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Eikelboom R, Whitlock RP, Sibilio S, Nguyen F, Perez R, Weitz JI, Belley-Cote E. Direct Oral Anticoagulation Versus Warfarin in Patients with Atrial Fibrillation and Bioprosthetic Heart Valves: a Retrospective, Real-World Cohort Study. Cardiovasc Drugs Ther 2024; 38:109-117. [PMID: 36121587 DOI: 10.1007/s10557-022-07381-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE In this retrospective cohort study of consecutive patients with atrial fibrillation and surgical or transcatheter bioprosthetic valve, we compared the efficacy and safety of direct oral anticoagulants with warfarin. METHODS Using linked health administrative databases housed at the Institute for Clinical Evaluative Sciences, we identified consecutive patients in Ontario (Canada) 65 years of age or older with AF who underwent bioprosthetic valve replacement between 1 April 2012 and 31 March 2017. We created a time-varying Cox model to examine the relationship between the type of anticoagulant and time to thrombotic or bleeding events after adjustment for baseline risk of thrombosis using the CHA2DS2-VASc score and risk of bleeding using the HAS-BLED scores. We conducted prespecified subgroup analyses according to whether valve implantation was surgical or transcatheter. RESULTS We identified 2245 eligible patients. The mean age was 79 years, 41% were female, and 39% had transcatheter aortic valve replacement. Risk of death or thrombosis was not different between direct oral anticoagulants and warfarin after adjustment for CHA2DS2-VASc score (hazard ratio [HR] 1.02, 95% confidence interval [CI], 0.83-1.25). Risk of death or bleeding was not different between direct oral anticoagulants and warfarin after adjustment for HAS-BLED score (HR 0.89, 95% CI 0.75-1.07). Subgroup analyses of surgical or transcatheter valves were consistent with overall results. CONCLUSIONS In a real-world population of patients with atrial fibrillation and bioprosthetic valve replacement, we found no difference between direct oral anticoagulants and warfarin with regard to the risk of thrombosis or bleeding.
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Affiliation(s)
- Rachel Eikelboom
- Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
- Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
| | - Richard P Whitlock
- Division of Cardiac Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Serena Sibilio
- Dipartimento Di Cardiochirurgia, Istituto Clinico Sant'Ambrogio, Milan, Lombardy, Italy
| | - Francis Nguyen
- Institute for Clinical Evaluative Sciences McMaster, McMaster University, Hamilton, ON, Canada
| | - Richard Perez
- Institute for Clinical Evaluative Sciences McMaster, McMaster University, Hamilton, ON, Canada
| | - Jeffrey I Weitz
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
- Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, ON, Canada
| | - Emilie Belley-Cote
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, ON, Canada
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2
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Nikolayevska O, Conradi L, Schirmer J, Reichenspurner H, Deuschl F, Blankenberg S, Schäfer U. Comparison of a novel self-expanding transcatheter heart valve with two established devices for treatment of degenerated surgical aortic bioprostheses. Clin Res Cardiol 2024; 113:18-28. [PMID: 37017780 PMCID: PMC10808493 DOI: 10.1007/s00392-023-02181-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/03/2023] [Indexed: 04/06/2023]
Abstract
AIMS This study was performed to compare haemodynamic properties of a novel transcatheter heart valve (THV) with two established valve technologies for treatment of failing surgical aortic bioprosthetic valves (SAV). The ALLEGRA THV has been recently described with a proven safety and performance profile. METHODS AND RESULTS The study was designed as a retrospective, single-centre study investigating 112 patients (77.7 ± 7.1 years, 53.8% female, STS score 6.8 ± 5.8% and logEuroSCORE I 27.4 ± 16.1%) with failing SAV. Patients were treated with the ALLEGRA THV (NVT, n = 24), the CoreValve/EvolutR (MTD, n = 64) or the Edwards Sapien/Sapien XT/Sapien 3 (EDW, n = 24). Adverse events, haemodynamic outcomes and patient safety were analysed according to VARC-3 definitions. Overall procedural success was high (94.6%), even though 58.9% of the treated SAV were classified as small (true inner diameter < 21 mm). After treatment, the mean pressure gradient was significantly reduced (baseline: 33.7 ± 16.5 mmHg, discharge: 18.0 ± 7.1 mmHg), with a corresponding increase in effective orifice area (EOA). The complication rates did not differ in between groups. There was a trend to lower mean transvalvular gradients after implantation of self-expanding THV with supra-annular valve function, despite a higher frequency of smaller SAVs in the NVT and MTD group. Additionally, comparison between NVT and MTD revealed statistically lower transvalvular gradients (NVT 14.9 ± 5.0 mmHg, MTD 18.7 ± 7.5 mmHg, p = 0.0295) in a subgroup analysis. CONCLUSIONS Valve-in-valve (ViV) treatment of failing SAV with supra-annular design like the ALLEGRA THV resulted in favourable haemodynamic outcomes with similar low clinical event rates and may therefore be an interesting alternative for VIV TAVI.
