Subject(s)
Aortic Valve Stenosis , Aortic Valve , Heart Valve Prosthesis , Transcatheter Aortic Valve Replacement , Humans , Transcatheter Aortic Valve Replacement/instrumentation , Transcatheter Aortic Valve Replacement/methods , Aortic Valve Stenosis/surgery , Treatment Outcome , Aortic Valve/surgery , Aortic Valve/diagnostic imaging , Male , Female , Aged, 80 and over , Aged , Prosthesis DesignSubject(s)
Aortic Valve , Cardiac Catheterization , Heart Valve Prosthesis Implantation , Heart Valve Prosthesis , Humans , Treatment Outcome , Aortic Valve/surgery , Aortic Valve/diagnostic imaging , Aortic Valve/physiopathology , Cardiac Catheterization/instrumentation , Heart Valve Prosthesis Implantation/instrumentation , Heart Valve Prosthesis Implantation/adverse effects , Suction , Transcatheter Aortic Valve Replacement/instrumentation , Transcatheter Aortic Valve Replacement/adverse effects , Male , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/surgery , Aortic Valve Stenosis/physiopathology , Aged, 80 and over , Echocardiography, Transesophageal , Prosthesis-Related Infections/surgery , Prosthesis-Related Infections/diagnostic imaging , Prosthesis-Related Infections/microbiology , Female , AgedSubject(s)
Aortic Valve Stenosis , Aortic Valve , Heart Valve Prosthesis Implantation , Humans , Aortic Valve/surgery , Aortic Valve Stenosis/surgery , Heart Valve Prosthesis , Heart Valve Prosthesis Implantation/adverse effects , Transcatheter Aortic Valve Replacement/adverse effects , Randomized Controlled Trials as TopicABSTRACT
Transcatheter aortic valve implantation (TAVI) was initially developed for adult patients, but there is a growing interest to expand this procedure to younger individuals with longer life expectancies. However, the gradual degradation of biological valve leaflets in transcatheter heart valves (THV) presents significant challenges for this extension. This study aimed to establish a multiphysics computational framework to analyze structural and flow measurements of TAVI and evaluate the integration of optical fiber and photoplethysmography (PPG) sensors for monitoring valve function. A two-way fluid-solid interaction (FSI) analysis was performed on an idealized aortic vessel before and after the virtual deployment of the SAPIEN 3 Ultra (S3) THV. Subsequently, an analytical analysis was conducted to estimate the PPG signal using computational flow predictions and to analyze the effect of different pressure gradients and distances between PPG sensors. Circumferential strain estimates from the embedded optical fiber in the FSI model were highest in the sinus of Valsalva; however, the optimal fiber positioning was found to be distal to the sino-tubular junction to minimize bending effects. The findings also demonstrated that positioning PPG sensors both upstream and downstream of the bioprosthesis can be used to effectively assess the pressure gradient across the valve. We concluded that computational modeling allows sensor design to quantify vessel wall strain and pressure gradients across valve leaflets, with the ultimate goal of developing low-cost monitoring systems for detecting valve deterioration.
Subject(s)
Heart Valve Prosthesis , Humans , Photoplethysmography/methods , Aortic Valve/physiology , Aortic Valve/surgery , Monitoring, Physiologic/methods , Monitoring, Physiologic/instrumentation , Transcatheter Aortic Valve Replacement , Hemodynamics/physiology , Optical FibersABSTRACT
Heart valve disease patients undergo multiple surgeries to replace structurally degraded valve prostheses, highlighting the need for valve replacements with growth and self-repair capacity. Given allogeneic valve transplantation's promise in meeting these goals by delivering a living valve replacement, we propose a framework for preserving and rehabilitating living valves ex vivo.
