Surgical Aortic Valve Replacement Research Articles

Surgical Technique And Clinical Implications Of Transcatheter Aortic Valve Bioprosthesis Explantation.

There has been a worldwide rapid adoption of transcatheter aortic valve replacement (TAVR) as an alternative to surgical aortic valve replacement (SAVR) for patients with severe aortic stenosis. Currently, more TAVR explants with SAVRs are performed than TAVR-in TAV. TAVR explantation is a technically hazardous procedure mainly due to significant aortic neo-endothelialization which incorporates the TAVR valve. Surgical techniques for TAVR explantation are not well established and surgeon experience at present is limited. In this manuscript, we describe our technique for surgical explantation of transcatheter aortic bioprosthesis. Familiarity with the procedure and its clinical implications is essential for all cardiac surgeons.

Cardiac Surgery 2023 Reviewed.

We reviewed the cardiac surgical literature for 2023. PubMed displayed almost 34,000 hits for the search term "cardiac surgery AND 2023." We used a PRISMA approach for a results-oriented summary. Key manuscripts addressed the mid- and long-term effects of invasive treatment options in patient populations with coronary artery disease (CAD), comparing interventional therapy (percutaneous coronary intervention [PCI]) with surgery (coronary artery bypass graft [CABG]). The literature in 2023 again confirmed the excellent long-term outcomes of CABG compared with PCI in patients with left main stenosis, specifically in anatomically complex chronic CAD, but even in elderly patients, generating further support for an infarct-preventative effect as a prognostic mechanism of CABG. For aortic stenosis, a previous trend of an early advantage for transcatheter (transcatheter aortic valve implantation [TAVI]) and a later advantage for surgical (surgical aortic valve replacement) treatment was also re-confirmed by many studies. Only the Evolut Low Risk trial maintained an early advantage of TAVI over 4 years. In the mitral and tricuspid field, the number of interventional publications increased tremendously. A pattern emerges that clinical benefits are associated with repair quality, making residual regurgitation not irrelevant. While surgery is more invasive, it currently generates the highest repair rates and longest durability. For terminal heart failure treatment, donor pool expansion for transplantation and reducing adverse events in assist device therapy were issues in 2023. Finally, the aortic diameter related to adverse events and technical aspects of surgery dominated in aortic surgery. This article summarizes publications perceived as important by us. It cannot be complete nor free of individual interpretation, but provides up-to-date information for patient-specific decision-making.

Deep-learning survival analysis for patients with calcific aortic valve disease undergoing valve replacement

Calcification of the aortic valve (CAVDS) is a major cause of aortic stenosis (AS) leading to loss of valve function which requires the substitution by surgical aortic valve replacement (SAVR) or transcatheter aortic valve intervention (TAVI). These procedures are associated with high post-intervention mortality, then the corresponding risk assessment is relevant from a clinical standpoint. This study compares the traditional Cox Proportional Hazard (CPH) against Machine Learning (ML) based methods, such as Deep Learning Survival (DeepSurv) and Random Survival Forest (RSF), to identify variables able to estimate the risk of death one year after the intervention, in patients undergoing either to SAVR or TAVI. We found that with all three approaches the combination of six variables, named albumin, age, BMI, glucose, hypertension, and clonal hemopoiesis of indeterminate potential (CHIP), allows for predicting mortality with a c-index of approximately 80%\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$80\\%$$\\end{document}. Importantly, we found that the ML models have a better prediction capability, making them as effective for statistical analysis in medicine as most state-of-the-art approaches, with the additional advantage that they may expose non-linear relationships. This study aims to improve the early identification of patients at higher risk of death, who could then benefit from a more appropriate therapeutic intervention.

Improvement in Left Ventricular Function of the Resected Myocardium after Septal Myectomy in Patients with Aortic Valve Replacement

