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Szlapka M, Hausmann H, Timm J, Bauer A, Metz D, Pohling D, Fritzsche D, Gyoten T, Kuntze T, Dörge H, Feyrer R, Brambate A, Sodian R, Buchholz S, Sack FU, Höhn M, Fischlein T, Eichinger W, Franke U, Nagib R. Transcatheter mitral valve implantation versus conventional redo surgery for degenerated mitral valve prostheses and rings in a multicenter registry. J Thorac Cardiovasc Surg 2024; 167:957-964. [PMID: 36088142 DOI: 10.1016/j.jtcvs.2022.07.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/23/2022] [Accepted: 07/07/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Degeneration of mitral prostheses/rings may be treated by redo surgery, and, recently, by transcatheter valve-in-valve/ring implantation. This multicenter registry presents results of transcatheter valve-in-valve and repeat surgery for prostheses/rings degeneration. METHODS Data provided by 10 German heart centers underwent propensity score-matched retrospective analysis. The primary endpoint was 30-day/midterm mortality. Perioperative outcome was assessed according to the Mitral Valve Academic Research Consortium criteria. Further, the influence of moderate or greater tricuspid regurgitation (TR) on 30-day/midterm mortality was analyzed. RESULTS Between 2014 and 2019, 273 patients (79 transcatheter mitral valve-in-valve [TM-ViV] and 194 redo mitral valve replacement [Re-MVR]) underwent repeat procedure for mitral prosthesis/ring degeneration. Propensity score matching distinguished 79 patient pairs. European System for Cardiac Operative Risk Evaluation (EuroSCORE) II-predicted risk was 15.7 ± 13.7% in the TM-ViV group and 15.0% ± 12.7% in the Re-MVR group (P = .5336). TM-ViV patients were older (74.73 vs 72.2 years; P = .0030) and had higher incidence of atrial fibrillation (54 vs 40 patients; P = .0233). Severe TR incidence was similar (17.95% in TM-ViV vs 14.10%; P = .1741). Sixty-eight TM-ViV patients previously underwent mitral valve replacement, whereas 41 Re-MVR patients underwent valve repair (P < .0001). Stenosis was the leading degeneration mechanism in 42 TM-ViV versus 22 Re-MVR patients (P < .0005). The 30-day/midterm mortality did not differ between groups. Moderate or greater TR was a predictor of total (odds ratio [OR], 4.36; P = .0011), 30-day (OR, 3.76; P = .0180), and midterm mortality (OR, 4.30; P = .0378), irrespective of group. CONCLUSIONS In both groups, observed mortality was less than predicted. Redo surgery enabled treatment of concomitant conditions, such as atrial fibrillation or TR. TR was shown to be a predictor of total, 30-day, and midterm mortality in both groups.
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Affiliation(s)
- Michal Szlapka
- Clinic for Cardiac Surgery, Asklepios Klinikum Harburg, Hamburg, Germany.
| | - Harald Hausmann
- Clinic for Cardiovascular Surgery, MediClin Heart Center Coswig, Coswig (Anhalt), Germany
| | - Jürgen Timm
- Competence Center for Clinical Trials Bremen, Bremen, Germany
| | - Adrian Bauer
- Clinic for Cardiovascular Surgery, MediClin Heart Center Coswig, Coswig (Anhalt), Germany
| | - Dietrich Metz
- Clinic for Cardiovascular Surgery, MediClin Heart Center Coswig, Coswig (Anhalt), Germany
| | - Daniel Pohling
- Clinic for Cardiovascular Surgery, MediClin Heart Center Coswig, Coswig (Anhalt), Germany
| | - Dirk Fritzsche
- Clinic for Cardiac Surgery, Sana Heart Center Cottbus, Cottbus, Germany
| | - Takayuki Gyoten
- Clinic for Cardiac Surgery, Sana Heart Center Cottbus, Cottbus, Germany
| | - Thomas Kuntze
- Clinic for Cardiac Surgery, Central Clinic Bad Berka, Bad Berka, Germany
| | - Hilmar Dörge
- Clinic for Cardiac and Thoracic Surgery, Clinic Fulda, Fulda, Germany
| | - Richard Feyrer
- Clinic for Cardiovascular Surgery, Central Military Hospital, Koblenz, Germany
| | - Agrita Brambate
- Clinic for Cardiovascular Surgery, Central Military Hospital, Koblenz, Germany
| | - Ralf Sodian
- Clinic for Cardiac Surgery, MediClin Heart Center Lahr, Lahr/Schwarzwald, Germany
| | - Stefan Buchholz
- Clinic for Cardiac Surgery, MediClin Heart Center Lahr, Lahr/Schwarzwald, Germany
| | - Falk Udo Sack
- Clinic for Cardiac Surgery, Heart Center Ludwigshafen
| | - Martina Höhn
- Clinic for Cardiac Surgery, Heart Center Ludwigshafen
| | - Theodor Fischlein
- Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Walter Eichinger
- Clinic for Cardiac Surgery, München Klinik Bogenhausen, München, Germany
| | - Ulrich Franke
- Clinic for Cardiovascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
| | - Ragi Nagib
- Clinic for Cardiovascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
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Rezvova MA, Klyshnikov KY, Gritskevich AA, Ovcharenko EA. Polymeric Heart Valves Will Displace Mechanical and Tissue Heart Valves: A New Era for the Medical Devices. Int J Mol Sci 2023; 24:ijms24043963. [PMID: 36835389 PMCID: PMC9967268 DOI: 10.3390/ijms24043963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023] Open
Abstract
The development of a novel artificial heart valve with outstanding durability and safety has remained a challenge since the first mechanical heart valve entered the market 65 years ago. Recent progress in high-molecular compounds opened new horizons in overcoming major drawbacks of mechanical and tissue heart valves (dysfunction and failure, tissue degradation, calcification, high immunogenic potential, and high risk of thrombosis), providing new insights into the development of an ideal artificial heart valve. Polymeric heart valves can best mimic the tissue-level mechanical behavior of the native valves. This review summarizes the evolution of polymeric heart valves and the state-of-the-art approaches to their development, fabrication, and manufacturing. The review discusses the biocompatibility and durability testing of previously investigated polymeric materials and presents the most recent developments, including the first human clinical trials of LifePolymer. New promising functional polymers, nanocomposite biomaterials, and valve designs are discussed in terms of their potential application in the development of an ideal polymeric heart valve. The superiority and inferiority of nanocomposite and hybrid materials to non-modified polymers are reported. The review proposes several concepts potentially suitable to address the above-mentioned challenges arising in the R&D of polymeric heart valves from the properties, structure, and surface of polymeric materials. Additive manufacturing, nanotechnology, anisotropy control, machine learning, and advanced modeling tools have given the green light to set new directions for polymeric heart valves.
