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Current in aortic valve prostheses

Stuart J Head, Mevlüt Çelik, A Pieter Kappetein
Mechanical valves used for aortic valve replacement (AVR) continue to be associated with bleeding risks because of anticoagulation therapy, while bioprosthetic valves are at risk of structural valve deterioration requiring reoperation. This risk/benefit ratio of mechanical and bioprosthetic valves has led American and European guidelines on valvular heart disease to be consistent in recommending the use of mechanical prostheses in patients younger than 60 years of age. Despite these recommendations, the use of bioprosthetic valves has significantly increased over the last decades in all age groups...
April 20, 2017: European Heart Journal
Anna Sonia Petronio, Piera Capranzano, Emanuele Barbato, Nicolò Piazza, Andreas Baumbach, Michael Haude, Stephan Windecker
AIMS: The European Association of Percutaneous Coronary Interventions (EAPCI) assessed the current status of transcatheter valve therapy in Europe through a web-based survey. Our aim here was to report the results of that survey regarding trends in percutaneous mitral valve repair (PMVR) therapy. METHODS AND RESULTS: Among 301 European centres participating in the overall EAPCI survey, 246 (81.7%) responded to the PMVR section questions. A total of 176 (71.5%) have been undertaking a PMVR programme...
March 20, 2017: EuroIntervention
M Abawi, P Agostoni, N H M Kooistra, M Samim, F Nijhoff, M Voskuil, H Nathoe, P A Doevendans, S A Chamuleau, K Urgel, J Hendrikse, T Leiner, A C Abrahams, B van der Worp, P R Stella
BACKGROUND AND OBJECTIVES: Periprosthetic aortic regurgitation (PPR) after transcatheter aortic valve implantation (TAVI) remains an important issue associated with impaired long-term outcomes. The current randomised study aims to evaluate potential differences between the balloon-expandable Edwards SAPIEN-3 and the self-expanding Medtronic CoreValve system with the main focus on post-TAVI PPR by means of novel imaging endpoints, and an additional focus on other clinical endpoints. ENDPOINTS: The primary endpoint of this study is quantitative assessment of the severity of post-procedural PPR using cardiac magnetic resonance imaging...
December 9, 2016: Netherlands Heart Journal
Alberto Repossini, Lorenzo Di Bacco, Bruno Passaretti, Herko Grubitzsch, Christina Schäfer, Benjamin Claus, Laura Giroletti, Thierry Folliguet, Gianluigi Bisleri, Theodor Fischlein, Giuseppe Santarpino, Roberto Di Bartolomeo, François Laborde, Claudio Muneretto
OBJECTIVE: Stentless aortic valves have been developed to overcome obstructive limitations associated with stented bioprostheses. The aim of the current multi-institutional study was to compare hemodynamics of transcatheter (TAVR) and the Freedom SOLO Stentless (FS) valve in an intermediate risk population undergoing surgical aortic valve replacement. METHODS: From 2010 to 2014, 420 consecutive patients underwent isolated surgical aortic valve replacement with FS and 375 patients underwent TAVR...
November 16, 2016: Journal of Thoracic and Cardiovascular Surgery
Gregory Roberts, Rasha Razooqi, Stephen Quinn
BACKGROUND: The immediate postoperative warfarin sensitivity for patients receiving heart valve prostheses is increased. Established warfarin initiation protocols may lack clinical applicability, resulting in dosing based on clinical judgment. OBJECTIVE: To compare current practice for warfarin initiation with a known warfarin initiation protocol, with doses proportionally reduced to account for the increased postoperative sensitivity. METHODS: We compared the Mechanical Heart Valve Warfarin Initiation Protocol (Protocol group) with current practice (clinical judgment-Empirical group) for patients receiving mechanical heart valves in an observational before-and-after format...
October 25, 2016: Annals of Pharmacotherapy
Peter E Hammer, Erin G Roberts, Sitaram M Emani, Pedro J Del Nido
OBJECTIVES: Neither heart valve repair methods nor current prostheses can accommodate patient growth. Normal aortic and pulmonary valves have 3 leaflets, and the goal of valve repair and replacement is typically to restore normal 3-leaflet morphology. However, mammalian venous valves have bileaflet morphology and open and close effectively over a wide range of vessel sizes. We propose that they might serve as a model for pediatric heart valve reconstruction and replacement valve design...
