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Future of heart valve replacements

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https://www.readbyqxmd.com/read/29790209/subclinical-leaflet-thrombosis-following-transcatheter-aortic-valve-replacement
#1
Somsupha Kanjanauthai, Luigi Pirelli, Nikhil Nalluri, Chad A Kliger
Since the inception of transcatheter aortic valve replacement (TAVR), there have been significant reductions in complications due to improvements of transcatheter heart valve (THV) designs and technologies. Given expanding TAVR applications, reducing complications further and better understanding THV durability has become a focus within the structural heart space. Recently, dedicated cardiac computed tomographic angiography (CTA) performed at 1 month post-TAVR has identified subclinical leaflet thrombosis (SLT), with rates as high as 40%...
May 23, 2018: Journal of Interventional Cardiology
https://www.readbyqxmd.com/read/29778453/mitral-valve-repair-complicated-by-left-circumflex-coronary-artery-occlusion-an-under-recognized-but-potentially-deadly-complication
#2
Tariq A Ahmad, Matthew Nudy, Dirk Pabst, Mark Kozak
Mitral valve repair is becoming an increasingly frequent surgery for patients with mitral valve regurgitation. Iatrogenic coronary artery injury and ischemic myocardial compromise have been previously reported in the literature as a rare but serious complication of surgical mitral valve repair. This potentially life-threatening complication should be considered and quickly recognized during perioperative mitral valve repair or replacement to prevent morbidity and mortality. To increase awareness and to prevent this complication from being missed in the future, we present a case report of iatrogenic left circumflex artery dynamic occlusion and subsequent myocardial infarction from mitral valve annuloplasty resulting in severe peri-operative heart failure and death...
April 25, 2018: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/29770888/mitral-valve-interventions-in-structural-heart-disease
#3
REVIEW
Matteo Saccocci, Maurizio Taramasso, Francesco Maisano
PURPOSE OF REVIEW: Analyze the current state of the art and the future perspectives of mitral interventions in clinical setting. RECENT FINDINGS: A systematic and critical review of the new mitral percutaneous therapies and imaging technologies is the basis to adopt the right treatment for each patient according to specific valve dysfunction and clinical presentation, waiting for definitive guidelines. While surgical mitral repair will remain the gold standard for low-risk healthy patients with degenerative mitral regurgitation (DMR), transcatheter mitral valve repair is becoming first line therapy in high risk patients with functional mitral regurgitation (FMR)...
May 17, 2018: Current Cardiology Reports
https://www.readbyqxmd.com/read/29747858/timing-of-referral-of-patients-with-severe-isolated-tricuspid-valve-regurgitation-to-surgeons-from-a-french-nationwide-database
#4
Julien Dreyfus, Nicolas Ghalem, Eric Garbarz, Claire Cimadevilla, Patrick Nataf, Alec Vahanian, Gilbert Caranhac, David Messika-Zeitoun
Series evaluating the results of isolated tricuspid valve surgery (ITVS) are rare and often limited by small sample size, selection bias, and/or long period of enrollment. Based on a mandatory administrative national database, we collected all consecutive ITVS performed in France during a 2-year period (2013 and 2014), the type of intervention, clinical profile, and in-hospital mortality and complications. During the 2-year period, 241 patients underwent an ITVS in France (84 repairs and 157 replacements). In-hospital mortality was high (10%), and most patients experienced at least 1 complication (65%) with a 19% rate of major complications (death, need for dialysis, or need for mechanical support using extracorporeal membrane oxygenation)...
April 12, 2018: American Journal of Cardiology
https://www.readbyqxmd.com/read/29743998/transcatheter-aortic-valve-in-valve-procedure-in-patients-with-bioprosthetic-structural-valve-deterioration
#5
REVIEW
Ross M Reul, Mahesh K Ramchandani, Michael J Reardon
Surgical aortic valve replacement is the gold standard procedure to treat patients with severe, symptomatic aortic valve stenosis or insufficiency. Bioprosthetic valves are used for surgical aortic valve replacement with a much greater prevalence than mechanical valves. However, bioprosthetic valves may fail over time because of structural valve deterioration; this often requires intervention due to severe bioprosthetic valve stenosis or regurgitation or a combination of both. In select patients, transcatheter aortic valve replacement is an alternative to surgical aortic valve replacement...
