Severe Aortic Regurgitation Research Articles

Echocardiographic assessment of aortic regurgitation: a narrative review.

Aortic regurgitation (AR) is the third most frequently encountered valve lesion and may be caused by abnormalities of the valve cusps or the aorta. Echocardiography is instrumental in the assessment of AR as it enables the delineation of valvular morphology, the mechanism of the lesion and the grading of severity. Severe AR has a major impact on the myocardium and carries a significant risk of morbidity and mortality if left untreated. Established and novel echocardiographic methods, such as global longitudinal strain and three-dimensional echocardiography, allow an estimation of this risk and provide invaluable information for patient management and prognosis. This narrative review summarises the epidemiology of AR, reviews current practices and recommendations with regards to the echocardiographic assessment of AR and outlines novel echocardiographic tools that may prove beneficial in patient assessment and management.

Surgical aortic valve replacement etiologies, hemodynamics, and outcomes in 1346 patients from the Malaysian heart centre

BackgroundThis study examined the characteristics and outcomes of surgical aortic valve replacement (SAVR) both isolated and in combination with other cardiac surgery in Malaysia from 2015 to 2021.MethodsThis was a retrospective study of 1346 patients analyzed on the basis of medical records, echocardiograms and surgical reports. The overall sample was both considered as a whole and divided into aortic stenosis (AS)/aortic regurgitation (AR)-predominant and similar-severity subgroups.ResultsThe most common diagnosis was severe AS (34.6%), with the 3 most common etiologies being bicuspid valve degeneration (45.3%), trileaflet valve degeneration (36.3%) and rheumatic valve disease (12.2%). The second most common diagnosis was severe AR (25.5%), with the most common etiologies being root dilatation (21.0%), infective endocarditis (IE) (16.6%) and fused prolapse (12.2%). Rheumatic valve disease was the most common mixed disease. A total of 54.5% had AS-predominant pathology (3 most common etiologies: bicuspid valve degeneration valve, degenerative trileaflet valve and rheumatic valve disease), 36.9% had AR-predominant pathology (top etiologies: root dilatation, rheumatic valve disease and IE), and 8.6% had similar severity of AS and AR. Overall, 62.9% of patients had trileaflet valve morphology, 33.3% bicuspid, 0.6% unicuspid and 0.3% quadricuspid. For AS, the majority were high-gradient severe AS (49.9%), followed by normal-flow low-gradient (LG) severe AS (10.0%), paradoxical low-flow (LF)-LG severe AS (6.4%) and classical LF-LG severe AS (6.1%). The overall in-hospital and total 1-year mortality rates were 6.4% and 14.8%, respectively. Pure severe AS had the highest mortality. For AS-predominant pathology, the etiology with the highest mortality was trileaflet valve degeneration; for AR-predominant pathology, it was dissection. The overall survival probability at 5 years was 79.5% in all patients, 75.7% in the AS-predominant subgroup, 83.3% in the AR-predominant subgroup, and 87.3% in the similar-severity subgroup.ConclusionsThe 3 most common causes of AS- predominant patients undergoing SAVR is bicuspid valve degeneration, degenerative trileaflet valve and rheumatic and for AR-predominant is root dilatation, rheumatic and IE. Rheumatic valve disease is an important etiology in our SAVR patients especially in mixed aortic valve disease.Study registration IJNREC/562/2022.

Case report: Surgical management of type 2 aortic dissection associated with bicuspid aortic valve and aortic coarctation

This case report describes an exceptional case of aortic aneurysm co-occurring with type II dissection, bicuspid aortic valve, and severe aortic valve regurgitation in a patient with aortic coarctation. A 39-year-old man without any medical history was admitted to the hospital with chest pain. Physical examination revealed a holosystolic murmur and a noticeable blood pressure difference between the upper and lower extremities. Imaging studies unveiled the presence of aortic dissection, aortic coarctation, and a bicuspid aortic valve. The patient underwent an urgent single-stage surgical intervention performed via a median sternotomy approach: the procedure involved patch angioplasty, a mechanical prosthetic valve, and a Dacron tube graft. The patient’s follow-up assessments indicated successful outcomes. This case report highlights the complexity of managing concurrent pathologies, suggests a unique surgical approach, and underscores the importance of tailored interventions in rare presentations of cardiovascular diseases.

