Biological Valve Research Articles

Early Outcomes of Intuity Rapid Deployment Aortic Valve Replacement Compared With Conventional Biological Valves in Japanese Patients.

This study aimed to elucidate the short-term surgical outcomes and hemodynamics of the Intuity valve compared to the standard bioprosthesis in Japanese patients. Among the 307 consecutive patients who underwent aortic valve replacement (AVR) between February 2019 and March 2021, the Intuity valve was implanted in 95 patients (Intuity group) and a conventional stented bioprosthesis was implanted in 193 patients (conventional group). After propensity score matching, there was no significant difference in in-hospital mortality between the Intuity (n=2, 3%) and conventional groups (n=0, P=0.490). Operation, cardiopulmonary bypass, and aortic cross-clamping times were significantly shorter in the Intuity group. Although the effective orifice area index, trans-prosthetic mean pressure gradient, and peak velocity were similar between the 2 groups at 1 week postoperatively, the Intuity group showed a better mean pressure gradient and peak velocity at 1 year postoperatively. Complete atrioventricular block requiring permanent pacemaker implantation developed in 2 patients (3%) in the Intuity group and none in the conventional group (P=0.476). Mild or greater paravalvular leakage was present in 8 patients (13%) in the Intuity group and 2 patients (3%) in the conventional group (P=0.095). AVR using the Intuity valve in Japanese patients is satisfactory, with a better valve performance and a low incidence of complete atrioventricular block at 1 year postoperatively.

Polyphenol based hybrid nano-aggregates modified collagen fibers of biological valve leaflets to achieve enhanced mechanical, anticoagulation and anti-calcification properties

Glutaraldehyde (Glut)-crosslinked porcine pericardium and bovine pericardium are mainly consisted of collagen and widely used for the preparation of heterogenous bioprosthetic heart valves (BHV), which play an important role in the replacement therapy of severe valvular heart disease, while their durability is limited by degeneration due to calcification, thrombus, endothelialization difficulty and prosthetic valve endocarditis. Herein, we develop a novel BHV, namely, TPly-BP, based on natural tannic acid and polylysine to improve the durability of Glut crosslinked bovine pericardium (Glut-BP). Impressively, tannic acid and polylysine could form nanoaggregates via multiple hydrogen bonds and covalent bonds, and the introduction of nanoaggregates not only improved the mechanical properties and collagen stability but also endowed TPly-BP with good biocompatibility and hemocompatibility. Compared to Glut-BP, TPly-BP showed significantly reduced cytotoxicity, improved endothelial cell adhesion, a low hemolysis ratio and obviously reduced platelet adhesion. Importantly, TPly-BP exhibited great antibacterial and in vivo anti-calcification ability, which was expected to improve the in vivo durability of BHVs. These results suggested that TPly-BP would be a potential candidate for BHV.Graphical abstract

Degeneration of biological heart valve grafts in a rat model of superoxide dismutase-3 deficiency.

While oxidative stress is known as key element in the pathogenesis of atherosclerosis and calcific aortic valve disease, its role in the degeneration of biological cardiovascular grafts has not been clarified yet. Therefore, the present study aimed to examine the impact of oxidative stress on the degeneration of biological cardiovascular allografts in a standardized chronic implantation model realized in rats exhibiting superoxide dismutase 3 deficiency (SOD3(-) ). Rats with SOD3 loss-of-function mutation (n=24) underwent infrarenal implantation of cryopreserved valved aortic conduits, while SOD3-competent recipients served as controls (n=28). After a follow-up period of 4 or 12 weeks, comparative analyses addressed degenerative processes, hemodynamics, and evaluation of the oxidative stress model. SOD3(-) rats presented decreased circulating SOD activity (p=.0079). After 12 weeks, 58% of the implant valves in SOD3(-) rats showed regurgitation (vs. 31% in controls, p=.2377). Intima hyperplasia and chondro-osteogenic transformation contributed to progressive graft calcification (p=.0024). At 12 weeks, hydroxyapatite deposition (p=.0198) and the gene expression of runt-related transcription factor-2 (Runx2) (p=.0093) were significantly enhanced in group SOD3(-) . This study provides the first in vivo evidence that impaired systemic antioxidant activity contributes to biological cardiovascular graft degeneration.