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Affiliation(s)
- Maria A. Rezvova
- Research Institute for Complex Issues of Cardiovascular Diseases, 650002 Kemerovo, Russia
| | - Kirill Y. Klyshnikov
- Research Institute for Complex Issues of Cardiovascular Diseases, 650002 Kemerovo, Russia
| | | | - Evgeny A. Ovcharenko
- Research Institute for Complex Issues of Cardiovascular Diseases, 650002 Kemerovo, Russia
- Correspondence:
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Yi K, Gao J, Wang WX, Ma YH, Wang W, He SE, Xu XM, Li PF, You T. Gender-related differences on outcome following transcatheter mitral valve repair (TMVR): a systematic review and meta-analysis. J Cardiothorac Surg 2023; 18:31. [PMID: 36650548 PMCID: PMC9843892 DOI: 10.1186/s13019-023-02123-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 01/02/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The effect of gender on patients with mitral valve regurgitation (MR) undergoing transcatheter mitral valve repair (TMVR) remains to be defined. The aim of the present study is a comprehensive meta-analysis of studies that investigate differences between men and women after TMVR. METHODS A systematic literature search was carried out on eight databases to collect all relevant studies on gender-related outcomes of TMVR before March 1, 2021. The main outcomes of interest were mortality, cardiac function, MR class and other complications. RESULTS A total of eight literatures were included, all of which were retrospective observational studies. Compared to women patients, men had lower postoperative New York Heart Association (NYHA) class (OR = 1.53, 95%CI [1.23, 1.91], P = 0.0001) and higher incidence of postoperative acute kidney injury (AKI) (OR = 1.25, 95%CI [1.16, 1.34], P < 0.05). There were no significant difference on mortality in 30 days (OR = 0.95, 95%CI [0.81, 1.11], P = 0.53) and in 2 years (OR = 0.99, 95%CI [0.75, 1.30], P = 0.93), mitral valve regurgitation (MR) class (OR = 1.30, 95%CI [0.97, 1.75], P = 0.08) and incidence of myocardial infarction (MI) (OR = 0.88, 95%CI [0.65, 1.18], P = 0.38), stroke (OR = 0.80, 95%CI [0.63, 1.02], P = 0.08) and bleeding in hospital (OR = 0.84, 95%CI [0.59, 1.19], P = 0.32). CONCLUSIONS Our meta-analysis demonstrates that men undergoing TMVR have worse preoperative diseases (diabetes mellitus, coronary artery disease, renal failure and myocardial infarction) while they have superior postoperative NYHA class at one-year. There are no significantly difference in other indexes between men and women.
