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Expandable prosthetic valves

E Coron, G David, S Lecleire, J Jacques, A Le Sidaner, T Barrioz, D Coumaros, C Volteau, B Vedrenne, P Bichard, C Boustière, Y Touchefeu, J Brégeon, F Prat, M Le Rhun
INTRODUCTION: Self-expanding metal stents (SEMS) are commonly used in the palliation of dysphagia in patients with inoperable esophageal carcinoma. However, they predispose to gastroesophageal reflux when deployed across the gastroesophageal junction. The aims of this study were to: 1) assess the influence of the antireflux valve on trans-prosthetic reflux (primary outcome); and 2) compare the results of SEMS with and without antireflux valve in terms of reflux symptoms, quality of life (QOL), improvement of dysphagia and adverse events (secondary outcomes)...
June 2016: Endoscopy International Open
Kosaku Toyota, Takashi Ota, Katsutoshi Nagamine, Yasuhiro Koide, Takeshi Nomura, Futoshi Yamanaka, Koki Shishido, Masashi Tanaka, Shigeru Saito
Transcatheter aortic valve implantation (TAVI) for patients with aortic stenosis is a less invasive alternative to surgical aortic valve replacement. Despite this, careful anesthetic management, especially strict control of blood pressure and fluid management, is necessary. During TAVI, normalization of left ventricular afterload due to aortic balloon valvuloplasty and prosthetic valve deployment is expected to result in rapid improvement of systolic function and consequent improvement in diastolic function...
August 11, 2016: Journal of Anesthesia
Augusto D'Onofrio, Erjon Tarja, Laura Besola, Giampaolo Luzi, Marco Agrifoglio, Marco Aiello, Davide Gabbieri, Giuseppe Tarantini, Giulio Rizzoli, Francesco Musumeci, Gino Gerosa
BACKGROUND: Transcatheter valve-in-valve (VIV) implantation is an alternative option in inoperable or high-risk patients with prosthetic valve dysfunction. Aim of this retrospective multicenter study was to evaluate early and midterm clinical and hemodynamic outcomes of patients undergoing aortic (VIV-A) and mitral VIV (VIV-M). METHODS: We analyzed data of 66 procedures performed in 65 patients who underwent VIV procedures in the VIV-A and VIV-M position at 5 Italian institutions from January 2008 to May 2015...
August 2, 2016: Annals of Thoracic Surgery
Francesco Nappi, Angelo Rosario Carotenuto, Arsenio Cutolo, Pierre Fouret, Christophe Acar, Juan Carlos Chachques, Massimiliano Fraldi
Synthetic grafts are often satisfactory employed in cardiac and vascular surgery, including expanded poly(ethylene terephthalate) or expanded poly(tetrafluoroethylene). However, accumulating evidences suggest the emergence of worrisome issues concerning the long-term fate of prosthetic grafts as large vessel replacement. Disadvantages related to the use of synthetic grafts can be traced in their inability of mimicking the elasto-mechanical characteristics of the native vascular tissue, local suture overstress leading to several prosthesis-related complications and retrograde deleterious effects on valve competence, cardiac function and perfusion...
October 2016: Journal of the Mechanical Behavior of Biomedical Materials
Xiang Chen, Ben Zhang, Yufeng Zhu, Hongwen Tan, Xianxian Zhao, Yongwen Qin, Junbo Ge
BACKGROUND: Transcatheter aortic valve implantation (TAVI) is an effective percutaneous treatment for high-risk patients with severe symptomatic aortic stenosis. However, TAVI is rendered less effective in patients with noncalcified aortic valve disease because noncalcified aortic valves lack an anchor site for the implanted stent, causing the stent to relocate to an unexpected position. In this study, we developed an improved TAVI with a snare loop-assisted device, and evaluated the feasibility and safety of this strategy in noncalcified aortic valve disease...
August 2016: European Journal of Clinical Investigation
Amar Krishnaswamy, Stephanie Mick, Samir R Kapadia
Optimization of hemodynamics during transcatheter aortic valve replacement (TAVR) using the commercially available balloon expandable and self-expanding valves is often accomplished through post-dilation of the valves' metallic frame. The direct flow medical (DFM) valve is a uniquely designed second-generation TAVR prosthetic without a rigid metallic frame. It is not widely known whether balloon dilation of this valve is beneficial when valve hemodynamics after initial deployment suboptimal due to valve underexpansion...
