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Valve prosthesis selection

A B Gopalamurugan, K Murali, B Jyotsana, A Jacob, V V Bashi
Transcatheter Aortic Valve Implantation (TAVI) is a well-described treatment for symptomatic calcific severe aortic stenosis. However, TAVI technology is being increasingly used around the world to treat selected cases of severe aortic regurgitation (AR). One of the main limitations of using TAVI technology for AR is the lack of calcification, which is common in such cases. This makes anchoring of a TAVI prosthesis to the aortic annulus difficult and risks displacement or embolization. However, with the availability of recapturable and repositionable TAVI technologies, these limitations have been overcome to a large extent...
September 2016: Indian Heart Journal
Marcus Lee, Thomas Modine, Nicolo Piazza, Darren Mylotte
Individualised, patient-centred care is a central tenet of modern medicine. The variety of transcatheter heart valves currently available affords the opportunity to select the most appropriate device for each individual patient. Prosthesis selection should be based on operator experience and pre-procedural multimodal three-dimensional imaging. Herein, we outline a number of clinical scenarios where specific transcatheter heart valve technologies have the potential to optimise clinical outcome.
September 18, 2016: EuroIntervention
Yoshimasa Sakamoto, Michio Yoshitake, Yoko Matsumura, Hitomi Naruse, Ko Bando, Kazuhiro Hashimoto
PURPOSE: The aim of this study was to evaluate the long-term results of aortic valve replacement (AVR) with mechanical (M) and bioprosthetic (B) valves as recommended by the Japanese guidelines. METHODS: From April 1995 to March 2014, 366 adult patients underwent AVR. Of these, 127 (35%) patients received M and 239 patients (65%) received B valves. A retrospective analysis of the entire and the selected 124 patients aged 60 to 70 years was carried out. RESULTS: In patients aged 60 to 70 years, the 15-year survival and freedom from reoperation were 88% ± 7% and 100% for the M group and 34% ± 25% (p <0...
September 12, 2016: Annals of Thoracic and Cardiovascular Surgery
Neal S Kleiman, Brijeshwar J Maini, Michael J Reardon, John Conte, Stanley Katz, Vivek Rajagopal, James Kauten, Alan Hartman, Raymond McKay, Robert Hagberg, Jian Huang, Jeffrey Popma
BACKGROUND: The risk for stroke after transcatheter aortic valve replacement (TAVR) is an important concern. Identification of predictors for stroke is likely to be a critical factor aiding patient selection and management as TAVR use becomes widespread. METHODS AND RESULTS: Patients enrolled in the CoreValve US Extreme Risk and High Risk Pivotal Trials or Continued Access Study treated with the self-expanding CoreValve bioprosthesis were included in this analysis...
September 2016: Circulation. Cardiovascular Interventions
Francesco Giannini, Matteo Montorfano, Vittorio Romano, Neil Ruparelia, Richard J Jabbour, Susanna Benincasa, Azeem Latib, Antonio Colombo
Valve embolization during transcatheter aortic valve implantation is a rare but potentially fatal complication of first generation transcatheter valves. As a result, second generation valves were designed to be fully retrievable and minimize this complication. We report a first case of embolization with a second-generation fully-retrievable and repositionable Lotus valve. In this case, the presence of severe left ventricular hypertrophy and a sigmoid septum may have contributed to prosthesis embolization with the initial 23mm Lotus valve...
November 15, 2016: International Journal of Cardiology
Carlos Ferrera, Luis Nombela-Franco, Eulogio Garcia, Pilar Jimenez-Quevedo, Corina Biagioni, Nieves Gonzalo, Ivan Nuñez-Gil, Ana Viana-Tejedor, Pablo Salinas, Jose Alberto de Agustin, Carlos Almeria, Fabian Islas, Leopoldo Perez de Isla, Cristina Fernandez-Perez, Javier Escaned, Antonio Fernández-Ortiz, Carlos Macaya
OBJECTIVES: To evaluate the safety and midterm hemodynamic results of direct transcatheter aortic valve replacement (TAVR) without pre-implantation balloon aortic valvuloplasty (BAV). BACKGROUND: BAV was considered a mandatory previous step in TAVR procedures. METHODS: A total of 339 consecutive patients who underwent transfemoral TAVR were prospectively selected. A 1:1 matching was conducted, pairing age, prosthesis type (self-expandable or balloon expandable) and size, and valve calcification grade (48% with moderate to severe valve calcification)...
August 12, 2016: Catheterization and Cardiovascular Interventions
Evaldas Girdauskas, Bernward Lauer, Thomas Kuntze
We report on a transapical tricuspid valve-in-ring implantation performed via right ventricular apex using the Sapien-XT-prosthesis. A 57-year-old woman with recurrent episodes of right heart failure and three previous sternotomies, including tricuspid valve repair with a 32 mm Carpentier-Edwards-Classic annuloplasty ring was admitted due to recurrent severe tricuspid regurgitation. Given the excessive surgical risk, a 29 mm Sapien-XT-prosthesis was selected for valve-in-ring implantation. Transapical valve-in-ring implantation procedure was uneventful...
