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Next-generation heart valves

Lakshmi P Dasi, Hoda Hatoum, Arash Kheradvar, Ramin Zareian, S Hamed Alavi, Wei Sun, Caitlin Martin, Thuy Pham, Qian Wang, Prem A Midha, Vrishank Raghav, Ajit P Yoganathan
Transcatheter aortic valves (TAVs) represent the latest advances in prosthetic heart valve technology. TAVs are truly transformational as they bring the benefit of heart valve replacement to patients that would otherwise not be operated on. Nevertheless, like any new device technology, the high expectations are dampened with growing concerns arising from frequent complications that develop in patients, indicating that the technology is far from being mature. Some of the most common complications that plague current TAV devices include malpositioning, crimp-induced leaflet damage, paravalvular leak, thrombosis, conduction abnormalities and prosthesis-patient mismatch...
November 21, 2016: Annals of Biomedical Engineering
Wenbin Mao, Kewei Li, Wei Sun
Computational modeling of heart valve dynamics incorporating both fluid dynamics and valve structural responses has been challenging. In this study, we developed a novel fully-coupled fluid-structure interaction (FSI) model using smoothed particle hydrodynamics (SPH). A previously developed nonlinear finite element (FE) model of transcatheter aortic valves (TAV) was utilized to couple with SPH to simulate valve leaflet dynamics throughout the entire cardiac cycle. Comparative simulations were performed to investigate the impact of using FE-only models vs...
December 2016: Cardiovascular Engineering and Technology
Iolanda Muntean, Rodica Togănel, Theodora Benedek
Congenital heart disease is the most common congenital anomaly, representing an important cause of infant morbidity and mortality. Congenital heart disease represents a group of heart anomalies that include septal defects, valve defects, and outflow tract anomalies. The exact genetic, epigenetic, or environmental basis of congenital heart disease remains poorly understood, although the exact mechanism is likely multifactorial. However, the development of new technologies including copy number variants, single-nucleotide polymorphism, next-generation sequencing are accelerating the detection of genetic causes of heart anomalies...
November 2, 2016: Biochemical Genetics
Liyong Zhang, David J Tester, Di Lang, Yili Chen, Jinxiang Zheng, Rui Gao, Robert F Corliss, Shuangbo Tang, John W Kyle, Chao Liu, Michael J Ackerman, Jonathan C Makielski, Jianding Cheng
OBJECTIVE: To look for previously unrecognized cardiac structural abnormalities and address the genetic cause for sudden unexplained nocturnal death syndrome (SUNDS). METHODS: Data for 148 SUNDS victims and 444 controls (matched 1:3 on sex, race, and age of death within 1 year) were collected from Sun Yat-sen University from January 1, 1998, to December 31, 2014, to search morphological changes. An additional 17 patients with Brugada syndrome (BrS) collected from January 1, 2006, to December 31, 2014, served as a comparative disease cohort...
November 2016: Mayo Clinic Proceedings
Maria G Andreassi, Alessandro Della Corte
PURPOSE OF REVIEW: The incidence of aortic dilation and acute complications (rupture and dissection) is higher in patients with a bicuspid aortic valve (BAV), the most frequent congenital heart defect.The present review focuses on the current knowledge in the genetics of BAV, emphasizing the clinical implications for early detection and personalized care. RECENT FINDINGS: BAV is a highly heritable trait, but the genetic causes remain largely elusive. NOTCH1 is the only proven candidate gene to be associated with both familial and sporadic BAV...
November 2016: Current Opinion in Cardiology
Irvin Teh, Darryl McClymont, Rebecca A B Burton, Mahon L Maguire, Hannah J Whittington, Craig A Lygate, Peter Kohl, Jürgen E Schneider
Cardiac architecture is fundamental to cardiac function and can be assessed non-invasively with diffusion tensor imaging (DTI). Here, we aimed to overcome technical challenges in ex vivo DTI in order to extract fine anatomical details and to provide novel insights in the 3D structure of the heart. An integrated set of methods was implemented in ex vivo rat hearts, including dynamic receiver gain adjustment, gradient system scaling calibration, prospective adjustment of diffusion gradients, and interleaving of diffusion-weighted and non-diffusion-weighted scans...