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Affiliation(s)
- Kang Yi
- grid.417234.70000 0004 1808 3203Department of Cardiovascular Surgery, Gansu Province, Gansu Provincial Hospital, No. 204, Donggang West Road, Lanzhou, 730000 China ,Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China
| | - Jie Gao
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China ,grid.412643.60000 0004 1757 2902The First Clinical Medical College of Lanzhou University, Lanzhou, China ,grid.412595.eDepartment of Pediatrics, First Affiliated Hospital of SunYat-sen University, Guangzhou, China
| | - Wen-Xin Wang
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China ,grid.418117.a0000 0004 1797 6990The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, China
| | - Yu-Hu Ma
- grid.412901.f0000 0004 1770 1022Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
| | - Wei Wang
- grid.412636.40000 0004 1757 9485Department of Cardiac Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Shao E. He
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China ,grid.411294.b0000 0004 1798 9345The Second Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Xiao-Min Xu
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China ,grid.412643.60000 0004 1757 2902The First Clinical Medical College of Lanzhou University, Lanzhou, China ,grid.511083.e0000 0004 7671 2506Division of Gastroenterology, Seventh Affiliated Hospital of Sun Yat-Sen University, Shenzhen, China
| | - Peng-Fei Li
- Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China ,grid.412643.60000 0004 1757 2902The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Tao You
- grid.417234.70000 0004 1808 3203Department of Cardiovascular Surgery, Gansu Province, Gansu Provincial Hospital, No. 204, Donggang West Road, Lanzhou, 730000 China ,Gansu International Scientific and Technological Cooperation Base of Diagnosis and Treatment of Congenital Heart Disease, Lanzhou, China
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Goode D, Dhaliwal R, Mohammadi H. Valve interstitial cells under impact load, a mechanobiology study. J Med Eng Technol 2023; 47:54-66. [PMID: 35856893 DOI: 10.1080/03091902.2022.2097328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Understanding the relationship between mechanobiology and the biosynthetic activities of the valve interstitial cells (VICs) in health and disease under severe dynamic loading conditions is of particular interest. The purpose of this study is to further understand the mechanobiology of heart valve leaflet tissue and the VICs under impact forces. Two novel computational and experimental platforms were developed to study the effect of impact load on the VICs to monitor for apoptosis. The first objective was to design and develop an apparatus to experimentally study viability (apoptosis) of the porcine heart valve leaflet tissue VICs in the aortic position under controlled impact forces. Apoptosis was assessed based on terminal transferase dUTP nick end-labelling (TUNEL) assay. The second objective was to develop a computational platform to estimate the stress and strain fields in the vicinity of VICs when the tissue experiences impact forces. A nonlinear finite element (FE) model with an anisotropic, hyperelastic and heterogeneous material model for the matrix and cells was developed. Preliminary results confirm that interstitial cells are successfully resistant to impact loads up to 30 times more than normal physiological conditions. Additionally, the structure and composition of heart valve leaflet tissue provides a mechanical shield for VICs protecting them from excessive mechanical forces such as impact loads. Although, the entire tissue may experience excessive stresses, which may lead to structural damage, the stresses around and near VICs remain consistency low. Results of this study may be used for heart valve leaflet tissue-engineering, as well as further understanding the mechanobiology of the VICs in health and disease.
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Affiliation(s)
- Dylan Goode
- Heart Valve Performance Laboratory, School of Engineering, University of British Columbia, Kelowna, Canada
| | - Ruby Dhaliwal
- Heart Valve Performance Laboratory, School of Engineering, University of British Columbia, Kelowna, Canada
| | - Hadi Mohammadi
- Heart Valve Performance Laboratory, School of Engineering, University of British Columbia, Kelowna, Canada
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5
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Samanidis G, Kanakis M, Perreas K. Outcomes after Transcatheter Mitral Valve Implantation: A Literature Review. J Pers Med 2022; 12:jpm12122074. [PMID: 36556294 PMCID: PMC9783604 DOI: 10.3390/jpm12122074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Mitral valve disease is the most common heart valve disease worldwide. Surgical mitral valve replacement or repair has been an established therapy in patients with severe mitral valve disease for many years. On the other hand, many patients with advanced mitral valve disease and severe comorbidities are treated conservatively and are excluded from the surgical procedure. Furthermore, in patients with severe comorbidities, transcatheter mitral valve repair by edge-to-edge technique with MitraClip or transcatheter mitral valve repair with a non-absorbable ring have been added as therapeutic options over the last few years. Alternative procedures for the treatment of patients with advanced prosthetic or native mitral valve diseases include transcatheter access for replacement or implantation of a new prosthetic valve in the diseased mitral valve. Promising results were published about short-term outcomes of patients who underwent the transcatheter mitral valve replacement. The current view and results of the transcatheter mitral valve implantation in patients with advanced native or prosthetic mitral valve disease are briefly discussed.
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Affiliation(s)
- George Samanidis
- Department of Adult Cardiac Surgery, Onassis Cardiac Surgery Center, 356 Leoforos Syggrou, 17674 Athens, Greece
- Correspondence: ; Tel.: +30-0032109493832
| | - Meletios Kanakis
- Department of Pediatric and Congenital Heart Surgery, Onassis Cardiac Surgery Center, 356 Leoforos Syggrou, 17674 Athens, Greece
| | - Konstantinos Perreas
- Department of Adult Cardiac Surgery, Onassis Cardiac Surgery Center, 356 Leoforos Syggrou, 17674 Athens, Greece
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6
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Brunel L, Williams ZA, Yastrebov K, Robinson BM, Wise IK, Paterson HS, Bannon PG. Splitting the anterior mitral leaflet impairs left ventricular function in an ovine model. EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY : OFFICIAL JOURNAL OF THE EUROPEAN ASSOCIATION FOR CARDIO-THORACIC SURGERY 2022; 63:6849520. [PMID: 36440952 DOI: 10.1093/ejcts/ezac539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 11/01/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES During mitral valve replacement, the anterior mitral leaflet is usually resected or modified. Anterior leaflet splitting seems the least disruptive modification. Reattachment of the modified leaflet to the annulus reduces the annulopapillary distance. The goal of this study was to quantify the acute effects on left ventricular function of splitting the anterior mitral leaflet and shortening the annulopapillary distance. METHODS In 6 adult sheep, a wire was placed around the anterior leaflet and exteriorized through the left ventricular wall to enable splitting the leaflet in the beating heart. Releasable snares to reduce annulopapillary distance were likewise positioned and exteriorized. A mechanical mitral prosthesis was inserted to prevent mitral incompetence during external manipulations of the native valve. Instantaneous changes in left ventricular function were recorded before and after shortening the annulopapillary distance, then before and after splitting the anterior leaflet. RESULTS After splitting the anterior leaflet, preload recruitable stroke work, stroke work, stroke volume, cardiac output, left ventricular end systolic pressure and mean pressure were significantly decreased by 26%, 23%, 12%, 9%, 15% and 11%, respectively. Shortening the annulopapillary distance was associated with significant decreases in the end systolic pressure volume relationship, preload recruitable stroke work, stroke work and left ventricular end systolic pressure by 67%, 33%, 15% and 13%, respectively. Shortening the annulopapillary distance after splitting the leaflet had no significant effect. CONCLUSIONS Splitting the anterior mitral leaflet acutely impaired left ventricular contractility and haemodynamics in an ovine model. Shortening the annulopapillary distance after leaflet splitting did not further impair left ventricular function.
