201
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Salaun E, Mahjoub H, Girerd N, Dagenais F, Voisine P, Mohammadi S, Yanagawa B, Kalavrouziotis D, Juni P, Verma S, Puri R, Coté N, Rodés-Cabau J, Mathieu P, Clavel MA, Pibarot P. Rate, Timing, Correlates, and Outcomes of Hemodynamic Valve Deterioration After Bioprosthetic Surgical Aortic Valve Replacement. Circulation 2018; 138:971-985. [DOI: 10.1161/circulationaha.118.035150] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Erwan Salaun
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Canada (E.S., H.M., F.D., P.V., S.M., D.K., R.P., N.C., J.R.-C., P.M., M.-A.C., P.P.)
- Centre de Résonance Magnétique Biologique et Médicale, Centre National de la Recherche Scientifique, Aix-Marseille Université, France (E.S.)
| | - Haïfa Mahjoub
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Canada (E.S., H.M., F.D., P.V., S.M., D.K., R.P., N.C., J.R.-C., P.M., M.-A.C., P.P.)
| | - Nicolas Girerd
- INSERM, Centre d’Investigations Cliniques, Université de Lorraine, CHU de Nancy, Institut Lorrain du Coeur et des Vaisseaux, France (N.G.)
| | - François Dagenais
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Canada (E.S., H.M., F.D., P.V., S.M., D.K., R.P., N.C., J.R.-C., P.M., M.-A.C., P.P.)
| | - Pierre Voisine
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Canada (E.S., H.M., F.D., P.V., S.M., D.K., R.P., N.C., J.R.-C., P.M., M.-A.C., P.P.)
| | - Siamak Mohammadi
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Canada (E.S., H.M., F.D., P.V., S.M., D.K., R.P., N.C., J.R.-C., P.M., M.-A.C., P.P.)
| | - Bobby Yanagawa
- Division of Cardiac Surgery, St Michael’s Hospital, Toronto, Ontario, Canada (B.Y., S.V.)
| | - Dimitri Kalavrouziotis
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Canada (E.S., H.M., F.D., P.V., S.M., D.K., R.P., N.C., J.R.-C., P.M., M.-A.C., P.P.)
| | - Peter Juni
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael’s Hospital, University of Toronto, Ontario, Canada (P.J.)
| | - Subodh Verma
- Division of Cardiac Surgery, St Michael’s Hospital, Toronto, Ontario, Canada (B.Y., S.V.)
| | - Rishi Puri
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Canada (E.S., H.M., F.D., P.V., S.M., D.K., R.P., N.C., J.R.-C., P.M., M.-A.C., P.P.)
- Cleveland Clinic Coordinating Center for Clinical Research, Cleveland, OH (R.P.)
- Department of Medicine, University of Adelaide, South Australia, Australia (R.P.)
| | - Nancy Coté
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Canada (E.S., H.M., F.D., P.V., S.M., D.K., R.P., N.C., J.R.-C., P.M., M.-A.C., P.P.)
| | - Josep Rodés-Cabau
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Canada (E.S., H.M., F.D., P.V., S.M., D.K., R.P., N.C., J.R.-C., P.M., M.-A.C., P.P.)
| | - Patrick Mathieu
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Canada (E.S., H.M., F.D., P.V., S.M., D.K., R.P., N.C., J.R.-C., P.M., M.-A.C., P.P.)
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Canada (E.S., H.M., F.D., P.V., S.M., D.K., R.P., N.C., J.R.-C., P.M., M.-A.C., P.P.)
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Canada (E.S., H.M., F.D., P.V., S.M., D.K., R.P., N.C., J.R.-C., P.M., M.-A.C., P.P.)
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Taraballi F, Sushnitha M, Tsao C, Bauza G, Liverani C, Shi A, Tasciotti E. Biomimetic Tissue Engineering: Tuning the Immune and Inflammatory Response to Implantable Biomaterials. Adv Healthc Mater 2018; 7:e1800490. [PMID: 29995315 DOI: 10.1002/adhm.201800490] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 05/31/2018] [Indexed: 12/31/2022]
Abstract
Regenerative medicine technologies rely heavily on the use of well-designed biomaterials for therapeutic applications. The success of implantable biomaterials hinges upon the ability of the chosen biomaterial to negotiate with the biological barriers in vivo. The most significant of these barriers is the immune system, which is composed of a highly coordinated organization of cells that induce an inflammatory response to the implanted biomaterial. Biomimetic platforms have emerged as novel strategies that aim to use the principle of biomimicry as a means of immunomodulation. This principle has manifested itself in the form of biomimetic scaffolds that imitate the composition and structure of biological cells and tissues. Recent work in this area has demonstrated the promising potential these technologies hold in overcoming the barrier of the immune system and, thereby, improve their overall therapeutic efficacy. In this review, a broad overview of the use of these strategies across several diseases and future avenues of research utilizing these platforms is provided.
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Affiliation(s)
- Francesca Taraballi
- Center for Biomimetic Medicine Houston Methodist Research Institute Houston TX 77030 USA
- Department of Orthopedic & Sports Medicine The Houston Methodist Hospital Houston TX 77030 USA
| | - Manuela Sushnitha
- Center for Biomimetic Medicine Houston Methodist Research Institute Houston TX 77030 USA
- Department of Bioengineering Rice University Houston TX 77005 USA
| | - Christopher Tsao
- Center for Biomimetic Medicine Houston Methodist Research Institute Houston TX 77030 USA
| | - Guillermo Bauza
- Center for Biomimetic Medicine Houston Methodist Research Institute Houston TX 77030 USA
- Center for NanoHealth Swansea University Medical School Swansea University Bay Singleton Park Wales Swansea SA2 8PP UK
| | - Chiara Liverani
- Center for Biomimetic Medicine Houston Methodist Research Institute Houston TX 77030 USA
- Biosciences Laboratory Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS Via Piero Maroncelli 40 47014 Meldola FC Italy
| | - Aaron Shi
- Center for Biomimetic Medicine Houston Methodist Research Institute Houston TX 77030 USA
- Wiess School of Natural Sciences Rice University Houston TX 77251‐1892 USA
| | - Ennio Tasciotti
- Center for Biomimetic Medicine Houston Methodist Research Institute Houston TX 77030 USA
- Department of Orthopedic & Sports Medicine The Houston Methodist Hospital Houston TX 77030 USA
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203
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Hahn RT, Pibarot P, Leipsic J, Blanke P, Douglas PS, Weissman NJ, Kapadia S, Thourani VH, Herrmann HC, Nazif T, McAndrew T, Webb JG, Leon MB, Kodali S. The Effect of Post-Dilatation on Outcomes in the PARTNER 2 SAPIEN 3 Registry. JACC Cardiovasc Interv 2018; 11:1710-1718. [PMID: 30121276 DOI: 10.1016/j.jcin.2018.05.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/17/2018] [Accepted: 05/18/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The purpose of this study was to understand the effects of balloon post-dilatation on outcomes following transcatheter aortic valve replacement with the SAPIEN 3 valve. BACKGROUND Hemodynamics and outcomes with balloon post-dilatation for the SAPIEN 3 valve have not been previously reported. METHODS The effects of balloon post-dilatation (BPD) in 1,661 intermediate (S3i cohort) and high surgical risk (S3HR cohort) patients with aortic stenosis enrolled in the PARTNER (Placement of Aortic Transcatheter Valves) 2, SAPIEN 3 observational study on outcomes, as well as procedural complications, were assessed. RESULTS 208 of 1,661 patients (12.5%) had BPD during the initial transcatheter aortic valve replacement. Baseline characteristics were similar except BPD had higher STS score (p < 0.001), significantly less % oversizing (p = 0.004), significantly more ≥moderate left ventricular outflow tract calcification (p = 0.005), and severe annular calcification (p = 0.006). BPD patients had no increase in permanent pacemaker, annular rupture, or valve embolization. Following transcatheter aortic valve replacement, BPD patients had significantly larger aortic valve area (1.72 ± 0.41 cm2 vs. 1.66 ± 0.37 cm2; p = 0.04) with no significant difference in prosthesis-patient mismatch (p = 0.08) or transvalvular aortic regurgitation (p = 0.65), but significantly more paravalvular regurgitation (p < 0.01). There was no significant difference in 30-day or 1-year outcomes of all-cause death (p = 0.65 to 0.76) or stroke (p = 0.28 to 0.72). However, at 1 year, there was a significantly higher incidence of minor stroke in BPD patients (p = 0.02). Adjusting for baseline differences, including calcium burden, minor strokes were no longer significantly different between the BPD and NoBPD groups (p = 0.21). CONCLUSIONS BPD is performed more frequently in patients with lower % oversizing and greater calcium burden. BPD is not associated with procedural complications or an increase in 1-year adverse events of death, rehospitalization, or stroke.
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Affiliation(s)
- Rebecca T Hahn
- Columbia University Medical Center/NY Presbyterian Hospital, New York, New York.
| | - Philippe Pibarot
- Department of Medicine, Laval University, Quebec, Quebec, Canada
| | - Jonathon Leipsic
- University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Philipp Blanke
- University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Pamela S Douglas
- Duke University Medical Center, and Duke Clinical Research Institute, Durham, North Carolina
| | - Neil J Weissman
- Georgetown University School of Medicine, Medstar Health Research Institute, Washington, DC
| | | | - Vinod H Thourani
- Georgetown University School of Medicine, Medstar Health Research Institute, Washington, DC
| | | | - Tamim Nazif
- Columbia University Medical Center/NY Presbyterian Hospital, New York, New York
| | | | - John G Webb
- University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Martin B Leon
- Columbia University Medical Center/NY Presbyterian Hospital, New York, New York
| | - Susheel Kodali
- Columbia University Medical Center/NY Presbyterian Hospital, New York, New York
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204
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Abstract
PURPOSE OF REVIEW To determine what influences patients and physicians to choose between transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) in intermediate-surgical-risk patients with severe, symptomatic aortic stenosis. RECENT FINDINGS Advances in transcatheter valve technology, techniques, and trials demonstrating non-inferiority compared to surgical aortic valve replacement (SAVR) have led to expanded eligibility of transcatheter aortic valve replacement (TAVR) to both intermediate-risk patients in clinical practice and low-risk patients in pivotal trials. Since lower-risk individuals tend to be younger and good operative candidates, concerns of valve durability, procedure-related morbidity, and patient survivability require careful consideration. Results from the PARTNER II intermediate risk trials and SURTAVI trials have given us insight into the benefits and potential risks of both treatment modalities. In this article, we review the brief yet remarkable history of TAVR and discuss its role in the treatment of intermediate-surgical-risk patients.
