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Renker M, Charitos EI, Choi YH, Sossalla S. [Catheter-based and surgical treatment for aortic valve diseases]. Inn Med (Heidelb) 2024; 65:431-438. [PMID: 38635087 DOI: 10.1007/s00108-024-01699-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/19/2024]
Abstract
The pathophysiology of aortic valve diseases is of predominantly degenerative nature, characterized by calcific aortic valve stenosis, which is associated with a reduction in prognosis. The prevalence of aortic valve insufficiency also increases with advancing age. Timely causal treatment is crucial in the management of aortic valve diseases. Following the indication for intervention, the heart team plays a central role in evaluating the results and making therapeutic decisions that consider the patient's preferences. In the assessment of treatment options, considerations regarding the long-term perspective are particularly crucial, especially in younger patients. The most common therapeutic approach for aortic valve diseases is the introduction of a new valve prosthesis. In the majority of cases, this is now achieved through catheter-based implantation of a bioprosthetic heart valve, known as transcatheter aortic valve implantation (TAVI). Open surgical aortic valve replacement (AVR) is favored in younger patients with low surgical risk or in the case that TAVI is not feasible. In AVR, both biological and the longest-lasting mechanical prosthesis types are used. Surgical repair techniques are primarily applied in cases of aortic valve regurgitation. Notably, TAVI, as well as surgical procedures for the treatment of aortic valve diseases, have undergone significant advancements in recent years, including expanded indications for TAVI and, on the surgical side, in particular the development of minimally invasive surgical techniques.
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Affiliation(s)
- Matthias Renker
- Abteilung Kardiologie, Kerckhoff-Klinik, Benekestr. 2-8, 61231, Bad Nauheim, Deutschland.
| | | | - Yeong-Hoon Choi
- Abteilung Herzchirurgie, Kerckhoff-Klinik, Bad Nauheim, Deutschland
| | - Samuel Sossalla
- Abteilung Kardiologie, Kerckhoff-Klinik, Benekestr. 2-8, 61231, Bad Nauheim, Deutschland
- Medizinische Klinik I, Abteilung Kardiologie und Angiologie, Justus-Liebig-Universität Gießen, Gießen, Deutschland
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2
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Plant A, Stewart F, Hooks D. Implantable cardioverter-defibrillator lead failure and revision following transcutaneous bicaval valve (TricValve®) implantation. J Cardiovasc Electrophysiol 2024; 35:1050-1054. [PMID: 38501328 DOI: 10.1111/jce.16249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/19/2024] [Accepted: 03/03/2024] [Indexed: 03/20/2024]
Abstract
INTRODUCTION Tricuspid regurgitation is associated with significant morbidity and mortality, and occurs at a higher rate in patients with cardiovascular implantable electronic devices. Percutaneous strategies for managing tricuspid regurgitation are evolving, including the development of bicaval valve implantation which has been successfully used in patients with pacing leads. METHODS AND RESULTS We present the first documented case of lead failure following TricValve® implantation, a dedicated self-expanding system for bicaval valve implantation, and the first successful lead revision procedure in this setting. CONCLUSION The case illustrates important considerations in undertaking percutaneous intervention in patients with cardiovascular implantable electronic devices, and their ongoing management.
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Affiliation(s)
- Allan Plant
- Department of Cardiology, Wellington Regional Hospital, Te Whatu Ora Capital and Coast, Newtown, Wellington, New Zealand
| | - Fergus Stewart
- Department of Cardiology, Wellington Regional Hospital, Te Whatu Ora Capital and Coast, Newtown, Wellington, New Zealand
| | - Darren Hooks
- Department of Cardiology, Wellington Regional Hospital, Te Whatu Ora Capital and Coast, Newtown, Wellington, New Zealand
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3
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Bartkowiak J, Vivekanantham H, Kassar M, Dernektsi C, Agarwal V, Lebehn M, Windecker S, Brugger N, Hahn RT, Praz F. Computed tomography anatomic predictors of outcomes in patients undergoing tricuspid transcatheter edge-to-edge repair. J Cardiovasc Comput Tomogr 2024; 18:259-266. [PMID: 38383226 DOI: 10.1016/j.jcct.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/09/2024] [Accepted: 02/08/2024] [Indexed: 02/23/2024]
Abstract
AIM To identify anatomical computed tomography (CT) predictors of procedural and clinical outcomes in patients undergoing tricuspid transcatheter edge-to-edge repair (T-TEER). METHODS AND RESULTS Consecutive patients undergoing T-TEER between March 2018 to December 2022 who had cardiac CT prior to the procedure were included. CT scans were automatically analyzed using a dedicated software that employs deep learning techniques to provide precise anatomical measurements and volumetric calculations. Technical success was defined as successful placement of at least one implant in the planned anatomic location without single leaflet device attachment. Procedural success was defined as tricuspid regurgitation reduction to moderate or less. Procedural complexity was assessed by measuring the fluoroscopy time. The clinical endpoint was a composite of death, heart failure hospitalization, or tricuspid re-intervention throughout two years. A total of 33 patients (63.6% male) were included. Procedural success was achieved in 22 patients (66.7%). Shorter end-systolic (ES) height between the inferior vena cava (IVC) and tricuspid annulus (TA) (r = - 0.398, p = 0.044) and longer ES RV length (r = 0.551, p = 0.006) correlated with higher procedural complexity. ES RV length was independently associated with lower technical(adjusted Odds ratio [OR] 0.812 [95% CI 0.665-0.991], p = 0.040) and procedural success (adjusted OR 0.766, CI [0.591-0.992], p = 0.043). Patients with ES right ventricular (RV) length of >77.4 mm had a four-fold increased risk of experiencing the composite clinical endpoint compared to patients with ES RV length ≤77.4 mm (HR = 3.964 [95% CI, 1.018-15.434]; p = 0,034]). CONCLUSION CT-derived RV length and IVC-to-TA height may be helpful to identify patients at increased risk for procedural complexity and adverse outcomes when undergoing T-TEER. CT provides valuable information for preprocedural decision-making and device selection.
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Affiliation(s)
- Joanna Bartkowiak
- Department of Medicine, The NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA; Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Hari Vivekanantham
- Department of Cardiology, University and Hospital of Fribourg, Fribourg, Switzerland; Arrhythmia Services, Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Cardiology, University of Bern, Inselspital, Bern, Switzerland
| | - Mohammad Kassar
- Department of Cardiology, University of Bern, Inselspital, Bern, Switzerland
| | - Chrisoula Dernektsi
- Department of Cardiology, University of Bern, Inselspital, Bern, Switzerland
| | - Vratika Agarwal
- Department of Medicine, The NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Mark Lebehn
- Department of Medicine, The NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Stephan Windecker
- Department of Cardiology, University of Bern, Inselspital, Bern, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, University of Bern, Inselspital, Bern, Switzerland
| | - Rebecca T Hahn
- Department of Medicine, The NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Fabien Praz
- Department of Cardiology, University of Bern, Inselspital, Bern, Switzerland.
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Kirchner J, Gesch J, Gercek M, Piran M, Friedrichs K, Pfister R, Rudolph F, Potratz M, Goncharov A, Ivannikova M, Rudolph V, Rudolph TK. Analysis of tricuspid annulus dimensions and RCA-proximity with artificial intelligence-based software for procedural planning of percutaneous tricuspid annuloplasty. J Cardiovasc Comput Tomogr 2024; 18:309-310. [PMID: 38290934 DOI: 10.1016/j.jcct.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/15/2023] [Accepted: 01/06/2024] [Indexed: 02/01/2024]
Affiliation(s)
- Johannes Kirchner
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.
| | - Johannes Gesch
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Muhammed Gercek
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Misagh Piran
- Department of Radiology, Nuclear Medicine and Molecular Imaging, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Kai Friedrichs
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Roman Pfister
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Felix Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Max Potratz
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Arsenyi Goncharov
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Maria Ivannikova
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Volker Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Tanja K Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
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Grubb KJ, Lisko JC, O'Hair D, Merhi W, Forrest JK, Mahoney P, Van Mieghem NM, Windecker S, Yakubov SJ, Williams MR, Chetcuti SJ, Deeb GM, Kleiman NS, Althouse AD, Reardon MJ. Reinterventions After CoreValve/Evolut Transcatheter or Surgical Aortic Valve Replacement for Treatment of Severe Aortic Stenosis. JACC Cardiovasc Interv 2024; 17:1007-1016. [PMID: 38573257 DOI: 10.1016/j.jcin.2024.01.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 12/26/2023] [Accepted: 01/20/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Data on valve reintervention after transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) are limited. OBJECTIVES The authors compared the 5-year incidence of valve reintervention after self-expanding CoreValve/Evolut TAVR vs SAVR. METHODS Pooled data from CoreValve and Evolut R/PRO (Medtronic) randomized trials and single-arm studies encompassed 5,925 TAVR (4,478 CoreValve and 1,447 Evolut R/PRO) and 1,832 SAVR patients. Reinterventions were categorized by indication, timing, and treatment. The cumulative incidence of reintervention was compared between TAVR vs SAVR, Evolut vs CoreValve, and Evolut vs SAVR. RESULTS There were 99 reinterventions (80 TAVR and 19 SAVR). The cumulative incidence of reintervention through 5 years was higher with TAVR vs SAVR (2.2% vs 1.5%; P = 0.017), with differences observed early (≤1 year; adjusted subdistribution HR: 3.50; 95% CI: 1.53-8.02) but not from >1 to 5 years (adjusted subdistribution HR: 1.05; 95% CI: 0.48-2.28). The most common reason for reintervention was paravalvular regurgitation after TAVR and endocarditis after SAVR. Evolut had a significantly lower incidence of reintervention than CoreValve (0.9% vs 1.6%; P = 0.006) at 5 years with differences observed early (adjusted subdistribution HR: 0.30; 95% CI: 0.12-0.73) but not from >1 to 5 years (adjusted subdistribution HR: 0.61; 95% CI: 0.21-1.74). The 5-year incidence of reintervention was similar for Evolut vs SAVR (0.9% vs 1.5%; P = 0.41). CONCLUSIONS A low incidence of reintervention was observed for CoreValve/Evolut R/PRO and SAVR through 5 years. Reintervention occurred most often at ≤1 year for TAVR and >1 year for SAVR. Most early reinterventions were with the first-generation CoreValve and managed percutaneously. Reinterventions were more common following CoreValve TAVR compared with Evolut TAVR or SAVR.