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Affiliation(s)
- Olga Nikolayevska
- Department of General and Interventional Cardiology, University Heart and Vascular Center, Klinik für Kardiologie, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Schirmer
- Department of Cardiovascular Surgery, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Florian Deuschl
- Department of General and Interventional Cardiology, University Heart and Vascular Center, Klinik für Kardiologie, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart and Vascular Center, Klinik für Kardiologie, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Ulrich Schäfer
- Department of General and Interventional Cardiology, University Heart and Vascular Center, Klinik für Kardiologie, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Department of Cardiology, Heart and Vascular Centre Bad Bevensen, Bad Bevensen, Germany
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3
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Lewies A, Botes L, van den Heever JJ, Dohmen PM, Smit FE. Monomeric glutaraldehyde fixation and amino acid detoxification of decellularized bovine pericardium for production of biocompatible tissue with tissue-guided regenerative potential. Heliyon 2023; 9:e19712. [PMID: 37809671 PMCID: PMC10559009 DOI: 10.1016/j.heliyon.2023.e19712] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 08/23/2023] [Accepted: 08/30/2023] [Indexed: 10/10/2023] Open
Abstract
The effect of monomeric glutaraldehyde fixation and amino acid detoxification on biocompatibility and tissue-guided regenerative potential of decellularized bovine pericardium was evaluated. The degree of cross-linking, porosity, enzymatic degradation, alpha-galactosyl content, the efficacy of detoxification, and cytotoxicity towards human epithelial cells were assessed. Tissue was subcutaneously implanted for eight weeks in male juvenile Sprague-Dawley rats, and mechanical properties, host cell infiltration, and calcification were evaluated. Three groups were compared i) decellularized tissue, ii) decellularized, monomeric glutaraldehyde fixed and amino acid detoxified tissue, and iii) commercial glutaraldehyde fixed non-decellularized tissue (Glycar®) (n = 6 rats per group). The fixation process gave a high degree of cross-linking (>85%), and was resistant to enzymatic degradation, with no significant effect on porosity. The detoxification process was effective, and the tissue was not toxic to mammalian cells in vitro. Tissue from both decellularized groups had significantly higher (p < 0.05) porosity and host cell infiltration in vivo. The process mitigated calcification. A non-significant decrease in the alpha-galactosyl content was observed, which increased when including the alpha-galactosidase enzyme. Mechanical properties were maintained. The fixation and detoxification process adequately removes free aldehyde groups and reduces toxicity, preventing enzymatic degradation and allowing for host cell infiltration while mitigating calcification and retaining the mechanical properties of the tissue. This process can be considered for processing decellularized bovine pericardium with tissue-guided regeneration potential for use in cardiovascular bioprostheses; however, methods of further reducing antigenicity, such as the use of enzymes, should be investigated.
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Affiliation(s)
- Angélique Lewies
- Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Lezelle Botes
- Department of Health Sciences, Central University of Technology, Free State, Bloemfontein, South Africa
| | | | - Pascal Maria Dohmen
- Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
- Department of Cardiac Surgery, Heart Centre Rostock, University of Rostock, Germany
| | - Francis Edwin Smit
- Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
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Tasoudis PT, Varvoglis DN, Vitkos E, Mylonas KS, Sá MP, Ikonomidis JS, Caranasos TG, Athanasiou T. Mechanical versus Bioprosthetic Valve for Aortic Valve Replacement: Systematic Review and Meta-Analysis of Reconstructed Individual Participant Data. Eur J Cardiothorac Surg 2022; 62:6571808. [PMID: 35445694 DOI: 10.1093/ejcts/ezac268] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 04/14/2022] [Accepted: 04/18/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To compare biological versus mechanical aortic valve replacement. METHODS We searched MEDLINE, Scopus, and Cochrane Library databases for randomized clinical trials and propensity-score matched studies published by October 14th, 2021 according to PRISMA statement. Individual patient data on overall survival were extracted. One- and two-stage survival analyses, and random-effects meta-analyses were conducted. RESULTS 25 studies were identified, incorporating 8,721 bioprosthetic and 8,962 mechanical valves:. In the one-stage meta-analysis, mechanical valves cumulatively demonstrated decreased hazard for mortality (Hazard Ratio [HR] : 0.79, 95% Confidence interval [CI] : 0.74-0.84, p < 0.0001). Overall survival was similar between the compared arms for patients <50 years old (HR: 0.88, 95% CI : 0.71-1.1, p = 0.216), increased in the mechanical valve arm for patients 50-70 years old (HR : 0.76, 95% CI : 0.70-0.83, p < 0.0001), and increased in the bioprosthetic arm for patients >70 years old (HR : 1.35, 95% CI : 1.17-1.57, p < 0.0001). Meta-regression analysis revealed that the survival in the 50-70 years old group was not influenced by the publication year of the individual studies. No statistically significant difference was observed regarding in-hospital mortality, post-operative strokes and post-operative reoperation. All-cause mortality was found decreased in the mechanical group, cardiac mortality was comparable between the two groups, major bleeding rates were increased in the mechanical valve group, and reoperation rates were increased in the bioprosthetic valve group. CONCLUSIONS Survival rates seem to not be influenced by the type of prosthesis in patients <50 years old. A survival advantage in favour of mechanical valves is observed in patients 50-70 years old, while in patients >70 years old bioprosthetic valves offer better survival outcomes.
