Bioprosthetic Valve Research Articles

Polymeric artificial heart valves derived from modified diol-based polycarbonate polyurethanes

A series of polycarbonate silicone polyurethanes (SiPCUs) have been synthesized to develop elastomers with the mechanical properties, biostability, and biocompatibility required for artificial heart valve manufacturing. In these SiPCUs, the polar functional group 4,4′-dicyclohexylmethane diisocyanate (HMDI) was incorporated into the soft segment 1,6-poly (hexamethylene carbonate) diol (PCDL) to form the modified macromolecular diol, PCDL-HMDI-PCDL. The hard segment consisted of HMDI and the chain extenders 1,4-butanediol and 1,3-bis(4-hydroxybutyl)-1,1,3,3-tetramethyl disiloxane (BHTD). The synthesized PHC-PCUB improves the excessive microphase separation caused by the introduction of PDMS. This material possesses good physicochemical properties, long-term oxidative degradation stability, and comparatively low mechanical performance loss after degradation. Compared to the commercially available bioprosthetic heart valve (BHV) material Glut-PP, PHC-PCUB demonstrated enhanced biocompatibility, good thromboresistant properties, less calcification, and higher endothelial cell adhesion. Furthermore, valve prototypes fabricated with PHC-PCUB showed improved hemodynamic performance under various simulated conditions, highlighting the potential of PHC-PCUB as an advanced material for valve leaflets. Statement of SignificanceArtificial heart valves are crucial for treating valve diseases, and polyurethane-based valves present a promising alternative due to their durability, strong biocompatibility, and customizable properties. This study improves the biostability and post-degradation mechanical properties of siloxane polyurethanes by reducing the content of polydimethylsiloxane (PDMS) and adding modified diol (PCDL-HMDI-PCDL). By integrating hexamethylene diisocyanate (HMDI) and chain extenders, we developed polycarbonate siloxane polyurethanes (SiPCUs) that improve phase mixing, mechanical strength, and oxidative stability. These SiPCUs also exhibit good thromboresistance and calcification resistance, low cytotoxicity, and promote cell adhesion, positioning them as highly promising materials for heart valve leaflets, effectively addressing the limitations of current mechanical and bioprosthetic valves.

Outcomes of Surgical Valve Replacements for Radiation-Induced Valvulopathy

Objective(s)Cancer patients who receive radiation therapy to the thorax often develop radiation-induced heart disease (RIHD) decades later. Prior chest radiation is associated with elevated perioperative risk of complications and mortality following cardiac surgery. Whether the type of valve (mechanical vs. bioprosthetic) used affects outcomes in patients with RIHD is unknown. MethodsThis retrospective review analyzed the characteristics and post-operative outcomes of patients with a prior history of chest radiation for Hodgkin or non-Hodgkin lymphoma who underwent surgical valve replacement at a single institution between 2000 and 2021. Both 30-day peri-operative outcomes and long-term survival were assessed. ResultsMechanical valve patients tended to be younger, have more valves replaced, and have undergone prior coronary artery bypass grafting (CABG) than bioprosthetic valve recipients. Valve type alone did not alter perioperative complications or overall survival. Median survival was 11.0 years in mechanical and 10.9 years in bioprosthetic valve patients (P = 0.930). Twelve patients underwent valve reinterventions (6 mechanical, 6 bioprosthetic), and three underwent transplant. Single valve (AV or MV) recipients fared better with median survival of 13.3 years compared to 6.2 years in those who underwent combined AVR+MVR (P<0.0001). ConclusionsPatients with RIHD who undergo surgical valve replacement have similarly suboptimal short- and long-term outcomes regardless of mechanical vs. bioprosthetic valve type. Those who required combined aortic and mitral valve replacement had especially high 10-year overall mortality. Further investigation in a larger dataset including transcatheter approaches is warranted.