July 2017: Methodist DeBakey Cardiovascular Journal
https://www.readbyqxmd.com/read/29740591/postnatal-and-adult-aortic-heart-valves-have-distinctive-transcriptional-profiles-associated-with-valve-tissue-growth-and-maintenance-respectively
#6
Emily Nordquist, Stephanie LaHaye, Casey Nagel, Joy Lincoln
Heart valves are organized connective tissues of high mechanical demand. They open and close over 100,000 times a day to preserve unidirectional blood flow by maintaining structure-function relationships throughout life. In affected individuals, structural failure compromises function and often leads to regurgitant blood flow and progressive heart failure. This is most common in degenerative valve disease due to age-related wear and tear, or congenital malformations. At present, the only effective treatment of valve disease is surgical repair or replacement and this is often impermanent and requires anti-coagulation therapy throughout life...
2018: Frontiers in Cardiovascular Medicine
https://www.readbyqxmd.com/read/29623986/transcatheter-mitral-valve-intervention-an-emerging-treatment-for-mitral-regurgitation
#7
Ryan Markham, Stephen Kyranis, Nicholas Aroney, Katherine Lau, Karl Poon, Gregory Scalia, Darren Walters
Mitral regurgitation (MR) is a valvular heart disease associated with significant morbidity and mortality. Transcatheter mitral valve intervention (TMVI) repairs or replaces the mitral valve through small arterial and venous entry sites and so avoids risks associated with open heart surgery. Transcatheter devices targeting components of the mitral apparatus are being developed to repair or replace it. Numerous challenges remain including developing more adaptable devices and correction of multiple components of the mitral annulus to attain durable results...
April 2018: Internal Medicine Journal
https://www.readbyqxmd.com/read/29593832/bioprosthetic-valve-fracture-during-valve-in-valve-tavr-bench-to-bedside
#8
John T Saxon, Keith B Allen, David J Cohen, Adnan K Chhatriwalla
Valve-in-valve (VIV) transcatheter aortic valve replacement (TAVR) has been established as a safe and effective means of treating failed surgical bioprosthetic valves (BPVs) in patients at high risk for complications related to reoperation. Patients who undergo VIV TAVR are at risk of patient-prosthesis mismatch, as the transcatheter heart valve (THV) is implanted within the ring of the existing BPV, limiting full expansion and reducing the maximum achievable effective orifice area of the THV. Importantly, patient-prosthesis mismatch and high residual transvalvular gradients are associated with reduced survival following VIV TAVR...
January 2018: Interventional Cardiology
https://www.readbyqxmd.com/read/29588730/a-glimpse-into-the-future-in-2020-which-patients-will-undergo-tavi-or-savr
#9
Crochan J O'Sullivan, Peter Wenaweser
Transcatheter aortic valve implantation (TAVI) has evolved into a safe and effective procedure to treat symptomatic patients with severe aortic stenosis (AS), with predictable and reproducible results. Rates of important complications such as vascular complications, strokes and paravalvular leaks are lower than ever, because of improved patient selection, systematic use of multidector computer tomography, increasing operator experience and device iteration. Accumulating data suggest that transfemoral TAVI with newer generation transcatheter heart valves and delivery systems is superior to conventional surgical aortic valve replacement among intermediate- and high-risk patients with severe symptomatic AS with regard to all-cause mortality and stroke...
May 2017: Interventional Cardiology
https://www.readbyqxmd.com/read/29566796/cerebral-embolic-risk-during-transcatheter-mitral-valve-interventions-an-unaddressed-and-unmet-clinical-need
#10
REVIEW
Matteo Pagnesi, Damiano Regazzoli, Marco B Ancona, Antonio Mangieri, Giuseppe Lanzillo, Francesco Giannini, Nicola Buzzatti, Bernard D Prendergast, Susheel Kodali, Alexandra J Lansky, Antonio Colombo, Azeem Latib
As new transcatheter mitral valve (MV) interventions continuously evolve, potential procedure-related adverse events demand careful investigation. The risk of cerebral embolic damage is ubiquitous in any left-sided structural heart intervention (and potentially linked to long-term neurocognitive sequelae); therefore, efforts to evaluate these aspects in the field of catheter-based MV procedures are justified. Given the peculiarities of MV anatomy, MV disease, and MV procedures, the lessons learned from other transcatheter heart interventions (i...
