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Hiremath CS, Jain AR, Garg A, Maslekar AA, Gupta NK, Sarkar BK, Bhat S, Porwal M, Meharwal ZS, Mishra YK, Vaijyanath P, Grover V, Chaudhary SK, Rajput SS, Sethuratnam R, Shastri N. Three-year outcomes of surgical valve replacement with Dafodil™ pericardial bioprosthesis: Dafodil™-1 trial. Front Cardiovasc Med 2024; 11:1393762. [PMID: 38873269 PMCID: PMC11171715 DOI: 10.3389/fcvm.2024.1393762] [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: 02/29/2024] [Accepted: 05/07/2024] [Indexed: 06/15/2024] Open
Abstract
Background The Dafodil™-1 trial was designed to evaluate the clinical safety and performance of Dafodil™ pericardial bioprosthesis for replacing diseased native or prosthetic aortic or mitral valves in patients with advanced valvular heart disease (VHD). Methods The Dafodil™-1 trial was a prospective, multicenter, first-in-human clinical trial. Patients were enrolled if they had advanced VHD requiring aortic valve replacement (AVR) or mitral valve replacement (MVR) with or without concomitant valve surgery and having surgical risk scores <4%. Major adverse cardiac events (MACE), including all-cause death, myocardial infarction (MI), and stroke; and hemodynamics were analyzed. Results A total of 136 patients (aortic: 67 and mitral: 69) were enrolled in the trial (with mean age-AVR group: 60.2 ± 8.3 years and MVR group: 49.7 ± 14.4 years). A total of 134 patients (aortic: 66 and mitral: 68) completed the 3-year follow-up (total 300 per 100 patient-years of follow-up). The AVR group demonstrated a significant reduction in the mean pressure gradients from 51.2 ± 24.1 mmHg at baseline to 11.1 ± 6.0 mmHg at the 3-year follow-up (p < 0.0001). The mean effective orifice area (EOA) improved from baseline (0.9 ± 0.6 cm2) to 3-year follow-up (1.8 ± 0.4 cm2) (p < 0.0001). In the MVR group, the mean indexed EOA (iEOA) increased significantly from baseline (0.7 ± 0.4 cm2/m2) to 3-year follow-up (1.1 ± 0.4 cm2/m2) (p < 0.001). There was significant improvement in New York Heart Association functional class and mean SF-12 scores in both groups. At 3-year follow-up, the MACE incidence was 2.3% per 100 patient-years (1.3% strokes per 100 patient-years and 1.3% deaths per 100 patient-years) for AVR group and 4.7% per 100 patient-years (0.6% strokes per 100 patient-years and 4.0% deaths per 100 patient-years) for MVR group. No cases of MI, structural valve deterioration and prosthetic valve endocarditis were reported. The AVR and MVR groups achieved 89.6% and 79.7% MACE-free survival, respectively at 3-year follow-up. Conclusions The Dafodil™-1 trial demonstrated satisfactory outcomes of clinical safety, hemodynamic performance, and quality-of-life metrics. Additionally, no incidence of structural valve deterioration and very low rates of valve thrombosis during the 3-year follow-up period of Dafodil™-1 first-in-human trial indicated acceptable valve durability up to three years and similar outcomes are warranted for longer follow-ups as a primary goal. Clinical Trial Registration Number https://www.ctri.nic.in/Clinicaltrials/showallp.php?mid1=18377&EncHid=&userName=CTRI/2017/07/009008, CTRI/2017/07/009008.