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Affiliation(s)
- Kendra J Grubb
- Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia, USA.
| | - John C Lisko
- Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | - Daniel O'Hair
- Cardiovascular Service Line, Boulder Community Health, Boulder, Colorado, USA
| | - William Merhi
- Department of Interventional Cardiology, Corewell Health, Grand Rapids, Michigan, USA; Department of Cardiothoracic Surgery, Corewell Health, Grand Rapids, Michigan, USA
| | - John K Forrest
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Paul Mahoney
- University of Pittsburgh Medical Center Harrisburg, Harrisburg, Pennsylvania, USA
| | | | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | | | | | - Stanley J Chetcuti
- University of Michigan Health Systems-University Hospital, Ann Arbor, Michigan, USA
| | - G Michael Deeb
- University of Michigan Health Systems-University Hospital, Ann Arbor, Michigan, USA
| | - Neal S Kleiman
- Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
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Amat-Santos IJ, García-Gómez M. SAPIEN 3 Ultra Resilia: Critical Reflections on Real-World Performance. JACC Cardiovasc Interv 2024; 17:1045-1046. [PMID: 38658118 DOI: 10.1016/j.jcin.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Ignacio J Amat-Santos
- Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.
| | - Mario García-Gómez
- Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
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Guerreiro C, Barreiro-Perez M, Estevez-Loureiro R, Baz JA, Caneiro-Queija B, Gonzalez-Ferreiro R, Iñiguez-Romo A. Fully Percutaneous Fusion-Guided Transcatheter Mitral Valve Replacement With a New Transseptal System. JACC Cardiovasc Interv 2024; 17:1063-1064. [PMID: 38520452 DOI: 10.1016/j.jcin.2024.01.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/08/2024] [Accepted: 01/23/2024] [Indexed: 03/25/2024]
Affiliation(s)
- Claudio Guerreiro
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IISGS), Vigo, Pontevedra, Spain
| | - Manuel Barreiro-Perez
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IISGS), Vigo, Pontevedra, Spain.
| | - Rodrigo Estevez-Loureiro
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IISGS), Vigo, Pontevedra, Spain
| | - Jose Antonio Baz
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IISGS), Vigo, Pontevedra, Spain
| | - Berenice Caneiro-Queija
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IISGS), Vigo, Pontevedra, Spain
| | - Rocio Gonzalez-Ferreiro
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IISGS), Vigo, Pontevedra, Spain
| | - Andres Iñiguez-Romo
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IISGS), Vigo, Pontevedra, Spain
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Ben-Shoshan J, Finkelstein A, Konigstein M. Reintervention After TAVR vs SAVR: A Self-Expanding Experience. JACC Cardiovasc Interv 2024; 17:1017-1019. [PMID: 38573258 DOI: 10.1016/j.jcin.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/26/2024] [Indexed: 04/05/2024]
Affiliation(s)
- Jeremy Ben-Shoshan
- Department of Cardiology, Faculty of Medical and Health Sciences, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel.
| | - Ariel Finkelstein
- Department of Cardiology, Faculty of Medical and Health Sciences, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Maayan Konigstein
- Department of Cardiology, Faculty of Medical and Health Sciences, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel
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Dakroub A, Malik S, Singh M, Wang L, Henry M, Petrossian G, Robinson N, Khan JM. Transcatheter Aortic Valve Embolization Complicated by Inversion and Left Ventricular Outflow Tract Obstruction. JACC Cardiovasc Interv 2024; 17:1060-1062. [PMID: 38573255 DOI: 10.1016/j.jcin.2024.01.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 01/27/2024] [Accepted: 01/30/2024] [Indexed: 04/05/2024]
Affiliation(s)
- Ali Dakroub
- St. Francis Hospital and Heart Center, Roslyn, New York, USA
| | - Sarah Malik
- St. Francis Hospital and Heart Center, Roslyn, New York, USA
| | - Mandeep Singh
- St. Francis Hospital and Heart Center, Roslyn, New York, USA
| | - Lin Wang
- St. Francis Hospital and Heart Center, Roslyn, New York, USA
| | - Matthew Henry
- St. Francis Hospital and Heart Center, Roslyn, New York, USA
| | | | - Newell Robinson
- St. Francis Hospital and Heart Center, Roslyn, New York, USA
| | - Jaffar M Khan
- St. Francis Hospital and Heart Center, Roslyn, New York, USA; Cardiovascular Branch, Division of Intramural Research, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA.
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Tarantini G, Nai Fovino L. Beyond Mortality: Unveiling the Nuances of Quality of Life in Aortic Valve Interventions. JACC Cardiovasc Interv 2024; 17:989-991. [PMID: 38658127 DOI: 10.1016/j.jcin.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padua Medical School, Padua, Italy.
| | - Luca Nai Fovino
- Department of Cardiac, Thoracic and Vascular Sciences, and Public Health, University of Padua Medical School, Padua, Italy
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Kleiman NS, Van Mieghem NM, Reardon MJ, Gada H, Mumtaz M, Olsen PS, Heiser J, Merhi W, Chetcuti S, Deeb GM, Chawla A, Kiaii B, Teefy P, Chu MWA, Yakubov SJ, Windecker S, Althouse AD, Baron SJ. Quality of Life 5 Years Following Transfemoral TAVR or SAVR in Intermediate Risk Patients. JACC Cardiovasc Interv 2024; 17:979-988. [PMID: 38658126 DOI: 10.1016/j.jcin.2024.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 01/12/2024] [Accepted: 02/04/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Symptomatic patients with severe aortic stenosis (AS) at high risk for surgical aortic valve replacement (SAVR) sustain comparable improvements in health status over 5 years after transcatheter aortic valve replacement (TAVR) or SAVR. Whether a similar long-term benefit is observed among intermediate-risk AS patients is unknown. OBJECTIVES The purpose of this study was to assess health status outcomes through 5 years in intermediate risk patients treated with a self-expanding TAVR prosthesis or SAVR using data from the SURTAVI (Surgical Replacement and Transcatheter Aortic Valve Implantation) trial. METHODS Intermediate-risk patients randomized to transfemoral TAVR or SAVR in the SURTAVI trial had disease-specific health status assessed at baseline, 30 days, and annually to 5 years using the Kansas City Cardiomyopathy Questionnaire (KCCQ). Health status was compared between groups using fixed effects repeated measures modelling. RESULTS Of the 1,584 patients (TAVR, n = 805; SAVR, n = 779) included in the analysis, health status improved more rapidly after TAVR compared with SAVR. However, by 1 year, both groups experienced large health status benefits (mean change in KCCQ-Overall Summary Score (KCCQ-OS) from baseline: TAVR: 20.5 ± 22.4; SAVR: 20.5 ± 22.2). This benefit was sustained, albeit modestly attenuated, at 5 years (mean change in KCCQ-OS from baseline: TAVR: 15.4 ± 25.1; SAVR: 14.3 ± 24.2). There were no significant differences in health status between the cohorts at 1 year or beyond. Similar findings were observed in the KCCQ subscales, although a substantial attenuation of benefit was noted in the physical limitation subscale over time in both groups. CONCLUSIONS In intermediate-risk AS patients, both transfemoral TAVR and SAVR resulted in comparable and durable health status benefits to 5 years. Further research is necessary to elucidate the mechanisms for the small decline in health status noted at 5 years compared with 1 year in both groups. (Safety and Efficacy Study of the Medtronic CoreValve® System in the Treatment of Severe, Symptomatic Aortic Stenosis in Intermediate Risk Subjects Who Need Aortic Valve Replacement [SURTAVI]; NCT01586910).
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Affiliation(s)
- Neal S Kleiman
- Department of Interventional Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.
| | | | - Michael J Reardon
- Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Hemal Gada
- Department of Interventional Cardiology, University of Pittsburgh Medical Center Pinnacle, Wormleysburg, Pennsylvania, USA
| | - Mubashir Mumtaz
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center Pinnacle Health, Harrisburg, Pennsylvania, USA
| | - Peter Skov Olsen
- Department of Cardiothoracic Surgery, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - John Heiser
- Department of Interventional Cardiology, Corewell Health, Grand Rapids, Michigan, USA
| | - William Merhi
- Department of Cardiothoracic Surgery, Corewell Health, Grand Rapids, Michigan, USA
| | - Stanley Chetcuti
- Interventional Cardiology, University of Michigan, Ann Arbor, Michigan, USA
| | - G Michael Deeb
- Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Atul Chawla
- Department of Cardiology, Iowa Heart Center, Des Moines, Iowa, USA
| | - Bob Kiaii
- Division of Cardiac Surgery, University of California-Davis Health, Sacramento, California, USA
| | - Patrick Teefy
- Divisions of Cardiology and Cardiac Surgery, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Michael W A Chu
- Divisions of Cardiology and Cardiac Surgery, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Steven J Yakubov
- Interventional Cardiology, OhioHealth Riverside Methodist Hospital, Columbus, Ohio, USA
| | - Stephan Windecker
- Department of Cardiology, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Suzanne J Baron
- Massachusetts General Hospital, Boston, Massachusetts, USA; Baim Institute for Clinical Research, Boston, Massachusetts, USA
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So KCY, Kam KKH, Tang GHL, Lee APW. Feasibility of Using TriClip Guide for Combined MitraClip and TriClip Transcatheter Edge-to-Edge Repair: First-in-Human Experience. JACC Cardiovasc Interv 2024; 17:1071-1072. [PMID: 38658124 DOI: 10.1016/j.jcin.2024.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/05/2024] [Accepted: 02/20/2024] [Indexed: 04/26/2024]
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13
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Fortmeier V, Körber MI, Rommel KP, Stolz L, Kassar M, Praz F, Pfister R, Hausleiter J, Lurz P, Rudolph V. New Diagnostic Criteria for Pulmonary Hypertension: Impact on Survival Prognostication Following Transcatheter Tricuspid Valve Intervention. JACC Cardiovasc Interv 2024; 17:1073-1075. [PMID: 38658125 DOI: 10.1016/j.jcin.2024.01.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/12/2024] [Accepted: 01/30/2024] [Indexed: 04/26/2024]
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Naganuma T, Onishi H, Ouchi T, Hozawa K. Long-Term Follow-Up Following Stent-in-Stent for Stenosis Caused by Late Endothelialization of Self-Expanding Aortic Valve Struts. JACC Cardiovasc Interv 2024; 17:1050-1052. [PMID: 38520451 DOI: 10.1016/j.jcin.2024.01.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 01/23/2024] [Indexed: 03/25/2024]
Affiliation(s)
- Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
| | | | - Toru Ouchi
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Koji Hozawa
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
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15
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Fialka NM, EL-Andari R, Wang S, Dokollari A, Kent WDT, Fatehi Hassanabad A. The Perceval Sutureless Bioprosthetic Aortic Valve: Evolution of Surgical Valve Technology. Innovations (Phila) 2024; 19:125-135. [PMID: 38465600 PMCID: PMC11055413 DOI: 10.1177/15569845241231989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
OBJECTIVE The surgical treatment of aortic stenosis continues to evolve, and sutureless aortic valve replacement (SUAVR) is an emerging technology. With the Perceval S (Corcym, London, UK) as the only true sutureless valve on the market, the objective of this review is to analyze the current literature on Perceval S. Focusing on valve design and deployment as well as applications of the technology for challenging pathology, clinical outcomes are assessed, including a comparison with transcatheter AVR (TAVR). METHODS PubMed and MEDLINE were searched by 3 authors for studies analyzing SUAVR from inception to May 19, 2023. RESULTS SUAVR facilitates minimally invasive surgery and offers an alternative strategy for patients with small aortic annuli. It also has a time-saving advantage for patients who require complex operations. SUAVR results in excellent long-term morbidity, mortality, durability, and hemodynamic function. In comparison with conventional surgical AVR (SAVR), SUAVR does have a greater risk of postoperative pacemaker implantation; however, increasing user experience and refinements in implantation technique have contributed to reductions in this outcome. SUAVR results in morbidity and mortality that is similar to rapid-deployment AVR. Midterm outcomes are superior to TAVR; however, further robust investigation into all of these comparisons is ultimately necessary. CONCLUSIONS SUAVR bridges the gap in technology between SAVR and TAVR. The application of this exciting technology will undoubtedly grow in the coming years, during which additional investigation is paramount to optimize preoperative planning, valve deployment, and reintervention strategies.
