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Future of heart valve replacements

Sang Min Park, Haemin Jeong, Kyung-Soon Hong, Christopher Kim
BACKGROUND: In a patient underwent aortic valve replacement (AVR) due to bicuspid aortic valve (BAV) insufficiency without marked dilation of ascending aorta, the development of delayed-typed aneurysmal complication of ascending aorta has been often reported because the dilated aorta tends to grow insidiously with age. CASE SUMMARY: A 58-year-old man who underwent AVR with mechanical valve due to severe aortic regurgitation secondary to BAV 7 years previously presented with exertional chest discomfort for 1 year...
October 2016: Medicine (Baltimore)
Jason R Cuomo, Gyanendra K Sharma, Preston D Conger, Neal L Weintraub
Radiation-induced cardiovascular disease (RICVD) is the most common nonmalignant cause of morbidity and mortality among cancer survivors who have undergone mediastinal radiation therapy (RT). Cardiovascular complications include effusive or constrictive pericarditis, cardiomyopathy, valvular heart disease, and coronary/vascular disease. These are pathophysiologically distinct disease entities whose prevalence varies depending on the timing and extent of radiation exposure to the heart and great vessels. Although refinements in RT dosimetry and shielding will inevitably limit future cases of RICVD, the increasing number of long-term cancer survivors, including those treated with older higher-dose RT regimens, will ensure a steady flow of afflicted patients for the foreseeable future...
September 26, 2016: World Journal of Cardiology
Emanuela S Fioretta, Petra E Dijkman, Maximilian Y Emmert, Simon P Hoerstrup
Heart valve replacement is often the only solution for patients suffering from valvular heart disease. However, currently available valve replacements require either life-long anti-coagulation or are associated with valve degeneration and calcification. Moreover, they are suboptimal for young patients, because they do not adapt to the somatic growth. Tissue-engineering has been proposed as a promising approach to fulfill the urgent need for heart valve replacements with regenerative and growth capacity. This review will start with an overview on the currently available valve substitutes and the techniques for heart valve replacement...
September 30, 2016: Journal of Tissue Engineering and Regenerative Medicine
Kevin Phan, Joshua M Haswell, Joshua Xu, Yusuf Assem, Stephanie L Mick, Samir R Kapadia, Anson Cheung, Frederick S Ling, Tristan D Yan, Vakhtang Tchantchaleishvili
De novo progressive aortic insufficiency (AI) is a side effect frequently related to prolonged support with continuous-flow left ventricular assist devices (CF-LVAD). Its progression can result in recurrent clinical heart failure symptoms and significantly increased mortality. Recently, percutaneous intervention methods such as transcatheter aortic valve replacement (TAVR) and percutaneous occluder devices have emerged, However, given the very scarce global experience with these approaches, evidence in the literature is lacking...
September 22, 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Joao S Soares, Kristen R Feaver, Will Zhang, David Kamensky, Ankush Aggarwal, Michael S Sacks
The use of replacement heart valves continues to grow due to the increased prevalence of valvular heart disease resulting from an ageing population. Since bioprosthetic heart valves (BHVs) continue to be the preferred replacement valve, there continues to be a strong need to develop better and more reliable BHVs through and improved the general understanding of BHV failure mechanisms. The major technological hurdle for the lifespan of the BHV implant continues to be the durability of the constituent leaflet biomaterials, which if improved can lead to substantial clinical impact...
August 9, 2016: Cardiovascular Engineering and Technology
J Liu, H M Guo, Q Gao, B Chen, B Xie, H L Huang, J Liu, C Lu, J M Chen, J Zhuang
OBJECTIVE: To summarize the clinical experience of 60 patients underwent three-dimensional video assisted thoracoscopic mitral valvuloplasty. METHODS: Sixty patients were enrolled retrospectively from March 2014 to January 2016 in Department of Cardiacvascular Surgery, Guangdong Cardiovascular Institute. They underwent three-dimensional video assisted thoracoscopic mitral valvuloplasty. There were 37 male and 23 female patients. The range of age was 15 to 78 years (the median age was 47 years)...