Chitosan/hyaluronic acid polyanion bilayer applied from carbon acid as an advanced coating with intelligent antimicrobial properties for improved biological prosthetic heart valves

The tightly bonded shielding coating on biomatrix significantly enhances the functionality of medical devices, bioprostheses in particular. In our work we have obtained a polyelectrolyte coating on a biomatrix by sequentially depositing chitosan and hyaluronic acid (HA) from solutions in carbonic acid under pressure. This approach makes it possible to obtain hybrid biomatrix with a firmly bonded polymer screen due to the electrostatic bonding of polyions. High-precision analysis using a tritium label shows a 3-fold increase in quantity of HA in carbonic acid under pressure compared to the conventional method. The presence of the chitosan layer increases the HA adsorption by 15–20 % due to electrostatic interaction of differently charged polymers. Antimicrobial results show the possibility of implementing an induced antimicrobial response, due to the lysis of the upper layer of the coating (HA) and the release of antimicrobial agents in the case of growth of pathogens on the bioprosthesis.

Long-Term Outcomes Stratified by Age in Patients with a Mechanical versus Biological Mitral Valve Replacement.

Objectives: Balancing anticoagulation and reoperation risks determines prostheses choice (mechanical/biological) for mitral valve replacement. We aimed to re-evaluate the outcomes after biological versus mechanical mitral valve replacement. Methods: We compared long-term benefits and risks of mechanical and biological prostheses in 2056 patients (52% men, 48% women; 65.4 ± 12.1 years) who underwent mitral valve replacements between 1993–2017, in a retrospective single-centre study. Data sources included prospective institutional database, social registry, general practitioner data and follow-up questionnaire. Patients were stratified by age: < = 39 y (n = 82), 40–49 y (n = 164), 50–59 y (n = 335), 60–69 y (n = 593), 70–79 y (n = 743) and > = 80 y (n = 139). Long-term outcomes (mortality, reoperations, bleeding) were analysed. Results: Altogether, 1308 mechanical (53% men, 47% women; 61.5 ± 11.7 years) and 748 biological (50% men, 50% women; 72.3 ± 9.6 years) valves were implanted. The reason for valve replacement was stenosis in 162, insufficiency in 823 and combined in 323 cases for mechanical, while it was 46, 567 and 135 for biological valves, respectively. Overall cumulative survival was higher with mechanical prosthesis (mean: 139 ± 4 vs. 102 ± 5 months, 10 y: 55% vs. 33%, p < 0.0001). Subgroup analysis revealed higher survival among patients receiving mechanical prosthesis up to 60 years (< = 39 y p = 0.047, 40–49 y p < 0.0001, 50–59 y p = 0.001). In patients 60–69 years, overall survival did not differ; however, in survivors beyond 8 years, mechanical prosthesis showed improved survival (p = 0.014). While between 70–79 years survival was nearly identical, for above 80 years, patients had a higher survival with biological prosthesis (p = 0.014). Conclusion: The present data demonstrated a higher survival of mechanical prosthesis in a wide range of patients after mitral valve replacement.

Embolization of Aortopulmonary Collateral Artery Cooperate with Valved Conduit Attached to the Right Ventricular Outflow Tract for Patient After Tetralogy of Fallot Repair: A One-Stop Procedure.

We describe a one-stop procedure for aortopulmonary collateral artery (APCA) and postoperative complications of Tetralogy of Fallot (TOF). Postoperative complications of TOF include right ventricular outflow tract stenosis, pulmonary valvular annular stenosis, pulmonary regurgitation, and aortopulmonary artery stenosis. The one-stop procedure was defined as after APCA embolization. The heart continued to function under cardiopulmonary bypass during median sternotomy to reconstruct the right ventricular outflow tract with a valved conduit and replace the aortopulmonary artery. A biological valved was sewed within the valved conduit in an artificial blood vessel in vitro and subsequently was used in the procedure and achieved significant results.