Subject(s)
Heart Defects, Congenital , Heart Valve Prosthesis , Humans , Heart Defects, Congenital/surgery , Heart Defects, Congenital/rehabilitation , Heart Valve Diseases/surgery , Heart Valve Diseases/rehabilitation , Heart Valves/surgery , Heart Valve Prosthesis Implantation/methodsABSTRACT
Infective endocarditis, particularly after implanting valve prostheses, poses significant surgical challenges, often requiring complex interventions. We describe a case of a 37-year-old male with Staphylococcus aureus endocarditis, unsuccessfully treated with mechanical valve prostheses. Continued infection led to the destruction of the intervalvular fibrous body, necessitating a Commando procedure involving radical debridement and replacement of both aortic and mitral valves with complex patch reconstruction. Prosthesis selection remains contentious, considering recurrence risk and long-term prognosis. Our case underscores timely intervention and meticulous technique in managing such complex situations. It highlights successful strategies for treating infective endocarditis with destruction of aortomitral continuity, emphasizing the pivotal role of the Commando procedure.
Subject(s)
Aortic Valve , Endocarditis, Bacterial , Heart Valve Prosthesis Implantation , Heart Valve Prosthesis , Prosthesis-Related Infections , Staphylococcal Infections , Humans , Male , Adult , Endocarditis, Bacterial/surgery , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/etiology , Heart Valve Prosthesis/adverse effects , Staphylococcal Infections/diagnosis , Staphylococcal Infections/surgery , Staphylococcal Infections/etiology , Prosthesis-Related Infections/surgery , Prosthesis-Related Infections/diagnosis , Prosthesis-Related Infections/etiology , Aortic Valve/surgery , Heart Valve Prosthesis Implantation/methods , Heart Valve Prosthesis Implantation/adverse effects , Mitral Valve/surgery , Staphylococcus aureus/isolation & purification , Reoperation , Debridement/methodsABSTRACT
INTRODUCTION: Avoiding patient-prosthesis mismatch (PPM) in patients with small aortic annulus (SAA) during aortic valve replacement (AVR) is still a challenging surgical problem. Among surgical options available, aortic root enlargement (ARE) and stentless valve implantation (SVI) are the two most commonly used strategies. This systematic review will be conducted searching for superiority evidence based on comparative studies between these two options. METHODS AND ANALYSIS: This systematic review will include all relevant articles published from 1 January 1946 to 31 March 2024, with available full texts from Medline (Ovid), Embase, Cochrane Library and Web of Science databases, without any language restriction. Observational studies and randomised controlled trials comparing surgical results of ARE versus SVI for AVR in patients with small aortic root will be screened. Studies will be classified into three groups: group 1 for studies that reported SVI or other tissue valve outcomes without comparing them with ARE outcomes; group 2 for studies that reported ARE outcomes without comparing them with SVI outcomes; and group 3 for studies that compared ARE outcomes with SVI outcomes. The quality of the evidence of each study will be evaluated according to Oxford Centre for Evidence-Based Medicine criteria. ETHICS AND DISSEMINATION: Ethical approval is not required because no primary data are collected. The findings will be presented at scientific conferences and/or reported in a peer-reviewed scientific journal. TRIAL REGISTRATION NUMBER: PROSPERO, CRD42023383793.
Subject(s)
Aortic Valve , Heart Valve Prosthesis Implantation , Heart Valve Prosthesis , Systematic Reviews as Topic , Humans , Heart Valve Prosthesis Implantation/methods , Aortic Valve/surgery , Research Design , Aortic Valve Stenosis/surgery , Prosthesis DesignABSTRACT
BACKGROUND AND OBJECTIVES: In patients with mechanical heart valves and recent intracranial hemorrhage (ICH), clinicians need to balance the risk of thromboembolism during the period off anticoagulation and the risk of hematoma expansion on anticoagulation. The optimal timing of anticoagulation resumption is unknown. We aimed to investigate the relationship between reversal therapy and ischemic stroke, between duration off anticoagulation and risk of ischemic strokes or systemic embolism and between timing of anticoagulation resumption and risk of rebleeding and ICH expansion. METHODS: We conducted a retrospective cohort observational study in 3 tertiary hospitals. Consecutive adult patients with mechanical heart valves admitted for ICH between January 1, 2000, and July 13, 2022, were included. The primary end points of our study were thromboembolic events (cerebral, retinal, or systemic) while off anticoagulation and ICH expansion after anticoagulation resumption (defined by the following criteria: increase by one-third in intracerebral hematoma volume, increase by one-third in convexity subdural hemorrhage diameter, or visually unequivocal expansion of other ICH locations to the naked eye). RESULTS: A total of 171 patients with mechanical heart valves who experienced ICH were included in the final analysis. Most of the patients (79.5%) received reversal therapy for anticoagulation. Patients who received anticoagulation reversal therapy did not have increased risk of thromboembolic complications. Time off anticoagulation was not associated with risk of ischemic stroke; only 2 patients had a stroke within 7 days of the ICH, and both had additional major risk factors of thromboembolism. The rate of ischemic stroke/transient ischemic attack while off anticoagulation was lower than the rate of ICH expansion once anticoagulation was resumed (6.4% vs 9.9%). Furthermore, patients who developed ICH expansion had higher mortality compared with patients who had ischemic stroke while being off anticoagulation (41% vs 9%). Use of intravenous heparin bridging upon resumption of warfarin was strongly associated with increased risk of ICH expansion as compared with restarting warfarin without a heparin bridge. DISCUSSION: Withholding anticoagulation for at least 7 days after ICH may be safe in patients with mechanical heart valves. Heparin bridging during anticoagulation resumption may be associated with increased risk of bleeding.
