Transaxillary access for valve prosthesis – advantages and features

The following are highlights from the new series, Circulation: Cardiovascular Quality and Outcomes Topic Reviews. This series will summarize the most important manuscripts, as selected by the Editor, which have been published in the Circulation portfolio. The objective of this new series is to provide our readership with a timely, comprehensive selection of important papers that are relevant to the quality and outcomes as well as general cardiology audience. The studies included in this article represent the most significant research in the area of valvular heart disease. ( Circ Cardiovasc Quality and Outcomes . 2012;5:-e103.) In recent years, no field of clinical cardiology has experienced a great influx of transformational therapeutic options as has the area of valvular heart disease. Treatment of severe aortic stenosis (AS) has been revolutionized by transcatheter aortic valve replacement (TAVR), which has been shown to improve life expectancy and functional outcomes in patients with inoperable AS1,2 and to have short-term outcomes comparable to surgical aortic valve replacement (AVR) in patients at high perioperative risk.3,4 Analogously, mitral valve disease has been amenable to percutaneous valve replacement,5,6 as well as clipping procedures7 that can substantively reduce severe mitral regurgitation (MR) and improve functional outcomes. Even right-sided heart disease involving valves in pulmonary8,9 and tricuspid10 positions has been treated successfully with endovascular techniques. Yet, even with this growing focus on percutaneous valvular interventions, open surgical techniques remain the dominant treatment strategies and standard of care for most advanced lesions. Surgical valve repair and replacement account for 10% to 20% of all cardiac surgical procedures,11–13 approximately two thirds of which are for AS.11–13 For patients undergoing surgery, there remains considerable debate about risk stratification,14 intraoperative technique,15 and postoperative …

The clinical development of percutaneous heart valve technology: A position statement of the Society of Thoracic Surgeons (STS), the American Association for Thoracic Surgery (AATS), and the Society for Cardiovascular Angiography and Interventions (SCAI)

Current evidence for prosthesis selection: What can we really say?

The Clinical Development of Percutaneous Heart Valve Technology: A Position Statement of The Society of Thoracic Surgeons (STS), the American Association for Thoracic Surgery (AATS), and the Society for Cardiovascular Angiography and Interventions (SCAI)

Totally Thoracoscopic Surgical Resection of Cardiac Myxoma in 12 Patients

An 80-year-old woman was admitted to our institution because of shortness of breath (New York Heart Association grade III) and stable angina pectoris (Canadian Cardiovascular Society [CCS] grade II). Two years ago, the patient had a posterior wall infarction successfully treated by percutaneous coronary intervention and stent implantation. A low-gradient aortic stenosis with an aortic valve area of 1.1 cm2 was also diagnosed but was considered to be clinically insignificant at the time. Because of the progression of symptoms within the last 2 years, a re-evaluation of coronary and aortic valve disease was performed. Coronary angiography revealed a 1-vessel coronary disease with a patent stent in the right coronary artery without any evidence of restenosis. The left ventricular ejection fraction was only moderately impaired (55%). However, the aortic valve area, as determined invasively, had decreased to 0.5 cm2. This was confirmed by echocardiography; the cusps of the aortic valve were calcified and their motion was impaired (Supplemental Data Movie 1). On the basis of these findings, the necessity of an aortic valve replacement was discussed. However, because the patient was anxious and refused conventional aortic valve …

Developmental efforts to achieve percutaneous catheter-based therapies for cardiac valve repair and replacement have advanced rapidly over the past several years. A variety of methods to treat mitral regurgitation (MR) and to replace aortic and pulmonic valves have already been successfully employed in patients. These innovative clinical transcatheter valve therapies were anticipated more than a decade ago by creative experimentalists who helped develop predicate techniques in animal models. For example, in 1992, a catheter-delivered ball-in-cage prosthetic aortic valve was implanted in a canine model by Pavcnik1 and a stent-mounted bioprosthetic valve was placed by Andersen, who used a retrograde transarterial approach in a swine model.2 Clearly, the catheter-based technologies used in clinical studies today in patients with aortic stenosis were derived from the fusion of known successful aortic valve replacement (AVR) surgical devices and adaptive interventional modalities, first studied in experimental animal models. Similarly, approaches for transcatheter treatment of MR have also borrowed heavily from preexisting and accepted surgical techniques, such as the edge-to-edge leaflet coaptation technique and reduction ring mitral annuloplasty.3 Importantly, recognition that the coronary sinus parallels the mitral annulus has spurred unique catheter-based transvenous approaches to treat MR by indirectly reducing mitral annular dimensions.4 Because many of the new percutaneous approaches to valve therapy have been developed by surgeons, a collaboration has emerged between thoughtful surgeons and interventionalists, combining skill sets and experiences to accelerate the developmental pathways of less-invasive transcatheter valve therapies. Growing recognition exists that percutaneous alternatives to surgical therapies are required in some patient subgroups with valvular heart disease. Among patients with either mitral and/or aortic valve disease, an expanding population of elderly patients with significant comorbidities may benefit from traditional surgical methods, but these methods are associated with unacceptable perioperative mortality or prolonged postoperative recoveries. In the EuroHeart Survey …