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205
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Mankad SV, Aldea GS, Ho NM, Mankad R, Pislaru S, Rodriguez LL, Whisenant B, Zimmerman K. Transcatheter Mitral Valve Implantation in Degenerated Bioprosthetic Valves. J Am Soc Echocardiogr 2018; 31:845-859. [DOI: 10.1016/j.echo.2018.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Indexed: 02/07/2023]
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206
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Böhm A, Hricak V, Tomasovic B, Bena M, Michalek P, Postulka J. Transcatheter Mitral Valve Prosthesis Dysfunction - Early Valve Degeneration or Thrombosis? Circ J 2018; 82:2210-2211. [PMID: 29398687 DOI: 10.1253/circj.cj-17-0740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Allan Böhm
- Department of Acute Cardiology, The National Institute of Cardiovascular Diseases
| | - Vasil Hricak
- Department of Acute Cardiology, The National Institute of Cardiovascular Diseases.,Department of Faculty of Health, Catholic University
| | - Branislav Tomasovic
- Department of Acute Cardiology, The National Institute of Cardiovascular Diseases
| | - Martin Bena
- Department of Cardiac Surgery, The National Institute of Cardiovascular Diseases
| | | | - Jan Postulka
- Department of Acute Cardiology, The National Institute of Cardiovascular Diseases
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207
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Atkins BZ, Aldea GS. “Drilling Down” on Structural Valve Deterioration. J Am Coll Cardiol 2018; 72:586. [DOI: 10.1016/j.jacc.2018.04.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 04/25/2018] [Indexed: 10/28/2022]
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208
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Fallon JM, DeSimone JP, Brennan JM, O’Brien S, Thibault DP, DiScipio AW, Pibarot P, Jacobs JP, Malenka DJ. The Incidence and Consequence of Prosthesis-Patient Mismatch After Surgical Aortic Valve Replacement. Ann Thorac Surg 2018; 106:14-22. [DOI: 10.1016/j.athoracsur.2018.01.090] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 11/25/2017] [Accepted: 01/18/2018] [Indexed: 10/17/2022]
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209
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Stewart WJ. Changing Paradigms for Bioprosthetic Valves. JACC Cardiovasc Imaging 2018; 11:959-961. [DOI: 10.1016/j.jcmg.2017.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 08/18/2017] [Accepted: 08/23/2017] [Indexed: 11/15/2022]
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210
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Garrido RQ, Brito JODR, Fernandes R, Barbosa GF, Correia MG, Golebiovski WF, Weksler C, Lamas CC. Early Onset Prosthetic Valve Endocarditis: Experience at a Cardiothoracic Surgical Hospital, 2006-2016. Surg Infect (Larchmt) 2018; 19:529-534. [PMID: 29957138 DOI: 10.1089/sur.2018.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Early onset prosthetic valve endocarditis (EO-PVE) is an serious complication associated with heart valve replacement surgery. OBJECTIVES To describe the epidemiologic, clinical, and laboratory profile of patients with EO-PVE in a cardiac surgical hospital. PATIENTS AND METHODS A retrospective analysis of an endocarditis database, implemented prospectively, with a post hoc study driven by analysis of cases of adults with definite endocarditis occurring up to 12 months after heart valve surgery. RESULTS We identified 26 cases in 2,496 surgeries in the period 2006-2016. The average annual incidence was 1.04%. The median time between valve replacement and the diagnosis of EO-PVE was 33 days (interquartile range [IQR] 19.25-118.75). Biologic and mechanical prostheses were affected in 53.8% and 46.2%, respectively. Rheumatic disease was present in 57.7% of patients. The most common causative pathogens were Staphylococcus epidermidis (23.1%). No Staphylococcus aureus infection was reported. Complications were present in 73.1% of cases, including embolism (65.4%), acute renal failure (38.5%), and heart failure (23.1%). The mortality rate at 30 days and 12 months was 3.8% and 34.6%, respectively. CONCLUSIONS In our cohort EO-PVE was an serious complication of heart valve replacement with a high morbidity and mortality, despite its low frequency.
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Affiliation(s)
- Rafael Quaresma Garrido
- 1 Infection Control Department, Instituto Nacional de Cardiologia , Rio de Janeiro, Brazil
- 5 Universidade Estacio de Sá , Rio de Janeiro, Brazil
- 7 Instituto Nacional de Infectologia , Rio de Janeiro, Brazil
| | | | | | | | | | - Wilma Felix Golebiovski
- 4 Cardiovascular Research Unit, Heart Valve Disease Department, Instituto Nacional de Cardiologia , Rio de Janeiro, Brazil
| | - Clara Weksler
- 4 Cardiovascular Research Unit, Heart Valve Disease Department, Instituto Nacional de Cardiologia , Rio de Janeiro, Brazil
| | - Cristiane C Lamas
- 4 Cardiovascular Research Unit, Heart Valve Disease Department, Instituto Nacional de Cardiologia , Rio de Janeiro, Brazil
- 6 Universidade do Grande Rio , Duque de Caxias, Brazil
- 7 Instituto Nacional de Infectologia , Rio de Janeiro, Brazil
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211
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Roh C, Gharib M. Asymmetry in the jet opening: underwater jet vectoring mechanism by dragonfly larvae. BIOINSPIRATION & BIOMIMETICS 2018; 13:046007. [PMID: 29848791 DOI: 10.1088/1748-3190/aac25a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Aquatic Anisopteran dragonfly larvae achieve respiration and propulsion by repetitive water jets flowing through their anal openings. Previous studies have shown that the tri-leaflet anal valves modulate the emerging jet by varying the opening size. We discovered that the valves are also capable of controlling the opening asymmetry by independent retraction of a leaflet. This study shows the effects of their valve asymmetry control on the respiratory and propulsive flows. Furthermore, the effects of size variation are re-evaluated using fluid momentum and power equations. Synchronized dual cameras recorded the valve movement and the flow generated by Aeshnidae sp. During the respiratory jetting, retraction of a single leaflet positions the opening in an off-centred locale, from which diagonally deflected jets emerge. The resulting flow field, together with the opening size modulation, implicates a reduction in the reinhalation of the exhaled jet and partial powering of the refilling process. Instead, during the propulsive jetting, concurrent partial retraction of the three leaflets results in the centred opening. The resulting jet flows straight, which has an implication for lowering form drag. Additionally, the propulsive aperture size control suggests improved thrust production. Our study highlights the significant influence that an asymmetrically positioned jet opening can have on biological jet flow. The findings inspire a new mechanism for jet vectoring that may prove useful for application in the broader engineering field.
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Affiliation(s)
- Chris Roh
- Author to whom any correspondence should be addressed
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212
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Dziubek M, Pierrakos C, Chebli L, Demanet H, Sanoussi A, Wauthy P. Para-prosthetic Leaks Following Mitral Valve Replacement: Case Analysis on a 20-year Period. Curr Cardiol Rev 2018; 14:15-24. [PMID: 29141552 PMCID: PMC5872258 DOI: 10.2174/1573403x13666171110110344] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 10/19/2017] [Accepted: 11/03/2017] [Indexed: 11/22/2022] Open
Abstract
Background: Mitral para-prosthetic leaks are rare but major complications of mitral heart valve replacements. When they must be re-operated, they are burdened with high mortality rates. We proposed to review our surgical experience in terms of approach and type of operation carried out. Methods: Demographic, preoperative, intraoperative and postoperative characteristics of 34 patients benefited from a surgical treatment of mitral paravalvular leak, at the Brugmann University Hospital between 1996 and 2016, have been analysed retrospectively. We analysed the data to identify the risk factors of postoperative mortality. We then compared the data depending on the approach and the type of surgical treatment in order to compare the morbidity-mortality. Results: The postoperative mortality rate was 11.7%. The presence of endocarditis and increase in lactate dehydrogenase were predictive factors of mortality. Cardiac complications and acute kidney failure were significantly more common in the decease population. Direct mitral paravalvular leak su-turing was more frequently performed on early apparition, anterior and isolated leaks, whereas a mi-tral heart valve replacement was most often performed to cure active primary endocarditis. The inci-dence of complications and mortality rates were identical according to the approach and the type of operation performed. A mitral para-prosthetic leak recurrence was observed in 33% of the cases. Conclusion: Surgical treatment of mitral para-prosthetic leaks is accompanied by a high mortality rate. The operative strategy plays a major role and can influence the morbidity-mortality encountered in those patients.
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Affiliation(s)
- Melvin Dziubek
- Department of Cardiac Surgery, Brugmann University Hospital, Universite Libre de Bruxelles, Bruxelles, Belgium
| | - Charalampos Pierrakos
- Department of Intensive Care, Brugmann University Hospital, Universite Libre de Bruxelles, Bruxelles, Belgium
| | - Louis Chebli
- Department of Cardiac Surgery, Brugmann University Hospital, Universite Libre de Bruxelles, Bruxelles, Belgium
| | - Helene Demanet
- Department of Cardiac Surgery, Brugmann University Hospital, Universite Libre de Bruxelles, Bruxelles, Belgium
| | - Ahmed Sanoussi
- Department of Cardiac Surgery, Brugmann University Hospital, Universite Libre de Bruxelles, Bruxelles, Belgium
| | - Pierre Wauthy
- Department of Cardiac Surgery, Brugmann University Hospital, Universite Libre de Bruxelles, Bruxelles, Belgium
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213
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Musumeci L, Jacques N, Hego A, Nchimi A, Lancellotti P, Oury C. Prosthetic Aortic Valves: Challenges and Solutions. Front Cardiovasc Med 2018; 5:46. [PMID: 29868612 PMCID: PMC5961329 DOI: 10.3389/fcvm.2018.00046] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 04/30/2018] [Indexed: 01/04/2023] Open
Abstract
Aortic Valve Disease (AVD) is the most common Valvular Heart Disease (VHD), affecting millions of people worldwide. Severe AVD is treated in most cases with prosthetic aortic valve replacement, which involves the substitution of the native aortic valve with a prosthetic one. In this review we will discuss the different types of prosthetic aortic valves available for implantation and the challenges faced by patients, medical doctors, researchers and manufacturers, as well as the approaches that are taken to overcome them.