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Affiliation(s)
| | - Zoe A Williams
- DVC Research Portfolio, The University of Sydney, NSW, Australia
| | - Konstantin Yastrebov
- Prince of Wales Medical School, Faculty of Medicine and Health, The University of New South Wales, NSW, Australia
| | - Benjamin M Robinson
- Institute of Academic Surgery and Baird Institute for Applied Heart and Lung Surgery, Camperdown, NSW, Australia
| | - Innes K Wise
- Department of Laboratory Animal Services, The University of Sydney, NSW, Australia
| | - Hugh S Paterson
- Central Clinical School-Surgery, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Paul G Bannon
- Institute of Academic Surgery and Baird Institute for Applied Heart and Lung Surgery, Camperdown, NSW, Australia.,Central Clinical School-Surgery, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
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7
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Bartorelli AL, Monizzi G, Mastrangelo A, Grancini L, Fabbiocchi F, Conte E, Moltrasio M, Andreini D. Transcatheter mitral valve replacement: there is still work to be done. Eur Heart J Suppl 2022; 24:I16-I21. [DOI: 10.1093/eurheartjsupp/suac098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Transcatheter mitral valve replacement (TMVR) is a novel therapeutic option for patients with severe mitral regurgitation (MR) at high or prohibitive surgical risk. Most TMVR technologies under investigation use either a trans-apical or a trans-septal approach via dedicated multistep anchoring systems. Transcatheter mitral valve replacement offers several potential advantages over transcatheter repair, notably a greater and more sustained MR reduction. At the same time, significant engineering challenges and potential disadvantages must be acknowledged. Preclinical and clinical studies have shown promising results, demonstrating TMVR feasibility. Nevertheless, further development, testing, and trials are needed before considering TMVR as a definitive therapeutic option for MR in a wide range of anatomical scenarios.
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Affiliation(s)
- Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS
- Department of Biomedical and Clinical Sciences, University of Milan
| | | | | | | | | | - Edoardo Conte
- Centro Cardiologico Monzino, IRCCS
- Department of Biomedical Sciences for Health, University of Milan , Milan
| | | | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS
- Department of Biomedical and Clinical Sciences, University of Milan
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Gill J, Zahra F, Retzer E. In-Hospital Outcomes and Predictors of Mortality for Redo Surgical Mitral Valve Replacement Versus Transcatheter Mitral Valve-in-Valve Replacement. Am J Cardiol 2022; 176:89-95. [PMID: 35644696 DOI: 10.1016/j.amjcard.2022.04.023] [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] [Received: 02/15/2022] [Revised: 04/09/2022] [Accepted: 04/14/2022] [Indexed: 11/01/2022]
Abstract
Durability is a major limitation with bioprosthetic heart valves. For mitral valve prosthesis dysfunction, redo surgical mitral valve replacement (rSMVR) has been the mainstay of treatment; however, transcatheter mitral valve-in-valve replacement (mViV) has emerged as a viable alternative. Data comparing these procedures remains limited; therefore, we sought to compare the real-world in-hospital mortality, likelihood of adverse peri-operative outcomes, and predictors of mortality between rSMVR versus mViV using the National Inpatient Sample. During the study period, a weighted total of 1,890 patients (78%) underwent rSMVR, and 520 (22%) underwent mViV. After propensity matching, there were 310 patients in each cohort. There was no statistically significant difference in mortality with these procedures (odds ratio 1.53; 95% confidence interval 0.67 to 3.45; p = 0.31). rSMVR was associated with increased length of hospitalization (13 vs 7.5 days; p <0.001), increased medical costs ($324,124 vs $241,147; p <0.001), and increased peri-operative complications compared with mViV. Predictors of mortality unique to rSMVR were age >75 years, cirrhosis, sleep apnea, malnourishment/low body mass index, and obesity, signalizing greater suitability for mViV in these populations.