May 19, 2016: Catheterization and Cardiovascular Interventions
André Luiz Silveira Souza, Constantino González Salgado, Ricardo Mourilhe-Rocha, Evandro Tinoco Mesquita, Luciana Cristina Lima Correia Lima, Nelson Durval Ferreira Gomes de Mattos, Arnaldo Rabischoffsky, Francisco Eduardo Sampaio Fagundes, Alexandre Siciliano Colafranceschi, Luiz Antonio Ferreira Carvalho
BACKGROUND: Transcatheter aortic valve implantation has become an option for high-surgical-risk patients with aortic valve disease. OBJECTIVE: To evaluate the in-hospital and one-year follow-up outcomes of transcatheter aortic valve implantation. METHODS: Prospective cohort study of transcatheter aortic valve implantation cases from July 2009 to February 2015. Analysis of clinical and procedural variables, correlating them with in-hospital and one-year mortality...
June 2016: Arquivos Brasileiros de Cardiologia
Francesco Sturla, Mattia Ronzoni, Mattia Vitali, Annalisa Dimasi, Riccardo Vismara, Georgia Preston-Maher, Gaetano Burriesci, Emiliano Votta, Alberto Redaelli
Transcatheter aortic valve implantation (TAVI) can treat symptomatic patients with calcific aortic stenosis. However, the severity and distribution of the calcification of valve leaflets can impair the TAVI efficacy. Here we tackle this issue from a biomechanical standpoint, by finite element simulation of a widely adopted balloon-expandable TAVI in three models representing the aortic root with different scenarios of calcific aortic stenosis. We developed a modeling approach realistically accounting for aortic root pressurization and complex anatomy, detailed calcification patterns, and for the actual stent deployment through balloon-expansion...
August 16, 2016: Journal of Biomechanics
Gaspare Di Lorenzo, Gennaro Martucci, Sergio Sciacca, Rosalia Longo, Michele Pilato, Antonio Arcadipane
Pregnant women with mechanical prosthetic heart valves have an increased risk of thrombosis and valve malfunctioning. Surgery carries a high risk of mortality for the mother and the fetus. A strategy for effective anticoagulation is crucial for these patients because both oral anticoagulants and heparin are associated with high risks for the mother and the fetus. The treatment of a pregnant woman with thrombosis and valve malfunction is a challenge, even for multidisciplinary teams, as cardiac surgery carries considerable risks...
October 2016: Perfusion
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
Per M Arvidsson, Sándor J Kovács, Johannes Töger, Rasmus Borgquist, Einar Heiberg, Marcus Carlsson, Håkan Arheden
The laws of fluid dynamics govern vortex ring formation and precede cardiac development by billions of years, suggesting that diastolic vortex ring formation is instrumental in defining the shape of the heart. Using novel and validated magnetic resonance imaging measurements, we show that the healthy left ventricle moves in tandem with the expanding vortex ring, indicating that cardiac form and function is epigenetically optimized to accommodate vortex ring formation for volume pumping. Healthy hearts demonstrate a strong coupling between vortex and cardiac volumes (R(2) = 0...
2016: Scientific Reports
Xiaopeng Liu, Yue Tang, Fuliang Luo, Yi Tian, Kai Li, Jiakang Sun, Liujun Jia, Wei Wang
OBJECTIVES: To evaluate a new transapical system which utilizes a novel designed positioning element and a two-step positioning mechanism for easy and accurate implantation of transcatheter valves. BACKGROUND: Transcatheter aortic valve implantation is an important treatment option for non-surgical patients with severe aortic stenosis. However, accurate placement of the transcatheter valve remains challenging. METHODS: Self-expandable aortic valve prosthesis with a flexibly connected, annulus-like positioning element was implanted through a transapical approach in 12 pigs...
January 26, 2016: Catheterization and Cardiovascular Interventions
Anna Kostopoulou, Panagiotis Karyofillis, Efthimios Livanis, George Karavolias, George Theodorakis, John Paraskevaides, Vassilis Voudris
Transcatheter aortic valve replacement (TAVR) is an expanding, catheter-based technology that allows the implantation of a prosthetic valve without requiring open heart surgery for the treatment of severe aortic stenosis (AS). The frequency of coronary artery disease (CAD) in patients (pts) with severe AS undergoing surgical treatment ranges from 30 to 50 %. This tends to be higher in pts undergoing TAVR with a prevalence of 49-76 % and is more prevalent with older age and the fact that TAVR is commonly performed in high-risk groups with more advanced cardiovascular disease...
