Implantation Of Bioprosthesis Research Articles

Valve-in-valve transcatheter aortic valve implantation after failed surgically implanted aortic bioprosthesis versus native transcatheter aortic valve implantation for aortic stenosis: Data from a nationwide analysis

Valve-in-valve transcatheter aortic valve implantation (TAVI) has emerged as a treatment for aortic bioprosthesis failure in case of prohibitive risk for redo surgery. However, clinical evaluation of valve-in-valve TAVI remains limited by the number of patients analysed. To evaluate outcomes of valve-in-valve TAVI compared with native aortic valve TAVI at a nationwide level in France. Based on the French administrative hospital discharge database, the study collected information for all consecutive patients treated with TAVI for aortic stenosis or with isolated valve-in-valve TAVI for aortic bioprosthesis failure between 2010 and 2019. Propensity score matching was used for the analysis of outcomes. A total of 44,218 patients were found in the database. After matching on baseline characteristics, 2749 patients were analysed in each arm. At 30 days, no significant differences were observed regarding the occurrence of major clinical events (composite of cardiovascular mortality, all-cause stroke, myocardial infarction, major or life-threatening bleeding and conversion to open heart surgery) (odds ratio [OR] 0.83, 95% confidence interval [CI] 0.68-1.01; P=0.32). During follow-up (mean 516 days), the combined endpoint of cardiovascular death, all-cause stroke or rehospitalization for heart failure was not different between the valve-in-valve TAVI and native TAVI groups (RR 1.03, 95% CI 0.94-1.13; P=1.00). We observed that valve-in-valve TAVI was associated with good short- and long-term outcomes. No significant differences were observed compared with native valve TAVI regarding clinical follow-up.

First Experience of Sutureless Redo on Mitral Valve Using Valve-in-Valve Technique: Two-Stage Implantation on a Large Animal.

Sutureless implantation of the mitral valve bioprosthesis using the valve-in-valve method was performed on a large animal (sheep). According to the results of a two-stage implantation (primary implantation of a xenopericardial 26-mm framed bioprosthesis and reimplantation of the developed 23-mm bioprosthesis), minor changes in quantitative indicators were revealed: an increase in the transprosthetic gradient by 1.3 mm Hg and a decrease in the area of the mitral orifice by 21.6%. Considerable reduction in the intervention time by 18 min was achieved (by 40% in comparison with the primary prosthesis). The absence of adverse events in the animal and complications in the post-operative period, as well as physiological hemodynamic indicators indicate the safety of the developed medical device.

Transcatheter valve-in-valve implantation of the 'MedLab-KT' prosthesis

Valve-in-valve repeat prosthetic reconstruction is a less invasive alternative to 'open' redo operation for degenerative dysfunction of an aortic bioprosthesis. At the beginning of the history of using this method it was resorted to only in cases of high surgical risk, involving virtually inoperable patients. Currently, the world experience numbers in thousands of such interventions, known to be also performed in patients not belonging to a high-risk group. Recent studies have demonstrated a decrease in the perioperative mortality and improved quality of life in the remote period after valve-in-valve transcatheter implantation of an aortic bioprosthesis. High gradients, occlusion of coronary arteries, and thrombosis of the prosthesis's leaflets remain the major problems encountered while using this method. Nevertheless, valve-in-valve prosthetic reconstruction proved to be a reliably safe and efficient procedure of correcting dysfunction of a previously implanted biological prosthesis.

Complex cause of ischaemic stroke in patient after mitral bioprosthesis implantation- A case report

Complex cause of ischaemic stroke in patient after mitral bioprosthesis implantation- A case report

Reintervention After Aortic Valve Replacement: Comparison of 3 Aortic Bioprostheses