Initial Findings Concerning the Latest Self-expandable Evolut FX Valve: A Report Using OCEAN-TAVI Registry Data

Data concerning the clinical effect of the latest-generation self-expandable transcatheter heart valve (Evolut FX) remain limited. We aimed to assess the in-hospital outcomes of 3 bioprosthetic valves (Evolut EPO, PRO+, and FX). We analyzed data from a Japanese multicenter registry involving 634 consecutive patients who underwent transcatheter aortic valve replacement (TAVR) with Evolut FX up until October 2023. Patients who underwent TAVR with Evolut EPO between 2018 and 2020 (n = 1128), and those with Evolut EPO+ between 2020 and 2023 (n = 1696) served as control groups. Exclusion criteria comprised patients on dialysis, with a history of infective endocarditis, or with insufficient data. Unmatched comparisons among the 3 valves were conducted, followed by a propensity score (PS)-matched comparison between Evolut EPO+ and FX. In the unmatched cohort, among the Evolut EPO, PRO+, and FX groups, all vascular complications (7.8% vs. 5.2% vs. 4.5%, respectively; p < 0.01) and new pacemaker implantation (PMI) rates (11.2% vs. 6.1% vs. 7.7%, respectively; p < 0.01) differed significantly. In the PS-matched analysis, the rate of all bleeding events was significantly higher in the Evolut EPO+ group (11.0%) than in the FX group (7.0%) (p = 0.02), while all vascular complications (4.6% vs. 4.6%, respectively; p = 1.00) and new PMI (5.9% vs. 7.6%, respectively; p = 0.28) rates were comparable. The incidence of stroke in the FX group was approximately half that of the EP+ group (3.7% vs. 1.9%, p = 0.095) without statistical significance. In conclusion, compared with Evolut EPO+, Evolut FX was associated with a lower incidence of in-hospital bleeding complications and may reduce an in-hospital stroke incidence.

Direct Oral Anticoagulants for RheumaticHeart Disease-Associated Atrial Fibrillation Post-Bioprosthetic Mitral Valve Replacement.

The efficacy of direct oral anticoagulants (DOACs) in preventing ischemic and thromboembolic events may be suboptimal in atrial fibrillation (AF) patients with rheumatic mitral stenosis. However, their safety and effectiveness after mitral valve replacement (MVR) using bioprosthetic valves is unclear. This study sought to evaluate the safety and effectiveness of DOACs vs warfarin among patients with rheumatic heart disease (RHD)-associated AF after bioprosthetic MVR. We performed an observational analysis identifying patients with RHD and AF who underwent bioprosthetic MVR. Primary effectiveness and safety outcomes were ischemic events and major bleeding, respectively. Secondary outcomes included all-cause mortality, cardiac thrombosis, myocardial infarction, and all-cause hospitalization. Propensity score matching was performed to account for the differences in baseline characteristics and comorbidities. A total of 3,950 patients were identified; 76% were on warfarin and 24% on DOAC post-MVR. The DOAC group had a higher burden of baseline comorbidities and prior cardiovascular procedures compared with the warfarin group. The propensity score matching balanced baseline characteristics in 1,832 patients (916 in each group), with a mean age of 69 years. At the 5-year follow-up, DOACs were associated with a lower incidence of major bleeding compared with warfarin (HR: 0.76; 95%CI: 0.62-0.94), with no significant difference in ischemic events, mortality, cardiac thrombosis, myocardial infarction, or hospitalization. Among patients with RHD-associated AF patients post-bioprosthetic MVR, DOACs are associated with lower major bleeding and comparable effectiveness, indicating a potential alternative to warfarin. Further randomized controlled trials are warranted to validate these findings in this population.

TCT-870 Prediction Models for the Treatment of Bioprosthetic Aortic Valve Failure in the United States

TCT-870 Prediction Models for the Treatment of Bioprosthetic Aortic Valve Failure in the United States

TCT-952 Identification and Analysis of Commissural Fibrosis of Bioprosthetic Heart Valve Explants: A Novel Mechanism of Bioprosthetic Stenosis

TCT-952 Identification and Analysis of Commissural Fibrosis of Bioprosthetic Heart Valve Explants: A Novel Mechanism of Bioprosthetic Stenosis

TCT-86 Real-World 30-Day Outcomes for the SAPIEN 3 Ultra Resilia Transcatheter Heart Valve in the Treatment of Failed Bioprosthetic Mitral Valves: A Propensity-Matched Analysis

TCT-86 Real-World 30-Day Outcomes for the SAPIEN 3 Ultra Resilia Transcatheter Heart Valve in the Treatment of Failed Bioprosthetic Mitral Valves: A Propensity-Matched Analysis

Effects of preoperative respiratory muscle training for improvement of postoperative health related quality of life in mitral valve replacement patients.