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Affiliation(s)
- Nicholas M. Fialka
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Ryaan EL-Andari
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Shaohua Wang
- Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Aleksander Dokollari
- Section of Cardiac Surgery, St. Boniface Hospital, University of Manitoba, Winnipeg, MB, Canada
| | - William D. T. Kent
- Section of Cardiac Surgery, Division of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, AB, Canada
| | - Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Division of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, AB, Canada
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16
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Tomii D, Reineke D, Hunziker L, Pilgrim T. Transcatheter aortic valve implantation for left ventricular assist device-related aortic regurgitation. Eur J Cardiothorac Surg 2024; 65:ezae074. [PMID: 38441148 DOI: 10.1093/ejcts/ezae074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2024] Open
Affiliation(s)
- Daijiro Tomii
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - David Reineke
- Department of Cardiac Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lukas Hunziker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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17
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Wang J, Liu X, Pu Z, Chen M, Fang Z, Jin J, Dong J, Guo Y, Cheng B, Xiu J, Luo J, Tang Y, Wang Y, Chen X, Zhang G, Shao Y, Song G, Hong L, Jiang H, Wu Y, Yuan Y, Chen L, He B, Wang J, Xu K, Yang Y, Zhou D, Zhang Q, Li Y, Ma K, Lam YY, Han Y, Ge J, Lim DS, Pivotal Trial Investigators FTD. Safety and efficacy of the DragonFly system for transcatheter valve repair of degenerative mitral regurgitation: one-year results of the DRAGONFLY-DMR trial. EUROINTERVENTION 2024; 20:e239-e249. [PMID: 38389469 PMCID: PMC10870008 DOI: 10.4244/eij-d-23-00361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 10/20/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND Severe degenerative mitral regurgitation (DMR) can cause a poor prognosis if left untreated. For patients considered at prohibitive surgical risk, transcatheter edge-to-edge repair (TEER) has become an accepted alternative therapy. The DragonFly transcatheter valve repair system is an innovative evolution of the mitral TEER device family to treat DMR. AIMS Herein we report on the DRAGONFLY-DMR trial (ClinicalTrials.gov: NCT04734756), which was a prospective, single-arm, multicentre study on the safety and effectiveness of the DragonFly system. METHODS A total of 120 eligible patients with prohibitive surgical risk and DMR ≥3+ were screened by a central eligibility committee for enrolment. The study utilised an independent echocardiography core laboratory and clinical event committee. The primary endpoint was the clinical success rate, which measured freedom from all-cause mortality, mitral valve reintervention, and mitral regurgitation (MR) >2+ at 1-year follow-up. RESULTS At 1 year, the trial successfully achieved its prespecified primary efficacy endpoint, with a clinical success rate of 87.5% (95% confidence interval: 80.1-92.3%). The rates of major adverse events, all-cause mortality, mitral valve reintervention, and heart failure hospitalisation were 9.0%, 5.0%, 0.8%, and 3.4%, respectively. MR ≤2+ was 90.4% at 1 month and 92.0% at 1 year. Over time, left ventricular reverse remodelling was observed (p<0.05), along with significant improvements in the patients' functional and quality-of-life outcomes, shown by an increase in the New York Heart Association Class I/II from 32.4% at baseline to 93.6% at 12 months (p<0.001) and increased Kansas City Cardiomyopathy Questionnaire (KCCQ) score of 31.1±18.2 from baseline to 12 months (p<0.001). CONCLUSIONS The DRAGONFLY-DMR trial contributes to increasing evidence supporting the safety and efficacy of TEER therapy, specifically the DragonFly system, for treating patients with chronic symptomatic DMR 3+ to 4+ at prohibitive surgical risk.
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Affiliation(s)
- Jian'an Wang
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xianbao Liu
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhaoxia Pu
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhenfei Fang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jun Jin
- Department of Cardiology, The Second Affiliated Hospital, Army Medical University, Chongqing, China
| | - Jianzhen Dong
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yansong Guo
- Department of Cardiology, Fujian Provincial Hospital, Fuzhou, China
| | - Biao Cheng
- Department of Cardiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China
| | - Jiancheng Xiu
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jianfang Luo
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangzhou, China and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yida Tang
- Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Yan Wang
- Department of Medicine, Xiamen University Cardiovascular Hospital, Xiamen, China
| | - Xiaomen Chen
- Cardiology Center, Ningbo First Hospital, Ningbo, China
| | - Gejun Zhang
- Department of Cardiology, Fuwai Cardiovascular Hospital of Yunnan Province, Kunming, China
| | - Yibing Shao
- Department of Cardiology, Qingdao Municipal Hospital, Qingdao, China
| | - Guangyuan Song
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lang Hong
- Department of Cardiology, Jiangxi Provincial People's Hospital, Nanchang, China and The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Hong Jiang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yangqin Wu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yiqiang Yuan
- Department of Cardiology, Henan Chest Hospital, Zhengzhou, China
| | - Lianglong Chen
- Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Ben He
- Department of Cardiology, Shanghai Chest Hospital, Shanghai, China and Shanghai Jiao Tong University, Shanghai, China
| | - Jingfeng Wang
- Department of Cardiology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Kai Xu
- Department of Cardiology, General Hospital of the Northern Theater of the Chinese People's Liberation Army, Shenyang, China
| | - Yining Yang
- Department of Cardiology, The First Affiliated Hospital, Xinjiang Medical University, Urumqi, China
| | - Daxin Zhou
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qi Zhang
- Department of Cardiology, Shanghai East Hospital, Shanghai, China and Tongji University, Shanghai, China
| | - Yi Li
- The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | | | - Yat-Yin Lam
- Hong Kong Asia Heart Centre, Canossa Hospital, Hong Kong, China
| | - Yaling Han
- Department of Cardiology, General Hospital of the Northern Theater of the Chinese People's Liberation Army, Shenyang, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - D Scott Lim
- Department of Medicine, University of Virginia Health System Hospital, Charlottesville, VA, USA
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VAN Kampen A, Kofler M, Meyer A, Gerber M, Sündermann SH, VAN Praet KM, Akansel S, Hommel M, Falk V, Kempfert J. Aortic valve replacement via right anterolateral minithoracotomy: preventing adverse events during the initial learning curve. J Cardiovasc Surg (Torino) 2022; 63:85-90. [PMID: 34825793 DOI: 10.23736/s0021-9509.21.11981-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Despite excellent outcomes and reduced invasiveness, the right anterolateral thoracotomy approach for aortic valve replacement (RALT-AVR) has not been broadly adopted. This study provides results regarding the initial experience and learning curve of a single surgeon performing this procedure. METHODS Periprocedural details and postoperative outcomes of the first 100 consecutive patients who underwent RALT-AVR at our institution were retrospectively analyzed. We conducted a cumulative sum analysis of surgical failure, defined as occurrence of 30-day-mortality, surgical revision for bleeding, conversion to sternotomy, 3rd degree heart block, paravalvular leakage, postoperative stroke or mean transvalvular gradient >20 mmHg. RESULTS The cohort was of low surgical risk (mean EuroSCORE II 1.31%±0.85, mean STS PROM 1.45%±0.97), 58% were males. Median cross-clamp time was 67.5 (57.8-76) min, median CPB time 105 (91.8-119) min, and median operation time 164.5 (144.5-183.2) min. There were no conversions to full sternotomy, 4 cases of revision for bleeding and 2 pacemaker implantations for 3rd degree heart block. Prosthesis function was good (median ΔPmean 10.9 [7.4-13.6] mmHg). Thirty-day-mortality was 0%. The log-likelihood graph never crossed the upper boundary, and after a steady decrease, crossed the lower boundary at 93 patients. CONCLUSIONS RALT-AVR can be performed with acceptable procedural times and satisfactory outcomes. For a well-trained surgeon, adapting to this new procedure does not expose patients to an increased risk, when patient selection and procedural planning are applied appropriately. Cumulative sum failure analysis is an appropriate tool to monitor the transition from standard AVR to the technically more demanding RALT-AVR.
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Affiliation(s)
- Antonia VAN Kampen
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany -
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany -
- University Clinic of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany -
| | - Markus Kofler
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Alexander Meyer
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Maria Gerber
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Simon H Sündermann
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Department of Cardiovascular Surgery, Charité University Hospital, Berlin, Germany
| | - Karel M VAN Praet
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Serdar Akansel
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Matthias Hommel
- Department of Anesthesiology, German Heart Center Berlin, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Department of Cardiovascular Surgery, Charité University Hospital, Berlin, Germany
- Department of Health Sciences and Technology, Translational Cardiovascular Technologies, Institute of Translational Medicine, Swiss Federal Institute of Technology (ETH), Zurich, Switzerland
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
- Department of Cardiovascular Surgery, Charité University Hospital, Berlin, Germany
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19
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Wu G, Zhu J, Hu K, Cai H, Li X, Yang Y. Analysis and Study on the Quality of Life of Patients Undergoing Transcatheter Aortic Valve Replacement. Comput Math Methods Med 2021; 2021:3147382. [PMID: 34956394 PMCID: PMC8702324 DOI: 10.1155/2021/3147382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/12/2021] [Accepted: 11/10/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Explore the factors affecting the QO of life after transcatheter aortic valve replacement (TAVR) and analyze and evaluate their surgical efficacy and postoperative survival status. METHODS Through correlation analysis and multiple regression analysis, we predict various clinical characteristics and postoperative quality and predict clinical changes in L postoperative quality. RESULTS The quality of life of patients with the disease has gradually improved and improved from 6 months after surgery. The differences in the three aspects of its physiological mechanism function, physiological function function, overall health, and vitality are statistically significant (p < 0.05). CONCLUSION Compared with traditional open-thoracic aortic valve (AV) surgery, TAVR has the significant advantages of smaller surgical incision and less trauma to the patient, which has become one of the reasons why patients are willing to accept it.
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Affiliation(s)
- Guoliang Wu
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830001 Xinjiang, China
| | - Jiajun Zhu
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830001 Xinjiang, China
| | - Kaixuan Hu
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830001 Xinjiang, China
| | - Huan Cai
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830001 Xinjiang, China
| | - Xiaomei Li
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830001 Xinjiang, China
| | - Yining Yang
- Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830001 Xinjiang, China
- Department of Cardiology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, 830001 Xinjiang, China
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20
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Assmann AK, Goschmer D, Sugimura Y, Chekhoeva A, Barth M, Assmann A, Lichtenberg A, Akhyari P. A Role for Peroxisome Proliferator-Activated Receptor Gamma Agonists in Counteracting the Degeneration of Cardiovascular Grafts. J Cardiovasc Pharmacol 2021; 79:e103-e115. [PMID: 34654784 PMCID: PMC8728763 DOI: 10.1097/fjc.0000000000001150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 09/25/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Aortic valve replacement for severe stenosis is a standard procedure in cardiovascular medicine. However, the use of biological prostheses has limitations especially in young patients because of calcifying degeneration, resulting in implant failure. Pioglitazone, a peroxisome proliferator-activated receptor gamma (PPAR-gamma) agonist, was shown to decrease the degeneration of native aortic valves. In this study, we aim to examine the impact of pioglitazone on inflammation and calcification of aortic valve conduits (AoC) in a rat model. Cryopreserved AoC (n = 40) were infrarenally implanted into Wistar rats treated with pioglitazone (75 mg/kg chow; n = 20, PIO) or untreated (n = 20, controls). After 4 or 12 weeks, AoC were explanted and analyzed by histology, immunohistology, and polymerase chain reaction. Pioglitazone significantly decreased the expression of inflammatory markers and reduced the macrophage-mediated inflammation in PIO compared with controls after 4 (P = 0.03) and 12 weeks (P = 0.012). Chondrogenic transformation was significantly decreased in PIO after 12 weeks (P = 0.001). Calcification of the intima and media was significantly reduced after 12 weeks in PIO versus controls (intima: P = 0.008; media: P = 0.025). Moreover, echocardiography revealed significantly better functional outcome of the AoC in PIO after 12 weeks compared with control. Interestingly, significantly increased intima hyperplasia could be observed in PIO compared with controls after 12 weeks (P = 0.017). Systemic PPAR-gamma activation prevents inflammation as well as intima and media calcification in AoC and seems to inhibit functional impairment of the implanted aortic valve. To further elucidate the therapeutic role of PPAR-gamma regulation for graft durability, translational studies and long-term follow-up data should be striven for.