March 26, 2018: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/29560553/development-of-an-off-the-shelf-tissue-engineered-sinus-valve-for-transcatheter-pulmonary-valve-replacement-a-proof-of-concept-study
#11
Sarah E Motta, Emanuela S Fioretta, Petra E Dijkman, Valentina Lintas, Luc Behr, Simon P Hoerstrup, Maximilian Y Emmert
Tissue-engineered heart valves with self-repair and regeneration properties may overcome the problem of long-term degeneration of currently used artificial prostheses. The aim of this study was the development and in vivo proof-of-concept of next-generation off-the-shelf tissue-engineered sinus valve (TESV) for transcatheter pulmonary valve replacement (TPVR). Transcatheter implantation of off-the-shelf TESVs was performed in a translational sheep model for up to 16 weeks. Transapical delivery of TESVs was successful and showed good acute and short-term performance (up to 8 weeks), which then worsened over time most likely due to a non-optimized in vitro valve design...
March 20, 2018: Journal of Cardiovascular Translational Research
https://www.readbyqxmd.com/read/29531755/how-much-does-a-heart-valve-implantation-cost-and-what-are-the-health-care-costs-afterwards
#12
Simone A Huygens, Lucas M A Goossens, Judith A van Erkelens, Johanna J M Takkenberg, Maureen P M H Rutten-van Mölken
Objective: In the era of limited healthcare budgets, healthcare costs of heart valve implantations need to be considered to inform cost-effectiveness analyses. We aimed to provide age group-specific costs estimates of heart valve implantations, related complications and other healthcare utilisation following the intervention. Methods: We performed retrospective analyses of healthcare costs of patients who had undergone heart valve implantations in 2010-2013 and controls using claims data from Dutch health insurers...
2018: Open Heart
https://www.readbyqxmd.com/read/29433351/transcatheter-pulmonary-valve-implantation-will-it-replace-surgical-pulmonary-valve-replacement
#13
Ahmed Kheiwa, Punag Divanji, Vaikom S Mahadevan
Right ventricular outflow tract (RVOT) dysfunction is a common hemodynamic challenge for adults with congenital heart disease (ACHD), including patients with repaired tetralogy of Fallot (TOF), truncus arteriosus (TA), and those who have undergone the Ross procedure for congenital aortic stenosis and the Rastelli repair for transposition of great vessels. Pulmonary valve replacement (PVR) has become one of the most common procedures performed for ACHD patients. Areas covered: Given the advances in transcatheter technology, we conducted a detailed review of the available studies addressing the indications for PVR, historical background, evolving technology, procedural aspects, and the future direction, with an emphasis on ACHD patients...
March 2018: Expert Review of Cardiovascular Therapy
https://www.readbyqxmd.com/read/29400260/noteworthy-literature-published-in-2017-for-cardiothoracic-anesthesiologists
#14
Dirk J Varelmann, Jochen Daniel Muehlschlegel
The year 2017 was a year dominated by large-scale clinical studies reporting the outcome of various interventions in cardiac surgery and heart failure (HF) patients, relevant to all cardiothoracic anesthesiologists. Among them were studies investigating the addition of levosimendan, an alternative inotropic agent, to standard management of patients with HF undergoing cardiac surgery. Also, corticosteroids have been used for various purposes in cardiac patients. Here, a new study reports the effect of high-dose methylprednisolone on recovery and delirium...
March 2018: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29387432/supar-predicts-postoperative-complications-and-mortality-in-patients-with-asymptomatic-aortic-stenosis
#15
Gethin W Hodges, Casper N Bang, Jesper Eugen-Olsen, Michael H Olsen, Kurt Boman, Simon Ray, Antero Y Kesäniemi, Jørgen L Jeppesen, Kristian Wachtell
Background: We evaluated whether early measurement of soluble urokinase plasminogen activator receptor (suPAR) could predict future risk of postoperative complications in initially asymptomatic patients with mild-moderate aortic stenosis (AS) undergoing aortic valve replacement (AVR) surgery. Methods: Baseline plasma suPAR levels were available in 411 patients who underwent AVR surgery during follow-up in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study...