Follow-Up Report of Patients With Moderate Aortic Valve Regurgitation After Cardiac Surgery.

The appropriateness of aortic valve surgery for patients with moderate aortic valve regurgitation undergoing coronary artery bypass graft (CABG), mitral valve replacement (MVR), or both is uncertain. This study aimed to investigate the outcomes of moderate aortic valve regurgitation following these procedures. This retrospective cohort study included 113 eligible participants with moderate aortic valve regurgitation who underwent CABG, MVR, or both procedures between January 2014 and January 2015 at Tehran Heart Center. Echocardiographic index data were extracted from the Tehran Heart Center data center after a 2-year follow-up to examine changes in the patients' conditions. A total of 113 patients (mean [SD] age, 64.7 [9.9] years; 78 [69.0%] female patients) were included in the study and followed up for a mean (SD) of 24 (6) months. Among those patients, 38 (33.6%) experienced improvement, with their aortic valve regurgitation downgraded to mild, while the remaining 75 (66.4%) patients maintained a moderate aortic valve regurgitation level. Notably, combined CABG and MVR procedures were associated with statistically significant improvement, with all cases downgraded to mild aortic valve regurgitation. Baseline characteristics, including diabetes, hypertension, dyslipidemia, smoking, family history of aortic valve regurgitation, and a history of drug use, did not differ statistically significantly between patients with improved aortic valve regurgitation and patients with no changes. Echocardiographic indices related to the aorta, such as aortic valve pressure gradient, showed improvement (P < .001), and ejection fractions before and after surgery remained comparable. Changes in aortic valve regurgitation severity were found to differ statistically significantly between the various procedures (P = .001). These findings suggest that it is not likely that moderate aortic valve regurgitation will progress after CABG or MVR. Hence, no support was found for concurrent aortic valve replacement during these procedures.

Silenced by heart – Ortner’s syndrome (cardio-vocal hoarseness) – An unusual manifestation of a distant dreadful disease: A cross-sectional observational study

ABSTRACT Aims and Objectives: This study aims to explore the pathogenesis of hoarseness of voice resulting from cardiovascular disorders that affect the left recurrent laryngeal nerve (LRLN), supported by a review of the existing literature. Materials and Methods: This is a cross-sectional observational study conducted over a 3-year period, spanning from May 2019 to May 2022. The study involved the evaluation of 720 cases of hoarseness of voice through video-laryngoscopy. Within this cohort, we scrutinized eight distinct cases of Ortner’s syndrome, each attributed to various underlying causes. All patients with LRLN paralysis underwent a comprehensive clinical assessment, which encompassed chest X-rays, echocardiography, and chest computed tomography scans. Results: Out of the eight Ortner’s syndrome cases, six were associated with dilated pulmonary arteries, stemming from various etiologies such as rheumatic heart disease, mitral valve prolapse, pulmonary embolism, interstitial lung disease, portopulmonary hypertension, and patent ductus arteriosus. One case presented with pericardial effusion and pulmonary hypertension, while another case featured a dilated aorta secondary to severe aortic regurgitation. Among these cases, three patients underwent valve replacement, one underwent pericardiocentesis, and the remaining cases were managed conservatively. Only one case that underwent mitral valve replacement showed partial improvement in voice, while there was no significant improvement in the other cases. All cases remained under follow-up. Conclusion: Although cardiovascular-related hoarseness is an unusual presentation, it should be kept in mind for all cases of altered voice with underlying cardiac disease. Indirect laryngoscopy should be routinely performed in all cases of cardiac illness having hoarseness of voice.