Background: Some surgeons have previously advocated for a more aggressive concomitant septal myectomy to address left ventricular outflow tract obstruction; however, concerns about the surgical complications of post-septal myectomy remain. Here, we aimed to assess the clinical, echocardiographic, and pathological findings following concomitant septal myectomy with surgical aortic valve replacement. Methods: We reviewed 21 patients who underwent surgical aortic valve replacement and concomitant septal myectomy from April 2014 to September 2019. The global and regional left ventricular ejection fraction changes between the perioperative periods were analyzed using two-dimensional speckle-tracking echocardiography. The resected myocardium was pathologically assessed. Results: No operative mortality was observed during the study period. Transthoracic echocardiography showed no significant differences in preoperative and postoperative left ventricular ejection fraction (68.1 ± 9.9% vs. 68.6 ± 6.0%, p = 0.82) or interventricular septum thickness (11.9 ± 1.4 mm vs. 11.5 ± 1.5 mm, p = 0.23). Interventricular septum thickness at the end-systolic phase, which is the maximum septal wall thickness, was significantly reduced postoperatively (27.7 ± 9.3 mm vs. 22.6 ± 5.5 mm, p < 0.05). The basal, mid, and apical septal areas improved with septal myectomy by 80%, 230%, and 27%, respectively, compared to perioperative echocardiography (basal septal, 80 ± 23%; mid septal, 230 ± 830%; apical septal, 27 ± 350%). Pathological examination of the resected myocardium revealed marked endocardial thickness (mean, 914 µm) with focal fibrosis. Conclusions: In aortic valve stenosis patients with septal hypertrophy, concomitant septal myectomy with surgical aortic valve replacement improved regional myocardial function and eliminated left ventricular outflow tract obstruction by removing thickened endocardium and prominent fibrosis.

The Effect of Surgical Aortic Valve Replacement on Arterial Stiffness: Does the Valve Type Matter?

The Effect of Surgical Aortic Valve Replacement on Arterial Stiffness: Does the Valve Type Matter?

First time surgical aortic valve replacement: nationwide trends and outcomes from The Netherlands heart registration.

To describe trends and outcomes for patients undergoing surgical aortic valve replacement in the Netherlands. The Netherlands Heart Registration database was used to report the number and outcomes of isolated, primary surgical aortic valve replacement procedures performed from 2007 to 2018 in adult patients. A total of 17142 procedures were included, of which 77.9% were performed using a biological prosthesis and 21.0% with a mechanical prosthesis. Median logistic EUROSCORE I decreased from 4.6 (IQR 2.4-7.7) to 4.0 (IQR 2.6-6.0). 120-day mortality decreased from 3.3% in 2007 to 0.7% in 2018. Median duration of follow-up was 76 months (IQR 53-111). Ten-year survival, when adjusted for age, EUROSCORE I, and body surface area, was 72.4%, and adjusted 10-year freedom from reinvervention was98.1%. Additional analysis for patients under the age of 60 showed no difference between patients treated with a biological or mechanical prosthesis in adjusted 10-year survival, 89.7% versus 91.9±%, respectively, (p = 0.25), but a significant difference in adjusted 10-year freedom from reintervention, 90.0±% versus 95.9%, respectively, (p < 0.01). Between 2007 and 2018, age and risk profile of patients undergoing surgical aortic valve replacement decreased, especially for patients treated with a biological prosthesis. The 120-day mortality decreased over time. Patients undergoing surgical aortic valve replacement nowadays have a risk of 120-day mortality of < 1% and 10-year freedom from valve-related reintervention of > 95%.

TAVI in younger patients: is it a reliable option?

Abstract Funding Acknowledgements None. Background/Introduction Severe aortic stenosis is the most common valve disease requiring intervention. It has very poor prognosis, and early intervention is recommended. Either surgical or percutaneous transcatheter intervention is possible. According to European guidelines, surgical aortic valve replacement (SAVR) is usually indicated for patients younger than 75 years old. However, some patients are refused surgery, and transcatheter aortic valve implantation (TAVI) might be an option of treatment for these patients, however medium-long term results are still uncertain. Purpose This study intends to evaluate the efficacy and safety of TAVI in younger patients with severe symptomatic aortic stenosis. Methods Retrospective cohort of 224 patients were submitted to TAVI in the last 3 years, of which 21 patients were younger than 75 years old. The primary endpoints are mortality, major adverse cardiovascular events (MACE) and rehospitalization (related to the procedure, valve, or heart failure). Efficacy and safety were evaluated during a follow-up of at least 6 months, compared with the traditional group. Results A total of 224 patients underwent TAVI during the last 3 years at our center. Of these, 21 patients (9%) were younger than 75 years. The mean age was 72,1±3 [62-75] years old and 33% were female (n=7). 95% (n=20) of the TAVI procedures were due to degenerative severe aortic stenosis and 5% (n=1) due to degenerative aortic surgical valve prothesis. The mean euroscore risk value was 6,2±1,3%, and 18 patients were refused for surgery (86%) and 3 patients refused surgery (14%). All procedures were performed by transfemoral access, with 2 peripheral access complications (9,5%), 1 hemorrhagic (4%), solved with covered stent, and 1 closure device occlusion solved with wire crossing and balloon inflation (4%). It was necessary to implant 3 temporary pacemakers, however, only 2 patients required a definitive pacemaker implantation (9,5%). There were no cases intraprocedural death, MACE or aortic severe complications. There was a statistically significant reduction of risk of peripheral complications and pacemaker implantation on younger patients comparing with older patients (p=0,04 and p=0,05 respectively). Mean follow-up time was 14±8,3 months [6-39 months]. During follow-up there were no deaths, MACE or episodes of rehospitalization due to heart failure recorded. Regarding echocardiographic evaluation, there were no cases of significant valve degeneration, with mean aortic gradient of 13±4,1mmHg, no significant leakage or other echocardiographic findings. In younger patients, TAVI appears to be also valid therapeutic option, with less risk of peripheral access complication or need of permanent pacemaker implantation. During the follow-up there was no cases of prothesis degeneration, proving to be a reliable option for the medium to long term.

