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Prosthetic heart valve innovation

Mario Barbosa, Luiz Menezes Falcão
Direct oral anticoagulants emerge as the most innovative and promising drug toward preventing and treating cardiovascular disease, raising great interest among the scientific community. Numerous studies and meta-analysis generated much data clarifying clinicians' doubts; however, uncertainties remain regarding their use in particular groups such as patients with prosthetic valves, in valvular atrial fibrillation (defined as atrial fibrillation related to mitral rheumatic heart disease or prosthetic heart valves), among the elderly, in paraneoplastic thromboembolism, in pulmonary embolism with hemodynamic compromise, and scarcity of specific antidotes...
August 29, 2016: American Journal of Therapeutics
Frederick J Schoen, Avrum I Gotlieb
The past several decades have witnessed major advances in the understanding of the structure, function, and biology of native valves and the pathobiology and clinical management of valvular heart disease. These improvements have enabled earlier and more precise diagnosis, assessment of the proper timing of surgical and interventional procedures, improved prosthetic and biologic valve replacements and repairs, recognition of postoperative complications and their management, and the introduction of minimally invasive approaches that have enabled definitive and durable treatment for patients who were previously considered inoperable...
July 2016: Cardiovascular Pathology: the Official Journal of the Society for Cardiovascular Pathology
Glenn R Barnhart, Malakh Lal Shrestha
Aortic stenosis is the most common valvular heart disease in the Western world. It is caused primarily by age-related degeneration and progressive calcification typically detected in patients 65 years and older. In patients presenting with symptoms of heart failure, the average survival rate is only 2 years without appropriate treatment. Approximately one half of all patients die within the first 2 to 3 years of symptom onset. In addition, the age of the patients presenting for aortic valve replacement (AVR) is increased along with the demographic changes...
January 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Candice Y Lee, Jude S Sauer, Heather R Gorea, Angelo J Martellaro, Peter A Knight
OBJECTIVE: This study compared the strength, consistency, and speed of prosthetic attachment sutures secured with automated fasteners with those of manual knots using an ex vivo porcine mitral valve annuloplasty model. A novel miniature pressure transducer system was developed to quantify pressures between sutured prosthetic rings and underlying cardiac tissue. METHODS: Sixteen mitral annuloplasty rings were sewn into ex vivo pig hearts. Eight rings were secured with the COR-KNOT device; and eight rings, with hand-tied knots using a knot pusher...
March 2014: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
JaBaris D Swain, Daniel N Pugliese, Joseph Mucumbitsi, Emmanuel K Rusingiza, Nathan Ruhamya, Abel Kagame, Gapira Ganza, Patricia C Come, Suellen Breakey, Bonnie Greenwood, Jochen D Muehlschlegel, Cecilia Patton-Bolman, Agnes Binagwaho, R Morton Bolman
IMPORTANCE: Rheumatic heart disease (RHD) in the developing world results in critical disability among children, adolescents, and young adults-marginalizing a key population at its peak age of productivity. Few regions in sub-Saharan Africa have independently created an effective strategy to detect and treat streptococcal infection and mitigate its progression to RHD. OBJECTIVE: We describe a unique collaboration, where the Rwanda Ministry of Health, the Rwanda Heart Foundation, and an expatriate humanitarian cardiac surgery program have together leveraged an innovative partnership as a means to expand Rwanda's current capacity to address screening and primary prevention, as well as provide life-saving cardiac surgery for patients with critical RHD...
September 2014: World Journal of Surgery
Venkateshwar Polsani, Stephen H Little
PURPOSE OF REVIEW: To review the current literature on prosthetic valve function and para-valvular regurgitation (PVR) after trans-catheter aortic valve replacement (TAVR). TAVR is a new alternative for the treatment of severe aortic stenosis in patients at high risk for surgical aortic valve replacement and nonsurgical candidates. RECENT FINDINGS: The innovations in three-dimensional trans-esophageal echocardiography have made it an integral part of the TAVR procedure...
September 2013: Current Opinion in Cardiology
Faisal H Cheema, Nasir Hussain, Alexander P Kossar, Gianluca Polvani
Valvular heart disease, inherited or acquired, affects more than 5 million Americans yearly. Whereas medical treatment is beneficial in the initial stages of valvular heart disease, surgical correction provides symptomatic relief and long-term survival benefits. Surgical options include either repair or replacement using mechanical or bio-prosthetic valves. Patient age and the post-operative need for anticoagulation therapy are major determinants of the choice between use of mechanical or bio-prosthetic valves...
