Cardiac valve prostheses and their selection

Background and objective Surgery for valvular heart disease by valve replacement procedures has become one of the most frequently performed cardiac operations to improve the quality of life (QoL). Its long-term outcomes are assessed using the quality-of-life index (QLI). This study aimed to evaluate the QoL in patients who received valve prostheses after surgery for valvular heart diseases at King Abdulaziz University in Jeddah from 2010 to 2023. Methods This was a descriptive cross-sectional study of 59 patients aged 18 years or older who underwent surgical mitral and aortic valve replacement, involving either mechanical or tissue valves, from January 2010 to May 2023 They were selected using a non-probability convenient sampling technique...

BACKGROUND: Various second-generation transcatheter heart valve (THV) prostheses with high clinical efficacy and safety are available, but there is limited large-scale data available comparing their hemodynamic performance and clinical implications. OBJECTIVE: To compare the hemodynamic performance and short-term clinical outcome of four second-generation THV prostheses. METHODS: 24,124 patients out of the German Aortic Valve Registry who underwent transfemoral transcatheter aortic valve implantation (TAVI) (Evolut™ R n = 7028, Acurate neo™ n = 2922, Portico n = 878 and Sapien 3 n = 13,296) were included in this analysis...

OBJECTIVES: The aims of this study were to evaluate and compare the outcomes after pulmonary valve replacement (PVR) with a mechanical prosthesis (MP) and a bioprosthesis (BP). METHODS: From 2004 through 2017, a total of 131 patients, who had already been repaired for tetralogy or Fallot or its variants, underwent their first PVR with an MP or a BP. Outcomes of interests were prosthesis failure (stenosis >3.5 m/s, regurgitation >mild or infective endocarditis) and reintervention...

INTRODUCTION: The use of rapid deployment sutureless aortic valve replacement (AVR) has become a viable alternative to conventional AVR especially in intermediate and high-risk patients. However, sutureless AVR has been associated with increased rates of permanent pacemaker (PPM) implantation compared with conventionally implanted aortic valve prostheses. The aim of this study was to determine predictive factors for complete heart block requiring insertion of a PPM post-AVR with a Perceval S sutureless valve (LivaNova, London, UK)...

OBJECTIVE: Although the results of aortic valve replacement are well documented for industrialized countries, the outcome in patients with rheumatic aortic valve disease in low- to middle-income countries is less well explored. The aim of this study was to determine the long-term survival and clinical outcomes after isolated aortic valve replacement in patients with rheumatic heart disease in a Sub-Saharan country where follow-up of indigent patients is often challenging. METHODS: A retrospective review of 969 aortic valve replacements performed between 2003 and 2013 was conducted at Cape Town's Groote Schuur Hospital...

BACKGROUND: The use of transcatheter aortic valve implantation (TAVI) following the introduction of Nitinol autoexpandable devices has spread rapidly during recent years. In addition, cardiac surgery has been revolutionized due to the use of Nitinol-based sutureless prostheses for aortic valve replacement (AVR). During the same period, however, permanent pacemaker (PPM) implantation has emerged as a frequent complication. The study aim was to identify the risk factors of PPM following the implantation of a Nitinol self-expanding prosthesis (for AVR or TAVI)...

OBJECTIVES: The Carpentier-Edwards pericardial (CEP) prostheses are the type of bioprostheses most used worldwide. Although they were designed to minimize the rate of valve deterioration and reoperation, their clinical superiority over other prostheses models still lacks confirmation. The objective of this study was to evaluate its effectiveness. METHODS: We performed a systematic review and meta-analysis in the PubMed, Embase, Cochrane, and Lilacs databases. Operative mortality, overall mortality and reoperation rates after heart valve surgery were compared between the use of CEP and other cardiac prostheses...

During the last decade, the rapid evolution of transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of severe aortic stenosis. Since the PARTNER A and B trials, this technique has become the treatment of reference for inoperable patients, and an attractive alternative to surgical aortic valve replacement in those at high risk for surgery. Large multicenter registries conducted since 2007, mainly in Europe, confirmed the excellent hemodynamic performances of the 2 percutaneous valves currently available on the market, the Edwards SAPIEN, and the Medtronic CoreValve, as well as their benefits in terms of symptom relief and survival...

BACKGROUND AND AIM OF THE STUDY: A number of sutureless bioprosthetic aortic valves have been recently introduced in clinical practice, their main advantage being a reduction in the aortic cross-clamp time (AXCT). The study aim was to investigate if AXCT was a determinant of cardiovascular morbidity in patients undergoing surgical aortic valve replacement (AVR) to treat aortic valve stenosis, and to identify any subset of patients who might benefit from a reduction in AXCT. METHODS: A retrospective analysis was conducted of 979 consecutive patients with aortic valve stenosis who underwent surgical AVR...

Synthetic leaflet heart valves have been widely studied as possible alternatives to the current mechanical and bioprosthetic valves. Assessing the in vitro hydrodynamic function of these prostheses is of great importance to predict their hemodynamic behaviour prior to implantation. This study introduces an innovative concept of a low-profile semi-stented surgical aortic valve (SSAV) made of a novel nanocomposite polyurethane with a polycarbonate soft segment (PCU) and polyhedral oligomeric silsesquioxane (POSS) nanoparticles covalently bonded as a pendant cage to the hard segment...