Subject(s)
Anticoagulants , Intracranial Hemorrhages , Thromboembolism , Humans , Male , Female , Anticoagulants/adverse effects , Anticoagulants/administration & dosage , Aged , Retrospective Studies , Middle Aged , Intracranial Hemorrhages/chemically induced , Intracranial Hemorrhages/epidemiology , Thromboembolism/prevention & control , Thromboembolism/etiology , Heart Valve Prosthesis/adverse effects , Ischemic Stroke , Time Factors , Risk Factors , Aged, 80 and overSubject(s)
Aortic Valve Stenosis , Heart Valve Prosthesis Implantation , Transcatheter Aortic Valve Replacement , Humans , Transcatheter Aortic Valve Replacement/methods , Heart Valve Prosthesis Implantation/methods , Aortic Valve Stenosis/surgery , Treatment Outcome , Aortic Valve/surgery , Heart Valve ProsthesisABSTRACT
BACKGROUND: The Alterra adaptive prestent is a novel self-expanding device designed to provide a landing zone for the 29 mm SAPIEN 3 valve to treat pulmonary regurgitation in patients with a right ventricular outflow tract that is too large for a balloon expandable valve alone. The mechanism of fixation for the Alterra prestent is radial force from the self-expanding stent frame, combined with a unique set of flared "tines" that protrude from both ends of the stent. AIMS, METHODS, AND RESULTS: In this report, we describe 6 patients who underwent uncomplicated transcatheter pulmonary valve replacement with an Alterra adaptive prestent and SAPIEN 3 valve and had surveillance chest computed tomography (CT) scans performed 1 day to 21 months after implant. In each patient, the CT scan demonstrated extravascular extension of a portion of the Alterra prestent, without clinical sequelae, but with extension into the ascending aorta in 1 patient and contact with the ascending aorta, left pulmonary vein, or left atrial appendage in 3 others. CONCLUSIONS: Surveillance CT imaging shows that the Alterra prestent can perforate the pulmonary artery and/or right ventricle. Although no sequelae were seen in these patients, prestent perforation has the potential to be clinically important. Implanters should be aware of this finding and its potential implications. As experience with the Alterra prestent grows, it will be important to further define the risk factors, incidence, and implications of this phenomenon.