The decision to implant a biological valve prosthesis is influenced by the issue of durability. We investigated the rate and the cause of reintervention in 3 different aortic valve bioprostheses. The study included all patients who underwent aortic valve replacement with a biological valve prosthesis between October 2009 and December 2018. Three different bioprostheses were compared: Carpentier-Edwards (CE) Magna Ease (Edwards Lifesciences, Irvine, CA), Trifecta (St. Jude Medical, St Paul, MN), and Mitroflow (LivaNova, London, United Kingdom). The primary end point was the rate of explantation. The degree of event-free survival and possible predictors for reintervention were also analyzed using Cox regression analysis. In total, 2004 biological aortic valves were implanted, including 923 CE, 719 Trifecta, and 362 Mitroflow bioprostheses. The CE group had a significantly higher degree of event-free survival (917 [99.3%]) compared with the Trifecta (685 [95.3%]) and Mitroflow (340 [93.9%]) groups (P < .0001). The only cause of reintervention in the CE group was prosthetic valve endocarditis (6 [100%]), whereas structural valve deterioration was the most common cause of reintervention in the Trifecta (14 [41.2%]) and Mitroflow (14 [63.6%]) groups. Cox regression analysis revealed that age (hazard ratio [HR] 0.9; 95% confidence interval [CI], 0.9-0.9; P < .0001) and type of prosthesis (Trifecta: HR, 6.3; 95% CI, 2.6-15.2; P < .0001; Mitroflow: HR, 6.0, 95% CI, 2.4-15.1; P < .0001) were associated with lower event-free survival. The freedom from reintervention after implantation of the CE bioprosthesis is significantly greater than that of the Trifecta and Mitroflow bioprostheses. Further investigations with larger patient populations and long-term follow-up are required to establish their durability and long-term efficacy.

The Heart Team Approach: What is the Role of the Surgeon?

Since the first percutaneous implantation of an aortic valve bioprosthesis by Alain Cribier in 2002 1 , we have seen a remarkable progression of the treatment of severe, symptomatic aortic stenosis...

Minimally Invasive Sutureless Aortic Valve Replacement is Associated With Improved Outcomes in Patients With Left Ventricular Dysfunction.

Patients with severe aortic stenosis and reduced left ventricular ejection fraction (LVEF) have a poor prognosis compared with patients with preserved LVEF. To evaluate the impact of sutureless Perceval (LivaNova, Italy) aortic bioprosthesis on LVEF and clinical outcomes in patients with baseline left ventricular (LV) dysfunction who underwent isolated aortic valve replacement (AVR). Between March 2011 and August 2017, 803 patients underwent AVR with Perceval bioprosthesis implantation. Fifty-two isolated AVR had preoperative LVEF ≤45%. Mean age of these patients was 77 ± 6 years, 24 patients were female (46%), and mean EuroSCORE II was 9.4% ± 4.8%. Perceval bioprosthesis was implanted in 9 REDO operations. In 43 patients (83%), AVR was performed in minimally invasive surgery with an upper ministernotomy (n = 13) or right anterior minithoracotomy (n = 30). One patient died in hospital. Cardiopulmonary bypass and aortic cross-clamp times were 85.5 ± 26 minutes and 55.5 ± 19 minutes, respectively. At mean follow-up of 33 ± 20 months (range: 1 to 75 months), survival was 90%, freedom from reoperation was 100%, and mean transvalvular pressure gradient was 11 ± 5 mmHg. LVEF improved from 37% ± 7% preoperatively to 43% ± 8% at discharge (P < 0.01) and further increased to 47% ± 9% at follow-up (P = 0.06), LV mass decreased from 149.8 ± 16.9 g/m2 preoperatively to 115.3 ± 11.6 g/m2 at follow-up (P < 0.001), and moderate paravalvular leakage occurred in 1 patient without hemolysis not requiring any treatment. AVR with sutureless aortic bioprosthesis implantation in patients with preoperative LV dysfunction demonstrated a significant immediate and early improvement in LVEF.

Comparison of patient-prothesis mismatch after surgical aortic valve replacement and transcatheter aortic valve implantation.