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Affiliation(s)
- Panagiotis T Tasoudis
- Department of Cardiothoracic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece; Surgery Working Group, Society of Junior Doctors, Athens, Greece
| | - Dimitrios N Varvoglis
- Department of Cardiothoracic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece; Surgery Working Group, Society of Junior Doctors, Athens, Greece
| | - Evangelos Vitkos
- Department of Cardiothoracic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa, Greece; Surgery Working Group, Society of Junior Doctors, Athens, Greece
| | | | - Michel Pompeu Sá
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA
| | - John S Ikonomidis
- Professor of Surgery, Chief, Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine, University of North Carolina, at Chapel Hill Chapel Hill, NC
| | - Thomas G Caranasos
- Division of Cardiothoracic Surgery, Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, W2 1NY, UK, Department of Cardiothoracic Surgery, University Hospital of Larissa, Biopolis, Larissa, Greece, 41110
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Amano M, Miyake M, Kitai T, Obayashi Y, Takegami M, Nishimura K, Furukawa Y, Izumi C. Additional Effects of Antiplatelet Therapy on Anticoagulant Agents in Patients With Bioprosthetic Valves and Atrial Fibrillation. Circ J 2021; 86:415-424. [PMID: 34853280 DOI: 10.1253/circj.cj-21-0716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The additional effects of single-antiplatelet therapy (SAPT) on anticoagulant therapy are still unclear in patients with atrial fibrillation (AF) after bioprosthetic valve replacement.Methods and Results:We conducted a subanalysis of a multicenter, retrospective, observational registry of patients with bioprosthetic valves and AF in Japan. Patients administered anticoagulants alone comprised the ACA group (n=107), and patients given concomitant SAPT and anticoagulant therapy comprised the On SAPT group (n=82). The primary efficacy endpoint was the incidence of stroke/systemic embolism, and the primary safety endpoint was the incidence of major bleeding. The observation period was 46.3±24.6 months. The primary efficacy endpoint occurred in 12 patients, and the cumulative incidence of primary efficacy events was significantly higher in the ACA group compared with the On SAPT group (P=0.039). The primary safety endpoint occurred in 22 patients, and the cumulative incidence of primary safety events was similar between groups (P=0.66). No differences between the groups were observed for cardiac events. CONCLUSIONS Additional SAPT on anticoagulant therapy in patients with bioprosthetic valves and AF was associated with a reduction in stroke/systemic embolic events, although the cumulative incidence of bleeding was similar, regardless of additional SAPT. These findings suggest that additional SAPT on anticoagulant therapy may be safe and effective in real-world clinical settings.
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Affiliation(s)
- Masashi Amano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Takeshi Kitai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center.,Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital
| | - Yuki Obayashi
- Department of Cardiology, Tenri Hospital.,Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Misa Takegami
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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6
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Bejko J, Della Barbera M, Valente M, Pettenazzo E, Gregori D, Basso C, Thiene G. Morphologic investigation on Perceval S, a sutureless pericardial valve prosthesis: collagen integrity after collapsing-ballooning and structural valve deterioration at distance. Int J Cardiol 2021; 341:62-67. [PMID: 34324948 DOI: 10.1016/j.ijcard.2021.07.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/21/2021] [Accepted: 07/23/2021] [Indexed: 11/16/2022]
Abstract
Perceval S is a self-expandable, stent-mounted bioprosthetic valve (BPV), with glutaraldehyde treated bovine pericardium, processed with homocysteic acid as an anti-calcification treatment. The stent is crimpable but the valve insertion is done surgically via a shorter procedure which does not require sutures. OBJECTIVES: MATERIAL AND METHODS: RESULTS: CONCLUSIONS: Collapsing and ballooning do not alter cusp collagen periodicity. Structural valve deterioration with stenosis, due to dystrophic calcification and fibrous tissue overgrowth, seldom occurred in the mid-term. Glutaraldehyde fixed pericardium has the potential to undergo structural valve deterioration with time, similar to well-known BPV failure. This supports the recommendation to pursue improvement of tissue valve treatment with enhanced durability.
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Affiliation(s)
- Jonida Bejko
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiovascular Pathology, University of Padua Medical School, Padua, Italy
| | - Mila Della Barbera
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiovascular Pathology, University of Padua Medical School, Padua, Italy
| | - Marialuisa Valente
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiovascular Pathology, University of Padua Medical School, Padua, Italy
| | - Elena Pettenazzo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiovascular Pathology, University of Padua Medical School, Padua, Italy
| | - Dario Gregori
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiovascular Pathology, University of Padua Medical School, Padua, Italy
| | - Cristina Basso
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiovascular Pathology, University of Padua Medical School, Padua, Italy
| | - Gaetano Thiene
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiovascular Pathology, University of Padua Medical School, Padua, Italy.
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7
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Naser JA, Arghami A, Eleid MF, Pislaru SV. Severe tricuspid bioprosthetic valve stenosis as an unusual cause of pulmonary embolism: a case report. Eur Heart J Case Rep 2021; 5:ytab169. [PMID: 34124568 PMCID: PMC8189298 DOI: 10.1093/ehjcr/ytab169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/18/2021] [Accepted: 04/07/2021] [Indexed: 12/03/2022]
Abstract
Background Bioprosthetic tricuspid valve stenosis (TS) is an uncommon and frequently under-diagnosed condition. Although the resulting right heart failure symptoms are well-known, the associated thrombogenic potential is under-recognized. Case summary A 44-year-old woman with bioprosthetic tricuspid valve (TV) replacement in 2001 was referred for urgent consultation due to acute worsening of dyspnoea and severe swelling and pain in her left arm and neck. She was diagnosed with atrial fibrillation 6 months before the presentation and was found to have right atrial (RA) thrombus with pulmonary embolism and extensive retrograde venous extension 1 month prior. Review of studies done at her local institution revealed 10 mmHg mean gradient (MG) across the bioprosthetic TV that was only reported as mild–moderate TS. Echocardiography done at our instruction confirmed suspicion of severe TS with calcified immobile leaflets. Computed tomography showed persistent RA thrombus and therefore surgical replacement of the TV was undertaken. Subsequently, patient’s dyspnoea rapidly improved. Discussion Progressive dyspnoea and symptoms of right heart failure in a patient with a history of bioprosthetic TV replacement should be investigated for prosthetic valve dysfunction. Due to its rarity, TS diagnosis can be overlooked on routine echocardiography. In our patient, despite a measured MG of 10 mmHg, the presence of critical TS was not initially recognized. As TS is associated with increased thrombogenic potential and given the rare occurrence of in situ RA thrombosis, physicians must have a high index of suspicion for TS in the appropriate clinical context.
