel Congello
- Cardiology Department, MercyOne North Iowa Medical Center, Mason City, IA, USA
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26
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 77:e25-e197. [PMID: 33342586 DOI: 10.1016/j.jacc.2020.11.018] [Citation(s) in RCA: 721] [Impact Index Per Article: 240.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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27
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O’Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary. J Am Coll Cardiol 2021; 77:450-500. [DOI: 10.1016/j.jacc.2020.11.035] [Citation(s) in RCA: 272] [Impact Index Per Article: 90.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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28
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Melina G, De Robertis F, Gaer JA, Angeloni E, El-Hamamsy I, Bahrami T, Pepper JR, Takkenberg JJM, Yacoub MH. Long-term survival after xenograft versus homograft aortic root replacement: Results from a prospective randomized trial. J Thorac Cardiovasc Surg 2021; 161:57-65. [PMID: 31735388 DOI: 10.1016/j.jtcvs.2019.09.119] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 09/01/2019] [Accepted: 09/04/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The study objective was to investigate the long-term survival of patients undergoing xenograft versus homograft full root aortic valve replacement. METHODS A total of 166 patients requiring aortic valve surgery were randomized to undergo the Freestyle (Medtronic Inc, Minneapolis, Minn) bioprosthesis (N = 90) or a homograft (N = 76) full root aortic valve replacement between 1997 and 2005 in a single institution. Six patients randomly assigned to the homograft crossed over to the Freestyle bioprosthesis because of the unavailability of suitably sized homografts. All surgeons were required to adhere to the standard surgical technique for homograft root implantation previously described. Follow-up was 98.5% complete. RESULTS The mean age of the study population was 65 ± 8 years. Coronary artery bypass grafting was associated with root aortic valve replacement in 76 of 166 patients (46%, P = not significant between groups), and overall hospital mortality was 4.8% (8/166, P = not significant between groups). Median follow-up was 13.8 years (range, 0-21.8 years; 2033 patient-years). The Kaplan-Meier survival analysis showed that there was no significant difference in overall survival between the 2 arms at 5, 10, and 15 years. Twenty-year survival was 28.3% ± 5% for the Freestyle group versus 25.1% ± 5.7% for the homograft group (P = .90), which was comparable to the age- and sex-matched UK general population. The freedom from aortic valve reoperation at 20 years was comparable for the Freestyle group versus the homograft group (67.9% ± 8.8% vs 67.2% ± 10.3%, respectively; P = .74). CONCLUSIONS This is the first study to investigate the long-term survival of xenograft versus homograft full root aortic valve replacement from a prospective randomized trial. The observed 20-year overall survival and freedom from aortic valve reoperation serve as a benchmark for future studies on interventions for aortic valve disease in the elderly.
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Affiliation(s)
- Giovanni Melina
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom; Department of Cardiac Surgery, Ospedale Sant'Andrea, "Sapienza" Università di Roma, Rome, Italy
| | - Fabio De Robertis
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Jullien A Gaer
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Emiliano Angeloni
- Department of Cardiac Surgery, Ospedale Sant'Andrea, "Sapienza" Università di Roma, Rome, Italy
| | - Ismail El-Hamamsy
- Division of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Toufan Bahrami
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - John R Pepper
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Johanna J M Takkenberg
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
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29
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Zervides C, Verran S, Yoganantharajah P, Sifeldeen KK. Don't go breaking my heart valve: historical review of mitral valve replacement. Future Cardiol 2020; 17:899-915. [PMID: 33191786 DOI: 10.2217/fca-2020-0136] [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
Management of mitral valve disease in the western world continues to lag behind its aortic counterpart, particularly in the realm of percutaneous valve replacement. It is a more complex anatomical region, with varying disease states and unique pathophysiological and epidemiological characteristics that make it a distinct challenge to treat in modern medicine. Latest research and development, however, have provided new answers to the challenges associated with the mitral valve. In this review, the most common disease states afflicting the mitral valve are outlined, specific challenges associated with treatment are discussed, and both current and cutting-edge replacement devices are described. This review focuses on replacement and prosthetic devices, while acknowledging the role of valve repair. The future of mitral valve replacement remains to be seen, as new methodologies and prosthetic designs continue to present themselves as the best answer to the challenge.
