A Clinical Study of Isolated Aortic Valve Replacement: A Univariate Analysis of Risk Factors

Between 1979 and 1990, 190 patients underwent isolated aortic valve replacement at Seoul National University Hospital in Korea. There were 11 (5.8%) in-hospital deaths. Univariate analysis identified advanced age (p = 0.026), preoperative serum GOT or GPT greater than 40IU/1 (p < 0.001, p = 0.003), NYHA Class III or IV (p = 0.029), preoperative mean pulmonary arterial pressure greater than 19 mmHg (p = 0.019), reoperation for aortic valve replacement (p = 0.035), second or third open heart surgery (p < 0.001), and use of mechanical valve (p = 0.008) as variables associated with increased in-hospital risk. Follow-up documented survival rates of 98.1% and 96.4% and event-free survival rates of 95.7% and 81.6% at 3 and 7 postoperative years, respectively. NYHA Class III or IV (p = 0.009), preoperative serum total bilirubin level greater than 1.2 mg/dl (p = 0.009), reoperation for aortic valve replacement (p = 0.03), second or third open heart surgery (p = 0.002), and use of mechanical valve were associated with decreased late survival and event-free survival.

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Simultaneous Repair of Severe Pectus Excavatum and Aortic Valve Replacement Following Previous Open-Heart Surgery

The Annals of Thoracic Surgery ◽

10.1016/s0003-4975(10)62403-4 ◽

1988 ◽

Vol 45 (1) ◽

pp. 82-84 ◽

Cited By ~ 5

Author(s):

Warren L. Gould ◽

G.K. Jett ◽

John Bostwick ◽

Ellis L. Jones ◽

Kamal A. Mansour

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Pectus Excavatum ◽

Heart Surgery ◽

Open Heart Surgery ◽

Open Heart

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Patient-Specific Computational Simulations of Transcatheter Aortic Valve Implantation (TAVI)

ASME 2013 Conference on Frontiers in Medical Devices: Applications of Computer Modeling and Simulation ◽

10.1115/fmd2013-16154 ◽

2013 ◽

Author(s):

Giorgia M. Bosi ◽

Claudio Capelli ◽

Robin Chung ◽

Michael Mullen ◽

Andrew M. Taylor ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Heart Surgery ◽

Open Heart Surgery ◽

Vascular Complications ◽

Negative Influence ◽

Paravalvular Leak ◽

Patient Specific ◽

Transcatheter Aortic Valve

In the past decade, Transcatheter Aortic Valve Replacement (TAVI) has been shown to be a feasible, less invasive option to open heart surgery for aortic valve replacement; however, TAVI is indicated only in patients with severe, symptomatic, aortic stenosis and who are considered at high or prohibitive risk for conventional surgery [1]. To date, two different TAVI devices are available on the market — the balloon-expandable Edwards-Sapien® Valve (Edwards Lifesciences, CA, USA) and the self-expandable CoreValve ReValving System® (Medtronic, MN, USA) — with many other devices currently under development and clinical trials. The procedural success rate has been >90% in all studies [1], but vascular complications, electrical conduction abnormalities and paravalvular leak — 65–89% of cases, the majority being trivial to mild, with 0 to 26% moderate and 0 to 10% severe — still remain major safety concerns. In particular, a negative influence of moderate to severe paravalvular leak on survival rates has recently been demonstrated [2].

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Aortic Annular Enlargement during Aortic Valve Replacement

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2016.098 ◽

2016 ◽

Vol 4 (3) ◽

pp. 455-457 ◽

Cited By ~ 1

Author(s):

Selman Dumani ◽

Ermal Likaj ◽

Laureta Dibra ◽

Stavri Llazo ◽

Ali Refatllari

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Heart Surgery ◽

Open Heart Surgery ◽

Left Ventricular ◽

Aortic Annulus ◽

Patient Prosthesis Mismatch ◽

Potential Benefits ◽

Transvalvular Gradient

In the surgery of aortic valve replacement is always attempted, as much as possible, to implant the larger prosthesis with the mains goals to enhance the potential benefits, to minimise transvalvular gradient, decrease left ventricular size and avoid the phenomenon of patient-prosthesis mismatch. Implantation of an ideal prosthesis often it is not possible, due to a small aortic annulus. A variety of aortic annulus enlargement techniques is reported to avoid patient-prosthesis mismatch. We present the case that has submitted four three times open heart surgery. We used Manouguian technique to enlarge aortic anulus with excellent results during the fourth time of surgery.