Subject(s)
Heart Valve Prosthesis Implantation , Heart Valve Prosthesis , Predictive Value of Tests , Prosthesis Design , Humans , Male , Female , Treatment Outcome , Heart Valve Prosthesis Implantation/instrumentation , Heart Valve Prosthesis Implantation/adverse effects , Time Factors , Adult , Cardiac Catheterization/instrumentation , Cardiac Catheterization/adverse effects , Pulmonary Valve/diagnostic imaging , Pulmonary Valve/surgery , Pulmonary Valve/physiopathology , Pulmonary Valve Insufficiency/diagnostic imaging , Pulmonary Valve Insufficiency/physiopathology , Pulmonary Valve Insufficiency/surgery , Pulmonary Valve Insufficiency/etiology , Young Adult , Computed Tomography Angiography , Adolescent , Pulmonary Artery/diagnostic imaging , Pulmonary Artery/physiopathology , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Pulmonary valve regurgitation is a significant long-term complication in patients with tetralogy of Fallot (TOF). OBJECTIVE: This study aims to investigate the effects of pulmonary valve implantation (PVI) on the anatomy and function of the right ventricle (RV) and the long-term evolution of the implanted prosthesis in the pulmonary position. METHODS: A single-center retrospective cohort analysis was performed in 56 consecutive patients with TOF who underwent PVI. The study included patients of both sexes, aged ≥ 12 years, and involved assessing clinical and surgical data, pre- and post-operative cardiovascular magnetic resonance imaging, and echocardiogram data more than 1 year after PVI. RESULTS: After PVI, there was a significant decrease in RV end-systolic volume indexed by body surface area (BSA), from 89 mL/BSA to 69 mL/BSA (p < 0.001) and indexed RV end-diastolic volume, from 157 mL/BSA to 116 mL/BSA (p < 0.001). Moreover, there was an increase in corrected RV ejection fraction [ RVEFC = net pulmonary flow (pulmonary forward flow - regurgitant flow) / R V end-diastolic volume ] from 23% to 35% (p < 0.001) and left ventricular ejection fraction from 58% to 60% (p = 0.008). However, a progressive increase in the peak pulmonary valve gradient was observed over time, with 25% of patients experiencing a gradient exceeding 60 mmHg. Smaller prostheses (sizes 19 to 23) were associated with a 4.3-fold higher risk of a gradient > 60 mmHg compared to larger prostheses (sizes 25 to 27; p = 0.029; confidence interval: 1.18 to 17.8). CONCLUSION: As expected, PVI demonstrated improvements in RV volumes and function. Long-term follow-up and surveillance are crucial for assessing the durability of the prosthesis and detecting potential complications. Proper sizing of prostheses is essential for improved prosthesis longevity.
Subject(s)
Heart Valve Prosthesis Implantation , Heart Valve Prosthesis , Pulmonary Valve Insufficiency , Pulmonary Valve , Tetralogy of Fallot , Humans , Tetralogy of Fallot/surgery , Tetralogy of Fallot/physiopathology , Tetralogy of Fallot/diagnostic imaging , Male , Female , Retrospective Studies , Pulmonary Valve Insufficiency/surgery , Pulmonary Valve Insufficiency/physiopathology , Pulmonary Valve Insufficiency/diagnostic imaging , Pulmonary Valve Insufficiency/etiology , Pulmonary Valve/surgery , Pulmonary Valve/diagnostic imaging , Pulmonary Valve/physiopathology , Treatment Outcome , Adult , Adolescent , Young Adult , Time Factors , Child , Echocardiography , Ventricular Function, Right/physiology , Stroke Volume/physiology , Heart Ventricles/physiopathology , Heart Ventricles/diagnostic imaging , Magnetic Resonance Imaging , Postoperative PeriodABSTRACT
BACKGROUND: In this prospective, observational study, we aimed to investigate epidemiologic and microbial trends of infective endocarditis in western Norway. METHODS: Clinical and microbiological characteristics of 497 cases of infective endocarditis from 2016 through 2022 were investigated. Categorical data were analysed using Chi-squared tests. Survival data were analysed using multiple Cox regression and reported using hazard ratios. RESULTS: The mean age was 67 years, and 74% were men. The annual incidence rates varied from 10.4 to 14.1 per 100,000 inhabitants per year. Infective endocarditis on native valves was observed in 257 (52%) of the cases, whereas infective endocarditis on prosthetic valves and/or cardiac implantable electronic devices was observed in 240 (48%) of the cases: infection on surgically implanted bioprostheses was observed in 124 (25%) of the patients, infection on transcatheter aortic valve implantation was observed in 47 (10%) patients, and infection on mechanical valves was observed in 34 (7%) cases. Infection related to cardiac implantable electronic devices was observed in a total of 50 (10%) cases. Staphylococcus aureus and viridans streptococci were the most common microbial causes, and isolated in 145 (29%) and 130 (26%) of the cases, respectively. Enterococcal endocarditis showed a rising trend during the study period and constituted 90 (18%) of our total cases of infective endocarditis, and 67%, 47%, and 26% of the cases associated with prosthetic material, transcatheter aortic valve implantation and cardiac implantable electronic devices, respectively. There was no significant difference in 90-day mortality rates between the native valve endocarditis group (12%) and the group with infective endocarditis on prosthetic valves or cardiac implants (14%), p = 0.522. In a model with gender, age, people who inject drugs, microbiology and type of valve affected, only advanced age was significantly associated with fatal outcome within 90 days. CONCLUSIONS: The incidence of infective endocarditis, and particularly enterococcal endocarditis, increased during the study period. Enterococci appeared to have a particular affinity for prosthetic cardiac material. Advanced age was the only independent risk factor for death within 90 days.