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Affiliation(s)
- Constantinos Zervides
- Department of Basic and Clinical Sciences, School of Medicine, University of Nicosia, Nicosia 2414, Cyprus
| | - Samantha Verran
- Department of Basic and Clinical Sciences, School of Medicine, University of Nicosia, Nicosia 2414, Cyprus
| | - Prusothman Yoganantharajah
- Department of Basic and Clinical Sciences, School of Medicine, University of Nicosia, Nicosia 2414, Cyprus
| | - Kassem K Sifeldeen
- Department of Basic and Clinical Sciences, School of Medicine, University of Nicosia, Nicosia 2414, Cyprus
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30
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Senapati A, Faza NN, Mahmarian J, Chang SM. Cardiac Computed Tomography for Structural Heart Disease Assessment and Therapeutic Planning: Focus on Prosthetic Valve Dysfunction. Methodist Debakey Cardiovasc J 2020; 16:86-96. [PMID: 32670468 DOI: 10.14797/mdcj-16-2-86] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Of the 100,000-plus valve surgeries performed each year in the United States, up to 6% of those develop complications from prosthetic valve dysfunction. Prosthetic valve dysfunction (PVD) can be life threatening and often challenging to diagnose. In this review, we discuss the prevalence and incidence of PVD, explore its different etiologies, and assess the role of multimodality imaging with an emphasis on cardiac multidetector computed tomography (MDCT) for evaluating patients with PVD. We also investigate the utility of MDCT in preprocedural planning for transcatheter devices and redo surgical planning and discuss management strategies for patients with PVD.
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Affiliation(s)
- Alpana Senapati
- METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
| | - Nadeen N Faza
- METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
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31
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Abstract
PURPOSE OF REVIEW Cardiac imaging after ischemic stroke or transient ischemic attack (TIA) is used to identify potential sources of cardioembolism, to classify stroke etiology leading to changes in secondary stroke prevention, and to detect frequent comorbidities. This article summarizes the latest research on this topic and provides an approach to clinical practice to use cardiac imaging after stroke. RECENT FINDINGS Echocardiography remains the primary imaging method for cardiac work-up after stroke. Recent echocardiography studies further demonstrated promising results regarding the prediction of non-permanent atrial fibrillation after ischemic stroke. Cardiac magnetic resonance imaging and computed tomography have been tested for their diagnostic value, in particular in patients with cryptogenic stroke, and can be considered as second line methods, providing complementary information in selected stroke patients. Cardiac imaging after ischemic stroke or TIA reveals a potential causal condition in a subset of patients. Whether systematic application of cardiac imaging improves outcome after stroke remains to be established.
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Affiliation(s)
- S Camen
- Clinic for Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research) (partner site Hamburg/Kiel/Luebeck), Berlin, Germany
| | - K G Haeusler
- Department of Neurology, Universitätsklinikum Würzburg, Würzburg, Germany
| | - R B Schnabel
- Clinic for Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.
- DZHK (German Center for Cardiovascular Research) (partner site Hamburg/Kiel/Luebeck), Berlin, Germany.
- University Heart Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
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32
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The difficult balance between thrombosis and bleeding after transcatheter aortic valve replacement: A translational review. Arch Cardiovasc Dis 2020; 113:263-275. [DOI: 10.1016/j.acvd.2019.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 11/26/2019] [Accepted: 12/02/2019] [Indexed: 01/04/2023]
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33
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Carabello BA. Bioprosthetic Valve Leaflet Thrombosis. J Am Coll Cardiol 2020; 75:867-869. [DOI: 10.1016/j.jacc.2019.12.038] [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: 12/19/2019] [Accepted: 12/23/2019] [Indexed: 11/17/2022]
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34
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Tam DY, Rocha RV, Wijeysundera HC, Austin PC, Dvir D, Fremes SE. Surgical valve selection in the era of transcatheter aortic valve replacement in the Society of Thoracic Surgeons Database. J Thorac Cardiovasc Surg 2020; 159:416-427.e8. [DOI: 10.1016/j.jtcvs.2019.05.081] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/29/2019] [Accepted: 05/13/2019] [Indexed: 11/30/2022]
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35
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Apostolidou E, Beale C, Poppas A, Stockwell P, Ehsan A. A Case of Bioprosthetic Mitral Valve Dysfunction, Initially Presenting with Valve Thrombosis Followed by Recurrent Thrombosis and Endocarditis. ACTA ACUST UNITED AC 2019; 3:210-214. [PMID: 31709372 PMCID: PMC6833127 DOI: 10.1016/j.case.2019.05.005] [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] [Indexed: 11/24/2022]
Abstract
Bioprosthetic valve thrombosis (BPVT) can occur beyond 3 months postimplantation. BPVT can reoccur after successful treatment with fibrinolysis and anticoagulation. Other forms of bioprosthetic valve dysfunction can coexist with thrombosis. Echocardiography can promptly diagnose bioprosthesis thrombosis. Management requires valve replacement, thrombolysis, or anticoagulation After BPVT long-term anticoagulation may be required.
