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Redo valve replacement

Julia Götte, Wolfgang Hemmer, Detlef Roser, Markus Liebrich, Nicolas Doll
We report the case of a 83-year-old man who had undergone a full root replacement with a stentless bioprosthesis 15 years earlier. He was now diagnosed with severe aortic valve regurgitation secondary to leaflet degeneration, moderate mitral regurgitation, and single-vessel coronary artery disease. To reduce cross-clamp time and technical difficulties a sutureless aortic prosthesis was used. His surgery and postoperative course were uneventful. This is the first report of the successful use of a sutureless aortic valve prosthesis in a patient after bioprosthetic full root replacement who required additional mitral repair and coronary artery bypass surgery...
November 2016: Annals of Thoracic Surgery
Jochen Reinöhl, Klaus Kaier, Holger Reinecke, Lutz Frankenstein, Andreas Zirlik, Manfred Zehender, Constantin von Zur Mühlen, Christoph Bode, Peter Stachon
OBJECTIVES: The aim of this study was to assess how the introduction of transcatheter aortic valve replacement (TAVR) has changed clinical practice and outcome in patients who have previously undergone coronary artery bypass grafting (CABG). BACKGROUND: A significant proportion of patients admitted for aortic valve replacement have previously undergone CABG and are therefore at increased operative risk in case of redo surgery. METHODS: In-hospital outcome data were analyzed from patients with or without previous CABG undergoing isolated surgical aortic valve replacement or TAVR in Germany from 2007 to 2013...
October 24, 2016: JACC. Cardiovascular Interventions
Pascal M Dohmen, Lukas Lehmkuhl, Michael A Borger, Martin Misfeld, Friedrich W Mohr
BACKGROUND We present a unique case of a 61-year-old female patient with homograft deterioration after redo surgery for prosthetic valve endocarditis with root abscess. CASE REPORT The first operation was performed for type A dissection with root, arch, and elephant trunk replacement of the thoracic aorta. The present re-redo surgery was performed as valve-in-valve with a sutureless aortic bioprosthesis. The postoperative course was uneventful and the patient was discharged on day 6. CONCLUSIONS The current case report demonstrates that sutureless bioprostheses are an attractive option for surgical valve-in-valve procedures, which can reduce morbidity and mortality...
October 3, 2016: American Journal of Case Reports
Poovendran Saththasivam, Elizabeth Herrera, Gerald Lawrie, Odeaa Al Jabbari, Collin M Barker, Roy Sheinbaum
The MitraClip procedure is an emerging endovascular technique for treating mitral regurgitation and an attractive alternative for patients who are at high risk for open heart mitral valve repair or replacement. We present the case of a failed redo MitraClip procedure that led to acute right ventricular failure in a patient with homozygous familial hypercholesterolemia and a preexisting secundum atrial septal defect. We highlight the sequelae of the failed redo MitraClip procedure and the anesthetic challenges associated with the emergent redo sternotomy and cardiopulmonary bypass procedure required to replace the mitral valve and repair the tricuspid valve and atrial septal defect...
September 23, 2016: A & A Case Reports
Miriam Silaschi, Olaf Wendler, Moritz Seiffert, Liesa Castro, Edith Lubos, Johannes Schirmer, Stefan Blankenberg, Hermann Reichenspurner, Ulrich Schäfer, Hendrik Treede, Philip MacCarthy, Lenard Conradi
OBJECTIVES: Transcatheter aortic valve-in-valve implantation (ViV) is a new treatment for failing bioprostheses (BP) in patients with high surgical risk. However, comparative data, using standard repeat surgical aortic valve replacement (redo-SAVR), are scarce. We compared outcomes after ViV with those after conventional redo-SAVR in two European centres with established interventional programmes. METHODS: In-hospital databases were retrospectively screened for patients ≥60 years, treated for failing aortic BP...
September 13, 2016: Interactive Cardiovascular and Thoracic Surgery
Hasan Bushnaq, Dietrich Metz, Asen Petrov, Stefan Frantz, Ulrich Hofmann, Christoph Raspé, Hendrik Treede
OBJECTIVE: The standard procedure of transcatheter aortic valve implantation involves transfemoral access. Nevertheless, the use of this access route is limited by the vessel diameter, calcification, and tortuosity, making a subgroup of patients ineligible for peripheral access. We report the first use of direct aortic transcatheter aortic valve implantation with the Direct Flow Medical valve (Direct Flow Medical, Inc, Santa Rosa, Calif) in 15 patients at the Halle-Wittenberg University...