Concomitant Mitral Regurgitation in Severe Aortic Stenosis - Insights From the CURRENT AS Registry-2.

Data on concomitant mitral regurgitation (MR) in patients with severe aortic stenosis (AS) are scarce.Methods and Results: We investigated the risk of concomitant MR in patients with severe AS in the CURRENT AS Registry-2 according to initial treatment strategy (transcatheter aortic valve implantation [TAVI], surgical aortic valve replacement [SAVR], or conservative). Among 3,365 patients with severe AS, 384 (11.4%) had moderate/severe MR (TAVI: n=126/1,148; SAVR: n=68/591; conservative: n=190/1,626). The cumulative 3-year incidence for death or heart failure (HF) hospitalization was significantly higher in the moderate/severe than no/mild MR group in the entire population (54.6% vs. 34.3%, respectively; P<0.001) and for each treatment strategy (TAVI: 45.0% vs. 31.8% [P=0.006]; SAVR: 31.9% vs. 18.7% [P<0.001]; conservative: 67.8% vs. 41.6% [P<0.001]). The higher adjusted risk of moderate/severe MR relative to no/mild MR for death or HF hospitalization was not significant in the entire population (hazard ratio [HR] 1.15; 95% confidence interval [CI] 0.95-1.39; P=0.15); however, the risk was significant in the SAVR (HR 1.92; 95% CI 1.04-3.56; P=0.04) and conservative (HR 1.30; 95% CI 1.02-1.67; P=0.04) groups, but not in the TAVI group (HR 1.03; 95% CI 0.70-1.52; P=0.86), despite no significant interaction (Pinteraction=0.37). Moderate/severe MR was associated with a higher risk for death or HF hospitalization in the initial SAVR and conservative strategies, while the association was less pronounced in the initial TAVI strategy.

Twenty-year experience following aortic valve replacement in patients younger than 60 years of age

ObjectiveReports on long-term outcomes of surgical aortic valve replacement (AVR) for patients aged < 60 years are scarce in Japan. Hence, we aimed to evaluate these outcomes in patients aged < 60 years.MethodsBetween March 2000 and December 2020, 1477 patients underwent aortic valve replacement. In total, 170 patients aged < 60 years who underwent aortic valve replacement were recruited. Patients aged < 18 years were excluded. Patient data collected from the operative records and follow-up assessments were reviewed.ResultsThe mean age was 49 ± 9 years, and 64.1% of patients were male. One-hundred-and-fifty-two patients (89.4%) underwent aortic valve replacement with a mechanical valve and 18 (10.6%) with a bioprosthetic valve. The mean follow-up period was 8.1 ± 5.5 years. No operative mortality occurred, and in-hospital mortality occurred in one patient (0.6%). Ten late deaths occurred, with seven cardiac-related deaths. The overall survival rate was 95.4 ± 1.7%, 93.9 ± 2.3%, 90.6 ± 3.9%, and 73.2 ± 11.8% at 5, 10, 15, and 20 years, respectively. Freedom from major bleeding was 96.4 ± 1.6% at 5, 10, and 15 years, and 89.0 ± 7.3% at 20 years. Freedom from thromboembolic events was 98.7 ± 1.3%, 97.3 ± 1.9%, 90.5 ± 4.5%, and 79.0 ± 11.3% at 5, 10, 15, and 20 years, respectively. Freedom from valve-related reoperation was 99.4 ± 0.6% at 5 years, 97.8 ± 1.7% at 10 and 15 years, and 63.9 ± 14.5% at 20 years.ConclusionsPatients aged < 60 years undergoing aortic valve replacement with a high mechanical valve implantation rate had favorable long-term outcomes.