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Affiliation(s)
- Channabasavaraj Shivalingaiah Hiremath
- Department of Cardiothoracic and Vascular Surgery, Sri Madhusudan Sai Institute of Medical Sciences and Research, Sri Sathya Sai Sanjeevani Group of Hospitals, Sathya Sai Grama Muddenahalli, Chikkaballapura, India
| | - Anil R. Jain
- Department of Cardiovascular and Thoracic Surgery, EPIC Hospital, Ahmedabad, India
| | - Anurag Garg
- Department of Cardiothoracic Surgery, Dr D. Y. Patil Medical College & Hospital, Pune, India
| | - Atul A. Maslekar
- Department of Cardiothoracic and Vascular Surgery, Narayana Multispeciality Hospital, Ahmedabad, India
| | - Nirmal K. Gupta
- Department of Cardiovascular and Thoracic Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Binay Krishna Sarkar
- Department of Cardiothoracic and Vascular Surgery, Nil Ratan Sircar Medical College and Hospital, Kolkata, India
| | - Seetharama Bhat
- Department of Cardiothoracic and Vascular Surgery, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bangalore, India
| | - Manish Porwal
- Department of Cardiothoracic Surgery, Convenient Hospitals Limited, Indore, India
| | - Zile Singh Meharwal
- Department of Cardiothoracic and Vascular Surgery, Fortis Escorts Heart Institute, New Delhi, India
| | - Yugal Kishore Mishra
- Department of Cardiothoracic and Vascular Surgery, Manipal Hospital, New Delhi, India
| | - Prashanth Vaijyanath
- Department of Cardiothoracic Surgery, Kovai Medical College and Hospital, Coimbatore, India
| | - Vijay Grover
- Department of Cardiothoracic and Vascular Surgery, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Shiv Kumar Chaudhary
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Subash S. Rajput
- Department of Cardiothoracic and Vascular Surgery, Ram Manohar Lohia Hospital, Lucknow, India
| | - Rajan Sethuratnam
- Department of Cardiac Surgery, Madras Medical Mission, Chennai, India
| | - Naman Shastri
- Department of Cardiac Anaesthesiology, EPIC Hospital, Ahmedabad, India
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Morany A, Bardon RG, Lavon K, Hamdan A, Bluestein D, Haj-Ali R. Analysis of fibrocalcific aortic valve stenosis: computational pre-and-post TAVR haemodynamics behaviours. ROYAL SOCIETY OPEN SCIENCE 2024; 11:230905. [PMID: 38384780 PMCID: PMC10878817 DOI: 10.1098/rsos.230905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 01/22/2024] [Indexed: 02/23/2024]
Abstract
Fibro-calcific aortic valve (AV) diseases are characterized by calcium growth or accumulation of fibrosis in the AV tissues. Fibrocalcific aortic stenosis (FAS) rises specifically in females, like calcification-induced aortic stenosis (CAS), may eventually necessitate valve replacement. Fluid-structure-interaction (FSI) computational models for severe CAS and FAS patients were developed using lattice Boltzmann method and multi-scale finite elements (FE). Three parametric AV models were introduced: pathology-free of non-calcified tri-and-bicuspid AVs with healthy collagen fibre network (CFN), a FAS model incorporated a thickened CFN with embedded small calcification volumes, and a CAS model employs healthy CFN with embedded high calcification volumes. The results indicate that the interaction between calcium deposits, adjacent tissue and fibres crucially influences haemodynamics and structural reactions. A fourth model of transcatheter aortic valve replacement (TAVR) post-procedure outcomes was created to study both CAS and FAS. TAVR-CAS had a higher maximum contact pressure and lower anchoring area than TAVR-FAS, making it prone to aortic tissue damage and migration. Finally, although the TAVR-CAS offered a larger opening area, its paravalvular leakage was higher. This may be attributed to a similar thrombogenicity potential characterizing both models. The computational framework emphasizes the significance of mechanobiology in FAS and underscores the requirement for tissue modelling at multiple scales.
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Affiliation(s)
- Adi Morany
- School of Mechanical Engineering, Tel Aviv University, Tel Aviv, Israel
| | | | - Karin Lavon
- School of Mechanical Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Ashraf Hamdan
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Danny Bluestein
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
| | - Rami Haj-Ali
- School of Mechanical Engineering, Tel Aviv University, Tel Aviv, Israel
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
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