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Affiliation(s)
- Anna Kathrin Assmann
- Department of Cardiac Surgery and Research Group for Experimental Surgery, Heinrich Heine University, Medical Faculty, Duesseldorf, Germany.
| | - Daniel Goschmer
- Department of Cardiac Surgery and Research Group for Experimental Surgery, Heinrich Heine University, Medical Faculty, Duesseldorf, Germany.
| | - Yukiharu Sugimura
- Department of Cardiac Surgery and Research Group for Experimental Surgery, Heinrich Heine University, Medical Faculty, Duesseldorf, Germany.
| | - Agunda Chekhoeva
- Department of Cardiac Surgery and Research Group for Experimental Surgery, Heinrich Heine University, Medical Faculty, Duesseldorf, Germany.
| | - Mareike Barth
- Department of Cardiac Surgery and Research Group for Experimental Surgery, Heinrich Heine University, Medical Faculty, Duesseldorf, Germany.
| | - Alexander Assmann
- Department of Cardiac Surgery and Research Group for Experimental Surgery, Heinrich Heine University, Medical Faculty, Duesseldorf, Germany.
| | - Artur Lichtenberg
- Department of Cardiac Surgery and Research Group for Experimental Surgery, Heinrich Heine University, Medical Faculty, Duesseldorf, Germany.
| | - Payam Akhyari
- Department of Cardiac Surgery and Research Group for Experimental Surgery, Heinrich Heine University, Medical Faculty, Duesseldorf, Germany.
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21
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Blessberger H, Kellermair J, Kammler J, Steinwender C, Zierer AF. Transapical off-pump mitral valve repair following prior mitral valve surgery: A case report. Medicine (Baltimore) 2021; 100:e26148. [PMID: 34032769 PMCID: PMC8154387 DOI: 10.1097/md.0000000000026148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/11/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Redo surgeries after mitral valve repair are technically demanding. Procedures applying the NeoChord device (NeoChord Inc, St. Louis Park, MN) have proven to be safe and feasible in selected patients requiring mitral valve repair due to a leaflet prolapse or flail. However, its use for redo procedures after conventional surgical repair has not been well established yet. PATIENT CONCERNS We report the case of a 57-year-old man who presented with dyspnea upon exertion. The patient had undergone a minimally invasive surgical mitral valve repair because of a flail leaflet of the segments segment 2 of the posterior mitral valve leaflet (P2)/segment 3 of the posterior mitral valve leaflet (P3) 4 years before. DIAGNOSES Transesophageal echocardiography identified a relapse of severe mitral valve regurgitation. The recurring regurgitant jet was caused by a flail leaflet due to newly ruptured native chords. INTERVENTIONS After discussion in an interdisciplinary heart team, we performed a minimally invasive off-pump redo procedure applying the NeoChord device under three-dimensional transesophageal echocardiographic guidance. OUTCOMES The echocardiographic result with only trivial residual mitral regurgitation as well as the further clinical course of the patient were favorable. LESSONS As redo surgery after minimally invasive mitral valve repair is challenging, the NeoChord device represents a novel treatment option that does not require cardiopulmonary bypass.
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Affiliation(s)
- Hermann Blessberger
- Department of Cardiology, Kepler University Hospital, Medical Faculty, Johannes Kepler University, Linz
| | - Joerg Kellermair
- Department of Cardiology, Kepler University Hospital, Medical Faculty, Johannes Kepler University, Linz
| | - Juergen Kammler
- Department of Cardiology, Kepler University Hospital, Medical Faculty, Johannes Kepler University, Linz
- Department of Internal Medicine II, Paracelsus Medical University, Salzburg
| | - Clemens Steinwender
- Department of Cardiology, Kepler University Hospital, Medical Faculty, Johannes Kepler University, Linz
- Department of Internal Medicine II, Paracelsus Medical University, Salzburg
| | - Andreas F. Zierer
- Department of Cardiothoracic and Vascular Surgery, Kepler University Hospital, Medical Faculty, Johannes Kepler University, Linz, Austria
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22
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Di Bacco L, Rosati F, Folliguet T, Petruccelli RD, Concistrè G, Santarpino G, Di Bartolomeo R, Bisleri G, Fischlein TJ, Muneretto C. Sutureless aortic valves in elderly patients with aortic stenosis and intermediate-risk profile. J Cardiovasc Med (Hagerstown) 2021; 22:297-304. [PMID: 33633045 DOI: 10.2459/jcm.0000000000001120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AIMS Sutureless valves became an alternative to standard bioprostheses, allowing surgeons to significantly reduce cross-clamping and extracorporeal circulation times, with a potential positive impact on major postoperative complications. The aim of this European multicentre study was to evaluate the safety and efficacy of sutureless valves in patients with an intermediate-risk profile undergoing aortic valve replacement (AVR). METHODS We investigated early and mid-term outcomes of 518 elderly patients with aortic stenosis at intermediate-risk profile (mean STS Score 6.1 ± 2%) undergoing AVR with sutureless aortic valve. Primary endpoints were 30-day mortality and freedom from all-cause death at follow-up. The secondary endpoint was survival freedom from MACCEs [all-cause death, stroke/transitory ischemic attack (TIA), bleeding, myocardial infarction, aortic regurgitation Grade II, endocarditis, reintervention and pacemaker implant; VARC 1--2 criteria]. RESULTS Sutureless valve implantation was successfully performed in 508 patients, with a procedural success rate of 98.1% (508/518) as per VARC criteria. Concomitant myocardial revascularization [coronary artery bypass grafting (CABG)] was performed in 74 out of 518 patients (14.3%). In-hospital mortality was 1.9% (10/518). Postoperative complications included revision for bleeding (23/518; 4.4%), prolonged intubation more than 48h (4/518; 0.7%), acute renal failure (14/518; 2.7%), stroke/TIA (11/518; 2.1%), pacemaker implantation (26/518; 5.1%) and aortic regurgitation more than Grade II (7/518; 1.4%). At 48-month follow-up, Kaplan-Meier overall survival and freedom from MACCEs in patients receiving isolated AVR were 83.7% [95% confidence interval (95% CI): 81.1-86.3] and 78.4% (95% CI: 75.5-81.4), respectively, while in patients with concomitant CABG, Kaplan-Meier overall survival and freedom from MACCEs were 82.3% (95% CI: 73.3-91.3) and 79.1% (95% CI: 69.9-88.3), respectively. CONCLUSION The use of sutureless aortic valves in elderly patients with an intermediate-risk profile provided excellent early and mid-term outcomes, providing a reliable tool in patients undergoing surgical AVR in this specific subset of population. These preliminary data need to be investigated with a TAVI control-group in further studies.
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Affiliation(s)
- Lorenzo Di Bacco
- Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy
| | - Fabrizio Rosati
- Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy
| | | | - Rocco D Petruccelli
- Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy
| | | | - Giuseppe Santarpino
- Città di Lecce Hospital, GVM Care and Research, Lecce, Italy
- Paracelsus Medical University Nuremberg, Nuremberg, Germany
| | | | - Gianluigi Bisleri
- Division of Cardiac Surgery, Queen's University, Kingston, Ontario, Canada
| | | | - Claudio Muneretto
- Division of Cardiac Surgery, University of Brescia Medical School, Brescia, Italy
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23
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Haberka M, Malczewska M, Pysz P, Kozłowski M, Wojakowski W, Smolka G. Cardiovascular magnetic resonance and transesophageal echocardiography in patients with prosthetic valve paravalvular leaks: towards an accurate quantification and stratification. J Cardiovasc Magn Reson 2021; 23:31. [PMID: 33745455 PMCID: PMC7983376 DOI: 10.1186/s12968-021-00722-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 02/01/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Objective assessment of prosthetic paravalvular leak (PVL) is complex and challenging even in transesophageal echocardiography (TEE). Our aim was to assess the value of cardiovascular magnetic resonance (CMR) in quantifying PVL in aortic (AVR) or mitral valve (MVR) replacement. METHODS Thirty-one patients (62 ± 15.1 years, 63% males) with a preliminary diagnosis of significant PVL (AVR, n-23; MVR, n = 8) were recruited. The TEE PVL grading was based on the semi-quantitative (SQ) TEE according to the VARC II PVL classification (%PVL: mild < 10%; moderate 10%-30%; severe > 30%). Non-contrast CMR studies were acquired at 1.5 T with a quantitative approach (phase-contrast velocity encoded imaging). The CMR PVL severity was classified according to regurgitant fraction (RF: (1) mild ≤ 20%, (2) moderate 21%-39%, or (3) severe ≥ 40%). RESULTS All patients revealed symptoms of heart failure (71%: New York Heart Association [NYHA] II; 91%: N-terminal pro-B-type natriuretic peptide [NT-proBNP] > 150 pg/ml) and typical cardiovascular disease risk factors. The SQ-TEE results revealed several categories: (1) mild (n = 5; 16%), (2) moderate (n = 21; 67%), and (3) severe (n = 5; 16%) PVL. However, CMR PVL RF reclassified the severity of PVL: (1) mild to moderate (in 80%), (2) moderate to severe (in 47%), and (3) severe to moderate (in 40%). The receiver operating characteristic analysis showed that SQ-TEE and CMR PVL-vol and -RF predicted the upper tertile of NT-proBNP (> 2000 pg/ml) with the best sensitivity for CMR parameters. CONCLUSION The SQ-TEE showed moderate agreement with CMR and underestimated a considerable number of AVR or MVR-PVL.
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Affiliation(s)
- Maciej Haberka
- Department of Cardiology, Medical University of Silesia, Ziołowa 45/47, 40-635, Katowice, Poland.
| | - Magdalena Malczewska
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Piotr Pysz
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
- Department of Cardiac Rehabilitation, Treatment and Rehabilitation Center, Long-Term Care Hospital, Jaworze, Poland
| | - Michał Kozłowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Grzegorz Smolka
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
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Alkhouli M, Alqahtani F, Kawsara A, Pislaru S, Schaff HV, Nishimura RA. National Trends in Mechanical Valve Replacement in Patients Aged 50 to 70 Years. J Am Coll Cardiol 2021; 76:2687-2688. [PMID: 33243387 DOI: 10.1016/j.jacc.2020.09.608] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/24/2020] [Accepted: 09/20/2020] [Indexed: 12/24/2022]
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El-Eshmawi A, Sun E, Boateng P, Pandis D, Rimsukcharoenchai C, Anyanwu A, Adams DH. Lessons from reoperations for mitral stenosis after mitral valve repair. J Thorac Cardiovasc Surg 2021; 161:937-946. [PMID: 33431213 DOI: 10.1016/j.jtcvs.2020.12.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 11/22/2020] [Accepted: 12/03/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The durability of mitral valve repair (MVr) is usually defined by the absence of recurrent significant mitral regurgitation. Postrepair mitral stenosis (MS) is a less frequent and less studied mode of failure of MVr. We analyzed our experience in patients who underwent reoperation for postrepair MS to characterize mechanisms resulting in MS and to summarize reoperative surgical strategies and mid-term outcomes. METHODS Using a prospective database, we retrospectively analyzed data on 35 consecutive patients who underwent reoperation for symptomatic moderate to severe MS between January 1, 2011, and February 1, 2020. RESULTS The mean patient age was 61.4 ± 11.4 years, and 69% were female. The median annuloplasty ring size used at the initial repair was 28 mm (interquartile range, 26-30 mm). Additional repair techniques at the initial operation included leaflet resection in 12 patients (34%) and commissuroplasty or edge-to-edge repair in 6 patients (18%). At reoperation, the most common mechanism of MS was pannus ingrowth in 20 patients (57%), leaflet calcification in 12 (34%), commissural fusion in 5 (14%), and tunnel effect (functional MS) in 3 (9%). Twenty-two patients (63%) underwent valve replacement, and 13 (37%) underwent valve re-repair. In patients who underwent re-repair, annuloplasty revision was performed in all patients, with 6 patients (46%) converted from complete ring to band, 4 (11%) converted from ring to pericardial annuloplasty, 2 (6%) converted to no annuloplasty, and 1 (8%) with annuloplasty ring upsizing. There were no in-hospital or 1-year mortalities. Survival at the 5-year follow-up was 93.9%. CONCLUSIONS MS causing late failure of MVr is frequently associated with smaller ring sizes and inflammatory or calcific changes in the valve. Highly selected patients may be good candidates for mitral valve re-repair.