Early results of rapid-deployment aortic prosthesis in multivalvular surgery – a propensity score matching

Abstract Background Multivalvular surgery (MV) requires prolonged extracorporeal circulation (ECC) and aortic cross-clamp times (X-Ao). Rapid-deployment aortic prosthesis (RD-AV) allow lower ECC and X-Ao times in isolated aortic valve surgery (AVR), but have not been studied in MV surgery. Purpose To determine if RD-AV use influences early outcomes when compared to biological stented or mechanical aortic valves in MV surgery. Methods Retrospectively collected pre, intra and immediate post-operatory data on all MV adult patients with AVR operated on our Department from January 2016 to February 2022. Bentall surgery and aortic dissection patients were excluded. A propensity score matching (PSM) of patients receiving RD-AV (Group A) compared to patients with non-RD-AV (Group B) was performed using sex, age, Euroscore II, type of surgery (involved valves, CABG, ascending aortic replacement), active endocarditis, ventricular function and redo surgery. After PSM, we compared outcomes until death or discharge. Normal distribution of samples was tested using the Kolmogorov-Smirnov test. Normal data was analysed with unpaired t-testing and non-normal data with non-parametric Mann Whitney U test. Categorical data were analysed with Fisher test. A significance level of p&amp;lt;0.05 was accepted. Results 205 patients received non-RD-AV and 58 patients RD-AV. After PSM, 57 pairs of patients were obtained. Sex, BMI, Euroscore II, age, redo surgery, insulin dependent DM, baseline creatinine, left ventricle ejection fraction, right ventricle dysfunction, pulmonary artery systolic pressure, and active endocarditis were similar in both groups. Intra-operatory, RD-AV valves (Group A) were associated with shorter surgery duration (167.3±52 vs 206.6±91 min, p=0.005), shorter ECC duration (89.5±36.5 vs. 118.9±56.5 min, p=0.002), and aortic X-clamp time (71.6±28 vs. 98.9±38.2 min, p&amp;lt;0.001). No differences were found between both groups A vs. B in ventilation time (1270±1911 vs. 2428±5627 min, p=0.59), inotropic support (113±178 h vs. 85±101 h, p=0.38), transfusion of red cells units (1.1±1.6, vs. 1.2±1.7, p=0.73), Fresh frozen plasma units (0.86±1.9, vs. 0.77±1.8, p=0.77), platelet pools (0.79±1.0 vs. 0.7±0,9, p=0.67), fibrinogen (0.77±1.5 vs. 0.75±1.4 g, p=0.98), intra-aortic balloon pump use (5 vs. 12 patients, p=0.11), chest drain output (804±656 vs. 825±992 ml, p=0.69), new-onset dialysis (10 vs. 10 patients, p=1.0), new-onset atrial fibrillattion (10 vs 13 patients, p=0.6) and permanent pacemaker implantation (8 vs. 3 patients, p=0.20). Total ICU stay (9.25±21 vs. 4.5±4 days, p=0.3), hospital stay (14.4±26 vs. 10.1±13 days, p=0.52) and intra-hospital mortality (7 vs 9 patients, p=0.79) were also similar. Conclusion Despite shorter surgery duration, ECC duration and aortic X-clamp duration, RD-AV have similar early outcomes when compared with non-RD-AV in multivalvular surgery. Funding Acknowledgement Type of funding sources: None.

Outcomes in pregnant women with valvular heart disease from sub Saharan Africa transferred to a developed nation. A distinct care model

