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Patient Prosthesis mismatch

Lakshmi P Dasi, Hoda Hatoum, Arash Kheradvar, Ramin Zareian, S Hamed Alavi, Wei Sun, Caitlin Martin, Thuy Pham, Qian Wang, Prem A Midha, Vrishank Raghav, Ajit P Yoganathan
Transcatheter aortic valves (TAVs) represent the latest advances in prosthetic heart valve technology. TAVs are truly transformational as they bring the benefit of heart valve replacement to patients that would otherwise not be operated on. Nevertheless, like any new device technology, the high expectations are dampened with growing concerns arising from frequent complications that develop in patients, indicating that the technology is far from being mature. Some of the most common complications that plague current TAV devices include malpositioning, crimp-induced leaflet damage, paravalvular leak, thrombosis, conduction abnormalities and prosthesis-patient mismatch...
November 21, 2016: Annals of Biomedical Engineering
Ravi K Ghanta, Irving L Kron
Patient prosthesis mismatch (PPM) can occur when a prosthetic aortic valve has an effective orifice area (EOA) less than that of a native valve. A recent study by Zorn and colleagues evaluated the incidence and significance of PPM in high risk patients with severe aortic stenosis who were randomized to transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR). TAVR is associated with decreased incidence of severe PPM compared to traditional SAVR valves. Severe PPM increases risk for death at 1 year postoperatively in high risk patients...
October 2016: Journal of Thoracic Disease
Vlatka Reskovic Luksic, D Dosen, M Pasalic, Jadranka Separovic Hanzevacki
AIM: To analyze whether PPM affects QOL and functional status in patients after isolated AVR for aortic stenosis (AS) with preserved left ventricular ejection fraction (LVEF). METHODS: Consecutive patients who underwent AVR in University Hospital Center Zagreb for isolated severe symptomatic AS and preserved EF were enrolled. Echo data was obtained from complete transthoracic examinations prior and after surgery by offline analysis. Patients were divided into two groups according to the presence of PPM (effective orifice area (EOA)/body surface area (BSA)<0,85cm(2)/m(2))...
November 8, 2016: International Journal of Cardiology
Jenny Lourdes Rivas de Oliveira, Renato Tambellini Arnoni, Magaly Arrais Dos Santos, Antonio Flávio Sanchez Almeida, Mário Issa, Antoninho Sanfins Arnoni, Paulo Chaccur, Luiz Carlos Bento de Souza
Introduction: Replacement of the aortic valve in patients with a small aortic annulus is associated with increased morbidity and mortality. A prosthesis-patient mismatch is one of the main problems associated with failed valves in this patient population. Objective: To evaluate the long-term mortality predictors in patients with a small aortic annulus undergoing aortic valve replacement with a bioprosthesis. Methods: In this retrospective observational study, a total of 101 patients undergoing aortic valve replacement from January 2000 to December 2010 were studied...
July 2016: Brazilian Journal of Cardiovascular Surgery
Selman Dumani, Ermal Likaj, Laureta Dibra, Stavri Llazo, Ali Refatllari
In the surgery of aortic valve replacement is always attempted, as much as possible, to implant the larger prosthesis with the mains goals to enhance the potential benefits, to minimise transvalvular gradient, decrease left ventricular size and avoid the phenomenon of patient-prosthesis mismatch. Implantation of an ideal prosthesis often it is not possible, due to a small aortic annulus. A variety of aortic annulus enlargement techniques is reported to avoid patient-prosthesis mismatch. We present the case that has submitted four three times open heart surgery...
September 15, 2016: Open Access Macedonian Journal of Medical Sciences
Amedeo Anselmi, Vito Giovanni Ruggieri, Bernard Lelong, Erwan Flecher, Hervé Corbineau, Thierry Langanay, Jean-Philippe Verhoye, Alain Leguerrier
OBJECTIVE: To clarify the mid-term durability of the Trifecta bioprosthesis for aortic valve replacement (AVR). METHODS: We retrospectively analyzed the prospectively collected data of 824 consecutive implants of the Trifecta valve at a single institution. A 100% complete follow-up was available (average duration, 2.2 ± 1.3 years; range, 0.03-6.9 years; 1747.6 patient-years). Echocardiography data at discharge were recorded prospectively. RESULTS: Operative mortality was 3...
August 30, 2016: Journal of Thoracic and Cardiovascular Surgery
Abdellaziz Dahou, Haïfa Mahjoub, Philippe Pibarot
Prosthesis-patient mismatch (PPM) occurs when the effective orifice area (EOA) of a normally functioning prosthesis is too small in relation to the patient's body size, resulting in abnormally high postoperative gradients. PPM is frequent following aortic valve replacement (AVR), and it is associated with increased risk of morbidity and mortality proportionally to its severity. Differential diagnosis between PPM and prosthetic valve stenosis is made by comparing the measured valve effective orifice area, by assessing the changes in valve area and gradient during follow-up and by evaluating leaflet morphology and mobility...