Assessing Anomalous Left Circumflex Artery Origin from the Right Sinus of Valsalva by Transthoracic Echocardiography

Coronary artery anomaly is a rare condition that is typically detected during coronary angiography, cardiac CT, or autopsy. Most cases are asymptomatic, but some anomalies can cause myocardial ischemia and sudden cardiac death. In most cases, anomalous left circumflex (LCx) origin from the right sinus of Valsalva is detected on angiography or cardiac CT prior to a transthoracic echocardiogram (TTE). On a TTE in the apical window, the “crossed aorta sign” can be seen. In this article, we will discuss two cases of coincidental findings of anomalous LCx origin from the right sinus of Valsalva during routine echocardiography. In the first case, a 76-year-old female presented to our echo lab for a routine echocardiogram to reassess a dilated ascending aorta and aortic regurgitation. In the second case, a 50-year-old male presented to our echo lab for a routine echocardiogram to reassess a known bicuspid aortic valve with moderate to severe aortic regurgitation. Both patients were found to have an anomalous LCx origin from the right sinus of Valsalva.

Pattern of Rheumatic Heart Disease in Western Nepal - an Echocardiographic study: a single centre experience

BACKGROUND AND AIMS Rheumatic heart disease (RHD) is a preventable but chronic debilitating sequela to the acute rheumatic fever. It takes several years for manifestations, however can present early in places with high prevalence. Most common valve involved are mitral and aortic. Echocardiography is simple tool to diagnose the presence as well as quantify the valvular lesion. This study aims at identifying the pattern of valvular involvement in RHD in community heart center in western Nepal.&#x0D; METHODS This was a retrospective analysis of the patients presenting with Rheumatic heart disease over the period of two years from July 2020 to July 2022.&#x0D; RESULTS Altogether 563 echocardiograms with diagnosis of RHD were recorded over the period of two years. The mean age was 33.59±12 years. The commonest age group involved was 21-40years (56.66%). Overall, there was female preponderance over male, 77.4% vs 22.6%. Isolated MR was the commonest among the isolated lesion (64.44%). Multivalvular lesion was more common than isolated lesions 76.03% vs 23.97%. Isolated mitral stenosis (MS) and isolated mitral regurgitation (MR) was more common in female 82.1% and 758% respectively whereas isolated aortic regurgitation (AR) was more common in male (55%). Involvement was in the order of MS+MR&gt;AR+MR&gt;MS+AR&gt;AS+AR&gt;MS+AS&gt;AS+MR in the cases of multivalvular lesion. Mean mitral valve area was .2±0.39 cm2. Among the MS, 65(19.69%) had mild, 145(43.93%) had moderate and 120(36.36%) had severe lesion and all were common in female and the age group 21-40years. Mild, moderate and severe MR was more common in female while severe AR was found only in male. Overall, 271(48.13%) had pulmonary hypertension and was more common in severe MS.&#x0D; CONCLUSION Valvular heart disease is common and the most common lesion is RHD in developing country like ours. This study shows that RHD is more common in female and middle age group. Multivalvular lesion is more common than the isolated lesions.

Predictors of outcome in patients with moderate mixed aortic valve disease

ObjectivesGrading the severity of moderate mixed aortic stenosis and regurgitation (MAVD) is challenging and the disease poorly understood. Identifying markers of haemodynamic severity will improve risk stratification and potentially guide...

Factors Associated with Newly Developed Postoperative Neurological Complications in Patients with Emergency Surgery for Acute Type A Aortic Dissection.

Background and Objectives: Postoperative neurological complications (NCs) are an important cause of mortality in patients with acute type A aortic dissection (ATAAD). The aim of the study was to determine the association between intraoperative risk factors and newly developed postoperative NCs in patients after emergency surgery for ATAAD. Materials and Methods: A total of 203 patients requiring emergency surgery were included in the study. Patients with preoperative neurological dysfunction, deceased on the operating table or within the first 48 h after intensive care admission, with uncertain postoperative neurologic status or with incomplete records were excluded. Results: Mean age was 57.61 ± 12.27 years. Hyperlipidemia was the most frequent comorbidity (69%). A bicuspid aortic valve was present in 12.8% of cases, severe acute aortic regurgitation was present in 29.1% of patients, and cardiac tamponade was present in 27.1% of cases. The innominate artery was the most frequently dissected supra-aortic artery in 27.1% of cases. In 65% of cases, the primary entry tear was at the level of the ascending aorta. The incidence of newly developed postoperative NCs was 39.4%. The most common surgical technique performed was supra-coronary ascending aorta and hemiarch replacement, in 53.2% of patients. Using logistic regression, cardiopulmonary bypass time (OR = 1.01; 95% CI = 1.01-1.02; p < 0.001), aortic cross-clamp time over 3 h (OR = 2.71, 95% CI = 1.43-5.14, p = 0.002) and cerebral perfusion time (OR = 1.02; 95% CI = 1.002-1.03; p = 0.027) were independently associated with newly developed postoperative NCs. Conclusions: Based on the results of the study, all efforts should be made to reduce operative times. Using a simple surgical technique, like the supra-coronary ascending aorta and hemiarch technique, whenever possible, and using a simpler technique for cerebral perfusion like unilateral cerebral perfusion via the right axillary artery, could reduce operating times.