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Affiliation(s)
- Eirini Apostolidou
- Section of Cardiology and Cardiothoracic Surgery, Rhode Island Hospital, Brown University, Providence, Rhode Island
| | - Charles Beale
- Section of Cardiology and Cardiothoracic Surgery, Rhode Island Hospital, Brown University, Providence, Rhode Island
| | - Athena Poppas
- Section of Cardiology and Cardiothoracic Surgery, Rhode Island Hospital, Brown University, Providence, Rhode Island
| | - Philip Stockwell
- Section of Cardiology and Cardiothoracic Surgery, Rhode Island Hospital, Brown University, Providence, Rhode Island
| | - Afshin Ehsan
- Section of Cardiology and Cardiothoracic Surgery, Rhode Island Hospital, Brown University, Providence, Rhode Island
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36
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Abstract
About 20–25% of all ischemic strokes are of cardioembolic etiology, with atrial fibrillation and heart failure as the most common underlying pathologies. Diagnostic work-up by noninvasive cardiac imaging is essential since it may lead to changes in therapy, e.g., in—but not exclusively—secondary stroke prevention. Echocardiography remains the cornerstone of cardiac imaging after ischemic stroke, with the combination of transthoracic and transesophageal echocardiography as gold standard thanks to their high sensitivity for many common pathologies. Transesophageal echocardiography should be considered as the initial diagnostic tool when a cardioembolic source of stroke is suspected. However, to date, there is no proven benefit of transesophageal echocardiography-related therapy changes on the main outcomes after ischemic stroke. Based on the currently available data, cardiac computed tomography and magnetic resonance imaging should be regarded as complementary methods to echocardiography, providing additional information in specific situations; however, they cannot be recommended as first-line modalities.
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Affiliation(s)
- S Camen
- Department of General and Interventional Cardiology, Building O70, University Heart Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - K G Haeusler
- Department of Neurology, Universitätsklinikum Würzburg, Würzburg, Germany
| | - R B Schnabel
- Department of General and Interventional Cardiology, Building O70, University Heart Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany. .,DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany.
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37
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Sellers SL, Blanke P, Leipsic JA. Bioprosthetic Heart Valve Degeneration and Dysfunction: Focus on Mechanisms and Multidisciplinary Imaging Considerations. Radiol Cardiothorac Imaging 2019; 1:e190004. [PMID: 33778509 PMCID: PMC7977715 DOI: 10.1148/ryct.2019190004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/11/2019] [Accepted: 05/02/2019] [Indexed: 06/12/2023]
Abstract
Bioprosthetic heart valves (BPHVs) have fundamentally changed the treatment of valvular heart disease. Despite the continuous progress of BPHVs, from early valve designs for use in surgical replacement to the rapidly evolving use of transcatheter replacement techniques and designs, valve dysfunction and degeneration remain fundamental issues. Current guidelines and proposed standard definitions of BPHV dysfunction and degeneration outline the importance of imaging. Imaging plays a key role in understanding valve degeneration, including clinical imaging to identify transvalvular gradients, leaflet thickening, thrombosis, calcification, and restricted or reduced leaflet motion. Similarly, translational imaging approaches-including micro-CT, high-speed video, computational modeling, and high-resolution microscopy-and histologic analysis are crucial to understanding mechanisms of valve degeneration and factors that may contribute to valve dysfunction. This article provides an overview of valve dysfunction and degeneration and the role of imaging. © RSNA, 2019.
