scholarly journals Aortic Annular Enlargement during Aortic Valve Replacement

2016 ◽  
Vol 4 (3) ◽  
pp. 455-457 ◽  
Author(s):  
Selman Dumani ◽  
Ermal Likaj ◽  
Laureta Dibra ◽  
Stavri Llazo ◽  
Ali Refatllari
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Left Ventricular ◽  
Aortic Annulus ◽  
Patient Prosthesis Mismatch ◽  
Potential Benefits ◽  
Transvalvular Gradient

In the surgery of aortic valve replacement is always attempted, as much as possible, to implant the larger prosthesis with the mains goals to enhance the potential benefits, to minimise transvalvular gradient, decrease left ventricular size and avoid the phenomenon of patient-prosthesis mismatch. Implantation of an ideal prosthesis often it is not possible, due to a small aortic annulus. A variety of aortic annulus enlargement techniques is reported to avoid patient-prosthesis mismatch. We present the case that has submitted four three times open heart surgery. We used Manouguian technique to enlarge aortic anulus with excellent results during the fourth time of surgery.

A Clinical Study of Isolated Aortic Valve Replacement: A Univariate Analysis of Risk Factors

1993 ◽  
Vol 1 (3) ◽  
pp. 137-142 ◽  
Author(s):  
Kim Wook Sung ◽  
Lee Jeong Ryul ◽  
Kim Ki Bong ◽  
Sung Sook Whan ◽  
Ahn Hyuk ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Heart Surgery ◽  
Nyha Class ◽  
Univariate Analysis ◽  
Survival Rates ◽  
Open Heart Surgery ◽  
Class Iii ◽  
Preoperative Serum

Between 1979 and 1990, 190 patients underwent isolated aortic valve replacement at Seoul National University Hospital in Korea. There were 11 (5.8%) in-hospital deaths. Univariate analysis identified advanced age (p = 0.026), preoperative serum GOT or GPT greater than 40IU/1 (p < 0.001, p = 0.003), NYHA Class III or IV (p = 0.029), preoperative mean pulmonary arterial pressure greater than 19 mmHg (p = 0.019), reoperation for aortic valve replacement (p = 0.035), second or third open heart surgery (p < 0.001), and use of mechanical valve (p = 0.008) as variables associated with increased in-hospital risk. Follow-up documented survival rates of 98.1% and 96.4% and event-free survival rates of 95.7% and 81.6% at 3 and 7 postoperative years, respectively. NYHA Class III or IV (p = 0.009), preoperative serum total bilirubin level greater than 1.2 mg/dl (p = 0.009), reoperation for aortic valve replacement (p = 0.03), second or third open heart surgery (p = 0.002), and use of mechanical valve were associated with decreased late survival and event-free survival.

Simultaneous Repair of Severe Pectus Excavatum and Aortic Valve Replacement Following Previous Open-Heart Surgery

1988 ◽  
Vol 45 (1) ◽  
pp. 82-84 ◽  
Author(s):  
Warren L. Gould ◽  
G.K. Jett ◽  
John Bostwick ◽  
Ellis L. Jones ◽  
Kamal A. Mansour
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Pectus Excavatum ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Open Heart

Patient-Specific Computational Simulations of Transcatheter Aortic Valve Implantation (TAVI)

2013 ◽  
Author(s):  
Giorgia M. Bosi ◽  
Claudio Capelli ◽  
Robin Chung ◽  
Michael Mullen ◽  
Andrew M. Taylor ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Vascular Complications ◽  
Negative Influence ◽  
Paravalvular Leak ◽  
Patient Specific ◽  
Transcatheter Aortic Valve

In the past decade, Transcatheter Aortic Valve Replacement (TAVI) has been shown to be a feasible, less invasive option to open heart surgery for aortic valve replacement; however, TAVI is indicated only in patients with severe, symptomatic, aortic stenosis and who are considered at high or prohibitive risk for conventional surgery [1]. To date, two different TAVI devices are available on the market — the balloon-expandable Edwards-Sapien® Valve (Edwards Lifesciences, CA, USA) and the self-expandable CoreValve ReValving System® (Medtronic, MN, USA) — with many other devices currently under development and clinical trials. The procedural success rate has been >90% in all studies [1], but vascular complications, electrical conduction abnormalities and paravalvular leak — 65–89% of cases, the majority being trivial to mild, with 0 to 26% moderate and 0 to 10% severe — still remain major safety concerns. In particular, a negative influence of moderate to severe paravalvular leak on survival rates has recently been demonstrated [2].

scholarly journals Low-Flow, Low-Gradient Severe Aortic Stenosis: Cardiac Computed Tomography Findings and Clinical Outcomes After Aortic Valve Replacement

2021 ◽  
Author(s):  
Se Jin Choi ◽  
Yura Ahn ◽  
Hyun Jung Koo ◽  
Dae-Hee Kim ◽  
Soyeon Lim ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Old Age ◽  
Valve Replacement ◽  
Left Ventricular ◽  
Aortic Annulus ◽  
Low Flow ◽  
High Gradient