Aortic regurgitation in athletes: the challenges of echocardiographic interpretation

BackgroundBicuspid aortic valve (BAV) is the most common congenital cardiac defect and prone to premature degeneration causing aortic regurgitation (AR). The assessment of AR in athletic individuals poses several challenges as the pathological left ventricle (LV) remodelling caused by AR may overlap with the physiological remodelling of intense exercise. The purpose of this study is to highlight these challenges, review the existing literature and discuss how to tackle these conundrums. As a real-world example, we compare the resting transthoracic echocardiographic (TTE) findings in a cohort of individuals with BAV and AR, sub-grouped into “highly active” or “lightly active”.MethodsAdult male subjects with an index TTE performed at a tertiary referral centre between 2019 and 2022 were included if the TTE confirmed a BAV and at least moderate AR. Further strict inclusion criteria were applied and parameters of valve disease severity was made in accordance with existing guidelines. Subjects completed a physical activity questionnaire over the telephone, and were classified into either group 1: “highly active” or group 2: “lightly active” based on their answers. Demographics and TTE parameters were compared between the two groups.Results30 male subjects (mean age 44 ± 13 years) with BAV-AR were included – 17 were highly active, and 13 lightly active. There was no significant difference in age (group 1, 45 ± 12.7 years vs. group 2, 42 ± 17 years; p = 0.49), height (p = 0.45), weight (p = 0.268) or severity of AR, when quantitative assessment was possible. Group 1 had a significantly higher stroke volume (131 ± 17mls vs. 102 ± 13 mls; p = 0.027), larger LV volumes, diastolic dimensions and significantly larger bi-atrial and right ventricular size. This LV dilatation in the context of AR and athleticism poses a diagnostic and management conundrum. Despite this, none of these 17 highly active individuals demonstrated any of the traditional criteria used to consider surgery.ConclusionThere is significant overlap between the physiological adaptations to exercise and those caused by AR. Multi-modality imaging and stress testing can aid clinicians in diagnostic and management decisions in exercising individuals when there is discordance between AR severity and symptoms.

Assessment of the Severity of Aortic Regurgitation by Noninvasive Imaging : Non-invasive MMI for AR.

The role of multimodality imaging in the evaluation of patients with aortic regurgitation is summarized in this review. The etiology (mechanism) of the aortic regurgitation and the severity of aortic regurgitation and hemodynamic consequences are key in the decision making of patients with severe aortic regurgitation. While echocardiography remains as the leading technique to assess all these parameters, other imaging techniques have become essential for the accurate assessment of aortic regurgitation severity and the timing of aortic intervention. The anatomic suitability of transcatheter aortic valve implantation in inoperable patients with severe aortic regurgitation is usually assessed with computed tomography. Aortic regurgitation is a prevalent disease with various pathophysiological mechanisms that need a personalized treatment. The evaluation of the mechanism and severity of aortic regurgitation can be initially performed with echocardiography. Three-dimensional techniques, including echocardiography, have become very relevant for accurate assessment of the regurgitation severity and its hemodynamic consequences. Assessment of myocardial tissue characteristics with cardiac magnetic resonance is key in the risk stratification of patients and in the timing of aortic intervention. Computed tomography is important in the assessment of aortic dimensions and selection of patients for transcatheter aortic valve implantation.

Multicentre experience with valve-sparing aortic root replacement by means of combined remodelling and external aortic ring annuloplasty in patients with Marfan syndrome.