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Affiliation(s)
- Ahmed El-Eshmawi
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sini, New York, NY.
| | - Erick Sun
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sini, New York, NY
| | - Percy Boateng
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sini, New York, NY
| | - Dimosthenis Pandis
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sini, New York, NY
| | | | - Anelechi Anyanwu
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sini, New York, NY
| | - David H Adams
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sini, New York, NY
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Nordmeyer S, Lee CB, Goubergrits L, Knosalla C, Berger F, Falk V, Ghorbani N, Hireche-Chikaoui H, Zhu M, Kelle S, Kuehne T, Kelm M. Circulatory efficiency in patients with severe aortic valve stenosis before and after aortic valve replacement. J Cardiovasc Magn Reson 2021; 23:15. [PMID: 33641670 PMCID: PMC7919094 DOI: 10.1186/s12968-020-00686-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 10/29/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Circulatory efficiency reflects the ratio between total left ventricular work and the work required for maintaining cardiovascular circulation. The effect of severe aortic valve stenosis (AS) and aortic valve replacement (AVR) on left ventricular/circulatory mechanical power and efficiency is not yet fully understood. We aimed to quantify left ventricular (LV) efficiency in patients with severe AS before and after surgical AVR. METHODS Circulatory efficiency was computed from cardiovascular magnetic resonance (CMR) imaging derived volumetric data, echocardiographic and clinical data in patients with severe AS (n = 41) before and 4 months after AVR and in age and sex-matched healthy subjects (n = 10). RESULTS In patients with AS circulatory efficiency was significantly decreased compared to healthy subjects (9 ± 3% vs 12 ± 2%; p = 0.004). There were significant negative correlations between circulatory efficiency and LV myocardial mass (r = - 0.591, p < 0.001), myocardial fibrosis volume (r = - 0.427, p = 0.015), end systolic volume (r = - 0.609, p < 0.001) and NT-proBNP (r = - 0.444, p = 0.009) and significant positive correlation between circulatory efficiency and LV ejection fraction (r = 0.704, p < 0.001). After AVR, circulatory efficiency increased significantly in the total cohort (9 ± 3 vs 13 ± 5%; p < 0.001). However, in 10/41 (24%) patients, circulatory efficiency remained below 10% after AVR and, thus, did not restore to normal values. These patients also showed less reduction in myocardial fibrosis volume compared to patients with restored circulatory efficiency after AVR. CONCLUSION In our cohort, circulatory efficiency is reduced in patients with severe AS. In 76% of cases, AVR leads to normalization of circulatory efficiency. However, in 24% of patients, circulatory efficiency remained below normal values even after successful AVR. In these patients also less regression of myocardial fibrosis volume was seen. Trial Registration clinicaltrials.gov NCT03172338, June 1, 2017, retrospectively registered.
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Affiliation(s)
- S Nordmeyer
- Department of Congenital Heart Disease, German Heart Centre Berlin, Berlin, Germany.
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - C B Lee
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - L Goubergrits
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - C Knosalla
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, German Heart Centre Berlin, Berlin, Germany
| | - F Berger
- Department of Congenital Heart Disease, German Heart Centre Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - V Falk
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, German Heart Centre Berlin, Berlin, Germany
| | - N Ghorbani
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - H Hireche-Chikaoui
- Department of Internal Medicine and Cardiology, German Heart Centre Berlin, Berlin, Germany
| | - M Zhu
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - S Kelle
- Department of Internal Medicine and Cardiology, German Heart Centre Berlin, Berlin, Germany
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - T Kuehne
- Department of Congenital Heart Disease, German Heart Centre Berlin, Berlin, Germany
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - M Kelm
- Department of Congenital Heart Disease, German Heart Centre Berlin, Berlin, Germany
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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Lebreton G. Structural valve degeneration: Redo or valve-in-valve? Enough meta-analysis and retrospective studies, we need a randomised trial. Arch Cardiovasc Dis 2021; 114:85-87. [PMID: 33602625 DOI: 10.1016/j.acvd.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/03/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Guillaume Lebreton
- Department of cardio-thoracic surgery, Pitié-Salpêtrière hospital, Institute of CArdioMetabolism (ICAN), UMR 1166, Sorbonne University, Paris, France.
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Hirai K, Baba K, Goto T, Ousaka D, Kondo M, Eitoku T, Kotani Y, Kasahara S, Ohtsuki S, Tsukahara H. Outcomes of Right Ventricular Outflow Tract Reconstruction in Children: Retrospective Comparison Between Bovine Jugular Vein and Expanded Polytetrafluoroethylene Conduits. Pediatr Cardiol 2021; 42:100-108. [PMID: 32968822 DOI: 10.1007/s00246-020-02458-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/16/2020] [Indexed: 11/27/2022]
Abstract
Bovine jugular vein (BJV) and expanded polytetrafluoroethylene (ePTFE) conduits have been described as alternatives to the homograft for right ventricular outflow tract (RVOT) reconstruction. This study compared RVOT reconstructions using BJV and ePTFE conduits performed in a single institution. The valve functions and outcomes of patients aged < 18 years who underwent primary RVOT reconstruction with a BJV or ePTFE conduit between 2013 and 2017 were retrospectively investigated. 44 patients (20 and 24 with BJV and ePTFE conduits, respectively) met the inclusion criteria. The mean follow-up time was 4.5 ± 1.5 years. No significant differences in peak RVOT velocity (1.8 ± 0.9 m/s vs 2.1 ± 0.9 m/s, P = 0.27), branch pulmonary stenosis (P = 0.50), or pulmonary regurgitation (P = 0.44) were found between the BJV and ePTFE conduit groups, respectively. Aneurysmal dilatation of the conduit was observed in 25.0% of the patients in the BJV conduit group but not in the ePTFE conduit group (P = 0.011). All the cases with aneurysmal dilatation of the BJV conduit were complicated with branch pulmonary stenosis up to 3.0 m/s (P = 0.004). No conduit infections occurred during the follow-up period, and no significant difference in conduit replacement (20.0% vs 8.3%, P = 0.43) was found between the BJV and ePTFE conduit groups, respectively. The outcomes of the RVOT reconstructions with BJV and ePTFE conduits were clinically satisfactory. Aneurysmal dilatation was found in the BJV conduit cases, with branch pulmonary stenosis as the risk factor.
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Affiliation(s)
- Kenta Hirai
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama, 700-8558, Japan
| | - Kenji Baba
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama, 700-8558, Japan.
| | - Takuya Goto
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Okayama, Japan
| | - Daiki Ousaka
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Okayama, Japan
| | - Maiko Kondo
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama, 700-8558, Japan
| | - Takahiro Eitoku
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama, 700-8558, Japan
| | - Yasuhiro Kotani
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Okayama, Japan
| | - Shingo Kasahara
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama City, Okayama, Japan
| | - Shinichi Ohtsuki
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama, 700-8558, Japan
| | - Hirokazu Tsukahara
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama, 700-8558, Japan
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Li Q, Gao H, Ji Q, Song J, Li L, Liu X. Analysis of risk factors for perioperative death in patients undergoing aortic valve replacement using biological valves. Medicine (Baltimore) 2020; 99:e23909. [PMID: 33350790 PMCID: PMC7769375 DOI: 10.1097/md.0000000000023909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 11/30/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Aortic valve disease has become one of the important factors affecting human health. Aortic valve disease is a progressive disease, if not actively treated, the prognosis is poor. Aortic valve replacement (AVR) surgery is an important treatment for aortic valve disease. At present, the AVR surgery using biological valve accounts for about 40% of the total number of AVR surgery. There are still more perioperative deaths in China due to the large number of AVR patients using biological valves. The objective of this study is to explore measures to reduce perioperative mortality of patients after AVR surgery with biological valves. METHODS The clinical data of patients undergoing AVR surgery with biological valves in Affiliated Hospital of Qingdao University from November 15, 2020 to December 31, 2022 were reviewed and analyzed. Patients were divided into death group and survival group according to their perioperative survival. Risk factors that may influence perioperative mortality were analyzed and compared between the 2 groups. DISCUSSION This study was a retrospective analysis of risk factors that may influence perioperative mortality in patients undergoing AVR surgery using biological valves. The conclusions of this study can be used to guide clinical decisions-making and relevant guidelines-developing for perioperative treatment of patients undergoing AVR surgery using biological valves.
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Affiliation(s)
- Qi Li
- Department of Medicine, Qingdao University
- Department of Cardiovascular Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hongbo Gao
- Department of Cardiovascular Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qiuxia Ji
- Department of Cardiovascular Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jianshu Song
- Department of Medicine, Qingdao University
- Department of Cardiovascular Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Longfei Li
- Department of Medicine, Qingdao University
- Department of Cardiovascular Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xu Liu
- Department of Cardiovascular Surgery, Affiliated Hospital of Qingdao University, Qingdao, China
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Wallace FRO, Buratto E, Naimo PS, Brink J, d'Udekem Y, Brizard CP, Konstantinov IE. Aortic valve repair in children without use of a patch. J Thorac Cardiovasc Surg 2020; 162:1179-1189.e3. [PMID: 33516462 DOI: 10.1016/j.jtcvs.2020.11.159] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 10/23/2020] [Accepted: 11/22/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND We aimed to assess the long-term outcomes of children in whom the aortic valve could be repaired without the use of patch material. We hypothesized that if the aortic valve is of sufficiently good quality to perform repair without patches, a durable repair could be achieved. METHODS All children (n = 102) who underwent aortic valve repair without the use of a patch between 1980 and 2016 were reviewed. RESULTS The median patient age at operation was 2 years (interquartile range, 1 month to 9.6 years). There were 25 neonates and 17 infants. There was no operative mortality. Mean overall survival at 10 years was 97.7% ± 0.01% (95% confidence interval, [CI] 91.0%-99.4%). Forty-three patients (42.2%) required 56 aortic valve reoperations, including 24 redo aortic valve repairs, 22 Ross procedures, 8 mechanical aortic valve replacements, and 2 homograft aortic valve replacements. Mean freedom from aortic valve reoperation at 10 years was 57.4% ± 0.06% (95% CI, 44.9%-68.1%), and freedom from aortic valve replacement at 10 years was 74.5% ± 0.05% (95% CI, 63.0%-82.9%) at 10 years. Freedom from aortic valve reoperation at 10 years was 33.1% ± 0.1% (95% CI, 14.5%-53.2%) in neonates and 68.9% ± 0.06% (95% CI, 54.5%-79.6%) in older children (P < .01). CONCLUSIONS In approximately one-third of children undergoing aortic valve repair, the repair could be achieved without patches. In these children, aortic valve repair was achieved without operative mortality. Infants and older children have low reoperation rates, whereas reoperation rates in neonates are higher. Initial repair allows valve replacement to be delayed to later in childhood, when a more durable result may be achieved.