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Abstract 16920: Transcatheter Aortic Valve Replacement in Aortic Regurgitation: The U.S. Experience

Circulation ◽

10.1161/circ.142.suppl_3.16920 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Chinmy T Jani ◽

Shilpkumar Arora ◽

Sopan Lahewala ◽

ZACHARY ZUZEK ◽

Rahul Jaswaney ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Heart Surgery ◽

Open Heart Surgery ◽

Vascular Complications ◽

Paravalvular Leak ◽

Open Heart ◽

Transcatheter Aortic Valve

Background: Transcatheter aortic valve replacement (TAVR) may be an effective option for high-risk AR patients. Although international experiences of TAVR for AR are published, U.S. data is limited. The primary objective of this study was to investigate periprocedural and 30-days outcomes in terms of mortality and post-procedural complications in patients undergoing TAVR for AR using large national U.S. databases. Hypothesis: TAVR is a promising option in AR Methods: Study cohorts were derived from Nationwide Inpatient Sample (NIS) and Nationwide Readmissions Database (NRD) 2016-17. TAVR and AR were identified using ICD-10-CM-codes. The key outcomes were all-cause mortality, disabling stroke, valvular complications, complete heart block (CHB)/ permanent pacemaker placement (PPM), open heart surgery, acute kidney injury (AKI) requiring dialysis, and vascular complications. Multivariate logistic regression was used to adjust for confounders. Results: 915 patients from the NIS (male-71%, age 65-84.2%) and 822 patients from the NRD (male-69.3%, age 65-80.5%) underwent TAVR for AR. The median length of stay (LOS) was 4 days for both cohorts. In-hospital mortality was 2.7% in NIS and 30-day mortality was 3.3% in NRD. Disabling strokes were noted in 0.6% peri-procedurally and 1.8% at 30-days. Valve-related complications were 18-19% with paravalvular leak being the most common. Approximately 11% of patients developed CHB and/or needed PPM in both cohorts. In NRD, 2.2% of patients required dialysis for AKI, 1.5% developed vascular complications, and 0.6% required open-heart surgery within 30-days post-procedure. Anemia was predictive of increased overall complications and valvular complications, whereas, peripheral vascular disease was predictor of increased valvular complications and CHB/PPM. Conclusion: TAVR is a promising option in AR. Further studies are necessary for the expansion of TAVR as standard treatment in AR.

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Prosthetic Valve Endocarditis with Valvular Obstruction after Transcatheter Aortic Valve Replacement

Texas Heart Institute Journal ◽

10.14503/thij-13-3961 ◽

2015 ◽

Vol 42 (2) ◽

pp. 172-174 ◽

Cited By ~ 2

Author(s):

Christine Pabilona ◽

Bernard Gitler ◽

Jeffrey A. Lederman ◽

Donald Miller ◽

Theodore N. Keltz

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Prosthetic Valve ◽

Heart Surgery ◽

Severe Aortic Stenosis ◽

Open Heart Surgery ◽

Prosthetic Valve Endocarditis ◽

Transcatheter Aortic Valve

Patients with severe aortic stenosis who are at high risk for open-heart surgery might be candidates for transcatheter aortic valve replacement (TAVR). To our knowledge, this is the first report of Streptococcus viridans endocarditis that caused prosthetic valve obstruction after TAVR. A 77-year-old man who had undergone TAVR 17 months earlier was admitted because of evidence of prosthetic valve endocarditis. A transthoracic echocardiogram revealed a substantial increase in the transvalvular peak gradient and mean gradient in comparison with an echocardiogram of 7 months earlier. A transesophageal echocardiogram showed a 1.5-cm vegetation obstructing the valve. Blood cultures yielded penicillin-sensitive S. viridans. The patient was hemodynamically stable and was initially treated with vancomycin because of his previous penicillin allergy. Subsequent therapy with levofloxacin, oral penicillin (after a negative penicillin skin test), and intravenous penicillin eliminated the symptoms of the infection. Transcatheter aortic valve replacement is a relatively new procedure, and sequelae are still being discovered. We recommend that physicians consider obstructive endocarditis as one of these.

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90Risk-adjusted comparison of in-hospital outcomes of transcatheter and surgical aortic valve replacement

European Heart Journal ◽

10.1093/eurheartj/ehz747.0019 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

P Stachon ◽

K K Kaier ◽

T H Heidt ◽

M Z Zehender ◽

C B Bode ◽

...

