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structural valve deterioration

Iman Manavitehrani, Pegah Ebrahimi, Irene Yang, Sean Daly, Aaron Schindeler, Akshat Saxena, David G Little, David F Fletcher, Fariba Dehghani, David S Winlaw
Despite advances in modern surgery, congenital heart disease remains a medical challenge and major cause of infant mortality. Valved conduits are routinely used to surgically correct blood flow in hearts with congenital malformations by connecting the right ventricle to the pulmonary artery (RV-PA). This review explores the current range of RV-PA conduits and describes their strengths and disadvantages. Homografts and xenografts are currently the primary treatment modalities, however both graft types have limited biocompatibility and durability, and present a disease transmission risk...
February 14, 2019: Cardiovascular Engineering and Technology
John Chambers, Madalina Garbi, Norman Briffa, Vishal Sharma, Rick Steeds
Echocardiography plays a vital role in the follow up of patients with replacement heart valves. However, there is considerable variation in international guidelines regarding the recommended time points after implantation at which routine echocardiography should be performed. The purpose of routine echocardiography is to detect early structural valve deterioration in biological valves to improve the timing of redo interventions. However the risk of valve deterioration depends on many valve-related factors (valve design, patient prosthesis mismatch) and patient-related factors (age, diabetes, systemic hypertension, renal dysfunction and smoking)...
February 1, 2019: Echo Research and Practice
Jonathan R G Etnel, Simone A Huygens, Pepijn Grashuis, Begüm Pekbay, Grigorios Papageorgiou, Jolien W Roos Hesselink, Ad J J C Bogers, Johanna J M Takkenberg
Background To support decision-making in aortic valve replacement in nonelderly adults, we aim to provide a comprehensive overview of reported outcome after bioprosthetic aortic valve replacement and to translate this to age-specific patient outcome estimates. Methods and Results A systematic review was conducted for papers reporting clinical outcome after aortic valve replacement with currently available bioprostheses in patients with a mean age <55 years, published between January 1, 2000, and January 9, 2016...
February 2019: Circulation. Cardiovascular Quality and Outcomes
Andrew Jones, Steven Livesey
Left ventricular outflow tract (LVOT) obstruction (LVOTO) is a rare but recognized complication of mitral valve surgery. Concomitant factors can cause significant clinical deterioration which requires urgent intervention. We present the case of a female patient who underwent closed valvotomy at age 20 for mitral stenosis secondary to rheumatic heart disease. Seventeen years later, a re-stenosed valve prompted mitral valve replacement (MVR) with a Carbomedics mechanical prosthesis. 8 years later, she re-presented with increasing dyspnoea...
January 2019: Journal of Surgical Case Reports
Lars Søndergaard, Nikolaj Ihlemann, Davide Capodanno, Troels H Jørgensen, Henrik Nissen, Bo Juel Kjeldsen, Yanping Chang, Daniel Andreas Steinbrüchel, Peter Skov Olsen, Anna Sonia Petronio, Hans Gustav Hørsted Thyregod
BACKGROUND: Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis and intermediate or high surgical risk. OBJECTIVES: The aim of this study was to compare the durability of transcatheter and surgical bioprosthetic aortic valves using standardized criteria. METHODS: In the NOTION (Nordic Aortic Valve Intervention) trial, all-comer patients with severe aortic stenosis and lower surgical risk for mortality were randomized 1:1 to TAVR (n = 139) or SAVR (n = 135)...
February 12, 2019: Journal of the American College of Cardiology
Anne Kristin Schaefer, Martin Andreas, Paul Werner, Carlo Gaetano Sassi, Thomas Haberl, Alfred Kocher, Guenther Laufer, Marco Russo
Structural valve deterioration represents the most important concern regarding the implantation of a biological heart valve in young patients. Several strategies have been proposed to improve prosthesis design in order to optimize performance and durability. Here we describe an early and specific mode for valve degeneration of prosthesis with outwards mounted pericardial leaflets due to pannus overgrowth on the aortic side. This led to leaflet retraction in two consecutive cases four and six years after the first implantation of a Trifecta valve...