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Affiliation(s)
- Jwan A Naser
- Department of Internal Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
| | - Arman Arghami
- Department of Cardiovascular Surgery, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA
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8
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Della Barbera M, Pettenazzo E, Livi U, Mangino D, Gerosa G, Bottio T, Basso C, Valente M, Thiene G. Structural valve deterioration and mode of failure of stentless bioprosthetic valves. Cardiovasc Pathol 2020; 51:107301. [PMID: 33130282 DOI: 10.1016/j.carpath.2020.107301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/22/2020] [Accepted: 10/22/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Aortic stentless bioprosthetic valve (SLBPV), either porcine or pericardial, minimizes transvalvular gradient and favors regression of left ventricular hypertrophy. The drawback consists of longer time for suturing. While structural valve deterioration (SVD) in stented porcine and pericardial BPVs has been extensively investigated, less information is available on SLBPVs. MATERIAL AND METHODS We studied 82 SLBPVs explants, either porcine (Toronto SPV, [St. Jude Medical, MN, USA], CryolifeO'Brien Model 300 and CryoLife-O'Brien [Cryolife International, GA, USA], BioCor PVS [St. Jude Medical, MN, USA] Prima and Prima Plus [Edwards Lifesciences Corp. One Edwards Way, CA, formerly Baxter Inc, CA, USA]) or pericardial ([Pericarbon Freedom and Freedom Solo [Sorin-Biomedica, S.p.A., Saluggia, Italy]). RESULTS By excluding cases with leak and endocarditis, we focused the investigation on 46 SLBPVs, which failed because of SVD. Gender was male in 29 (63%). Mean age of patients at time of implant was 59.8 years. Postoperative time of SVD was 115.0 months for porcine and 79.0 months for pericardial SLBPVs. Dysfunction requiring reoperation was mainly incompetence for porcine and stenosis for pericardial SLBPVs. Even pinpoint mineralization at the commissures resulted in sudden cusp tearing and incompetence. Cuspal atheromasia accounted for cusp tearing even in the absence of calcification. Mineralization showed progression with time in pericardial but not in porcine SLBPVs. CONCLUSIONS Tissue mineralization remains the nightmare also of SLBPVs, with the peculiar features of pinpoint calcific deposits at commissures, tearing and abrupt incompetence in porcine SLBPVs and of massive cuspal mineralization and stenosis in pericardial SLBPVs.
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Affiliation(s)
- Mila Della Barbera
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Italy
| | - Elena Pettenazzo
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Italy
| | - Ugolino Livi
- Department of Cardiopulmonary Sciences, University of Udine, Italy
| | | | - Gino Gerosa
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Italy
| | - Tomaso Bottio
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Italy
| | - Cristina Basso
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Italy
| | - Marialuisa Valente
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Italy
| | - Gaetano Thiene
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Italy.
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9
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Vriesendorp MD, de Lind van Wijngaarden RAF, Rao V, Moront MG, Patel HJ, Sarnowski E, Vatanpour S, Klautz RJM. An in vitro comparison of internally versus externally mounted leaflets in surgical aortic bioprostheses. Interact Cardiovasc Thorac Surg 2020; 30:417-423. [PMID: 31778161 DOI: 10.1093/icvts/ivz277] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 10/18/2019] [Accepted: 10/23/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To improve haemodynamic performance, design modifications of prosthetic valves have been proposed with each new generation of valves. These different designs also impact the amount of mechanical wear, because mechanical stresses are distributed differently. Because long-term evidence for new prosthetic valves is lacking, this in vitro study compared hydrodynamic performance and durability among 3 currently available bioprosthetic valves with internally (IMLV) or externally mounted leaflets (EMLV). METHODS Prostheses of the internally mounted Medtronic Avalus and Carpentier-Edwards Perimount Magna Ease valves were compared to prostheses of the externally mounted Abbott Trifecta valve. For each labelled size (e.g. 19, 21 and 23) of the 3 types, 3 valves underwent accelerated wear testing for up to 600 million cycles, corresponding to ∼15 years of simulated wear. The valves underwent hydrodynamic testing and visual inspection. RESULTS EMLV had the largest effective orifice area and lowest pressure gradient for each labelled size at baseline and 600 million cycles; the effective orifice area and the pressure gradient were equivalent for the 2 types of IMLV. Five of 9 EMLVs had at least 1 hole or tear in the leaflet tissue around the stent posts, which resulted in severe regurgitation at 500 million cycles in 2 cases. All IMLVs were intact at 600 million cycles with minimal tissue wear. CONCLUSIONS EMLV showed superior hydrodynamic performance but inferior mechanical durability compared to IMLV after 600 million cycles of testing. The primary failures were because of significant mechanical abrasion in the commissural region, which may warrant close monitoring of EMLV during long-term follow-up.
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Affiliation(s)
- Michiel D Vriesendorp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | | | - Vivek Rao
- Department of Cardiovascular Surgery, Toronto General Hospital, Toronto, ON, Canada
| | - Michael G Moront
- Department of Cardiothoracic Surgery, ProMedica Toledo Hospital, Toledo, OH, USA
| | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
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10
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Hatoum H, Girault E, Heim F, Dasi LP. In-vitro characterization of self-expandable textile transcatheter aortic valves. J Mech Behav Biomed Mater 2020; 103:103559. [PMID: 31786509 PMCID: PMC11107174 DOI: 10.1016/j.jmbbm.2019.103559] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/10/2019] [Accepted: 11/25/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This study aims at assessing the global dynamic behavior, closing energy and turbulence characteristics of self-expandable textile (inclined and straight yarn) transcatheter aortic valves (TAV) versus bioprosthetic TAVs. METHODS Two self-expandable textile TAVs one with inclined yarn textile and another with straight yarn textile leaflets were assessed in a pulse duplicator and compared with a self-expandable commercial bioprosthetic TAV under physiological pressure and flow. Particle Image Velocimetry and high-speed imaging were performed. Effective orifice areas (EOA), leakage fractions (LF), Pinwheeling indices (PI), closing energy (E), viscous shear stresses (VSS) and Reynolds shear stresses (RSS) were calculated. RESULTS (a) EOAs and LFs were 2.27 ± 0.03 cm2, 31.7 ± 0.6%; 2.25 ± 0.08 cm2, 26.6 ± 0.7%; and 1.63 ± 0.01 cm2, 29.1 ± 1.25% for inclined textile, bioprosthetic and straight textile TAV respectively (p < 0.0001). (b) Following same order, PIs were significantly different going from 1.16 ± 0.21%, 8.48 ± 0.8% and 8.865 ± 0.58% with the exception of CoreValve and straight yarn valve (p = 0.37); (c) E is lowest for straight textile TAV (0.0024 ± 0.0017 J), followed by bioprosthetic valve (0.00259 ± 0.0011 J) and then 45° Oriented Yarn Valve (0.00334 ± 0.03 J) (d) At peak systole, the highest RSS distribution was with the Straight textile TAV reaching up to 330Pa. The bioprosthetic TAV shows the smallest range with RSS reaching around 230Pa and the inclined textile TAV up to 280Pa. VSS limits were comparable among the 3 valves ranging between 5.2Pa and 5.7Pa. CONCLUSION Hemodynamic similarities were found between the textile self-expandable valves and the bioprosthetic valve. This study constitutes another step towards showing the potential that textile valves have to become an alternative for the biological ones.