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Affiliation(s)
- Lucia Musumeci
- Laboratory of Thrombosis and Hemostasis and Valvular Heart Disease, GIGA Cardiovascular Sciences, University of Liège Hospital, CHU Sart Tilman, Liège, Belgium
| | - Nicolas Jacques
- Laboratory of Thrombosis and Hemostasis and Valvular Heart Disease, GIGA Cardiovascular Sciences, University of Liège Hospital, CHU Sart Tilman, Liège, Belgium
| | - Alexandre Hego
- Laboratory of Thrombosis and Hemostasis and Valvular Heart Disease, GIGA Cardiovascular Sciences, University of Liège Hospital, CHU Sart Tilman, Liège, Belgium
| | - Alain Nchimi
- Department of Cardiology, GIGA Cardiovascular Sciences, University of Liège Hospital, Heart Valve Clinic, CHU Sart Tilman, Liège, Belgium
| | - Patrizio Lancellotti
- Laboratory of Thrombosis and Hemostasis and Valvular Heart Disease, GIGA Cardiovascular Sciences, University of Liège Hospital, CHU Sart Tilman, Liège, Belgium.,Department of Cardiology, GIGA Cardiovascular Sciences, University of Liège Hospital, Heart Valve Clinic, CHU Sart Tilman, Liège, Belgium.,Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
| | - Cécile Oury
- Laboratory of Thrombosis and Hemostasis and Valvular Heart Disease, GIGA Cardiovascular Sciences, University of Liège Hospital, CHU Sart Tilman, Liège, Belgium
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214
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Salaun E, Clavel MA, Rodés-Cabau J, Pibarot P. Bioprosthetic aortic valve durability in the era of transcatheter aortic valve implantation. Heart 2018; 104:1323-1332. [DOI: 10.1136/heartjnl-2017-311582] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/02/2018] [Accepted: 03/06/2018] [Indexed: 02/02/2023] Open
Abstract
The main limitation of bioprosthetic valves is their limited durability, which exposes the patient to the risk of aortic valve reintervention. Transcatheter aortic valve implantation (TAVI) is considered a reasonable alternative to surgical aortic valve replacement (SAVR) in patients with intermediate or high surgical risk. TAVI is now rapidly expanding towards the lower risk populations. Although the results of midterm durability of the transcatheter bioprostheses are encouraging, their long-term durability remains largely unknown. The objective of this review article is to present the definition, mechanisms, incidence, outcome and management of structural valve deterioration of aortic bioprostheses with specific emphasis on TAVI. The structural valve deterioration can be categorised into three stages: stage 1: morphological abnormalities (fibrocalcific remodelling and tear) of bioprosthesis valve leaflets without hemodynamic valve deterioration; stage 2: morphological abnormalities and moderate hemodynamic deterioration (increase in gradient and/or new onset of transvalvular regurgitation); and stage 3: morphological abnormalities and severe hemodynamic deterioration. Several specifics inherent to the TAVI including valve oversizing, manipulation, delivery, positioning and deployment may cause injuries to the valve leaflets and increase leaflet mechanical stress, which may limit the long-term durability of transcatheter bioprostheses. The selection of the type of aortic valve replacement and bioprosthesis should thus take into account the ratio between the demonstrated durability of the bioprostheses versus the life expectancy of the patient. Pending the publication of robust data on long-term durability of transcatheter bioprostheses, it appears reasonable to select SAVR with a bioprosthesis model that has well-established long-term durability in patients with low surgical risk and long life expectancy.
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215
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Shan Y, Jia B, Ye M, Shen H, Chen W, Zhang H. Application of Heparin/Collagen-REDV Selective Active Interface on ePTFE Films to Enhance Endothelialization and Anticoagulation. Artif Organs 2018; 42:824-834. [PMID: 29667205 DOI: 10.1111/aor.13131] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 12/12/2017] [Accepted: 01/25/2018] [Indexed: 12/12/2022]
Abstract
Expanded polytetrafluoroethylene (ePTFE) prosthetic valves have been widely used in clinical applications in Asian countries. However, these valves still have limits with regard to thrombosis, neointimal hyperplasia, restenosis, and valvar vegetation. The achievement of in situ endothelialization on implant materials is a promising way to overcome those limits. Here, heparin/collagen multilayers were fabricated on ePTFE films via a layer-by-layer (LBL) self-assembly technique, and then, the endothelial cell (EC) adhesive peptide sequence Arg-Glu-Asp-Val (REDV) was immobilized on the multilayers. After modification with the heparin/collagen multilayers with or without REDV peptide, less platelet activation and aggregation were observed, the blood coagulation time was increased, and the hemolysis rate was decreased compared to that on pristine ePTFE films. The REDV-functionalized ePTFE films positively impacted early EC adhesion, later cell proliferation and cell activity. The EC barrier was confirmed to be successfully achieved on the functionalized ePTFE film surface in vitro. The successful assembly of the REDV-functionalized heparin/collagen multilayer on ePTFE films improved the blood compatibility, anticoagulant properties, and cell compatibility of the films in vitro, and thus, represents a candidate approach for applications requiring quick in situ endothelialization in vivo.
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Affiliation(s)
- Yaping Shan
- Department of Cardiovascular Center, Children's Hospital of Fudan University, Shanghai, China
| | - Bing Jia
- Department of Cardiovascular Center, Children's Hospital of Fudan University, Shanghai, China
| | - Ming Ye
- Department of Cardiovascular Center, Children's Hospital of Fudan University, Shanghai, China
| | - Hua Shen
- Department of Cardiovascular Center, Children's Hospital of Fudan University, Shanghai, China
| | - Weicheng Chen
- Department of Cardiovascular Center, Children's Hospital of Fudan University, Shanghai, China
| | - Huifeng Zhang
- Department of Cardiovascular Center, Children's Hospital of Fudan University, Shanghai, China
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216
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Cigarroa R, Elmariah S. Anticoagulation Management After Transcatheter and Surgical Valve Replacement. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:42. [DOI: 10.1007/s11936-018-0629-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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217
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Why I choose to repair and not to replace the aortic valve? Gen Thorac Cardiovasc Surg 2018; 67:20-24. [PMID: 29623558 DOI: 10.1007/s11748-018-0920-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 03/29/2018] [Indexed: 02/06/2023]
Abstract
Aortic valve replacement whether surgical or transcutaneous remains an option for the treatment of severe aortic valve disease; however, current prosthetic devices are associated with complications including, but no limited to, valve thrombosis and thromboembolic events, bleeding events associated with anticoagulation use, prosthetic valve endocarditis and structural valve deterioration. In this effect, aortic valve repair (AVr) has become an attractive alternative in circumventing these potential complications by preservation of the native aortic valve apparatus. In this article, we attempt to present the progress made for AVr over the last two decades. We also wish to highlight the critical steps for successful AVr and the outcome data that demonstrate that can be first-choice treatment in selected patients and finally to emphasize on the key steps for further future development.
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218
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Mahmood F, Matyal R, Mahmood F, Sheu RD, Feng R, Khabbaz KR. Intraoperative Echocardiographic Assessment of Prosthetic Valves: A Practical Approach. J Cardiothorac Vasc Anesth 2018; 32:823-837. [DOI: 10.1053/j.jvca.2017.10.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Indexed: 12/30/2022]
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219
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Xu F, Morganti S, Zakerzadeh R, Kamensky D, Auricchio F, Reali A, Hughes TJ, Sacks MS, Hsu MC. A framework for designing patient-specific bioprosthetic heart valves using immersogeometric fluid-structure interaction analysis. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2018; 34:e2938. [PMID: 29119728 PMCID: PMC5893448 DOI: 10.1002/cnm.2938] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 09/08/2017] [Accepted: 10/22/2017] [Indexed: 05/07/2023]
Abstract
Numerous studies have suggested that medical image derived computational mechanics models could be developed to reduce mortality and morbidity due to cardiovascular diseases by allowing for patient-specific surgical planning and customized medical device design. In this work, we present a novel framework for designing prosthetic heart valves using a parametric design platform and immersogeometric fluid-structure interaction (FSI) analysis. We parameterize the leaflet geometry using several key design parameters. This allows for generating various perturbations of the leaflet design for the patient-specific aortic root reconstructed from the medical image data. Each design is analyzed using our hybrid arbitrary Lagrangian-Eulerian/immersogeometric FSI methodology, which allows us to efficiently simulate the coupling of the deforming aortic root, the parametrically designed prosthetic valves, and the surrounding blood flow under physiological conditions. A parametric study is performed to investigate the influence of the geometry on heart valve performance, indicated by the effective orifice area and the coaptation area. Finally, the FSI simulation result of a design that balances effective orifice area and coaptation area reasonably well is compared with patient-specific phase contrast magnetic resonance imaging data to demonstrate the qualitative similarity of the flow patterns in the ascending aorta.
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Affiliation(s)
- Fei Xu
- Department of Mechanical Engineering, Iowa State University, 2025 Black Engineering, Ames, IA 50011, USA
| | - Simone Morganti
- Department of Electrical, Computer, and Biomedical Engineering, University of Pavia, via Ferrata 3, 27100, Pavia Italy
| | - Rana Zakerzadeh
- Center for Cardiovascular Simulation, Institute for Computational Engineering and Sciences, The University of Texas at Austin, 201 East 24th St, Stop C0200, Austin, TX 78712, USA
| | - David Kamensky
- Department of Structural Engineering, University of California, San Diego, 9500 Gilman Drive, Mail Code 0085 La Jolla, CA 92093, USA
| | - Ferdinando Auricchio
- Department of Civil Engineering and Architecture, University of Pavia, via Ferrata 3, 27100, Pavia, Italy
| | - Alessandro Reali
- Department of Civil Engineering and Architecture, University of Pavia, via Ferrata 3, 27100, Pavia, Italy
| | - Thomas J.R. Hughes
- Center for Cardiovascular Simulation, Institute for Computational Engineering and Sciences, The University of Texas at Austin, 201 East 24th St, Stop C0200, Austin, TX 78712, USA
| | - Michael S. Sacks
- Center for Cardiovascular Simulation, Institute for Computational Engineering and Sciences, The University of Texas at Austin, 201 East 24th St, Stop C0200, Austin, TX 78712, USA
| | - Ming-Chen Hsu
- Department of Mechanical Engineering, Iowa State University, 2025 Black Engineering, Ames, IA 50011, USA
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220
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Yao RJ, Simonato M, Dvir D. Optimising the Haemodynamics of Aortic Valve-in-valve Procedures. Interv Cardiol 2018; 12:40-43. [PMID: 29588729 DOI: 10.15420/icr.2016:25:2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Bioprosthetic surgical valves are increasingly implanted during cardiac surgery, instead of mechanical valves. These tissue valves are associated with limited durability and as a result transcatheter valve-in-valve procedures are performed to treat failed bioprostheses. A relatively common adverse event of aortic valve-in-valve procedures is residual stenosis. Larger surgical valve size, supra-annular transcatheter heart valve type, as well as higher transcatheter heart valve implantation depth, have all been shown to reduce the incidence of elevated post-procedural gradients. With greater understanding of technical considerations and surgical planning, valve-in-valve procedures could be more effective and eventually may become the standard of care for our increasingly ageing and comorbid population with failed surgical bioprostheses.
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Affiliation(s)
- Ren Jie Yao
- Department of Cardiology, St Paul's Hospital, Vancouver, Canada
| | | | - Danny Dvir
- Department of Cardiology, St Paul's Hospital, Vancouver, Canada
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221
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D'Souza R, Ostro J, Shah PS, Silversides CK, Malinowski A, Murphy KE, Sermer M, Shehata N. Anticoagulation for pregnant women with mechanical heart valves: a systematic review and meta-analysis. Eur Heart J 2018; 38:1509-1516. [PMID: 28329059 PMCID: PMC5429939 DOI: 10.1093/eurheartj/ehx032] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 02/13/2017] [Indexed: 12/21/2022] Open
Abstract
Aims To review maternal and foetal outcomes in women with mechanical heart valves (MHVs) treated with vitamin-K antagonists (VKAs), first-trimester heparin followed by VKAs (sequential treatment), low molecular weight heparin (LMWH) and unfractionated heparin (UFH) during pregnancy, in order to inform practice. Methods and results Medline, Embase and Central were searched from inception until February 2016. Two reviewers independently screened 1786 titles, reviewed 110 full-texts and extracted data and assessed risk-of-bias from 46 articles. Pooled incidence (95% confidence intervals) was calculated for maternal and foetal outcomes. Included studies had a moderate or high risk-of-bias. With VKAs, sequential treatment and LMWH, maternal mortality occurred in 0.9% (0.4–1.4), 2.0% (0.8–3.1) and 2.9% (0.2–5.7), thromboembolic complications in 2.7% (1.4–4.0), 5.8% (3.8–7.7) and 8.7% (3.9–13.4), livebirths in 64.5% (48.8–80.2), 79.9% (74.3–85.6) and 92.0% (86.1–98.0) and anticoagulant-related foetal/neonatal adverse events (embryopathy or foetopathy) in 2.0% (0.3–3.7), 1.4% (0.3–2.5) and 0%, respectively. When UFH is used throughout pregnancy, 11.2% (2.8–19.6) suffered thromboembolic complications. Foetal loss and adverse events occurred with first-trimester warfarin doses ≤ 5 mg/day, although there were more livebirths [83.6% (75.8–91.4) vs. 43.9% (32.8–55.0)] and fewer foetal anomalies [2.3% (0.7–4.0) vs. 12.4% (3.3–21.6)] with lower doses than with warfarin > 5 mg/day. Conclusions VKAs are associated with fewest maternal complications but also with fewest livebirths. Sequential treatment does not eliminate anticoagulant-related foetal/neonatal adverse events. LMWH is associated with the highest number of livebirths. The safety of UFH throughout pregnancy and first-trimester warfarin ≤ 5 mg/day remains unconfirmed.