April 2013: Recent Patents on Cardiovascular Drug Discovery
J Cremer, J Schöttler, R Petzina, G Hoffmann
INTRODUCTION: Biological stented prostheses are currently the main type of prosthetic valve used for aortic valve replacement. The ratio of bioprotheses to mechanical prostheses has switched in the last 15 years; the percentage of biological  prostheses implanted has risen from 30 % to 85 %. Moreover the total number of implanted stented bioprostheses remained stable over the last years despite competing procedures like stentless prostheses or transcatheter aortic valve implantation...
2012: HSR Proceedings in Intensive Care & Cardiovascular Anesthesia
F Auricchio, M Conti, S Morganti, A Reali
Until recently, heart valve failure has been treated adopting open-heart surgical techniques and cardiopulmonary bypass. However, over the last decade, minimally invasive procedures have been developed to avoid high risks associated with conventional open-chest valve replacement techniques. Such a recent and innovative procedure represents an optimal field for conducting investigations through virtual computer-based simulations: in fact, nowadays, computational engineering is widely used to unravel many problems in the biomedical field of cardiovascular mechanics and specifically, minimally invasive procedures...
2014: Computer Methods in Biomechanics and Biomedical Engineering
Oliver Reuthebuch, Jens Fassl, John Brown, Martin Grapow, Friedrich Eckstein
OBJECTIVES: To offer surgical treatment in patients with aortic valve stenosis and contraindications for aortic valve replacement (e.g. ostial encroachment and previous mitral valve replacement). The aim of this study was to prove the feasibility and efficacy of this novel innovative off-pump apico-aortic conduit technique. METHODS: The bipartite conduit consists of an 18-mm prosthetic tube graft containing a stentless porcine aortic valve as well as a flexible semi-rigid and curved ventricular connector...
April 2013: Interactive Cardiovascular and Thoracic Surgery
Alessandro Gandaglia, Andrea Bagno, Filippo Naso, Michele Spina, Gino Gerosa
The development of viable and functional tissue-engineered heart valves (TEHVs) is a challenge that, for almost two decades, the scientific community has been committed to face to create life-lasting prosthetic devices for treating heart valve diseases. One of the main drawbacks of tissue-based commercial substitutes, xenografts and homografts, is their lack of viability, and hence failure to grow, repair, and remodel. In adults, the average bioprostheses life span is around 13 years, followed by structural valve degeneration, such as calcification; in pediatric, mechanical valves are commonly used instead of biological substitutes, as in young patients, the mobilization of calcium, due to bone remodeling, accelerates the calcification process...
April 2011: European Journal of Cardio-thoracic Surgery
Jose L Navia, Edward R Nowicki, Eugene H Blackstone, Nicolas A Brozzi, Daniel E Nento, Fernando A Atik, Jeevanantham Rajeswaran, A Marc Gillinov, Lars G Svensson, Bruce W Lytle
OBJECTIVES: Techniques employed today concomitantly with left-sided heart valve surgery address secondary tricuspid valve regurgitation at 3 anatomic levels-annulus, commissure, and leaflet-although success of these alone or in combination in eliminating tricuspid regurgitation is uncertain. Our objective was to assess the comparative effectiveness of these techniques in reducing or eliminating secondary tricuspid regurgitation. METHODS: From 1990 to 2008, 2277 patients underwent tricuspid valve procedures for secondary tricuspid regurgitation concomitantly with mitral (n = 1527, 67%), aortic (n = 180, 7...
June 2010: Journal of Thoracic and Cardiovascular Surgery
Karthik Vaidyanathan, Ravi Agarwal, Raghav Johari, Kotturathu Mammen Cherian
Prosthetic replacement of valves in children is limited by size constraints of the prosthesis and lack of growth potential. In specific situations like infective endocarditis, valve preservation is near impossible and in such instances alternatives are hard to get. Furthermore, in the tricuspid position the long-term results of both mechanical and bioprosthesis are not optimal. We used an innovative method in a small boy with tricuspid valve endocarditis by using a tricuspid homograft in the tricuspid position...