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38
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Gaudino M, Chikwe J. Commentary: Who needs evidence when patient preference is a Class I indication? J Thorac Cardiovasc Surg 2019; 159:430-431. [PMID: 31227179 DOI: 10.1016/j.jtcvs.2019.05.021] [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: 05/20/2019] [Accepted: 05/21/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY.
| | - Joanna Chikwe
- Department of Surgery, The State University of New York, Stony Brook, NY; Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York, NY
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39
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Bamford P, Rogers J, Bassin L, Kull A. Large Bioprosthetic Aortic Valve Thrombi on DOACs. Heart Lung Circ 2019; 28:e139-e142. [PMID: 31076237 DOI: 10.1016/j.hlc.2019.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 04/13/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Paul Bamford
- Department of Cardiology, Gosford Hospital, Gosford, NSW, Australia; University of Newcastle, Newcastle, NSW, Australia
| | - James Rogers
- Department of Cardiology, Gosford Hospital, Gosford, NSW, Australia
| | - Levi Bassin
- Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Anthony Kull
- Department of Cardiology, Gosford Hospital, Gosford, NSW, Australia
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40
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Balakrishnan K, Herman B, Koshy G. Very late bioprosthetic aortic valve thrombosis. BMJ Case Rep 2019; 12:12/5/e228871. [PMID: 31068347 DOI: 10.1136/bcr-2018-228871] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
A 79-year-old man with a history of bioprosthetic aortic valve (AV) replacement in 2008 and atrial fibrillation was admitted with acute pulmonary oedema. Transthoracic and transoesophageal echocardiograms revealed significantly elevated AV gradients and thickened AV leaflets. These findings were suggestive of bioprosthetic valve thrombosis (BVT). The patient was treated with intravenous heparin and commenced on vitamin K antagonist. BVT remains an under recognised cause of late prosthetic valve dysfunction. A lack of awareness of BVT occurring beyond 3 months post-implantation is likely to account for this. Furthermore, structural valve degeneration is the most common mechanism of late prosthetic valve dysfunction. Recognising the difference between the two aetiologies is crucial as the management plan differs significantly. Here, we report a case of very late bioprosthetic AV thrombosis diagnosed 8 years after implantation. This was successfully treated with systemic anticoagulation, thereby avoiding the need for redo cardiac surgery.
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Affiliation(s)
- Kuhendra Balakrishnan
- Cardiology, Launceston General Hospital, Launceston, Tasmania, Australia.,Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
| | - Brian Herman
- Cardiology, Launceston General Hospital, Launceston, Tasmania, Australia.,School of Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - George Koshy
- Cardiology, Launceston General Hospital, Launceston, Tasmania, Australia
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41
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Rosseel L, De Backer O, Søndergaard L. Clinical Valve Thrombosis and Subclinical Leaflet Thrombosis Following Transcatheter Aortic Valve Replacement: Is There a Need for a Patient-Tailored Antithrombotic Therapy? Front Cardiovasc Med 2019; 6:44. [PMID: 31058168 PMCID: PMC6482296 DOI: 10.3389/fcvm.2019.00044] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 03/25/2019] [Indexed: 11/13/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has become an established therapeutic option for patients with symptomatic, severe aortic valve stenosis at increased surgical risk. Antithrombotic therapy after TAVR aims to prevent transcatheter heart valve (THV) thrombosis, in which two different entities have to be recognized: clinical valve thrombosis and subclinical leaflet thrombosis. In clinical valve thrombosis, obstructive thrombus formation leads to an increased transvalvular gradient, often provoking heart failure symptoms. Subclinical leaflet thrombosis is most often an incidental finding, characterized by a thin layer of thrombus covering the aortic side of one or more leaflets; it is also referred to as Hypo-Attenuating Leaflet Thickening (HALT) as described on multi-detector computed tomography (MDCT) imaging. This phenomenon may also affect leaflet motion and is then classified as Hypo-Attenuation affecting Motion (HAM). Even in case of HAM, the transvalvular pressure gradient remains within normal range and does not provoke heart failure symptoms. Whereas, clinical valve thrombosis requires treatment, the clinical impact and need for intervention in subclinical leaflet thrombosis is still uncertain. Oral anticoagulant therapy protects against and resolves both clinical valve thrombosis and subclinical leaflet thrombosis; however, large-scale randomized clinical trials studying different antithrombotic strategies after TAVR are still under way. This review article summarizes the currently available data within the field of transcatheter aortic valve/leaflet thrombosis and discusses the need for a patient tailored antithrombotic approach.