November 2016: Current Treatment Options in Cardiovascular Medicine
Rachael W Quinn, Arthur A Bert, Gabriel L Converse, Eric E Buse, Stephen L Hilbert, William B Drake, Richard A Hopkins
BACKGROUND: Cardiac allometric organ growth after pediatric valve replacement can lead to patient-prosthesis size mismatch and valve re-replacement, which could be mitigated with allogeneic decellularized pulmonary valves treated with collagen conditioning solutions to enhance biological and mechanical performance, termed "bioengineered valves." In this study, we evaluated functional, dimensional, and biological responses of these bioengineered valves compared with traditional cryopreserved valves implanted in lambs during rapid somatic growth...
October 2016: Journal of Thoracic and Cardiovascular Surgery
Aly Ghoneim, Ismail Bouhout, Philippe Demers, Amine Mazine, Mary Francispillai, Ismail El-Hamamsy, Michel Carrier, Yoan Lamarche, Denis Bouchard
OBJECTIVE: Aortic valve replacement (AVR) in patients with a small aortic annulus is a challenging problem. The objective of this study was to compare 4 surgical approaches in terms of hemodynamics and perioperative outcomes. METHODS: A retrospective single-center study included 351 consecutive patients with a small aortic annulus (≤21 mm) who underwent aortic valve surgery between January 2007 and December 2014. Surgical techniques included standard AVR in 259 (74%) patients, aortic root enlargement in 20 (6%), implantation of a stentless bioprosthesis in 23 (6%), and sutureless AVR in 49 (13%)...
October 2016: Journal of Thoracic and Cardiovascular Surgery
Tobias Schmidt, Christian Frerker, Hannes Alessandrini, Michael Schlüter, Felix Kreidel, Ulrich Schäfer, Thomas Thielsen, Karl-Heinz Kuck, John Jose, Erik W Holy, Mohamed El-Mawardy, Abdelhakim Allali, Gert Richardt, Mohamed Abdel-Wahab
AIMS: The aim of this study was to assess the feasibility and early outcomes of transcatheter aortic valve implantation (TAVI) in dysfunctional TAVI prostheses (redo TAVI). METHODS AND RESULTS: Nineteen redo TAVI procedures were performed between October 2011 and November 2015 at two German centres. Mean age was 78 years, 13 (68%) were male, and the mean logistic EuroSCORE was 32%. Median time elapsed since index TAVI was 644 days (interquartile range 191-1,831)...
September 18, 2016: EuroIntervention
Michel Kindo, Tam Hoang Minh, Stéphanie Perrier, Hélène Petit-Eisenmann, Jonathan Bentz, Mircea Cristinar, Gharib Ajob, Olivier Collange, Jean-Philippe Mazzucotelli
OBJECTIVES: Prosthesis-patient mismatch (PPM) has been reported to impact early haemodynamic status and early mortality after prosthetic aortic valve replacement (AVR) in patients with aortic stenosis (AS). The aim of this study was to assess the impact of PMM on early haemodynamic status after AVR using vasoactive-inotropic dependency index (VDI), postoperative pressures and end-organ perfusion. METHODS: A total of 183 patients with AS were included in this prospective cohort study, and underwent elective AVR with or without combined coronary artery bypass graft surgery...
September 13, 2016: Interactive Cardiovascular and Thoracic Surgery
John B Chambers
This is a practical description of how replacement valves are assessed using echocardiography. Normal transthoracic appearances including normal variants are described. The problem of differentiating normal function, patient-prosthesis mismatch and pathological obstruction in aortic replacement valves with high gradients is discussed. Obstruction and abnormal regurgitation is described for valves in the aortic, mitral and right-sided positions and when to use echocardiography in suspected infective endocarditis...
September 2016: Echo Research and Practice
Sathish Chikkabyrappa, Doff B McElhinney, Muhamed Saric
We report a rare case of progressive left ventricular outflow tract (LVOT) obstruction after percutaneous device closure of a mechanical prosthetic mitral valve (MV) paravalvular leak (PVL) in the region of aortomitral curtain in a patient who also had small mechanical aortic valve prosthesis with patient-prosthesis mismatch.
November 2016: Echocardiography
Sophia Airhart, Ivan Medvedev, Larry S Dean
Prosthesis-patient mismatch (PPM) is defined as a small effective orifice area (EOA) of a normally functioning prosthetic valve in relation to patient body size. Even moderate impediment to forward flow has been associated with an increase in all-cause mortality. We report an unusual cause of PPM where a transcatheter implantation of a large EOA valve in an aortic position results in relative PPM in a patient with morbid obesity. © 2016 Wiley Periodicals, Inc.