Abstract Background Pregnant women with valvular heart disease (VHD) in African countries still bear a disproportionate burden of maternal morbidity and mortality, due to the reduced accessibility to health care and the scarcity of skilled professionals. It is unclear if outcomes would be improved by care-delivery model changes. Purpose We performed a clinical audit of African pregnant women with VHD who were transferred for their care from five countries to our cardio-obstetrics unit, during a twenty-year period, through a memorandum of agreement of international cooperation. Methods A retrospective analysis of 81 pregnancies (P) in 45 African women with VHD (median age 24, IQR 22–29 years) from 2001 to 2020. The main outcome measures were major maternal complications and perinatal outcome. Results History of rheumatic heart disease was determined in 74.1% of the P. Most women were in NHYA I or II before P (79.0%), 43.2% had previous cardiac medication and 60.5% were anticoagulated (33.3% with acenocoumarol and 27.2% with warfarin). 59.3% of P had at least one valvular prosthesis, including 38 mechanical prosthetic valve (MPV) and 10 biological valves. 22.2% had prior surgical or percutaneous VHD correction, excluding prosthesis implantation. At baseline, impaired left ventricular ejection fraction was found in 12.3%. Previous arrhythmic event, stroke or infectious endocarditis were found in 12.3%, 8.6% and 6.2% of P, respectively. During P, deterioration in NYHA functional class occurred in 42.0% and 9.9% required initiation or intensified cardiac medication. For MPV, 51% maintained a vitamin K antagonist, 15.7% used LMWH from 6 to 12th weeks and 9.8% used LMWH throughout P. Valve thrombosis occurred in 4 women (4.9% of P), with one maternal death in a patient with double MPV. Hemorrhagic complications happened in 8.6% of P, all anticoagulated, in immediate postpartum or puerperal period. The 81 P resulted in 56 live births (69.1%), with a medium birth weight of 3026±471g. Delivery by caesarean section was performed in 28.3% of newborns. The incidence of miscarriage was 23.5% and fetal malformations occurred in 14.8%, with warfarin embryopathy in 4 cases. In univariate analysis, the presence of valvular protheses (p=0.001), and anticoagulation (p=0.001) were related to unsuccessful P. In multivariate analysis, VKA therapy was the unique independent predictor of unsuccessful P (p=0.048). Conclusion With the multidisciplinary care provided, pregnancy was relatively well tolerated and successful for women transferred from sub–Saharan Africa. However, the presence of a valvular prothesis is associated with unsuccessful pregnancy even in a developed nation. Efforts other than the implantation of a MPV should be pursued vigorously in sub Saharan Africa. Funding Acknowledgement Type of funding sources: None.

Technical features of a self-expandable prosthetic valve for the treatment of pulmonary valve disease

Background. Balloon-expandable prostheses authorized for transcatheter pulmonary valve replacement in the Russian Federation have a barrel-shaped frame, which requires pre-stenting of a native right ventricular outflow tract or a conduit. This increases procedure duration, complicates implantation technique, and increases operation costs. Aim. To develop a self-expandable pulmonary valve model for transcatheter replacement and prepare it for preclinical trials.Methods. The model of a self-expandable pulmonary valve bioprothesis for transcatheter replacement made of nitinol was developed. The leaflets and the lining of the frame were made of porcine pericardium and assembled manually. Radial force testing was performed; valve loading into the delivery system was also tested.Results. According to the results of the tests, the valve biomaterial and the suture sites were not damaged after compression. In 2022, initial preclinical tests are scheduled to determine viability of the implanted valves at 6 and 12 months after surgery, and the rate of calcification for this observation period is to be assessed as well.Conclusion. By optimizing the design of the support frame, we improved the transcatheter model of the biological valve with satisfactory results at the initial stage of preclinical trials. Received 22 April 2022. Revised 5 May 2022. Accepted 11 May 2022. Funding: This work is supported by a grant of the Russian Science Foundation (project No. 21-75-10041). Conflict of interest: Authors declare no conflict of interest. Contribution of the authorsConception and study design: K.A. Rzaeva, T.P. Timchenko, A.N. Arkhipov, N.R. NichayData collection and analysis: A.V. Voitov, N.R. NichayDrafting the article: K.A. Rzaeva, A.V. GorbatykhCritical revision of the article: I.Yu. Zhuravleva, I.A. Soynov, A.V. Bogachev-ProkophievFinal approval of the version to be published: K.A. Rzaeva, T.P. Timchenko, I.Yu. Zhuravleva, A.N. Arkhipov, A.V. Gorbatykh, A.V. Voitov, N.R. Nichay, A.V. Bogachev-Prokophiev, I.A. Soynov

Comparison of hemodynamics in biological surgical aortic valve replacement and transcatheter aortic valve implantation: An in-silico study.