The most recent valve-sparing root replacement technique combines the advantages of the reimplantation (David) and remodelling (Yacoub) techniques. The aortic root is reconstructed according to the remodelling technique, the aortic valve is repaired according to the principle of effective height, and an external ring provides annular support. The purpose of this study was to evaluate operative and mid-term outcomes using this technique in patients with Marfan syndrome. Adult patients with Marfan syndrome who had an indication for aortic root surgery according to European Society of Cardiology guidelines and were operated on using this new root replacement technique were retrospectively evaluated. Follow-up was obtained from standard outpatient visits and included echocardiography. The study group comprised 22 patients (mean age 36 years, 68% males). Mean follow-up was 7.5 years. There were no mortalities. Two patients required aortic valve replacement because of aortic regurgitation. In both patients, the aortic root was severely dilated (≥65 mm) preoperatively, with grade III aortic valve regurgitation and aortic valve cusps that were very fragile. Aortic regurgitation was grade ≤I on follow-up in 18 of the remaining 20 patients. Valve-sparing root replacement using remodelling combined with aortic-ring annuloplasty is safe in patients with Marfan syndrome. The mid-term outcome is promising in patients undergoing elective valve-sparing root replacement at recommended root diameters. However, in patients with extremely dilated aortic roots and already severe aortic regurgitation, the technique should be used cautiously as aortic cusps are fragile and might not be suitable for durable repair. UMCG Research registry #11208.

Case Report: Pre-emptive intra-aortic balloon counterpulsation in patients with aortic regurgitation initiated after cross-clamping during cardiopulmonary bypass

Preoperative implantation of an intra-aortic balloon pump has been shown to reduce mortality in high-risk cardiac surgery cases. However, one main contraindication for its use is severe aortic regurgitation. We describe a case of safe and beneficial use in a patient presenting with moderate to severe aortic regurgitation and highly reduced ejection fraction undergoing aortic valve replacement.

Laubry-PEZZI Syndrome Surgical Repair in Adult: A Case Report

The presence of aortic regurgitation (AR) in the setting of the ventricular septal defect (VSD) has always been a management challenge. A 21-year-old male patient presented to the Cardiovascular surgery department with a restrictive perimembranous VSD with severe aortic regurgitation (AR). VSD was first diagnosed at 3 years of age. The surgical correction was decided when he was symptomatic of severe aortic regurgitation. Trans-aortic approach was performed to close the ventricular septal defect and correct the aortic regurgitation simultaneously. Surgical management was followed by a complete heart block.

Surgical treatment of Behcet's disease with severe aortic regurgitation.

Behcet's disease (BD) is a multisystem inflammatory disease that is characterized by oral aphthosis, genital aphthosis, ocular lesions, and cutaneous lesions. Although BD rarely affects the cardiovascular system, its symptoms can be shown as aortic regurgitation (AR), which requires surgical intervention. Due to the special pathogenesis of BD, a low preoperative diagnosis rate and a high incidence of serious complications, such as perivalvular leakage, valve detachment, and pseudoaneurysm after prosthetic valve replacement, surgical treatment of BD with severe AR has a poor prognosis. In recent years, new surgical strategies have been developed to improve treatment efficacy for this disease. This article reviews and summarizes the evolution of surgical techniques for BD with AR and aims to provide a reference for optimizing surgical strategies, improving perioperative management, and assisting prognosis in patients suffering from BD with severe AR.

Additional Impact of Aortic Regurgitation on Left Ventricular Strain and Remodeling in Essential Hypertension Patients Evaluated Using MRI.