February 2017: Journal of Thoracic and Cardiovascular Surgery
Trust Saidi, Tania S Douglas
The treatment of rheumatic heart disease presents a medical and surgical challenge, particularly in developing countries, where the disease is prevalent. Most of these countries find it prohibitively expensive to import heart valve prostheses that are required for treatment and are largely manufactured in the United States and Europe. Even if the valves were available, the absence of facilities to conduct open-heart surgery for valve replacement results in many people from developing countries dying needlessly of the disease...
October 2016: Expert Review of Medical Devices
Costantino Del Gaudio, Pier Luca Gasbarroni, Giovanni Paolo Romano
End-stage failing heart valves are currently replaced by mechanical or biological prostheses. Both types positively contribute to restore the physiological function of native valves, but a number of drawbacks limits the expected performances. In order to improve the outcome, tissue engineering can offer an alternative approach to design and fabricate innovative heart valves capable to support the requested function and to promote the formation of a novel, viable and correctly operating physiological structure...
December 2016: Journal of the Mechanical Behavior of Biomedical Materials
Muhammet Onur Hanedan, İlker Mataracı, Mehmet Ali Yürük, Tanıl Özer, Ufuk Sayar, Ali Kemal Arslan, Uğur Ziyrek, Murat Yücel
BACKGROUND: In elderly high-risk surgical patients, sutureless aortic valve replacement (AVR) should be an alternative to standard AVR. The potential advantages of sutureless aortic prostheses include reducing cross-clamping and cardiopulmonary bypass (CPB) time and facilitating minimally invasive surgery and complex cardiac interventions, while maintaining satisfactory hemodynamic outcomes and low rates of paravalvular leakage. The current study reports our single-center experience regarding the early outcomes of sutureless aortic valve implantation...
June 2016: Korean Journal of Thoracic and Cardiovascular Surgery
Mirko Doss, Thomas Walther
Transcatheter aortic valve implantation (T-AVI) has been established as an alternative to conventional aortic valve replacement. The number of procedures is steadily rising and has reached comparable implant rates to conventional aortic valve replacement. The success of T-AVI is easily explained by their true minimally invasive nature, ease of use, and excellent hemodynamics. Whilst their use was initially limited to high-risk patients, current trends show that more and more intermediate-risk patients are now treated with theses prostheses...
2016: Seminars in Thoracic and Cardiovascular Surgery. Pediatric Cardiac Surgery Annual
Simone A Huygens, Mostafa M Mokhles, Milad Hanif, Jos A Bekkers, Ad J J C Bogers, Maureen P M H Rutten-van Mölken, Johanna J M Takkenberg
Many observational studies have reported outcomes after surgical aortic valve replacement (AVR), but there are no recent systematic reviews and meta-analyses including all available bioprostheses and allografts. The objective of this study is to provide a comprehensive and up-to-date overview of the outcomes after AVR with bioprostheses and allografts reported in the last 15 years. We conducted a systematic literature review (PROSPERO register: CRD42015017041) of studies published between 2000-15. Inclusion criteria were observational studies or randomized controlled trials reporting on outcomes of AVR with bioprostheses (stented or stentless) or allografts, with or without coronary artery bypass grafting (CABG) or valve repair procedure, with study population size n ≥ 30 and mean follow-up length ≥5 years...
October 2016: European Journal of Cardio-thoracic Surgery
K E O'Sullivan, S Bargenda, D Sugrue, J Hurley
BACKGROUND: Recent developments in the management of severe aortic stenosis have resulted in a paradigm shift in the way we view the condition. Patients previously denied intervention in the form of surgical aortic valve replacement (SAVR) are now candidates for transcatheter aortic valve implantation and the risk and age profiles of those undergoing SAVR are rising with the ageing population. This review article is designed to provide an overview of developments in the surgical management of severe aortic stenosis...
May 2016: Irish Journal of Medical Science
Matthew Fok, Matthew Shaw, Elena Sancho, David Abello, Mohamad Bashir
UNLABELLED: Background : It is widely accepted that aortic valve disease is surgically managed with aortic valve replacement (AVR) using different available prostheses. The long-term survival, durability of the valve, and freedom from reoperation after AVR are well established in published literature. Over the past two decades, aortic valve repair (AVr) has evolved into an accepted surgical option for patients with aortic valve disease. We review and analyze the published literature on AVr...
February 2014: Aorta (Stamford, Conn.)