2016: Scientific Reports
S Yücel, H Ince, S Kische, M A Sherif, H Bushnaq, A Bärisch, A Öner
The demographic changes in society lead to an increasing number of patients with aortic valve stenosis and mitral regurgitation. Simultaneously the higher age of patients is associated with an increase in multimorbidity with a high surgical risk so that they cannot be referred to surgery. Besides the current gold standard of surgery, minimally invasive therapeutic options are increasingly becoming established for these patients. For the differentiated indications and therapeutic success, a multidisciplinary heart team assumes an important role...
August 2016: Herz
Rakesh M Suri, Sa'ar Minha, Oluseun Alli, Ron Waksman, Charanjit S Rihal, Lowell P Satler, Kevin L Greason, Rebecca Torguson, Augusto D Pichard, Michael Mack, Lars G Svensson, Jeevanantham Rajeswaran, Ashley M Lowry, John Ehrlinger, Stephanie L Mick, E Murat Tuzcu, Vinod H Thourani, Raj Makkar, David Holmes, Martin B Leon, Eugene H Blackstone
OBJECTIVES: Introduction of hybrid techniques, such as transapical transcatheter aortic valve replacement (TA-TAVR), requires skills that a heart team must master to achieve technical efficiency: the technical performance learning curve. To date, the learning curve for TA-TAVR remains unknown. We therefore evaluated the rate at which technical performance improved, assessed change in occurrence of adverse events in relation to technical performance, and determined whether adverse events after TA-TAVR were linked to acquiring technical performance efficiency (the learning curve)...
September 2016: Journal of Thoracic and Cardiovascular Surgery
Susheel Kodali, Vinod H Thourani, Jonathon White, S Chris Malaisrie, Scott Lim, Kevin L Greason, Mathew Williams, Mayra Guerrero, Andrew C Eisenhauer, Samir Kapadia, Dean J Kereiakes, Howard C Herrmann, Vasilis Babaliaros, Wilson Y Szeto, Rebecca T Hahn, Philippe Pibarot, Neil J Weissman, Jonathon Leipsic, Philipp Blanke, Brian K Whisenant, Rakesh M Suri, Raj R Makkar, Girma M Ayele, Lars G Svensson, John G Webb, Michael J Mack, Craig R Smith, Martin B Leon
AIMS: Based on randomized trials using first-generation devices, transcatheter aortic valve replacement (TAVR) is well established in the treatment of high-risk (HR) patients with severe aortic stenosis (AS). To date, there is a paucity of adjudicated, prospective data evaluating outcomes with newer generation devices and in lower risk patients. We report early outcomes of a large, multicentre registry of inoperable, HR, and intermediate-risk (IR) patients undergoing treatment with the next-generation SAPIEN 3 transcatheter heart valve (THV)...
July 21, 2016: European Heart Journal
Boris Schmitt, Hendrik Spriestersbach, Darach O H-Icí, Torben Radtke, Marco Bartosch, Heiner Peters, Matthias Sigler, Laura Frese, Petra E Dijkman, Frank P T Baaijens, Simon P Hoerstrup, Felix Berger
AIMS: The objective was to implant a stented decellularised tissue-engineered heart valve (sdTEHV) percutaneously in an animal model, to assess its in vivo functionality and to examine the repopulation and remodelling of the valvular matrix by the recipient's autologous cells. METHODS AND RESULTS: Prototypes of sdTEHV were cultured in vitro, decellularised and percutaneously implanted into the pulmonary position in 15 sheep. Functionality was assessed monthly by intracardiac echocardiography (ICE)...