Temporal Trends, Outcomes, and Predictors of Next-Day Discharge and Readmission Following Uncomplicated Evolut Transcatheter Aortic Valve Replacement: A Propensity Score-Matched Analysis.

Next-day discharge (NDD) outcomes following uncomplicated self-expanding transcatheter aortic valve replacement have not been studied. Here, we compare readmission rates and clinical outcomes in NDD versus non-NDD transcatheter aortic valve replacement with Evolut. Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) Registry patients (n=29 597) undergoing elective transcatheter aortic valve replacement with self-expanding supra-annular valves (Evolut R, PRO, and PRO+) from July 2019 to June 2021 were stratified by postprocedure length of stay: ≤1 day (NDD) versus >1 day (non-NDD). Propensity score matching was used to compare risk adjusted 30-day readmission rates and 1-year outcomes in NDD versus non-NDD, and multivariable regression to determine predictors of NDD and readmission. Between the first and last calendar quarter, the rate of NDD increased from 45.4% to 62.1% and median length of stay decreased from 2 days to 1. Propensity score matching produced relatively well-matched NDD and non-NDD cohorts (n=10 549 each). After matching, NDD was associated with lower 30-day readmission rates (6.3% versus 8.4%; P<0.001) and 1-year adverse outcomes (death, 7.0% versus 9.3%; life threatening/major bleeding, 1.6% versus 3.4%; new permanent pacemaker implantation/implantable cardioverter-defibrillator, 3.6 versus 11.0%; [all P<0.001]). Predictors of NDD included non-Hispanic ethnicity, preexisting permanent pacemaker implantation/implantable cardioverter-defibrillator, and previous surgical aortic valve replacement. Most patients undergoing uncomplicated self-expanding Evolut transcatheter aortic valve replacement are discharged the next day. This study found that NDD can be predicted from baseline patient characteristics and was associated with favorable 30-day and 1-year outcomes, including low rates of permanent pacemaker implantation and readmission.

Examining the typical hemodynamic performance of nearly 3000 modern surgical aortic bioprostheses.

The objective of this analysis was to assess the normal haemodynamic performance of contemporary surgical aortic valves at 1 year postimplant in patients undergoing surgical aortic valve replacement (SAVR) for significant valvular dysfunction. By pooling data from four multicentre studies, this study will contribute to a better understanding of the effectiveness of SAVR procedures, aiding clinicians and researchers in making informed decisions regarding valve selection and patient management. Echocardiograms were assessed by a single core laboratory. Effective orifice area (EOA), dimensionless velocity index (DVI), mean aortic gradient, peak aortic velocity, and stroke volume were evaluated. The cohort included 2958 patients. Baseline age in the studies ranged from 70.1 ± 9.0 to 83.3 ± 6.4 years, and STS risk of mortality was 1.9 ± 0.7 to 7.5 ± 3.4%. Twenty patients who had received a valve model implanted in fewer than 10 cases were excluded. Ten valve models (all tissue valves; N = 2938 patients) were analyzed. At 1 year, population mean EOA ranged from 1.46 ± 0.34 to 2.12 ± 0.59 cm2, and DVI, from 0.39 ± 0.07 to 0.56 ± 0.15. The mean gradient ranged from 8.6 ± 3.4 to 16.1 ± 6.2 mmHg with peak aortic velocity of 1.96 ± 0.39 to 2.65 ± 0.47 m/s. Stroke volume was 75.3 ± 19.6 to 89.8 ± 24.3 mL. This pooled cohort is the largest to date of contemporary surgical aortic valves with echocardiograms analyzed by a single core lab. Overall haemodynamic performance at 1 year ranged from good to excellent. These data can serve as a benchmark for other studies and may be useful to evaluate the performance of bioprosthetic surgical valves over time.