June 2010: Interactive Cardiovascular and Thoracic Surgery
J Scott Rankin, Calvin A Burrichter, Melissa K Walton-Shirley, James H Whiteside, Stephen M Teague, Victor W McLaughlin, Mukesh K Sharma, Thomas S Johnston, A Thomas McRae, Paul R Myers
BACKGROUND AND AIM OF THE STUDY: Mitral repair has evolved to a point where three methods can be used to address most pathologies: full ring annuloplasty (RA) for annular disease; Gore-Tex artificial chordal replacement (ACR) for chordal disease; and autologous pericardial augmentation (PA) for leaflet disease. The study aim was to assess the impact of the increasing application of these methods on operative results over time. METHODS: Of 328 consecutive mitral valve procedures, 34% involved myxomatous prolapse, 23% rheumatic, 13% ischemic, 12% pure annular dilatation, 7% prosthetic dysfunction, 6% endocarditis, 3% hypertrophic obstructive cardiomyopathy (HOCM), and 2% 'other'...
July 2009: Journal of Heart Valve Disease
Valentin Fuster, Seth H Goldbarg, Riple J Hansalia, Gerin R Stevens, Satish R Tiyyagura
The spectrum of potentially successful treatment options for inoperable valvular disease is limited. Aortic valvuloplasty may offer temporary improvement in symptoms and some survival benefit in select non-surgical patients with aortic stenosis, but it does not improve long-term outcome. Mitral valve incompetence often responds well to surgical repair, though patients with significantly reduced left ventricular function have worsened outcomes. The design of a percutaneous implantable prosthetic heart valve is a promising alternative to valvuloplasty...
August 2006: EuroIntervention
Makoto Yanatori, S Tomita, Y Ueno, Y Miura, T Goto, M Komeda
We presented a case of endocarditis with methicillin-resistant Staphylococcus epidermidis that was successfully treated with linezolid. Endocarditis has been hard to cure completely with either antibiotics or surgery. In particular, it is harder to eradicate disease-causing bacteria when it is staphylococci or streptococci. In this case, an innovative operative technique and a new kind of antibiotics were involved after the failure with some sorts of antibiotics. We put a strip shaped pericardium around a newly implanted artificial ring to prevent its organism from touching it...
June 2007: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Leonid Goubergrits, Klaus Affeld, Ulrich Kertzscher
Prosthetic heart valves are routinely used for replacing diseased natural heart valves. Even today, after five decades of prosthetic heart valve development, in the authors opinion the main problem associated with these valves is the risk of thromboembolic complications caused by unnatural hemodynamics. Further growing application of prosthetic heart valves is their use in the pulsatile ventricular assist devices (VADs). VADs may provide life-saving solutions to patients with severe cardiovascular diseases and are superior to drug therapy for patients with severe heart failure...
January 2005: Expert Review of Medical Devices
Mauro Grigioni, Carla Daniele, Giuseppe D'Avenio, Umberto Morbiducci, Costantino Del Gaudio, Mara Abbate, David Di Meo
Prosthetic heart valves (PHVs) are engineered devices used for replacing diseased natural cardiac valves. This article presents several investigational techniques for the evaluation of the performance of these clinical devices, whose implantation is not completely free of drawbacks. The state-of-the-art in the technological approach for PHV testing is addressed. As the fluid dynamics of PHVs are particularly complex, the main focus will be on experimental velocimetric techniques and computational analysis. A methodology for the analysis of the valve's signature, in terms of its characteristic sound in the opening and closing phases, is also presented...
September 2004: Expert Review of Medical Devices
R Parker Ward, Roberto M Lang
Over the last three decades, the continuing development of transesophageal echocardiography (TEE) has represented a major advance in our ability to visualize cardiovascular structures with ultrasound. TEE serves as a valuable complement to transthoracic echocardiography (TTE) by allowing: images to be obtained with less attenuation from structures such as the lung, muscle, bone, and soft tissue; high resolution visualization of structures not well seen by TTE, such as left atrial appendage, descending thoracic aorta, and prosthetic heart valves; and assessment of hemodynamics and flow disorders in greater detail...
November 2003: Echocardiography
P Bonhoeffer, Y Boudjemline, Z Saliba, J Merckx, Y Aggoun, D Bonnet, P Acar, J Le Bidois, D Sidi, J Kachaner
BACKGROUND: Valved conduits from the right ventricle to the pulmonary artery are frequently used in paediatric cardiac surgery. However, stenosis and insufficiency of the conduit usually occur in the follow-up and lead to reoperations. Conduit stenting can delay surgical replacement, but it aggravates pulmonary insufficiency. We developed an innovative system for percutaneous stent implantation combined with valve replacement. METHODS: A 12-year-old boy with stenosis and insufficiency of a prosthetic conduit from the right ventricle to the pulmonary artery underwent percutaneous implantation of a bovine jugular valve in the conduit...
October 21, 2000: Lancet
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