May 17, 2016: EuroIntervention
Ramón Rodríguez-Olivares, Lennart van Gils, Nahid El Faquir, Zouhair Rahhab, Luigi F M Di Martino, Sander van Weenen, John de Vries, Tjebbe W Galema, Marcel L Geleijnse, Ricardo P J Budde, Eric Boersma, Peter P de Jaegere, Nicolas M Van Mieghem
BACKGROUND: The interaction of left ventricular outflow tract (LVOT) and transcatheter heart valve (THV) is complex and may be device design specific. We sought to study LVOT characteristics and its relation with permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR). METHODS: We studied 302 patients with a median age of 81years [75-84]. Computed tomography was used to assess LVOT in terms of amount of calcium, perimeter and device size relative to LVOT...
August 1, 2016: International Journal of Cardiology
Gidon Y Perlman, Philipp Blanke, Danny Dvir, Gregor Pache, Thomas Modine, Marco Barbanti, Erik W Holy, Hendrik Treede, Philipp Ruile, Franz-Josef Neumann, Caterina Gandolfo, Francesco Saia, Corrado Tamburino, George Mak, Christopher Thompson, David Wood, Jonathon Leipsic, John G Webb
OBJECTIVES: This study evaluated the results of transcatheter aortic valve replacement (TAVR) in bicuspid aortic stenosis (AS) using a new-generation TAVR device. BACKGROUND: A bicuspid AS is often considered a relative contraindication to TAVR. Although initial reports have demonstrated feasibility using early-generation devices, outcomes have not matched those seen with tricuspid AS. Paravalvular aortic regurgitation (AR) has been particularly problematic. METHODS: We collected baseline characteristics, procedural data, and 30-day clinical follow-up findings from 8 centers in Europe and Canada that had performed TAVR in bicuspid AS using the SAPIEN 3 valve...
April 25, 2016: JACC. Cardiovascular Interventions
Zahra Mosala Nezhad, Alain Poncelet, Laurent de Kerchove, Pierre Gianello, Caroline Fervaille, Gebrine El Khoury
Extracellular matrix (ECM) derived from small intestinal submucosa (SIS) is widely used in clinical applications as a scaffold for tissue repair. Recently, CorMatrix® porcine SIS-ECM (CorMatrix Cardiovascular, Inc., Roswell, GA, USA) has gained popularity for 'next-generation' cardiovascular tissue engineering due to its ease of use, remodelling properties, lack of immunogenicity, absorbability and potential to promote native tissue growth. Here, we provide an overview of the biology of porcine SIS-ECM and systematically review the preclinical and clinical literature on its use in cardiovascular surgery...
June 2016: Interactive Cardiovascular and Thoracic Surgery
Smita Scholtz, Dieter Horstkotte, Jan Gummert, Jochen Börgermann, Werner Scholtz
Next-generation transcatheter heart valves are designed to overcome procedure-related adverse events such as vascular complications and annulus rupture, and to minimize paravalvular regurgitation. The Direct Flow Medical valve is fully repositionable and shows promising results. The case is presented of Direct Flow Medical valve implantation in a patient with a functional bicuspid aortic valve. Multiple repositioning maneuvers failed to overcome the anatomic difficulties, and this resulted in a moderately high persisting gradient and moderate paravalvular leakage...
May 2015: Journal of Heart Valve Disease
Oliver Husser, Costanza Pellegrini, Thorsten Kessler, Christof Burgdorf, Hannah Thaller, N Patrick Mayr, Albert M Kasel, Adnan Kastrati, Heribert Schunkert, Christian Hengstenberg
OBJECTIVES: This study investigates the influence of implantation depth and prosthesis oversizing on conduction abnormalities (CA) and permanent pacemaker implantation (PPI) after SAPIEN 3 (Edwards Lifesciences, Irvine, California) implantation. BACKGROUND: CA and PPIs are frequent complications after transcatheter aortic valve replacement with a next-generation balloon-expandable transcatheter heart valve (SAPIEN 3). The potential underlying mechanisms are incompletely understood...