Abstract Aortic valve calcium scoring by cardiac computed tomographic (CT) has been recommended as an alternative to classify the AS severity, but it is unclear that whether CT findings can predict and have prognostic implication in low-flow, low-gradient aortic stenosis (LF-LG AS), which has fewer benefit from surgery among the AS subtypes. In this study, we examined the clinical and cardiac CT findings of LF-LG AS patients and evaluated factors affecting outcomes after surgical aortic valve replacement (AVR). This study included 511 (66.9±8.8 years, 55% men) consecutive patients with severe AS who underwent surgical AVR. Aortic valve area (AVA) was obtained by echocardiography (AVAecho) and by CT (AVACT) using each modalities measurement of the left ventricular outflow tract. Patients with AS were classified as 1) high-gradient severe (n=438), 2) classic LF-LG (n=18), and 3) paradoxical LF-LG (n=55) based on echocardiography. Classic LF-LG AS patients had higher end-systolic and end-diastolic volume indices, lower left ventricular ejection fraction, larger AVAecho and AVACT, and larger aortic annulus compared to high-gradient severe AS (P<0.05, for all). In classic LF-LG AS group, 27.8% of patients presented AVACT≥1.2 cm2. After multivariable adjustment, old age (hazard ratio [HR], 1.04, P=0.049), high B-type natriuretic peptide (BNP) (HR, 1.005; P<0.001), preoperative atrial fibrillation (HR, 2.75; P=0.003), classic LF-LG AS (HR, 5.53, P=0.004), and small aortic annulus (HR, 0.57; P=0.002) were independently associated with major adverse cardiac and cerebrovascular events (MACCE). The classic LF-LG AS group presented larger AVACT and aortic annulus than those in high-gradient severe AS group and one third of them had AVACT ≥1.2 cm2. Old age, high BNP, atrial fibrillation, classic LF-LG AS, and small aortic annulus were associated with MACCE in severe AS patients after surgical AVR.

Abstract 16920: Transcatheter Aortic Valve Replacement in Aortic Regurgitation: The U.S. Experience

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Chinmy T Jani ◽  
Shilpkumar Arora ◽  
Sopan Lahewala ◽  
ZACHARY ZUZEK ◽  
Rahul Jaswaney ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Vascular Complications ◽  
Paravalvular Leak ◽  
Open Heart ◽  
Transcatheter Aortic Valve

Background: Transcatheter aortic valve replacement (TAVR) may be an effective option for high-risk AR patients. Although international experiences of TAVR for AR are published, U.S. data is limited. The primary objective of this study was to investigate periprocedural and 30-days outcomes in terms of mortality and post-procedural complications in patients undergoing TAVR for AR using large national U.S. databases. Hypothesis: TAVR is a promising option in AR Methods: Study cohorts were derived from Nationwide Inpatient Sample (NIS) and Nationwide Readmissions Database (NRD) 2016-17. TAVR and AR were identified using ICD-10-CM-codes. The key outcomes were all-cause mortality, disabling stroke, valvular complications, complete heart block (CHB)/ permanent pacemaker placement (PPM), open heart surgery, acute kidney injury (AKI) requiring dialysis, and vascular complications. Multivariate logistic regression was used to adjust for confounders. Results: 915 patients from the NIS (male-71%, age 65-84.2%) and 822 patients from the NRD (male-69.3%, age 65-80.5%) underwent TAVR for AR. The median length of stay (LOS) was 4 days for both cohorts. In-hospital mortality was 2.7% in NIS and 30-day mortality was 3.3% in NRD. Disabling strokes were noted in 0.6% peri-procedurally and 1.8% at 30-days. Valve-related complications were 18-19% with paravalvular leak being the most common. Approximately 11% of patients developed CHB and/or needed PPM in both cohorts. In NRD, 2.2% of patients required dialysis for AKI, 1.5% developed vascular complications, and 0.6% required open-heart surgery within 30-days post-procedure. Anemia was predictive of increased overall complications and valvular complications, whereas, peripheral vascular disease was predictor of increased valvular complications and CHB/PPM. Conclusion: TAVR is a promising option in AR. Further studies are necessary for the expansion of TAVR as standard treatment in AR.

scholarly journals Preoperative aortic annulus size assessment by transthoracic echocardiography compared to the size of surgically implanted aortic prostheses

2019 ◽  
Vol 6 (2) ◽  
pp. 37-41
Author(s):  
I J Ingimarsdóttir ◽  
L Hellgren Johansson ◽  
F A Flachskampf
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transthoracic Echocardiography ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Aortic Annulus ◽  
Valve Prosthesis ◽  
Open Heart ◽  
Annulus Diameter