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Affiliation(s)
- Hoda Hatoum
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, United States
| | - Elise Girault
- Laboratoire de Physique et Mécanique Textiles, Université de Haute Alsace, Mulhouse, France
| | - Frederic Heim
- Laboratoire de Physique et Mécanique Textiles, Université de Haute Alsace, Mulhouse, France
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, United States.
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Sturla F, Piatti F, Jaworek M, Lucherini F, Pluchinotta FR, Siryk SV, Giese D, Vismara R, Tasca G, Menicanti L, Redaelli A, Lombardi M. 4D Flow MRI hemodynamic benchmarking of surgical bioprosthetic valves. Magn Reson Imaging 2020; 68:18-29. [PMID: 31981709 DOI: 10.1016/j.mri.2020.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/23/2019] [Accepted: 01/19/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE We exploited 4-dimensional flow magnetic resonance imaging (4D Flow), combined with a standardized in vitro setting, to establish a comprehensive benchmark for the systematic hemodynamic comparison of surgical aortic bioprosthetic valves (BPVs). MATERIALS AND METHODS 4D Flow analysis was performed on two small sizes of three commercialized pericardial BPVs (Trifecta™ GT, Carpentier-Edwards PERIMOUNT Magna and Crown PRT®). Each BPV was tested over a clinically pertinent range of continuous flow rates within an in vitro MRI-compatible system, equipped with pressure transducers. In-house 4D Flow post-processing of the post-valvular velocity field included the quantification of BPV effective orifice area (EOA), transvalvular pressure gradients (TPG), kinetic energy and viscous energy dissipation. RESULTS The 4D Flow technique effectively captured the 3-dimensional flow pattern of each device. Trifecta exhibited the lowest range of velocity and kinetic energy, maximized EOA (p < 0.0001) and minimized TPGs (p ≤ 0.015) if compared with Magna and Crown, these reporting minor EOA difference s (p ≥ 0.042) and similar TPGs (p ≥ 0.25). 4D Flow TPGs estimations strongly correlated against ground-truth data from pressure transducers; viscous energy dissipation proved to be inversely proportional to the fluid jet penetration. CONCLUSION The proposed 4D Flow analysis pinpointed consistent hemodynamic differences among BPVs, highlighting the not negligible effect of device size on the fluidynamic outcomes. The efficacy of non-invasive 4D Flow MRI protocol could shed light on how standardize the comparison among devices in relation to their actual hemodynamic performances and improve current criteria for their selection.
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Affiliation(s)
- Francesco Sturla
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
| | - Filippo Piatti
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Michal Jaworek
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Federico Lucherini
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Francesca R Pluchinotta
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy; Multimodality Cardiac Imaging, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; Department of Pediatric and Adult Congenital Heart Disease, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Sergii V Siryk
- CONCEPT Lab, Istituto Italiano di Tecnologia, Genova, Italy
| | | | - Riccardo Vismara
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Giordano Tasca
- Cardiac Surgery Unit, Heart Health Center, King Saud Medical City, Riyadh, Saudi Arabia
| | - Lorenzo Menicanti
- Department of Cardiovascular Disease, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Alberto Redaelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Massimo Lombardi
- Multimodality Cardiac Imaging, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
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Agathos EA, Tomos PI, Kostomitsopoulos N, Koutsoukos PG. Calcitonin as an anticalcification treatment for implantable biological tissues. J Cardiol 2018; 73:179-182. [PMID: 30377016 DOI: 10.1016/j.jjcc.2018.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 07/27/2018] [Accepted: 07/30/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY Calcification remains the major role of failure of implantable biomedical material and in particular of bioprosthetic valves. Various treatments have been proposed to mitigate calcification of glutaraldehyde-fixed bioprosthetic valves but none have succeeded in inhibiting or mitigating efficiently the calcification process of the implantable biological tissues. Since the discovery of calcitonin (CT) and its therapeutic role in treating hypercalcemic patients, CT has never been tried as an anticalcification treatment for biomaterials. It is postulated, that tissue calcification may be efficiently minimized by forming adducts with aldehyde groups thus eliminating the places of the biological tissues onto the calcium cations could be deposited. MATERIAL AND METHODS Fresh porcine aortic leaflets were cut radially in three parts. Three groups of tissue were created. Group I (glutaraldehyde only), Group II (glutaraldehyde with 1% CT) and Group III (glutaraldehyde with 10% CT). All tissues were then implanted subdermally in three sets of 8 (Group I) and 9 (Group II and Group III) male Wistar rats of 12 days old. 21 days later the rats were euthanized by inhalation of CO2. The tissues were retrieved and after rinsing with distilled water 3 times, were lyophilized at -40°C at high vacuum pressure of approximately 100mmHg for 16h. The calcium content was then measured with flat atomic absorption technique. RESULTS The preimplantation values of Ca concentration as expressed in mg Ca/g of tissue were 1.79±0.14 in Group I, 4.78±0.0079 in Group II and 2.88±0.17 in Group III (p=ns). 21 days later the values of Ca concentration were 126.95±12.97 for Group I, 24.69±2.71 for Group II (p<0.05) and 27.16±2.95 for Group III (p<0.05). There was not significance difference between Groups II and III, even if Group II showed a less accumulation of Ca concentration (×5.16) than Group III (×9.43). CONCLUSION An anticalcification treatment based on calcitonin as an additive to buffered glutaraldehyde, mitigates the calcification process of the implantable biological tissues, as compared to glutaraldehyde treatment only.