February 8, 2016: JACC. Cardiovascular Interventions
Mehdi Jahandardoost, Guy Fradet, Hadi Mohammadi
To date, to the best of the authors' knowledge, in almost all of the studies performed around the hemodynamics of bileaflet mechanical heart valves, a heart rate of 70-72 beats/min has been considered. In fact, the heart rate of ~72 beats/min does not represent the entire normal physiological conditions under which the aortic or prosthetic valves function. The heart rates of 120 or 50 beats/min may lead to hemodynamic complications, such as plaque formation and/or thromboembolism in patients. In this study, the hemodynamic performance of the bileaflet mechanical heart valves in a wide range of normal and physiological heart rates, that is, 60-150 beats/min, was studied in the opening phase...
March 2016: Proceedings of the Institution of Mechanical Engineers. Part H, Journal of Engineering in Medicine
Mehdi Jahandardoost, Guy Fradet, Hadi Mohammadi
Despite successful implantation of St. Jude Medical bileaflet mechanical heart valves, red blood cell lysis and thrombogenic complications associated with these types of valves are yet to be addressed. In our previous study, we proposed an elliptic housing where 10% ovality was applied to the housing of St. Jude Medical valves. Our preliminary results suggested that the overall hemodynamic performance of St. Jude Medical valves improved in both the closing and opening phases. In this study, we evaluated the hemodynamics around the leaflets in the opening phase using a more sophisticated computational platform, computational fluid dynamics...
February 2016: Proceedings of the Institution of Mechanical Engineers. Part H, Journal of Engineering in Medicine
Natasha Dargis, Maxime Lamontagne, Nathalie Gaudreault, Laura Sbarra, Cyndi Henry, Philippe Pibarot, Patrick Mathieu, Yohan Bossé
Bicuspid aortic valve (BAV) is the most frequent congenital heart defect and has a male predominance of 3 to 1. A large proportion of patients develop valvular and aortic complications. Despite the high prevalence of BAV, its cause and genetic origins remain elusive. The goal of this study was to identify genetic variants associated with BAV. Nine genes previously associated with BAV (NOTCH1, AXIN1, EGFR, ENG, GATA5, NKX2-5, NOS3, PDIA2, and TGFBR2) were sequenced in 48 patients with BAV using the Ion Torrent Personal Genome Machine...
February 1, 2016: American Journal of Cardiology
Andreas Schaefer, Matthias Linder, Hendrik Treede, Florian Deuschl, Niklas Schofer, Moritz Seiffert, Yvonne Schneeberger, Stefan Blankenberg, Hermann Reichenspurner, Ulrich Schaefer, Lenard Conradi
OBJECTIVES: Physicians are frequently confronted with patients suffering from aortic stenosis with annular diameters exceeding dimensions in which currently available transcatheter heart valves (THV) are formally approved. Experience in patients receiving significantly undersized Sapien 3 (S3) THV (Edwards Lifesciences, Inc., Irvine, CA, USA) in aortic annuli up to 32 mm has not been reported so far. METHODS: Patients with aortic annuli exceeding the formally determined upper size limit and who received a 29 mm S3, were identified from our database...
July 2016: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Joshua A Stern, Weihow Hsue, Kun-Ho Song, Eric S Ontiveros, Virginia Luis Fuentes, Rebecca L Stepien
Mitral valve degeneration (MVD) is the most common form of heart disease in dogs, frequently leading to left-sided congestive heart failure and cardiac mortality. Although breed-specific disease characteristics and overrepresentation point towards a genetic origin for MVD, a causative mutation and complete molecular pathogenesis are unknown. Whippet dogs are overrepresented in incidence of MVD, suggesting an inherited component in this breed. Expressivity of this condition is variable with some dogs showing evidence of more severe disease at earlier ages than other dogs...
2015: PloS One
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