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Affiliation(s)
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen, Denmark
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42
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Schussler O, Lila N, Perneger T, Mootoosamy P, Grau J, Francois A, Smadja DM, Lecarpentier Y, Ruel M, Carpentier A. Recipients with blood group A associated with longer survival rates in cardiac valvular bioprostheses. EBioMedicine 2019; 42:54-63. [PMID: 30878598 PMCID: PMC6491382 DOI: 10.1016/j.ebiom.2019.02.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 02/12/2019] [Accepted: 02/20/2019] [Indexed: 01/02/2023] Open
Abstract
Background Pigs/bovines share with humans some of the antigens present on cardiac valves. Two such antigens are: the major xenogenic Ag, “Gal” present in all pig/bovine very close to human B-antigen of ABO-blood-group system; the minor Ag, pig histo-blood-group AH-antigen identical to human AH-antigen and present by some animals. We hypothesize that these antigens may modify the immunogenicity of the bioprosthesis and also its longevity. ABO distribution may vary between patients with low (<6 years) and high (≥15 years) bioprostheses longevity. Methods Single-centre registry study (Paris, France) including all degenerative porcine bioprostheses (mostly Carpentier-Edwards 2nd/3rd generation heart valves) explanted between 1985 and 1998 and some bovine bioprostheses. For period 1998–2014, all porcine bioprostheses with longevity ≥13 years (follow-up ≥29 years). Important predictive factors for bioprosthesis longevity: number, site of implantation, age were collected. Blood group and other variables were entered into an ordinal logistic regression analysis model predicting valve longevity, categorized as low (<6 years), medium (6–14.9 years), and high (≥15 years). Findings Longevity and ABO-blood group were obtained for 483 explanted porcine bioprostheses. Mean longevity was 10.2 ± 3.9 years [0–28] and significantly higher for A-patients than others (P = 0.009). Using multivariate analysis, group A was a strong predictive factor of longevity (OR 2.09; P < 0.001). For the 64 explanted bovine bioprosthesis with low/medium longevity, the association, with A-group was even more significant. Interpretation Patients of A-group but not B have a higher longevity of their bioprostheses. Future graft-host phenotyping and matching may give rise to a new generation of long-lasting bioprosthesis for implantation in humans, especially for the younger population. Fund None.
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Affiliation(s)
- O Schussler
- Division of Cardiovascular Surgery and Cardiovascular Research Laboratory, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
| | - N Lila
- Laboratory of Biosurgical Research (Alain Carpentier Foundation), University Paris Descartes, Sorbonne Paris Cité, Paris F-75475, France
| | - T Perneger
- Department of Clinical Epidemiology, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - P Mootoosamy
- Division of Cardiovascular Surgery and Cardiovascular Research Laboratory, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - J Grau
- Division of Cardiac Surgery and Research Laboratory, Department of Epidemiology, Ottawa Heart Institute, University of Ottawa Heart, Ottawa, Ontario, Canada
| | - A Francois
- Etablissement Français du Sang (EFS), Ile de France, Immuno-hematology Laboratory, Georges Pompidou Hospital, Paris, France
| | - D M Smadja
- Division of Cardiovascular Surgery and Cardiovascular Research Laboratory, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; AP-HP, Hôpital Européen Georges Pompidou, Hematology Department, Paris Descartes University, Sorbonne Paris Cite, Inserm UMR-S1140, Paris, France
| | - Y Lecarpentier
- Centre de Recherche Clinique, Grand Hôpital de l'Est Francilien (GHEF), Meaux, France
| | - M Ruel
- Division of Cardiac Surgery and Research Laboratory, Department of Epidemiology, Ottawa Heart Institute, University of Ottawa Heart, Ottawa, Ontario, Canada
| | - A Carpentier
- Laboratory of Biosurgical Research (Alain Carpentier Foundation), University Paris Descartes, Sorbonne Paris Cité, Paris F-75475, France; AP-HP, Hôpital Européen Georges Pompidou, Department of Cardiovascular Surgery, Paris, France
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43
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Sibilio S, Koziarz A, Belley‐Côté EP, McClure GR, MacIsaac S, Reza SJ, Um KJ, Lengyel A, Mendoza P, Alsagheir A, Alraddadi H, Gupta S, Schneider AW, Patel PM, Brown JW, Chu MWA, Peterson MD, Ouzounian M, Paparella D, El‐Hamamsy I, Whitlock RP. Outcomes after Ross procedure in adult patients: A meta‐analysis and microsimulation. J Card Surg 2019; 34:285-292. [DOI: 10.1111/jocs.14020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/20/2019] [Accepted: 02/26/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Serena Sibilio