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9
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Musuku SR, Shah QN, Quranta N, Grinn M, Shapeton AD. Atrial Embolization after a Transcatheter Mitral Valve Replacement. J Cardiothorac Vasc Anesth 2022; 36:3414-3417. [PMID: 35461774 DOI: 10.1053/j.jvca.2022.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 03/21/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Sridhar R Musuku
- The Department of Anesthesiology and Perioperative Medicine, Albany Medical Center, Albany, NY.
| | | | - Nicholas Quranta
- The Department of Anesthesiology and Perioperative Medicine, Albany Medical Center, Albany, NY
| | - Michael Grinn
- The Department of Anesthesiology and Perioperative Medicine, Albany Medical Center, Albany, NY
| | - Alexander D Shapeton
- Department of Anesthesia, Critical Care and Pain Medicine, Veterans Affairs Boston Healthcare System, and Tufts University School of Medicine, Boston, MA
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Asymptomatic Stroke in the Setting of Percutaneous Non-Coronary Intervention Procedures. Medicina (B Aires) 2021; 58:medicina58010045. [PMID: 35056353 PMCID: PMC8778528 DOI: 10.3390/medicina58010045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 11/16/2022] Open
Abstract
Advancements in clinical management, pharmacological therapy and interventional procedures have strongly improved the survival rate for cardiovascular diseases (CVDs). Nevertheless, the patients affected by CVDs are more often elderly and present several comorbidities such as atrial fibrillation, valvular heart disease, heart failure, and chronic coronary syndrome. Standard treatments are frequently not available for “frail patients”, in particular due to high surgical risk or drug interaction. In the past decades, novel less-invasive procedures such as transcatheter aortic valve implantation (TAVI), MitraClip or left atrial appendage occlusion have been proposed to treat CVD patients who are not candidates for standard procedures. These procedures have been confirmed to be effective and safe compared to conventional surgery, and symptomatic thromboembolic stroke represents a rare complication. However, while the peri-procedural risk of symptomatic stroke is low, several studies highlight the presence of a high number of silent ischemic brain lesions occurring mainly in areas with a low clinical impact. The silent brain damage could cause neuropsychological deficits or worse, a preexisting dementia, suggesting the need to systematically evaluate the impact of these procedures on neurological function.
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Rogers JH, Sorajja P, Thourani VH, Sharma RP, Chehab B, Cowger J, Heimansohn D, Badhwar V, Guerrero M, Ailawadi G. Randomized Trials Are Needed for Transcatheter Mitral Valve Replacement. JACC Cardiovasc Interv 2021; 14:2039-2046. [PMID: 34556279 DOI: 10.1016/j.jcin.2021.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/08/2021] [Indexed: 10/20/2022]
Abstract
Transcatheter mitral valve replacement (TMVR) is a new therapy for treating symptomatic mitral regurgitation (MR) and stenosis. The proposed benefit of TMVR is the predictable, complete elimination of MR, which is less certain with transcatheter repair technologies such as TEER (transcatheter edge-to-edge repair). The potential benefit of MR elimination with TMVR needs to be rigorously evaluated against its risks which include relative procedural invasiveness, need for anticoagulation, and chronic structural valve deterioration. Randomized controlled trials (RCTs) are a powerful method for evaluating the safety and effectiveness of TMVR against current standard of care transcatheter therapies, such as TEER. RCTs not only help with the assessment of benefits and risks, but also with policies for determining operator or institutional requirements, resource utilization, and reimbursement. In this paper, the authors provide recommendations and considerations for designing pivotal RCTs for first-in-class TMVR devices.
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Affiliation(s)
- Jason H Rogers
- University of California-Davis, Medical Center, Davis, California, USA.
| | - Paul Sorajja
- Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Vinod H Thourani
- Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | | | | | | | | | - Vinay Badhwar
- West Virginia University, Morgantown, West Virginia, USA
| | | | - Gorav Ailawadi
- University of Michigan Medical Center, Ann Arbor, Michigan, USA
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Yousef S, Arnaoutakis GJ, Gada H, Smith AJC, Sanon S, Sultan I. Transcatheter mitral valve therapies: State of the art. J Card Surg 2021; 37:225-233. [PMID: 34532900 DOI: 10.1111/jocs.15995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 09/04/2021] [Indexed: 12/11/2022]
Abstract
Mitral regurgitation (MR) is one of the most prevalent valvular pathologies in the developed world. There continues to be a growing population of aging patients with MR who may be too high risk for surgical management. The rapid adoption and remarkable success of transcatheter aortic valve replacement (TAVR) generated enthusiasm for transcatheter mitral valve therapies; however, the complex anatomy and pathophysiology of the mitral valve confers several unique challenges for a fully percutaneous approach. Nevertheless, several devices are under development and in various phases of preclinical or clinical testing, both for transcatheter mitral valve replacement and repair. MitraClip (Abbott Vascular), which has received FDA approval, is the most established percutaneous repair strategy and has been performed in over 80,000 patients as of 2019. The following article serves as a review of the available and upcoming devices for the various etiologies of mitral valvular disease, as well as the unique challenges and potential complications of transcatheter mitral valve intervention.