August 1, 2016: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Justin T Tretter, Mark K Friedberg, Rachel M Wald, Doff B McElhinney
Transcatheter pulmonary valve replacement (TPVR) is an important treatment option in repaired tetralogy of Fallot (TOF) and right ventricular outflow tract (RVOT) dysfunction. Indications for timing of TPVR are extrapolated from surgical pulmonary valve replacement guidelines, which are themselves controversial as published evidence is scarce and expert opinion therefore prevails. We review current indications for PVR following TOF repair, focusing on those for TPVR specifically, and discuss anatomical and functional considerations as these pertain to determination of candidacy for TPVR...
October 15, 2016: International Journal of Cardiology
Marc Kottmaier, Ina Hettich, Marcus-André Deutsch, Catalin Badiu, Markus Krane, Ruediger Lange, Sabine Bleiziffer
Objective Since biological valve recipients are likely to need a redo procedure in the future for valve deterioration, we hypothesized patients might be more fearful about the progression of their disease than patients after aortic valve replacement (AVR) with a mechanical valve. The aim of this study is to compare the quality of life (QOL) and anxiety in patients who have undergone biological versus mechanical AVR. Methods A total of 56 patients after mechanical AVR (mean age: 64.4 ± 8.17 years) and 66 patients after biological AVR (mean age: 64...
July 5, 2016: Thoracic and Cardiovascular Surgeon
Kanan Kurahashi, Takafumi Inoue, Akihiro Yoshimoto, Masayuki Fujisaki, Sei Morisumi, Toshiya Ohtsuka, Yoshihiko Suematsu
Total endoscopic left atrial appendectomy for non-valvular atrial fibrillation(Af) has been reported to be a safe and effective procedure to prevent cardiogenic thromboembolism and also discontinue oral anticoagulant therapy. On the other hand, open-heart surgery is generally indicated for valvular Af. We report the case of a 67-year-old male patient with valvular Af and recurrent episodes of cardiogenic thromboembolism who underwent total endoscopic left atrial appendectomy. He was diagnosed as having mitral valve stenosis and scheduled for surgery, but presented with cerebellar hemorrhage after warfarin was replaced with heparin in the preoperative phase...
June 2016: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Holger Eggebrecht, Maike Bestehorn, Michael Haude, Axel Schmermund, Kurt Bestehorn, Thomas Voigtländer, Karl-Heinz Kuck, Rajendra H Mehta
AIMS: Performing transcatheter aortic valve implantation (TAVI) at hospitals with only cardiology department but no cardiac surgery (CS) on-site is at great odds with current Guidelines. METHODS AND RESULTS: We analysed data from the official, prospective German Quality Assurance Registry on Aortic Valve Replacement to compare characteristics and in-hospital outcomes of patients undergoing transfemoral TAVI at hospitals with (n = 75) and without CS departments (n = 22)...
July 21, 2016: European Heart Journal
Brian R Lindman, Marie-Annick Clavel, Patrick Mathieu, Bernard Iung, Patrizio Lancellotti, Catherine M Otto, Philippe Pibarot
Calcific aortic stenosis (AS) is the most prevalent heart valve disorder in developed countries. It is characterized by progressive fibro-calcific remodelling and thickening of the aortic valve leaflets that, over years, evolve to cause severe obstruction to cardiac outflow. In developed countries, AS is the third-most frequent cardiovascular disease after coronary artery disease and systemic arterial hypertension, with a prevalence of 0.4% in the general population and 1.7% in the population >65 years old...
2016: Nat Rev Dis Primers
Maurizio Taramasso, Francesco Maisano, Alberto Pozzoli, Ottavio Alfieri, Bernhard Meier, Fabian Nietlispach
The incidence of paravalvular leaks after surgical valve replacement is estimated to be 2-17%. Paravalvular leaks (PVL) can be asymptomatic and not require treatment or can cause haemolysis or heart failure. If symptomatic or if the severity of the leak is moderate or severe, redo surgery is a therapeutic option, but this is accompanied by a high perioperative risk and a high recurrence rate. A lower risk alternative is percutaneous PVL closure, with a 1-2% risk of periprocedural death or need for reoperation...
May 17, 2016: EuroIntervention
Debora Kehl, Benedikt Weber, Simon Philipp Hoerstrup
Valvular heart disease remains to be a major cause of death worldwide with increasing prevalence, mortality, and morbidity. Current heart valve replacements are associated with several limitations due to their nonviable nature. In this regard, heart valve tissue engineering has shown to represent a promising concept in order to overcome these limitations and replace diseased cardiac valves with living, autologous constructs. These bioengineered valves hold potential for in situ remodeling, growth, and repair throughout the patient's lifetime without the risk of thromboembolic complications and adverse immune responses...