BACKGROUND: Doppler-derived hemodynamic data for normal tricuspid mechanical valve prostheses are limited. METHODS: A comprehensive retrospective Doppler echocardiographic assessment of 78 normal St. Jude Medical Standard (St. Jude Medical, Inc., St. Paul, MN), CarboMedics Standard (CarboMedics, Inc., Sorin Group, Burnaby, British Columbia, Canada), and Starr-Edwards (Edwards Lifesciences, LLC, Irvine, CA) mechanical tricuspid valve prostheses was performed early after implantation...

BACKGROUND: Children with pulmonary hypertension secondary to large left-to-right, post-tricuspid valve shunts can eventually have severe and/or irreversible pulmonary vascular disease, yielding them inoperable for conventional surgery. It has been shown, however, that unloading of the pulmonary hypertension can result in remodeling of the pulmonary vasculature and, thus, improvement of the pulmonary hypertension. METHODS: This study explored whether such patients might experience a significant reduction in pulmonary vascular resistance (PVR) after pulmonary artery band (PAB) placement...

AIMS: Prior cardiac surgery limits epicardial ventricular tachycardia (VT) ablation due to epicardial adhesions formation. METHODS AND RESULTS: We describe an epicardial VT ablation through the coronary venous system in a patient with mechanical mitro-aortic prostheses. The different possible ablation approaches and their potential limitations are discussed. CONCLUSION: In selected patients, especially after cardiac surgery, coronary venous system approach can be considered as a safety possible approach for the ablation of some epicardial VTs...

The use of surgically implanted devices has increased as a result of their beneficial effect on quality of life, and in some circumstances, on patient survival rates. They can, however, be associated with a variety of complications, the most dreaded being infection. Device-related infections are important to understand because of the morbidity and mortality associated with them. Frequently, patients are managed with hospitalization, prolonged courses of antibiotics, and surgical interventions, all of which can negatively impact on patients' quality of life...

The results of 35-year breeding of a new variety of laboratory animals for biological and medical studies, termed Minisibs (miniature Siberian swine), are summarized. Minisibs were obtained via hybridization between Swedish Landrace pigs, who have an epistatic white coat color, and black Vietnamese masked pigs of breed I, who have genes of dwarfism. Some genes of wild boars Sus scrofa scrofa and S. s. nigripes from Central Europe and Central Asia, respectively, were introduced to the Minisibs gene pool in order to strengthen the constitution, increase the general resistance, and improve the functions of the cardiac muscle and valves...

OBJECTIVES: Our objectives were to evaluate the long-term bioprosthetic and cardiac functional outcome after insertion (over a 10-year period) of a new-generation porcine zero pressure-fixed Biocor bioprosthesis, as well as to determine the echocardiographic accuracy for selection of patients requiring reoperation. The long-term systematic Doppler echocardiographic assessment after valve replacement with this bioprosthesis is lacking. METHODS: Between January 1983 and January 1993, we inserted 756 Biocor prostheses in the aortic (619) or mitral (137) positions...

During the period of 1977 to 1990, 960 Carpentier-Edwards standard prostheses (Baxter Healthcare Corp., Santa Ana, Calif.) were placed in 875 operations. Freedom from reoperation at 10 years was 57% +/- 4%, 76% +/- 3%, and 95% +/- 5% for mitral, aortic, and tricuspid valve replacement, respectively. Age was the only independent determinant of reoperation for both aortic and mitral valves. Likelihood of reoperation decreased with age, with freedom from reoperation after 10 years in patients aged less than 60 years versus 60 or more years being 65% +/- 5% versus 90% +/- 4% after aortic valve replacement and 48% +/- 5% versus 75% +/- 6% after mitral valve replacement...

Since the development of cardiac prostheses, numerous chemical treatments have been assayed to prevent the process of their mineralization, causing 60% of the failures. The effect of the extraction of lipids from the tissue employed in porcine valves is assessed in a model of subcutaneous implantation in rats. Tissue from aortic and pulmonary porcine valves was treated with chloroform-methanol and 0.625% glutaraldehyde and was implanted into young rats for periods of 21 and 60 d. The calcium accumulated was then quantified by atomic absorption...

A series of 146 consecutive patients who underwent tricuspid valve replacement at the University Brugmann Hospital between 1967 and 1987 was reviewed. Mean age at operation was 51.4 years (+/- 12.1 years). Different types of prostheses were implanted including porcine and bovine pericardial bioprostheses and older and bileaflet mechanical valves. Most patients were severely disabled by their cardiac disease before operation, with 30.1% in New York Heart Association functional class III and 69.9% in class IV...

Operation for the purpose of cardiac valve repair or replacement has become commonplace since its initial trial some 80 years ago. Cardiac surgical techniques have been refined dramatically during the last 10 years and a number of sophisticated and innovative devices for valvular replacement have been developed. Valve research has concentrated on the development of a prosthetic valve that closely resembles the human valve in terms of hemodynamic performance, durability, and freedom from complications. Each currently available artificial heart valve has unique performance qualities, advantages, and disadvantages...