The aim of this study is to analyze the outcomes and incidence of postoperative patient-prothesis mismatch after surgical aortic valve replacement using supra-annular bioprosthesis and transcatheter aortic valve implantation. Between January 2012 and June 2015, a total of 73 patients (37 males, 36 females; mean age 71.8±5.7 years; range, 65 to 82 years) who underwent either surgical aortic valve replacement using supraannular bioprosthesis (n=36) or transcatheter aortic valve implantation (n=37) were included. Postoperative patient-prothesis mismatch was defined as absent, mild-to-moderate, and severe, if the indexed effective orifice area was >0.85 cm2/m2, >0.65 to <0.85 cm2/m2, and <0.65 cm2/m2, respectively. Both groups were compared in terms of patient-prothesis mismatch, postoperative outcomes, and mortality. The overall incidence of mild-to-moderate patient-prosthesis mismatch was 17.8% (13/73). No severe patient-prosthesis mismatch was observed. Mild-to-moderate patient-prosthesis mismatch was found in three patients (8.1%) in the transcatheter group and in 10 patients (27.8%) in the surgery group (p=0.035). Body surface area was the significant predictor of patient-prosthesis mismatch (p=0.007). Diameters of bioprosthetic valves in the surgery and transcatheter groups were 21.4±2 and 23.9±2.6 mm, respectively (p=0.002). Early mortality and pacemaker implantation rates were higher in the transcatheter group (p>0.05). Postoperative outcomes were similar between the groups. Mid-term mortality at a mean follow-up of 47.7±7.3 months was similar between the groups (p=0.158). In high-risk patients with severe aortic stenosis, patientprosthesis mismatch is mild-to-moderate after surgical aortic valve replacement and transcatheter aortic valve implantation; however, this has no effect on early mortality. Based on our study results, we suggest that the use of surgical approach for aortic valve replacement may prevent potential complications of transcatheter aortic valve implantation.

Transcatheter “valve-in-valve” implantation of bioprosthesis in failed surgical tricuspid bioprosthesis (first experience in Russia)

Aim. In the issue we report first in Russia experience of transcatheter “valve-invalve” implantation (TVIV) for treatment of severe tricuspid stenosis due to the structural deterioration of surgical tricuspid bioprosthesis.Material and methods. TVIV was performed in 4 high-risk redo patients (1 to 3 previous sternotomies) of various ages across (18-68 years) with structural deterioration of surgical tricuspid bioprosthesis.Results. Technical success was achieved in 100% cases. Diastolic gradients on tricuspid valve markedly decreased in all patients. Peak transtricuspidal gradient decreased from 20,4 to 10 mmHg in average. Clinical improvement as assessed by 6-minute walk test after TVIV was observed in 3 patients with congestive heart failure. In 1 patient with asymptomatic right ventricle dysfunction TVIV resulted in the enhancement of echocardiographic parameters.Conclusion. TVIV is a mininvasive alternative to conventional surgical tricuspid valve redo replacement. Based on available data including own experience TVIV should be considered an effective and safe treatment option for failed TV bioprostheses in high-risk patients of different age. Further studies are needed to assess long-term results of the method.

The first clinical case of implantation of a composite frame xenopericardial bioprosthesis “MedEng-Bio” in the mitral position

The article presents the first clinical case of the implantation of a composite frame xenopericardial bioprosthesis “MedEng-Bio” in the mitral position. The special design of the prosthesis implantation procedure simplifies and reduces the risks associated with possible repeated operations.

EP36 SUTURELESS AORTIC BIOPROSTHESIS IS ASSOCIATED WITH IMPROVEMENT OF EJECTION FRACTION IN PATIENTS WITH PREOPERATIVE LEFT VENTRICULAR DYSFUNCTION

Background and Aim: Patients with severe aortic stenosis and reduced left ventricular ejection fraction (LVEF) have a poor prognosis compared with patients with preserved LVEF. To evaluate the impact of sutureless Perceval (LivaNova, Italy) aortic bioprosthesis on LVEF and clinical outcomes in patients with baseline left ventricular dysfunction underwent isolated aortic valve replacement. Methods: Between March 2011 and August 2017, 803 patients underwent AVR with Perceval bioprosthesis implantation. Fifty-two patients had preoperative LVEF ≤ 45%. Mean age of these patients was 77 ± 6 years, twenty-four patients were female (46%), and mean logistic EuroSCORE was 17.7 ± 10.2%. Perceval bioprosthesis was implanted in 9 REDO operations. In 43 patients (83%), AVR was performed in minimally invasive surgery with an upper ministernotomy (n = 13) or right anterior minithoracotomy (n = 30). Results: One patient died in-hospital. Cardiopulmonary bypass and aortic cross-clamp times were 98 ± 26 minutes and 61 ± 19 minutes, respectively. At mean follow-up of 33 ± 20 months (range: 1–75 months), survival was 90%, freedom from reoperation was 100%, and mean transvalvular pressure gradient was 11 ± 5 mmHg. LVEF improved from 37 ± 7% preoperatively to 43 ± 8% at discharge (p &lt; 0.01) and further increased to 47 ± 9% at follow-up (p = 0.06), and moderate paravalvular leakage occurred in one patient without hemolysis not requiring any treatment. Conclusions: AVR with sutureless aortic bioprosthesis implantation in patients with preoperative left ventricular dysfunction demonstrated a significant immediate and early improvement in LVEF.