January 23, 2019: Annals of Thoracic Surgery
Tomasz Stankowski, Sleiman Sebastian Aboul-Hassan, Farzaneh Seifi-Zinab, Volker Herwig, Miroslava Kubikova, Axel Harnath, Dirk Fritzsche, Bartłomiej Perek
OBJECTIVES: The aim of this study was to evaluate outcomes of valve-in-valve transcatheter aortic valve implantation (VIV-TAVI) in patients with degenerated small bioprostheses. METHODS: Outcomes of consecutive 27 high-risk patients (logistic EuroSCORE 35.5 ± 18.5%) with a mean age of 81.0 ± 5.9 years who underwent VIV-TAVI for degenerated small bioprostheses (19 mm-11.1%; 20 mm-11.1%; 21 mm-77.8%) were analyzed. Medtronic CoreValve (n = 11) or CoreValve Evolut-R prostheses (n = 16) were implanted...
January 9, 2019: Journal of Cardiac Surgery
Amine Mazine, Subodh Verma, Bobby Yanagawa
PURPOSE OF REVIEW: The purpose of this study is to review the contemporary evidence surrounding aortic bioprosthetic valve deterioration, with a focus on early failure of surgically implanted valves. RECENT FINDINGS: Structural valve deterioration (SVD) remains the most frequent cause of premature bioprosthetic aortic valve failure. However, recent evidence suggests that SVD represents a spectrum, and that clinically silent hemodynamic valve deterioration frequently precedes and predisposes to overt SVD...
December 19, 2018: Current Opinion in Cardiology
Romain Didier, Hélène Eltchaninoff, Patrick Donzeau-Gouge, Karine Chevreul, Jean Fajadet, Pascal Leprince, Alain Leguerrier, Michel Lièvre, Alain Prat, Emmanuel Teiger, Thierry Lefevre, Didier Tchetché, Didier Carrié, Dominique Himbert, Bernard Albat, Alain Cribier, Arnaud Sudre, Didier Blanchard, Gilles Rioufol, Frederic Collet, Remi Houel, Pierre Dos Santos, Nicolas Meneveau, Said Ghostine, Thibaut Manigold, Philippe Guyon, Thomas Cuisset, Herve Le Breton, Stephane Delepine, Xavier Favereau, Geraud Souteyrand, Patrick Ohlmann, Vincent Doisy, Thérèse Lognoné, Antoine Gommeaux, Jean-Philippe Claudel, Francois Bourlon, Bernard Bertrand, Bernard Iung, Martine Gilard
BACKGROUND: The FRANCE-2 registry (French Aortic National Corevalve and Edwards) previously reported good early- and medium-term clinical and echocardiographic efficacy for transcatheter aortic valve replacement. We here report 5-year follow-up results from the registry. METHODS: The registry includes all consecutive patients undergoing transcatheter aortic valve replacement for severe aortic stenosis in France. Follow-up is scheduled at 30 days, 6 months, then annually from 1 to 5 years...
December 4, 2018: Circulation
Francesca R Pluchinotta, Breanna L Piekarski, Valentina Milani, Oliver Kretschmar, Phillip T Burch, Lale Hakami, David B Meyer, Frederic Jacques, Olivier Ghez, Matteo Trezzi, Adriano Carotti, Shakeel A Qureshi, Ina Michel-Behnke, James M Hammel, Paul Chai, David McMullan, Bret Mettler, Queralt Ferrer, Mario Carminati, Sitaram M Emani
Background Pediatric patients with atrioventricular valve disease have limited options for prosthetic valve replacement in sizes <15 mm. Based on successful experience with the stented bovine jugular vein graft (Melody valve) in the right ventricular outflow tract, the prosthesis has been modified for surgical valve replacement in pediatric patients with atrioventricular dysfunction with the intention of subsequent valve expansion in the catheterization laboratory as the child grows. Methods and Results A multicenter, retrospective cohort study was performed among patients who underwent atrioventricular valve replacement with Melody valve at 17 participating sites from North America and Europe, including 68 patients with either mitral (n=59) or tricuspid (n=9) replacement at a median age of 8 months (range, 3 days to 13 years)...