A patient's defective mitral valve is replaced as part of a treatment called mitral valve replacement (MVR) with a mechanical or biological (bioprosthetic) valve. To evaluate the effects of preoperative respiratory muscle training (RMT) on the improvement of postoperative Health related quality of life in MVR patients. A quasi-experimental study was conducted at Faisalabad Institute of Cardiology. A Sample of 40 adult patients aged 25-50years of both genders who underwent MVR was selected and divided into two groups Group 1 (Respiratory Muscle Training Group) was received RMT consisting of 10-15 repetitions a day for 5days; for 3weeks. Whereas Group 2 (Conventional Group) was receive breathing exercise consisting of 10-12 repetitions a day for 5days; for 3weeks. Modified Healthy Heart Questionnaire (HHQ-GP-1) was used as screening tool. In outcome measuring tools Health Related Quality of life Questionnaire (EuroQol), New York Heart Association, was used at baseline, 3rd week and postoperatively. Duration of Postoperative Mechanical Ventilation (hours) and Hospital Stay was also noted as outcome measures of this study. Results obtained indicate that level of Self-Care in EuroQol-5-D-5L has improved in group 1 3.35±1.03 to 1.35±0.48 showing significant improvement similarly in case of Hospital Length of Stay, Mechanical ventilation 4.05±0.68 to 5.05±0.51 and Pain 65.25±8.34 to 71.50±6.70 has improved. It was concluded that Respiratory Muscle Training and Conventional Muscle Training both are effective in MVR patients. But RMT is more effective in improving self-care, reducing pain, Hospital Length of Stay and Mechanical Ventilation in postoperative period as compared to Conventional Muscle Treatment.

Stroke Prevention With Prophylactic Left Atrial Appendage Occlusion in Cardiac Surgery Patients Without Atrial Fibrillation: A Meta-Analysis of Randomized and Propensity-Score Studies.

The role of left atrial appendage occlusion (LAAO) in patients without previous atrial fibrillation (AF) is not established. This meta-analysis was conducted on patients with normal sinus rhythm who underwent cardiac surgery, with and without concomitant LAAO, to evaluate its effect on the incidence of cerebrovascular accidents (CVAs). A systematic review was conducted from inception until December 2023 for randomized and propensity-score studies comparing CVA in patients without AF undergoing cardiac surgery with or without LAAO. Six studies met our inclusion criteria with a total of 4130 patients: 2146 in the LAAO group and 1984 in the no-LAAO group. The risk ratio of postoperative AF was 1.05 (95% CI, 0.86-1.28); P=0.628. The CVA rates at 5 years were 6.8±1.0% in the no-LAAO group and 4.3±0.8% in the LAAO group (log-rank P=0.021). The Cox regression analysis for CVA in patients undergoing LAAO reported a hazard ratio of 0.65 (95% CI, 0.45-0.94); P=0.022. Landmark analysis at 4 years highlighted a significant difference in overall survival between no-LAAO and LAAO groups, 86±12.2% versus 89.6±11.0%; P=0.041. In this meta-analysis of patients without previous AF undergoing cardiac surgery, LAAO was associated with a decreased risk of CVA, no difference in the incidence of postoperative atrial fibrillation, and a significant overall survival benefit at a 4-year landmark analysis. Although these findings support LAAO, the randomized LeAAPS trial (Left Atrial Appendage Exclusion for Prophylactic Stroke Reduction Trial), LAA-CLOSURE trial (A Randomized Prospective Multicenter Trial for Stroke Prevention by Prophylactic Surgical Closure of the Left Atrial Appendage in Patients Undergoing Bioprosthetic Aortic Valve Surgery), and LAACS-2 trial (Left Atrial Appendage Closure by Surgery-2) will help define the effectiveness of LAAO in patients undergoing cardiac surgery who have risk factors for AF and CVA. URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42024496366.

TCT-119 Long-Term Incidence and Predictors of Transcatheter vs Surgical Bioprosthetic Pulmonary Valve Failure

TCT-119 Long-Term Incidence and Predictors of Transcatheter vs Surgical Bioprosthetic Pulmonary Valve Failure

Redo surgical aortic valve replacement for bioprosthetic structural valve deterioration.