In aortic valve replacement (AVR), the treatment strategy as well as the model and size of the implanted prosthesis have a major impact on the postoperative hemodynamics and thus on the clinical outcome. Preinterventional prediction of the hemodynamics could support the treatment decision. Therefore, we performed paired virtual treatment with transcatheter AVR (TAVI) and biological surgical AVR (SAVR) and compared hemodynamic outcomes using numerical simulations. 10 patients with severe aortic stenosis (AS) undergoing TAVI were virtually treated with both biological SAVR and TAVI to compare post-interventional hemodynamics using numerical simulations of peak-systolic flow. Virtual treatment procedure was done using an in-house developed tool based on position-based dynamics methodology, which was applied to the patient's anatomy including LVOT, aortic root and aorta. Geometries were automatically segmented from dynamic CT-scans and patient-specific flow rates were calculated by volumetric analysis of the left ventricle. Hemodynamics were assessed using the STAR CCM+ software by solving the RANS equations. Virtual treatment with TAVI resulted in realistic hemodynamics comparable to echocardiographic measurements (median difference in transvalvular pressure gradient [TPG]: -0.33 mm Hg). Virtual TAVI and SAVR showed similar hemodynamic functions with a mean TPG with standard deviation of 8.45 ± 4.60 mm Hg in TAVI and 6.66 ± 3.79 mm Hg in SAVR (p=0.03) while max. Wall shear stress being 12.6 ± 4.59 vs. 10.2 ± 4.42 Pa (p=0.001). Using the presented method for virtual treatment of AS, we were able to reliably predict post-interventional hemodynamics. TAVI and SAVR show similar hemodynamics in a pairwise comparison.

Fifteen-year experience with the Tirone David procedure in bicuspid aortic valve: A safe option.

We evaluated shortand midterm outcomes with use of aortic valve-sparing root replacement to treat bicuspid aortic valves (BAVs). From December 2007 to January 2022, all patients with BAVs who underwent aortic root replacement using Tirone's procedure were included. This study based on department database information for retrospective and follow-up data. Among 51 adults undergoing aortic root replacement using Tirone's procedure, the mean age was 47.4 ± 12.5 years, and most were men (92.2%). Three presented with a dysmorphic syndrome and one had Marfan's syndrome. All patients were alive at 30 days, and as of January 2022, 45 were alive, two were lost to follow-up, and there were four noncardiac deaths. Two patients had infectious endocarditis and needed a Bentall's procedure. One patient had a double biologic valve replacement in the context of severe mitral insufficiency with moderate aortic stenosis at 4.5 years postprocedure. Echocardiographic follow-up showed a left ventricular ejection fraction of 63 ± 7% (n = 36), Vmax 2 ± 0.6 m/s (n = 17), and a mean gradient of 9.4 ± 5.4 mmHg (n = 27). No patients had grade 3 or 4 aortic regurgitation, one patient had grade 2, and four had grade 1. Tirone's procedure is an option for BAV surgery, with good safety and outcomes, especially in younger patients.

Massive Thrombosis of Mitral Bioprosthesis Due to SARS-CoV-2 Infection

Thromboembolic events have been reported as frequent and fearsome complications in patients affected by SARS-CoV-2 infection. Patients undergoing cardiac valve replacement exhibit an increased risk of valve thrombosis, even with prosthetic biological valves, and especially in the first period after surgery. The management of these patients is challenging and requires prompt interventions. We report the case of a young woman infected by SARS-CoV-2 three months after double cardiac valve replacement that developed a massive prosthetic biological valve thrombosis despite optimal anticoagulant therapy.