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Affiliation(s)
- Fraser R O Wallace
- Cardiac Surgery Unit, The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Edward Buratto
- Cardiac Surgery Unit, The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Phillip S Naimo
- Cardiac Surgery Unit, The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Johann Brink
- Cardiac Surgery Unit, The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Yves d'Udekem
- Cardiac Surgery Unit, The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; Melbourne Children's Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia
| | - Christian P Brizard
- Cardiac Surgery Unit, The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Igor E Konstantinov
- Cardiac Surgery Unit, The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia; Melbourne Children's Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia.
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Abstract
PURPOSE The paper present findings from an in vitro experimental study of a stentless human aortic bioprosthesis (HAB) made of bacterial cellulose (BC). Three variants of the basic model were designed and tested to identify the valve prosthesis with the best performance parameters. The modified models were made of BC, and the basic model of pericardium. METHODS Each model (named V1, V2 and V3) was implanted into a 90 mm porcine aorta. Effective Orifice Area (EOA), rapid valve opening time (RVOT) and rapid valve closing time (RVCT) were determined. The flow resistance of each bioprosthesis model during the simulated heart systole, i.e. for the mean differential pressure (ΔP) at the time of full valve opening was measured. All experimental specimens were exposed to a mean blood pressure (MBP) of 90.5 ± 2.3 mmHg. RESULTS The V3 model demonstrated the best performance. The index defining the maximum opening of the bioprosthesis during systole for models V1, V2 and V3 was 2.67 ± 0.59, 2.04 ± 0.23 and 2.85 ± 0.59 cm2, respectively. The mean flow rate through the V3 valve was 5.7 ± 1, 6.9 ± 0.7 and 8.9 ± 1.4 l/min for stroke volume (SV) of 65, 90 and 110 mL, respectively. The phase of immediate opening and closure for models V1, V2 and V3 was 8, 7 and 5% of the cycle duration, respectively. The mean flow resistance of the models was: 4.07 ± 2.1, 4.28 ± 2.51 and 5.6 ± 2.32 mmHg. CONCLUSIONS The V3 model of the aortic valve prosthesis is the most effective. In vivo tests using BC as a structural material for this model are recommended. The response time of the V3 model to changed work conditions is comparable to that of a healthy human heart. The model functions as an aortic valve prosthesis in in vitro conditions.
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Affiliation(s)
- Kinga Dawidowska
- Medical Engineering Division, Maritime Advanced Research Centre, Szczecińska 65, 80-392, Gdańsk, Poland.
| | - Piotr Siondalski
- Cardiac and Vascular Surgery Department, Medical University of Gdańsk, Dębinki 7, 80-211, Gdańsk, Poland
| | - Magdalena Kołaczkowska
- Cardiac and Vascular Surgery Department, Medical University of Gdańsk, Dębinki 7, 80-211, Gdańsk, Poland
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Poulsen KB, Tjørnild MJ, Skov SN, Sharghbin M, Hanse LC, Benhassen LL, Røpcke DM, Nielsen SL, Hasenkam JM. Annular Dynamics and Leaflet Geometry in Patch Reconstruction of the Posterior Mitral Leaflet After Adding a Flexible Annuloplasty Ring. Cardiovasc Eng Technol 2020; 11:748-759. [PMID: 33200342 DOI: 10.1007/s13239-020-00502-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 11/05/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Patch reconstruction of the posterior mitral leaflet using small intestinal submucosa extracellular matrix has been successfully performed in a porcine study. The patch reconstruction, however, resulted in non-physiological systolic widening of the mitral annulus, suggesting the need for an annuloplasty ring. The objective was to characterize the impact on annular dynamics and leaflet geometry of adding a flexible annuloplasty ring to the posterior mitral leaflet patch reconstruction. METHODS Measurements were performed in an acute 80-kg porcine model, with seven pigs acting as their own controls. The posterior mitral leaflet was reconstructed with a 2-ply small intestinal submucosa extracellular matrix patch (CorMatrix®). Additionally, a Simulus® Flexible Annuloplasty Ring (Medtronic Inc., Minneapolis, MN, USA) was inserted. Mitral annular dynamics were evaluated using sonomicrometry, and leaflet geometry was described using echocardiography. RESULTS The annuloplasty ring reduced mitral annular dimensions and restricted cyclic changes in mitral annular area (126 ± 19 vs. 30 ± 13 mm2, p < 0.001), septal-lateral and commisure-commisure distances. Ring annuloplasty prevented systolic widening in the mitral annulus after posterior mitral leaflet reconstruction. The annular saddle shape and leaflet coaptation length (8.7 ± 2.3 vs. 9.7 ± 1.3 mm, p = 0.221) were comparable before and after ring insertion. CONCLUSIONS The flexible annuloplasty ring resulted in a downsized annulus with restriction of cyclic annular changes in the reconstructed mitral valve. Ring insertion preserved the annular saddle shape and coaptation length. The ring annuloplasty counteracted the non-physiological annular dynamics, and this may improve durability of the posterior mitral leaflet patch reconstruction.
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Affiliation(s)
- Karen B Poulsen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, 8200, Aarhus N, Denmark.
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
| | - Marcell J Tjørnild
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Søren N Skov
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Mona Sharghbin
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Lisa Carlson Hanse
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Leila L Benhassen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Diana M Røpcke
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Sten L Nielsen
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - J Michael Hasenkam
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, 8200, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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Mathur M, Malinowski M, Timek TA, Rausch MK. Tricuspid Annuloplasty Rings: A Quantitative Comparison of Size, Nonplanar Shape, and Stiffness. Ann Thorac Surg 2020; 110:1605-1614. [PMID: 32251659 PMCID: PMC11040511 DOI: 10.1016/j.athoracsur.2020.02.064] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/05/2020] [Accepted: 02/26/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Functional tricuspid regurgitation due to annular and ventricular dilatation is increasingly recognized as a significant source of morbidity and mortality. To repair the annulus, surgeons implant one of many annuloplasty devices that differ in size, 3-dimensional (3D) shape, and stiffness. However, there have been no quantitative comparisons between various available devices. METHODS Three-dimensional scanning, micro-computed tomography imaging, analytical methods, and mechanical tests were used to compare 3 Edwards Lifesciences (Irvine, CA) and 3 Medtronic (Minneapolis, MN) annuloplasty devices of all available sizes. We measured in-plane metrics of maximum diameter, perimeter, area, height, as well as elevation and curvature profiles. Furthermore, we computed bending stiffness as well as the maximum and minimum axes of the bending stiffness. RESULTS Most annular prostheses differed little in their in-plane geometries but varied significantly in height. In-plane properties deviated significantly from measurements of healthy human tricuspid annuli. Height of the Edwards' MC3 and Medtronic's Contour 3D resembled healthy human tricuspid valve annuli, whereas the Edwards' Physio and Classic, and Medtronic's TriAd, did not. Additionally, the elevation profiles of the MC3 and Contour 3D and curvature profiles between all devices were consistent and matched those of healthy human annuli. The tested devices also differed in their bending stiffness, both in terms of absolute values and their maximum and minimum axes. CONCLUSIONS Contoured devices, such as Edwards' MC3 and Medtronic's Contour 3D, most accurately resembled the healthy human tricuspid annulus but differed significantly in bending stiffness. To what extent prosthesis properties and shape affect tricuspid valve function remains to be determined.
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Affiliation(s)
- Mrudang Mathur
- Walker Department of Mechanical Engineering, The University of Texas at Austin, Austin, Texas
| | - Marcin Malinowski
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Michigan; Department of Cardiac Surgery, Medical University of Silesia School of Medicine in Katowice, Katowice, Poland
| | - Tomasz A Timek
- Division of Cardiothoracic Surgery, Spectrum Health, Grand Rapids, Michigan
| | - Manuel K Rausch
- Department of Aerospace Engineering and Engineering Mechanics, The University of Texas at Austin, Austin, Texas; Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX; Oden Institute for Computational Engineering and Science, The University of Texas at Austin, Austin, Texas.
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Addis DR, Law M, von Mering G, Ahmed M. Codeployment of a percutaneous edge-to-edge mitral valve repair device and a ventriculoseptal defect occluder device to address complex mitral regurgitation with leaflet perforation. Catheter Cardiovasc Interv 2020; 96:1333-1338. [PMID: 32735734 PMCID: PMC7680454 DOI: 10.1002/ccd.29147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/16/2020] [Accepted: 07/03/2020] [Indexed: 11/07/2022]
Abstract
An 80-year-old male with severe, complex mitral regurgitation (MR) after recent transcatheter aortic valve replacement presented in heart failure for percutaneous mitral valve repair and possible tricuspid valve repair. Transesopheageal echocardiography (TEE) demonstrated mixed Carpentier Types 1 and 2 components with annular dilation, two leaflet perforations, and excessive leaflet motion (P2 flail). There were three distinct MR jets appreciated reflecting a central coaptation defect and two posterior mitral valve leaflet perforations emanating from a cystic dilatation. Under TEE guidance transseptal puncture and percutaneous edge-to-edge mitral valve repair was performed with a MitraClip XTR device (Abbott, IL). A 10 mm Amplatzer Muscular VSD Occluder (Abbott, Abbott Park, IL) was deployed to close one of the perforations on the posterior leaflet with a significant reduction in MR severity. Attempts at crossing the remaining defect were unsuccessful and the procedure was concluded. The patient recovered uneventfully and transthoracic echocardiography on postoperative day (POD) 1 and again on POD 34 demonstrated normal systolic dominance on pulmonary venous Doppler interrogation, mild to moderate MR, and a mean transvalvular gradient of 5 mmHg. Both devices appeared firmly attached and stable. This is the first documented use of a VSD occluder device in this clinical scenario. Management of complex MR with an approach combining edge-to-edge repair for a central coaptation defect and leaflet flail with codeployment of a VSD occluder device to address a perforated leaflet is feasible and can achieve durable results.
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Affiliation(s)
- Dylan R Addis
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiothoracic Anesthesiology, Division of Molecular and Translational Biomedicine, and the UAB Comprehensive Cardiovascular Center, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Mark Law
- Department of Pediatrics, Division of Pediatric Cardiology and Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Gregory von Mering
- Department of Medicine, Division of Cardiovascular Disease, and the UAB Comprehensive Cardiovascular Center, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Mustafa Ahmed
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
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Abdulwadoud Alshoabi S, Noman Aljaber N, Omer Hussain A, Mohammed Aloufi K, Gafar Salih S. Khat Chewing Effect on the International Normalized Ratio in Patients with Mechanical Heart Valves under Warfarin Therapy. Pak J Biol Sci 2020; 23:1487-1491. [PMID: 33274879 DOI: 10.3923/pjbs.2020.1487.1491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Khat is a plant that contains the alkaloids cathine and cathinone which have some amphetamine-like properties. It is cultivated and it's leaves chewed for their euphoric effect. This study intended to elucidate the effect of khat chewing on blood coagulation by using the International Normalized Ratio (INR) value as a calculable benchmark. MATERIALS AND METHODS In this cohort study, 146 patients with Mechanical Heart Valves (MHV) were assessed for two consecutive visits at one-month intervals. For each visit, the date of surgery, the patient's compliance, the dose of warfarin and the INR reading were assessed by the researcher. RESULTS Out of 146 patients with MHV, the mean age was 33.72±12.43 years (range, 14-65 years); 82 (56.2%) were female and 64 (43.8%) were male. The results revealed that the mean of absolute INR readings was lower in khat-chewers than non-chewers by average 0.2 on the first and second visits (p = 0.038 and 0.002, respectively). CONCLUSION Khat chewing has a significant coagulant effect. There was a significant decrease in the value of INR for khat chewers patients with MHV when compared to non-khat chewers.