To compare isolated primary bioprosthetic surgical aortic valve replacement (SAVR) with isolated redo surgical aortic valve replacement (rSAVR) due to structural valve deterioration (SVD). Clinical data of consecutive patients who underwent primary isolated SAVR and isolated rSAVR due to SVD between January 1, 2011, and December 31, 2022, at Leipzig Heart Center were retrospectively compared with regard to the primary outcome of all-cause mortality or stroke during hospitalization. Secondary outcomes of interest included myocardial infarction, re-exploration for bleeding, and permanent pacemaker implantation. A total of 2620 patients, 39.5% females, with a median EuroSCORE II of 1.7 (interquartile Range [IQR] 1.1; 2.7] were identified, of which rSAVR was performed in 174 patients (6.6%). Patients undergoing primary SAVR were older (69 versus 67 years of age, p = 0.001) and were less likely to have a history of prior stroke (0.9% versus 4.0%, p = 0.003). Although both all-cause death and death or stroke occurred less often following primary SAVR (0.5% versus 5.8%, and 2.2% versus 6.9%, respectively; p < 0.001), prior surgery was not associated with adverse clinical outcome in multivariable analysis. In a matched comparison of 322 patients, rates of death or stroke did not differ between groups (4.8% for both rSAVR and SAVR, p = 1.0). Although redo surgery for SVD is associated with increased rates of early mortality and stroke by univariate analysis, much of this increased risk can be accounted for by comorbidities. Patients undergoing rSAVR on an elective basis can expect an outcome similar to that of primary SAVR.

Anticoagulant therapy in pregnant women with mechanical and bioprosthetic heart valves.

The aim of the present study was to review maternal and fetal outcomes in pregnant women with prosthetic heart valves. A retrospective record review of pregnant women with prosthetic heart valves on anticoagulation was performed at the Specialist Cardiac Antenatal Clinic, Johannesburg South Africa from 2015 to 2023. Fifty pregnancies with mechanical heart valves and three with tissue valves, on anticoagulation for comorbid atrial fibrillation were identified. The majority were of African ethnicity at a mean age of 33 ± 6 years. Anti-Xa adjusted enoxaparin was commenced at 10.5 ± 5.6 weeks' gestation until delivery in 48 (90.6%) pregnancies and warfarin was continued in five (9.4%) pregnancies. The live birth rates on enoxaparin and warfarin were 56.3% (95% confidence interval [CI]: 42.3-69.3) and 20.0% (95% CI: 2.0-64.0), respectively. There were 12 (22.6%) miscarriages at a mean of 11.3 ± 3.7 weeks' gestation, four (7.5%) intrauterine fetal deaths on warfarin and two (3.8%) warfarin embryopathy/fetopathy. The rates of antepartum/secondary postpartum bleeding and primary postpartum bleeding were 29.4% (95% CI: 18.6-43.1) and 5.9% (95% CI: 1.4-16.9), respectively. Maternal complications included anemia (n = 11, 20.8%), arrhythmia (n = 2, 3.8%), heart failure (n = 2, 3.8%) and paravalvular leak (n = 2, 3.8%). There was one (1.9%) mitral valve thrombosis and one (1.9%) stuck valve in pregnancies who defaulted warfarin prior to pregnancy. There were no maternal deaths. Multidisciplinary management of pregnant women with prosthetic heart valves with anti-Xa adjusted low molecular weight heparin throughout pregnancy represents an effective anticoagulation option for low-middle-income countries.