Early pacemaker insertion after aortic valve replacement with an Edwards Intuity sutureless valve

BackgroundPostoperative conduction disorders are serious adverse events in patients undergoing aortic valve replacement, and may prolong the duration of hospitalization and require pacemaker insertion. AimOur aim was to evaluate the rate of pacemaker insertion after implantation of an Edwards Intuity sutureless aortic valve (Edwards Lifesciences, Irvine, CA, USA) compared with a standard surgical bioprosthesis. MethodsThis retrospective single-centre study included patients who underwent aortic valve replacement with an Intuity sutureless aortic valve or a standard bioprosthetic valve between 4 June 2014 and 27 June 2016. The main outcome criterion was the rate of postoperative pacemaker insertion. Secondary outcome criteria included the rate of new conduction disorders, the rate of atrial arrhythmia or paroxysmal conduction disorders, mortality and duration of hospital stay. ResultsNinety-three patients received an Intuity sutureless aortic valve (median age 76 years, interquartile range 71–80 years), and 176 were implanted with a standard biological aortic valve (median age 73 years, interquartile range 68–79 years; P=0.007). The rate of postoperative pacemaker insertion, after adjustment, was 22.44% in the Intuity group and 5.66% in the standard aortic valve group (P=0.030). The main indications for postoperative pacemaker insertion were complete atrioventricular block and left bundle branch block with prolongation of the H-V interval. The rate of new postoperative left bundle branch block conduction disorders was significantly higher in patients implanted with an Intuity valve (odds ratio 5.28, 95% confidence interval 1.59 to 23.05; P=0.012). ConclusionHigher rates of pacemaker insertion and new conduction disorders were observed in patients implanted with an Intuity sutureless bioprosthesis compared with those who received a standard surgical aortic valve.

Method for non-invasive assessment of the structure of a heart valve bioprosthesis

Background. The study of explanted heart valve bioprostheses is a valuable source of information about the destructive processes in their components that develop as a result of prolonged contact with the recipient’s body. An analysis of the morphology, staging and degree of involvement of various valve prosthesis materials in the prevalence of pathological processes – calcification, mechanical damage, growth of the connective tissue capsule, is the basis for developing potential methods for increasing the service life of these products and reducing the risk of re-interventions. The aim of the study was to evaluate the potential of computed microtomography to analyze the internal structure of a biological prosthetic heart valve explanted due to dysfunction. Material and methods. In this work, we investigated the prevalence of pathological mineralization of the PeriCor bioprosthesis, explanted as a result of the developed dysfunction of the leaflet apparatus with a clinical picture of grade 2B prosthetic insufficiency. The material was described macroscopically, after which it was subjected to high-resolution computed microtomography. In the structure of the sample, X-ray dense areas of pathological mineralization were identified and described, and the volume of the material involved in calcification was assessed. Results. It was shown that the main pathological changes that led to prosthetic dysfunction were degenerative changes in the biomaterial with signs of calcification, thickening and rupture of the leaflets. It was quantitatively determined that the areas of radiologically dense inclusions (calcifications) occupy 11.1 % of the volume of the material. It has been established that the described areas are associated with the sheathing of the frame and with the elements of the suture material used in the production of this bioprosthesis. Conclusion. The method of non-destructive analysis of the internal structure of altered materials of a biological prosthesis studied in this work has demonstrated the possibility of а qualitative and quantitative assessment of areas of pathological mineralization, their distribution and connection with other processes leading to the development of prosthetic dysfunction. The method makes it possible to visualize macro- and microsites of calcification and can become a valuable tool to complement existing approaches to the study of explanted bioprostheses.

Is It The Blame of The Occluder? Two Cases of Massive Thrombosis in the Left Atrium in Patients with Bioprosthetic Mitral Valve and the Presence of the Occluder Implanted Percutaneously

In the following case report, we present two clinical cases of patients after valvular intervention and percutaneous occluder implantation into the left atrium. The first patient is a 68-year-old male admitted to the Department of Cardiology because of Non-ST-Elevation Myocardial Infarction (NSTEMI). He had a medical history of paroxysmal atrial fibrillation and implantation of a biological mitral prosthesis due to severe secondary mitral regurgitation. Due to contraindications to the chronic use of anticoagulants, the patient underwent percutaneous closure of the left atrium appendage. The second patient is an 80-year-old man with a history of permanent atrial fibrillation. 8 years ago, the patient underwent percutaneous atrial septal defect type II (ASD II) closure with and the Amplatz occluder. A year later, the patient underwent Coronary Artery Bypass Graft (CABG) and biological mitral valve implantation due to multivessel coronary disease accompanied by severe mitral regurgitation. In both patients, Transthoracic Echocardiogram (TTE) showed massive thrombosis in the left atrium.