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Affiliation(s)
- Rohan D'Souza
- Department of Obstetrics and Gynaecology, Division of Maternal and Fetal Medicine, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Toronto ON M5G 1Z5, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto ON M5T 3M6, Canada
| | - Jackie Ostro
- Department of Medicine, Division of Hematology, University of Toronto, Toronto, Canada
| | - Prakesh S Shah
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto ON M5T 3M6, Canada.,Department of Paediatrics, Division of Neonatology, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Toronto ON M5G 1Z5, Canada
| | - Candice K Silversides
- Department of Medicine, Division of Cardiology, Obstetric Medicine Program, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Toronto ON M5G 1Z5, Canada
| | - Ann Malinowski
- Department of Obstetrics and Gynaecology, Division of Maternal and Fetal Medicine, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Toronto ON M5G 1Z5, Canada
| | - Kellie E Murphy
- Department of Obstetrics and Gynaecology, Division of Maternal and Fetal Medicine, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Toronto ON M5G 1Z5, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto ON M5T 3M6, Canada
| | - Mathew Sermer
- Department of Obstetrics and Gynaecology, Division of Maternal and Fetal Medicine, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Toronto ON M5G 1Z5, Canada
| | - Nadine Shehata
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto ON M5T 3M6, Canada.,Departments of Medicine and Laboratory Medicine and Pathobiology, Mount Sinai Hospital, Division of Hematology, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Toronto ON M5G 1Z5, Canada
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222
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Onwuka E, King N, Heuer E, Breuer C. The Heart and Great Vessels. Cold Spring Harb Perspect Med 2018; 8:cshperspect.a031922. [PMID: 28289246 DOI: 10.1101/cshperspect.a031922] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Cardiovascular disease is the leading cause of mortality worldwide. We have made large strides over the past few decades in management, but definitive therapeutic options to address this health-care burden are still limited. Given the ever-increasing need, much effort has been spent creating engineered tissue to replaced diseased tissue. This article gives a general overview of this work as it pertains to the development of great vessels, myocardium, and heart valves. In each area, we focus on currently studied methods, limitations, and areas for future study.
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Affiliation(s)
- Ekene Onwuka
- Tissue Engineering and Surgical Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio 43205.,College of Medicine, The Ohio State University, Columbus, Ohio 43210
| | - Nakesha King
- Tissue Engineering and Surgical Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio 43205.,College of Medicine, The Ohio State University, Columbus, Ohio 43210
| | - Eric Heuer
- Tissue Engineering and Surgical Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio 43205
| | - Christopher Breuer
- Tissue Engineering and Surgical Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio 43205.,College of Medicine, The Ohio State University, Columbus, Ohio 43210.,Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio 43205
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223
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Blum KM, Drews JD, Breuer CK. Tissue-Engineered Heart Valves: A Call for Mechanistic Studies. TISSUE ENGINEERING PART B-REVIEWS 2018; 24:240-253. [PMID: 29327671 DOI: 10.1089/ten.teb.2017.0425] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Heart valve disease carries a substantial risk of morbidity and mortality. Outcomes are significantly improved by valve replacement, but currently available mechanical and biological replacement valves are associated with complications of their own. Mechanical valves have a high rate of thromboembolism and require lifelong anticoagulation. Biological prosthetic valves have a much shorter lifespan, and they are prone to tearing and degradation. Both types of valves lack the capacity for growth, making them particularly problematic in pediatric patients. Tissue engineering has the potential to overcome these challenges by creating a neovalve composed of native tissue that is capable of growth and remodeling. The first tissue-engineered heart valve (TEHV) was created more than 20 years ago in an ovine model, and the technology has been advanced to clinical trials in the intervening decades. Some TEHVs have had clinical success, whereas others have failed, with structural degeneration resulting in patient deaths. The etiologies of these complications are poorly understood because much of the research in this field has been performed in large animals and humans, and, therefore, there are few studies of the mechanisms of neotissue formation. This review examines the need for a TEHV to treat pediatric patients with valve disease, the history of TEHVs, and a future that would benefit from extension of the reverse translational trend in this field to include small animal studies.
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Affiliation(s)
- Kevin M Blum
- 1 Center for Regenerative Medicine, The Research Institute at Nationwide Children's Hospital , Columbus, Ohio.,2 The Ohio State University College of Medicine , Columbus, Ohio
| | - Joseph D Drews
- 1 Center for Regenerative Medicine, The Research Institute at Nationwide Children's Hospital , Columbus, Ohio.,3 Department of Surgery, The Ohio State University Wexner Medical Center , Columbus, Ohio
| | - Christopher K Breuer
- 1 Center for Regenerative Medicine, The Research Institute at Nationwide Children's Hospital , Columbus, Ohio.,3 Department of Surgery, The Ohio State University Wexner Medical Center , Columbus, Ohio
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224
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Fiedler AG, Tolis G. Surgical Treatment of Valvular Heart Disease: Overview of Mechanical and Tissue Prostheses, Advantages, Disadvantages, and Implications for Clinical Use. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:7. [DOI: 10.1007/s11936-018-0601-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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225
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Basir A, Grobben RB, Cramer MJ, van Herwaarden JA, Vink A, Pasterkamp G, Kluin J, Gründeman PF. Flexible mechanoprosthesis made from woven ultra-high-molecular-weight polyethylene fibres: proof of concept in a chronic sheep model. Interact Cardiovasc Thorac Surg 2018; 25:942-949. [PMID: 29049662 DOI: 10.1093/icvts/ivx244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 06/26/2017] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES Ultra-high-molecular-weight polyethylene (UHMWPE) fibres are flexible, have high tensile strength, and platelet and bacterial adhesion is low. Therefore, UHMWPE may overcome limitations of current mechanical valves and bioprostheses. In this study, the biocompatibility and functionality of prototype handmade stented valves from woven UHMWPE (U-valve) was assessed in a chronic sheep model with acetylsalicylic acid monotherapy. METHODS Native pulmonary valves of 23 sheep were replaced by U-valves (n = 18) or Perimount bovine bioprostheses (reference group, n = 5). Sheep received 80 mg of acetylsalicylic acid daily. Follow-up was conducted at 1 week (n = 4), 1 month (n = 5), 3 months (n = 5) and 6 months (n = 4) in the U-valve group and at 3 months (n = 2) and 6 months (n = 3) in the reference group. Epicardial echocardiography and histology were used to assess valve function and tissue deposition, respectively. RESULTS Seventeen U-valve sheep (94%) and 3 reference sheep (60%) survived the perioperative period. One reference valve sheep was sacrificed after 4 months because of congestive heart failure. At explantation, all U-valves were intact without leaflet tearing. Up to 3 months, U-valves were flexible and free of stenosis. Regurgitation was mostly mild though gradually increasing; histology showed minimal connective tissue near the leaflet base and sparse calcification. At 6 months, connective tissue was diffusely observed on the leaflets with retraction and consecutive regurgitation and leaflet thickening. CONCLUSIONS Valves made from UHMWPE fibres demonstrated early feasibility in the pulmonary valve position with reasonably good haemodynamics and intact valve materials up to 6 months. Gradual leaflet thickening and retraction were observed after 3 months due to connective tissue overgrowth.
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Affiliation(s)
- Amir Basir
- Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Remco B Grobben
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Maarten Jan Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Aryan Vink
- Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Gerard Pasterkamp
- Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Jolanda Kluin
- Department of Cardiothoracic Surgery, Amsterdam Medical Center, Amsterdam, Netherlands
| | - Paul F Gründeman
- Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
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226
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Van Hemelrijck M, Taramasso M, De Carlo C, Kuwata S, Regar E, Nietlispach F, Ferrero A, Weber A, Maisano F. Recent advances in understanding and managing aortic stenosis. F1000Res 2018; 7:58. [PMID: 29375823 PMCID: PMC5770996 DOI: 10.12688/f1000research.11906.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2018] [Indexed: 11/20/2022] Open
Abstract
Over the last few years, treatment of severe symptomatic aortic stenosis in high-risk patients has drastically changed to adopt a less-invasive approach. Transcatheter aortic valve implantation (TAVI) has been developed as a very reproducible and safe procedure, as shown in many trials. When compared to surgery, TAVI has produced superior, or at least comparable, results, and thus a trend to broaden treatment indications to lower-risk patients has erupted as a natural consequence, even though there is a lack of long-term evidence. In this review, we summarize and underline aspects that still remain unanswered that are compulsory if we want to enhance our understanding of this disease.
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Affiliation(s)
- Mathias Van Hemelrijck
- Department of Cardiovascular Surgery, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Maurizio Taramasso
- Department of Cardiovascular Surgery, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Carlotta De Carlo
- Department of Cardiovascular Surgery, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Shingo Kuwata
- Department of Cardiovascular Surgery, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Evelyn Regar
- Department of Cardiovascular Surgery, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Fabian Nietlispach
- Department of Cardiology, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Adolfo Ferrero
- Department of Cardiovascular Surgery, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Alberto Weber
- Department of Cardiovascular Surgery, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Francesco Maisano
- Department of Cardiovascular Surgery, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
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227
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Fino C, Iacovoni A, Pibarot P, Pepper JR, Ferrero P, Merlo M, Galletti L, Caputo M, Ferrazzi P, Anagnostopoulos C, Cugola D, Senni M, Bellavia D, Magne J. Exercise Hemodynamic and Functional Capacity After Mitral Valve Replacement in Patients With Ischemic Mitral Regurgitation. Circ Heart Fail 2018; 11:e004056. [DOI: 10.1161/circheartfailure.117.004056] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 11/30/2017] [Indexed: 01/06/2023]
Abstract
Background
In patients with ischemic mitral regurgitation requiring mitral valve replacement (MVR), the choice of the prosthesis type is crucial. The exercise hemodynamic and functional capacity performance in patients with contemporary prostheses have never been investigated. To compare exercise hemodynamic and functional capacity between biological (MVRb) and mechanical (MVRm) prostheses.