Trends and Outcomes of Aortic Root Enlargement During Bioprosthetic Aortic Valve Replacement

BackgroundAortic root enlargement (ARE) during aortic valve replacement (AVR) mitigates prosthesis-patient mismatch, but its use has been low. Transcatheter aortic valve-in-valve (VIV) as a treatment for failing bioprosthetic valves is limited by small surgical valves, renewing interest in ARE during the index AVR. This study demonstrates trends and outcomes of ARE after commercial approval of VIV in 2015. MethodsThis retrospective cohort study analyzed 2182 patients undergoing nonemergent AVR between August 2007 and December 2022. Endocarditis, aortic dissection, and concomitant root replacement or ventricular assist device placement were excluded. Trends in ARE use, valve size, and types were compared. Outcome measures included 30-day mortality and gradients and were compared between patients with and without ARE. ResultsOverall, 74 patients (3.4%) underwent ARE, 14 (1.0%) before 2015 and 60 (7.6%, P < .0001) after 2015. Use of smaller valves (19-21 mm) decreased from 372 (26.8%) before 2015 to 85 (10.7%, P < .0001) after 2015. ARE group was younger than the AVR-alone group (64 vs 68 years, P = .001) but had similar predicted risk of mortality (median, 1.7%). Both groups had comparable postoperative mean gradients (ARE: 11 vs AVR-alone: 10 mm Hg, P = .42). ARE had higher 30-day mortality (5 [7%] vs 48 [2%], P = .014); however, no difference was found in elective patients (2 of 65 [3%] vs 39 of 1898 [2%], P = .57). ConclusionsARE use has increased since commercial approval of VIV. The addition of ARE to AVR did not affect early safety in elective cases, and postoperative gradients were similar to those in patients not requiring ARE. Further studies are required to determine long-term outcomes after ARE, including VIV candidacy.

A review of polymeric heart valves leaflet geometric configuration and structural optimization

Valvular heart disease (VHD) is a major cause of loss of physical function, quality of life and longevity, and its prevalence is growing worldwide due to increased survival rates and an aging population. The most common treatment for VHD is surgical heart valve replacement with mechanical heart valves (MHVs) and bioprosthetic heart valves (BHVs), but with different limitations. Polymeric heart valves (PHVs) exhibit promising material properties, valve dynamics and biocompatibility, representing the most feasible alternative to existing artificial heart valves. However, inadequate fatigue performance remains a critical obstacle to their clinical translation. In this case, geometry and material design are essential to obtain the best mechanical properties of the PHV. In this study, we summarized the effects of optimal design of PHVs from geometrical configuration optimization (valve height, thickness and design curve) and structural material optimization (anisotropy, fiber reinforcement, variable thickness, microstructure and asymmetric optimization), and selected the parameters including Effective Orifice Area (EOA), Regurgitant fraction (RF), and Stress Distribution to compare the performance of valves. It would provide the theoretical support for the optimal design of PHVs.

Natural biomaterials in the management of the aortic valve pathology. Biomedical and clinical aspects: A review.

Heart valve diseases are a prevalent cardiovascular pathology worldwide, affecting nearly 2.5% of the population. Degenerative aortic stenosis is the most common form of heart valve disease. The treatment options include surgical or transcatheter procedures. There are two main categories of valve prostheses available: mechanical heart valves constructed from synthetic materials and bioprosthetic heart valves made from natural biomaterials. The choice of valve type depends on various factors, including the underlying medical condition, suitability for anticoagulation, valve durability, and the patient's age and preferences. Mechanical heart valves have the advantage of long-term durability. However, patients receiving mechanical implants are subjected to lifelong anticoagulation therapy with an increased risk of thromboembolism and bleeding. Natural biomaterials do not require long-term anticoagulation. However, they experience degenerative changes leading to structural valve deterioration that may require reoperation. The purpose of this article is to review the role of natural biological materials used for aortic valve replacement or repair, assess their biomedical and clinical advantages and limitations, and analyze the direction and perspectives of future development.

Progressive calcification of bioprosthetic mitral valve observed during pregnancy resulting from in vitro fertilization: a case report