November 2018: Circulation. Cardiovascular Interventions
Erwan Salaun, Nancy Côté, Marie-Annick Clavel, Philippe Pibarot
PURPOSE OF REVIEW: Bioprosthetic valves are now used for the majority of surgical aortic valve replacements and for all transcatheter aortic valve replacements. However, bioprostheses are subject to structural valve deterioration (SVD) and have, therefore limited durability. RECENT FINDINGS: Clinical, imaging, and circulating biomarkers may help to predict or indicate the presence of bioprosthetic valve SVD. The most important biomarkers of SVD includes: patient-related clinical biomarkers, such as diabetes and renal failure; valve-related biomarkers, such as absence of antimineralization process and severe prosthesis-patient mismatch; imaging biomarkers: the presence of valve leaflet mineralization on multidetector computed tomography or sodium fluoride uptake on positron emission tomography; and circulating biomarkers including: increased levels of HOMA index, ApoB/ApoA-I ratio, PCSK9, Lp-PLA2, phosphocalcic product...
December 17, 2018: Current Opinion in Cardiology
Roberta Antonazzo Panico, Cristina Giannini, Marco De Carlo, Marco Angelillis, Paolo Spontoni, Andrea Pieroni, Giulia Costa, Pietro Bertini, Fabio Guarracino, Anna Sonia Petronio
AIMS: to determine long-term outcomes of high-risk patients who underwent transcatheter aortic valve implantation (TAVI) with third-generation CoreValve device, according to the 2017 EAPCI/ESC/EACTS definition of valve durability. METHODS AND RESULTS: between 2007 and 2013, 278 consecutive patients were enrolled in our prospective single-centre CoreValve registry (mean age 82±6 years, mean STS score 6.4±5.0%); median follow-up of survivors was 6.8 years. The Cox proportional hazards model was used to identify independent predictors of HF-rehospitalization and all-cause mortality...
December 18, 2018: EuroIntervention
Michele Celiento, Giacomo Ravenni, Leonardo Tomei, Stefano Pratali, Aldo D Milano, Uberto Bortolotti
BACKGROUND: Biological prostheses are widely employed for aortic valve replacement (AVR). The study aim was to evaluate the performance of the Mosaic porcine bioprosthesis in the aortic position over two decades. METHODS: Between November 1995 and December 2016, a total of 254 patients (194 males, 60 females; mean age 74 ± 9 years) underwent AVR with a Mosaic bioprosthesis at the authors' institution. Among the patients, 14% were aged ≥80 years and 86% had pure or prevalent calcific aortic stenosis...
January 2018: Journal of Heart Valve Disease
Katherine V Gates, Qi Xing, Leigh G Griffiths
PURPOSE: The purpose of this case-control retrospective discovery study is to identify antigenic bovine pericardium (BP) proteins that stimulate graft-specific humoral immune response in patients implanted with glutaraldehyde fixed bovine pericardial (GFBP) heart valves. EXPERIMENTAL DESIGN: Banked serum was collected from age and sex matched patients who had received either a GFBP or mechanical heart valve replacement. Serum IgG was isolated and used to generate poly-polyclonal antibody affinity chromatography columns from each patient...