Paravalvular regurgitation after transcatheter aortic valve replacement: incidence, quantification, and prognostic impact

Abstract Transcatheter aortic valve replacement (TAVR) is standard of care in aortic stenosis (AS) with results comparable to surgical aortic valve replacement (SAVR). However, paravalvular regurgitation (PVR) is more common after TAVR. With the alteration of devices and implantation techniques, the incidence of moderate or more PVR has declined. Mild PVR is still common in around 30% of TAVR patients in low risk trials. Progression of AS causes myocardial hypertrophy and varying degrees of diastolic dysfunction which may cause heart failure even in combination with small volumes of PVR. Any degree of PVR is associated with increased risk of overall and cardiovascular mortality. Predictors of PVR are annular eccentricity, severe calcification of the aortic valve, bicuspid aortic valves, and type of prosthesis where balloon-expandable devices are associated with less PVR. PVR is diagnosed using echocardiography, aortic angiogram with or without videodensitometry, hemodynamic parameters, or cardiac magnetic resonance (CMR). PVR can be treated using post-dilation, interventional treatment using a vascular plug, or implantation of a second device. Successful post-dilation depends on balloon size which should at least be equal to or more than 95% of the mean annulus diameter. Implantation of a second device to reduce PVR is successful in approximately 90% of cases, either through lengthening of the sealing skirt in case of inadequate position or through further expansion of the index device. Implantation of a vascular plug can successfully reduce PVR and reduce mortality.

Left and Right Ventricular Longitudinal Systolic Function Following Aortic Valve Replacement in the PARTNER 2 Trial And Registry.

Evaluation of left and right ventricular longitudinal systolic function may enhance risk stratification following aortic valve replacement (AVR). The study objective was to evaluate the changes in left and right ventricular longitudinal systolic function and RV-pulmonary artery (RV-PA) coupling from baseline to 30-days and 1-year after aortic valve replacement (AVR). LV longitudinal strain (LS), tricuspid annulus plane systolic excursion (TAPSE), and RV-PA coupling were evaluated in patients from the PARTNER-2A surgical AVR (SAVR) arm (n=985) and from the PARTNER-2 SAPIEN-3 registry (n=719). TAPSE and RV-PA coupling decreased significantly following SAVR, but remained stable following TAVR. Lower LV LS, TAPSE, or RV-PA coupling at baseline were associated with increased risk of the composite of death, hospitalization, and stroke at 5-years (Adjusted-HRs for LV LS<15%: 1.24 95%CI 1.05-1.45, p=0.001; TAPSE<14mm: 1.44 95%CI 1.21-1.73, p<0.001; RV/PA coupling<0.55mm/mmHg: 1.32 95% CI 1.07-1.63, p=0.011). Reduced TAPSE at baseline was the most powerful predictor of the composite endpoint at 5-years. Patients with LV ejection fraction <50% at baseline had increased risk of the primary endpoint with SAVR (HR: 1.34, 95%CI 1.08-1.68, p=0.009) but not with TAVR (HR: 1.12, 95%CI 0.88-1.42). Lower RV-PA coupling at 30-days showed the strongest association with cardiac mortality. SAVR but not TAVR was associated with a marked deterioration in RV longitudinal systolic function and RV-PA coupling. Lower TAPSE and RV-PA coupling at 30-days were associated with inferior clinical outcomes at 5-years. In patients with LVEF<50%, TAVR was associated with superior 5-year outcomes.

Transcatheter Aortic Valve Replacement in Low-Surgical Risk Patients: an updated metanalysis of extended follow-up randomized controlled trials.

The long-term safety and effectiveness of transcatheter aortic valve replacement (TAVR) compared to surgical aortic valve replacement (SAVR) in low surgical risk has not been evaluated in a pooled analysis. An electronic database search was conducted for randomized controlled trials (RCTs) with a maximal 5 years clinical and echocardiographic follow-up including low surgical risk patients underwent TAVR or SAVR. We calculated Odds Ratio (OD) and 95% confidence intervals (CIs) using a random-effects model. Subgroups analysis was performed for PPI and PVLs. Three randomized controlled trials (RCTs) were included with a total of 2611 low-surgical risk patients (STS score < 4%). Compared to SAVR, TAVR group had similar rates of all-cause of mortality (OR 0.94,95%CI 0.65 to 1.37, p value 0.75) and disabling stroke (OR 0.84, 95%CI 0.52 to 1.36, p value 0.48). No significant differences were registered in the TAVR group in terms of major cardiovascular events (OR 0.96, 95%CI 0.67 to 1.38,value 0.83), myocardial infarction (OR 0.69, 95% CI 0.34 to 1.40, p value 0.31),valve thrombosis (OR 3.11, 95%CI 0.29 to 33.47, p value 0.35), endocarditis (OR 0.71,95%CI 0.35 to 1.48, p value 0.36), aortic valve reintervention (OR 0.93, 95%CI 0.52 to 1.66, p value 0.80), and rehospitalization (OR 0.80, 95%CI 0.52 to 1.02, p value 0.07) compared to SAVR. However, TAVR patients had a higher risk of paravalvular leaks (OR 8.21, 95%CI 4.18 to 16.14, p value < 0.00001), but lower rates of new-onset atrial fibrillation (OR 0.27,95%CI 0.17 to 0.30, p value <0.0001). The rates of permanent pacemaker implantation were comparable from 1 year up to a maximum of 5 years (OR 1.32, 95%CI 0.88 to 1.97, p value 0.18). Lastly, TAVR had a greater effective orifice area (0.10 cm2/m2, 95%CI 0.05 to 0.15, p value 0.0001), but similar transvalvular mean gradients (0.60, 95%CI 3.94 to 2.73, p value 0.72). In conclusion, TAVR patients had similar long-term outcomes compared to SAVR, except for an elevated risk of PVLs in the TAVR group and increased rates of atrial fibrillation in the SAVR cohort.