August 12, 2016: Catheterization and Cardiovascular Interventions
Danny Dvir, Anson Cheung, Robert Boone, Jonathon Leipsic, Philipp Blanke, Gidon Perlman, Robert Moss, Mustafa Toma, Dion Stub, Shmuel Banai, John Webb
AIMS: Transcatheter mitral valve implantation (TMVI) is a novel approach that may enable a less invasive effective reduction of mitral regurgitation (MR). A limitation of the MitraClip is that definitive implantation of a clip precludes future therapy with TMVI. The purpose of this paper is to describe contemporary treatment considerations in patients with mitral valve regurgitation. METHODS AND RESULTS: In this report we describe an attempted MitraClip implantation which resulted in no reduction of MR severity...
June 12, 2016: EuroIntervention
Cecilia Becattini, Agnese Sembolini, Maurizio Paciaroni
The clinical benefit of resuming anticoagulant treatment after an anticoagulants-associated intracranial hemorrhage (ICH) is debated. No randomized trial has been conducted on this particular clinical issue. The risk of ICH recurrence from resuming anticoagulant therapy is expected to be higher after index lobar than deep ICH and in patients with not amendable risk factors for ICH. Retrospective studies have recently shown improved survival with resumption of treatment after index anticoagulants-associated ICH...
September 2016: Vascular Pharmacology
Abhijeet Dhoble, Tarun Chakravarty, Mamoo Nakamura, Yigal Abramowitz, Rikin Tank, Hirotsugu Mihara, Geeteshwar Mangat, Hasan Jilaihawi, Takahiro Shiota, Raj Makkar
BACKGROUND: Significant paravalvular leak (PVL) occurs in up to 13% of patients after transcatheter aortic valve replacement (TAVR) with a balloon-expandable bioprosthesis. Transcatheter PVL repair has emerged as a less invasive alternative for this problem. OBJECTIVES: The aim of this study was to evaluate the safety, feasibility, and clinical outcomes of transcatheter PVL repair after TAVR with balloon-expandable valve. METHODS: We retrospectively identified 15 patients who underwent 16 PVL repair procedures after the TAVR at our center...
May 24, 2016: Catheterization and Cardiovascular Interventions
Michaela Hell, Mohamed Marwan, Luise Gaede, Stephan Achenbach
Computed tomography (CT) provides high, isotropic spatial resolution and has become firmly established in pre-procedural imaging for structural heart disease interventions. It allows determination of the exact dimensions of the target structure, provides information regarding the access route and permits identification of fluoroscopic projection angles to provide optimal visualisation for device placement. Several software solutions are available and have been systematically evaluated in the context of transcatheter aortic valve implantation (TAVI)...
May 17, 2016: EuroIntervention
Peter Wenaweser, Stefan Stortecky, Torsten Schütz, Fabien Praz, Steffen Gloekler, Stephan Windecker, Albrecht Elsässer
AIMS: We aimed to demonstrate the feasibility and investigate the safety of a novel, self-expanding trans-catheter heart valve in a selected patient population with severe aortic stenosis. METHODS AND RESULTS: Between January and September 2013, a total of 21 patients with symptomatic severe aortic stenosis were eligible for transcatheter aortic valve implantation (TAVI) with the self-expanding NVT Allegra bioprosthesis (New Valve Technology, Hechingen, Germany) at two cardiovascular centres...
May 17, 2016: EuroIntervention
Nima Mirkhani, Mohammad Reza Davoudi, Pedram Hanafizadeh, Daryoosh Javidi, Niloofar Saffarian
Numerical simulation of the bileaflet mechanical heart valves (BMHVs) has been of interest for many researchers due to its capability of predicting hemodynamic performance. A lot of studies have tried to simulate this three-dimensional complex flow in order to analyze the effect of different valve designs on the blood flow pattern. However, simplified models and prescribed motion for the leaflets were utilized. In this paper, transient complex blood flow in the location of ascending aorta has been investigated in a realistic model by fully coupled simulation...
September 2016: Cardiovascular Engineering and Technology
Jérôme Pierrart, Damien Delgrande, William Mamane, Daniel Tordjman, Emmanuel H Masmejean
Paronychia and felon are the most common infections of the hand. Surgical treatment is required once an abscess develops, but systematic use of postoperative antibiotic therapy remains open for discussion. Antibiotics both favor the selection of resistant bacteria and increase the cost of treatment. To our knowledge, no study has demonstrated their benefit following excision, yet many practitioners prescribe them systematically and empirically. In our current practices, we do not use antibiotic coverage following excision of uncomplicated paronychia or felon (no signs of arthritis, osteitis, flexor tenosynovitis, lymphangitis), except in potentially at-risk patients (immunosuppressed, diabetic, cardiac valve prosthesis recipient)...