Methods and Results
We analyzed 86 consecutive patients with ischemic mitral regurgitation who underwent MVRb (n=41) or MVRm (n=45) and coronary artery bypass grafting. All patients underwent preoperative resting echocardiography and 6-minute walking test. At follow-up, exercise stress echocardiography was performed, and the 6-minute walking test was repeated. Resting and exercise indexed effective orifice areas of MVRm were larger when compared with MVRb (resting: 1.30±0.2 versus 1.19±0.3 cm
2
/m
2
;
P
=0.03; exercise: 1.57±0.2 versus 1.18±0.3 cm
2
/m
2
;
P
=0.0001). The MVRm had lower exercise systolic pulmonary arterial pressure at follow-up compared with MVRb (41±5 versus 59±7 mm Hg;
P
=0.0001). Six-minute walking test distance was improved in the MVRm (pre-operative: 242±43, post-operative: 290±50 m;
P
=0.001), whereas it remained similar in the MVRb (pre-operative: 250±40, post-operative: 220±44 m;
P
=0.13). In multivariable analysis, type of prosthesis, exercise indexed effective orifice area, and systolic pulmonary arterial pressure were joint predictors of change in 6-minute walking test (ie, difference between baseline and follow-up).
Conclusions
In patients with ischemic mitral regurgitation, bioprostheses are associated with worse hemodynamic performance and reduced functional capacity, when compared with MVRm. Randomized studies with longer follow-up including quality of life and survival data are required to confirm these results.
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Affiliation(s)
- Carlo Fino
- >From the Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy (C.F., A.I., P.F., M.M., L.G., P.F., D.C., M.S.); Hypertrofic Cardiomyopathy Centre, Policlinico di Monza, Monza, Italy (P.F.); Québec Heart & Lung Institute, Department of Medicine, Laval University, Quebec City, QC, Canada (P.P.); Department of Cardiothoracic Surgery, Royal Brompton and Harefield Hospital, London, United Kingdom (J.R.P.); Bristol Royal Infirmary, University of Bristol, United Kingdom (M.C.)
| | - Attilio Iacovoni
- >From the Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy (C.F., A.I., P.F., M.M., L.G., P.F., D.C., M.S.); Hypertrofic Cardiomyopathy Centre, Policlinico di Monza, Monza, Italy (P.F.); Québec Heart & Lung Institute, Department of Medicine, Laval University, Quebec City, QC, Canada (P.P.); Department of Cardiothoracic Surgery, Royal Brompton and Harefield Hospital, London, United Kingdom (J.R.P.); Bristol Royal Infirmary, University of Bristol, United Kingdom (M.C.)
| | - Philippe Pibarot
- >From the Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy (C.F., A.I., P.F., M.M., L.G., P.F., D.C., M.S.); Hypertrofic Cardiomyopathy Centre, Policlinico di Monza, Monza, Italy (P.F.); Québec Heart & Lung Institute, Department of Medicine, Laval University, Quebec City, QC, Canada (P.P.); Department of Cardiothoracic Surgery, Royal Brompton and Harefield Hospital, London, United Kingdom (J.R.P.); Bristol Royal Infirmary, University of Bristol, United Kingdom (M.C.)
| | - John R. Pepper
- >From the Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy (C.F., A.I., P.F., M.M., L.G., P.F., D.C., M.S.); Hypertrofic Cardiomyopathy Centre, Policlinico di Monza, Monza, Italy (P.F.); Québec Heart & Lung Institute, Department of Medicine, Laval University, Quebec City, QC, Canada (P.P.); Department of Cardiothoracic Surgery, Royal Brompton and Harefield Hospital, London, United Kingdom (J.R.P.); Bristol Royal Infirmary, University of Bristol, United Kingdom (M.C.)
| | - Paolo Ferrero
- >From the Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy (C.F., A.I., P.F., M.M., L.G., P.F., D.C., M.S.); Hypertrofic Cardiomyopathy Centre, Policlinico di Monza, Monza, Italy (P.F.); Québec Heart & Lung Institute, Department of Medicine, Laval University, Quebec City, QC, Canada (P.P.); Department of Cardiothoracic Surgery, Royal Brompton and Harefield Hospital, London, United Kingdom (J.R.P.); Bristol Royal Infirmary, University of Bristol, United Kingdom (M.C.)
| | - Maurizio Merlo
- >From the Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy (C.F., A.I., P.F., M.M., L.G., P.F., D.C., M.S.); Hypertrofic Cardiomyopathy Centre, Policlinico di Monza, Monza, Italy (P.F.); Québec Heart & Lung Institute, Department of Medicine, Laval University, Quebec City, QC, Canada (P.P.); Department of Cardiothoracic Surgery, Royal Brompton and Harefield Hospital, London, United Kingdom (J.R.P.); Bristol Royal Infirmary, University of Bristol, United Kingdom (M.C.)
| | - Lorenzo Galletti
- >From the Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy (C.F., A.I., P.F., M.M., L.G., P.F., D.C., M.S.); Hypertrofic Cardiomyopathy Centre, Policlinico di Monza, Monza, Italy (P.F.); Québec Heart & Lung Institute, Department of Medicine, Laval University, Quebec City, QC, Canada (P.P.); Department of Cardiothoracic Surgery, Royal Brompton and Harefield Hospital, London, United Kingdom (J.R.P.); Bristol Royal Infirmary, University of Bristol, United Kingdom (M.C.)
| | - Massimo Caputo
- >From the Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy (C.F., A.I., P.F., M.M., L.G., P.F., D.C., M.S.); Hypertrofic Cardiomyopathy Centre, Policlinico di Monza, Monza, Italy (P.F.); Québec Heart & Lung Institute, Department of Medicine, Laval University, Quebec City, QC, Canada (P.P.); Department of Cardiothoracic Surgery, Royal Brompton and Harefield Hospital, London, United Kingdom (J.R.P.); Bristol Royal Infirmary, University of Bristol, United Kingdom (M.C.)
| | - Paolo Ferrazzi
- >From the Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy (C.F., A.I., P.F., M.M., L.G., P.F., D.C., M.S.); Hypertrofic Cardiomyopathy Centre, Policlinico di Monza, Monza, Italy (P.F.); Québec Heart & Lung Institute, Department of Medicine, Laval University, Quebec City, QC, Canada (P.P.); Department of Cardiothoracic Surgery, Royal Brompton and Harefield Hospital, London, United Kingdom (J.R.P.); Bristol Royal Infirmary, University of Bristol, United Kingdom (M.C.)
| | - Constantinos Anagnostopoulos
- >From the Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy (C.F., A.I., P.F., M.M., L.G., P.F., D.C., M.S.); Hypertrofic Cardiomyopathy Centre, Policlinico di Monza, Monza, Italy (P.F.); Québec Heart & Lung Institute, Department of Medicine, Laval University, Quebec City, QC, Canada (P.P.); Department of Cardiothoracic Surgery, Royal Brompton and Harefield Hospital, London, United Kingdom (J.R.P.); Bristol Royal Infirmary, University of Bristol, United Kingdom (M.C.)
| | - Diego Cugola
- >From the Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy (C.F., A.I., P.F., M.M., L.G., P.F., D.C., M.S.); Hypertrofic Cardiomyopathy Centre, Policlinico di Monza, Monza, Italy (P.F.); Québec Heart & Lung Institute, Department of Medicine, Laval University, Quebec City, QC, Canada (P.P.); Department of Cardiothoracic Surgery, Royal Brompton and Harefield Hospital, London, United Kingdom (J.R.P.); Bristol Royal Infirmary, University of Bristol, United Kingdom (M.C.)
| | - Michele Senni
- >From the Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy (C.F., A.I., P.F., M.M., L.G., P.F., D.C., M.S.); Hypertrofic Cardiomyopathy Centre, Policlinico di Monza, Monza, Italy (P.F.); Québec Heart & Lung Institute, Department of Medicine, Laval University, Quebec City, QC, Canada (P.P.); Department of Cardiothoracic Surgery, Royal Brompton and Harefield Hospital, London, United Kingdom (J.R.P.); Bristol Royal Infirmary, University of Bristol, United Kingdom (M.C.)
| | - Diego Bellavia
- >From the Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy (C.F., A.I., P.F., M.M., L.G., P.F., D.C., M.S.); Hypertrofic Cardiomyopathy Centre, Policlinico di Monza, Monza, Italy (P.F.); Québec Heart & Lung Institute, Department of Medicine, Laval University, Quebec City, QC, Canada (P.P.); Department of Cardiothoracic Surgery, Royal Brompton and Harefield Hospital, London, United Kingdom (J.R.P.); Bristol Royal Infirmary, University of Bristol, United Kingdom (M.C.)
| | - Julien Magne
- >From the Cardiovascular Department, Ospedale Papa Giovanni XXIII, Bergamo, Italy (C.F., A.I., P.F., M.M., L.G., P.F., D.C., M.S.); Hypertrofic Cardiomyopathy Centre, Policlinico di Monza, Monza, Italy (P.F.); Québec Heart & Lung Institute, Department of Medicine, Laval University, Quebec City, QC, Canada (P.P.); Department of Cardiothoracic Surgery, Royal Brompton and Harefield Hospital, London, United Kingdom (J.R.P.); Bristol Royal Infirmary, University of Bristol, United Kingdom (M.C.)
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Hurtado-Aguilar LG, Mulderrig S, Moreira R, Hatam N, Spillner J, Schmitz-Rode T, Jockenhoevel S, Mela P. Ultrasound for In Vitro, Noninvasive Real-Time Monitoring and Evaluation of Tissue-Engineered Heart Valves. Tissue Eng Part C Methods 2017; 22:974-981. [PMID: 27673356 DOI: 10.1089/ten.tec.2016.0300] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Tissue-engineered heart valves are developed in bioreactors where biochemical and mechanical stimuli are provided for extracellular matrix formation. During this phase, the monitoring possibilities are limited by the need to maintain the sterility and integrity of the valve. Therefore, noninvasive and nondestructive techniques are required. As such, optical imaging is commonly used to verify valve's functionality in vitro. It provides important information (i.e., leaflet symmetry, geometric orifice area, and closing and opening times), which is, however, usually limited to a singular view along the central axis from the outflow side. In this study, we propose ultrasound as a monitoring method that, in contrast to established optical imaging, can assess the valve from different planes, scanning the whole three-dimensional geometry. We show the potential benefits associated with the application of ultrasound to bioreactors, in advancing heart valve tissue engineering from design to fabrication and in vitro maturation. Specifically, we demonstrate that additional information, otherwise unavailable, can be gained to evaluate the valve's functionality (e.g., coaptation length, and effective cusp height and shape). Furthermore, we show that Doppler techniques provide qualitative visualization and quantitative evaluation of the flow through the valve, in real time and throughout the whole in vitro fabrication phase.
