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Valve durability

David Hasler, Dominik Obrist
The flow field past a prosthetic aortic valve comprises many details that indicate whether the prosthesis is functioning well or not. It is, however, not yet fully understood how an optimal flow scenario would look, i.e. which subtleties of the fluid dynamics in place are essential regarding the durability and compatibility of a prosthetic valve. In this study, we measured and analyzed the 3D flow field in the vicinity of a bio-prosthetic heart valve in function of the aortic root size. The measurements were conducted within aortic root phantoms of different size, mounted in a custom-built hydraulic setup, which mimicked physiological flow conditions in the aorta...
2018: PloS One
Prashant Rao, Jack B Keenan, Taufiek K Rajab, Samuel Kim, Richard Smith, Orazio Amabile, Zain Khalpey
INTRODUCTION: Cardiovascular complications represent the leading cause of morbidity and mortality in patients with Marfan syndrome. Here, we describe a unique case where a total artificial heart was implanted in a young Marfan syndrome woman. METHODS: A 22-year-old postpartum African American female with Marfan syndrome developed multiple severe valve dysfunction and biventricular failure that was refractory to medical management. She previously had a Bentall procedure for Type A aortic dissection and repair of a Type B dissection...
March 2018: International Journal of Artificial Organs
Hsiu-An Lee, Chun-Yu Lin, Yung-Chang Chen, Shao-Wei Chen, Yu-Yun Nan, Kuo-Sheng Liu, Meng-Yu Wu, Yu-Sheng Chang, Jaw-Ji Chu, Pyng-Jing Lin, Feng-Chun Tsai
The feasibility and durability of mitral valve (MV) repair in active infective endocarditis (IE) has been reported, but proper management of perioperative neurological complications and surgical timing remains uncertain and may crucially affect the outcome.In this single-center retrospective observational study, patients who underwent isolated MV surgery for active native IE in our institution between August 2005 and August 2015 were reviewed and analyzed. Patients who were operated on for healed IE or who required combined procedures were excluded from this study...
March 2018: Medicine (Baltimore)
Peter Murin, Nicodème Sinzobahamvya, Antonia Schulz, Victoria Lorenzen, Stanislav Ovroutski, Felix Berger, Joachim Photiadis, Mi-Young Cho
OBJECTIVES: The technique of subcoronary autograft implantation for the Ross procedure has shown excellent durability of aortic valve function in adults. However, its use in children with hypoplastic aortic annulus or multilevel left ventricular outflow tract obstruction (LVOTO) was traditionally precluded. We combined this technique with a Konno incision and evaluated LVOTO relief and durability of the autograft function in growing patients. METHODS: Between January 2012 and January 2017, 13 patients with severe LVOTO and hypoplastic aortic annulus underwent Ross-Konno procedure with subcoronary autograft implantation...
March 9, 2018: Interactive Cardiovascular and Thoracic Surgery
Phillip S Naimo, Tyson A Fricke, Yves d'Udekem, Johann Brink, Robert G Weintraub, Christian P Brizard, Igor E Konstantinov
OBJECTIVES: Preoperative moderate or greater truncal valve (TV) insufficiency is one of the most important factors influencing mortality in children with truncus arteriosus. We therefore sought to determine the impact of TV insufficiency and concomitant TV surgery on children who underwent truncus arteriosus repair at a single institution. METHODS: We reviewed 180 patients who underwent truncus arteriosus repair between 1979 and 2016. Preoperative echocardiography demonstrated TV insufficiency in 80 patients (mild: 33...
March 8, 2018: European Journal of Cardio-thoracic Surgery
Aline L Y Nachlas, Siyi Li, Rajneesh Jha, Monalisa Singh, Chunhui Xu, Michael E Davis
Despite recent advances in tissue engineered heart valves (TEHV), a major challenge is identifying a cell source for seeding TEHV scaffolds. Native heart valves are durable because valve interstitial cells (VICs) maintain tissue homeostasis by synthesizing and remodeling the extracellular matrix. In this study, the goal is to demonstrate that induced pluripotent stem cells (iPSC)-derived mesenchymal stem cells (iMSCs) can be derived from iPSCs using a feeder-free protocol and then further matured into VICs by encapsulation within 3D hydrogels...
March 2, 2018: Acta Biomaterialia
Marek Jasinski
We present a modified bicuspid aortic valve reimplantation operation using a unique technique of second line, continuous suturing during implantation of the aortic valve scallop to the prosthesis that mimics stentless, minicylinder implantation.  The feasibility of bicuspid aortic valve repair with associated aortic root management has been demonstrated. However, this repair seems to be less durable than tricuspid aortic valve repair, and this may be partly because of the connective tissue disorders that are an inherent feature of bicuspid aortic valve disease...