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Affiliation(s)
- Sarah Yousef
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - George J Arnaoutakis
- Division of Cardiovascular Surgery, University of Florida, Gainesville, Florida, USA
| | - Hemal Gada
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Anson Jay Conrad Smith
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Saurabh Sanon
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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13
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Fudim M, Abraham WT, von Bardeleben RS, Lindenfeld J, Ponikowski PP, Salah HM, Khan MS, Sievert H, Stone GW, Anker SD, Butler J. Device Therapy in Chronic Heart Failure: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 78:931-956. [PMID: 34446165 PMCID: PMC9941752 DOI: 10.1016/j.jacc.2021.06.040] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 06/21/2021] [Indexed: 12/12/2022]
Abstract
The regulatory landscape for device-based heart failure (HF) therapies has seen a major shift in the last 7 years. In 2013, the U.S. Food and Drug Administration released guidance for early feasibility and first-in-human studies, thereby encouraging device innovation, and in 2016 the U.S. Congress authorized the Breakthrough Devices Program to expedite access for Americans to innovative devices indicated for diagnosis and treatment of serious illnesses, such as HF. Since December 2016, there has been an increase in the number of HF devices for which manufacturers are seeking approval through the breakthrough designation pathway. This has led to a rapid uptake in the development and evaluation of device-based HF therapies. This article reviews the current and future landscape of device therapies for chronic HF and associated comorbidities and the regulatory environment that is driving current and future innovation.
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Affiliation(s)
- Marat Fudim
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA.
| | - William T. Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | - Ralph Stephan von Bardeleben
- Medizinische Klinik - Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsmedizin Mainz, Mainz, Germany
| | - JoAnn Lindenfeld
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Piotr P. Ponikowski
- Centre for Heart Diseases, University Hospital, Wroclaw, Poland,Department of Heart Diseases, Medical University, Wroclaw, Poland
| | - Husam M. Salah
- Department of Medicine, University of Arkansas for Medical Sciences, AR, USA
| | - Muhammad Shahzeb Khan
- Department of Medicine, University of Mississippi School of Medicine, Jackson, MS, USA
| | - Horst Sievert
- CardioVascular Center Frankfurt, Frankfurt, Germany,Anglia Ruskin University, Chelmsford, United Kingdom
| | - Gregg W. Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, and the Cardiovascular Research Foundation, New York, NY, USA
| | - Stefan D. Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin, Germany
| | - Javed Butler
- Department of Medicine, University of Mississippi School of Medicine, Jackson, Mississippi, USA.
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14
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Bui HT, Khair N, Yeats B, Gooden S, James SP, Dasi LP. Transcatheter Heart Valves: A Biomaterials Perspective. Adv Healthc Mater 2021; 10:e2100115. [PMID: 34038627 DOI: 10.1002/adhm.202100115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/23/2021] [Indexed: 11/11/2022]
Abstract
Heart valve disease is prevalent throughout the world, and the number of heart valve replacements is expected to increase rapidly in the coming years. Transcatheter heart valve replacement (THVR) provides a safe and minimally invasive means for heart valve replacement in high-risk patients. The latest clinical data demonstrates that THVR is a practical solution for low-risk patients. Despite these promising results, there is no long-term (>20 years) durability data on transcatheter heart valves (THVs), raising concerns about material degeneration and long-term performance. This review presents a detailed account of the materials development for THVRs. It provides a brief overview of THVR, the native valve properties, the criteria for an ideal THV, and how these devices are tested. A comprehensive review of materials and their applications in THVR, including how these materials are fabricated, prepared, and assembled into THVs is presented, followed by a discussion of current and future THVR biomaterial trends. The field of THVR is proliferating, and this review serves as a guide for understanding the development of THVs from a materials science and engineering perspective.
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Affiliation(s)
- Hieu T. Bui
- Department of Biomedical Engineering Georgia Institute of Technology 387 Technology Cir NW Atlanta GA 30313 USA
| | - Nipa Khair
- School of Advanced Materials Discovery Colorado State University 700 Meridian Ave Fort Collins CO 80523 USA
| | - Breandan Yeats
- Department of Biomedical Engineering Georgia Institute of Technology 387 Technology Cir NW Atlanta GA 30313 USA
| | - Shelley Gooden
- Department of Biomedical Engineering Georgia Institute of Technology 387 Technology Cir NW Atlanta GA 30313 USA
| | - Susan P. James
- School of Advanced Materials Discovery Colorado State University 700 Meridian Ave Fort Collins CO 80523 USA
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering Georgia Institute of Technology 387 Technology Cir NW Atlanta GA 30313 USA
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15
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Abstract
PURPOSE OF REVIEW Transcatheter mitral valve replacement (TMVR) has been developed to address the need for an alternative therapeutic option to surgery in patients suffering from severe mitral regurgitation who are at high surgical risk. The present review illustrated the state-of-the-art of catheter-based mitral valve replacement evaluating technical characteristics and early clinical experience of different devices to outline prospects and challenges of TMVR. RECENT FINDINGS Several devices are currently under clinical assessment. Early experience has demonstrated high procedural success of TMVR. However, TMVR faces several possible hurdles such as left ventricular outflow tract obstruction (LVOTO) after prosthesis deployment, access site complications, and thrombotic risk requiring anticoagulatory therapy. Future studies should assess long-term prosthesis stability, optimal anticoagulation regime, and occurrence of paravalvular leakage. The development of smaller TMVR prostheses suitable for transseptal implantation could overcome bleeding complications. In perspective, TMVR may emerge to a clinically relevant therapeutic approach for patients with severe MR at high surgical risk.