Mid-term follow-up after suture-less aortic heart valve implantation.

Aortic stenosis (AS) is the most common valve disease in the adult population and its prevalence increases with age. Unfortunately, older age and comorbidities significantly increase mortality, operative risk and worsen prognosis. In recent years, sutureless bioprosthesis [sutureless-aortic valve replacement (SU-AVR)] has become an alternative to standard AVR or TAVI in high-risk patients. Compared to standard AVR, the advantages of SU-AVR include shorter valve implantation, shorter aortic cross clamp (ACC) and cardiopulmonary bypass (CPB) times and higher valve EOA with more favorable hemodynamic parameters. Good early clinical and hemodynamic outcomes have been reported in several studies. However, although early SU-AVR results reported in the literature are encouraging, there are few results of long term follow-up. The aim of this study is to present long term echocardiographic hemodynamic outcomes of the Enable sutureless bioprosthesis. The first human implantation of the Enable sutureless bioprosthesis was performed on the 13th January, 2005 by the authors of this manuscript. From that time until July 2008, 25 patients underwent isolated SU-AVR implantation. The median preoperative logistic EuroSCORE was 1.92±0.17 [standard deviation (SD)] and the STS score was 2.96±2.73. Preoperatively, 65.4% of patients were in NYHA class III or IV, the peak/mean gradient transaortic gradient was 84.6/52.1 mmHg. After the SU-AVR procedure, the average peak/mean aortic gradients were respectively: 12.9/7.1 mmHg at the intraoperative time; 18.1/9.5 mmHg at 3-6 months; 18.3/9.6 mmHg at 11-14 months; 16.9/9.3 mmHg at 2 years; 15.3/8 mmHg at 3 years; 13.4/7.1 mmHg at 4 years; 16.7/8.9 mmHg at 5 years follow-up. Other hemodynamic echocardiographic parameters such as LVOT diameter, LVOT peak velocity, LVOT TVI, valve peak velocity and valve TVI were stable during the follow-up period. In summary, sutureless bioprostheses are safe and effective treatments for valve stenosis with excellent outcomes and hemodynamic profile which remained stable during the follow-up period. The peak and mean gradients were 16.7 and 8.9 mmHg, respectively, over a 5-year follow-up period.

RF80 SUTURELESS AORTIC PERCEVAL BIOPROSTHESIS IMPLANTATION IN AORTIC VALVE DISEASE AND CONCOMITANT PROCEDURES: SINGLE CENTER EXPERIENCE WITH 121 PATIENTS

Abstract Background and Aim: Perceval sutureless aortic bioprosthesis (LivaNova Group, Italy) represents an innovative approach for surgical aortic valve replacement (AVR), in order to facilitate prosthesis implantation and reduce operative time, specially in complex procedures. We described our experience in AVR and concomitant procedures with Perceval bioprosthesis implantation. Methods: From March 2011 to December 2017, 841 patients underwent AVR with sutureless aortic Perceval bioprosthesis at our Institution. Of these, 121 patients (mean age, 77 ± 6.3 years; female patients, 64%; mean logistic EuroSCORE, 18 ± 12.3%) underwent Perceval bioprosthesis implantation with concomitant procedures. The concomitant procedures were coronary artery bypass grafting (CABG) (n = 38), septal myectomy (n = 3), CABG + other procedures (n = 15), and 65 other procedures. Preoperative, periprocedural and echocardiographic parameters, as well as clinical outcomes, were analyzed. Results: In-hospital deaths occurred in 4 (3.3%) patients, one patient had cardiac death, and all patients were alive at a mean follow-up of 28.6 ± 12.4 months. Mean aortic cross-clamp and extracorporeal circulation times were 139.5 ± 46.6 and 92.4 ± 41 minutes, respectively. At follow-up, mean trasprosthetic gradient was 11.3 ± 5.3 mmHg. There were 3 mild paravalvular leaks and one Perceval replacement for endocarditis 10 months after implantantion. Events at follow-up included cerebral ischemia in one patient, and need of pacemaker implantation in 4 patients. Conclusions: Perceval sutureless AVR is a fast and safe procedure, specially in AVR with concomitant procedures, providing a good hemodynamic performance with excellent clinical results.