February 12, 2018: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Hiroshi Tanaka, Yutaka Okita
Annular fixation has an important role aortic valve repair for aortic regurgitation. We have used the reimplantation procedure as annular fixation combined with cusp repair rechniques for aortic valve repair even in small aortic root( <50 mm) since 2010. Freedom from aortic valve reoperation was 93% at 5 years and 79% at 8 years. Freedom from greater than moderate aortic regurgitation was 80% at 5 years and 71% at 8 years. Although the outcomes were not satisfactory and should be improved, this technique would be one of choices in selected patients, considering durability of bioprostheses and anticoagulation-related events in mechanical valves...
January 2018: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Masato Mutsuga, Akihiko Usui
The Bentall procedures using biological valved conduit is expanding owing to the increasing incidence of aortic valve disease in the aging population and usage for young generation. The long-term durability of the biological valve including the risks of structural valve deterioration(SVD) is the major concern of the bio-Bentall procedure. Bio-Bentall in our hospital are reviewed and literature review are added. Our surgical results of long-term survival in bio-Bentall patients is acceptable compare to other study and freedom from SVD and reoperation is better than other results...
January 2018: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Guglielmo Stefanelli, Fabrizio Pirro, Alina Olaru, Giuseppe Danniballe, Clorinda Labia, Luca Weltert
OBJECTIVES: Information on the long-term safety, efficacy and durability of third-generation stentless aortic valves is lacking. METHODS: In this single-centre, single-surgeon retrospective observational study, between 2003 and 2015, consecutive, non-selected aortic valve replacement (AVR) patients were implanted with the LivaNova-Sorin Pericarbon Freedom™, a third-generation stentless aortic xenograft. Changes in clinical and echocardiographic parameters were examined, as were mortality, structural valve deterioration and reoperation, according to age at 5, 10 and 14 years...
February 21, 2018: Interactive Cardiovascular and Thoracic Surgery
Thierry Bourguignon, Fabien Espitalier, Clémence Pantaleon, Emmanuelle Vermes, Jean Marc El-Arid, Claudia Loardi, Elias Karam, Pascal Candolfi, Fabrice Ivanes, Michel Aupart
OBJECTIVES: Mitral valve replacement using a bioprosthesis remains controversial in young patients because data on long-term outcomes are missing. This study evaluated the long-term results of the PERIMOUNT pericardial mitral bioprosthesis in patients aged 65 years or younger. METHODS: From 1984 to 2010, 148 Carpentier-Edwards PERIMOUNT mitral bioprostheses were implanted in 148 patients aged 65 years or younger. Baseline clinical, perioperative and follow-up data were recorded prospectively...
February 12, 2018: European Journal of Cardio-thoracic Surgery
Diana M Ropcke, Jonas Rasmussen, Christine Ilkjær, Søren N Skov, Marcell J Tjørnild, Ulrik T Baandrup, Carl Christian Danielsen, Vibeke E Hjortdal, Sten L Nielsen
OBJECTIVE: Tricuspid valve reconstruction using a small intestinal submucosal porcine extracellular matrix (ECM) tube graft is hypothesized to be durable for six months and show signs of recellularization and growth potential. The purpose was to histologically and biomechanically test ECM valves before and after six months of implantation in pigs for comparison with native valves. METHODS: Ten 60 kg pigs were included, which survived tricuspid valve tube graft insertion...
February 2, 2018: Journal of Biomechanics
Anton Tomšic, Robert J M Klautz, Thomas J van Brakel, Nina Ajmone Marsan, Michel I M Versteegh, Meindert Palmen
OBJECTIVES: Surgical correction of commissural mitral valve prolapse can be challenging. Several surgical techniques, including commissural closure, leaflet resection with sliding plasty and chordal replacement, remain commonly in use. Conversely, papillary muscle head repositioning remains uncommonly utilized for the treatment of commissural prolapse. METHODS: Between January 2003 and December 2015, 518 patients underwent primary mitral valve repair for severe degenerative mitral valve regurgitation at our institution...
February 6, 2018: Interactive Cardiovascular and Thoracic Surgery
Amy G Fiedler, George Tolis
Valvular heart disease (VHD) affects a large number of patients annually. From a surgical standpoint, there are two primary options for valve replacement: mechanical or bioprosthetic. While there are clear advantages and disadvantages to either option, and recent literature does challenge some of the prior dictums of valve choice, a handful of absolutes remain true. Mechanical valves provide superior durability and freedom from re-operation when compared to their bioprosthetic counterparts, at the expense of bleeding or thrombotic complications associated with the need for lifelong oral anticoagulation...