Recommendations for Evaluation of Prosthetic Valves With Echocardiography and Doppler Ultrasound: A Report From the American Society of Echocardiography's Guidelines and Standards Committee and the Task Force on Prosthetic Valves, Developed in Conjunction With the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the

Thrombolytic Therapy for Obstruction of Mechanical Prosthetic Valves

Unrepairable Infant Mitral Valve: An Unexpected Case of Decompensated Heart Failure.

Objective The prosthesis used for aortic valve replacement (AVR) may be too small in relation to the body size, thus causing valve prosthesis-patient mismatch (PPM) and abnormally high transvalvular pressure gradients. The aim of this study was to evaluate the prevalence of PPM and the impact of PPM on hemodynamic and early mortality after AVR. Methods A total of 292 patients ( 167 males, 125 females; mean age of ( 52.8 ± 14.6 ) years, with ranging 22 - 82 years) who underwent AVR between January 2007 and December 2009 were retrospectively evaluated. Etiologies were: rheumatic in 243 cases, degenerative in 36, congenitally bicuspid aortic valve in 8, and infective endocarditis in 5. Combined operations with AVR including mitral valve replacement ( 172 cases), mitral valve repair (56 cases), tricuspid valve repair (238 cases), and coronary artery bypass grafting (32 cases). The aortic valve prosthesis effective valve orifice area (EOA) was divided by the body surface area (BSA) to obtain the EOA index (EOAI). PPM was then defined as none or mild if EOAI was ＞0.85 cm2/m2, as moderate for 0.65 -0.85 cm2/m2 and as severe for ＜0.65 cm2/m2. The mean flow rate through aortic prostheses and mean transvalvular pressure gradients were measured by color Doppler after AVR. The prevalence of PPM was compared between the different type ( mechanical or bioprosthetic valve) and the different size ( ＞21 mm or ≤21 mm) of aortic valve prostheses. The effect of PPM on hemodynamic and early mortality after AVR was also studied. Results 219 patients received mechanical AVR and 73 bioprosthetic AVR. Moderate PPM occurs more frequently with bioprosthetic AVR (6.25% versus 48.22%, P ＜0. 01 ). Bigger than 21mm prostheses were used in 191 patients and ≤21 mm prostheses in 101 patients. The prevalence of PPM was 13.61% and 33.66% respectively ( P ＜ 0. 05 ). According to the EOAI of the aortic valve prostheses,all the 219 patients were divided into two group, PPM group and non-PPM group. The mean flow rate of aortic prostheses and mean transvalvular pressure gradients in PPM group was significantly higher than those in non-PPM group [(2.66 ± 0.87 ) m/s versus ( 1. 58 ± 0.47 ) m/s, ( 26.50 ± 6.25 ) mm Hg versus ( 16.75 ± 3.46 ) mm Hg, P ＜ 0. 01]. There were 9 deaths during early period of operation, and the total 30-day operative mortality was 3.08%. The postoperative early mortality of PPM group and non-PPM group was 6.67% and 2.16% respectively, and there were significantly difference between the two group ( P ＜ 0. 05 ). Conclusion Prosthesis-patient mismatch is common present after AVR, especially in patients with bioprostheses and small size valve prostheses. PPM has a negative impact on postoperative hemodynamic and early mortality. PPM results in higher transvalvular pressure gradients and higher early mortality. Key words: Heart valre prosthesis implantation; Heart valve, prosthesis; Cardiac surgical procedures

The clinical development of percutaneous heart valve technology: A position statement of the Society of Thoracic Surgeons (STS), the American Association for Thoracic Surgery (AATS), and the Society of Cardiovascular Angiography and Intervention (SCAI)

PII: S0003-4975(99)01307-7

PII: S0003-4975(99)00723-7

Effects of Preoperative Intravenous Erythropoietin Plus Iron on Outcome in Anemic Patients After Cardiac Valve Replacement