- Facoltá di Medicina e ChirugiaUniversity of Bari “Aldo Moro”Bari Italy
| | - Alex Koziarz
- Faculty of MedicineUniversity of TorontoToronto Ontario Canada
- Department of SurgeryDivision of Cardiac Surgery, McMaster UniversityHamilton Ontario Canada
| | - Emilie P. Belley‐Côté
- Department of MedicineMcMaster UniversityHamilton Ontario Canada
- Population Health Research InstituteHamilton Ontario Canada
| | - Graham R. McClure
- Department of SurgeryDivision of Cardiac Surgery, McMaster UniversityHamilton Ontario Canada
- Population Health Research InstituteHamilton Ontario Canada
| | - Sarah MacIsaac
- Department of SurgeryDivision of Cardiac Surgery, McMaster UniversityHamilton Ontario Canada
- School of Medicine, Faculty of Medicine and Health SciencesRoyal College of Surgeons in IrelandDublin Ireland
| | - Seleman J. Reza
- Department of SurgeryDivision of Cardiac Surgery, McMaster UniversityHamilton Ontario Canada
| | - Kevin J. Um
- Department of MedicineMcMaster UniversityHamilton Ontario Canada
| | - Alexandra Lengyel
- Department of SurgeryDivision of Cardiac Surgery, McMaster UniversityHamilton Ontario Canada
| | - Pablo Mendoza
- Department of SurgeryDivision of Cardiac Surgery, McMaster UniversityHamilton Ontario Canada
| | - Ali Alsagheir
- Department of SurgeryDivision of Cardiac Surgery, McMaster UniversityHamilton Ontario Canada
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamilton Ontario Canada
| | - Hatim Alraddadi
- Department of SurgeryDivision of Cardiac Surgery, McMaster UniversityHamilton Ontario Canada
| | - Saurabh Gupta
- Department of SurgeryDivision of Cardiac Surgery, McMaster UniversityHamilton Ontario Canada
| | - Adriaan W. Schneider
- Department of Cardiothoracic SurgeryLeiden University Medical CenterLeiden Netherlands
| | - Parth M. Patel
- Department of Cardiothoracic SurgeryEmory UniversityAtlanta Georgia
| | - John W. Brown
- Section of Cardiothoracic SurgeryIndiana University School of MedicineIndianapolis Indiana
| | - Michael W. A. Chu
- Department of Surgery, Division of Cardiac Surgery, London Health Sciences CentreWestern UniversityLondon Ontario Canada
| | - Mark D. Peterson
- Division of Cardiac SurgerySt. Michael's Hospital, University of TorontoToronto Ontario Canada
| | - Maral Ouzounian
- Division of Cardiac Surgery, Peter Munk Cardiac CenterUniversity of TorontoToronto Ontario Canada
| | - Domenico Paparella
- Department of Emergency and Organ Transplant, Division of Cardiac Surgery and Santa Maria Hospital, GVM Care & ResearchUniversity of Bari “Aldo Moro”Bari Italy
| | - Ismail El‐Hamamsy
- Division of Cardiac SurgeryMontreal Heart Institute, Université de MontréalMontreal Quebec Canada
| | - Richard P. Whitlock
- Department of SurgeryDivision of Cardiac Surgery, McMaster UniversityHamilton Ontario Canada
- Population Health Research InstituteHamilton Ontario Canada
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44
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van Kelle MAJ, Oomen PJA, Janssen-van den Broek WJT, Lopata RGP, Loerakker S, Bouten CVC. Initial scaffold thickness affects the emergence of a geometrical and mechanical equilibrium in engineered cardiovascular tissues. J R Soc Interface 2018; 15:rsif.2018.0359. [PMID: 30429259 DOI: 10.1098/rsif.2018.0359] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 10/16/2018] [Indexed: 01/22/2023] Open
Abstract
In situ cardiovascular tissue-engineering can potentially address the shortcomings of the current replacement therapies, in particular, their inability to grow and remodel. In native tissues, it is widely accepted that physiological growth and remodelling occur to maintain a homeostatic mechanical state to conserve its function, regardless of changes in the mechanical environment. A similar homeostatic state should be reached for tissue-engineered (TE) prostheses to ensure proper functioning. For in situ tissue-engineering approaches obtaining such a state greatly relies on the initial scaffold design parameters. In this study, it is investigated if the simple scaffold design parameter initial thickness, influences the emergence of a mechanical and geometrical equilibrium state in in vitro TE constructs, which resemble thin cardiovascular tissues such as heart valves and arteries. Towards this end, two sample groups with different initial thicknesses of myofibroblast-seeded polycaprolactone-bisurea constructs were cultured for three weeks under dynamic loading conditions, while tracking geometrical and mechanical changes temporally using non-destructive ultrasound imaging. A mechanical equilibrium was reached in both groups, although at different magnitudes of the investigated mechanical quantities. Interestingly, a geometrically stable state was only established in the thicker constructs, while the thinner constructs' length continuously increased. This demonstrates that reaching geometrical and mechanical stability in TE constructs is highly dependent on functional scaffold design.