August 27, 2016: Catheterization and Cardiovascular Interventions
Nels D Carroll, Kevin M Beers, Elaine M Maldonado, John H Calhoon, S Adil Husain
Reparative procedures are not always feasible in congenitally abnormal mitral valves. Mechanical prosthesis has been accepted as the choice for valve replacement in the pediatric population. This report describes a case of congenital mitral valve disease requiring mitral valve replacement. The infant's mitral valve annulus was not amenable to placement of the smallest available mechanical prosthesis. The approach used here for annular and subvalvular enlargement facilitated implantation of a larger prosthesis for congenital mitral valve replacement...
September 2016: Annals of Thoracic Surgery
Manolis Vavuranakis, Konstantinos Kalogeras, Maria Lavda, Michail-Aggelos Kolokathis, Theodoros Papaioannou, Euaggelos Oikonomou, Mursini Stasinopoulou, Dimitrios Vrachatis, Carmen Moldovan, Maria Kariori, Evelina Bei, Sophia Vaina, Georgios Lazaros, Ourania Katsarou, Gerasimos Siasos, Dimitrios Tousoulis
BACKGROUND: 'Cover index' has been proposed to appraise the congruence between the aortic annulus and the device, with the assumption of not taking into account the actual device implantation depth. The aim of this study was to investigate whether the annulus-prosthesis mismatch, as expressed with the new proposed 'true cover index' according to actual implantation depth, can predict aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI). METHODS: Patients who had undergone TAVI with the self-expandable CoreValve device, were retrospectively studied...
November 15, 2016: International Journal of Cardiology
Giordano Tasca, Riccardo Vismara, Andrea Mangini, Claudia Romagnoni, Monica Contino, Alberto Redaelli, Gianfranco Beniamino Fiore, Carlo Antona
BACKGROUND: Aortic valve replacement has evolved recently with the development of the sutureless bioprosthesis. One such valve is the Perceval bioprosthesis, which is built by mounting leaflets of bovine pericardium to a thin stent; this approach has the potential to provide an excellent fluid dynamic performance. We undertook an in vitro study to compare the hydrodynamic performance of the sutureless bioprosthesis with two standard pericardial stented bioprostheses (Crown and Magna)...
August 17, 2016: Annals of Thoracic Surgery
Rishi Puri, Jonathan Byrne, Ralf Muller, Hardy Baumbach, Helene Eltchaninoff, Simon Redwood, Asim Cheema, Christophe Dubois, Leo Ihlberg, Harindra C Wijeysundera, Alfredo Cerillo, Matthias Götberg, Kaj Erik Klaaborg, Marc Pelletier, Roberto Blanco-Mata, Richard Edwards, Caterina Gandolfo, Douglas Muir, Francesco Meucci, Jan-Malte Sinning, Pieter Stella, Verena Veulemans, Marko Virtanen, Ander Regueiro, Martin Thoenes, Philippe Pibarot, Emilie Pelletier-Beaumont, Josep Rodés-Cabau
BACKGROUND: While transcatheter aortic valve implantation (TAVI) is established for treating high-operative risk surgical aortic valve replacement candidates, until recently the smallest transcatheter heart valve (THV) measured 23 mm, posing greater risk for annular rupture and THV failure in patients with aortic stenosis (AS) with small aortic annuli (≤20 mm). OBJECTIVES: In the setting of a multicentre registry, we report on the safety, efficacy and early clinical outcomes of the SAPIEN XT 20 mm balloon-expanding THV...
August 17, 2016: Heart: Official Journal of the British Cardiac Society
Vito Mannacio, Luigi Mannacio, Emilo Mango, Anita Antignano, Michele Mottola, Sergio Caparrotti, Francesco Musumeci, Carlo Vosa
BACKGROUND: Severe prosthesis-patient mismatch (PPM) is considered to further decrease survival compared to moderate PPM. This study aimed to assess the impact of severe PPM on survival after aortic valve replacement (AVR). METHODS: We retrospectively studied 2404 consecutive patients with PPM who underwent first-time AVR for pure stenosis between January 2003 and December 2014. Mismatch was moderate for indexed effective valve orifice >0.65 to <0.85cm(2)/m(2) and severe for indexed effective valve orifice ≤0...
August 1, 2016: Journal of Cardiology
Hiroshi Izumoto, Kenichi Fukushima, Tomohiko Hayashi, Yasuhiko Hori, Makoto Takiguchi, Taichi Murayama, Masahiro Suzuki, Nobuyuki Komiyama, Kazuaki Ishihara
We report a case of an 80-year-old female presenting with a mitral valve tumor. Postoperatively, pathologic diagnosis was caseous calcification of the mitral annulus. In surgery, she successfully underwent a mitral valve replacement with a 20 mm mechanical valve. The importance of correctly making a preoperative diagnosis cannot be over-emphasized. Technical discussion on possibility of mitral valve repair and patient-prosthesis mismatch after mitral valve replacement is also made.
July 2016: Kyobu Geka. the Japanese Journal of Thoracic Surgery
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