Evaluation of Conduction Disorders after Aortic Valve Replacement with Rapid Deployment Bioprostheses

The aim of this retrospective, single-center study was to evaluate the occurrence of conduction disorders after rapid deployment aortic bioprosthesis implantation. Electrocardiograms of patients undergoing INTUITY (Edwards Lifesciences, Irvine, CA USA) bioprosthesis implantation were collected at admission, during postoperative course, and at discharge. Primary end point was the occurrence of new-onset conduction disorders, defined as complete left bundle branch block, complete right bundle branch block, permanent pacemaker implantation, and worsening of pre-existing rhythm abnormalities. Secondary end points were the assessment of preoperative and postoperative QRS duration and the identification of transitory conduction disorders. Forty-four patients (July 2015-December 2016) were included in the analysis. Preoperatively, patients with normal conduction and with already existing disorders were 25 (56.8%) and 19 (43.2%), respectively. Primary end point occurred in 14 patients (31.8%). Two patients (4.5%) received pacemaker implantation. In patients with normal preoperative conduction, new abnormalities were found in eight cases (32%): all left bundle branch blocks with one pacemaker implantation. Worsening of pre-existing conduction disorders was found in six patients (31.6%) with one pacemaker implantation. QRS duration increased in 20 patients (45.4%), and average increase was 37 milliseconds. Overall, we observed a significant increase of QRS (96 ± 21 milliseconds vs. 111 ± 28 milliseconds, P < 0.001). Three patients experienced a new-onset temporary left bundle branch block. New-onset conduction disorders or worsening of pre-existing rhythm abnormalities occur in one third of patients after rapid deployment aortic bioprosthesis implantation. Although the incidence of postoperative pacemaker implantation before discharge is low, strict follow-up is mandatory to identify a potential need for pacemaker implantation in a timely manner.

Sutureless aortic bioprosthesis replacement in elderly Asian patients with aortic stenosis: Experience in a single institution

BackgroundSutureless aortic valve replacement (SU-AVR) has emerged as a promising alternative for the treatment of patients with aortic valve stenosis. This study aims to assess the safety and efficacy of SU-AVR in an elderly Asian population. MethodsFrom June 2015 to May 2016, 15 adults with severe aortic stenosis (9 females) with a median age of 79 years underwent Perceval sutureless bioprosthesis (LivaNova, UK) implantation in a single Taiwanese institution; peri-operative recovery, clinical improvement, and valve performance were analyzed. ResultsThree (20%) patients underwent concomitant procedures (coronary artery bypass grafting, 1 patient; maze, 2 patients) and 6/12 (50%) patients underwent J-ministernotomy for isolated SU-AVR. Median cardiopulmonary bypass and cross-clamp time were 105 min and 69 min, respectively. All sutureless bioprosthesis were implanted successfully without conversion to a traditional valve, but 2 patients (13.3%) need intraoperative valve repositioning because of paravalvular leakage. Median extubation time and intensive care unit stay were 5 h and 2 days, respectively. One patient experienced in-hospital mortality due to sudden collapse thought secondary to high degree atrioventricular block. Serial echocardiographic evaluations were performed preoperatively and at 1, 3, and 6 months postoperatively. The final echocardiographic exams showed nothing greater than mild aortic insufficiency and the median mean trans-valvular gradient was 13.2 (range, 6.0–26.3) mmHg. ConclusionsBy simplified procedure and improved hemodynamics, SU-AVR can be implanted safely in elderly Asian population with excellent valvular performance.