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Affiliation(s)
- Luis G Hurtado-Aguilar
- 1 Department of Tissue Engineering and Textile Implants, AME-Helmholtz Institute for Biomedical Engineering, University Hospital RWTH Aachen , Aachen, Germany
| | - Shane Mulderrig
- 1 Department of Tissue Engineering and Textile Implants, AME-Helmholtz Institute for Biomedical Engineering, University Hospital RWTH Aachen , Aachen, Germany
| | - Ricardo Moreira
- 1 Department of Tissue Engineering and Textile Implants, AME-Helmholtz Institute for Biomedical Engineering, University Hospital RWTH Aachen , Aachen, Germany
| | - Nima Hatam
- 2 Department for Cardiothoracic and Vascular Surgery, University Hospital RWTH Aachen , Aachen, Germany
| | - Jan Spillner
- 2 Department for Cardiothoracic and Vascular Surgery, University Hospital RWTH Aachen , Aachen, Germany
| | - Thomas Schmitz-Rode
- 1 Department of Tissue Engineering and Textile Implants, AME-Helmholtz Institute for Biomedical Engineering, University Hospital RWTH Aachen , Aachen, Germany
| | - Stefan Jockenhoevel
- 1 Department of Tissue Engineering and Textile Implants, AME-Helmholtz Institute for Biomedical Engineering, University Hospital RWTH Aachen , Aachen, Germany .,3 Institute for Textile Engineering, RWTH Aachen University , Aachen, Germany
| | - Petra Mela
- 1 Department of Tissue Engineering and Textile Implants, AME-Helmholtz Institute for Biomedical Engineering, University Hospital RWTH Aachen , Aachen, Germany
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230
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McIntyre V, Butany J, Boles D, Shao T. Recurrent infective endocarditis causing heart valve failure: A case report. HUMAN PATHOLOGY: CASE REPORTS 2017. [DOI: 10.1016/j.ehpc.2016.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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231
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Huntley GD, Thaden JJ, Alsidawi S, Michelena HI, Maleszewski JJ, Edwards WD, Scott CG, Pislaru SV, Pellikka PA, Greason KL, Ammash NM, Malouf JF, Enriquez-Sarano M, Nkomo VT. Comparative study of bicuspid vs. tricuspid aortic valve stenosis. Eur Heart J Cardiovasc Imaging 2017; 19:3-8. [DOI: 10.1093/ehjci/jex211] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 08/14/2017] [Indexed: 11/12/2022] Open
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Short-Term Outcome and Hemodynamic Performance of Next-Generation Self-Expanding Versus Balloon-Expandable Transcatheter Aortic Valves in Patients With Small Aortic Annulus. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.117.005013. [DOI: 10.1161/circinterventions.117.005013] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 08/22/2017] [Indexed: 01/30/2023]
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233
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Jose J, Sulimov DS, El-Mawardy M, Sato T, Allali A, Holy EW, Becker B, Landt M, Kebernik J, Schwarz B, Richardt G, Abdel-Wahab M. Clinical Bioprosthetic Heart Valve Thrombosis After Transcatheter Aortic Valve Replacement: Incidence, Characteristics, and Treatment Outcomes. JACC Cardiovasc Interv 2017; 10:686-697. [PMID: 28385406 DOI: 10.1016/j.jcin.2017.01.045] [Citation(s) in RCA: 184] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 01/23/2017] [Accepted: 01/27/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim of this study was to determine the incidence, characteristics, and treatment outcomes of patients diagnosed with clinical transcatheter heart valve thrombosis. BACKGROUND Limited data exists on clinical or manifest transcatheter heart valve thrombosis. Prior studies have focused on subclinical thrombosis. METHODS A retrospective analysis was conducted of prospectively collected data from a single-center registry that included 642 consecutive patients who underwent transcatheter aortic valve replacement between 2007 and 2015 (305 patients had self-expanding valves; balloon-expandable, n = 281; mechanically expanding, n = 56). Long-term oral anticoagulation (OAC) was indicated in 261 patients, while 377 patients received dual-antiplatelet therapy post-procedure. All patients underwent scheduled clinical and echocardiographic follow-up. RESULTS The overall incidence of clinical valve thrombosis was 2.8% (n = 18). No patient on OAC developed thrombosis. Of the detected thrombosis cases, 13 patients had balloon-expandable, 3 had self-expanding, and 2 had mechanically expanding valves. Thrombosis occurred significantly more often with balloon-expandable valves (odds ratio: 3.45; 95% confidence interval: 1.22 to 9.81; p = 0.01) and following valve-in-valve procedures (odds ratio: 5.93; 95% confidence interval: 2.01 to 17.51; p = 0.005). Median time to diagnosis of valve thrombosis was 181 days. The median N-terminal pro-brain natriuretic peptide level was 1,318 pg/ml (interquartile range: 606 to 1,676 pg/ml). The mean transvalvular gradient and valve area were 34 ± 14 mm Hg and 1.0 ± 0.46 cm2, respectively. Computed tomography showed hypoattenuating areas with reduced leaflet motion. Initiation of OAC resulted in significant reduction of transvalvular gradient and clinical improvement. No deaths were related to valve thrombosis. CONCLUSIONS Clinical transcatheter heart valve thrombosis is more common than previously considered, characterized by imaging abnormalities and increased gradients and N-terminal pro-brain natriuretic peptide levels. It occurred more commonly after balloon-expandable transcatheter aortic valve replacement and valve-in-valve procedures. OAC appeared to be effective in the prevention and treatment of valve thrombosis. Randomized control trials are needed to define optimal antithrombotic therapy after transcatheter aortic valve replacement.
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Affiliation(s)
- John Jose
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany; Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Dmitriy S Sulimov
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany
| | - Mohamed El-Mawardy
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany
| | - Takao Sato
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany; Tachikawa General Hospital, Nagaoka, Japan
| | - Abdelhakim Allali
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany
| | - Erik W Holy
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany
| | - Björn Becker
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany
| | - Martin Landt
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany
| | - Julia Kebernik
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany
| | - Bettina Schwarz
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany
| | - Gert Richardt
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany
| | - Mohamed Abdel-Wahab
- Heart Center, Segeberger Kliniken (Academic Teaching Hospital of the Universities of Kiel, Lübeck, and Hamburg), Bad Segeberg, Germany.
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Abstract
PURPOSE OF REVIEW Our review is intended to provide readers with an overview of disease processes involving the pulmonic valve, highlighting recent outcome studies and guideline-based recommendations; with focus on the two most common interventions for treating pulmonic valve disease, balloon pulmonary valvuloplasty and pulmonic valve replacement. RECENT FINDINGS The main long-term sequelae of balloon pulmonary valvuloplasty, the gold standard treatment for pulmonic stenosis, remain pulmonic regurgitation and valvular restenosis. The balloon:annulus ratio is a major contributor to both, with high ratios resulting in greater degrees of regurgitation, and small ratios increasing risk for restenosis. Recent studies suggest that a ratio of approximately 1.2 may provide the most optimal results. Pulmonic valve replacement is currently the procedure of choice for patients with severe pulmonic regurgitation and hemodynamic sequelae or symptoms, yet it remains uncertain how it impacts long-term survival. Transcatheter pulmonic valve replacement is a rapidly evolving field and recent outcome studies suggest short and mid-term results at least equivalent to surgery. The Melody valve® was FDA approved for failing pulmonary surgical conduits in 2010 and for failing bioprosthetic surgical pulmonic valves in 2017 and has been extensively studied, whereas the Sapien XT valve®, offering larger diameters, was approved for failing pulmonary conduits in 2016 and has been less extensively studied. Patients with pulmonic valve disease deserve lifelong surveillance for complications. Transcatheter pulmonic valve replacement is a novel and attractive therapeutic option, but is currently only FDA approved for patients with failing pulmonary conduits or dysfunctional surgical bioprosthetic valves. New advances will undoubtedly increase the utilization of this rapidly expanding technology.
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A bioprosthetic total artificial heart for end-stage heart failure: Results from a pilot study. J Heart Lung Transplant 2017; 37:33-37. [PMID: 28986001 DOI: 10.1016/j.healun.2017.09.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/05/2017] [Accepted: 09/11/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The electro-hydraulically actuated Carmat total artificial heart (C-TAH) is designed to replace the heart in patients with end-stage heart failure, either as bridge to transplant or destination therapy. It provides pulsatile flow and contains bio-prosthetic blood contacting materials. A clinical feasibility study was conducted to evaluate the C-TAH safety and performance. METHODS Hospitalized patients, at imminent risk of death from irreversible biventricular failure despite optimal medical management, and not eligible for transplant or eligible but on extracorporeal life support, were enrolled. The primary endpoint was 30-days survival. RESULTS Four patients were implanted with the C-TAH, three as destination therapy (ages 76, 68, 74) and one as bridge to transplant (age 58). They had implant times of 74, 270, 254 and 20 days respectively. All patients were free from hemolysis, clinical neurologic events, clinical evidence of thrombus and device-related infections. Hemodynamic and physical recovery allowed two patients to be discharged home for a cumulative duration of 7 months. The anticoagulation management strategy comprised initial unfractionated heparin, from postoperative day 2, followed by low molecular weight heparin and aspirin. An increased D-dimer level was observed in all patients during months 1 to 4. Temporary suspension of heparin anticoagulation resulted in thrombocytopenia and increased fibrin monomer, reversed by resuming anticoagulation with heparin. Causes of death were device-related (2 cases), respiratory failure and multi-organ failure. CONCLUSIONS Preliminary clinical results with the C-TAH demonstrated good safety and performance profiles in patients suffering from biventricular failure, which need to be confirmed in a pivotal study.
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236
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An investigation on the effects of the angles between the mitral and aortic orifice during diastolic period using FSI. PATHOPHYSIOLOGY 2017; 24:133-153. [DOI: 10.1016/j.pathophys.2017.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 02/04/2017] [Accepted: 03/15/2017] [Indexed: 11/18/2022] Open
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237
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Hasan A, Kolahdouz EM, Enquobahrie A, Caranasos TG, Vavalle JP, Griffith BE. Image-based immersed boundary model of the aortic root. Med Eng Phys 2017; 47:72-84. [PMID: 28778565 PMCID: PMC5599309 DOI: 10.1016/j.medengphy.2017.05.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/04/2017] [Accepted: 05/24/2017] [Indexed: 10/19/2022]
Abstract
Each year, approximately 300,000 heart valve repair or replacement procedures are performed worldwide, including approximately 70,000 aortic valve replacement surgeries in the United States alone. Computational platforms for simulating cardiovascular devices such as prosthetic heart valves promise to improve device design and assist in treatment planning, including patient-specific device selection. This paper describes progress in constructing anatomically and physiologically realistic immersed boundary (IB) models of the dynamics of the aortic root and ascending aorta. This work builds on earlier IB models of fluid-structure interaction (FSI) in the aortic root, which previously achieved realistic hemodynamics over multiple cardiac cycles, but which also were limited to simplified aortic geometries and idealized descriptions of the biomechanics of the aortic valve cusps. By contrast, the model described herein uses an anatomical geometry reconstructed from patient-specific computed tomography angiography (CTA) data, and employs a description of the elasticity of the aortic valve leaflets based on a fiber-reinforced constitutive model fit to experimental tensile test data. The resulting model generates physiological pressures in both systole and diastole, and yields realistic cardiac output and stroke volume at physiological Reynolds numbers. Contact between the valve leaflets during diastole is handled automatically by the IB method, yielding a fully competent valve model that supports a physiological diastolic pressure load without regurgitation. Numerical tests show that the model is able to resolve the leaflet biomechanics in diastole and early systole at practical grid spacings. The model is also used to examine differences in the mechanics and fluid dynamics yielded by fresh valve leaflets and glutaraldehyde-fixed leaflets similar to those used in bioprosthetic heart valves. Although there are large differences in the leaflet deformations during diastole, the differences in the open configurations of the valve models are relatively small, and nearly identical hemodynamics are obtained in all cases considered.