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Affiliation(s)
- E Andreas Agathos
- Department of Cardiac Surgery, Euroclinic of Athens, Athanassiadou 7-9, 115 21 Athens, Greece.
| | - Periklis I Tomos
- Academic Department of Thoracic Surgery, "Attikon" University General Hospital, Rimini 1, Chaidari Athens, Attiki, 124 64, Greece
| | - Nikolaos Kostomitsopoulos
- Center of Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, 4 Soranou Ephesus St, 11527 Athens, Greece
| | - Petros G Koutsoukos
- Department of Chemical Engineering and FORTH-ICEHT, University of Patras, Patras, Greece
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Hatoum H, Heim F, Dasi LP. Stented valve dynamic behavior induced by polyester fiber leaflet material in transcatheter aortic valve devices. J Mech Behav Biomed Mater 2018; 86:232-9. [PMID: 29986298 DOI: 10.1016/j.jmbbm.2018.06.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 06/21/2018] [Accepted: 06/25/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study aims at assessing the global dynamic behavior, elastic deformability, closing energy and turbulence of rigid versus deformable stented (RS vs DS) valve systems with deformable and rigid textile materials (DT vs RT) through studying the stent-valve interaction compared to a bioprosthetic material in transcatheter aortic valves (TAV). METHODS Three 19 mm stented textile TAV designs (RS-DT, RS-RT and DS-RT) with different stent and leaflet properties were tested and compared with a control bioprosthetic TAV (RS-DB) in a left heart simulator flow loop under physiological pressure and flow. Particle Image Velocimetry and high speed imaging were performed. Pressure gradients (PG), leakage fractions (LF), Pinwheeling indices (PI), closing energy (E) and Reynolds shear stresses (RSS) were calculated. RESULTS (a) PGs and LFs were 11.86 ± 0.51 mmHg, 11.70 ± 0.34%; 8.84 ± 0.40 mmHg, 29.80 ± 0.76%; 11.59 ± 0.12 mmHg, 14.23 ± 1.64%; and 7.05 ± 0.09 mmHg, 12.08 ± 0.45% % for RS-DB, RS-DT, RS-RT and DS-RT respectively. (b) PIs were 15.79 ± 2.34%, 4.36 ± 0.84%, 2.47 ± 0.51% and 2.03 ± 0.33% for RS-DB, RS-DT, RS-RT and DS-RT respectively. (c) E is lowest for DS-RT (0.0010 ± 0.0002 J) followed by RS-RT (0.0017 ± 0.0002 J), RS-DB (0.0023 ± 0.0004 J) and highest with RS-DT (0.0036 ± 0.0007 J). (d) At peak systole lowest RSS was obtained with RS-DT (87.82 ± 0.58 Pa) and highest with DS-RT (122.98 ± 1.87 Pa). CONCLUSION PGs, LFs, PIs and E were improved with DS-RT compared to other textile TAVs and RS-DB. Despite achieving more RSS than the rest of TAVs, DS-RT still falls within the same range of RSS produced by the other 2 valves and control exceeding the threshold for platelet activation.
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Klautz RJM, Kappetein AP, Lange R, Dagenais F, Labrousse L, Bapat V, Moront M, Misfeld M, Zeng C, Sabik Iii JF. Safety, effectiveness and haemodynamic performance of a new stented aortic valve bioprosthesis. Eur J Cardiothorac Surg 2018; 52:425-431. [PMID: 28475690 PMCID: PMC5848807 DOI: 10.1093/ejcts/ezx066] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 02/07/2017] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES We assessed the safety, effectiveness and haemodynamic performance of a new bovine stented aortic valve bioprosthesis (Avalus™). METHODS The PERIGON Pivotal Trial is a prospective, non-randomized, multicentre study. Subjects had symptomatic moderate or severe aortic stenosis or chronic, severe aortic regurgitation. Death, valve-related adverse events (AEs), functional recovery and haemodynamic performance were assessed at discharge, 3-6 months and 1 year. The primary analysis compared 'late' (>30 days post-implant) linearized rates of valve-related thromboembolism, thrombosis, all and major haemorrhage, all and major paravalvular leak (PVL) and endocarditis after implantation with objective performance criteria (OPC) for AEs, in accordance with EN ISO 5840:2009. We hypothesized that the upper 95% confidence bounds of the true linearized AE rates would be ≥ 2 × OPC; rejection of the null hypothesis would demonstrate that these rates were below acceptable rates. The analysis was required to include at least 150 patients followed to 1 year and 400 valve-years. Kaplan-Meier survival analysis was also performed. RESULTS Total number of valve-years was 459.5 (n = 686). Linearized rates were <2 × OPC for death and valve-related thromboembolism, valve thrombosis, all and major PVL, and endocarditis, but ≥2 × OPC for all and major haemorrhage. Survival at 1 year (n = 270) was 96.4%. Patients showed good functional recovery, and haemodynamic performance was within expected range. CONCLUSIONS This analysis demonstrated a good safety profile and clinical effectiveness of the Avalus valve except for bleeding rates. The linearized rates of all and major haemorrhage may be related to long-term anticoagulation for non-valvular indications and the length of follow-up of this cohort. Trial registration NCT02088554 (www.clinicaltrials.gov).