2018: Open Heart
https://www.readbyqxmd.com/read/29343297/pulmonary-valve-replacement-after-right-ventricular-outflow-tract-reconstruction-with-homograft-vs-contegra%C3%A2-a-case-control-comparison-of-mortality-and-morbidity
#16
Nicolas Poinot, Jean-Francois Fils, Hélène Demanet, Hugues Dessy, Dominique Biarent, Pierre Wauthy
BACKGROUND: Repair of congenital heart defects involving the right ventricular outflow tract may require the implantation of a right ventricle to pulmonary artery conduit. This conduit is likely to be replaced during childhood. This study compares the operative outcomes of the replacement procedure of Contegra® and homografts in pulmonary position. METHODS: From 1999 to 2016, 82 children underwent 87 right ventricle to pulmonary artery conduit replacements (60 Contegra® and 27 homografts)...
January 17, 2018: Journal of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/29339677/acute-myocardial-infarction-shortly-after-valve-in-valve-transcatheter-aortic-valve-implantation-successfully-managedwith-challenging-percutaneous-coronary-intervention
#17
Kenan Yalta, Çağlar Kaya, Yüksel Aksoy, Mustafa Yılmaztepe, Fatih Kardaş
In recent years, transcatheter aortic valve implantation (TAVI) has been considered a novel option for the management of surgically high-risk patients requiring aortic valve replacement. Presently described is a case of acute coronary syndrome (ACS) managed with a challenging primary percutaneous coronary intervention (PCI) shortly after a valve-in-valve TAVI intervention. This case highlights 2 important issues: PCI may be an option for the management of coronary heart disease in patients after TAVI even in the setting of demanding features associated with coronary osteal engagement, and secondly, TAVI may serve as a potential risk factor for future coronary ischemic syndromes, largely due to its potential adverse effects on coronary flow dynamics, etc...
January 2018: Türk Kardiyoloji Derneği Arşivi: Türk Kardiyoloji Derneğinin Yayın Organıdır
https://www.readbyqxmd.com/read/29327671/tissue-engineered-heart-valves-a-call-for-mechanistic-studies
#18
Kevin M Blum, Joseph D Drews, Christopher K Breuer
Heart valve disease carries a substantial risk of morbidity and mortality. Outcomes are significantly improved by valve replacement, but currently available mechanical and biological replacement valves are associated with complications of their own. Mechanical valves have a high rate of thromboembolism and require lifelong anticoagulation. Biological prosthetic valves have a much shorter lifespan, and they are prone to tearing and degradation. Both types of valves lack the capacity for growth, making them particularly problematic in pediatric patients...
February 13, 2018: Tissue Engineering. Part B, Reviews
https://www.readbyqxmd.com/read/29304514/antithrombotic-treatment-after-transcatheter-heart-valves-implant
#19
Sabato Sorrentino, Gennaro Giustino, Kamilia Moalem, Ciro Indolfi, Roxana Mehran, George D Dangas
Transcatheter heart valve replacement technology was introduced as alternative to surgery for the growing high-risk profile population. Developed first, aortic valve replacement (TAVR) became a standard of care for patients with severe aortic stenosis at high operative risk, with a potential future use also for low-risk subjects. In the last decade, a multitude of transcatheter mitral valve replacement (TMVR) devices have been developed for the treatment of severe mitral regurgitation, with encouraging results coming from first-in-man and feasibility studies...
February 2018: Seminars in Thrombosis and Hemostasis
https://www.readbyqxmd.com/read/29229649/isolated-tricuspid-regurgitation-outcomes-and-therapeutic-interventions
#20
REVIEW
Erin A Fender, Chad J Zack, Rick A Nishimura
Isolated tricuspid regurgitation (TR) can be caused by primary valvular abnormalities such as flail leaflet or secondary annular dilation as is seen in atrial fibrillation, pulmonary hypertension and left heart disease. There is an increasing recognition of a subgroup of patients with isolated TR in the absence of other associated cardiac abnormalities. Left untreated isolated TR significantly worsens survival. Stand-alone surgery for isolated TR is rarely performed due to an average operative mortality of 8%-10% and a paucity of data demonstrating improved survival...
May 2018: Heart: Official Journal of the British Cardiac Society
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