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Cardiac valve prostheses and their selection

Carlos Alberto S Magliano, Roberto M Saraiva, Vitor Manuel P Azevedo, Adriana M Innocenzi, Bernardo R Tura, Marisa Santos
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...
January 2015: International Journal of Technology Assessment in Health Care
Amir-Ali Fassa, Dominique Himbert, Alec Vahanian
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...
April 2013: Current Cardiology Reports
Marco Ranucci, Alessandro Frigiola, Lorenzo Menicanti, Serenella Castelvecchio, Carlo de Vincentiis, Valeria Pistuddi
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...
November 2012: Journal of Heart Valve Disease
Benyamin Rahmani, Spyridon Tzamtzis, Hossein Ghanbari, Gaetano Burriesci, Alexander M Seifalian
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...
April 30, 2012: Journal of Biomechanics
Lori A Blauwet, Harold M Burkhart, Joseph A Dearani, Joseph F Malouf, Heidi M Connolly, David O Hodge, Regina M Herges, Fletcher A Miller
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...
April 2011: Journal of the American Society of Echocardiography
Sadaf A Khan, Bruce D Gelb, Khanh H Nguyen
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...
September 2006: Congenital Heart Disease
Jamal Najjar, Agustín Bortone, Serge Boveda, Jean-Paul Albenque
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...
November 2007: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Donald C Vinh, John M Embil
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...
2005: Journal of Long-term Effects of Medical Implants
V N Tikhonov
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...
June 2000: Genetika
P S Mykén, H E Berggren, S Larsson, B Roberts, I Wallentin, K Caidahl
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...
October 1998: Journal of Thoracic and Cardiovascular Surgery
D D Glower, W D White, A C Hatton, L R Smith, W G Young, W G Wolfe, J E Lowe
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...
February 1994: Journal of Thoracic and Cardiovascular Surgery
E Jorge-Herrero, P Fernández, N de la Torre, C Escudero, J M García-Páez, J Buján, J L Castillo-Olivares
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...
August 1994: Biomaterials
G J Van Nooten, F Caes, Y Taeymans, Y Van Belleghem, K François, D De Bacquer, F E Deuvaert, F Wellens, G Primo
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...
September 1995: Journal of Thoracic and Cardiovascular Surgery
A P Weiland
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...
September 1983: Heart & Lung: the Journal of Critical Care
S D Bruck
Biomaterials used as implants and in various devices must exhibit long-term (years) compatibility with the physiological environment, including blood, and additionally must also remain stable to perform mechanical functions, excepting applications where biodegradation is required. This paper focuses on problems and challenges of polymeric materials in contact with blood in the following categories: (1) artificial heart valves, (2) cardiovascular assist devices and artificial hearts, (3) vascular prostheses, and (4) the biological evaluation of materials prior to their human use, especially with respect to species related hematological differences of experimental animals...
1983: Biomaterials, Medical Devices, and Artificial Organs
P Jacobs, E Knottenbelt
The rational use of antithrombic drugs centres on the fundamental differences in the pathogenesis of arterial or venous thrombosis. The major role of platelets in the development of occlusion in arteries contrasts with prominent fibrin deposition in the slower moving venous blood. Logically, antiplatelet agents are used to treat patients at high risk from arterial disease and anticoagulants for those with venous thrombo-embolism. These sound theoretical principles have been linked to steady improvement in diagnostic techniques, and there now exists an extensive literature on available drugs and their clinical evaluation...
June 25, 1983: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
Y Biale, A Cantor, H Lewenthal, M Gueron
Continuing improvements in cardiac surgery and a wider selection of young patients for prosthetic valve replacement mean that an increasing number of women of childbearing age will undergo such procedures and will also subsequently become pregnant. At present, most patients with prosthetic heart valves are treated with anticoagulant drugs for life. The main problem with anticoagulant therapy during pregnancy is fetal and maternal hemorrhage. Congenital anomalies have been described in infants born to mothers treated with coumarin derivatives during the first trimester of pregnancy...
September 1980: International Journal of Gynaecology and Obstetrics
T Kazui, S Komatsu, O Yamada, T Sasaki
Marked improvements have been achieved in the results of valve replacement due to recent developments in cardiac valve prostheses, surgical procedures, myocardial protection methods, and supportive techniques. Since 1974, the aortic valve has been replaced with mechanical valves and the mitral valve with biological valves at our institution. During a cumulative follow-up of 1024 patient-years after 306 valve replacements (126 AVR, 148 MVR and 32 AVR + MVR), the 10-year survival rates were 88% for AVR, 72.6% for MVR and 77...
September 1986: Japanese Circulation Journal
F Galdiero, M Cotrufo, P G Catalanotti, T S De Luca, R Ianniello, E Galdiero
The adherence of bacterial cells to valvular prostheses has been studied. Bacteria were selected on the basis of their surface features (fimbriae, hydrophobicity and specific receptors). It was found that only strains having fimbriae and high cell surface hydrophobicity adhered to bioprostheses, while they did not adhere to metallic prostheses to any significant extent. Adherence to bioprostheses depended on the exposure time and it was affected by the saline concentration of the suspension medium. Furthermore, different bacterial binding capacity was observed for bioprostheses from different companies...
September 1987: European Journal of Epidemiology
M Cotrufo, T S de Luca, R Calabrò, G Mastrogiovanni, D Lama
Between January 1987 and December 1989, 20 female patients with one mechanical valve prosthesis (MVP) for at least 1 year postoperatively were studied while on coumarin therapy for the full length of pregnancy. In each case, caesarean section was scheduled for the 38th week. Patients were selected according to the following criteria: (1) prothrombin ratios remaining within the therapeutic range for more than 85% of their total estimations in the previous 12 months with mean daily doses of warfarin less than 5 mg; (2) stable cardiac status; (3) no previous obstetric diseases and (4) full acceptance of the risks involved in the protocol...
1991: European Journal of Cardio-thoracic Surgery
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