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Affiliation(s)
- M A J van Kelle
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.,Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - P J A Oomen
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.,Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - W J T Janssen-van den Broek
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.,Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - R G P Lopata
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - S Loerakker
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands .,Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - C V C Bouten
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.,Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
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45
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Eltchaninoff H, Durand E, Barbanti M, Abdel-Wahab M. TAVI and valve performance: update on definitions, durability, transcatheter heart valve failure modes and management. EUROINTERVENTION 2018; 14:AB64-AB73. [DOI: 10.4244/eij-d-18-00653] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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46
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Marinval N, Morenc M, Labour M, Samotus A, Mzyk A, Ollivier V, Maire M, Jesse K, Bassand K, Niemiec-Cyganek A, Haddad O, Jacob M, Chaubet F, Charnaux N, Wilczek P, Hlawaty H. Fucoidan/VEGF-based surface modification of decellularized pulmonary heart valve improves the antithrombotic and re-endothelialization potential of bioprostheses. Biomaterials 2018; 172:14-29. [DOI: 10.1016/j.biomaterials.2018.01.054] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 01/29/2018] [Accepted: 01/29/2018] [Indexed: 12/02/2022]
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47
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Hasan A, Soliman S, El Hajj F, Tseng YT, Yalcin HC, Marei HE. Fabrication and In Vitro Characterization of a Tissue Engineered PCL-PLLA Heart Valve. Sci Rep 2018; 8:8187. [PMID: 29844329 PMCID: PMC5974353 DOI: 10.1038/s41598-018-26452-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 04/25/2018] [Indexed: 11/25/2022] Open
Abstract
Heart valve diseases are among the leading causes of cardiac failure around the globe. Nearly 90,000 heart valve replacements occur in the USA annually. Currently, available options for heart valve replacement include bioprosthetic and mechanical valves, both of which have severe limitations. Bioprosthetic valves can last for only 10-20 years while patients with mechanical valves always require blood-thinning medications throughout the remainder of the patient's life. Tissue engineering has emerged as a promising solution for the development of a viable, biocompatible and durable heart valve; however, a human implantable tissue engineered heart valve is yet to be achieved. In this study, a tri-leaflet heart valve structure is developed using electrospun polycaprolactone (PCL) and poly L-lactic acid (PLLA) scaffolds, and a set of in vitro testing protocol has been developed for routine manufacturing of tissue engineered heart valves. Stress-strain curves were obtained for mechanical characterization of different valves. The performances of the developed valves were hemodynamically tested using a pulse duplicator, and an echocardiography machine. Results confirmed the superiority of the PCL-PLLA heart valve compared to pure PCL or pure PLLA. The developed in vitro test protocol involving pulse duplicator and echocardiography tests have enormous potential for routine application in tissue engineering of heart valves.