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Affiliation(s)
- Ali Hasan
- Department of Mathematics, University of North Carolina, Chapel Hill, NC, USA
| | - Ebrahim M Kolahdouz
- Department of Mathematics, University of North Carolina, Chapel Hill, NC, USA
| | | | - Thomas G Caranasos
- Division of Cardiothoracic Surgery, Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - John P Vavalle
- Division of Cardiology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Boyce E Griffith
- Department of Mathematics and McAllister Heart Institute, University of North Carolina, Chapel Hill, NC, USA.
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Hellmeier F, Nordmeyer S, Yevtushenko P, Bruening J, Berger F, Kuehne T, Goubergrits L, Kelm M. Hemodynamic Evaluation of a Biological and Mechanical Aortic Valve Prosthesis Using Patient-Specific MRI-Based CFD. Artif Organs 2017; 42:49-57. [PMID: 28853220 DOI: 10.1111/aor.12955] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 02/22/2017] [Accepted: 03/28/2017] [Indexed: 12/13/2022]
Abstract
Modeling different treatment options before a procedure is performed is a promising approach for surgical decision making and patient care in heart valve disease. This study investigated the hemodynamic impact of different prostheses through patient-specific MRI-based CFD simulations. Ten time-resolved MRI data sets with and without velocity encoding were obtained to reconstruct the aorta and set hemodynamic boundary conditions for simulations. Aortic hemodynamics after virtual valve replacement with a biological and mechanical valve prosthesis were investigated. Wall shear stress (WSS), secondary flow degree (SFD), transvalvular pressure drop (TPD), turbulent kinetic energy (TKE), and normalized flow displacement (NFD) were evaluated to characterize valve-induced hemodynamics. The biological prostheses induced significantly higher WSS (medians: 9.3 vs. 8.6 Pa, P = 0.027) and SFD (means: 0.78 vs. 0.49, P = 0.002) in the ascending aorta, TPD (medians: 11.4 vs. 2.7 mm Hg, P = 0.002), TKE (means: 400 vs. 283 cm2 /s2 , P = 0.037), and NFD (means: 0.0994 vs. 0.0607, P = 0.020) than the mechanical prostheses. The differences between the prosthesis types showed great inter-patient variability, however. Given this variability, a patient-specific evaluation is warranted. In conclusion, MRI-based CFD offers an opportunity to assess the interactions between prosthesis and patient-specific boundary conditions, which may help in optimizing surgical decision making and providing additional guidance to clinicians.
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Affiliation(s)
- Florian Hellmeier
- Biofluid Mechanics Laboratory, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Institute for Computational and Imaging Science in Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sarah Nordmeyer
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Pavlo Yevtushenko
- Biofluid Mechanics Laboratory, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Bruening
- Biofluid Mechanics Laboratory, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Institute for Computational and Imaging Science in Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Berger
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Titus Kuehne
- Institute for Computational and Imaging Science in Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.,Department of Pediatric Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Leonid Goubergrits
- Biofluid Mechanics Laboratory, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Institute for Computational and Imaging Science in Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Marcus Kelm
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
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239
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Cardiac Auscultation for Noncardiologists: Application in Cardiac Rehabilitation Programs: PART II: ADULT PATIENTS AFTER HEART SURGERY. J Cardiopulm Rehabil Prev 2017; 37:397-403. [PMID: 28787352 DOI: 10.1097/hcr.0000000000000272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This clinical skills review describes the most common cardiac auscultatory findings in adults after heart surgery and correlates them with prognostic indicators. It was written for noncardiologist health care providers who work in outpatient cardiac rehabilitation programs.Mechanical prosthetic valves produce typical closing and opening clicks. Listening to their timing and features, as well as to presence and quality of murmurs, contributes to the awareness of potential prosthesis malfunction before other dramatic clinical signs or symptoms become evident. In patients with biological prostheses, murmurs should be carefully evaluated to rule out both valve malfunction and degeneration. Rubs of post-pericardiotomy pericarditis should prompt further investigation for early signs of cardiac tamponade. Third and fourth heart sounds and systolic murmurs in anemic patients should be differentiated from pathological conditions. Relatively new groups of heart surgery patients are those with chronic heart failure treated with continuous-flow left ventricle assist devices. These devices produce characteristic continuous noise that may suddenly disappear or vary in quality and intensity with device malfunction. After heart transplantation, a carefully performed and regularly repeated cardiac auscultation may contribute to suspicion of impending acute rejection. During cardiac rehabilitation, periodic cardiac auscultation may provide useful information regarding clinical-hemodynamic status and allow detection of heralding signs of possible complications in an efficient and low-cost manner.
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240
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Stassen OMJA, Muylaert DEP, Bouten CVC, Hjortnaes J. Current Challenges in Translating Tissue-Engineered Heart Valves. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:71. [PMID: 28782083 PMCID: PMC5545463 DOI: 10.1007/s11936-017-0566-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Heart valve disease is a major health burden, treated by either valve repair or valve replacement, depending on the affected valve. Nearly 300,000 valve replacements are performed worldwide per year. Valve replacement is lifesaving, but not without complications. The in situ tissue-engineered heart valve is a promising alternative to current treatments, but the translation of this novel technology to the clinic still faces several challenges. These challenges originate from the variety encountered in the patient population, the conversion of an implant into a living tissue, the highly mechanical nature of the heart valve, the complex homeostatic tissue that has to be reached at the end stage of the regenerating heart valve, and all the biomaterial properties that can be controlled to obtain this tissue. Many of these challenges are multidimensional and multiscalar, and both the macroscopic properties of the complete heart valve and the microscopic properties of the patient’s cells interacting with the materials have to be optimal. Using newly developed in vitro models, or bioreactors, where variables of interest can be controlled tightly and complex mixtures of cell populations similar to those encountered in the regenerating valve can be cultured, it is likely that the challenges can be overcome.
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Affiliation(s)
- O M J A Stassen
- Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB, Eindhoven, The Netherlands.
| | - D E P Muylaert
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C V C Bouten
- Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB, Eindhoven, The Netherlands.,Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - J Hjortnaes
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.,Regenerative Medicine Center Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
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Rodriguez-Gabella T, Voisine P, Puri R, Pibarot P, Rodés-Cabau J. Aortic Bioprosthetic Valve Durability. J Am Coll Cardiol 2017; 70:1013-1028. [DOI: 10.1016/j.jacc.2017.07.715] [Citation(s) in RCA: 200] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 06/25/2017] [Accepted: 07/06/2017] [Indexed: 11/25/2022]
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CT-Defined Prosthesis–Patient Mismatch Downgrades Frequency and Severity, and Demonstrates No Association With Adverse Outcomes After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2017; 10:1578-1587. [DOI: 10.1016/j.jcin.2017.05.031] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 05/11/2017] [Accepted: 05/16/2017] [Indexed: 12/21/2022]
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243
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Yoon SH, Whisenant BK, Bleiziffer S, Delgado V, Schofer N, Eschenbach L, Fujita B, Sharma R, Ancona M, Yzeiraj E, Cannata S, Barker C, Davies JE, Frangieh AH, Deuschl F, Podlesnikar T, Asami M, Dhoble A, Chyou A, Masson JB, Wijeysundera HC, Blackman DJ, Rampat R, Taramasso M, Gutierrez-Ibanes E, Chakravarty T, Attizzani GF, Kaneko T, Wong SC, Sievert H, Nietlispach F, Hildick-Smith D, Nombela-Franco L, Conradi L, Hengstenberg C, Reardon MJ, Kasel AM, Redwood S, Colombo A, Kar S, Maisano F, Windecker S, Pilgrim T, Ensminger SM, Prendergast BD, Schofer J, Schaefer U, Bax JJ, Latib A, Makkar RR. Transcatheter Mitral Valve Replacement for Degenerated Bioprosthetic Valves and Failed Annuloplasty Rings. J Am Coll Cardiol 2017; 70:1121-1131. [DOI: 10.1016/j.jacc.2017.07.714] [Citation(s) in RCA: 160] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/29/2017] [Accepted: 07/04/2017] [Indexed: 11/25/2022]
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Early Hemodynamic Results in Patients with Small Aortic Annulus after Aortic Valve Replacement. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 12:254-258. [DOI: 10.1097/imi.0000000000000380] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objective Patients with a small aortic annulus (≤21 mm) have an increased risk of patient-prosthesis mismatch after valve replacement. The aim of this study was to compare the early hemodynamic performance of the balloon-expandable transaortic valve implantation Edwards system (SAPIEN) and the sutureless Perceval prostheses. Methods Fifty patients underwent transcatheter aortic valve implantation, and 113 patients underwent sutureless aortic valve replacement. Mean ± SD aortic annulus diameter was 19.7 ± 1 mm, with no significant difference between groups. SAPIEN valve size was 23 mm in 40 patients (80%) and 26 mm in 10 patients (20%). Perceval valve size was small in 45 patients (40%), medium in 62 patients (55%), and large in 6 patients (5%). Transthoracic Doppler echocardiographic images were collected at baseline and before discharge. Results There were no significant difference in predischarge effective orifice area (SAPIEN: 1.5 ± 0.5 cm2 and Perceval: 1.48 ± 0.34 cm2, P = 0.58) and indexed effective orifice areas (SAPIEN: 0.93 ± 0.32 cm2/m2 and Perceval: 0.88 ± 0.22 cm2/m2, P = 0.42). Predischarge mean ± SD transaortic gradient was lower with the SAPIEN than with Perceval valves (12 ± 6 and 17 ± 6 mm Hg, respectively, P < 0.001). Rates of moderate and severe prosthesis-patient mismatch were similar (SAPIEN: 44% and 10% and Perceval: 50% and 14%, P = 0.53 and 0.75, respectively). There were no moderate-severe paravalvular leaks. Conclusions Although indexed effective orifice areas were similar, transcatheter aortic valve implantation with the balloon-expandable SAPIEN system yielded lower predischarge transaortic mean gradients than the surgically implanted Perceval, in patients with a small annulus.