December 13, 2018: Proteomics. Clinical Applications
Andrea L Axtell, David C Chang, Serguei Melnitchouk, Arminder S Jassar, George Tolis, Mauricio A Villavicencio, Thoralf M Sundt, David A D'Alessandro
BACKGROUND: Structural valve deterioration (SVD) is a known limitation of bioprosthetic valves. Recent reports have suggested a concerning rate of early SVD in patients receiving a Mitroflow aortic bioprosthesis. We therefore compared the incidence of SVD and SVD requiring reoperation among patients receiving a Mitroflow versus a common contemporary bioprosthesis. METHODS: A retrospective cohort analysis was performed on 592 patients receiving a Mitroflow aortic bioprosthesis at our institution between 2010 and 2014...
December 7, 2018: Journal of Cardiac Surgery
Benish Fatima, Divyanshu Mohananey, Fazal W Khan, Yash Jobanputra, Ramyashree Tummala, Kinjal Banerjee, Amar Krishnaswamy, Stephanie Mick, E Murat Tuzcu, Eugene Blackstone, Lars Svensson, Samir Kapadia
Importance: Although several studies have reported data on surgical aortic valve durability, variability in study methodologies and definitions as well as inadequate follow-up make the interpretation of data from these studies difficult to interpret. Objective: To review available data on structural valve deterioration (SVD) of surgical bioprosthetic aortic valves by examining the published literature as well as data reported to the US Food and Drug Administration (FDA)...
December 5, 2018: JAMA Cardiology
Arman Kilic, Ibrahim Sultan, Forozan Navid, Edgar Aranda-Michel, Danny Chu, Floyd Thoma, Thomas G Gleason
BACKGROUND: The St. Jude Medical Trifecta bioprosthesis is a bovine pericardial valve mounted on a titanium stent. The objective of this study was to report a single center experience with the Trifecta aortic valve. METHODS: Patients undergoing aortic valve replacement (AVR) with the Trifecta valve between 2011-2017 at a single center were included. The primary outcome was overall survival. Secondary outcomes included operative mortality and morbidity, aortic valve reoperations, and reoperation for structural valve deterioration...
December 1, 2018: Annals of Thoracic Surgery
Akash Kataruka, Catherine M Otto
Transcatheter aortic valve implantation (TAVI) is a minimally invasive procedure to treat severe symptomatic aortic stenosis. While the TAVI procedure can be performed safely and provide excellent 5-year results, little is known about long-term durability. TAVI valves are composed of bioprosthetic leaflets are prone to deterioration, which are categorized as structural valve deterioration (SVD) and non-SVD. SVD refers to an intrinsic pathology of the leaflets or stent structure with mechanisms that include leaflet calcification, leaflet tear, stent fracture, or stent creep...
November 2018: Journal of Thoracic Disease
Simone A Huygens, Jonathan R G Etnel, Milad Hanif, Jos A Bekkers, Ad J J C Bogers, Maureen P M H Rutten-van Mölken, Johanna J M Takkenberg
OBJECTIVE: To support decision-making in aortic valve replacement (AVR) in elderly patients, we provide a comprehensive overview of outcome after AVR with bioprostheses. METHODS: A systematic review was conducted of studies reporting clinical outcome after AVR with bioprostheses in elderly patients (mean age ≥70 years; minimum age ≥65 years) published between January 1, 2000, to January 9, 2016. Reported event rates and time-to-event data were pooled and entered into a microsimulation model to calculate life expectancy and lifetime event risks...
October 22, 2018: Journal of Thoracic and Cardiovascular Surgery
Naoto Fukunaga, Tadaaki Koyama
PURPOSE: Isolated tricuspid valve surgery (TVS) following valvular surgery has been still challenging. We reviewed our experience to determine early and late outcomes. METHODS: We retrospectively analyzed 14 patients (mean age, 57.0 ± 17.8 years old) who underwent isolated TVS after valvular surgery between January 1990 and December 2010. The causes of isolated TVS were structural valve deterioration (SVD) (n = 5) and symptomatic severe tricuspid regurgitation (n = 9)...
November 28, 2018: Annals of Thoracic and Cardiovascular Surgery
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