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Affiliation(s)
- Anwarul Hasan
- Department of Mechanical and Industrial Engineering, College of Engineering, Qatar University, Doha, Qatar.
| | | | - Fatima El Hajj
- Biomedical Engineering, Faculty of Engineering and Architecture, American University of Beirut, Beirut, 11-0236, Lebanon
| | - Yuan-Tsan Tseng
- Division of Qatar Cardiovascular Research Center, Sidra Medicine, Doha, Qatar
- Imperial College, NHLI, Heart Science Centre, Harefield, Middlesex, UB9 6JH, United Kingdom
| | - Huseyin C Yalcin
- Biomedical Research Center, Qatar University, Doha, PO Box 2713, Qatar
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48
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Kanjanauthai S, Pirelli L, Nalluri N, Kliger CA. Subclinical leaflet thrombosis following transcatheter aortic valve replacement. J Interv Cardiol 2018; 31:640-647. [DOI: 10.1111/joic.12521] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/22/2018] [Accepted: 04/26/2018] [Indexed: 11/29/2022] Open
Affiliation(s)
| | | | - Nikhil Nalluri
- Staten Island University Hospital; Valve and Structural Heart Center; New York New York
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49
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Dahl AB, Gregory SH, Ursprung E, Kawabori M, Couper GS, Hueneke R. Acute Presentation of Bioprosthetic Mitral Valve Thrombosis in a Patient on Venoarterial Extracorporeal Membranous Oxygenation. J Cardiothorac Vasc Anesth 2018; 33:844-849. [PMID: 29880428 DOI: 10.1053/j.jvca.2018.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Indexed: 11/11/2022]
Abstract
The management of patients presenting with bioprosthetic valve thrombosis presents a major clinical challenge from a diagnostic and management standpoint. This patient population becomes especially challenging to manage when presenting with cardiogenic shock and additional risks for bleeding. In this clinical conference, the authors present the case of a 64-year-old male who developed intraoperative bioprosthetic mitral valve thrombosis and cardiogenic shock necessitating support with venoarterial extracorporeal membrane oxygenation. The discussion focuses on the diagnostic challenges with transesophageal echocardiography and the difficulty in determining the proper approach to systemic anticoagulation.
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Affiliation(s)
- Aaron B Dahl
- Washington University School of Medicine, Department of Anesthesiology, St. Louis, MO.
| | - Stephen H Gregory
- Washington University School of Medicine, Department of Anesthesiology, St. Louis, MO
| | - Eric Ursprung
- Tufts Medical Center, Department of Anesthesiology, Boston MA
| | | | | | - Rocco Hueneke
- Washington University School of Medicine, Department of Anesthesiology, St. Louis, MO
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De Paulis R, Scaffa R, Salica A, Weltert L, Chirichilli I. Biological solutions to aortic root replacement: valve-sparing versus bioprosthetic conduit. J Vis Surg 2018; 4:94. [PMID: 29963383 DOI: 10.21037/jovs.2018.04.12] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/11/2018] [Indexed: 11/06/2022]
Abstract
Composite valve graft implantation described by Bentall and De Bono is a well-documented technique of aortic root replacement used for a large spectrum of pathologic conditions involving the aortic valve and the ascending aorta. While mechanical valves were initially used, biological prostheses were later introduced in order to avoid long-term anticoagulation and its related complications. The increasing age of patients who undergo aortic root surgery, and data supporting the use of a biological aortic valve in the younger population, have significantly increased the need for a composite biological valved conduit. However, parallel to the increased use of biological valve in the context of a Bentall operation, aortic valve-sparing (AVS) operation have also been performed in a growing number of patients. Sarsam and David described the remodeling and the reimplantation procedures more than 25 years ago with the aim of sparing otherwise normal aortic valves in the presence of a root aneurysm. Important achievements in this discipline have occurred over the past decade including development and refinement of valve preserving aortic root replacement techniques, development of a classification system for aortic insufficiency, surgical approaches to cusp disease with different cusp anatomy. Both procedures can now provide excellent root reconstruction and adequate clinical results in terms of late valve durability. The AVS technique offers several advantages over the Bentall procedure, such as no need for oral anticoagulation and lifestyle adjustments. AVS operations have become established alternatives to Bentall procedures for patients with aortic root pathology. However, data comparing the safety and durability of these approaches are lacking.
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Affiliation(s)
| | - Raffaele Scaffa
- Department of Cardiac Surgery, European Hospital, Rome, Italy
| | - Andrea Salica
- Department of Cardiac Surgery, European Hospital, Rome, Italy
| | - Luca Weltert
- Department of Cardiac Surgery, European Hospital, Rome, Italy
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