Grégoire Massoullié, Pierre Bordachar, Kenneth A Ellenbogen, Géraud Souteyrand, Frédéric Jean, Nicolas Combaret, Charles Vorilhon, Guillaume Clerfond, Mehdi Farhat, Philippe Ritter, Bernard Citron, Jean-R Lusson, Pascal Motreff, Sylvain Ploux, Romain Eschalier
New-onset left bundle branch block (LBBB) is a specific concern of transcutaneous aortic valve implantation (TAVI) given its estimated incidence ranging from 5% to 65%. This high rate of occurrence is dependent on the type of device used (size and shape), implantation methods, and patient co-morbidities. The appearance of an LBBB after TAVI reflects a very proximal lesion of the left bundle branch as it exits the bundle of His. At times transient, its persistence can lead to permanent pacemaker implantation in 15% to 20% of cases, most often for high-degree atrioventricular block...
March 1, 2016: American Journal of Cardiology
Kevin L Greason, Alberto Pochettino, Gurpreet S Sandhu, Katherine S King, David R Holmes
OBJECTIVES: Transfemoral transcatheter aortic valve insertion may be performed in a catheterization laboratory (ie, the minimalist approach). It seems reasonable when considering this approach to avoid it in patients at risk for intraoperative morbidity that would require surgical intervention. We hypothesized that it would be possible to associate baseline characteristics with such morbidity, which would help heart teams select patients for the minimalist approach. METHODS: We reviewed the records of 215 consecutive patients who underwent transfemoral transcatheter aortic valve insertion with a current commercially available device from November 2008 through July 2015...
April 2016: Journal of Thoracic and Cardiovascular Surgery
Cristian Rosu, Edward G Soltesz
The lack of an ideal prosthetic heart valve leaves surgeons and their patients with a difficult choice at the time of valve replacement surgery. Current guidelines mainly emphasize patient age, contraindications to anticoagulation, and patient desires in their recommendations for the type of prosthesis to implant. Aortic valve replacement is the most frequently performed valve replacement, and 5 articles in recent years have presented important data on outcomes with different prosthesis types. The findings suggest that in young patients, transvalvular prosthesis gradients have an effect on long-term bioprosthesis durability...
2015: Seminars in Thoracic and Cardiovascular Surgery
D Reineke, F Gisler, L Englberger, T Carrel
Aortic valve replacement (AVR) is the most frequently performed procedure in valve surgery. The controversy about the optimal choice of the prosthetic valve is as old as the technique itself. Currently there is no perfect valve substitute available. The main challenge is to choose between mechanical and biological prosthetic valves. Biological valves include pericardial (bovine, porcine or equine) and native porcine bioprostheses designed in stented, stentless and sutureless versions. Homografts and pulmonary autografts are reserved for special indications and will not be discussed in detail in this review...
2016: Expert Review of Cardiovascular Therapy
Janina Rivas Gruber, Rossella Sarro, Julie Delaloye, Jean-Francois Surmely, Giuseppe Siniscalchi, Piergiorgio Tozzi, Cyril Jaques, Katia Jaton, Alain Delabays, Gilbert Greub, Tobias Rutz
INTRODUCTION: Tropheryma whipplei infection should be considered in patients with suspected infective endocarditis with negative blood cultures. The case (i) shows how previous symptoms can contribute to the diagnosis of this illness, and (ii) elucidates current recommended diagnostic and therapeutic approaches to Whipple's disease. CASE PRESENTATION: A 71-year-old Swiss man with a past history of 2 years of diffuse arthralgia was admitted for a possible endocarditis with severe aortic and mitral regurgitation...
2015: Journal of Medical Case Reports
Esther M A Wiegerinck, Floortje Van Kesteren, Martijn S Van Mourik, Marije M Vis, Jan Baan
Over the past decade transcatheter aortic valve implantation (TAVI) has evolved towards the routine therapy for high-risk patients with severe aortic valve stenosis. Technical refinements in TAVI are rapidly evolving with a simultaneous expansion of the number of available devices. This review will present an overview of the current status of development of TAVI-prostheses; describes the technical features and applicability of each device and the clinical data available.
2016: Expert Review of Medical Devices
Jean-Michel Paradis, Maria Del Trigo, Rishi Puri, Josep Rodés-Cabau
Bioprosthetic valve use has increased significantly. Considering their limited durability, there will remain an ongoing clinical need for repairing or replacing these prostheses in the future. The current standard of care for treating bioprosthetic valve degeneration involves redo open-heart surgery. However, repeat cardiac surgery may be associated with significant morbidity and mortality. With the rapid evolution of transcatheter heart valve therapies, the feasibility and safety of implanting a transcatheter heart valve within a failed tissue valve has been established...
November 3, 2015: Journal of the American College of Cardiology
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