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Spieker M, Metze C, Kavsur R, Horn P, Iliadis C, Tiyerili V, Pfister R, Becher MU, Westenfeld R. Prognostic Value of the CHA 2DS 2-VASc Score in Patients Undergoing the MitraClip Procedure. JACC Cardiovasc Interv 2020; 12:2562-2564. [PMID: 31857031 DOI: 10.1016/j.jcin.2019.08.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 08/19/2019] [Accepted: 08/20/2019] [Indexed: 11/15/2022]
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Tozzi P, Kampouri EE, Tzimas G, Prior JO, Monney P, Kamani C, Lamoth F. COVID-19 Pandemics: A Surprising Link to Bread Flour With Collateral Damage to a Prosthetic Heart Valve. Circ Cardiovasc Imaging 2020; 13:e011395. [PMID: 33003958 DOI: 10.1161/circimaging.120.011395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Piergiorgio Tozzi
- Cardiac Surgery Division (P.T.), Lausanne University Hospital, CHUV, Lausanne, Switzerland
| | - Eleftheria Evdokia Kampouri
- Infectious Diseases Division and Institute of Microbiology (E.E.K., F.L.), Lausanne University Hospital, CHUV, Lausanne, Switzerland
| | - Georgios Tzimas
- Cardiology Service (G.T., P.M.), Lausanne University Hospital, CHUV, Lausanne, Switzerland
| | - John O Prior
- Nuclear Medicine and Molecular Imaging Department (J.O.P., C.K.), Lausanne University Hospital, CHUV, Lausanne, Switzerland
| | - Pierre Monney
- Cardiology Service (G.T., P.M.), Lausanne University Hospital, CHUV, Lausanne, Switzerland
| | - Christel Kamani
- Nuclear Medicine and Molecular Imaging Department (J.O.P., C.K.), Lausanne University Hospital, CHUV, Lausanne, Switzerland
| | - Frederic Lamoth
- Infectious Diseases Division and Institute of Microbiology (E.E.K., F.L.), Lausanne University Hospital, CHUV, Lausanne, Switzerland
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Furukawa Y, Miyake M, Fujita T, Koyama T, Takegami M, Kimura T, Sugio K, Takita A, Nishimura K, Izumi C. Rationale, Design, and Baseline Characteristics of the BioProsthetic Valves with Atrial Fibrillation (BPV-AF) Study. Cardiovasc Drugs Ther 2020; 34:689-696. [PMID: 32710129 PMCID: PMC7497314 DOI: 10.1007/s10557-020-07038-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To date, clinical data on real-world treatment practices in Japanese patients with atrial fibrillation (AF) after bioprosthetic valve (BPV) replacement are needed. We conducted a large-scale, prospective, multicenter study to understand the actual usage of antithrombotic therapy and the incidence of thromboembolic and bleeding events in these patients, and to eliminate the clinical data gap between Japan and Western countries. METHODS This was an observational study, in patients who had undergone BPV replacement and had a confirmed diagnosis of AF, with no mandated interventions. We report the baseline demographic and clinical data for the 899 evaluable patients at the end of the enrollment period. RESULTS Overall, 45.7% of patients were male; the mean age was 80.3 years; AF was paroxysmal, persistent, or permanent in 36.9%, 34.6%, and 28.5% of patients, respectively. Mean risk scores for stroke and bleeding were 2.5 (CHADS2), 4.1 (CHA2DS2-VASc), and 2.5 (HAS-BLED). Many patients (76.2%) had comorbid hypertension and 54.8% had heart failure. Most BPVs (65.5%) were positioned in the aortic valve. Warfarin-based therapy, direct oral anticoagulant (DOAC)-based therapy, and antiplatelet therapy (without warfarin and DOAC) were administered to 55.0%, 29.3%, and 9.7% of patients, respectively. CONCLUSION Patients enrolled into this study are typical of the wider Japanese AF/BPV population in terms of age and clinical history. Future data accruing from the observational period will contribute to future treatment recommendations and guide therapeutic decisions in patients with BPV and AF. TRIAL REGISTRATION ClinicalTrials.gov Identifier: UMIN000034485.
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Affiliation(s)
- Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
| | - Makoto Miyake
- Department of Cardiology, Tenri Hospital, Tenri, Japan
| | - Tomoyuki Fujita
- Cardiovascular Surgery Department, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tadaaki Koyama
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Misa Takegami
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tetsuya Kimura
- Medical Science Department, Daiichi Sankyo Co., Ltd, Tokyo, Japan
| | - Kumiko Sugio
- Medical Science Department, Daiichi Sankyo Co., Ltd, Tokyo, Japan
| | - Atsushi Takita
- Biostatistics and Data Management Department, Daiichi Sankyo Co., Ltd, Tokyo, Japan
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
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Sathananthan J, Hensey M, Fraser R, Landes U, Blanke P, Hatoum H, Dasi LP, Sedaghat A, Bapat VN, Leipsic J, Søndergaard L, Wood DA, Webb JG. Implications of hydrodynamic testing to guide sizing of self-expanding transcatheter heart valves for valve-in-valve procedures. Catheter Cardiovasc Interv 2020; 96:E332-E340. [PMID: 31647178 DOI: 10.1002/ccd.28537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 09/27/2019] [Indexed: 11/07/2022]
Abstract
AIMS The commonly used valve-in-valve (VIV) app recommends sizing based on dimensions of both the transcatheter heart valve (THV) and bioprosthetic surgical valve. The implications of hydrodynamic testing to guide VIV sizing are poorly understood. This bench study assessed the hydrodynamic performance of different sizes of self-expanding supra-annular THVs in three different surgical aortic bioprostheses at different implantation depths. METHODS A small versus medium ACURATE neo (ACn), and a 26 mm versus 29 mm Evolut R were assessed after VIV implantation in 25 mm Mitroflow, Mosaic, and Magna Ease aortic surgical bioprostheses, at three implantation depths (+2 mm, -2 mm, and -6 mm). RESULTS The medium-sized ACn had lower gradients compared to the small ACn when the THV was implanted high (+2 mm, or -2 mm). The 29 mm Evolut R had lower gradients compared to a 26 mm Evolut R for all implantation depths, except for a depth of -2 mm in the 25 mm Mitroflow. The medium ACn and 29 mm Evolut R had larger effective orifice areas compared to the small ACn and 26 mm Evolut R, respectively. Both Evolut R sizes had acceptable regurgitant fractions (<15%), while both ACn sizes were above the acceptable performance criteria (>15%), at all implantation depths. CONCLUSIONS Use of a larger self-expanding THV was associated with superior hydrodynamic performance if the THV was implanted high. Hydrodynamic testing can provide additional information to the VIV app to help guide VIV sizing.
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Affiliation(s)
- Janarthanan Sathananthan
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Mark Hensey
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | | | - Uri Landes
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Philipp Blanke
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, Canada
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, Canada
| | - Hoda Hatoum
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio
| | - Alexander Sedaghat
- Med. Klinik und Poliklinik II, Herzzentrum, Universitätsklinikum Bonn, Germany
| | | | - Jonathon Leipsic
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, Canada
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, Canada
| | - Lars Søndergaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - David A Wood
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - John G Webb
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, Canada
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Hatoum H, Maureira P, Lilly S, Dasi LP. Impact of Leaflet Laceration on Transcatheter Aortic Valve-in-Valve Washout: BASILICA to Solve Neosinus and Sinus Stasis. JACC Cardiovasc Interv 2020; 12:1229-1237. [PMID: 31272669 DOI: 10.1016/j.jcin.2019.04.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/26/2019] [Accepted: 04/09/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate any potential leaflet washout benefits after bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction during TAVR (BASILICA) in transcatheter valve-in-valve (ViV) in the context of leaflet thrombosis. BACKGROUND Leaflet thrombosis after transcatheter aortic valve replacement is secondary to flow stasis in both the sinus and neosinus. Strategies to improve washout and ameliorate neosinus and sinus flow velocities may have the potential to mitigate the occurrence of clinical and subclinical leaflet thrombosis. METHODS A 23-mm Edwards SAPIEN 3 and a 26-mm Medtronic Evolut were deployed in a 23-mm transparent surgical aortic valve model before and after leaflet laceration. The valves were placed in the aortic position of a pulse duplicator flow loop. Particle image velocimetry was performed to quantify sinus flow hemodynamic status. A tracing fluorescent dye was injected to evaluate the number of cycles to washout in both regions of interest. RESULTS The leaflet laceration procedure led to an increase in the velocities in the sinus and the neosinus by 50% for Evolut ViV and 61.9% for SAPIEN 3 ViV. In addition, leaflet laceration led to a reduction in overall cycles to washout in the neosinus by at least 56% with the Evolut and 54.5% with the SAPIEN 3 and in the sinus by at least 16.7% with the Evolut and 60.8% with the SAPIEN. CONCLUSIONS Leaflet laceration using a BASILICA-type approach may hold the potential to mitigate neosinus and sinus flow stasis. Controlled in vivo trials are necessary to establish the potential benefit of BASILICA to reduce the occurrence of leaflet thrombosis.
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Affiliation(s)
- Hoda Hatoum
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio
| | - Pablo Maureira
- Department of Cardiovascular Surgery, CHU de Nancy, Nancy, France
| | - Scott Lilly
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio.
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Niikura H, Bae R, Gössl M, Sun B, Mudy K, Sorajja P. Transcatheter Mitral Valve Repair of Recurrent Mitral Regurgitation Following Mitral Surgery. JACC Cardiovasc Interv 2020; 12:1395-1397. [PMID: 31320033 DOI: 10.1016/j.jcin.2019.02.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 02/26/2019] [Indexed: 11/30/2022]
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Maragiannis D, Jackson MS, Autry K, Flores Arredondo JH, Aggeli C, Tousoulis D, Zoghbi WA, Shah DJ, Little SH. Functional assessment of bioprosthetic mitral valves by cardiovascular magnetic resonance: An in vitro validation and comparison to Doppler echocardiography. J Cardiovasc Magn Reson 2020; 22:55. [PMID: 32727590 PMCID: PMC7392719 DOI: 10.1186/s12968-020-00635-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 05/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A comprehensive non-invasive evaluation of bioprosthetic mitral valve (BMV) function can be challenging. We describe a novel method to assess BMV effective orifice area (EOA) based on phase contrast (PC) cardiovascular magnetic resonance (CMR) data. We compare the performance of this new method to Doppler and in vitro reference standards. METHODS Four sizes of normal BMVs (27, 29, 31, 33 mm) and 4 stenotic BMVs (27 mm and 29 mm, with mild or severe leaflet obstruction) were evaluated using a CMR- compatible flow loop. BMVs were evaluated with PC-CMR and Doppler methods under flow conditions of; 70 mL, 90 mL and 110 mL/beat (n = 24). PC-EOA was calculated as PC-CMR flow volume divided by the PC- time velocity integral (TVI). RESULTS PC-CMR measurements of the diastolic peak velocity and TVI correlated strongly with Doppler values (r = 0.99, P < 0.001 and r = 0.99, P < 0.001, respectively). Across all conditions tested, the Doppler and PC-CMR measurement of EOA (1.4 ± 0.5 vs 1.5 ± 0.7 cm2, respectively) correlated highly (r = 0.99, P < 0.001), with a minimum bias of 0.13 cm2, and narrow limits of agreement (- 0.2 to 0.5 cm2). CONCLUSION We describe a novel method to assess BMV function based on PC measures of transvalvular flow volume and velocity integration. PC-CMR methods can be used to accurately measure EOA for both normal and stenotic BMV's and may provide an important new parameter of BMV function when Doppler methods are unobtainable or unreliable.