Objectives The aortic annulus diameter measured by transthoracic echocardiography yields lower values than by computed tomography, and echo-based selection of transcatheter aortic valve prosthesis size has been implied to result in more frequent paravalvular leakage. We investigated the relation of preoperative annulus diameter by echo with the ring size of the aortic prosthesis chosen by direct assessment during open-heart aortic valve replacement. Methods Preoperative annulus diameter by echo (from parasternal long-axis cross-sections of the left ventricular outflow tract and aortic valve) and implanted prosthetic diameter (tissue annulus diameter, determined intraoperatively using a sizing instrument) were compared retrospectively in 285 consecutive patients undergoing open-heart aortic valve replacement. Results A total of 285 prostheses (240 biologic and 45 mechanical) were implanted, with prosthetic diameter ranging between 19 and 27 mm. There was a significant linear correlation (P < 0.0001) with r = 0.51, between preoperative annulus diameter by echo (mean 21.8 ± 2.8 mm) and prosthetic diameter (22.9 ± 1.7 mm). Preoperative annulus diameter of patients receiving prostheses no. 21, 23 and 25 mm aortic prostheses (the most frequent prosthesis sizes) were significantly different (P < 0.001) from each other. On average, preoperative annulus diameter by echo underestimated prosthetic diameter by a bias of 1.07 mm. Conclusion Our data confirm that preoperative echo assessment of the aortic valve may slightly underestimates the optimal surgical prosthesis diameter for the aortic valve annulus.

Aortic Valve Replacement With the Freestyle Stentless Bioprosthesis

Circulation ◽  
1999 ◽  
Vol 100 (suppl_2) ◽  
Author(s):  
Kwok L. Yun ◽  
Colleen F. Sintek ◽  
Alden D. Fletcher ◽  
Thomas A. Pfeffer ◽  
Gary S. Kochamba ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Artery Bypass ◽  
Clinical Results ◽  
Left Ventricular ◽  
Effective Orifice Area ◽  
Actuarial Survival ◽  
Orifice Area ◽  
Transvalvular Gradient

Background —Stentless aortic valves were designed to provide a more physiological flow pattern and lower transvalvular gradient, which may have an important bearing on postoperative left ventricular function and remodeling. In this study, we prospectively analyzed the 5-year clinical results with the Freestyle valve (Medtronic, Inc) and its hemodynamic performance by serial echocardiography. Methods and Results —Between January 1993 and August 1997, 95 patients with a mean age of 75 years underwent aortic valve replacement with the Freestyle prosthesis. Sixty-four percent of patients received valves ≤23 mm, and 37% had concomitant coronary artery bypass grafting. Average follow-up was 44±18 months (mean±SD), and echocardiography was performed preoperatively, at discharge, at 3 to 6 months, and annually thereafter. The 30-day operative mortality rate was 3%, with an overall actuarial survival rate of 80±6% (mean±SEM) at 5 years. Of the 10 late deaths, only 2 were cardiac related, thereby yielding a freedom from cardiac mortality of 94±3% after 5 years. No patient required reoperation on the aortic valve for any reason, including structural degeneration, nonstructural dysfunction, or prosthetic valve endocarditis. There were 9 thromboembolic and 3 anticoagulant-related bleeding events, none of which was fatal. The actuarial freedom from valve-related morbidity and mortality was 79±4% at 5 years. Hemodynamically, the mean transvalvular gradient significantly decreased after valve replacement and was reduced further by 41% by 6 months with a corresponding increase in effective orifice area. Left ventricular mass index fell to 75% of the preoperative value by 2 years. Conclusions —The Freestyle stentless valve can be implanted safely in the elderly with excellent midterm clinical results. It has superb hemodynamics in terms of residual transvalvular gradient, effective orifice area, and regression of left ventricular hypertrophy.

scholarly journals Prosthetic Valve Endocarditis with Valvular Obstruction after Transcatheter Aortic Valve Replacement

2015 ◽  
Vol 42 (2) ◽  
pp. 172-174 ◽  
Author(s):  
Christine Pabilona ◽  
Bernard Gitler ◽  
Jeffrey A. Lederman ◽  
Donald Miller ◽  
Theodore N. Keltz
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Prosthetic Valve ◽  
Heart Surgery ◽  
Severe Aortic Stenosis ◽  
Open Heart Surgery ◽  
Prosthetic Valve Endocarditis ◽  
Transcatheter Aortic Valve

Patients with severe aortic stenosis who are at high risk for open-heart surgery might be candidates for transcatheter aortic valve replacement (TAVR). To our knowledge, this is the first report of Streptococcus viridans endocarditis that caused prosthetic valve obstruction after TAVR. A 77-year-old man who had undergone TAVR 17 months earlier was admitted because of evidence of prosthetic valve endocarditis. A transthoracic echocardiogram revealed a substantial increase in the transvalvular peak gradient and mean gradient in comparison with an echocardiogram of 7 months earlier. A transesophageal echocardiogram showed a 1.5-cm vegetation obstructing the valve. Blood cultures yielded penicillin-sensitive S. viridans. The patient was hemodynamically stable and was initially treated with vancomycin because of his previous penicillin allergy. Subsequent therapy with levofloxacin, oral penicillin (after a negative penicillin skin test), and intravenous penicillin eliminated the symptoms of the infection. Transcatheter aortic valve replacement is a relatively new procedure, and sequelae are still being discovered. We recommend that physicians consider obstructive endocarditis as one of these.

Sign in / Sign up

Export Citation Format

Share Document