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Olivier Dionne P, Poulin F, Bouchard D, Généreux P, Ibrahim R, Cartier R, Lamarche Y, Demers P. Early Hemodynamic Results in Patients with Small Aortic Annulus after Aortic Valve Replacement. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017. [DOI: 10.1177/155698451701200404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Pierre Olivier Dionne
- Department of Surgery, Montreal Heart Institute, Université de Montréal, Montreal, QC Canada
| | - Frédéric Poulin
- Department of Cardiology, Hôpital Sacré-Coeur de Montréal, Montreal, QC Canada
| | - Denis Bouchard
- Department of Surgery, Montreal Heart Institute, Université de Montréal, Montreal, QC Canada
| | - Philippe Généreux
- Department of Cardiology, Hôpital Sacré-Coeur de Montréal, Montreal, QC Canada
| | - Reda Ibrahim
- Department of Surgery, Montreal Heart Institute, Université de Montréal, Montreal, QC Canada
| | - Raymond Cartier
- Department of Surgery, Montreal Heart Institute, Université de Montréal, Montreal, QC Canada
| | - Yoan Lamarche
- Department of Surgery, Montreal Heart Institute, Université de Montréal, Montreal, QC Canada
| | - Philippe Demers
- Department of Surgery, Montreal Heart Institute, Université de Montréal, Montreal, QC Canada
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246
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Mǎrgulescu AD. Assessment of aortic valve disease - a clinician oriented review. World J Cardiol 2017; 9:481-495. [PMID: 28706584 PMCID: PMC5491466 DOI: 10.4330/wjc.v9.i6.481] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 03/11/2017] [Accepted: 05/19/2017] [Indexed: 02/06/2023] Open
Abstract
Aortic valve disease [aortic stenosis (AS) and aortic regurgitation (AR)] represents an important global health problem; when severe, aortic valve disease carries poor prognosis. For AS, aortic valve replacement, either surgical or interventional, may provide definite treatment in carefully selected patients. For AR, valve surgery (either replacement or - in selected cases - aortic valve repair) remains the gold standard of care. To properly identify those patients who are candidates for surgery, the clinician has to carefully assess the severity of valve disease with an understanding of the potential pitfalls involved in these assessments. This review focuses on the practical issues concerning the evaluation of patients with AS and AR from a general cardiologist’s perspective. The most important issues regarding the documentation of the severity of AS and AR are summarized. More specific issues, such as the role of stress echocardiography, other imaging techniques and details regarding the treatment options (medical, surgical, or interventional), are mentioned briefly.
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Högerle BA, Schneider M, Sudrow K, Souidi N, Stolk M, Werner I, Biermann A, Brockbank KG, Stock UA, Seifert M. Effects on human heart valve immunogenicity
in vitro
by high concentration cryoprotectant treatment. J Tissue Eng Regen Med 2017; 12:e1046-e1055. [DOI: 10.1002/term.2426] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 01/16/2017] [Accepted: 01/20/2017] [Indexed: 01/07/2023]
Affiliation(s)
- Benjamin A. Högerle
- Department for Thoracic and Cardiovascular SurgeryJohann Wolfgang Goethe University Frankfurt am Main Germany
| | - Maria Schneider
- Institute of Medical ImmunologyCharité Universitätsmedizin Berlin Germany
- Berlin‐Brandenburg Center for Regenerative Therapies (BCRT)Charité Universitätsmedizin Berlin Germany
| | - Katrin Sudrow
- Berlin‐Brandenburg Center for Regenerative Therapies (BCRT)Charité Universitätsmedizin Berlin Germany
| | - Naima Souidi
- Institute of Medical ImmunologyCharité Universitätsmedizin Berlin Germany
- Berlin‐Brandenburg Center for Regenerative Therapies (BCRT)Charité Universitätsmedizin Berlin Germany
| | - Meaghan Stolk
- Berlin‐Brandenburg Center for Regenerative Therapies (BCRT)Charité Universitätsmedizin Berlin Germany
| | - Isabella Werner
- Department for Thoracic and Cardiovascular SurgeryJohann Wolfgang Goethe University Frankfurt am Main Germany
| | - Anna Biermann
- Department for Thoracic and Cardiovascular SurgeryJohann Wolfgang Goethe University Frankfurt am Main Germany
| | - Kelvin G.M. Brockbank
- Tissue Testing Technologies LLC North Charleston SC USA
- Department of BioengineeringClemson University SC USA
- Department of Regenerative Medicine and Cell BiologyMedical University of South Carolina Charleston SC USA
| | - Ulrich A. Stock
- Department for Thoracic and Cardiovascular SurgeryJohann Wolfgang Goethe University Frankfurt am Main Germany
| | - Martina Seifert
- Institute of Medical ImmunologyCharité Universitätsmedizin Berlin Germany
- Berlin‐Brandenburg Center for Regenerative Therapies (BCRT)Charité Universitätsmedizin Berlin Germany
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248
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Anticoagulation Therapy for Pregnant Women With Mechanical Prosthetic Heart Valves. J Am Coll Cardiol 2017; 69:2692-2695. [DOI: 10.1016/j.jacc.2017.04.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 04/24/2017] [Indexed: 11/19/2022]
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Mao J, Wang Y, Philippe E, Cianciulli T, Vesely I, How D, Bourget JM, Germain L, Zhang Z, Guidoin R. Microstructural alterations owing to handling of bovine pericardium to manufacture bioprosthetic heart valves: A potential risk for cusp dehiscence. Morphologie 2017; 101:77-87. [PMID: 28442174 DOI: 10.1016/j.morpho.2017.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 02/06/2017] [Accepted: 03/21/2017] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Cross-linking and anti-calcification of prosthetic heart valves have been continuously improved to prevent degeneration and calcification. However, non-calcific structural deteriorations such as cuspal dehiscences along the stent still require further analysis. MATERIAL AND METHOD Based upon the previous analysis of an explanted valve after 7 years, a fresh commercial aortic valve was embedded in poly(methyl methacrylate) (PMMA) and cut into slices to ensure the detailed observation of the assembly and material structures. A pericardial patch embossed to provide the adequate shape of the cusps was investigated after paraffin embedding and appropriate staining. The microstructural damages that occurred during manufacturing process were identified and evaluated by light microscopy, polarized microscopy, scanning electron microscopy (SEM) and transmission electron microscopy (TEM). RESULTS The wavy collagen bundles, the key structure of the pericardium patch, were damaged to a great extent at suture sites along the stent and in the compressed areas around the stent post. The fixation of the embossed pericardium patch along the plots of the stent aggravated the microstructural modifications. The damages mainly appeared as the elimination of collagen bundle waviness and delamination between the bundles. CONCLUSION Considering the modes of failure of the explant, the damages to the collagen bundles may identify the vulnerable sites that play an important role in the cusp dehiscence of heart valve implants. Such information is important to the manufacturers. Recommendations to prevent in vivo cusp dehiscence can therefore be formulated.
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Affiliation(s)
- J Mao
- Department of Surgery, Faculty of Medicine, Laval University and Axe médecine régénérative, centre de recherches du CHU, Ferdinand-Vandry Building, Room 4873, 2325, rue de l'Université, Québec G1V 0A6, QC, Canada
| | - Y Wang
- Department of Surgery, Faculty of Medicine, Laval University and Axe médecine régénérative, centre de recherches du CHU, Ferdinand-Vandry Building, Room 4873, 2325, rue de l'Université, Québec G1V 0A6, QC, Canada
| | - E Philippe
- Department of Surgery, Faculty of Medicine, Laval University and Axe médecine régénérative, centre de recherches du CHU, Ferdinand-Vandry Building, Room 4873, 2325, rue de l'Université, Québec G1V 0A6, QC, Canada
| | - T Cianciulli
- Department of Cardiology, Hospital of the Government of the City of Buenos Aires "Prof. Cosme Argerich", Pi y Margall 780, C1155AHB Ciudad Autónoma de Buenos Aires, Argentina
| | - I Vesely
- Cardiology, School of Medicine, University of Colorado Denver, Denver (CO) 80045, USA
| | - D How
- Peninsula School of Medicine and Dentistry, Plymouth University, PL4 8AA, Plymouth, UK
| | - J-M Bourget
- Department of Surgery, Faculty of Medicine, Laval University and Axe médecine régénérative, centre de recherches du CHU, Ferdinand-Vandry Building, Room 4873, 2325, rue de l'Université, Québec G1V 0A6, QC, Canada
| | - L Germain
- Department of Surgery, Faculty of Medicine, Laval University and Axe médecine régénérative, centre de recherches du CHU, Ferdinand-Vandry Building, Room 4873, 2325, rue de l'Université, Québec G1V 0A6, QC, Canada
| | - Z Zhang
- Department of Surgery, Faculty of Medicine, Laval University and Axe médecine régénérative, centre de recherches du CHU, Ferdinand-Vandry Building, Room 4873, 2325, rue de l'Université, Québec G1V 0A6, QC, Canada
| | - R Guidoin
- Department of Surgery, Faculty of Medicine, Laval University and Axe médecine régénérative, centre de recherches du CHU, Ferdinand-Vandry Building, Room 4873, 2325, rue de l'Université, Québec G1V 0A6, QC, Canada.
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Guo L, Zheng J, Chen L, Li R, Ma L, Ni Y, Zhao H. Impact of prosthesis-patient mismatch on short-term outcomes after aortic valve replacement: a retrospective analysis in East China. J Cardiothorac Surg 2017; 12:42. [PMID: 28545592 PMCID: PMC5445281 DOI: 10.1186/s13019-017-0596-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 05/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prosthesis-patient mismatch (PPM) may affect the clinical outcomes of patients undergoing aortic valve replacement (AVR). We aimed to determine the incidence of PPM, its effect on short-term mortality, and the factors contributing to PPM in China. METHODS We retrospectively examined all consecutive patients with isolated or concomitant AVR at our hospital between January 1, 2013 and December 31, 2015. PPM was defined as an effective orifice area index (EOAi) of ≤ 0.85 cm2/m2. The baseline, echocardiographic, operative, and outcome data of all patients were collected from the national database. RESULTS A total of 869 patients were included in the study. PPM was detected in 15.9% (138/869) of the patients. Four patients (0.5%) met the criteria for severe PPM. Patients with PPM were older and had a higher prevalence of diabetes, coronary heart disease, aortic stenosis (AS), and preoperative left ventricular dysfunction but a lower incidence of smoking history and aortic regurgitation. Logistic regression analysis showed that female gender (P < 0.001), AS (P = 0.014), higher body mass index (BMI) (P < 0.001), and bioprosthesis (P < 0.001) were independent predictors of PPM. We also found that PPM (P = 0.005) was associated with 30-day all-cause mortality, along with smoking history (P = 0.001) and low preoperative left ventricular ejection fraction (LVEF) (P = 0.004). CONCLUSIONS PPM is associated with high short-term mortality after AVR in China. Female gender, aortic stenosis, bioprosthesis, and high BMI are risk factors for the incidence of PPM.
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Affiliation(s)
- Lei Guo
- Department of Thoracic and Cardiovascular Surgery, First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Junnan Zheng
- Department of Thoracic and Cardiovascular Surgery, First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Liangwei Chen
- Department of Thoracic and Cardiovascular Surgery, First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Renyuan Li
- Department of Thoracic and Cardiovascular Surgery, First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Liang Ma
- Department of Thoracic and Cardiovascular Surgery, First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Yiming Ni
- Department of Thoracic and Cardiovascular Surgery, First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Haige Zhao
- Department of Thoracic and Cardiovascular Surgery, First Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China. .,Department of Cardiothoracic Surgery, the First Affiliated Hospital, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, China.
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