February 5, 2018: Current Treatment Options in Cardiovascular Medicine
Nicola Galea, Filippo Piatti, Francesco Sturla, Jonathan W Weinsaft, Christopher Lau, Ilaria Chirichilli, Iacopo Carbone, Emiliano Votta, Carlo Catalano, Ruggero De Paulis, Leonard N Girardi, Alberto Redaelli, Mario Gaudino
OBJECTIVES: This study was undertaken to evaluate the flow dynamics in the aortic root after valve-sparing root replacement with and without neosinuses of Valsalva reconstruction, by exploiting the capability of 4D Flow imaging to measure in vivo blood velocity fields and 3D geometric flow patterns. METHODS: Ten patients who underwent valve-sparing root replacement utilizing grafts with neosinuses or straight tube grafts (5 cases each) were evaluated by 4D Flow imaging at a mean of 46...
February 1, 2018: Interactive Cardiovascular and Thoracic Surgery
Andrea Colli, Laura Besola, Matteo Montagner, Nicola Soriani, Erica Manzan, Eleonora Bizzotto, Fabio Zucchetta, Danila Azzolina, Roberto Bellu, Cristiano Sarais, Demetrio Pittarello, Gino Gerosa
OBJECTIVES: Our aim is to investigate the acute intraoperative effects of the NeoChord repair procedure on mitral valve (MV) annular geometry and LV function and the impact of these changes on MR at 1-year follow-up. BACKGROUND: Recently transapical off-pump mitral valve repair with NeoChord implantation has been demonstrated to be safe and effective in patients with degenerative mitral regurgitation (DMR). METHODS: We retrospectively analyzed baseline and early postoperative 3-dimensional transesophageal echocardiography of 66 patients who underwent NeoChord repair for isolated posterior leaflet MV disease using semiautomatic off-line analysis software...
January 25, 2018: International Journal of Cardiology
Hiroshi Tanaka, Yuki Ikeno, Noriyuki Abe, Hiroaki Takahashi, Takeshi Inoue, Yutaka Okita
OBJECTIVES: To investigate the long-term durability of aortic valves, we reviewed the outcomes of patients who underwent valve-sparing root replacement with acute Type A aortic dissection. METHODS: We included patients who underwent emergent aortic repair for acute Type A aortic dissection at our university hospital between 2000 and 2016. We identified patients who underwent valve-sparing root replacement from the included cohort and assessed their survival and long-term valve durability...
January 29, 2018: European Journal of Cardio-thoracic Surgery
Klaas Loger, Saskia Pokorny, Tim Schaller, Irma Haben, Derk Frank, Georg Lutter
OBJECTIVES: In this study, results of a functional in vitro study of 2 newly developed valved stents for transcatheter mitral valve implantation are presented. METHODS: Two novel stent designs, an oval-shaped and a D-shaped stent with a strut fixation system were developed. The fixation force of the novel stents were tested in vitro in porcine hearts with a tensile test set-up. In further experiments, the stents were equipped with a circular valved stent, and the valve performances were investigated in a pulsatile heart valve tester...
February 1, 2018: Interactive Cardiovascular and Thoracic Surgery
Danny Dvir, Thierry Bourguignon, Catherine M Otto, Rebecca T Hahn, Raphael Rosenhek, John G Webb, Hendrik Treede, Maurice E Sarano, Ted Feldman, Harindra C Wijeysundera, Yan Topilsky, Michel Aupart, Michael J Reardon, G Burkhard Mackensen, Wilson Y Szeto, Ran Kornowski, James S Gammie, Ajit P Yoganathan, Yaron Arbel, Michael A Borger, Matheus Simonato, Mark Reisman, Raj R Makkar, Alexandre Abizaid, James M McCabe, Gry Dahle, Gabriel S Aldea, Jonathon Leipsic, Philippe Pibarot, Neil E Moat, Michael J Mack, A Pieter Kappetein, Martin B Leon
Bioprostheses are prone to structural valve degeneration, resulting in limited long-term durability. A significant challenge when comparing the durability of different types of bioprostheses is the lack of a standardized terminology for the definition of a degenerated valve. This issue becomes especially important when we try to compare the degeneration rate of surgically inserted and transcatheter bioprosthetic valves. This document, by the VIVID (Valve-in-Valve International Data), proposes practical and standardized definitions of valve degeneration and provides recommendations for the timing of clinical and imaging follow-up assessments accordingly...
January 23, 2018: Circulation
Nadejda Monsefi, Petar Risteski, Aleksandra Miskovic, Andreas Zierer, Anton Moritz
OBJECTIVES: The aim of the study was to compare the results of David procedure through conventional or minimally invasive approach. METHODS: A propensity-matched comparison in patients undergoing a minimally invasive (partial upper sternotomy, n = 103) or complete sternotomy (n = 103) David procedure from 1991 to 2016 was performed. Patients were 57 ± 14 years old on average in both groups. The David technique was modified by generating a neosinus (P < 0...
January 16, 2018: European Journal of Cardio-thoracic Surgery
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