Perioperative stroke after aortic valve replacement for aortic stenosis - incidence, risk factors and short-term outcome

One of the most serious complications of surgical aortic valve replacement (SAVR) is stroke that can result in increased rates of complications, morbidity and mortality postoperatively. The aim of this study was to investigate incidence, risk factors and short-term outcome in a well defined cohort of SAVR-patients. A retrospective study on 740 consecutive aortic stenosis patients who underwent SAVR in Iceland 2002-2019. Patients with stroke were compared with non-stroke patients; including preoperative risk factors of cardiovascular disease, echocardiogram-results, rate of early postoperative complications other than stroke and 30 day mortality. Mean age was 71 yrs (34% females) with 57% of the patients receiving stented bioprosthesis, 31% a stentless Freestyle®-valve and 12% a mechanical valve. Mean EuroSCORE-II was 3.6, with a maximum preop-gradient of 70 mmHg and an estimated valvular area of 0.73 cm2. Thirteen (1.8%) patients were diagnosed with stroke where hemiplegia (n=9), loss of consciousness (n=3) and/or aphasia (n=4) were the most common presenting symptoms. In 70% of cases the neurological symptoms resolved or disappeared in the first weeks and months after surgery. Only one patient out of 13 died within 30-days (7.7%). Stroke-patients had significantly lower BMI than non-stroke patients, but other risk factors of cardiovascular diseases, intraoperative factors or the rate of other severe postoperative complications than stroke were similar between groups. Total length of stay was 14 days vs. 10 days median, including 2 vs. 1 days in the ICU, in the stroke and non-stroke-groups, respectively. The rate of stroke after SAVR was low (1.8%) and in line with other similar studies. Although a severe complication, most patients with perioperative stroke survived 30 days postoperatively and in majority of cases neurological symptoms recovered.

OR7-8 | Transcatheter Aortic Valve Replacement (TAVR) vs Surgical Aortic Valve Replacement (SAVR) in Patients with Liver Cirrhosis- Nationwide Readmission Analysis

OR7-8 | Transcatheter Aortic Valve Replacement (TAVR) vs Surgical Aortic Valve Replacement (SAVR) in Patients with Liver Cirrhosis- Nationwide Readmission Analysis

Doing well for those who do well: Surgical Aortic Valve Replacement in Bicuspid Aortic Valve Patients

Doing well for those who do well: Surgical Aortic Valve Replacement in Bicuspid Aortic Valve Patients

Surgical aortic valve replacement in a patient with severe scoliosis

Aortic valve replacement for severe symptomatic Aortic stenosis is a low-risk procedure, but when compounded with coexisting conditions, procedural risk may increase. We present the case of a middle-aged female patient presenting with a constellation of complexities, including oblique sternum, severe dextroscoliosis, severe symptomatic aortic stenosis with bicuspid aortic valve, aortic root distortion, and a relatively rare blood group. Despite multiple problems, she underwent successful surgical aortic valve replacement. This case highlights the importance of a multidisciplinary approach in complex cardiac patients with the utmost need for a heart team concept for patient-centric decision-making.

E-29 | Analysis of Procedure Volume and Outcomes of Surgical and Transcatheter Aortic Valve Replacement following Regulatory Approval of low-surgical risk patients

E-29 | Analysis of Procedure Volume and Outcomes of Surgical and Transcatheter Aortic Valve Replacement following Regulatory Approval of low-surgical risk patients

OR7-6 | The Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Pure Aortic Regurgitation: A Systematic Review and Meta-analysis

OR7-6 | The Outcomes of Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Pure Aortic Regurgitation: A Systematic Review and Meta-analysis