Understanding the impact of aortic regurgitation (AR) on hypertensive patients' hearts is important. To assess left ventricular (LV) strain and structure in hypertensive patients and investigate the relationship with AR severity. Retrospective. 263 hypertensive patients (99 with AR) and 62 controls, with cardiac MRI data. Balanced steady-state free precession (bSSFP) sequence at 3.0T. AR was classified as mild, moderate, or severe based on echocardiographic findings. LV geometry was classified as normal, concentric remodeling, eccentric hypertrophy, or concentric hypertrophy based on MRI assessment of LV mass/volume ratio and LV Mass index (LVMI). LV global radial peak strain (GRPS), global circumferential peak strain (GCPS), and global longitudinal peak strain (GLPS) were obtained by post-processing bSSFP cine datasets using commercial software. ANOVA, Kruskal-Wallis test, Spearman's correlation coefficients (r), chi-square test, and multivariable linear regression analysis. A P value <0.05 was considered statistically significant. Hypertensive patients with AR had significantly lower LV myocardial strain and higher LVMI than the group without AR (GRPS 26.25 ± 12.23 vs. 34.53 ± 9.85, GCPS -17.4 ± 5.84 vs. -20.57 ± 3.57, GLPS -9.86 ± 4.08 vs. -12.95 ± 2.94, LVMI 90.56 ± 38.56 vs.58.84 ± 17.55). Of the 99 patients with AR, 56 had mild AR, 26 had moderate AR and 17 had severe AR. The degree of AR was significantly negatively correlated to the absolute values of LV GRPS, GCPS and GLPS (r = -0.284 - -0.416). LV eccentric hypertrophy increased significantly with AR severity (no AR 21.3%, mild AR 42.9%, moderate AR 73.1%, severe AR 82.4%). In multivariable analysis, the degree of AR was an independent factor affecting LV global strain and LVMI even after considering confounding factors (β values for global myocardial strain were -0.431 to -0.484, for LVMI was 0.646). Increasing AR severity leads to decreased cardiac function and worse ventricular geometric phenotypes in hypertensive patients. 4 TECHNICAL EFFICACY: Stage 3.

Short-term outcomes following total correction of tetralogy of fallot in adult patients

ObjectivesTetralogy of Fallot (TOF) is a common congenital heart disease which should be corrected. The recommended time for the Tetralogy of Fallot Total Correction (TFTC) surgery is during the infancy for the possible difficulties during the surgery and the related issues. However, sometimes TOF is diagnosed and managed during the adulthood.MethodsThis study is a descriptive and retrospective one which included all patients who underwent TFTC at the age of 15-year and older in 10 years (between the years 2010 and 2020) to identify short-term (in-hospital mortality, ICU stay, postoperative bleeding, respiratory complications after the surgery such as pulmonary edema, pneumonia, etc.) and one-year (left ventricle ejection fraction (LVEF), right ventricle (RV) ejection fraction, the severity of tricuspid and aortic regurgitation after surgery) outcomes. All data were taken from medical records at Rajaie Cardiovascular Medical and Research Center. Data were analyzed using SPSS 22.Results94 patients with the mean ± SD age of 26.7 ± 9.6 years were enrolled. Most of them were male (59.6%) (P-value: 0.009). In-hospital mortality in our study were 5.3%. Tricuspid regurgitation (TR) was significantly resolved after the surgery (P-value: 0.006). Of 17 (18.1%) patients with small or hypoplastic pulmonary artery (PA) branches, 14 patients had acceptable PA branch size after surgery.ConclusionTFTC at an older age is safe with acceptable results. Age is not a contraindication for TFTC and surgery should be recommended if the patients are diagnosed with TOF in adulthood. Also, the TOF diagnosis should be considered in adult patients with suspicious signs and symptoms.

Aortic root reinforcement combined with vascular rafts eversion and built-in procedure for Acute Type A Aortic dissection surgery