BackgroundWomen with pre-existing cardiac conditions who undergo assisted reproductive technologies (ART) are believed to be at a heightened risk of cardiovascular events during both the treatment and pregnancy phases. An unresolved question within this context pertains to whether the ART procedure itself constitutes a risk factor for individuals with bioprosthetic heart valves (BHV). Additionally, there is ongoing controversy regarding whether pregnancies expedite the process of structural valve degeneration (SVD) in BHV. The purpose of this study is to present the developmental process of BHV calcification, which is considered the primary cause of SVD, during a pregnancy resulting from in vitro fertilization and embryo transfer (IVF-ET), an ART modality, and to elucidate the underlying mechanisms.Case presentationAt 7 + 3 weeks of gestation in a twin pregnancy resulting from IVF-ET, a 27-year-old woman with a bioprosthetic mitral valve manifesting severe mitral stenosis and moderate pulmonary arterial hypertension, was suspected of SVD. Despite undergoing fetal reduction, she experienced progressive calcification of the bioprosthetic valve, increasing pulmonary arterial pressure and ultimately deteriorated into heart failure. An elective cesarean section and redo valve replacement was subsequently administered to improve her cardiovascular condition. As a result, a healthy young boy was delivered and the dysfunctional BHV was replaced with a mechanical valve. She did not report any discomfort during the 3-month follow-up.ConclusionThe progressive calcification of the BHV was observed during IVF pregnancy, indicating a potential connection between fertility therapy, pregnancy and calcification of BHV. Pregnant women with pre-implanted BHV should be treated with caution, as any medical interventions during ART and pregnancy can have a significant impact on both maternal and fetal outcomes. Thus, involving a multidisciplinary team in decision-making early on, starting from the treatment of the original heart disease, throughout the entire process of ART and pregnancy, is crucial.

Impact and limitations of 3D computational modelling in transcatheter mitral valve replacement-atwo-centre Dutch experience.

Transcatheter mitral valve replacement (TMVR) has emerged as aminimally invasive alternative to mitral valve surgery for patients at high or prohibitive operative risk. Prospective studies reported favourable outcomes in patients with annulus calcification (valve-in-mitral annulus calcification; ViMAC), failed annuloplasty ring (mitral valve-in-ring; MViR), and bioprosthetic mitral valve dysfunction (mitral valve-in-valve; MViV). Multi-slice computed tomography (MSCT)-derived 3D-modelling and simulations may provide complementary anatomical perspectives for TMVR planning. We aimed to illustrate the implementation of MSCT-derived modelling and simulations in the workup of TMVR for ViMAC, MViR, and MViV. For this retrospective study, we included all consecutive patients screened for TMVR and compared MSCT data, echocardiographic outcomes and clinical outcomes. Sixteen out of 41patients were treated with TMVR (ViMAC n = 9, MViR n = 3, MViV n = 4). Eleven patients were excluded for inappropriate sizing, 4for anchoring issues and 10for an unacceptable risk of left ventricular outflow tract obstruction (LVOTO) based on 3D modelling. There were 3procedure-related deaths and 1non-procedure-related cardiovascular death during 30days of follow-up. LVOTO occurred in 3ViMAC patients and 1MViR patient, due to deeper valve implantation than planned in 3patients, and anterior mitral leaflet displacement with recurrent basal septum thickening in 1patient. TMVR significantly reduced mitral mean gradients as compared with baseline measurements (median mean gradient 9.5(9.0-11.5) mm Hg before TMVR versus 5.0(4.5-6.0) mm Hg after TMVR, p = 0.03). There was no residual mitral regurgitation at 30days. MSCT-derived 3D modelling and simulation provide valuable anatomical insights for TMVR with transcatheter balloon expandable valves in ViMAC, MViR and MViV. Further planning iterations should target the persistent risk for neo-LVOTO.

A rare differential diagnosis of aortic stenosis with a black aortic valve: A case report

BackgroundCardiac ochronosis, presenting as a rare manifestation of alkaptonuria, an autosomal recessive disorder, is characterised by black pigmentation of calcified cardiac valves and atherosclerotic plaques. We report an intraoperative dilemma on the discovery on the black aortic valve in a case of an old lady with degenerative calcific aortic stenosis.Case presentationA 60-year-old lady was electively admitted for valve replacement with a bioprosthetic valve for severe aortic stenosis. She was symptomatic with complaints of headache and giddiness and had a pressure gradient of 113/17mmhg across the aortic valve. Intraoperatively, she was found to have cardiac ochronosis on the discovery of pigmented aortic intima extending to the valve leaflets and underwent valve replacement with a mechanical prosthetic valve. She was post-operatively evaluated for the same and diagnosed with alkaptonuria. Though the surgery went uneventful and the patient was discharged without any complication, she was advised to be on regular follow-up to assess valve gradients, paravalvular leaks and to monitor the disease progression.ConclusionThe presented case sheds light on the rare cardiac manifestation of alkaptonuria. In the absence of definitive pre-operative diagnosis, intraoperative findings played a pivotal role in guiding the surgical approach and choice of prosthetic valve. The decision to use a mechanical valve was influenced by the potential risks associated with bioprosthetic valves in the setting of ochronosis. Ongoing follow-up and monitoring are essential to assess the durability of the chosen prosthetic valve and to manage any long-term consequences of the underlying metabolic condition.