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Affiliation(s)
- Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | - A Pieter Kappetein
- Department of Cardio-Thoracic Surgery, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Rüdiger Lange
- German Heart Centre, Technical University of Munich, Munich, Germany
| | - Francois Dagenais
- Deparment of Cardiac Surgery, Québec Heart and Lung Institute, Québec City, Canada
| | - Louis Labrousse
- Department of Cardiac and Vascular Surgery, University Hospital of Bordeaux, Bordeaux, France
| | - Vinayak Bapat
- Department of Cardiothoracic Surgery, St Thomas' Hospital, London, UK
| | - Michael Moront
- Department of Cardiothoracic Surgery, ProMedica Toledo Hospital, Toledo, OH, USA
| | - Martin Misfeld
- Department of Cardiac Surgery, Leipzig Heart Centre, University Hospital, Leipzig, Germany
| | - Cathy Zeng
- Statistical Services Department, Medtronic, Minneapolis, MN, USA
| | - Joseph F Sabik Iii
- Department of Surgery, University Hospitals, Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Rosa B, Machaidze Z, Shin B, Manjila S, Brown DW, Baird CW, Mayer JE, Dupont PE. A low-cost bioprosthetic semilunar valve for research, disease modelling and surgical training applications. Interact Cardiovasc Thorac Surg 2018; 25:785-792. [PMID: 29049565 DOI: 10.1093/icvts/ivx189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 03/04/2017] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES This paper provides detailed instructions for constructing low-cost bioprosthetic semilunar valves for animal research and clinical training. This work fills an important gap between existing simulator training valves and clinical valves by providing fully functioning designs that can be employed in ex vivo and in vivo experiments and can also be modified to model valvular disease. METHODS Valves are constructed in 4 steps consisting of creating a metal frame, covering it with fabric and attaching a suture ring and leaflets. Computer-aided design files are provided for making the frame from wire or by metal 3D printing. The covering fabric and suturing ring are made from materials readily available in a surgical lab, while the leaflets are made from pericardium. The entire fabrication process is described in figures and in a video. To demonstrate disease modelling, design modifications are described for producing paravalvular leaks, and these valves were evaluated in porcine ex vivo (n = 3) and in vivo (n = 6) experiments. RESULTS Porcine ex vivo and acute in vivo experiments demonstrate that the valves can replicate the performance of clinical valves for research and training purposes. Surgical implantation is similar, and echocardiograms are comparable to clinical valves. Furthermore, valve leaflet function was satisfactory during acute in vivo tests with little central regurgitation, while the paravalvular leak modifications consistently produced leaks in the desired locations. CONCLUSIONS The detailed design procedure presented here, which includes a tutorial video and computer-aided design files, should be of substantial benefit to researchers developing valve disease models and to clinicians developing realistic valve training systems.
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Affiliation(s)
- Benoit Rosa
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Zurab Machaidze
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Borami Shin
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Sunil Manjila
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA
| | - David W Brown
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA
| | | | - John E Mayer
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Pierre E Dupont
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA
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Kounis NG, Grapsas N, Soufras GD, Lianas D, Patsouras N, Hahalis G. Clinical and subclinical leaflet thrombosis in bioprosthetic aortic valves: A manifestation of Kounis syndrome? Int J Cardiol 2016; 214:86-7. [PMID: 27057985 DOI: 10.1016/j.ijcard.2016.03.130] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 03/19/2016] [Indexed: 11/15/2022]
Affiliation(s)
- Nicholas G Kounis
- Department of Medical Sciences, Western Greece Highest Institute of Education and Technology, Patras, Achaia, Greece.
| | - Nicholas Grapsas
- Department of Cardiology and Emergency Medicine, "Saint Andrews" State General Hospital, Patras, Achaia, Greece
| | - George D Soufras
- Department of Cardiology and Emergency Medicine, "Saint Andrews" State General Hospital, Patras, Achaia, Greece
| | - Dimitrios Lianas
- Department of Cardiology and Emergency Medicine, "Saint Andrews" State General Hospital, Patras, Achaia, Greece
| | - Nicholas Patsouras
- Department of Cardiology, University of Patras Medical School, Patras, Rio, Achaia, Greece
| | - George Hahalis
- Department of Cardiology, University of Patras Medical School, Patras, Rio, Achaia, Greece
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Al Mosa AF, Omair A, Arifi AA, Najm HK. Mitral valve replacement for mitral stenosis: A 15-year single center experience. J Saudi Heart Assoc 2016; 28:232-8. [PMID: 27688670 PMCID: PMC5034490 DOI: 10.1016/j.jsha.2016.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 02/02/2016] [Accepted: 02/11/2016] [Indexed: 11/25/2022] Open
Abstract
Objectives Mitral valve replacement with either a bioprosthetic or a mechanical valve is the treatment of choice for severe mitral stenosis. However, choosing a valve implant type is still a subject of debate. This study aimed to evaluate and compare the early and late outcomes of mitral valve replacement [mechanical (MMV) vs. bioprosthetic (BMV)] for severe mitral stenosis. Methods A retrospective cohort study was performed on data involving mitral stenosis patients who have undergone mitral valve replacement with either BMV (n = 50) or MMV (n = 145) valves from 1999 to 2012. Data were collected from the patients’ records and follow-up through telephone calls. Data were analyzed for early and late mortality, New York Heart Association (NYHA) functional classes, stroke, pre- and postoperative echocardiographic findings, early and late valve-related complications, and survival. Chi-square test, logistic regression, Kaplan–Meier curve, and dependent proportions tests were some of the tests employed in the analysis. Results A total of 195 patients were included in the study with a 30-day follow-up echocardiogram available for 190 patients (97.5%), while 103 (53%) were available for follow-up over the telephone. One patient died early postoperatively; twelve patients died late in the postoperative period, six in the bioprosthesis group and six in the mechanical group. The late mortality had a significant association with postoperative stroke (p < 0.001) and postoperative NYHA Classes III and IV (p = 0.002). Postoperative NYHA class was significantly associated with age (p = 0.003), pulmonary disease (p = 0.02), mitral valve implant type (p = 0.01), and postoperative stroke (p = 0.02); 14 patients had strokes in the mechanical (9) and in the bioprosthetic (5) groups. NYHA classes were significantly better after the replacement surgeries (p < 0.001). BMV were significantly associated with worse survival (p = 0.03), worse NYHA postoperatively (p = 0.01), and more reoperations (p = 0.006). Survival was significantly better with MMV (p = 0.03). When the two groups were matched for age and mitral regurgitation, the analysis revealed that BMV were significantly associated with reoperations (p = 0.02) but not significantly associated with worse survival (p = 0.4) or worse NYHA (p = 0.4). Conclusion MMV replacement in mitral stenosis patients is associated with a lower reoperation rate, but there was no difference in survival compared with BMV replacement.