February 2016: Hand Surgery and Rehabilitation
John W Brown, Parth M Patel, Jiuann-Huey Ivy Lin, Asma S Habib, Mark D Rodefeld, Mark W Turrentine
BACKGROUND: The Ross aortic valve replacement (AVR) has been the AVR of choice for children at our center since 1993. Absence or inadequate quality of the pulmonary valve or, less commonly, family or surgeon preference caused us to select an alternative AVR prosthesis for some children. This review compares the outcomes of 42 children who received a non-Ross AVR with 115 children undergoing Ross root replacement at our institution during the most recent 22 years. METHODS: A retrospective chart review of the 42 pediatric non-Ross AVRs was compared with 115 Ross AVRs...
May 2016: Annals of Thoracic Surgery
Nicolas M Van Mieghem, Ramón Rodríguez-Olivares, Ben C Ren, Lennart van Gils, Annemarie Maugenest, Marcel L Geleijnse, Ricardo P J Budde, Johan Vogelaar, Luc Verstraeten, Peter P de Jaegere
AIMS: Our aim was to illustrate the pragmatic use of pre-procedural multislice computed tomography (MSCT) to facilitate fluoroscopy guidance of transcatheter mitral valve interventions. METHODS AND RESULTS: A dedicated software package (3mensio Structural Heart) is used to analyse MSCT studies and localise anatomical entities by fluoroscopy which would otherwise be invisible (e.g., interatrial septum, paravalvular leaks, mitral leaflets), and to provide optimal C-arm gantry angles to facilitate crucial steps of catheter-based mitral interventions...
March 2016: EuroIntervention
Miha Mrak, Jana Ambrožič, Špela Mušič, Simon Terseglav, Bojan Kontestabile, Nikola Lakič, Matjaž Bunc
BACKGROUND: Aortic stenosis is a progressive disease. Symptomatic aortic stenosis has a poor prognosis, which is frequently worse than that of a malignant disease. Cancer patients with severe aortic stenosis may be denied for optimal oncologic treatment because of high operative risk and for aortic valve replacement because of the significant comorbidity itself. In patients treated with medical therapy alone, 1-year-mortality exceeds 50 %. CASE REPORT: A 71-year-old woman with well-differentiated, surgically treated, ovarian carcinoma and two relapses treated with chemo- and radiotherapy presented with symptomatic severe aortic stenosis (aortic valve area 0...
July 2016: Wiener Klinische Wochenschrift
Leonid Barbarash, Natalya Rutkovskaya, Olga Barbarash, Yuri Odarenko, Alexander Stasev, Evgenya Uchasova
BACKGROUND: The problem of prosthetic heart valve selection in fertile women with acquired heart defects remains crucial in modern cardiology. Mechanical heart valves require lifelong indirect anticoagulant therapy, which has significant fetal toxicity and is unacceptable for women planning pregnancy. Bioprosthetic heart valves are the best choice for fertile women; however, their durability is limited, and reoperations are required. CASE PRESENTATION: We describe the clinical case of a 21-year-old Russian woman with infectious endocarditis who underwent heart valve replacement with an epoxy-treated mitral valve prosthesis...
2016: Journal of Medical Case Reports
Sandy Engelhardt, Raffaele De Simone, Sameer Al-Maisary, Silvio Kolb, Matthias Karck, Hans-Peter Meinzer, Ivo Wolf
PURPOSE: Mitral valve reconstruction is a widespread surgical method to repair incompetent mitral valves, which usually includes implantation of a ring prosthesis. To date, intraoperative analysis of the mitral valve is merely based on visual assessment using simple surgical tools, which might not allow for accurate assessment of the complex anatomy. METHODS: We propose a novel intraoperative computer-based assistance system, which combines passive optical tracking technology with tailored measurement strategies applicable during different phases of the intraoperative workflow...
October 2016: International Journal of Computer Assisted Radiology and Surgery
Martin Haensig, Lukas Lehmkuhl, Axel Linke, Philipp Kiefer, Chirojit Mukherjee, Gerhard Schuler, Matthias Gutberlet, Friedrich-Wilhelm Mohr, David Holzhey
BACKGROUND: Transapical aortic valve implantation (TAAVI) has evolved into a routine procedure for select high-risk patients. The aim was to study the impact of native aortic valve calcification on paravalvular leaks in cardiac contrast-enhanced computed tomography (CT). METHODS: The degree and distribution of valve calcification were quantified using an Aortic Valve Calcium Score (AVCS) for each cusp separately (3mensio Valves). To reduce an artificial increase of the AVCS due to the presence of contrast material, we used thresholds for density [mean aortic density + 2*SD] and volume [0, 3, 5, 25, and 50 mm3] of calcification...
2016: Heart Surgery Forum
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