Subject(s)
Prosthesis-Related Infections , Humans , Male , Norway/epidemiology , Female , Aged , Prospective Studies , Middle Aged , Aged, 80 and over , Prosthesis-Related Infections/epidemiology , Prosthesis-Related Infections/microbiology , Prosthesis-Related Infections/mortality , Incidence , Endocarditis/epidemiology , Endocarditis/microbiology , Endocarditis/mortality , Heart Valve Prosthesis/adverse effects , Heart Valve Prosthesis/microbiology , Endocarditis, Bacterial/epidemiology , Endocarditis, Bacterial/microbiology , Endocarditis, Bacterial/mortality , Adult , Staphylococcus aureus/isolation & purificationSubject(s)
Cardiac Catheterization , Heart Valve Prosthesis Implantation , Tricuspid Valve Insufficiency , Humans , Tricuspid Valve Insufficiency/surgery , Tricuspid Valve Insufficiency/etiology , Tricuspid Valve Insufficiency/physiopathology , Tricuspid Valve Insufficiency/diagnostic imaging , Heart Valve Prosthesis Implantation/adverse effects , Heart Valve Prosthesis Implantation/instrumentation , Cardiac Catheterization/adverse effects , Cardiac Catheterization/instrumentation , Cardiac Catheterization/methods , Treatment Outcome , Heart Valve Prosthesis , Tricuspid Valve/diagnostic imaging , Tricuspid Valve/surgery , Tricuspid Valve/physiopathology , Female , Ventricular Function, Right , Male , Aged , Ventricular Dysfunction, Right/etiology , Ventricular Dysfunction, Right/physiopathology , Ventricular Dysfunction, Right/diagnostic imagingABSTRACT
BACKGROUND: New prosthetic valves and surgical approaches that shorten operation time and improve the outcome of patients with aortic valve (AV) infective endocarditis (IE) and AV insufficiency (AVI) are crucial. The aim of this study was to evaluate the outcome of patients with AV IE or AVI treated with the EDWARDS INTUITY Rapid-Deployment AV prosthesis for this off-label indication. METHODS: This single-centre retrospective study analyzed data from patients who underwent AV replacement with the EDWARDS INTUITY Rapid-Deployment AV prosthesis for AV IE or regurgitation. (n = 8 for IE and n = 6 for AVI). RESULTS: Heart-lung machine times were significantly shorter in the AVI group (111.3 ± 20.7 min) compared to the IE group (171.9 ± 52.4 min) (p = 0.02). Aortic cross-clamp followed a similar trend (73.7 ± 9.9 min for AVI vs. 113.4 ± 35.6 min for IE) (p = 0.02). The length of ICU stay was also shorter in the AVI group (3.8 ± 2.6 days) compared to the IE group (16.9 ± 8.9 days) (p = 0.005). Postoperative echocardiography revealed no paravalvular leakage or significant valvular dysfunction in any patient. One patient died postoperatively from aspiration pneumonia. CONCLUSION: The INTUITY valve demonstrates as a safe option for complex AV IE and AVI surgery. Further prospective studies with larger patient cohorts are necessary to confirm these findings and explore the long-term benefits of this approach.