Correlations between intraoperative and postoperative echocardiographic measurements in patients undergoing aortic bioprosthetic valve replacement: a prospective observational study.

Patient-prosthesis mismatch (PPM) should be avoided during surgical aortic valve replacement because PPM would worsen the mortality and morbidity. Diagnosis of PPM could be made using various parameters measured by intraoperative transesophageal echocardiography. However, few studies have examined which parameters correlate most accurately between intraoperative and postoperative values. This single-center prospective observational study analyzed 46 patients who underwent surgical aortic valve replacement (SAVR). Echocardiography was performed at the following 3-time points: preoperatively, intraoperatively, and 1month postoperatively. The correlation between intraoperative and postoperative measurement values, including peak velocity (PV), mean pressure gradient (MPG), effective orifice area (EOA), and effective orifice area index (EOAI), were assessed using Pearson's correlation coefficient. Moreover, to evaluate whether a multivariable linear regression model with intraoperative and postoperative stroke volume added as an explanatory variable improves the correlation, the multiple correlation coefficients were calculated. PV, MPG, EOA, and EOAI measured intraoperatively and 1month postoperatively were significantly correlated. The r values of each measurement were 0.35, 0.344, 0.411 and 0.323, respectively. The multivariable linear regression model showed that the multiple correlation coefficients for MG and EOA were 0.491 and 0.663, respectively. Intraoperative and postoperative PV, MPG, EOA, and EOAI were significantly correlated in patients undergoing SAVR with a bioprosthetic valve. The r value for EOA was 0.441, the largest among the measured values. Adjustment for stroke volume improved the strength of the correlation. Intraoperative evaluation of prosthetic valve function was considered most appropriate using EOA. University Hospital Medical Information Network Clinical Trials Registry, registration number UMIN000046164, https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000052695 .

Short-Term Results With Ozaki Valved Conduit-A Simple Solution for Patients Needing Right Ventricle to Pulmonary Artery Conduit in a Low-Resource Setting.

The repair of certain types of complex congenital cardiac defects may require a right ventricle-pulmonary artery (RV-PA) conduit. Using the Ozaki Aortic valve neocuspidization (AVNeo)technique, a valved RV-PA conduit was constructed with an Ozaki valve inside a Dacron graft. This study aims to evaluate the short-term outcome of the Ozaki valved RV-PA conduit. A total of 22 patients received the Ozaki valved RV-PA conduit from November 2019 until December 2023. The median age was 12 years (interquartile range [IQR], 5.5-21), median body weight was 35 kg (IQR, 15.8-48.5). The conduit was used in 16 patients (72.7%) under 18 years of age. Indications for conduit placement included: anatomic repair of corrected transposition of the great arteries, ventricular septal defect/pulmonary stenosis, conduit replacement, pulmonary atresia with associated anomalies, pulmonary artery aneurysm with dysplastic pulmonary valve, tetralogy of Fallot with coronary artery crossing the right ventricular outflow tract, bioprosthetic pulmonary valve regurgitation, and rheumatic heart disease. Native pericardium was used for the Ozaki valve in 12 patients and bovine pericardium for 10 patients. Conduit sizes ranged from 18 mm to 30 mm. The median intensive care unit stay was 4 (IQR, 2-6) days and the median hospital stay was 9 (IQR, 5.5-13.5) days. There were two perioperative mortalities (9.1%) both unrelated to the conduit. The median follow-up was 12.3 (IQR, 4.43-21.2) months. There was no infective endocarditis of the conduit. The median peak gradient across the conduit was 22 mm Hg (range 0-44 mm), and all were competent with trivial regurgitation on follow up. Creation of an Ozaki valved conduit is an attractive option due to low cost, reproducibility, and excellent hemodynamics. Longer-term studies are needed to confirm the durability.