July 2016: Cardiovascular Pathology: the Official Journal of the Society for Cardiovascular Pathology
Hans R Figulla, John G Webb, Alexander Lauten, Ted Feldman
The transcatheter valve technology pipeline has started as simple balloon valvuloplasty for the treatment of stenotic heart valves and evolved since the year 2000 to either repair or replace heart valves percutaneously with multiple devices. In this review, the present technology and its application are illuminated and a glimpse into the near future is dared from a physician's perspective.
July 21, 2016: European Heart Journal
Andreas A Giannopoulos, Michael L Steigner, Elizabeth George, Maria Barile, Andetta R Hunsaker, Frank J Rybicki, Dimitris Mitsouras
Medical 3-dimensional (3D) printing is emerging as a clinically relevant imaging tool in directing preoperative and intraoperative planning in many surgical specialties and will therefore likely lead to interdisciplinary collaboration between engineers, radiologists, and surgeons. Data from standard imaging modalities such as computed tomography, magnetic resonance imaging, echocardiography, and rotational angiography can be used to fabricate life-sized models of human anatomy and pathology, as well as patient-specific implants and surgical guides...
September 2016: Journal of Thoracic Imaging
Elizabeth Braunlin, Raymond Wang
The growing availability of innovative treatments for rare genetic diseases with a cardiac component-such as the mucopolysaccharidoses (MPSs)-has changed these syndromes from 'back of the textbook' curiosities of childhood to chronic, but rare, adult cardiac conditions that require both centres of expertise and knowledgeable subspecialists. The MPSs are inherited progressive lysosomal storage diseases, occurring in about 1:25 000 births and resulting from absence of functional hydrolases responsible for the degradation of glycosaminoglycans, naturally occurring complex sugars ubiquitous throughout the body...
August 15, 2016: Heart: Official Journal of the British Cardiac Society
Miriam Silaschi, James Barr, Sanjay Chaubey, Niki Nicou, Raj Srirajaskanthan, Jonathan Byrne, John Ramage, Philip MacCarthy, Olaf Wendler
BACKGROUND: Carcinoid heart disease (CHD) is common in patients with carcinoid syndrome (CS). Surgical treatment improves the poor prognosis of CHD, although the reported perioperative mortality is high (∼17%). We attempted to improve outcomes by implementation of a protocol for the management of patients with CHD at a UK Neuroendocrine Centre of Excellence and report our experience. METHODS: All patients treated for CHD between 2008 and 2015 were included. Peri-operative treatment included surgical features such as invasive pulmonary valve (PV) inspection and preservation of the tricuspid subvalvular apparatus...
April 21, 2016: Neuroendocrinology
Feroze Mahmood, Stanton Keith Shernan
Transoesophageal echocardiography (TOE) is used in the perioperative arena to monitor patients during life-threatening emergencies, cardiac and high-risk non-cardiac surgeries. It provides qualitative and quantitative information on valvular and ventricular functions, and dynamic cardiac anatomy can be displayed with a physiological perspective. This technology has evolved from two-dimensional (2D) to the ready availability of real-time three-dimensional (RT-3D) imaging in the operating rooms. Enhanced spatial and temporal resolutions with 3D imaging have most significantly impacted the quality of intraoperative surgical valve repair and replacement decisions...
August 1, 2016: Heart: Official Journal of the British Cardiac Society
Andrzej Klapkowski, Rafał Pawlaczyk, Maciej Kempa, Dariusz Jagielak, Maciej Brzeziński, Jan Rogowski
BACKGROUND: Temporary atrioventricular (AV) conduction disturbances are a common complication following cardiac surgery, especially involving the aortic valve. Permanent complete AV block is a serious and rare complication. Its prevalence has been estimated at 3-6% of all patients undergoing aortic valve replacement. Identification of factors that affect the occurrence of complete AV block requiring permanent pacemaker implantation might help reduce the risk of this problem in the future...
2016: Kardiologia Polska
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 sizen≥ 30 and mean follow-up length ≥5 years...
March 29, 2016: European Journal of Cardio-thoracic Surgery
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