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Affiliation(s)
- Dimitrios Maragiannis
- Department of Cardiology, 401 General Military Hospital of Athens, Leoforos Mesogion 138, 11525, Athens, Greece.
| | - Matthew S Jackson
- Department of Cardiology, Houston Methodist Hospital, Houston, TX, USA
| | - Kyle Autry
- Department of Cardiology, Houston Methodist Hospital, Houston, TX, USA
| | | | - Constantina Aggeli
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - Dimitrios Tousoulis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, Greece
| | - William A Zoghbi
- Department of Cardiology, Houston Methodist Hospital, Houston, TX, USA
| | - Dipan J Shah
- Department of Cardiology, Houston Methodist Hospital, Houston, TX, USA
| | - Stephen H Little
- Department of Cardiology, Houston Methodist Hospital, Houston, TX, USA
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Keller K, Hobohm L, Geyer M, Kreidel F, Ostad MA, Lavie CJ, Lankeit M, Konstantinides S, Münzel T, von Bardeleben RS. Impact of obesity on adverse in-hospital outcomes in patients undergoing percutaneous mitral valve edge-to-edge repair using MitraClip® procedure - Results from the German nationwide inpatient sample. Nutr Metab Cardiovasc Dis 2020; 30:1365-1374. [PMID: 32513574 DOI: 10.1016/j.numecd.2020.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 03/29/2020] [Accepted: 04/08/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND AIM The number of percutaneous edge-to-edge mitral regurgitation (MR) valve repairs with MitraClip® implantations increased exponentially in recent years. Studies have suggested an obesity survival paradox in patients with cardiovascular diseases. We investigated the influence of obesity on adverse in-hospital outcomes in patients with MitraClip® implantation. METHODS AND RESULTS We analyzed data on characteristics of patients and in-hospital outcomes for all percutaneous mitral valve repairs using the edge-to-edge MitraClip®-technique in Germany 2011-2015 stratified for obesity vs. normal-weight/over-weight. The nationwide inpatient sample comprised 13,563 inpatients undergoing MitraClip® implantations. Among them, 1017 (7.5%) patients were coded with obesity. Obese patients were younger (75 vs.77 years,P < 0.001), more often female (45.4% vs.39.5%,P < 0.001), had more often heart failure (87.1% vs.79.2%,P < 0.001) and renal insufficiency (67.0% vs.56.4%,P < 0.001). Obese and non-obese patients were comparable regarding major adverse cardiac and cerebrovascular events (MACCE) and in-hospital death. The combined endpoint of cardio-pulmonary resuscitation (CPR), mechanical ventilation and death was more often reached in non-obese than in obese patients with a trend towards significance (20.6%vs.18.2%,P = 0.066). Obesity was an independent predictor of reduced events regarding the combined endpoint of CPR, mechanical ventilation and death (OR 0.75, 95%CI 0.64-0.89,P < 0.001), but not for reduced in-hospital mortality (P = 0.355) or reduced MACCE rate (P = 0.108). Obesity class III was associated with an elevated risk for pulmonary embolism (OR 5.66, 95%CI 1.35-23.77,P = 0.018). CONCLUSIONS We observed an obesity paradox regarding the combined endpoint of CPR, mechanical ventilation and in-hospital death in patients undergoing MitraClip® implantation, but our results failed to confirm an impact of obesity on in-hospital survival or MACCE.
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Affiliation(s)
- Karsten Keller
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Heart Center Mainz, Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.
| | - Lukas Hobohm
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Heart Center Mainz, Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Martin Geyer
- Heart Center Mainz, Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Felix Kreidel
- Heart Center Mainz, Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Mir A Ostad
- Heart Center Mainz, Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Carl J Lavie
- Department of Cardiovascular Disease, John Ochsner Heart & Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, United States
| | - Mareike Lankeit
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Department of Internal Medicine and Cardiology, Campus Virchow Klinikum (CVK), Charité-University Medicine, Berlin, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Stavros Konstantinides
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Department of Cardiology, Democritus University Thrace, Alexandroupolis, Greece
| | - Thomas Münzel
- Heart Center Mainz, Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Ralph Stephan von Bardeleben
- Heart Center Mainz, Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
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Rumpf PM, Lahmann AL, Joner M, Xhepa E. Successful Repeat Transcatheter Mitral Valve Replacement After Late Prosthesis Failure. JACC Cardiovasc Interv 2020; 13:e109-e110. [PMID: 32553345 DOI: 10.1016/j.jcin.2020.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/03/2020] [Accepted: 03/10/2020] [Indexed: 11/19/2022]
Affiliation(s)
| | - Anna Lena Lahmann
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Michael Joner
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Erion Xhepa
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
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45
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Tang GHL, Ro RJ, Sengupta A, Khera S, Sharma SK, Kini A, Lerakis S. A Novel Method to Quantify Leaflet Insertion During Transcatheter Mitral Valve Repair With the MitraClip. JACC Cardiovasc Interv 2020; 13:1499-1500. [PMID: 32222438 DOI: 10.1016/j.jcin.2020.01.199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/02/2020] [Accepted: 01/07/2020] [Indexed: 11/16/2022]
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46
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Fan L, Lucking AJ, Kelion A, Sabharwal N, Langrish JP. Aortic Pseudoaneurysm With Compression of Left Main Stem Following Aortic Valve Replacement. Can J Cardiol 2020; 36:968.e9-968.e11. [PMID: 32360172 DOI: 10.1016/j.cjca.2020.02.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 01/27/2020] [Accepted: 02/04/2020] [Indexed: 11/20/2022] Open
Affiliation(s)
- Lampson Fan
- Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom.
| | - Andrew J Lucking
- Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom
| | - Andrew Kelion
- Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom
| | - Nikant Sabharwal
- Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom
| | - Jeremy P Langrish
- Department of Cardiology, John Radcliffe Hospital, Oxford, United Kingdom
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47
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Ncho BE, Pierce EL, Bloodworth CH, Imai A, Okamoto K, Saito Y, Gorman RC, Gorman JH, Yoganathan AP. Optimized mitral annuloplasty ring design reduces loading in the posterior annulus. J Thorac Cardiovasc Surg 2020; 159:1766-1774.e2. [PMID: 31272749 PMCID: PMC6885108 DOI: 10.1016/j.jtcvs.2019.05.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/26/2019] [Accepted: 05/07/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The study objective was to develop a novel annuloplasty ring with regional flexibility and assess its suture force dynamics in healthy ovine subjects compared with fully rigid or fully flexible rings. METHODS Materially heterogeneous rings were created with rigid anterior and posterior, and flexible commissural segments. These rings were created to match the geometry of the Profile 3D ring (Medtronic, Minneapolis, Minn). Each ring was instrumented with 10 force transducers to measure cyclic suture forces (FC) and undersized annuloplasty was performed in 6 healthy ovine subjects. Each FC was recorded and examined for cardiac cycles reaching a maximum left ventricular pressure of 100, 125, and 150 mm Hg. FC was compared with previously reported values from fully rigid Profile 3D and fully flexible prototype rings. RESULTS Relative to the fully rigid ring, the heterogeneous ring exhibited 48% reduction in FC at its commissural (rigid vs heterogeneous: 1.80 ± 0.94 N vs 0.95 ± 0.52 N; P < .001) and 32% reduction in posterior (1.90 ± 0.92 N vs 1.29 ± 0.91 N; P < .001) regions, but not in its anterior region (2.45 ± 1.21 N vs 2.23 ± 1.22 N; P = .279). Relative to the fully flexible ring, the heterogeneous ring exhibited no significant differences in FC in any region. CONCLUSIONS The reduced FC of the heterogeneous ring relative to the fully rigid ring suggests a promising approach to reduce suture loading while preserving the annular remodeling capability of fully rigid rings. Future studies in diseased subjects are necessary to explore repair effectiveness of this ring.
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Affiliation(s)
- Beatrice E Ncho
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Ga
| | - Eric L Pierce
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Ga
| | - Charles H Bloodworth
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Ga
| | - Akito Imai
- Gorman Cardiovascular Research Group, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Keitaro Okamoto
- Gorman Cardiovascular Research Group, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Yoshiaki Saito
- Gorman Cardiovascular Research Group, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Robert C Gorman
- Gorman Cardiovascular Research Group, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Joseph H Gorman
- Gorman Cardiovascular Research Group, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Ajit P Yoganathan
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Ga.
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48
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Case BC, Khan JM, Satler LF, Ben-Dor I, Lederman RJ, Babaliaros VC, Greenbaum AB, Waksman R, Rogers T. Tip-to-Base LAMPOON to Prevent Left Ventricular Outflow Tract Obstruction in Valve-in-Valve Transcatheter Mitral Valve Replacement. JACC Cardiovasc Interv 2020; 13:1126-1128. [PMID: 32305393 DOI: 10.1016/j.jcin.2020.01.235] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 01/14/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Brian C Case
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC. https://twitter.com/bcase07
| | - Jaffar M Khan
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health (NIH), Bethesda, Maryland
| | - Lowell F Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Robert J Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health (NIH), Bethesda, Maryland
| | | | - Adam B Greenbaum
- Structural Heart and Valve Center, Emory University Hospital, Atlanta, Georgia
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC. https://twitter.com/ron_waksman
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health (NIH), Bethesda, Maryland.
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49
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Meijerink F, Bouma BJ, van den Brink RBA, Baan J. [Treatment of mitral regurgitation with the MitraClip]. Ned Tijdschr Geneeskd 2020; 164:D4381. [PMID: 32392000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The consideration for treatment of mitral regurgitation is dependent on its underlying cause: degenerative or functional. The percutaneous MitraClip treatment is mostly suitable for patients with severe, symptomatic mitral regurgitation and additional risk factors, who therefore do not qualify for surgical treatment but still have a life expectancy of more than one year. The MitraClip treatment has undergone technical improvements in the past ten years and has a low rate of periprocedural and postprocedural complications. Patients with severe functional mitral regurgitation, a relatively preserved left ventricular function, and a limited left ventricular volume benefit most from a MitraClip treatment. The number of MitraClip procedures in the Netherlands is strongly increasing and has shown good results. Besides the development of the MitraClip and introduction of new devices, careful patient selection is the most important instrument to achieve better results.
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Affiliation(s)
- Frank Meijerink
- Hartcentrum Amsterdam UMC, locatie AMC, Amsterdam
- Contact: Frank Meijerink
| | | | | | - Jan Baan
- Hartcentrum Amsterdam UMC, locatie AMC, Amsterdam
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50
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Lucinian YA, Lamarche Y, Demers P, Martineau P, Harel F, Pelletier-Galarneau M. FDG-PET/CT for the Detection of Infection Following Aortic Root Replacement Surgery. JACC Cardiovasc Imaging 2020; 13:1447-1449. [PMID: 32199841 DOI: 10.1016/j.jcmg.2020.01.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/31/2019] [Accepted: 01/02/2020] [Indexed: 12/11/2022]
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