Radiopaque preventive landmarks' placement during stentless bioprosthesis implantation.

In patients with aortic stenosis, bioprosthetic valves are increasingly used. Although their benefits, they are also presenting limitations, as their time-related degeneration. Reoperation which was, until a few years ago, the only treatment for this condition, carries a significant surgical risk, especially in patients with multiple comorbidities, so the benefit of less invasive technique enabling the implantation of aortic valve prosthesis [transcatheter aortic valve-in-surgical aortic valve (TAV-in-SAV)] by a percutaneous access is remarkably important. Eligible patients are judged by a heart team, and imaging plays a key role in this selection, focusing on correct identification of bioprosthetic aortic valves type and size, evaluation of patients at increased anatomical risk for coronary artery occlusion. Radiolucency of stentless bioprosthetic valves, represent a significant challenge. Surgical aortic valve replacements (SAVRs) with a bioprosthesis were performed using a stentless valve with no radiopaque components (Solo Smart, Sorin). The chosen method, in order to evaluate the results of the operation, was computed tomography (CT) scanning (64-slice MDCT, Brilliance, Philips). The study consisted of a thin sliced contrast electrocardiograph (ECG) gated chest CT (1 systolic cardiac phase), trying to simulate the required assessment of aortic root and the radiopaque placed markers. As surgical implant technique varies and may impact the relationship of the prosthetic annulus to the coronary ostia, marking the aortic annulus during the operation in order to have some useful radiopaque landmarks, is a great assistance promoting better orientation and correct identification of the position of the bioprosthetic valve. Although the implantation of metallic vascular clips at the level of aortic annulus (in any commissure or in the middle of any cups) was considered, the decision was to position three metallic clips bellow the aortic annulus in the three stiches ligated during the solo valve implantation. We are suggesting the preventive implantation of radiopaque landmarks, during SAVRs using tissue valves which are lacking fixed anatomic markers, as a guide for a presumptive TAV-in-SAV procedure, keeping in mind that appropriate guidance is crucial and can prevent valve misplacement, coronary obstruction and other potentially lethal complications.

In vitro implantation of a new transcatheter prosthesis in mitral valve position

Aim. The study was designed to focus on the evaluation of in vitro implantation of a new transcatheter mitral bioprosthesis. Methods. A prototype of the first domestic self-expanding transcatheter bioprosthesis “Solertis” was tested by implanting it in the position of a native mitral valve of isolated pig heart by using transatrial access. Results. A correct orientation of the atrial and ventricular elements of the bioprosthesis and reliable circular coverage/adaptation of the annular part of the stent, which provide stable fixation of the prosthesis in a mitral position without left ventricular outflow tract obstruction, were determined. The function of the prosthesis during saline load test was adequate and without paraprosthetic regurgitation. Conclusion. The prototype of “Solertis” self-expanding transcatheter bioprosthesis demonstrated its efficiency for the native mitral valve replacement in vitro. The study results allow for proceeding to the next stage of preclinical testing—in vivo investigation.Received 5 December 2017. Accepted 20 December 2017. Published online 28 December 2017.Funding: The study was carried out with the support of a grant of the Russian Science Foundation (16-15-10315).Conflict of interest: The authors declare no conflict of interest.Author contributionsConception and study design: I.Yu. ZhuravlevaData collection and analysis: D.P. DemidovDrafting the article: R.M. SharifulinArticle editing: A.V. Bogachev-Prokophiev, A.M. KaraskovFinal approval of the version to be published: A.V. Bogachev-Prokophiev, I.Yu. Zhuravleva, R.M. Sharifulin, D.P. Demidov, A.M. Karaskov