Randomized controlled trial between conventional versus sutureless bioprostheses for aortic valve replacement: Impact of mini and full sternotomy access at 1-year follow-up

BackgroundThe present study is a sub-analysis of the multicenter, randomized PERSIST-AVR trial (PERceval Sutureless Implant versus Standard Aortic Valve Replacement) comparing the in-hospital and 1-year results of sutureless versus conventional stented bioprostheses in isolated surgical aortic valve replacement (SAVR) within two different surgical approaches: mini-sternotomy (MS) and full-sternotomy (FS). MethodsA total of 819 patients (per-protocol population) underwent preoperative randomization to sutureless or stented biological valve at 47 centers worldwide. Sub-analysis on isolated SAVR was performed. Results were compared between sutureless and stented within the two different surgical approaches. Results285 patients were implanted with Perceval (67% in MS) and 293 with stented valves (65% in MS). Sutureless group showed significantly reduced surgical times both in FS and MS. In-hospital results show no differences between Perceval and stented valves in FS, while a lower incidence of new-onset of atrial fibrillation (3.7% vs 10.8%) with Perceval in MS. After 1-year, use of sutureless valve showed a significant reduction of MACCE (5.2% vs 10.8%), stroke rate (1.0% vs 5.4%), new-onset of atrial fibrillation (4.2% vs 11.4%) and re-hospitalizations (21.8 days vs 47.6 days), compared to stented valves but presented higher rate of pacemaker implantation (11% vs 1.6%). ConclusionsSutureless bioprosthesis showed significantly reduced procedural times during isolated SAVR in both surgical approaches. Patients with sutureless valves and MS access showed also better 1-year outcome regarding MACCEs, stroke, re-hospitalization and new-onset atrial fibrillation, but presented a higher rate of permanent pacemaker implantation compared to patients with stented bioprosthesis.

Analysis of Clinical Features and Outcomes of Infective Endocarditis with Very Large Vegetations: A Retrospective Observational Study from 2016 to 2022.

Cases of infective endocarditis (IE) with 30 mm vegetations are rare and are associated with high mortality. Clinical experience, clear therapeutic standards, and outcome evidence about these cases are still lacking. Detailed clinical data from patients suffering from IE complicated with 30 mm vegetations were collected from a hospital medical record system. Age- and sex-matched IE cases with 10-20 mm vegetations were used as a control group. Twenty-two patients with 30 mm IE vegetations confirmed by biopsy and transthoracic echocardiography (TTE) were included. Thirteen (59.0%) patients had basic cardiac diseases, mainly congenital heart disease (CHD), rheumatic heart disease, and device-related issues. Fever (81.8%), heart murmur (86.4%), heart failure (86.4%), and embolism (50.0%) were common clinical manifestations and complications. TTE showed the diameter of vegetations was 34.5 (30.0-39.8) mm. The vegetations were usually accompanied by severe valvular regurgitation and pulmonary hypertension, and were most often located in the mitral valve (38.4%). Laboratory examinations indicated anemia, hypoalbuminemia, heart failure and inflammation. The rate of positive blood culture was 68.2%. Streptococcus viridans was the most frequent pathogen (26.7%). All individuals underwent vegetectomy and valve replacement or repair surgery, within 2 days of diagnosis. Compared with 10-20 mm vegetations group, 30 mm vegetations group had more complicated basic cardiac diseases, more special microbial infection, higher levels of procalcitonin (PCT) and D-dimer, more common heart failure and embolism. They received more biological valve replacements, and had longer intensive care unit length of stay (ICU-LOS). A few patients developed significant postoperative adverse events, including intracerebral hemorrhage (ICH), septic shock, and new symptomatic thrombosis. Re-exploratory thoracotomy was performed in two cases. All patients survived during 6-month follow-up without IE recurrence in 30 mm vegetations group, while there was one death and one recurrence in the 10-20 mm vegetations group. For IE complicated with 30 mm vegetations, clinical characteristics are diverse and vegetations on TTE are prone to misdiagnosis as thrombus or tumors. This article also emphasizes the use of 30 mm IE vegetations as an independent indication for early surgery to improve prognosis.