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Affiliation(s)
- Elias Rawish
- University Hospital Schleswig-Holstein, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Tobias Schmidt
- University Hospital Schleswig-Holstein, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Ingo Eitel
- University Hospital Schleswig-Holstein, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Christian Frerker
- University Hospital Schleswig-Holstein, Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
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16
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Wang H, Cui Z, Zhou Z, He Z. A Single-opening&closing Valve Tester for Direct Measurement of Closing Volume of the Heart Valve. Cardiovasc Eng Technol 2021; 13:80-89. [PMID: 34173164 DOI: 10.1007/s13239-021-00560-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 06/22/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE The objective of this study was to develop a novel single opening&closing pulsatile flow in-vitro valve tester for direct measurement of closing volume of the heart valve. METHODS A single opening&closing valve tester was composed of a piston pump, valve mounting chamber, reservoir, measurement and control system. The piston pump was used to drive a valve to open and close with dictated flow which comprised three phases of accelerated, constant, and decelerated flow with six slopes. A high speed camera was used to record valve opening and closing images. Two pressure transducers across the tested valve were used to capture the ending time of valve closing which was verified by the high-speed photography. The closing time was measured and closing volume was calculated with a piston displacement volume during valve closing. A tilting disc valve and porcine mitral valve were tested. RESULTS There was a big difference in flowrate between the Transonic flowmeter and piston pump. The heart valve opened and closed under the dictated flow driven by the piston pump. The transvalvular pressure was minor during valve opening and then increased sharply during valve closing. The closing time varied approximately linearly with the slope of the decelerated flow and was comparable between the two methods by the transvalvular pressure and high-speed photography. The closing volumes did not change much with the slope of the decelerated flow and were 7.0 ± 1.0 and 14.0 ± 1.5 mL for the tilting disc valve and mitral valve, respectively. CONCLUSION Pulsatile flow is challenging to the flowmeter. A novel single opening&closing pulsatile flow in-vitro valve tester for the heart valve has successfully been developed and can be used to simulate and evaluate the opening and closing hemodynamics of the heart valve. The tester can be used to measure valve closing volume and time accurately with a standardized testing protocol free from effect of other components such as the resistance, compliance units and auxiliary valve in the continuous pulsatile flow valve tester.
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Affiliation(s)
- Hao Wang
- Research Center of Fluid Machinery Engineering & Technology, Jiangsu University, Zhenjiang, 212013, Jiangsu Province, People's Republic of China
| | - Zhan Cui
- Research Center of Fluid Machinery Engineering & Technology, Jiangsu University, Zhenjiang, 212013, Jiangsu Province, People's Republic of China
| | - Zhongxi Zhou
- Research Center of Fluid Machinery Engineering & Technology, Jiangsu University, Zhenjiang, 212013, Jiangsu Province, People's Republic of China
| | - Zhaoming He
- Department of Mechanical Engineering, Texas Tech University, 2703 7th Street, PO Box 41021, Lubbock, TX, 79409-1021, USA.
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17
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Wei P, Liu J, Ma J, Zhang Y, Chen Z, Liu Y, Tan T, Wu H, Chen J, Zhuang J, Guo H. Long-term outcomes of a totally thoracoscopic approach for reoperative mitral valve replacement: a propensity score matched analysis. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:987. [PMID: 34277787 PMCID: PMC8267274 DOI: 10.21037/atm-21-2407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/28/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND This study aimed to summarize the perioperative and long-term outcomes of patients with previous mitral valve surgery (MVS) undergoing reoperative mitral valve replacement (MVR). METHODS Data for all reoperative mitral valve replacements (re-MVRs) with or without concomitant tricuspid surgery were analyzed from Guangdong Provincial People's Hospital between January 2013 and December 2019. Propensity score matching resulted in 30 matched pairs with improved balance after matching in baseline covariates. Perioperative data and long-term clinical outcomes were analyzed. RESULTS Results are based on the matched cohorts between the two groups. The in-hospital mortality was 3.3% (two deaths) in the entire cohort and was not significantly different between the median sternotomy (MS) group and the totally thoracoscopic (TT) group. Most patients in the TT group had their tracheal intubation removed within 24 hours of surgery. The TT group had a diminished requirement for blood transfusion and a reduced 4-day postoperative chest tube drainage amount. The incidence of early major complications, including all-cause death and reoperation due to bleeding, was lower in the TT group. No significant differences were observed in the 7-year survival probability between the two groups. CONCLUSIONS The encouraging results regarding the perioperative and long-term outcomes of patients who underwent a TT re-MVR show that this approach is particularly beneficial for patients requiring reoperation.
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Affiliation(s)
- Peijian Wei
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Jian Liu
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Jiexu Ma
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Yuyuan Zhang
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Zhao Chen
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Yanjun Liu
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Tong Tan
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Hongxiang Wu
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Jimei Chen
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Jian Zhuang
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
| | - Huiming Guo
- Department of Cardiovascular Surgery, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China
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18
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Liu Y, Lutter G, Knueppel P, Frank D, Lozonschi L, Berndt R, Attmann T, Puehler T. Transcatheter Mitral Valve Replacement: A Novel Anchor Technology. Thorac Cardiovasc Surg 2021; 70:126-132. [PMID: 33540424 DOI: 10.1055/s-0041-1722976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Mitral valved stents tend to migrate or to develop paravalvular leakage due to high-left ventricular pressure in this cavity. Thus, this study describes a newly developed mitral valved stent anchoring technology. METHODS Based on an existing mitral valved stent, four anchoring units with curved surgical needles were designed and fabricated using three-dimensional (3D) software and print technology. Mitral nitinol stents assembled with four anchoring units were successively fixed on 10 porcine annuli. Mechanical tests were performed with a tensile force test system and recorded the tension forces of the 10 nitinol stents on the annulus. RESULTS The average maximum force was 28.3 ± 5.21 N, the lowest was 21.7 N, and the highest was 38.6 N until the stent lost contact with the annulus; for the break force (zero movement of stent from annulus), the average value was 18.5 ± 6.7 N with a maximum value of 26.9 N and a minimum value of 6.07 N. It was additionally observed that the puncture needles of the anchoring units passed into the mitral annulus in all 10 hearts and further penetrated the myocardium in only one additional heart. The anchoring units enhanced the tightness of the mitral valved stent and did not destroy the circumflex coronary artery, coronary sinus, right atrium, aortic root, or the left ventricular outflow tract. CONCLUSION The new anchoring units for mitral nitinol stents were produced with 3D software and printing technology; with this new type of anchoring technology, the mitral valved stent can be tightly fixed toward the mitral annulus.