Abstract Background Acute type A aortic dissection (ATAAD) is a life-threatening disease with high mortality. Surgery remains the gold standard for the treatment of ATAAD. However, ATAAD surgery, especially the aortic root reinforcement technique, is still a challenge for surgeons. Methods All Stanford type A aortic dissection patients undergoing surgery in our hospital from January 2020 to December 2021 were retrospectively entrolled. These patients were divided into three groups according to the surgical procedures of aortic rot: continuous aortic root suture group (CARS group); "intermittent mattress type built-in skirt forming method" group, which was created by our group (XJ-procedure group), aortic root replacement group (Bentall group). The primary outcomes were 30-day mortality and incidence of recurrent dissection of aortic root (before dis-charge, 3 and 6 months of follow-up). The secondly outcomes were the rate of reoperation for aortic root bleeding, the incidence of pseudoaneurysms and the severe aortic valve regurgitation (the residual aortic valve regurgitation greater than grade 2+) rate before discharge, 3 and 6 months of follow-up. Results A total of 221 patients were entrolled in this study, including 69, 114 and 38 in CARS group, XJ-procedure group and Bentall group, respectively. The total operation time in the CARS group, XJ-procedure group and Bentall group were 391.74±74.05 minutes, 371.59±79.36minutes and 427.76±100.78 minutes, respectively (P=0.001, Pa=0.108, Pb=0.001). The overall 30-day mortality rate was 6.8% (15/221), 7.2% (5/69), 7.0% (8/114) and 5.3% (2/38) for all patients, CARS group, XJ-procedure group and Bentall group, respectively. In the CARS group, the incidence of recurrent dissection of aortic root was much lower in the XJ-procedure group than the CARS group before discharge (1.8% versus 10.6%), 3 months (9.4% versus 0%) and 6 months (7.8% vs 0%) follow-up, respectively. The rates of reoperation for aortic root bleeding in the CARS group, XJ-procedure group and Bentall group were 4.3%, 0.9%, and 2.6%, respectively (P=0.306, Pa=0.151, Pb=0.439). In the CARS group, the incidence of pseudoaneurysm was 3.0%,3,1%,3.0% before discharge, at 3 months and 6 months follow-up. In the XJ-procedure group, there was no reported pseudoaneurysm. The residual severe aortic valve regurgitation incidence was much lower in the XJ-procedure group than the CARS group at 3 months (0.9% versus 4.7%) and 6 months (0.9% versus 4.7%) follow-up, respectively. Compared with the traditional procedure, the XJ-procedure does not increase the perioperative mortality and reduces the incidence of aortic root complications. Conclusion XJ-procedure is a safe and effective aortic root reinforcement technique for ATAAD surgery and reduces aortic root complications by reinforcing the fragile aortic root tissue.

Blood and imaging biomarkers in the long-term follow-up of bicuspid aortic valve patients

Abstract Background Bicuspid aortic valve (BAV) is a common congenital heart defect. Patients with BAV are at risk for long-term complications such as arrhythmias and reinterventions. Purpose This study aimed to investigate (1) sex differences in blood and imaging biomarkers and (2) the role of blood and echocardiographic biomarkers in the long-term risk prediction of patients with BAV. Methods In this multicenter prospective observational study, all included adult BAV patients underwent venous blood sampling and transthoracic echocardiography including speckle tracking at the time of inclusion. Analyzed blood biomarkers were: RDW, creatinine, CRP, TroponinT, NT-proBNP and TGF-beta. Sex differences were analyzed at baseline. Associations between blood &amp; echocardiographic biomarkers and arrhythmia-free &amp; intervention-free survival were determined by Cox proportional hazards models. Results A total of 182 patients were included (median age 34 (Interquartile range: 23-46) years, 55.5% male). Significant differences were found in blood biomarkers at baseline between men and women. CRP, NT-proBNP and RDW were higher in women while creatinine, TroponinT and TGF-beta were higher among men (figure 1). After a median follow-up time up of 6.9 (IQR: 6.5- 9.9) years, arrhythmia-free and event-free survival rates were respectively 81.0% and 73.1%. NT-proBNP was the only blood biomarker independently associated with both arrhythmia free and intervention free survival. On echocardiography an increase in LA size, LVEDD, LV mass index and E/E’ratio were associated with arrhythmia free survival. Intervention free survival was associated with increased LA size, LV mass index, aortic valve peak velocity and the presence of moderate or severe aortic regurgitation. No associations were found with ejection fraction and global longitudinal strain (figure 2). Conclusion Significant sex-related differences were observed in blood biomarkers between men and women with BAV at baseline. NT-proBNP was the only blood biomarker associated with arrhythmia-and intervention-free survival. The strongest associations of echocardiographic markers were those indicating diastolic function and LV mass index.Sex differences in blood biomarkersForest plot

Severe aortic regurgitation after short-term treatment with microaxial left ventricular assist device in the transaxillary approach.

Severe aortic regurgitation after short-term treatment with microaxial left ventricular assist device in the transaxillary approach.