February 2016: Current Treatment Options in Cardiovascular Medicine
Gaetano Burriesci, Paolo Peruzzo, Francesca Maria Susin, Giuseppe Tarantini, Andrea Colli
OBJECTIVE: We aimed to in-vitro test Amplatzer devices (Amplatzer Vascular Plug II and Amplatzer Vascular Plug III, SJM, St. Paul, MN) in closing PVL generated by transcatheter balloon expandable aortic valve prosthesis in order to quantify the effective treatment of PVL. BACKGROUND: Transcatheter aortic valve implantation (TAVI) procedures represent the treatment of choice for high risk patients. Despite evolving technologies paravalvular leak (PVL) is still a major unaddressed issue...
January 15, 2016: International Journal of Cardiology
Lai Wei, Huan Liu, Liming Zhu, Ye Yang, Jiayu Zheng, Kefang Guo, Hong Luo, Weipeng Zhao, Xue Yang, Aikebaier Maimaiti, Chunsheng Wang
OBJECTIVES: This study introduces a newly designed transcatheter aortic valve system, the J-Valve system, and evaluates its application in patients with predominant aortic regurgitation without significant valve calcification. We also report the early results of one of the first series of transapical implantations of this device and aim to offer guidance on the technical aspects of the procedure. BACKGROUND: Transcatheter aortic valve replacement (TAVR) has been widely used in high-risk patients for surgical aortic valve replacement...
December 21, 2015: JACC. Cardiovascular Interventions
Jae K Oh, Stephen H Little, Sahar S Abdelmoneim, Michael J Reardon, Neal S Kleiman, Grace Lin, David Bach, Linda Gillam, Biswajit Kar, Joseph Coselli, Partho P Sengupta, Kanny Grewal, James Chang, Yanping Chang, Mike Boulware, David H Adams, Jeffrey J Popma
OBJECTIVES: The aim of this study was to describe the natural history and clinical importance of paravalvular aortic regurgitation (PVAR) after CoreValve transcatheter aortic valve replacement (TAVR) and to relate these findings to the structural and hemodynamic changes documented by serial echocardiographic analysis. BACKGROUND: PVAR after TAVR with the self-expanding CoreValve bioprosthesis has been shown to regress over time, but the time course and the mechanism of PVAR regression has not been completely characterized...
December 2015: JACC. Cardiovascular Imaging
Jens Sundbøll, Nils Henrik Stubkjær Hansson, Steen Baerentzen, Manan Pareek
A 64-year-old previously healthy woman consulted her general practitioner because of recurrent episodes of right-sided monocular transient visual loss (ie, amaurosis fugax). At first, these symptoms were followed over time, but as the attacks worsened, and were accompanied by dizziness and general discomfort, the patient was admitted to the department of neurology for further investigations. CT of the brain was normal; however, during admission, the patient developed rapid atrial fibrillation and was transferred to the department of cardiology...
2015: BMJ Case Reports
Yosuke Nishimura
Prosthetic valve replacement has mainly been performed on patients with mitral regurgitation. In such cases, prosthetic valve related complications, such as thromboembolism, bleeding, prosthetic valve infection, and structural valve deterioration, are unavoidable. With valve plasty, however, not only can such complications be avoided, but patients can also have as good a quality of life as healthy people without medications. Although mitral valve plasty requires complicated techniques like chordal reconstruction and has problems of residue, recurrence, and progression of regurgitation, patients with mitral valve prolapse are considered to be good candidates for this procedure...
September 1, 2015: Journal of UOEH
Kazuaki Tanabe
Echocardiographic evaluation of prosthetic valves is similar in many respects to evaluation of native valve disease. However, there are some important differences. First, there are several types of prosthetic valves with different fluid dynamics for each basic design and differing flow velocities for each valve size. Second, the mechanisms of valve dysfunction are somewhat different from those for native valve disease. Third, the technical aspects of imaging artificial devices, specifically the problem of acoustic shadowing, significantly affect the diagnostic approach when prosthetic valve dysfunction is suspected...
December 2015: Journal of Echocardiography
Jonathon Bailey, Nick Curzen, Neil W Bressloff
Computational simulation of transcatheter aortic valve implantation (TAVI) device deployment presents a significant challenge over and above similar simulations for percutaneous coronary intervention due to the presence of prosthetic leaflets. In light of the complexity of these leaflets, simulations have been performed to assess the effect of including the leaflets in a complete model of a balloon-expandable TAVI device when deployed in a patient-specific aortic root. Using an average model discrepancy metric, the average frame positions (with and without the leaflets) are shown to vary by 0...
2016: Computer Methods in Biomechanics and Biomedical Engineering
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