August 12, 2016: Journal of Thoracic and Cardiovascular Surgery
Jong Hun Kim, Tae Youn Kim, Jong Bum Choi, Ja Hong Kuh
Patients requiring redo cardiac surgery for diseased heart valves other than mitral valves may show increased pressure gradients and reduced valve areas of previously placed mechanical mitral valves due to subvalvular pannus formation. We treated four women who had mechanical mitral valves inserted greater than or equal to 20 years earlier and who presented with circular pannus that protruded into the lower margin of the valve ring but did not impede leaflet motion. Pannus removal improved the haemodynamic function of the mitral valve...
September 1, 2016: Interactive Cardiovascular and Thoracic Surgery
Marco Barbanti, John G Webb, Claudia Tamburino, Nicolas M Van Mieghem, Raj R Makkar, Nicolò Piazza, Azeem Latib, Jan-Malte Sinning, Kim Won-Keun, Sabine Bleiziffer, Francesco Bedogni, Samir Kapadia, Didier Tchetche, Josep Rodés-Cabau, Claudia Fiorina, Luis Nombela-Franco, Federico De Marco, Peter P de Jaegere, Tarun Chakravarty, Beatriz Vaquerizo, Antonio Colombo, Lars Svensson, Rüdiger Lange, Georg Nickenig, Helge Möllmann, Thomas Walther, Francesco Della Rosa, Yacine Elhmidi, Danny Dvir, Nedy Brambilla, Sebastiano Immè, Carmelo Sgroi, Simona Gulino, Denise Todaro, Gerlando Pilato, Anna Sonia Petronio, Corrado Tamburino
BACKGROUND: Transcatheter aortic valves can degenerate in a manner similar to surgical bioprostheses. METHODS AND RESULTS: Clinical and echocardiographic outcomes of patients who underwent redo transcatheter aortic valve replacement (TAVR) procedures >2 weeks post procedure were collected from 14 centers. Among 13 876 patients, 50 (0.4%) underwent redo TAVR procedure at participating centers. Indications for redo TAVR were moderate-severe prosthetic aortic valve stenosis (n=10, 21...
September 2016: Circulation. Cardiovascular Interventions
Conor F Hynes, Omid Fatemi, Aditya C Sharma, Christian D Nagy, Gregory D Trachiotis
We present a complex case of a transapical redo mitral valve-in-valve replacement. Repeat mitral valve replacement was indicated for severe symptomatic bioprosthetic stenosis. In addition to the patient's numerous comorbidities that included diabetes, hepatic cirrhosis, ischemic cardiomyopathy, and atrial flutter, he had undergone a previous open mitral valve replacement that was complicated by sternal dehiscence requiring extensive chest wall reconstruction. Transapical approach was performed through left minithoracotomy incision with balloon-expandable valve...
May 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Byung Kwon Chong, Sung-Ho Jung, Suk Jung Choo, Cheol Hyun Chung, Jae Won Lee, Joon Bum Kim
BACKGROUND: Generalization of standardized surgical techniques to treat aortic valve (AV) and aortic root diseases has benefited large numbers of patients. As a consequence of the proliferation of patients receiving aortic root surgeries, surgeons are more frequently challenged by reoperative aortic root procedures. The aim of this study was to evaluate the outcomes of redo-aortic root replacement (ARR). METHODS: We retrospectively reviewed 66 patients (36 male; mean age, 44...
August 2016: Korean Journal of Thoracic and Cardiovascular Surgery
Cüneyt Toprak, Anil Avci, Mehmed Yanartas, Mehmet Mustafa Tabakci, Emrah Acar, Mehmet Ozkan
The fastest growing demographic group in Europe and America is the elderly, and significant mitral regurgitation is very prevalent in this population. At present, with mitral valve surgery in elderly individuals gaining greater acceptance worldwide, the question whether to repair or replace the valve remains controversial. Recent studies have demonstrated the safety, feasibility, and durability of repair over replacement in elderly patients. Herein, we report the case of an elderly patient who underwent surgical re-interventions on the mitral valve following an unsuccessful mitral valve repair procedure...
June 2016: Kardiochirurgia i Torakochirurgia Polska, Polish Journal of Cardio-Thoracic Surgery
Muhammet Onur Hanedan, Ferit Çiçekçioğlu, Ayşen Aksöyek, Adem İlkay Diken, Ertekin Utku Ünal, Ali İhsan Parlar, Salih Fehmi Katırcıoğlu
BACKGROUND: The tricuspid valve is usually ignored and tricuspid interventions are mostly done in the context of other planned cardiac surgery. Isolated tricuspid reoperative procedure, especially tricuspid valve replacement (TVR) is very rare and carries a very high mortality rate. In this prospective study, clinical results of isolated TVR either through a median re-sternotomy or an antero-lateral thoracotomy with conventional cardiopulmonary bypass (CPB) have been evaluated. METHODS: Thirty patients with previous open heart surgery through median sternotomy had isolated TVR between 2004 and 2011...