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Affiliation(s)
- Yazhou Liu
- Department of Experimental Cardiac Surgery and Heart Valve Replacement, Christian-Albrechts-University of Kiel, School of Medicine, UKSH, Kiel, Germany.,Department of Cardiothoracic Surgery, The First People's Hospital of Jingmen, Hubei Minzu University, Jingmen, Hubei, China
| | - Georg Lutter
- Department of Experimental Cardiac Surgery and Heart Valve Replacement, Christian-Albrechts-University of Kiel, School of Medicine, UKSH, Kiel, Germany.,Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, School of Medicine, UKSH, Kiel, Germany
| | - Philipp Knueppel
- Department of Experimental Cardiac Surgery and Heart Valve Replacement, Christian-Albrechts-University of Kiel, School of Medicine, UKSH, Kiel, Germany.,Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, School of Medicine, UKSH, Kiel, Germany
| | - Derk Frank
- Department of Cardiology and Angiology, Christian-Albrechts-University of Kiel, School of Medicine, UKSH, Kiel, Germany
| | - Lucian Lozonschi
- Department of Cardiothoracic Surgery, Tampa University, Tampa, Florida, United States
| | - Rouven Berndt
- Department of Experimental Cardiac Surgery and Heart Valve Replacement, Christian-Albrechts-University of Kiel, School of Medicine, UKSH, Kiel, Germany.,Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, School of Medicine, UKSH, Kiel, Germany
| | - Tim Attmann
- Department of Experimental Cardiac Surgery and Heart Valve Replacement, Christian-Albrechts-University of Kiel, School of Medicine, UKSH, Kiel, Germany.,Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, School of Medicine, UKSH, Kiel, Germany
| | - Thomas Puehler
- Department of Experimental Cardiac Surgery and Heart Valve Replacement, Christian-Albrechts-University of Kiel, School of Medicine, UKSH, Kiel, Germany.,Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, School of Medicine, UKSH, Kiel, Germany
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19
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Wu B, Zheng C, Ding K, Huang X, Li M, Zhang S, Lei Y, Guo Y, Wang Y. Cross-Linking Porcine Pericardium by 3,4-Dihydroxybenzaldehyde: A Novel Method to Improve the Biocompatibility of Bioprosthetic Valve. Biomacromolecules 2020; 22:823-836. [PMID: 33375781 DOI: 10.1021/acs.biomac.0c01554] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Heart valve replacement is an effective therapy for patients with moderate to severe valvular stenosis or regurgitation. Most bioprosthetic heart valves applied clinically are based on cross-linking with glutaraldehyde (GLUT), but they have some drawbacks like high cytotoxicity, severe calcification, and poor hemocompatibility. In this study, we focused on enhancing the properties of bioprosthetic heart valves by cross-linking with 3,4-dihydroxybenzaldehyde (DHBA). The experiment results revealed that compared with GLUT cross-linked porcine pericardium (PP), the relative amount of platelets absorbed on the surface of DHBA cross-linked PP decreased from 0.294 ± 0.034 to 0.176 ± 0.028, and the activated partial thromboplastin time (APTT) increased from 9.9 ± 0.1 to 15.2 ± 0.1 s, indicating improved hemocompatibility. Moreover, anticalcification performance and cytocompatibility were greatly enhanced by DHBA cross-linking. In conclusion, the properties of bioprosthetic valves could be effectively improved by processing valves with a DHBA-based cross-linking method.
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Affiliation(s)
- Binggang Wu
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, P. R. China.,Department of Cardiovascular Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu 610041, P. R. China
| | - Cheng Zheng
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, P. R. China
| | - Kailei Ding
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, P. R. China
| | - Xueyu Huang
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, P. R. China
| | - Meiling Li
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, P. R. China
| | - Shumang Zhang
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, P. R. China
| | - Yang Lei
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, P. R. China
| | - Yingqiang Guo
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu 610041, P. R. China
| | - Yunbing Wang
- National Engineering Research Center for Biomaterials, Sichuan University, No. 29 Wangjiang Road, Chengdu 610064, P. R. China
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20
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Pizano A, Hirji SA, Nguyen TC. Severe Mitral Annular Calcification and Mitral Valve Surgery: An Algorithmic Approach to Management. Semin Thorac Cardiovasc Surg 2020; 32:630-634. [DOI: 10.1053/j.semtcvs.2020.05.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/13/2020] [Accepted: 05/16/2020] [Indexed: 11/11/2022]
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