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Affiliation(s)
- Alqasem F. Al Mosa
- King Saud bin Abdulaziz University for Health Sciences, College of Medicine, Riyadh, aSaudi Arabia
| | - Aamir Omair
- King Saud bin Abdulaziz University for Health Sciences, Medical Education, Riyadh, bSaudi Arabia
| | - Ahmed A. Arifi
- Cardiac Clinical Research, Cardiac Surgery, Cardiac Sciences, King Abdulaziz Cardiac Center, Ministry of National Guard, Riyadh, cSaudi Arabia
| | - Hani K. Najm
- Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave/M41, Cleveland, Ohio, 44195, dUnited States
- Corresponding author at: Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave/M41, Cleveland, Ohio, 44195, United States.Heart and Vascular InstituteCleveland Clinic9500 Euclid Ave/M41ClevelandOhio44195United States
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18
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Thukkani AK, Klein MR, Mauney M, Kouchoukos N, Baker JN. Successful use of 20mm SAPIEN 3 for valve-in-valve intervention within a 19 mm degenerated aortic bioprosthetic valve. Int J Cardiol 2016; 203:156-7. [PMID: 26512831 DOI: 10.1016/j.ijcard.2015.10.158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 10/18/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Arun K Thukkani
- BJC Medical Group Cardiology, Missouri Baptist Hospital, St. Louis, MO 63131, United States.
| | - Michael R Klein
- BJC Medical Group Cardiology, Missouri Baptist Hospital, St. Louis, MO 63131, United States
| | - Michael Mauney
- Cardiac, Vascular, and Thoracic Consultants, Missouri Baptist Hospital, St. Louis, MO 63131, United States
| | - Nicholas Kouchoukos
- Cardiac, Vascular, and Thoracic Consultants, Missouri Baptist Hospital, St. Louis, MO 63131, United States
| | - Joshua N Baker
- Cardiac, Vascular, and Thoracic Consultants, Missouri Baptist Hospital, St. Louis, MO 63131, United States
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Pislaru SV, Hussain I, Pellikka PA, Maleszewski JJ, Hanna RD, Schaff HV, Connolly HM. Misconceptions, diagnostic challenges and treatment opportunities in bioprosthetic valve thrombosis: lessons from a case series. Eur J Cardiothorac Surg 2014; 47:725-32. [PMID: 24829402 DOI: 10.1093/ejcts/ezu201] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Bioprosthetic valve thrombosis (BPVT) is a rare but potentially life-threatening complication. Current guidelines favour surgery or thrombolysis as initial treatment. We set forth to characterize timing, diagnostic criteria and treatment strategies in BPVT. METHODS A free-text search tool was used to identify patients diagnosed with BPVT at Mayo Clinic between 1997 and 2013. We compared patients treated initially with vitamin K antagonists (VKA group; N = 15) versus surgery/thrombolysis (non-VKA group; N = 17). RESULTS Peak incidence of BPVT was 13-24 months after implantation in both groups. VKA and surgery/thrombolysis decreased prosthetic mean gradients to a similar extent (VKA group: 13 ± 5 to 6 ± 2 mmHg in mitral position, 9 ± 3 to 5 ± 1 mmHg in tricuspid position and 39 ± 3 to 24 ± 7 mmHg in aortic/pulmonary position; non-VKA group: 16 ± 12 to 5 ± 1 mmHg in mitral, 10 ± 5 to 4 ± 1 mmHg in tricuspid and 57 ± 9 to 18 ± 6 mmHg in aortic position; P = 0.59 for group effect). NYHA class improved in 11 of 15 patients in the VKA group and 10 of 17 patients in the non-VKA group (P = 0.39). There were no deaths, strokes or recognized embolic events; 1 patient in each group experienced gastrointestinal bleeding requiring transfusion. Index transthoracic echocardiogram formally identified BPVT in a minority of patients. CONCLUSIONS BPVT may occur late after surgical implantation. VKA therapy resulted in haemodynamic and clinical improvement with minimal risk, and should be considered the first-line therapy in haemodynamically stable patients. Echocardiographic criteria for improving BPVT diagnosis are proposed.
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Affiliation(s)
- Sorin V Pislaru
- Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Imad Hussain
- Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Patricia A Pellikka
- Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | - Richard D Hanna
- Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Hartzell V Schaff
- Cardiovascular Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Heidi M Connolly
- Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA
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