Long-Term Outcomes Following Surgical Aortic Bioprosthesis Implantation

BackgroundFew data exist on long-term outcomes and structural valve degeneration (SVD) in consecutive unselected patients undergoing surgical aortic valve replacement (SAVR). ObjectivesThe goal of this study was to determine the long-term outcomes of a contemporary cohort of consecutive unselected SAVR recipients with a focus on evaluating clinical outcomes and SVD based on echocardiographic criteria. MethodsA total of 672 consecutive patients (mean age: 72 ± 8 years; 61.5% male) undergoing SAVR with a bioprosthesis between 2002 and 2004 were included. Baseline and follow-up data were prospectively collected in a dedicated database. Baseline post-operative echocardiographic data were obtained in the 624 patients alive at hospital discharge and in 209 patients at 10 years (87% of the patients at risk). SVD was defined as subclinical (increase >10 mm Hg in mean transvalvular gradient + decrease >0.3 cm2 in valve area and/or new-onset mild or moderate aortic regurgitation) and clinically relevant (increase >20 mm Hg in mean transvalvular gradient + decrease >0.6 cm2 in valve area and/or new-onset moderate-to-severe aortic regurgitation). ResultsAt a median follow-up of 10 years (interquartile range: 5 to 13 years), 432 patients (64.3%) had died. Older age, left ventricular dysfunction, atrial fibrillation, chronic obstructive pulmonary disease, greater body mass index, and diabetes mellitus were associated with an increased mortality risk (p < 0.05 for all). Clinically relevant SVD occurred in 6.6% of patients; 30.1% of patients had subclinical SVD. A greater body mass index and the use of a specific aortic bioprosthesis were independently associated with clinically relevant SVD (p < 0.05 for both), and 83% of these patients underwent aortic valve reintervention (valve-in-valve transcatheter aortic valve replacement in 44% of them). ConclusionsThe 10-year mortality rate in elderly SAVR recipients of a bioprosthetic valve was considerable, chiefly determined by their older age and the presence of comorbidities. Clinically relevant SVD was infrequent, but close to one third of the population exhibited subclinical SVD. These results provide contemporary data on long-term clinical outcomes and SVD post-SAVR, and they should be taken into consideration when evaluating late clinical outcomes and valve durability after transcatheter aortic valve replacement.

Our experience with surgical minimally invasive aortic valve replacement

BackgroundIn the context of the development of modern cardiac valve interventional methods (TAVI, TMVI, MitraClip), miniinvasivity in cardiac surgery is becoming increasingly important. An alternative approach to complete sternotomy in isolated aortic valve replacement (AVR) is access from anterior thoracotomy or upper ministernotomy. In CKTCH Brno, is performed an isolated aortic valve replacement (AVR) from the upper hemisternotomy (UHS) from 2013 onwards. MethodsBetween 2013 and 2016, isolated AVR was perfomed in our institution 666 patients. Full median sternotomy approach was used in 565 patients, minimally invasive approach (UHS) in 101 patients. In the ministernotomy group, classical biological or mechanical prosthesis was implanted in 55 patients; in 46 patients we used rapid deployment (sutureless) bioprosthesis Sorin Perceval S. In our study we compare the results of full sternotomy a hemisternotomy approach and also describe our surgical technique of minimally invasive aortic valve replacement. ResultsWe registered gradual increase in minimally invasive AVR between 2013 and 2016 (9 patients in 2013, 59 patients in 2016). The combined hospitalization and 30-day mortality was 0.53% (3 patients) in the full sternotomy group and 0.99% (1 patient) in the ministernotomy group. In the most risky patients, we indicated ministernotomy with implantation of rapid deployment bioprosthesis (Euroscore II. 3,0 vs. 1,6 in the group of patients with full sternotomy AVR). As published, we confirmed longer aortic cross clamp time (AoX) and lenght of extracorporal circulation (ECC) in the patients with ministernotomy and implantation of sutured aortic prosthesis in comparison with full sternotomy AVR. Conversely, shorter AoX time and ECC time was observed in patients with rapid deployment prosthesis implantation from ministernotomy. We also recorded smaller postoperative blood loss in patients with ministernotomy apporach. The other monitored parameter were comparable. ConclusionIn this study we describe our technique and results of minimally invasive aortic valve replacement in our institution. Based on our results, we evaluate this technique as safe and well reproducible.

Contained Aortic Root Rupture: A Rare Complication after Transfemoral Implantation of Self-Expandable Aortic Valve Bioprosthesis

Contained Aortic Root Rupture: A Rare Complication after Transfemoral Implantation of Self-Expandable Aortic Valve Bioprosthesis