July 2, 2016: Heart, Lung & Circulation
Suguru Ohira, Hiroaki Miyata, Kiyoshi Doi, Noboru Motomura, Shinichi Takamoto, Hitoshi Yaku
OBJECTIVES: The aims of this study were to investigate early results of aortic valve replacement (AVR) after cardiovascular surgery and create a risk model using a national database in Japan. METHODS: We used the Japan Adult Cardiovascular Surgery Database. Between 2008 and 2013, 2157 patients who underwent AVR for aortic stenosis after cardiovascular surgery or redo AVR were retrospectively analysed. RESULTS: The background of prior surgery (including overlapping cases) was as follows: coronary artery bypass grafting (CABG), 31...
July 11, 2016: European Journal of Cardio-thoracic Surgery
Fredrik Halvorsen, Christoph Haller, Edward Hickey
More than 50% of children who undergo repair of tetralogy of Fallot (TOF) using a transannular patch will require pulmonary valve replacement (PVR) in early adulthood. The premise of PVR in this setting is to ameliorate the relentless right ventricular (RV) dilatation that otherwise occurs in the presence of severe pulmonary regurgitation. Severe RV dilatation is associated with RV dysfunction, symptoms of exercise intolerance, tricuspid regurgitation and-occasionally-life-threatening RV failure or dangerous ventricular tachyarrhythmia...
2016: Multimedia Manual of Cardiothoracic Surgery: MMCTS
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
Marek Kazibudzki, Pawel Latacz, Tomasz Ludyga, Marian Simka
AIM: In this technical note we present the results of endovascular treatment for chronic cerebrospinal venous insufficiency with the use of cutting balloons, with focus on feasibility and safety of these endovascular devices. METHODS: We used cutting balloons during 70 procedures in 65 multiple sclerosis patients presenting with strictures of the internal jugular veins, primarily at the level of jugular valves. These devices were used only in selected cases, following unsuccessful standard balloon angioplasty, and on condition that commercially available devices could be applied (currently they are maximally 8 mm in diameter)...
June 28, 2016: Journal of Cardiovascular Surgery
Mio Kasai, Yoshito Inoue, Satoru Suzuki, Ryo Suzuki
Left atrial (LA) dissection is an extremely rare and life-threatening complication which is most commonly associated with mitral valve surgery. We report a case of LA dissection after a redo mitral valve replacement and discuss its etiology and management.
August 2016: Journal of Cardiac Surgery
Young Joo Suh, Geu-Ru Hong, Kyunghwa Han, Dong Jin Im, Suyon Chang, Yoo Jin Hong, Hye-Jeong Lee, Jin Hur, Byoung Wook Choi, Byung-Chul Chang, Chi Young Shim, Young Jin Kim
BACKGROUND: The diagnostic performance of cardiac computed tomography (CT) for detection of paravalvular leakage (PVL) after mitral valve replacement has not been investigated in a large population. We aimed to investigate the diagnostic accuracy of CT for diagnosis of mitral PVL using surgical findings as the standard reference and to compare the diagnostic performance of CT with those of transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE). METHODS AND RESULTS: A total of 204 patients with previous mitral valve replacement who underwent cardiac CT were retrospectively included...
June 2016: Circulation. Cardiovascular Imaging
Laura Brown, Lowell Tilzer, Fred Plapp
A 33-year-old male was admitted to the hospital for a repeat mitral valve replacement. The original surgery, performed in India in 2008 due to rheumatic heart disease, required massive amounts of plasma replacement during and after the surgery. The patient was admitted to our hospital with extremely low Factor V and Factor VIII activities due to a rare combined Factor V and Factor VIII deficiency. His clinical condition on admission was grave due to severe pulmonary hypertension. It was decided to replace the patient's Factor V using therapeutic plasma exchange (TPE) with fresh frozen plasma (FFP) just prior to surgery, and his Factor VIII with Factor VIII concentrate...
June 16, 2016: Journal of Clinical Apheresis
Dimitri Arangalage, Laurent Lepage, Dorothée Faille, Claire Cimadevilla, Marie-Pierre Dilly, Emmanuelle Papy, Martine Alhenc-Gelas, Walid Ghodbane, Patrick Nataf, Bernard Iung, Philippe Gabriel Steg, Alec Vahanian, Nadine Ajzenberg, David Messika-Zeitoun
OBJECTIVES: The use of heparin exposes patients to heparin-induced thrombocytopenia, which is a challenging issue for both diagnosis and patient management. We sought to describe the clinical presentation, management and outcome of a series of patients diagnosed with heparin-induced thrombocytopenia after heart valve surgery. METHODS: All consecutive patients diagnosed with heparin-induced thrombocytopenia during the postoperative period of heart valve surgery over a 6-year period were prospectively enrolled in a single-centre registry...
June 14, 2016: European Journal of Cardio-thoracic Surgery
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