Keyword(s):

Renal Failure ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Aortic Valve Stenosis ◽

Nyha Class ◽

Operative Risk ◽

Class Iii ◽

Hospital Outcomes ◽

Significant Difference

Abstract Background Transcatheter aortic valve replacement (TAVR) is recommended for patients suffering from aortic valve stenosis at increased operative risk or age over 75 years. Beyond that patients with different co-morbidities could profit from TAVR. Purpose The present study analyzes in-hospital outcomes of aortic valve replacement procedures in order to identify subgroups of patients in which TAVR might be preferable. Methods For all 33,789 isolated transfemoral TAVR and SAVR procedures performed in Germany in 2014 and 2015, co-morbidities and in-hospital outcomes were identified by ICD- and OPS-codes. Results Patients undergoing TAVR were older with more co-morbidities and at increased estimated risk (logistic EuroSCORE TAVR: 13.9±10.3%; SAVR: 5.3±4.7%; p<0.001). In order to allow comparison of outcomes after TAVR and SAVR, a covariate and propensity-adjusted analysis was performed in different subgroups. The risk of mortality is significantly lower in patients undergoing TAVR with an age over 80 years (TAVR vs. SAVR 80–84: OR 0.55; p=0.002; ≥85 OR 0.42, p=0.006) and at high operative risk (patients with EuroSCORE >9: OR 0.62, p=0.001). No significant difference in in-hospital mortality occurs between TAVR and SAVR in patients under 80 and intermediate or low risk (<75: OR 0.85; p=0.404; 75–79 OR 0.82, p=0.219; EuroSCORE <4: OR 1.44, p=0.308; EuroSCORE 4–9: OR 0.81, p=0.156). In contrast, patients with advanced renal failure and patients in NYHA-class III/IV had better outcomes after TAVR (GFR<30: OR 0.45, p=0.005; NYHA III/IV: OR 0.72, p=0.015). Female sex, previous CABG, peripheral arterial disease, COPD, pulmonary hypertension, and diabetes were not found to be factors which favor a treatment strategy. Patients undergoing TAVR suffered more often from strokes and acute kidney failure. After risk-adjustment TAVR was associated with a lower risk for acute kidney injuries (OR 0.62, p<0.001). Risk for stroke was similar (OR 1.07, p=0.558). Risk of bleeding (OR 0.17, p<0.001) and requiring prolonged mechanical ventilation (>48h, OR 0.21, p<0.001) was decreased in patients undergoing TAVR. As expected, the TAVR procedure is associated with an increased risk for pacemaker implantations (OR 4.61, p<0.001). Conclusions The present study analyzing over 33.000 real-world procedures confirms that TAVR is the safer procedure in clinical practice for patients with severe aortic valve stenosis at increased operative risk, over 80 years, in NYHA-class III/IV, and with renal failure.

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Surgical treatment for accidentally discovered pseudoaneurysm of the mitral-aortic intervalvular fibrosa with bicuspid aortic valve, ascending aortic aneurysm, and myocardial ischemia: a case report

The Cardiothoracic Surgeon ◽

10.1186/s43057-021-00049-0 ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Kentaro Kiryu ◽

Gembu Yamaura ◽

Itaru Igarashi ◽

Takayuki Kadohama ◽

Fuminobu Tanaka ◽

...

Keyword(s):

Coronary Artery ◽

Infective Endocarditis ◽

Aortic Valve ◽

Aortic Aneurysm ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Bicuspid Aortic Valve ◽

Heart Surgery ◽

Open Heart Surgery ◽

Ascending Aortic Aneurysm

Abstract Background Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (P-MAIVF) is a rare complication of infective endocarditis and aortic valve replacement. Ruptured P-MAIVF and angina due to compression of the coronary arteries are severe complications of this condition. Case presentation We report a case of P-MAIVF that was diagnosed accidentally during a routine checkup. The patient was asymptomatic; however, she had a systolic murmur. She had a history of infective endocarditis, which was treated conservatively without open-heart surgery. In addition, she was diagnosed with aortic valve stenosis, aortic valve regurgitation, bicuspid aortic valve, right coronary artery stenosis, and an ascending aortic aneurysm. She was treated with surgery, which involved patch closure of P-MAIVF with aortic valve replacement, coronary artery bypass grafting, and ascending aorta replacement. After the operation, echocardiography showed no leakage from the P-MAIVF. Conclusions It is necessary to have knowledge of P-MAIVF. Following up cases of infective endocarditis and post-aortic valve replacement using echocardiography is important for both, diagnosing P-MAIVF and preventing serious complications such rupture and angina.

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Emergency aortic valve replacement complicated by unsuspected pheochromocytoma

10.22541/au.160992999.93168998/v1 ◽

2021 ◽

Author(s):

Rihito Tamaki ◽

Manabu Yamasaki ◽

Hiroyuki Nishi ◽

Kunihiko Yoshino ◽

Kohei Abe ◽

...