First CARMAT implantation in Italy: A Nurse's Experience

Abstract Funding Acknowledgements Type of funding sources: None. Main funding source(s): Anyone Introduction CARMAT is a new fully implantable device that simulates heart function. CARMAT has three characteristics that allow a physiological simulation that is at the top of biomedical engineering: it is blood-compatible for the use of bovine pericardium; it is pulsatile because it has hydraulic pumps that mimic systole and diastole; it is capable of self-regulating with the physiological needs of the patient. CARMAT has four biological valves that allow the intake of acetylsalicylic acid avoiding the use of warfarin and continuous blood draw. CARMAT also has two hybrid membranes with an internal part formed by bovine pericardium and an external polyurethane membrane; CARMAT has self-regulation sensors that adapt the system to the patient's efforts. The operation is relatively simple because the rollers placed inside move the silicondressingstely and so it pushes the walls creating systole and diastole not synchronously as it normally happens but asynchronously, one ventricle at a time. Objectives Evaluation of the patient's hemodynamics, monitoring of vital parameters, dressings of the drive-line and psychological state. Materials and methods Training in the field by the manufacturer due to the absence of material in literature. Outcome and Discussion Since it was the first CARMAT implantation in Italy , we tried to combine experience with the clinical practice of other artificial hearts. The patient was weaned from anesthesia early and extubated; the patient did not show neurological damage. Psychologically, the artificial heart was accepted without any problems by the patient, the drive line had no infections and the patient was discharged quickly. Conclusions The Carmat system appears to be the one that best simulates the physiology of the heart because it involves fewer complications than other artificial hearts. This device is used as a brige to transplant, but research and continuous studies tend to transform it as a therapy to end for patients who leave the transplant list and therefore the possibility of having a heart transplant.

Comparative study on Sichuan yak pericardium and Australian cattle pericardium

Currently, as the key raw material of artificial biological heart valve, bovine pericardium is mainly depend on import and has become a "bottleneck" challenge, greatly limiting the development of domestic biological heart valve. Therefore, the localization of bovine pericardium is extremely urgent. In this study, the pericardium of Sichuan yak was compared with that of Australian cattle in terms of fundamental properties and anti-calcification performance. The results demonstrated that the appearance and thickness of yak pericardium were more advantageous than the Australian one. Sichuan yak pericardium and Australian cattle pericardium had comparable performance in shrinkage temperature, mechanical test and anti-calcification test. This study preliminarily verifies the feasibility of substitution of Australian cattle pericardium by Sichuan yak pericardium and promotes the progression of bovine pericardium localization with data support.

Therapeutic options in the treatment of infectious endocarditis of an implantable cardiac device lead

Right-sided endocarditis, and endocarditis of the tricuspid valve in particular, is a relatively uncommon condition, encountered in approximately 5 to 10 percent of all cases of infectious endocarditis (IE). The recent increase in the prevalence of right-sided IE is attributed to intravenous drug abuse as well as the increased utilization of implantable cardiac devices such as pacemakers, implantable cardioverter-defi brillators, and cardiac resynchronization therapy devices. These cases pose signifi cant therapeutic challenges, especially when right-sided devices are involved. We present a case of 45-year-old male patient with proven IE with involvement of the tricuspid valve and implantable&amp;nbsp;cardiac device lead and demonstrate the results of an antibacterial treatment and surgical interventions carried out in two steps &amp;ndash; explanation of the lead of the implantable cardiac device, excision of the tricuspid valve, and implantation of an epicardial implantable device; subsequent tricuspid valve replacement with mechanical valve, surgical revascularization, and fi nally replacement of the thrombosed mechanical valve with a biological valve. The optimal preoperative management and the following comprehensive surgical intervention resulted in resolution of IE as it has been demonstrated by the lack of recurrence of systemic infl ammatory response syndrome and no further hospitalisations due to cardiovascular events.