Subject(s)
Aortic Valve Insufficiency , Aortic Valve , Endocarditis , Heart Valve Prosthesis Implantation , Heart Valve Prosthesis , Humans , Male , Retrospective Studies , Female , Middle Aged , Aortic Valve Insufficiency/surgery , Heart Valve Prosthesis Implantation/methods , Endocarditis/surgery , Endocarditis/complications , Aortic Valve/surgery , Aged , Treatment Outcome , AdultABSTRACT
BACKGROUND: Interventional valve implantation into the inferior vena cava (CAVI) lowers venous congestion in patients with tricuspid regurgitation (TR). We evaluated the impact of a reduction of abdominal venous congestion following CAVI on circulating immune cells and inflammatory mediators. METHODS: Patients with severe TR were randomized to optimal medical therapy (OMT) + CAVI (n = 8) or OMT (n = 10). In the OMT + CAVI group, an Edwards Sapien XT valve was implanted into the inferior vena cava. Immune cells and inflammatory mediators were measured in the peripheral blood at baseline and three-month follow-up. RESULTS: Leukocytes, monocytes, basophils, eosinophils, neutrophils, lymphocytes, B, T and natural killer cells and inflammatory markers (C-reactive protein, interferon-gamma, interleukin-2, -4, -5, -10, and tumor necrosis factor-alpha) did not change substantially between baseline and three-month follow-up within the OMT + CAVI and OMT group. CONCLUSION: The present data suggest that reduction of venous congestion following OMT + CAVI may not lead to substantial changes in systemic inflammation within a short-term follow-up. CLINICAL TRIAL REGISTRATION: NCT02387697.
Subject(s)
Heart Valve Prosthesis Implantation , Inflammation Mediators , Severity of Illness Index , Tricuspid Valve Insufficiency , Vena Cava, Inferior , Humans , Male , Female , Vena Cava, Inferior/diagnostic imaging , Vena Cava, Inferior/immunology , Inflammation Mediators/blood , Treatment Outcome , Tricuspid Valve Insufficiency/surgery , Tricuspid Valve Insufficiency/blood , Tricuspid Valve Insufficiency/diagnostic imaging , Tricuspid Valve Insufficiency/physiopathology , Tricuspid Valve Insufficiency/etiology , Tricuspid Valve Insufficiency/immunology , Middle Aged , Heart Valve Prosthesis Implantation/adverse effects , Heart Valve Prosthesis Implantation/instrumentation , Aged , Biomarkers/blood , Time Factors , Heart Valve Prosthesis , Tricuspid Valve/surgery , Tricuspid Valve/physiopathology , Tricuspid Valve/immunology , Tricuspid Valve/diagnostic imaging , Cytokines/blood , Prosthesis Design , Prospective StudiesABSTRACT
OBJECTIVE: This study aimed to compare hemodynamic performances and clinical outcomes of patients with small aortic annulus (SAA) who underwent aortic valve replacement by means of sutureless aortic valve replacement (SUAVR) or transcatheter aortic valve implantation (TAVI). METHODS: From 2015 to 2020, 622 consecutive patients with SAA underwent either SUAVR or TAVI. Through a 1:1 propensity score matching analysis, two homogeneous groups of 146 patients were formed. Primary endpoint: all cause-death at 36 months. Secondary endpoints: incidence of moderate to severe patient-prosthesis mismatch (PPM) and incidence of major adverse cardiovascular and cerebrovascular events (MACCEs). RESULTS: All-cause death at three years was higher in the TAVI group (SUAVR 12.2% vs. TAVI 21.0%, P=0.058). Perioperatively, comparable hemodynamic performances were recorded in terms of indexed effective orifice area (SUAVR 1.12 ± 0.23 cm2/m2 vs. TAVI 1.17 ± 0.28 cm2/m2, P=0.265), mean transvalvular gradients (SUAVR 12.9 ± 5.3 mmHg vs. TAVI 12.2 ± 6.2 mmHg, P=0.332), and moderate-to-severe PPM (SUAVR 4.1% vs. TAVI 8.9%, P=0.096). TAVI group showed a higher cumulative incidence of MACCEs at 36 months (SUAVR 18.1% vs. TAVI 32.6%, P<0.001). Pacemaker implantation (PMI) and perivalvular leak ≥ 2 were significantly higher in TAVI group and identified as independent predictors of mortality (PMI: hazard ratio [HR] 3.05, 95% confidence interval [CI] 1.34-6.94, P=0.008; PPM: HR 2.72, 95% CI 1.25-5.94, P=0.012). CONCLUSION: In patients with SAA, SUAVR and TAVI showed comparable hemodynamic performances. Moreover, all-cause death and incidence of MACCEs at follow-up were significantly higher in TAVI group.