Keyword(s):

Blood Pressure ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Heart Surgery ◽

Early Recognition ◽

Hypertensive Crisis ◽

Open Heart Surgery ◽

Pressure Change ◽

Pressure Control

A 53-year-old male undergoing emergency aortic valve replacement for infective endocarditis developed a hypertensive crisis early during the operation. Suspecting a pheochromocytoma, intravenous phentolamine was immediately administered, after which the procedure was completed as scheduled. Although quite rare, a pheochromocytoma can be encountered during emergency open heart surgery, thus early recognition of abnormal blood pressure change and appropriate management are important. Here, we present details of blood pressure control mainly by phentolamine use in this case to demonstrate effective management of a hypertensive crisis during emergency cardiac surgery because of a pheochromocytoma.

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Pulmonary Homografts for Aortic Valve Replacement: Long-term Comparison with Aortic Grafts

The Heart Surgery Forum ◽

10.1532/hsf98.20101162 ◽

2011 ◽

Vol 14 (4) ◽

pp. 237 ◽

Cited By ~ 3

Author(s):

Ferdinand Vogt ◽

Anke Kowert ◽

Andres Beiras-Fernandez ◽

Martin Oberhoffer ◽

Ingo Kaczmarek ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Survival Rates ◽

Long Term Results ◽

Rank Test ◽

Aortic Graft ◽

Valve Prostheses ◽

Retrospective Comparative Study

Objective: The use of homografts for aortic valve replacement (AVR) is an alternative to mechanical or biological valve prostheses, especially in younger patients. This retrospective comparative study evaluated our single-center long-term results, with a focus on the different origins of the homografts.Methods: Since 1992, 366 adult patients have undergone AVR with homografts at our center. We compared 320 homografts of aortic origin and 46 homografts of pulmonary origin. The grafts were implanted via either a subcoronary technique or the root replacement technique. We performed a multivariate analysis to identify independent factors that influence survival. Freedom from reintervention and survival rates were calculated as cumulative events according to the Kaplan-Meier method, and differences were tested with the log-rank test.Results: Overall mortality within 1 year was 6.5% (21/320) in the aortic graft group and 17.4% (8/46) in the pulmonary graft group. In the pulmonary graft group, 4 patients died from valve-related complications, 1 patient died after additional heterotopic heart transplantation, and 1 patient who entered with a primary higher risk died from a prosthesis infection. Two patients died from non-valve-related causes. During the long-term follow-up, the 15-year survival rate was 79.9% for patients in the aortic graft group and 68.7% for patients in the pulmonary graft group (P = .049). The rate of freedom from reoperation was 77.7% in the aortic graft group and 57.4% in the pulmonary graft group (P < .001). The reasons for homograft explantation were graft infections (aortic graft group, 5.0%; pulmonary graft group, 6.5%) and degeneration (aortic graft group, 7.5%; pulmonary graft group, 32.6%).Conclusion: Our study demonstrated superior rates of survival and freedom from reintervention after AVR with aortic homografts. Implantation with a pulmonary graft was associated with a higher risk of redo surgery, owing to earlier degenerative alterations.

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Prosthesis-Patient Mismatch Causes a Significantly Increased Risk of Operative Mortality in Aortic Valve Replacement

The Heart Surgery Forum ◽

10.1532/hsf98.2013304 ◽

2014 ◽

Vol 17 (3) ◽

pp. 127 ◽

Cited By ~ 1

Author(s):

Muhammad Shahzeb Khan ◽

Faizan Imran Bawany ◽

Asadullah Khan ◽

Mehwish Hussain

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Operative Mortality ◽

Univariate Analysis ◽

Female Gender ◽

Valve Prosthesis ◽

Predictors Of Mortality ◽

Increased Risk ◽

Urgent Operation

Background: Small aortic prosthesis can lead to prosthesis-patient mismatch (PPM). Implanting such small prosthesis remains a controversial issue. This study was done to investigate whether or not PPM causes an increased operative mortality in aortic valve replacement (AVR).Methods: Two-hundred-two consecutive patients undergoing primary AVR in a tertiary hospital were included. The sample was grouped according to the aortic valve prosthesis size: ?21 mm (small) and >21 mm (standard). The effect of variables on outcomes was determined by univariate and multivariable regression analyses.Results: PPM was found significantly more among patients with AVR ? 21mm (P < 0.0001). Moreover, the likelihood of mortality also was significantly higher in these patients (P < 0.0001). Univariate analysis demonstrated small prosthesis size, urgent operation, PPM, female gender, and NYHA Class IV as significant predictors of mortality. Multivariate regression identified female gender, PPM, and urgent operation as the key independent predictors of mortality.Conclusion: PPM and female gender are significant predictors of mortality. Care should be taken to prevent PPM by implanting larger prosthesis especially in females.

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